Hopeful Updates and a Quick PSA!

Hopeful Updates and a Quick PSA!

Well, about 10 days have passed since my last chemo (still celebrating!), and I thought I’d update everyone on the emotional roller coaster that was the last week. It’s been surprisingly eventful!

I took the past week off to get a few appointments and scans done. I forgot to update on this, but on my last day of chemo last week, my manager at work notified me that we’ll be closing our COVID negative results call center at the end of this week (Nov. 7). It’s not lost on me how lucky I was to be able to have work through this pandemic, especially a safe job that I was able to do from home. I don’t think it’s a coincidence that chemo and that job will be ending at the same time. Time to start thinking about going back to some patient care (eventually)!

On Wednesday, I repeated my mammogram and ultrasound. Mammo was quick & easy but the tech was running behind so didn’t say much about anything she might’ve seen on the images. I’m able to see the ultrasound, however, and it was clear that there continues to be a small mass (6mm – about 1/3 the size of my original tumor) still remaining in my left breast. The poor ultrasound tech probably felt weird with me reading over her shoulder because she called in the radiologist who reminded me that the MRI would give more information. Because the MRI is done with contrast dye, any cancer cells will light up on the image. If no “lights,” then the mass may just be scar tissue.

Thursday morning, I had my MRI, and then in the afternoon I went in to my oncologist’s office for (hopefully) my last Zoladex injection (#SaveTheOvaries). I ran into my oncology APRN there and he printed the impression from my mammo & ultrasound for me and just casually mentioned, “The MRI showed nothing.” I won’t really believe it until I see the words on paper, and don’t worry I’ve been obsessively opening MyChart to see if the results are online. Not yet. Still, not yet. But I’m currently taking his word for it just so I can sleep at night.

Quick PSA: If you have “dense” or “very dense” breasts, a mammogram can be less accurate at detecting tumors or calcifications in the breast. You should talk with your doctor about what other imaging can be done to be sure nothing is ever missed!
I’m going to post pictures below of my mammogram and ultrasound impressions to give you an example.

Otherwise, yesterday was Halloween, and I couldn’t miss a chance to dress up again! (Last year we landed in Japan at midnight on Halloween, and I wasn’t packing a costume with me.) Last night, Justin & I were able to get together for a socially distant dinner with his sister and her boyfriend which was so fun and I’m looking forward to getting to see more friends and family now that I won’t be so immunocompromised. We also got to make a quick pit stop at our friends’ place to see their new baby so all is right in the world ❤

And, as today is November 1, we are celebrating el Dia de los Muertos and reminding you to #FeelItOnTheFirst!! The first of the month is the perfect time for you do your monthly breast/chest self-exam!

Check yoself!

Due to COVID, breast cancer diagnoses are down by 51.8% — NOT because less people are getting cancer, but because they aren’t going in for their appointments! DO NOT DELAY your mammograms and OB/GYN appointments – your doctors and clinics are doing everything they can to keep you safe during this time. It could save your life!
*Remember: Men can get breast cancer, too, so encourage the men in your life to do their screenings!

With Breast Cancer Awareness Month coming to a close, please remember that breast cancer research does not stop needing support at the end of October and cancer survivors do no stop needing support once they’re “cured.” The fear of recurrence and survivorship in general evoke just as many emotions as the diagnosis and treatment. Treat everyone with a little grace and consider donating to cancer research if you have the means. I outlined some great breast cancer organizations in my previous post.

In case you’re following my Instagram page (@bri.d.pt), my sister-in-law Marisa & I had a great conversation about the inevitable thoughts of death/dying after receiving a cancer diagnosis or terminal illness. Check it out! If you’re interested in an intuitive angel card reading with Marisa, you can book one here!

I hope you all have a great week! Please stay healthy and safe, wear your masks, and wash your hands! Going into the holiday season, we want to be able to spend time with family and friends so the safer, the better!

Aloha ❤

Transgender Health & Breast Cancer

Transgender Health & Breast Cancer

As research builds for our transgender community, cancer screenings and preventative health must be encouraged. As hormonal therapy and surgery are often part of transitioning, trans people should be aware of their risk of developing certain cancers including breast cancer, reproductive cancers, or prostate cancer dependent on their individual treatment.

Risk of Breast Cancer in Trans Women

According to a Dutch study from 2019, for a trans female on hormonal therapy, the risk of developing breast cancer is slightly higher than in the cisgender male population, but still lower than the general cisgender female population.1 Just as hormonal replacement therapy has been shown to increase breast cancer risk in a post-menopausal cisgender female population, so it is for trans women.

Another Dutch study from 2013 noted that 60% of trans women whose records were reviewed in the study had dense or very dense breasts which is known to limit effectiveness of mammogram studies and puts someone at increased individual risk for breast cancer in all populations.2

Those with BRCA1/BRCA2 genetic mutations likely also have an increased risk of breast cancer, although more research is needed specifically for the transgender population. If someone has a BRCA mutation or significant family history of breast cancer, they should discuss screening options with their healthcare providers.

Risk of Breast Cancer in Trans Men

For trans men on hormonal therapy, the risk of developing breast cancer is lower than in the cisgender female population. Trans men also may choose to have top surgery which could include a breast reduction or removal of the breasts (bilateral mastectomy). The risk of developing breast cancer after mastectomy in this population is unknown at this time.1,3

Breast Cancer Screenings for the Trans Population

In the United States, some studies show that transgender people are less adherent to mammogram screening guidelines than cisgender people (often due to stigma or limited access to healthcare).4 However, it is important for these screenings to take place regularly as early detection of breast cancer can save lives.

Current guidelines for trans women who are age 50 or older and have been on hormonal therapy >5 years, a mammogram is recommended every 2 years.1

Trans men who have not had bilateral mastectomy or who only had a breast reduction should undergo an annual mammogram after age 40. After age 50, mammograms can be done every 2 years (but can be continued annually dependent on patient risk and preference). For trans men who have had bilateral mastectomy, chest wall examinations are recommended.3

Breast/Chest self-exams are recommended monthly for both transgender and cisgender populations to pick up early signs of cancer! To learn more about how to do a self-exam, see my previous post here.

Aloha ❤

Frozen Shoulder & Capsulitis after Breast Cancer Surgery

Frozen Shoulder & Capsulitis after Breast Cancer Surgery

Staying on topic with complications after breast cancer surgery. The two I’ll discuss today are common and can be disruptive to daily life. You’ve probably heard of frozen shoulder (adhesive capsulitis), but you may not have heard about breast capsulitis after breast reconstruction. Let’s dive in a little deeper.

What is capsulitis?

Capsulitis is inflammation of a joint capsule or the capsule around a breast implant that can lead to scar tissue adhesions and stiffening or immobilization of the joint or breast capsule. Uncomfortable – yes. Functionally limiting? Also, yes.

Frozen shoulder

While frozen shoulder (adhesive capsulitis) can occur after any shoulder injury, it can occasionally occur without any injury, and is more common in females and in people with diabetes mellitus or hypothyroidism. Frozen shoulder typically presents as a significant loss of motion in the shoulder with or without pain. To read a bit more about frozen shoulder, click here.

After breast cancer surgery, frozen shoulder is also common. For women aged 50-59, women who had mastectomy, or women who had breast reconstruction, the risk of developing frozen shoulder on the affected side is approximately 10%.1

Functionally, frozen shoulder leads to difficulty getting dressed, showering, combing your hair, lifting and carrying objects, driving, sleeping, and a whole lot of things we do on a daily basis.

Physical therapists treat frozen shoulder using manual therapy like joint mobilizations, teaching passive stretches and gradually strengthening around the joint as motion improves, and educating patients on healing timeline and ways to modify daily activities to improve use of the arm and reduce pain.

Rehab for frozen shoulder can sometimes take close to a year before a person feels “back to normal.” If caught early enough (i.e. during the “freezing phase” when motion loss begins to occur), a steroid injection can help to minimize the symptoms and restrictions. See your doctor right away if you notice a major loss in joint motion after breast cancer surgery.

Post-reconstruction capsulitis

Post-reconstruction capsulitis or capsular contracture can occur when fibrotic changes occur in the tissue capsule that forms around new breast impants. The breast around the new implant hardens, can become painful, and the breast shape can become distorted. To read a bit more about capsular contracture, click here.

Risk for developing capsular contracture is higher after radiation therapy or following infection, hematoma, or seroma that develops around a new implant. It is not clear whether smooth versus textured implants play a role in development of capsulitis.

Typically, if capsulitis occurs and is painful, distorts the breast shape or an underlying infection is present, revision surgery is needed. In Australia, approximately 39% of revision surgeries each year are due to capsular contracture.2 With early stage contracture, a physical therapist can use manual therapy to try to restore motion and prevent further fibrosis of the breast. A PT will also be sure to address shoulder, neck, and chest wall motion which could be compromised with post-implant capsulitis.

For both frozen shoulder and post-reconstruction capsulitis, getting into see a physical therapist early is important to prevent loss of motion and to reduce pain. Ideally, PT’s would love to see breast cancer patients within 4-6 weeks after breast surgery or reconstruction. Developing a relationship with a physical therapist during and after breast cancer can be a great asset to your health and wellness beyond cancer. Ask your surgeon for a referral or find a PT in your area here.

Aloha ❤

Lymphedema after Breast Cancer Surgery

Lymphedema after Breast Cancer Surgery

Lymphedema, a type of swelling in the arm, is an unfortunate complication after breast cancer surgery. I hope this blog will give you a better understanding of the lymphatic system and how to recognize early signs of lymphedema if you’ve recently had or are about to have breast cancer surgery.
*Technically, lymphedema can occur in any limb after lymph nodes are removed, but to keep it simple, I’ll focus on upper extremity lymphedema today.

Overview of Lymphatic System

The lymphatic system is a network of nodes, vessels and organs that function as the body’s immune system. Lymphatic fluid (or lymph) is a protein-rich fluid which contains white blood cells. Lymph carries bacteria and viruses to be filtered through the lymph nodes and helps to prevent infection in the body.

Unlike blood, which is circulated around the body, lymph only flows one way (toward the heart) and requires a pressure gradient and muscular contractions to flow efficiently.

Anatomy of the Lymphatic System
Photo borrowed from Merck Manual1

Lymphatic Disruption after Breast Surgery

From my last post, you know that surgery for breast cancer usually involves removal of the tumor itself as well as removal of lymph nodes in the axilla (underarm). Lymph node removal is done because cancer cells can break off and travel through the lymphatic system and those nodes in the axilla are usually the first place they go.

To be sure the correct nodes are examined, the surgeon uses a radioactive dye to determine which nodes drain directly from the tumor site. Procedures to remove lymph nodes can range from removal of only a few nodes in a sentinel lymph node biopsy to many nodes (up to 20 nodes) in an axillary dissection.

With any amount of nodes removed (but especially with >5 nodes removed), there can be disruption to lymphatic flow through the axilla. In some cases, the lymph is unable to drain from the arm, resulting in lymphedema.

Lymphedema presents as a “swollen” arm, but this is not your usual swelling for two reasons. One, because lymphatic flow is a one-way street, the extra fluid needs to be physically cleared in some way (more on this in a minute…) and, two, because lymph is full of protein and fats that won’t drain into the venous system the way typical swelling does. The limb can actually grow and harden if left untreated.

Stages of Lymphedema – Photo borrowed from Sigvaris2

Studies show that lymphedema occurs in 0-3% of people who choose lumpectomy and up to 65-70% of those who have a modified radical mastectomy.3 Radiation therapy also seems to increase the risk of lymphedema. While many people will develop symptoms in the first 3 years after surgery, lymphedema can take up to 5 years to develop after cancer treatments. Be sure to ask your doctor or physical therapist what your risk for developing lymphedema is and learn about risk reduction practices.

Signs & Symptoms of Lymphedema

  • Swelling in the arm (usually only on side of surgery)
  • Heaviness/tightness of the arm
  • Reduced range of motion of the joints in the affected arm
  • Thickening/hardening of the skin

Physical Therapy Treatment for Lymphedema

A trained lymphedema physical therapist can be an incredible asset to someone who develops lymphedema. Ideally, a physical therapist will be able to work with a patient pre- and post-operatively to monitor girth measurements of the limb and identify lymphedema early on. Stage I lymphedema is potentially reversible, and both stage II and III can demonstrate significant reduction, so seeing a PT sooner than later is key in managing this condition!

With development of lymphedema, a physical therapist can perform or recommend the following interventions:

  • Bandaging of the limb or prescription of compression garments
  • Manual Lymphatic Drainage (specialized lymphatic massage)
  • Exercise prescription (progressive muscle pump, aerobic activity)
  • Patient education on proper skin care and prevention of infection

It’s important to see your doctor or physical therapist as soon as possible if you notice signs/symptoms of lymphedema. Here is a great resource to find a lymphedema specialist in your area. As always, feel free to reach out to me with any questions!

Aloha ❤

Big thanks to Joanne Zazzera, PT, DPT, WCS, for sharing her knowledge and editing this blog!

Physical Therapy after Breast Cancer Surgery

Physical Therapy after Breast Cancer Surgery

Ever since Angelina Jolie publicly addressed her preventative bilateral mastectomy in 2013, many women have the idea that removing both breasts is typical care for breast cancer. While a bilateral mastectomy is still a popular option (both to prevent recurrence and to reduce anxiety about recurrence), there are actually many options for women with breast cancer to consider.

Breast Surgery Overview

The goals of surgery are to remove as much of the cancer as possible and also to examine the lymph nodes nearby to determine how much the cancer has spread locally. Thus, a breast cancer surgery often includes one incision on the chest where the cancer is removed and one in the underarm where the lymph nodes are removed for biopsy. There are also options for breast reconstruction (which is usually multiple surgeries), should someone desire it for cosmetic purposes.

  • Options for breast surgery include:
    • Breast-conserving surgery or BCS (lumpectomy, partial mastectomy, etc.) – removal of part of the breast which contains cancer and a margin of normal cells surrounding the tumor.
    • Mastectomy
      • Simple – removal of all breast tissue including nipple and areola (and usually some skin, but it is possible to have skin- and/or nipple-sparing procedures).
      • Modified radical – removal of all breast tissue along with all lymph nodes under the arm.
      • Radical – removal of all breast tissue and the chest wall muscle (this surgery is rarely done unless the cancer has spread into the chest wall).
  • Types of lymph node removal include:
    • Sentinel lymph nose biopsy (SLNB) – removal of the lymph node(s) to which the cancer would likely spread first
    • Axillary lymph node dissection (ALND) – removal of many (usually less than 20) lymph nodes from under the arm
  • Optional breast reconstruction can include:
    • Implants
    • Autografts – tissue from another part of the body is used to recreate the breast (Reconstruction options are a whole post in itself!)

Many breast surgeons now push for breast conserving surgery (BCS) because having a more aggressive surgery doesn’t always result in better quality of life or reduce cancer survival rates significantly. In fact, having BCS in combination with radiation therapy has been proven to be equally, if not more, effective at improving survival rates than a mastectomy alone.1, 2 This information is especially important for those with triple negative breast cancer who do no have the option of hormonal therapy.

Of course, cancer stage (how large the tumor is and whether the cancer has spread) and grade (how quickly the cancer is growing) both influence the type of surgery and treatment someone may need. Discuss with your oncologist and surgeon which option is the best for you in your recovery.

Physical Therapy

No matter the type of surgery a person chooses for breast cancer treatment, a physical therapist is an integral part of post-surgical recovery. PTs help to maximize the body’s natural healing process, restore range of motion to the shoulder, neck and chest wall after surgery, perform scar mobilization and soft tissue work to the affected muscles, and (most importantly) help people to return to their usual activities!

Some post-op considerations for physical therapy after breast cancer include care of post-surgical drains, observance of proper wound care at the incision site, monitoring for signs of infection, and protecting sensitive skin with post-operative radiation. While all PTs are able to treat a patient post-surgically, there are oncology physical therapists who have more training to look for other complications, especially early signs of lymphedema and cording (stay tuned for my next post).

If you or a loved one are interested in trying physical therapy after breast cancer, ask your doctor for a referral. Most oncologists and breast surgeons work closely with physical therapists and they can send you to a PT they trust in your area. If you want to do some research on physical therapists who are familiar with breast cancer rehabilitation in your area, you can use the APTA PT Locator or search through the APTA Academy of Pelvic Health.

Hope this information is helpful – go schedule with your PT today!

Aloha ❤

Cancer, Sex, & Intimacy

Cancer, Sex, & Intimacy

Cancer isn’t pretty. Besides generally feeling unwell, the hair loss, body composition changes, aches and pains, and hormonal fluctuations are not exactly sexy. Having cancer (or loving someone who does) can certainly challenge intimate relationships. It’s important for cancer warriors to know this isn’t unusual and there are plenty of ways to maintain healthy relationships with their partners ❤

Some cancer- or treatment-related challenges that may affect someone’s sexual function, sexuality, or intimacy with their partner can include:

  • Chemo side effects including fatigue, nausea/vomiting, weight loss/gain, or infertility concerns (etc, etc, etc….)
  • Post-surgical or post-radiation considerations like:
    • pain or restrictions from scar tissue or irradiated tissues (especially with cancer of the reproductive organs)
    • decreased sensation around the nipples after mastectomy
    • urinary incontinence or erectile dysfunction post-prostatectomy
  • New medications that reduce desire or arousal
  • Hormonal changes resulting in low libido, vaginal dryness, or painful sex
  • Body image concerns including attractiveness to self or partner
  • Depression, anxiety, or PTSD surrounding a cancer diagnosis and treatment

There are many ways that pelvic floor physical therapists (PFPTs) can help support both men and women during and after cancer in this realm. PFPTs can treat the physical changes that come with cancer including post-surgical rehab or prescribe general strength/aerobic training. We can treat incontinence after surgery or radiation. We can recommend sexual positions or devices to reduce or eliminate pain with sex. And sometimes, we help our patients find new ways to connect with their partners when they’re not ready to be sexually intimate yet.

Often, seeing a licensed counselor or psychologist for individual and/or couples therapy can be very helpful to maintain or restore intimacy. Remember, cancer is not pretty, and there is no shame in asking for help! If you’re having concerns or challenges in your relationship, please reach out to me to see if pelvic floor PT or a referral to a mental health professional might be right for you.

Aloha ❤

*This blog is part 3 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Cancer & Pelvic Pain Conditions

Cancer & Pelvic Pain Conditions

On today’s blog, I wanted to bring attention to female pelvic pain and dyspareunia (pain with intercourse) secondary to cancer treatments.

Often, when a woman has gone through adjuvant hormonal treatments, chemotherapy, abdominal/pelvic radiation, or fertility-saving drugs during active treatment, the body goes into a state of menopause or “chemopause” as it’s commonly referred to in the cancer world.

Low estrogen levels during chemopause can cause symptoms like:

  • Amenorrhea (loss of menstrual cycle)
  • Low libido
  • Vaginal dryness or atrophy
  • Hot flashes
  • Mood changes
  • Joint aches and pains

In particular, vaginal dryness or atrophy can have a huge impact on sexual health, emotional health, and relationships post-cancer. If the pelvic floor muscles are compromised by treatment, it can result in pelvic pain (like pain from overactive or tight pelvic floor muscles, pain in the tailbone, lower abdominal pain, or pain around post-surgical scars), bladder/bowel changes, or painful sex.

Thankfully, a pelvic floor physical therapist with specialized training in examination and treatment of the pelvic floor muscles can treat these conditions and are an amazing asset to oncology patients on their road to recovery. Some PT treatments for pelvic pain and dyspareunia may involve:

  • Pelvic floor muscle strengthening or relaxation exercises with or without biofeedback training (computer or ultrasound-based pelvic floor training technology)
  • Stretches for tight muscles around the abdomen, pelvis or hips
  • Manual therapy including general massage, pelvic floor muscle release techniques, or scar tissue mobilization
  • Education and lifestyle strategies surrounding posture, nutrition, bowel and bladder habits, and lubrication options during intercourse
  • Education in the use of vaginal dilators to reduce pain that occurs with tampon insertion, gynecological exams, or sex
  • Encouragement around body image and sexual health (this could include referral to a sex therapist or psychologist when appropriate)

If you’re reading this, and you feel like you could benefit from pelvic floor physical therapy during or after cancer treatment, you can find a qualified pelvic floor PT in your area here or here. Ask your doctor for a referral today!

And a quick reminder for all of us…
The path to recovery from cancer involves a whole host of treatments including chemo, hormonal treatments, surgery, and radiation just to name a few. Each of these treatments can come with significant side effects or long-lasting comorbidities. Just because someone is “cured” from cancer doesn’t always mean they are living without long-term effects from treatment. Keep this in mind, and be kind!

*This blog is part 2 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Chemo & Constipation

Chemo & Constipation

Chemo and constipation. Oh, poop! As a pelvic floor physical therapist and breast cancer thriver who is currently in the home stretch of chemotherapy, I can personally testify that constipation is no joke!

Having regular bowel movements during chemo is important to help detox the body of chemotherapy medications. In doing so, other side effects of chemo can be reduced. Backed-up bowels can contribute to or worsen nausea and vomiting. Unmanaged constipation during chemo can cause painful hemorrhoids or anal fissures that can put a patient at risk of infection while immunocompromised.

So how do we treat or avoid constipation during chemo? Well, let’s start with the basics and go from there…

What is constipation?

Typically, a person should expect to have a bowel movement anywhere from three times per day to three times per week. Stools should be soft and easy to pass (like #3 or 4 on the Bristol Stool Chart below). You may have constipation if your bowel movements are irregular (several days pass between BM’s) or your stool is very firm and is painful or requires straining to pass. Sometimes, it may feel that you’re not able to empty your bowels completely as well.

Borrowed from abc.net.au1

What causes constipation?

Generally, constipation is related to not getting enough water or fiber in your diet. It can also be from not getting enough exercise or from changing your routine when you travel. Unfortunately for some people going through cancer treatment, certain chemotherapy medications can cause gastroparesis (slow or paused digestion of food), which can lead to constipation.

How can you relieve constipation?

*Drink warm liquids (water, tea, coffee) first thing in the morning to kick start digestion and bowel movements, and be sure to drink plenty of water throughout the day (aim to drink half your body weight in ounces of water).

*Exercise! Take a short 10-15 minute walk or try these gentle stretches to stimulate the bowels.

*Eat plenty of fiber. Try to eat 25-30 grams of fiber daily with foods like broccoli, Brussels sprouts, beans, lentils, oatmeal or whole grains.

*Practice good toileting habits:

  • Use proper pooping posture – place your feet on a stool or rest your elbows on your knees to make it easier to empty the rectum.
  • Relax your pelvic floor muscles & breathe!
  • Don’t strain – come back later if you’ve got to push!
Borrowed from MacMillan Cancer Support3

*Try supplements and medications if the above fail. Ask your doctor about magnesium supplements, fiber/psyllium supplements (like Benefiber or Metamucil), stool softeners, or laxatives that might be helpful.

Remember: When it comes to constipation – consistency is key! Don’t scale back on your bowel routine because things begin to lighten up. During chemotherapy, you’ve got to stay on top of things to stay comfortable. If you need help getting a routine that works well for you, ask your doctor about a referral to a pelvic floor physical therapist in your area!

*This blog is part 1 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Round 12

Round 12

Well, another week or so has passed! I had my 12th (8th taxol) treatment last Thursday and that means I’m 3/4 of the way through chemo. I am getting ahead of myself a little bit with the countdown and keep finding myself saying things like “only 3 left after this week,” but who can blame me?

By the time I’m done with chemo at the end of October, I’ll have been in treatment for a full 5 months. Everything goes fast and slow at the same time. I’m going a little bit stir crazy working from home, working out at home, getting most of my social interaction from home (thanks, FaceTime & Zoom) as I know most of you are, too. I’m thankful we’re starting to re-open beaches, trails and business this week so I’ll have some more opportunity to get out of my dang apartment! Island fever is a real thing, and I’m really looking forward to travelling again when my health and the COVID situation is more stable.

For the past few weeks I’ve been having some rib pain on my left side. My physical therapist brain feels that it’s postural from sitting so much, but my cancer patient brain tells me to be more cautious as it could be one of several other things including bone pain from my zarxio injections, a rib fracture (although I didn’t specifically injure my ribs, all the weekly steroids and injections do put me at risk for lower bone density), or, in absolute worst case scenario, a metastasis to my ribs. My oncology APRN and I agreed to monitor it and if pain becomes worse we’ll do a new scan. It’s getting better with stretching and doing more standing or lying flat so I think all is going to be okay.

FYI – “cancer pain” (pain from a tumor or metastasis) typically follows a unique pattern. Often, pain is worst at night or will wake you up in the middle of the night (for some people, it wakes them at the same time every night). Cancer pain is not resolved with changing your position or stretching typically. Over time, cancer pain usually becomes consistent or unrelenting. Anyone with active cancer or a history of cancer should be aware of pain anywhere in their body and consult their doctor as soon as possible if the pain follows any of these patterns. You can see my other post here about cancer warning signs for other symptoms that might accompany pain.

Always something to be grateful for!

Also, in the past few weeks I’ve been diving a little deeper into the Native Hawaiian practice of Ho’oponopono which translates to “to make right twice (with self & others).” I stumbled upon this after doing a tapping meditation based on Louise Hay’s work. Louise believed that cancer can be related to a deep resentment held in the body and she suggests healing your relationships with others as part of a cancer journey.

Ho’oponopono is the ancient Hawaiian way of resolving conflict and issues within a family but also applies to government or individual relationships. It is the process of forgiveness and making right relationships that have gone wrong. The process of Ho’oponopono can be done with a mediator who is the go-between for the two individuals or parties, but it can also be done individually with mindfulness and meditation on the relationship.

As part of my tapping and meditation, I’ve been using the common Ho’oponopono meditation which is as follows:

I’m sorry.
Please forgive me.
Thank you.
I love you.

I envision the person with whom my relationship requires healing as I’m meditating. This process has been very freeing and beautiful to me. I urge you to try it and to read this article and this article to learn more if you’re interested. Having cancer has put me on a journey to learn more about myself and I think Ho’oponopono is one of the most healing practices I’ve learned so far.

On a fun note, my hair is slowly starting to grow back in, although it’s only baby hairs. At the same time, my eyebrows and lashes are pretty much gone now. I’m looking forward to all of that renewal post-chemo, too! Hope you all are having a great week! I’m looking forward to posting a lot more PT and breast cancer content in October as it’s both National Physical Therapy Month and Breast Cancer Awareness Month so STAY TUNED!!

Aloha ❤

Round 11

Round 11

Just wanted to leave a quick update today – I completed my 7th paclitaxel/carboplatin infusion yesterday which is my 11th cycle of chemo overall. I can now officially count down on 1 hand the number of infusions I have left. My white counts continue to be iffy and were a bit low this week so two more GCSF injections it is! Fortunately, with reduction of the paclitaxel dose and adding milk thistle supplements, my liver counts are improving so I’m thankful for that!

Otherwise, all is well. Trying to get enough sleep and exercise to keep my immune system as strong as possible. I probably should write a whole post on sleep at some point here…stay tuned! Also, our governor finally announced that he’ll be lifting the transpacific travel quarantine beginning October 15, so that means my family can finally come down to visit without the hassle of having to quarantine for 2 weeks! Looking forward to seeing my mama ❤

Justin and I watched The Social Dilemma on Netflix last week. I highly recommend it and would love to discuss it with anyone who has thoughts on the good and bad effects of social media on the people in our society. It’s an important ethical discussion and may make you realize why there is so much division in our nation right now. Let me know what you think!

For those of you still exercising at home, here’s a link to a beginner/intermediate Pilates class that I taught last week for my sister. Justin bought me the cute rainbow tapestry in the background so I was inspired to create a routine around rainbows! Enjoy!

Hope all is well and everyone is staying healthy! Please continue to wear a mask to protect your kupuna (elderly) and those with health conditions that put them at high risk. We’re not out of the woods with COVID-19 yet so please be considerate of those around you!

Aloha ❤