Pregnancy after Breast Cancer

October 2, 2023 by bridewitt ♥ 2 Comments

Hi – it’s been a minute and…SURPRISE! If you didn’t already know – I’m pregnant! My husband and I are so thrilled to be expecting our first child in December, especially because we weren’t sure what this ride would be like for us. It’s such a blessing to be here three years post-diagnosis sharing this news!

I wanted to take this opportunity to write about a few of the normal and not-so-normal experiences I’ve had during this post-cancer pregnancy, because there are a few things I’ve had to consider beyond what someone without my medical history might experience. I also want to acknowledge that every person’s experience with conception and pregnancy is so different, and with so many dealing with the heartbreak of infertility, I want to be as respectful as possible. What works for me, may not be helpful to your experience. I send my love to anyone on their family building journey, however that may look!

Conception Concerns

Conceiving naturally after breast cancer treatment was NOT a given. You’ve all read my saga of a fertility preservation journey through cancer… Thankfully, though, natural conception is not impossible! I remember speaking with my fertility specialist when we were starting the egg-freezing process prior to chemo and asking him what percentage of people do conceive naturally after treatment and then proceeded to blurt out “Well, you probably don’t get to see those patients return anyway!” when he told me it’s “not likely.”

From the moment I realized that infertilty after cancer was looming, I decided to change my mindset. I decided I’d do whatever I could to support my body during and beyond cancer treatments to give me the best chance of conceiving naturally (because, not sure if you’ve heard, but IVF is expensive!!!).

Here are some of the ways I have tried to support my body’s ability to conceive from early in my diagnosis:

Eating a well-balanced diet (& actually switching from a primarily plant-based diet to a paleo diet)
Acupuncture
Seed cycling for menstrual support
Supplementing with vitamins, minerals, and antioxidants with guidance from my naturopath
Tracking my cycle and understanding my norms
Managing stress with meditation, tapping, and time outside
Positive mindset and visualization
Exercise!
Medically – Zoladex to protect my ovaries during chemo & Egg-freezing (oocyte cryopreservation) as a “Plan B”

Here’s a cool story for you…

If I haven’t mentioned it here before, I am a HUGE fan of my Oura ring for tracking my cycles and other biohacking purposes. Even before I had missed my period, my ring indicated elevated basal body temperatures and resting heart rate so I knew even before I took my first pregnancy test that I was likely pregnant!

And so I was just lucky (?) that I was able to conceive naturally this time around, but I can honestly say that I did what I thought I needed to do to support that. It may not be feasible or even physically possible for some or may just be all too much for others, but I just wanted to share my personal experience here.

Cancer Screening Change-Up

Prior to pregnancy, I was having an annual mammogram and an annual MRI (staggered every six months) to monitor for any signs of recurrence. I’ve never monitored tumor markers because mine were never elevated, and therefore wouldn’t give an accurate snapshot of my health. With triple negative breast cancer, the risk of recurrence is absolutely highest in the first three years and begins to taper down signficantly after 5 years of being cancer free. I had just celebrated my 3-year diagnosis cancer-versary in April when we found out we were pregnant, so I am definitely not out of the woods and screening are still important.

First of all, for the rule followers…my oncologist did clear me to try for pregnancy, and she knew I was pregnant before I even told my family!

Second of all, I obviously don’t want to cause any harm to the baby by undergoing procedures with high levels of x-rays or heavy metals contrast. So, for screenings throughout pregnancy, I resort to clinical breast exams and should any concerns arise, an ultrasound is safe and the first step we’d take to check everything out.

I continue to do my monthly breast self-exams (don’t listen to what the American Cancer Society says, these continue to be important for everyone!). This has honestly been very difficult for me emotionally throughout pregnancy for several reasons. One, being that I found my lump myself so there is a bit of PTSD there… and, two, because TNBC is notorious for popping up in the pregnant/postpartum phase. With many changes happening in my body during pregnancy (normal), finding a lump is not my favorite thing to think about. I say this only to validate others who may be experiencing the same thing!

Lastly, last year I requested to start doing blood draws twice annually which can specifically detect my tumor’s unique DNA in my system. This test is run by Natera Genetics and is commonly used with more advanced stage disease to ensure treatments are working. It is generally not indicated for early stage survivors as there is no protocol for “next steps” should any elevation of circulating tumor cells be detected.

However, knowing that I was intending to get pregnant and screening options would be limited, my doctor magically got my insurance to cover this for me and my most recent test does NOT indicate any signs of recurrence – yay!

As scary as it can feel to pursue pregnancy and parenthood with a not-so-distant cancer diagnosis, there are options to continue screening throughout pregnancy. I find that mindset is so important, and I remind myself on a daily basis that my baby and I are healthy and thriving through this pregnancy and it keeps me present.

Non-Cancery Curve Balls

Honestly, I’ve been very lucky to have a relatively uneventful pregnancy thus far. I tell most people I did it backwards since I felt so well throughout my first trimester and have had a slow decline in energy and motivation after getting halfway through my second trimester.

I did find out early on that my Rh- blood type means I need a Rhogam shot so my body’s antibodies don’t attack the baby’s if their blood type is Rh+ so I’m heading to get that later today.

I learned the hard way that Paxlovid can be taken during pregnancy if you get COVID-19 with moderate to severe symptoms. However, from my brief research, the U.S. is currently the only country deeming it safe for pregnant women/fetuses so I opted not to take it. I primarily blame COVID (& not the tiny human growing inside) for my listlessness these days…

And, as it turns out, the 1-hour glucose screening test is made to be quite difficult to pass. Obviously, it would not be great to allow someone to go through pregnancy with undiagnosed gestational diabetes. So here I sit, waiting to complete my 3-hour glucose tolerance test. As inconvenient as these tests can be, it’s all for the health of mama and baby, and I’d rather make a few lifestyle changes to get us both safely to somewhere closer to our December due date!

Beyond all that, I’m just immensely grateful to be on this post-cancer, prenatal journey with my incredible hubs and family and friends who’ve been the ultimate support. As I start my third trimester, I am definitely in nesting mode and doing my best to connect to this little soul that I’ll get to bring earthside in a few short months!

I’ll be scaling back my work days at the end of the month, testing out for my official Pilates certifcation in the next few weeks, and prepping for a few upcoming education opportunities on the state and national levels!

My last reminder today is that while we all may have good intentions for Breast Cancer Awareness Month this October, please check who benefits from your dollars spent before you buy anything PINK! My favorite organizations to donate to that support breast cancer research or survivors themselves include:

Breast Cancer Research Foundation – Largest funder of breaast cancer research in the U.S.
Triple Negative Breast Cancer Foundation – Funds research for TNBC
Metavivor – Funds research for Stage IV
Breast Cancer Hawaii – Supports Hawaii’s breast cancer thrivers
Rural Gone Urban Foundation – Love Bombs for cancer patients

Click on the links to donate! And don’t forget to do your self-exams and schedule your annual screenings!

Aloha ❤

How life goes on…

June 22, 2022 by bridewitt ♥ 0 Leave a Comment

I’ve been meaning to make some time to write, but it’s been busy around here! 2022 feels a bit more like the pre-pandemic rat race, and I’m trying my hardest to stay present through the madness. Recently, most of my focus has been on treating patients, and though the days can be long, the weeks fly by and I’m not totally sure how it’s already nearing the end of June.

To describe a typical day at work, I usually see about 7-8 patients. I get to help people who have:

bladder issues (incontinence, overactive bladder, bladder pain)
bowel issues (constipation, fecal incontinence)
pelvic pain (including endometriosis, vaginismus, or vulvodynia)
conditions associated with pregnancy or postpartum
musculoskeletal, neurologic, or lymphatic conditions after breast and prostate cancer
dizziness/vertigo or other vestibular conditions

Did you know physical therapists can treat those conditions?! Now you know!

Despite being over 18 months out of treatment, I’m still doing a lot of healing. Some of the things I focus on include:

Therapy
Meditation/EFT Tapping
Exercise
Acupuncture
Infrared Sauna
Spending time outside
Connecting with friends
Connecting with other survivors
Having fun!

Because I feel like I lost a lot of strength during treatment and during the pandemic, I recently joined a 6-week women’s empowerment strength training program run by a friend that I met through a cancer fundraiser way back in 2020 (but this is the first time we’ve really met in person – isn’t that crazy!). My one fitness goal this year is to get really strong again! I also plan to participate in a 12-week exercise study run through University of Hawaii and Rehabilitation of the Pacific later this year.

Overall, things are going well. I will have some annual screening scans at the end of July. Justin and I have plans to see Jack Johnson in concert shortly after (obviously to celebrate clear scan results). Even though I’m “pretty far out,” the scanxiety still gets me so I do appreciate prayers for squeaky clean pictures when the time comes.

A few weeks ago, I’d been feeling a bit down. My body felt achy and I had little motivation. There were actually several days when I had to nap after work beause I was just exhausted. I recognized that this was unusual for me.

First, I realized that much of the overwhelm I’d been feeling was partially related to some PTSD. Trauma memories can be stored in the body and can manifest as pain and emotional distress. I finally realized that June 9 was actually 2 years from the day when I had my first chemo. So, even though I wasn’t fully aware of that “cancer-versary” this year, my body remembered. It sounds wild, I know, but I promise there’s a bunch of research to support it. If you want to learn more I suggest reading The Body Keeps the Score by Bessel van der Kolk, MD.

Second, I had my thyroid re-tested recently and my levels were way off. I adjusted the dose of my medication and it’s been a game changer! I feel significantly better in terms of energy so I’m hoping it will stay stable. If you don’t know, the thyroid gland is a small gland in the front of the neck that regulates thyroid hormones which maintain the body’s metabolism and affect every body system including the brain, eyes, skin/hair/nails, GI system, stress response, etc. etc. etc. It’s a tiny little organ with a very big job!

So all that to say that I really am still healing. I don’t see it as a finite process. I’m not following a well-illumined path forward, but rather zigzagging through the woods trying to find a clearing. There are ups and downs, but mostly all is shifting toward wellness.

I do have some plans to sit down and cut out time to blog more regularly. I love sharing information with everyone and hope it can help others in their own healing, too. If there’s anything you’d like to learn more about in terms of cancer diagnosis, cancer treatment, pelvic floor rehab…. send your requests my way!

Aloha ❤

Family Planning After a Cancer Diagnosis

February 4, 2022February 2, 2022 by bridewitt ♥ 1 Comment

As I’ve written many times before, life as a young adult cancer survivor comes with a whole host of unique challenges! One of those, specifically, is the fact that many adolescent/young adult (AYA) survivors have to face possible infertility after their treatments. Though the road may be a bit more winding, there are many options for survivors to have thriving families beyond their diagnoses. I understand that having children isn’t for everyone, but for those of you who do want kiddos, keep on reading to learn more!

*FYI – for this post, I’ll mostly focus on options for those assigned female at birth who are undergoing or have undergone cancer treatment, but know that there are also options for those assigned male at birth as well!

Before and During Treatment

Upon diagnosis, many doctors now recommend fertility preservation prior to treatment. There are a few options and you could choose either or both if recommended by your MD. The first type of fertility preservation would include freezing eggs or embryos before treatment. This is usually done by a reproductive endocrinologist and may require blood work, ultrasounds, and outpatient procedures for egg retrieval itself. Oftentimes, treatment can be delayed just long enough for egg or embryo preservation to allow for future family planning options. These procedures are usually timed with the menstrual cycle for the best results, but it can be done any time if you’re worried about delaying treatment too long or if you’re not cycling regularly!

During treatment, your oncologist may also recommend anti-hormonal treatments (like ovarian suppression) during treatment to try to minimize damage to the reproductive organs. This type of medication can put you into “medical menopause” which is usually reversible once discontinued, but can have side effects similar to those you’d experience during actual menopause (i.e. hot flashes, joint pains, weight gain, etc.).

If you’re newly diagnosed, be sure to ask your doctors about these options and weigh the pros and cons for your unique situation. Remember, there is usually adequate time to figure things out before starting treatment if it’s something that’s important to you!

If you’d like to read more about my personal experience with fertility preservation, click HERE!

Family Building after Cancer Treatment

It’s important to remember that, no matter what happens, there are always options for starting or expanding a family after a cancer diagnosis. Whether you never come out of medical menopause, your eggs/embryos weren’t viable, or you didn’t have time for fertility preservation before treatment, there are many ways to grow your family. Below are a few of the options that many cancer survivors choose. The decision is very personal and there are plenty of reasons why some would choose one option over another.

In-Vitro Fertilization (IVF)

IVF is a type of assisted reproductive technology. A physician would use fertilized eggs (embryos) retrieved prior to cancer treatment and then implant them into your uterus for you to carry your own pregnancy. Of course it’s much more complex than that, but I’m not a reproductive endocrinologist (learn more HERE)!

Partnering with a Gestational Carrier (Surrogacy)

For some who can’t carry their own child, using a gestational carrier can be a good option. Learn more about gestational carriers and surrogacy HERE. This site has a great breakdown of the whole process and outlines the difference between traditional surrogacy and gestational surrogacy!

Fostering/Adoption

In case IVF or partnering with a surrogate aren’t good options, you can always consider fostering or adopting a child. There, again, are many options down this path and each agency and state have varying rules/regulations. HERE is a good overview.

Financial Assistance for Family Building

One of the biggest road blocks in ALL of these processes, however, is the actual cost. For many, the out-of-pocket cost renders nearly all of these options to be out of the question. Most insurances do not cover fertility preservation as the patient (who is otherwise “healthy” – you know, besides the cancer thing) does not have a diagnosis of infertility. Some (but not all) insurances will cover the cost of IVF if a true diagnosis of infertility exists. So then, what?

Many organizations do offer some financial assistance or grants for cancer survivors seeking options for family planning around their diagnosis. Here are a few to look into:

Alliance for Fertility Preservation

A Damn Good Life (For those seeking support during their surrogacy journey)

I personally benefited from the Livestrong Fertility Program and The Heartbeat Program which discounted my fertility preservation costs and covered the costs of the medications required for my egg retrieval ❤

For those considering adoption, there may be grants or loans available as well. Check with the adoption agency you’re using or use THIS site to get you started. Know that there may be more local resources for you as well!

Virtual Family Building Panel – February 2022!

Finally, on February 17, 2022, I’m collaborating with Breast Cancer Hawaii on a virtual Family Building after Cancer Panel to bring information to AYA survivors on options for starting or expanding their families after treatment! (HOW LUCKY AM I?!) This will be a great intro for anyone who is newly-diagnosed, in active treatment, or who’ve completed treatments. We’ll have experts in oncology, reproductive medicine, fostering/adoption, and surrogacy on board to give us the details on what family building after cancer may look like for us survivors! It will be a bit heavy on options for those of us living in Hawaii, but all are welcome to join us and ask questions. For more information, please check out our Eventbrite link HERE!

Aerobic Exercise during Cancer Treatments

October 12, 2021September 30, 2021 by bridewitt ♥ 0 Leave a Comment

Aerobic exercise (a.k.a. “cardio”) has many proven benefits for all humans. Cardio relates to cardiac, meaning it’s for the heart! For cancer thrivers, aerobic exercise can have many excellent benefits (including improved survival rates and decreased rates of recurrence!) and should be recommended for all oncology patients. Read on to learn about the benefits and general recommendations for aerobic exercise during cancer treatments.

Benefits of Aerobic Exercise

Increase your sensitivity to treatment = better tumor cell destruction!
Prevent muscle loss and build strength (including your heart muscles)
Reduce treatment-related side effects
Reduce depression and anxiety
Improve your sleep
Reduce your recurrence and mortality risk significantly (up to 50% for some)
Improve your quality of life

Psstttt… if you’re not convinced already, I’m not sure what will get you on board this point!

Types of Aerobic Exercise

Walking
Riding your bike
Running*
Interval Training
Swimming**

*If running was part of your pre-treatment routine, it may be ok to continue, BUT as some treatments can put you at risk of cardiac dysfunction, it may be best to stick with more gentle cardio until your heart gets stronger. Always check with your doctor or physical therapist!

**Avoid swimming in the ocean or public pools if you are neutropenic, have recently had surgery, or have open wounds/blisters from radiation therapy due to increased risk of infection!

Aerobic Exercise Guidelines

We’ll use the FITT principle for aerobic exercise guidelines:

Frequency: 3-5 days per week
Intensity: RPE 2-3 – keep it light for cardioPROTECTIVE benefits!
Time: 10-60 minute sessions for total of 150 minutes per week
Type: Choose your favorite from those listed above!

What is RPE, you ask? RPE, or Rate of Perceived Exertion, is a measure of how hard you feel you’re working. Use this Modified Borg Scale to guide your intensity during your workouts!

	Modified Borg Scale
0	RESTING
1	VERY EASY
2	SOMEWHAT EASY
3	MODERATE
4	SOMEWHAT HARD
5	HARD
6
7	VERY HARD
8
9
10	VERY, VERY HARD

Special Considerations

Understand if the chemotherapeutic agents you received can cause cardiotoxicity. If so, be sure to request a baseline cardiac workup. Know that low-intensity exercise may have a cardioprotective effect during treatment!
Monitor your vital signs!
- Use your fitness tracker to monitor your heart rate OR here’s a video on how to check your heart rate manually!
- Report any significant or unusual shortness of breath to your physician.
- Watch for swelling that may be early signs of lymphedema or cardiac dysfunction.
Monitor lab values! Generally, if your lab values fall in the following ranges, you should check with your provider before exercising:
- Neutrophils (ANC) <1.5 x 10^9/L
- Platelets < 20,000 cells/uL
- Hemoglobin < 8g/dL (anemia)
Be cautious if you know you have any of the following:
- Bone or lung metastasis
- Osteoporosis
- Abnormal sensation or dizziness/imbalance which may increase your fall risk

Now you know some general guidelines for aerobic exercise for cancer patients! By the way, these general guidelines apply to those without cancer as well! Always seek medical advice before starting a new exercise program and remember: All information shared on this page is for educational purposes only. If you are thinking of starting an exercise program, consult with your physical therapist or physician to determine what is right for you!

Aloha ❤

Resistance Training during Cancer Treatments

October 4, 2021October 4, 2021 by bridewitt ♥ 2 Comments

You’ve probably heard the old saying, “If you don’t use it, you lose it,” right? Well, it’s true! For oncology patients in particular, resistance training is an important way to maintain strength, balance, and quality of life during and beyond cancer treatments.

Benefits of Resistance Training

Maintain functional STRENGTH to continue to do the activities you love
Improve or maintain MUSCLE mass
Improve or maintain BONE health
Improve QUALITY OF LIFE
Reduce MORTALITY risk by 33% [Hardee, et al, 2015]

Types of Resistance Training

Bodyweight Training
Pilates
Yoga
Weightlifting (free weights, machines, resistance bands, etc.)
TRX / Suspension Training

*Pro tip: Choose a type of exercise you enjoy to make it fun and something you look forward to!

Resistance Training Guidelines

2-3 days per week
Focus on major muscle groups
Moderate Intensity
- 40-60% of maximal effort
- RPE 3-6

What is RPE, you ask? RPE, or Rate of Perceived Exertion, is a measure of how hard you feel you’re working. Use this Modified Borg Scale to guide your intensity during your workouts!

	Modified Borg Scale
0	RESTING
1	VERY EASY
2	SOMEWHAT EASY
3	MODERATE
4	SOMEWHAT HARD
5	HARD
6
7	VERY HARD
8
9
10	VERY, VERY HARD

Special Considerations for the Oncology Population

Take extra precaution AND work with a specialist if you know that you have:

Bone Metastasis
Osteoporosis
Abnormal sensation or dizziness/imbalance which may increase your fall risk!

Now you know some general guidelines for resistance training for cancer patients! By the way, these general guidelines apply to those without cancer as well! Always seek medical advice before starting a new exercise program and remember: All information shared on this blog is for educational purposes only. If you are thinking of starting an exercise program, consult with your physical therapist or physician to determine what is right for you!

Aloha ❤

Chemotherapy: Stretches for Health

May 3, 2021 by bridewitt ♥ 0 Leave a Comment

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

April 15, 2021 by bridewitt ♥ 0 Leave a Comment

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

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 ❤

5 Things I Learned from A Naturopath

January 26, 2021 by bridewitt ♥ 0 Leave a Comment

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.

Radiation & Reflections

January 16, 2021 by bridewitt ♥ 0 Leave a Comment

It feels like it’s been a bit since I gave an update so here we go! I had my radiation simulation on January 5 which is basically a practice run for the actual radiation treatment. The radiation oncologist and radiation technicians set up the treatment table and placed stickers on my chest to help them line up the radiation beams during treatment. I was able to practice with the deep inspiration breath hold (DIBH) technique which is meant to draw the heart away from the chest wall as I inhale to minimize radiation exposure to the heart for people with left-sided breast cancer. It’s actually very fun – like a video game! They give you goggles, and as you inhale a bar rises up into a green box. The goal is to keep the bar in the middle of the box for about 30-45 seconds during treatment.

I started the actual treatment on Thursday, and it has gone well so far. The first session took about 45 minutes for the alignment and set up to be confirmed. The second treatment was much quicker (about 15 minutes) as the correct table settings were already known, and I just had to lie down and get treatment. The treatment uses 2 beams (one goes right to left across my left breast, and one goes from back to front in my left armpit), done separately, so that the whole breast receives treatment and no rogue cancer cells are left behind. I use the DIBH with each blast of radiation to protect my heart. The plan for me is to go daily (Monday through Friday) for 20 sessions (16 whole breast radiation, 4 boost to the tumor bed itself).

Learning about the process of radiation therapy has been fascinating to me! There is so much complexity and nuance from the set up, dosing, and treatment delivery. I have a lot respect for my providers and feel that I am in very good hands. How incredible is it to have these kind of treatments that are literally life-saving for so many people?!

As with any treatment, there are risks. The radiation can affect the heart and/or lungs which could cause some tissue fibrosis and the physicians/technicians do all they can to minimize this during their planning so there are no long-term effects on those vital organs. Skin irritation/breakdown is also a consideration so I am on a very strict moisturizing schedule using MyGirls Radiation Burn Cream every 3-4 hours and Aquaphor (with or without pure aloe vera mixed in) nightly. I can expect to see discoloration of my skin (tanning or redness) as treatment progresses. Other side effects can include fatigue and/or swelling of the treatment area.

Some other ways that I am supporting my body throughout radiation is to drink green tea 1 hour prior to each treatment. EGCG, which is a compound in relatively high concentration in green tea, has been shown to reduce damage to the body’s healthy cells during radiation. I am also continuing supplementation of vitamin D, a vitamin B complex, fish oils, and a few others that my physician ok’d.
**Disclaimer: Always check with your doctor about any medications or supplements you’re taking during cancer treatments as some supplements can reduce the effectiveness of chemotherapy or radiation.

Otherwise, I was able to start part-time work again on transitional duty. My department has some old paperwork that needs to be scanned into our electronic medical records system, and I couldn’t be more thankful to have an option to work outside of patient care as I finish treatment. I am trying to be very mindful about balancing my return to work with taking care of myself. The old me would have jumped in head first, but I feel a deep need to let me body guide my choices these days and it’s telling me to take it slow.

Justin & I are in the process of selling our condo and buying a new place! It seems like the right time for a change in scenery and a fresh start for us. Wish us luck in this process! When COVID settles, we’ll be taking applications for visitors…

I’ve also been reflecting a lot about getting cancer as a 30-year-old, “healthy” person, and I have two points to make about this right now. For one, I am a big believer in root cause medicine. I may never know 100% why I got breast cancer without any genetic factors or significant family history. However, I am working with a naturopath to determine if there is an underlying factor that heightened my risk for cancer in the first place. My ND is testing me for things like Hashimoto’s thyroiditis (an autoimmune thyroid condition…I have a history of hypothyroidism and a family history of Hashimoto’s), celiac’s disease/gluten sensitivity, heavy metals toxicity, and food allergies/sensitivities. This will likely be a long process of exploration, but I’ll try to update as I know more. I am a big proponent of integrative medicine and I will always strive to incorporate both natural and conventional principles into my care. I believe strongly that there is an important place for both in cancer care and recovery.

Secondly, I have been looking at cancer not as a detour in my life, but as a brand new path I’m setting out on. I realized that I feel this pressure to “get back on track,” but I prefer to see it as carving a new path for my life. It’s a scary feeling to know that I am not on the same “timeline” that I envisioned for my life before cancer, and yet I feel a sense of freedom knowing there is unlimited potential in this redirection. I am trusting God that this is the true path I was meant to tread, and that this is not the first or the last time I’ll be redirected to serve His purpose for me. I choose humility and I release control of my journey.

I hope you all have a wonderful weekend. I’m going to take some time off social media and get a bit more introspective for a bit so I’ll catch ya on the flip side!

Aloha ❤

Stronger than Cancer

January 3, 2021January 3, 2021 by bridewitt ♥ 1 Comment

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 ❤