Chemotherapy: Stretches for Health

Chemotherapy: Stretches for Health

Before beginning any exercise program, please check with your physician or physical therapist! Not all exercises or stretches are appropriate for everyone – please read my full medical disclaimer here before trying any of the exercises listed below.

It’s no secret that it can be difficult to stay active during chemotherapy. While exercise has been proven to have many physical and emotional benefits during cancer treatment, some days it’s just difficult to get moving. I’ve designed this short stretching compilation to stretch the spine and major joints of the body to promote mobility and circulation on even the most difficult chemo days. Make these stretches part of your daily routine or use them to loosen up after a nap or before bed!

Watch the video for a full demonstration:

*Note: Video plays at 2x speed! Take your time when you’re stretching!

Child’s Pose

From a kneeling, or seated position, slide the hands forward until you feel a stretch in the shoulders and lower back. Hold for 30-60 seconds as tolerated.

Modifications: For greater stretch of the side body, walk the hands to the left or right.

Cat/Cow

Begin on hands and knees in a neutral spine position with hips stacked over knees and shoulders stacked over the wrists. Inhale and slowly drop the belly to arch the back, lifting the breast bone. The, exhale and round the back from the tailbone to the neck, broadening the space between the shoulder blades. Alternate moving into each position for 5-10 repetitions.

Modifications: Perform in a seated position, reaching forward as you round the back, and allowing the arms to reach behind you as you lift the chest.

Hip Flexor Stretch

In a kneeling position, square your hips and tuck your tailbone until a gentle stretch is felt across the front of the hip. Perform deep breaths. Hold 30-60 seconds as tolerated.

Modifications: Perform in a standing partial lunge position, hold onto something for balance. To increase the depth of the stretch, sidebend the body away from the bottom/back leg.

Hamstring Stretch

In a kneeling or seated position, stretch one leg out in front of you. Square the hips and straighten the knee as you hinge from your hips to deepen the stretch along the back of the leg. Try not to round the lower back to allow for the best stretch. Hold for 30-60 seconds as tolerated.

Modifications: Lie on your back and use a strap/towel to pull a straight leg up toward the ceiling. Flex your foot to deepen the stretch.

Butterfly Stretch

Sit with the soles of your feet touching and knees dropping down toward the floor. Perform deep breaths. Hold for 30-60 seconds as tolerated.

Modifications: Place pillows or yoga blocks under the knees to reduce strain on the hips, lean forward to deepen the stretch.

All stretches are designed to be gentle, but can be progressed if they become too easy. Stretches can be performed 1-3 times per day as needed.

Happy stretching!

Aloha ❤

Breast Surgery: Post-Op Stretches

Breast Surgery: Post-Op Stretches

Before beginning any exercise program, please check with your physician or physical therapist! Not all exercises or stretches are appropriate for everyone – please read my full medical disclaimer here before trying any of the exercises listed below.

After both breast-conserving surgeries and mastectomies, people often find they have difficulty reaching overhead or behind their back, washing or fixing their hair, or feeling tightness throughout the chest wall. The following stretches are helpful to improve range of motion and help you restore your ability to complete your usual daily tasks!

These stretches should be done after a sufficient amount of time has passed post-operatively so all incisions in the breast, chest, or axilla (armpit) have healed. Be sure that any incisions are well-healed before attempting these stretches without guidance from a healthcare professional. Normal soft tissue healing of the skin and underlying tissues takes about 4-6 weeks. Stretching might be uncomfortable as you push into tight areas, but you should not typically experience pain >5/10 while performing stretches.

Watch the video for a full demonstration:

*Note: video plays at 1.5x speed – take your time when you stretch!

Shoulder Stretches

In a kneeling, or seated position, slide the hands forward until you feel a stretch in the shoulder or axilla. Perform gentle repeated stretches (10-15 repetitions) or hold for longer durations (30-60 seconds) as tolerated.

Modifications: For greater stretch of the side body, walk the hands to the left or right.

Cat/Cow

Begin on hands and knees in a neutral spine position with hips stacked over knees and shoulders stacked over the wrists. Inhale and slowly drop the belly to arch the back, lifting the breast bone. The, exhale and round the back from the tailbone to the neck, broadening the space between the shoulder blades. Alternate moving into each position for 5-10 repetitions.

Modifications: Perform in a seated position, reaching forward as you round the back, and allowing the arms to reach behind you as you lift the chest.

Sidebend Stretch

In a seated or standing position, grasp your affected arm with the opposite hand and gently lean away to stretch the shoulder and side body. Breathe deeply into the ribs on the affected side. Hold 30-60 seconds as tolerated.

Modifications: Lie on the unaffected side over a pillow or foam roller and gently stretch the affected arm overhead, limit the range of motion as tolerated.

Pec Stretch

Lie on your back and allow one or both elbows to fall out to the side. For mastectomy patients, perform only one side at a time until cleared by your physician to perform both sides together. Do not allow the back to arch away from the floor or bed. Hold for 30-60 seconds as tolerated.

Modifications: place pillow/s or a yoga block under the elbow to allow tight shoulders/chest walls to relax during the stretch. This stretch can also be performed standing with forearms placed against a doorframe.

Open Book Stretch

Begin lying on the unaffected side with knees bent to 90 degrees to protect the low back. Place the affected arm behind the head and allow the body to rotate and open up the front of the affected shoulder/chest. Breathe in as you open and exhale to return to the starting position. Repeat 5-10 times.

Modifications: Straighten the affected arm for a greater stretch or circle the arm over the head to stretch in various angles.

All stretches are designed to be gentle, but can be progressed if they become too easy or maintained if full range of motion is achieved. Stretches can be performed 1-3 times per day as needed.

Happy stretching!

Aloha ❤

365

365

It’s been one whole trip around the sun since we read the dreaded pathology report… “consistent with invasive ductal carcinoma.” And in these last 365 days, I feel like I’ve lived 100 different lifetimes. Newly diagnosed. Fertility planner. Chemo baldie. Breast conservation surgery advocate. Radiation breath-holding champion. Student. Educator. Survivor.

Now, the scars are fading. My irradiated skin is healed (although a little pale if you ask me). My energy is slowly returning. Life is going back to “normal,” whatever that is these days. I’ve been a little silent on the blog and on social media because a lot of my energy is going toward trying to remember what I told myself when I was first diagnosed…

YOU ARE NOT YOUR DIAGNOSIS.

Some days it’s difficult to remember who I was before cancer. Honestly, sometimes I come across an old photo and I don’t even recognize that girl! So I’m setting out to reinvent myself a bit. I’m prioritizing adventure, travel, learning new things, letting in old things that bring me joy, and not wasting one single second doing something I don’t feel passionate about…at least trying anyway.

I learned in the past year that I am fearless. I can do anything I put my mind to, but the one thing that scares me is missing out on doing the things I love and crave with the people I care about the most because of things I “should” be doing. Nothing is more important to me in this lifetime. From here on out, if it’s not a whole-hearted “yes!” for me, I’m not doing it.

You’ll likely be seeing a lot of different content from me in the future as I plan to continue the blog to share information about physical therapy, pelvic health, oncology, and other things that I feel everyone should know about. At heart, I am most passionate about teaching, sharing knowledge, and educating myself, so if you’d like to keep learning with me, I’m happy to share this space with you.

In the meantime, please keep me in your prayers as I have my “new baseline” mammogram today. As it usually works with true divine intervention, my scans are scheduled exactly on my 1 year anniversary of my diagnosis. While I feel deep down that everything’s going to look great, there’s always that tiny voice in the back of my mind saying “what if…” Honestly, I’m not sure if it will ever get easier to repeat imaging, but I’m choosing to see it as a privilege that I get to have these scans at all. God must want me here for something!

As my friend Kate says, “If you’re very lucky, life goes on.”

I hope you’ll do something that makes you feel wildly, beautifully alive today. Do it for all those we’ve loved and lost. I’m incredibly grateful for all of you.

Aloha ❤

Radiation Fibrosis

Radiation Fibrosis

Radiation therapy is used as an adjunct treatment for cancer to kill off any remaining cancer cells in the surrounding tissues which are often called “micrometastases.” Radiation therapy is not appropriate for all cancer patients, but for those who do have treatment plans which include radiation, the short and long-term effects can be difficult to tolerate. Today, I want to share more about one long-term effect of radiation therapy called radiation fibrosis.

What is Radiation Fibrosis?

Radiation fibrosis (RF) refers to tissue changes which occur locally after someone goes through radiation therapy. Tissues which are most often affected are the skin, subcutaneous tissues (fat, muscle, bone), organs such as the lungs or heart, or the gastrointestinal/genitourinary tracts depending on the part of the body that is irradiated. Ions from radiation beams cause DNA damage and localized inflammation around the tumor site as well as in the surrounding normal tissues. The degree of damage often depends on each individual’s sensitivity to the radiation itself as well as the dose given and area of tissue treated.

Who is at Risk for Radiation Fibrosis?

Anyone who undergoes radiation therapy as part of their cancer treatments is at risk for RF. Some factors that increase susceptibility of developing RF include:

  • Those who also have concurrent chemotherapy or surgery
  • Those with pre-existing connective tissue disorders (scleroderma, lupus, or Marfan’s syndrome)
  • Those with a genetic mutation in the ataxia-telangiectasia (ATM) gene which assists to repair damaged DNA

How does Radiation Fibrosis Present?

RF onset can be immediate, early delayed (0-3 months after treatment), or late delayed (>3 months after treatment), however most find that symptoms begin to show up 3-4 months after treatment ends. Symptoms usually come on gradually and they are, unfortunately, not reversible.

Some of the symptoms include:

  • Thickening of the skin
  • Muscle tightness or atrophy
  • Limited joint mobility
  • Lymphedema
  • Mucosal fibrosis (mouth, throat, GI tract, genitourinary tracts)
  • Pain

What Treatments are Available for Radiation Fibrosis?

Physical therapy is proven to increase range of motion lasting up to six months post-treatment (and probably longer if the person continues their exercises)! PT’s can use manual therapy or prescribe specific exercises to mobilize the skin and myofascial tissues, increase range of motion in affected joints, improve strength, and manage lymphedema (if they are a lymphedema specialist – if not, then they should refer you to someone who is a certified lymphedema specialist).

For reproductive/colorectal cancers in particular, seeing a pelvic floor physical therapist may be indicated to ensure independence with toileting (especially bowel movements) or to assist with sexual concerns like pelvic pain or tightness.

Other potentially-beneficial treatments may include hyperbaric oxygen therapy, pentoxyfilline (a drug that helps to improve blood flow to the tissues) with or without the addition of vitamine E (a powerful antioxidant), and botox injections – but the research is still pending on the true benefits of these treatments!

If you or someone you know is going through radiation therapy, let them know about RF & send them to a physical therapist to help with any mobility concerns they may have!

Aloha ❤

References:

  1. Radiation-induced fibrosis: mechanisms and implications for therapy (Straub, et al. 2015)
  2. Supervised physical therapy in women treated with radiotherapy for breast cancer (Braz da Silva Leal, et al. 2016)
  3. Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors (Stubblefield, et al. 2011)
TNBC Day!

TNBC Day!

Hi everyone!

I wanted to share that today, March 3, is TNBC Day! In fact, the whole month of March is dedicated to raising awareness about triple negative breast cancer and fundraising for TNBC research! As you know, I was diagnosed with TNBC last April. TNBC primarily affects younger people (age <50), people with a BRCA1 genetic mutation, black & Hispanic women, and people with Ashkenazi Jewish heritage.

15-20% of new breast cancer diagnoses are triple negative, which means their tumors lack receptors for estrogen, progesterone, or the HER2 protein. Because of this, treatment options are limited for TNBC and there are no targeted therapies available as there are for other types of breast cancer. For this reason, TNBC (which is typically more aggressive and tends to metastasize to the bone, brain, or lungs) can be difficult to treat and that is why I advocate for TNBC research!

Current research is focusing on:

  • Anti-androgen hormonal therapy
  • Immunotherapy for TNBC with specific basal-like tumors
  • PARP-inhibitors for TNBC + BRCA patients
  • Development of a TNBC vaccine (whatttt?!)

For the month of March, 100% of all donations to the Triple Negative Breast Cancer Foundation will go to research. If you are able to give, know that all of us TNBC thrivers (past, present, and future) appreciate you!

Click the photo below to use my personal link to donate to TNBC Foundation!

If you are here because you were recently diagnosed with triple negative breast cancer, here are three things I wish I would have known at the time of my diagnosis (#PowerOf3):

  • O N E : 40% of breast cancers are found on a self-exam! Check you chest & advocate for those under 40 who do not qualify for mammograms yet!
  • T W O : A TNBC diagnosis is not a death sentence! TNBC is an aggressive cancer and it’s treated aggressively, but it also has a higher rate of complete response to chemotherapy than other types of breast cancer – stay hopeful!
  • T H R E E : There is an incredible online community full of young & old TNBC thrivers on Facebook & Instagram. Through these incredible people, I’ve receive comfort, advice, and comedic relief from the cancer saga – come thrive with us! Check out @tnbcfoundation and @tnbc_thrivers on Instagram.

Mahalo & Alooooooha! ❤

Heart Health & Breast Cancer

Heart Health & Breast Cancer

❤ February is American Heart Month ❤

Did you know that heart disease is the #1 leading cause of death for Americans and that 1 in 4 Americans will die of heart disease each year?

Did you also know that women who’ve had certain types of cancer treatments are at a greater risk for heart disease as well? As treatments for breast cancer have advanced, more breast cancer survivors are living with these long-term consequences of treatments. Some treatments known to have adverse effects on the heart include:

  • Chemotherapeutic agents:
    • Anthracyclines (doxorubicin, epirubicin…a.k.a. “red devil”)
    • Anti-HER2 Agents (herceptin, perjeta)
  • Hormonal therapies (tamoxifen, anastrozole, letrozole)
  • Radiation to the breast/chest wall

For all of the treatments listed above, risk of cardiovascular disease including coronary artery disease and cardiomyopathies (dysfunction of the heart muscle) is elevated. Evidence of cardiotoxicity can show up several months to several years after these treatments are administered. So what does the research say about prevention or reversal of these cardiac side effects?

Prevention of Cardiotoxicity during Cancer Treatments

Firstly, anyone starting any of the above-listed treatments should undergo a baseline cardiac function screening such as an EKG and electrocardiogram to allow for close monitoring of the heart once treatment is administered or completed. Doctors will specifically watch the left ventricle ejection fraction which is an indicator of how well the heart can pump blood to the body.

The benefits of eating a healthy diet full of fruits, vegetables, and whole grains and maintaining a consistent exercise routine during treatment also apply to cancer patients (we’ll discuss this more in a minute). Avoidance of smoking and drinking alcohol is also very important.

From a medical standpoint, oncologists can specify the dosage, timing, and frequency of chemotherapy treatments to minimize their effects on the heart. In some instances, they can prescribe a cardioprotective medication such as a beta-blocker or ACE inhibitor to reduce strain on the heart during chemotherapy, especially if a patient is symptomatic.

Some symptoms that may indicate heart concerns include:

  • shortness of breath
  • swelling in the feet or lower legs
  • rapid or irregular heart beat
  • pain or swelling in the abdomen
  • mental confusion

During radiation, the heart is most at risk if the left side is being treated. Radiation oncologists can have a person use a deep breath hold to minimize the risk of radiation to the heart. They use the radiation simulation to plan the most effective delivery of radiation and ever-advancing treatment techniques to reduce the dose of radiation to the heart.

As you can see, there are many ways to be proactive about heart health during cancer treatment. Patient should never feel as though it’s inevitable to come out on the other side of treatment with heart problems!

Management of Treatment-Related Cardiotoxicity

Should a person develop cardiac issues during cancer treatments, there are more and more evidence-based guidelines emerging for how to improve cardiac function and prevent long-term health consequences. In many cases, treatment-related heart conditions are reversible!

Just like any other muscle in the body, the heart needs to be challenged to get stronger. During cancer treatments, people tend to lose about 27% of their exercise capacity. This means that, as a survivor, it’s time to get in shape.

Ideally, patients and survivors are recommended to get 150 minutes of moderate aerobic exercise per week – that’s about 30 minutes, five days per week. Walking is a great place to start, but patients should choose their favorite type of exercise! Aerobic exercise like running, biking, swimming, or high-intensity interval training (HIIT) are very effective ways to promote healthy heart function. Those who consistently get 150 minutes per week are also shown to reduce their risk of mortality by up to 60% – perks!

From a physical therapy perspective, supervised exercise is best for a few reasons. A knowledgeable physical therapist or exercise physiologist can help prescribe exercise according to guidelines related to the phase of treatment someone is in. Someone in active treatment should not be exercising at the same intensity as a survivor who is 6-12 months out of treatment. Just like recovery from an injury, exercise progression should be progressive and individualized!

Cardiotoxicity is a serious side effect of cancer treatments and should not be overlooked. There are many options for prevention and management of heart conditions that arise for cancer patients and survivors. To find a physical therapist or exercise physiologist who is experienced working with oncology patients, ask your physician for a referral to a trusted provider in your area or use the APTA Find a PT locator!

Sending love to you!

Aloha ❤

To read more, check out these articles:
1. Cardiotoxicity of Contemporary Breast Cancer Treatments (Chuy, et al.)
2. Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity (Avila, et al.)

5 Things I Learned from A Naturopath

5 Things I Learned from A Naturopath

It’s no secret that I am freakishly in-tune with my body and that I also value knowing exactly what’s happening behind the scenes of my symptoms. Even before I was diagnosed with breast cancer, I knew something was off with my body, and I’d started to research root causes and naturopathic/functional medicine approaches to help me with some things I’d been experiencing. Then, cancer came into my life and between the 85 million appointments (not exaggerating…), I decided to hold off on seeing yet another practitioner.

Now that I’m approaching the end of active cancer treatment, I decided it’s time to get some additional support and testing done. A few things I was concerned about include the health of my digestive system, support for my thyroid, and restoring equilibrium for my female hormones. I chose to see a naturopath (ND) based on recommendations from friends and based on her experience level and social media content (never underestimate the power of social media!). Here’s a few things I’ve learned after my initial consultation and lab work:

Get that Good Gut Health

Chemo is designed to destroy cancer cells which are typically rapidly dividing and multiplying in our bodies. Well – guess what else rapidly divides and multiplies? Healthy cells in our digestive tracts! Side effects from chemotherapy tend to hit the GI tract hard and can include mouth sores, nausea/vomiting, heartburn, and diarrhea or constipation. Seeing as I had several of these symptoms during my 16 rounds of chemo, I knew my gut was going to need support and healing.

First of all, the GI tract is full of trillions of happy, healthy bacteria typically referred to as the gut microbiome. These bacteria help us to digest food and maintain a strong immune system. It’s all a bit complex honestly, but a lack in diversity of these bacteria can lead to a whole host of health issues, including mental health concerns.

My ND recommended a few important things to get me started: a good probiotic to promote microbiome diversity and a drink called GI Revive which supports the intestinal lining and promotes regularity. It’s also crucial to eat a diverse, supportive diet that includes plenty of fiber, vegetables and whole grains, and fermented foods.
*Side note – if I’d known GI Revive existed, I would have started it during chemotherapy. However at that time, I did use L-glutamine supplements which helped me prevent issues in my mouth and lower GI tract.

Altogether, I feel like things are coming back around to normal after chemotherapy with this added support. I imagine that the more my gut heals, the more I’ll see my immune system improve and I’ll be able to maintain low levels of inflammation in my body.

Clarity on Chemopause

I started chemo on June 9, 2020, and that was also the first day I received a Zoladex injection. Zoladex is a hormonal therapy designed to stop the ovaries from creating follicles which release estrogen. The ovaries have a high rate of cell turnover like the GI tract, so chemotherapy can lead to infertility if not protected by hormonal therapy. Modern medicine is truly incredible, and I’m grateful that as a 30-year-old woman going through chemo, I had the option to try to save my fertility in this way.

Joke’s on me though, because after 6 months of this hormonal therapy, I am officially in chemopause (a medically-induced menopause), and I have all the symptoms to show for it. I specifically asked my ND for post-chemo baseline labs for my estrogen, progesterone, and testosterone levels. No surprise here, but my labs confirm I’m in a menopausal state and that explains the hot flashes, joint pain, dyspareunia (learn more here), and amenorrhea…

Now, true menopause means a woman has had no menstrual cycle for >12 months. Being only two months out from my last Zoladex injection, I’d say there’s still hope for my ovaries to bounce back. Most women who’ve been on this type of treatment have seen their menstrual cycles return after 5-6 months on average. In the meantime, I need to be supportive of my body! I attempt to exercise 3-5 times per week (walking, resistance training, and stretching) to relieve joint pain and both my ND and OB/GYN have recommended vaginal moisturizers to prevent vaginal atrophy until my estrogen levels improve. (If this is TMI for my family & friends reading this – sorry, but it’s just #RealTalk!)

I’ll continue to monitor my labs every few months to be sure things are trending in the right direction. Chemopause isn’t necessarily permanent, so here’s hoping my body can pull through!

The Thyroid Needs to Thrive

About seven years ago, while I was deep in PT school, I began having unnatural fatigue. I ended up being diagnosed with an underactive thyroid gland (hypothyroidism). The thyroid gland produces hormones which help regulate our metabolism, and if the thyroid isn’t functioning optimally, you can have symptoms like fatigue, dry skin, hair loss, weight gain, constipation, or feeling like you’re always cold. Every body system relies on the thyroid so it’s a priority to take care of it!

Trying to find the root cause of my thyroid dysfunction has always been something I was curious about before my cancer diagnosis, and after treatment I wanted to know if there was: a) any additional support needed for my thyroid after chemo, and b) if there was an underlying cause for my hypothyroidism. After running a full thyroid panel, my ND diagnosed me with Hashimoto’s thyroiditis, an autoimmune condition in which my own immune system is attacking my thyroid. She educated me that Hashimoto’s is actually the most common cause of hypothyroidism and affects about 5 in 100 people.1 It seems that Hashimoto’s is a combination of genetic factors and environmental factors such as food sensitivities or heavy metals toxicity.

My next step is to try to determine what may have triggered this autoimmune condition. The more I know about my condition, the better I can treat it or avoid any sensitivities that may make my condition worse. It might seem like I am seeking out more health problems, but my intent is really to understand my own body and how I can best support it to remain healthy and cancer-free. I will likely always have to be on thyroid medication, but I’d like to try to prevent the condition from progressing as much as I can (I plan on living a long life, you know?!).

Sometimes You Just Have to Supplement

In all honesty, I’ve never been a fan of supplements because I just can’t remember to take them every day! I now understand, however, that there are certain vitamins and minerals that I’m unable to get enough of through a vegan/vegetarian diet (like vitamin B12 which is only found in animal products), and also, based on my recent lab work, we found that some others (like my vitamin D and zinc levels) were significantly depleted for me during chemotherapy.

There are certain supplements I need to be cautious taking during radiation therapy as high levels of antioxidants (like those in vitamins A, C, and E) can interfere with the treatment itself. For now, I am supplementing with:

  • B vitamin complex to improve my energy levels and cognitive functioning
  • Vitamin D3 which promotes bone health and has been shown to reduce the risk of cancer metastasis
  • Omega-3 which helps to reduce inflammation and supports brain and heart function
  • Zinc which supports the immune system
  • A probiotic and the GI drink I mentioned earlier for gut health

It sounds like a lot, but I’m currently finding it very worthwhile. Some of the brain fog that started during chemo has lifted since I started supplementing more regularly, my GI system is more settled, and my hair is growing back much faster than I anticipated! Maybe eventually I won’t need so much supplementation, but I feel now is the time to be very supportive of my body and it’s healing.

The Cost of Collaborative Care is: Priceless.

I know what you’re all thinking – this all sounds expensive! And it is to some extent. Supplements can be pricey & aren’t covered by insurance like most pharmaceuticals. When providers don’t contract with insurance companies, the costs can add up. I don’t need to explain myself, but I just want to let you all in on my thought process at this point.

Seeing an ND and using supplements and acupuncture to support my healing have brought me immense benefits and peace of mind both before and after my cancer diagnosis. I personally feel that seeing a fee-for-service provider is excellent because they are not held to unreasonable standards that insurance companies often dictate. These providers can spend more 1:1 time with their patients, can recommend tests and treatments that can be run through insurance companies, and can provide a more holistic approach to your care. I personally feel it worth every penny to have this kind of care.

If you don’t have your health, you have nothing. This year my body has been through the ringer and besides feeling physically unwell, I saw my mental health and my relationships challenged. I was hardly able to concentrate on anything besides getting through treatment and managing my symptoms. My husband became a “caregiver” and most of our life revolved around what I could and couldn’t do with friends during a pandemic when you’re immunocompromised. I haven’t been able to treat patients for almost a year and so my sense of purpose got a little muddy at times.

Now is the time for me to heal from all of that. I am beyond grateful for good health insurance that got me through treatment without any debt, family and friends who contributed to my GoFundMe so I can seek out alternative care options as I continue to heal, and for my super-supportive coworkers who’ve donated time off and kept me in the loop at work so I don’t feel like a complete outsider. These things may seem small, but they can mean the world to someone living with a complex illness.

Again, my purpose here is to share my journey in case someone else going through this can benefit from what I’ve learned. Much of this info is very personal, and I choose to be open about this. I’ve said this before, but just because someone is considered “cancer-free” doesn’t mean they’re not still experiencing some of the long-term effects of treatment. We use fire to fight fires in cancer care and there are often side effects of side effects!

Please be kind! If you know someone in treatment (or if you know someone who may just need a little extra help), reach out today and see how you can support them – we’ve all got to have each other’s backs.

Aloha ❤

*This post is not intended to provide medical advice or recommendations. I am simply stating what has worked or been recommended to me on my personal journey. For more information, read my full disclaimer here.

Stronger than Cancer

Stronger than Cancer

According to the National Cancer Institute, as of January 2019, the United States had 16.9 million cancer survivors and estimates that number will increase to 22.2 million by the year 2030.1 Although I’m still technically in active treatment until I complete radiation therapy, I’m now considered NED (no evidence of disease) a.k.a. “cancer free,” a survivor. While it would seem that being a survivor is just one big party, I’ve found myself seeing from a perspective that people who haven’t gone through cancer may not consider. Today, I have a few thoughts on survivorship that I wanted to share – it’s a long one, but an important one so get comfy…

Survivor or Thriver?

In the true sense of the word, a survivor is someone who’s overcome hardship or who copes well with the challenges they’ve been given. For some of us who’ve lived or are living through cancer, surviving doesn’t quite describe what it’s like to take on a complex illness and somehow maintain a semi-normal life. That’s why many in the cancer community now prefer the term “thriver” because they choose to continue to not only survive, but thrive through and beyond a cancer diagnosis. It’s not about getting through it without complications, but rather just living as normally as possible during treatment. Being a thriver means rolling with the punches, accepting what you have to do to get through it all, and getting to live how you want despite your diagnosis.

Being a thriver takes on a whole new meaning, though, for someone with metastatic/stage IV cancer. As of now, there’s no true cure for Stage IV cancer and treatment continues until the cancer doesn’t respond anymore. However, many people live for years on palliative treatment since research and treatments continue to advance all the time (#StageIVNeedsMore). In the meantime, there is always normal life running parallel to someone’s diagnosis. The world doesn’t just stop turning. I bring this up only to remind you that everyone’s diagnosis is different – not everyone can be cured, and it seems unfair to put “surviving” on a pedestal when, honestly, what it takes to thrive after a cancer diagnosis is so much more honorable.

If you’re interested in donating to support Stage IV breast cancer reseach, click here.

Mental Health after Cancer

Despite much stigma around mental illness in the past, I think the narrative about mental health issues is gradually (thankfully) starting to change. Many of us experience some degree of mental health concerns throughout our lifetime, but there are a few specific things that someone with cancer may go through after diagnosis and especially in the years after someone may be considered NED.

Scanxiety is the term used by cancer thrivers to convey anxiety around pending imaging (mammogram, CT/PET scans, etc.) or about the results of them. Imaging is the first stop on the cancer diagnosis train and so repeating this process every six months to a year can bring up a lot of emotions, even if it’s expected the scan results will all be normal. It’s important to recognize these feelings are normal and expected (especially in those first 5 years after diagnosis when the likelihood of recurrence is highest), and this would be a good time to throw your toxic positivity out the window. Here are a few ways to be there for someone preparing for follow up scans:

Don’t say….

“Everything will be fine…”

“You have nothing to worry about…”

“It’s just an MRI/CT/mammogram…”

“Stay positive – negative thoughts only lead to disease…”

Instead try….

“I know you’re worried about your tests/results, do you want to talk about it?”

“It’s ok to feel [insert emotion here] after all you’ve been through.”

“Do you want to go for a walk/coffee/other activity to take your mind off all of this for a bit?”

Post-Traumatic Stress Disorder, another anxiety condition, is widely publicized as something that combat veterans get after serving in war. Fun fact – anyone who has been through any kind of trauma can get PTSD. After being diagnosed with cancer, there are so many things that can trigger anxiety and panic attacks. A few of my triggers include hearing of someone young who died of cancer, upcoming medical appointments (particularly with new doctors or doctors that don’t know my recent medical history), and especially blood draws, but other events or news may trigger someone differently. Please be kind and allow space for others to feel their stress and anxiety.

Another thing I’d like to address is actually the first thing I experienced after surgery confirmed I was NED. Survivor’s guilt. I was surprised that I felt this since I was very confident in my doctors and myself that I would get through this (I guess when you’re doctor writes on your FMLA paperwork that your cancer is “curable” it leaves you mostly hopeful). But this “guilt” hit me hard and unexpectedly and so I’ve taken some time to sit with it and understand it.

Truthfully, I don’t actually feel guilty that I survived cancer. I know many other survivors and have met many amazing women this year who’ve overcome a breast cancer hurdle, and they never talk about feeling guilty to be alive either. So I came to the realization that what I’m feeling is actually empathy for those still in treatment and compassion for those who will always be in treatment or for whom treatment didn’t work. Being a survivor is a strange position to be in, but I’m hoping that my experience will only make me a better friend and clinician when I have the opportunity to support someone going through a similar experience.

Expectation of Transformation

The one last thing that’s been on my mind is this idea that because I’ve survived cancer, I must be a changed person. Cancer is eye-opening in many ways, that’s true, but it’s not like Cinderella putting on that glass slipper. I don’t suddenly have this new lease on life, and I don’t feel newly inspired to pick up the torch and run wildly toward some new life where every experience is profoundly meaningful and joyous. That’s great if someone else does have a big transformation, but for me (and likely many others) it’s just not the case. Instead, I feel a bit more reserved. I want to live a simple, mostly happy (sometimes messy) life focused on loving the people I surround myself with and learning as much as I can with whatever time I have left here on this Earth.

I don’t strive to be an inspiration and I hope everyone can recognize that a diagnosis isn’t a definition. I had cancer. I am not defined by that or limited to that. I share my experience because I hope it can help someone else who’s going through it. While I’ve learned a lot, I’m not going to dwell on the experience. Instead, I’ll take what I’ve learned and get back to my life, applying that new knowledge whenever I get the chance. I hope you’ll all hold me accountable to that.

Aloha ❤

Happy New Year!

Happy New Year!

Well, we did it. We made it through 2020, a year no one could have ever expected. A year that we were all “safer at home” and “socially distanced.” A year in which we all struggled as a collective against a common enemy and were challenged on a personal level as well.

It’s easy to look back on this as a very difficult year, but for me it was also a year of major growth, learning, and finding love. Love for myself, my partner, my family and friends, and even for strangers. A year to prioritize my health, both physically and mentally. A year to allow many tears and also to find joy in the most ordinary of days.

I’m actually unable to hold back tears thinking of all we went through this year with such little reprieve. To go through cancer on top of it all was just ridiculous, honestly. So, I am grateful to sit here and reflect on the highs and lows of 2020. I am even more grateful to be able to look ahead to the ordinary joys, the eventual hugs, and the lessons that 2021 will bring.

I know I’ve mentioned this before, but on my 30th birthday last year, I kept feeling that 2020 would be a big year. Not like the “best year ever” kind of year, but the kind where you’re challenged in all the important ways. I usually decide on a word that symbolizes my intentions for the year, and I just couldn’t pick one last year, but as the second quarter of the year began with COVID and a cancer diagnosis, I found myself always coming back to a Japanese phrase I learned a few years ago:

And so that’s what I’ve done this year. I just kept putting one foot in front of the other and doing the best I could to get through each day. Trust me, some days were better than others and there were many days that I had to ask for help. So to those of you who prayed for me, who let me cry with you on the phone, who laughed with me on zoom calls, who sent cards and letters, who wore masks & socially distanced to protect the immunocompromised – I am incredibly thankful for you.

A few highlights from this year:
Getting to spend a whole month with my mom in Hawaii. Staycations. Cooking at home and learning new recipes. Being outside more often. Meeting new people (mainly my excellent medical team and an incredible group of cancer thrivers). Growing closer to my husband as we rounded out our second year of marriage and head into our third. Working on my Pilates certification. New babies. Friends getting married. Learning my own strength.

I won’t dwell on the lows, but I will remember how much I learned from them. This year my word is JOY. I hope to find more joy in each day, be more present, and celebrate every little victory. There will be setbacks, I’m sure of it, but if I’ve learned anything this year, it’s that they can be overcome. Wishing you all a happy, healthy, safe new year and sending you so much love and gratitude.

Cheers to 2021! ❤

A Fertility Update

A Fertility Update

How it’s going…

You may remember me posting a while back about the different ways I tried to protect my fertility as I prepared to start chemotherapy. First, I froze some eggs. In case I’m unable to conceive naturally later, I can use them for IVF. I also started monthly Zoladex injections – a medication that halts ovarian function in an attempt to preserve fertility overall.

And so, at age 31, I’ve been in a Zoladex-induced menopause since June. Six whole months later, my estrogen levels have tanked and my joints ache like I’m an 100-year-old lady! Some other fun side effects include amenorrhea (lack of a period), hot flashes, and dyspareunia. So, I’m currently staying as active as possible (mostly walking and stretching when I have the energy) in order to mitigate some of those side effects, and thankfully, my oncologist and I decided it was time to discontinue the Zoladex now that the bulk of treatment is behind me. Today marks one month since my last injection!

For more detailed info about fertility preservation, you can read my earlier post here.

What to expect now?

Typically, the menstrual cycle can take a few months to return as the body figures out its new normal once again. As I have some previous experience with amenorrhea after I came off the birth control pill in 2019, I know that what I eat will play a huge role in how quickly my body gets back to normal. Thus, the plant-based diet continues (plus no dairy, processed sugars, or alcohol) and I will try my absolute hardest to cut back on caffeine to keep my nervous system calm.

I also plan to use seed cycling to help my body regulate the essential hormones it needs for menstruation and ovulation. This is a great article about how to do seed cycling if you’re interested in learning more. Seed cycling is an excellent, natural way to balance hormones, however if you have hormone-positive cancer, please ask your doctor if a daily dose of phytoestrogens is safe for you!

Once I’ve completed radiation therapy, I’ll speak with my medical oncologist and OB/GYN about when it will be safe to start trying to conceive. With that said, I think my body deserves a long break to heal completely before that all happens. Actually, this might be a good time to kindly remind you that it’s just not acceptable to ask a person when they plan to have children. A person’s body is their own to make decisions for and, sometimes, people aren’t capable or willing to have children at all.

My goal for this blog has always been to be as open and honest about my experiences as possible in the hopes that whoever may be reading this can gain some insight for their own health and wellness. Personally, I don’t think there’s ever TMI (too much information) disclosed when it comes to learning about your own body and how it works. This coming from a pelvic floor PT who talks about poop all day… Anyway, I’d love to know what questions you have about:

  • fertility preservation during cancer treatments
  • long-term side effects of the birth control pill
  • nutrition around hormone balance
  • seed cycling

Drop your Q’s in the comments below!