Tag: breast cancer awareness month

And Another One…

And Another One…

by bridewitt ♥ 2 Comments

I’m coming up on the 3rd anniversary of my breast cancer diagnosis this week. It was April 8, 2020, when I went in for the ultrasound that quickly led to my first mammogram and a same-day (pandemic-style) biopsy. I’ll never forget the ultrasound tech saying, “I hope it all goes well for you,” and that was probably the exact second I realized I was in for a wild ride.

Today, I went in for my annual mammogram and MRI. Actually, I’ve been putting off my MRI since 2021 when I had an MRI and another MRI biopsy back to back and my face broke out in horrible acne which I now know was related to my body having difficulty eliminating the gadolinium from the MRI contrast… So, it’s been 18 months since I had an MRI, and I still hesitate whenever my doctor recommends it. The benefits are that they are more sensitive than a mammogram (great option for additional screening for someone with dense breasts like me) and the downfalls are that they are more sensitive and often lead to more biopsies (hopefully of the benign sort)! The contrast is still a concern for me so I’m using a support protocol that my naturopath has recommended so I can avoid any weird side effects, especially the kind that come with heavy metals toxicity.

Anyway, while I wait for official results (I already got the preliminary “mammo looks good” from my radiologist), I’m manifesting 2.5 years officially cancer free! Even though I finished treatment, the work has still continued toward optimizing my health for prevention of recurrence. I continue to work with my naturopath, eat a well-balanced diet, exercise (aerobic and strength training), manage my stress levels, and do all my cancer screenings. We can’t ever know what the future holds because we’re not in control of a lot of things, but I stand by the saying that an ounce of prevention is worth a pound of cure!

Even though the cancer-y stuff is still prominent in my life, it’s no longer at the forefront and I’m thankful for that. Some days my diagnosis feels like it was yesterday and some days it’s like none of it ever happened. I know that someone out there needs to hear that life CAN go back to feeling normal again after cancer, if you make it so.

I get to go to work and treat my patients every day, I get to teach really awesome PT students, and I’ve been busy learning and teaching Pilates, too. I’m the strongest I’ve been since treatment, and I’m proud of the hard work I’ve put in. I’m working on saying yes to the things that light me up and NO to the things that I don’t feel 100% sure about. Justin and I have had fun becoming cat parents and we just got back from a 2-week trip to Europe! There are many adventures to be had after cancer and I say, “Keep ’em coming!”

Here’s hoping you’re all out there seeking the next adventure today. Wishing you all good health and happiness!

Aloha ❤

Been There. Doing That.

Been There. Doing That.

by bridewitt ♥ 1 Comment

This post is just proof I’m still kicking…actually, the past few months have been a total blur! Get busy livin’ or die trying (as they say)!

In July, Justin and I adopted our first fur-baby, Indy, and we’ve been having fun being cat parents and learning how to be responsible for another tiny life. He’s the sweetest and it’s ADORABLE to see my husband be a “cat dad.” We also got to see Jack Johnson’s Kokua Festival with our friends. There’s just something so nostalgic about Jack’s music that always brings me back to simpler times. All the feels!

I N D Y Y Y !
My sis & I at Manoa Falls hike!
Witnessing Justin’s business
partner’s marriage!

August started off with a visit from my whole, wonderful fam! It may have been slightly interrupted by a few of us catching COVID, but we did our best to have a great time all together. I love hanging with my nephews and nieces and seeing them grow into the coolest kiddos.

After two and a half years, I officially completed my mat Pilates certification. I hope to be teaching some group classes in the near, near future (stay tuned!). Being the crazy person that I am, I jumped right into the Pilates equipment training (unplanned), and eventually I’ll be able to teach on the reformer, Cadillac, chair, and all the other wild equipment invented by Joe Pilates 100-some years ago. I’m extremely grateful to Pilates O Ka La owner, Chelsea Peck, for her guidance and patience with me as I navigated training through my diagnosis and treatment in 2020. I don’t really believe in coincidences, and I know that having the mat routine to keep me active during treatment was more than just chance. If you’re ever on Oahu, go take a class at Chelsea’s gorgeous studio!

Then, just in case I didn’t have enough going on, I also started on adjunct faculty at Hawaii Pacific University’s new Doctor of Physical Therapy program. I assisted with cadaver lab (yes, I dissected human bodies). It is and always has been a very humbling experience to learn from these donors who so graciously give their earthly bodies to those of us learning. I learn so much more now that I’ve been practicing for several years, and I also realize how much I still don’t know! I’ll be helping with their labs in October as well, and I look forward to facilitating the next generation of PTs.

September has flown by, too, but Justin and I were able to sneak up to the north shore for our 4th anniversary. We spent the whole weekend camping by the beach and it was just magical. There’s so much to be said about spending time in nature with no agenda and NO cell service! Highly recommend. Cheers to our year 5 and all the new adventures that will bring! Hopefully a trip abroad…

At this point in the year, I’m always looking forward to the holiday season, but in the present moment, I’m grateful that my hair is now officially long enough to pull back into a bun, several of my friends are about to have sweet babies join their families, and my work has been consistently fulfilling.

In the cancer realm, it’s been one of those weeks. The kind where my recent scans were squeaky clean and we celebrate, but also the kind where you learn that you lost a friend to this awful disease. The kind where another friend’s miracle post-cancer baby passed away shortly after birth. The kind where a new friend got the same diagnosis as you had. So, I just pray because what else can you really do? Give it to God and put lots of love out there.

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

And so it does.

Current hair update – 23 months post-chemo (at my new home away from home!)

As Breast Cancer Awareness month rolls around in October, please consider donating to organizations that fund breast cancer research like the Triple Negative Breast Cancer Foundation, Metavivor, or the Breast Cancer Research Foundation. If you’d rather, you can donate money directly to someone going through treatment. Or take them a meal. Or pick up their kids from school. And if you have a survivor in your life, tell them you love them and you’re happy they’re here.

Wishing you all a great week ahead – will be in touch again soon…er or later?!

Aloha ❤

Aerobic Exercise during Cancer Treatments

Aerobic Exercise during Cancer Treatments

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

Resistance Training during Cancer Treatments

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

BCAM is BACK!

BCAM is BACK!

by bridewitt ♥ 1 Comment

I know I’ve been terrible at keeping y’all up to date on my life lately, but that’s because I’m just busy living right now. When I look back on my life one year ago, I still have a hard time believing any of this actually happened. Cancer treatments consume your life for nearly a year (or more for some), and then you’re just done? When chatting with other survivors, we all seem to comment on how none of it seems real. We were in survival mode for so long, and when the dust finally settled, we had to come to terms with the fact that, yes, indeed, we did have cancer. What a trip!

  • September 2020
  • September 2021

Every day gets easier, but some days all the feels creep up and you don’t know whether to be sad or angry or go hide in the corner until it passes. I try not to take anything for granted, but I’m just human, too, and I often get sucked back into the usual work, sleep, eat, repeat. With that said, I’ve been making a concerted effort to go for walks by the beach, do yoga, hit up weekly farmer’s markets, and get together with friends when I can. Those things help. A lot. Make time to do things that bring you joy.

On Monday, I had my annual MRI – just a follow up scan to keep a close eye on things. Thankfully, all looks clear. There is a small area of enhancement in the same area where I mentioned I needed a biopsy back in July which already came back benign so here’s hoping I don’t need another biopsy! In my professional opinion, I’m right in the middle of tissue healing from radiation therapy, and there’s a lot of scar tissue forming right now. With that comes a lot of tightness and discomfort in my left chest wall, and I think that friction is creating a small cyst in that region.

Again, the survivorship game is not all sunshine and rainbows. While everything is technically “all good” now, sometimes it isn’t. There are a lot of things that I still need to work through, but I just choose to take it one day at a time.

October is Breast Cancer Awareness Month

This brings me to the main point of this post which is that Breast Cancer Awareness Month is back! I personally choose to refer to BCAM as “Breast Cancer ACTION Month” as I think it’s a great time to donate to breast cancer research, reach out to family/friends you know going through cancer and offer your support, and speak up to lawmakers and organizations with power to make change in medical care for cancer patients.

October is a time of pink ribbons and shameless promotion of products that support breast cancer. Breast cancer thrivers have coined this “pinkwashing” and want to remind you to be mindful of any products you purchase this year. Any major company that claims to put proceeds to support breast cancer better be donating at least 20% of their profits to organizations that fund breast cancer research. And, if you choose to make a donation to breast cancer organizations, choose one or two that fund research primarily or that you know directly supports thrivers with care packages, financial support, or practical support (like providing free wigs, offering transportation or house cleaning, or fertility preservation assistance).

Here are a few of my favorite breast cancer organizations to support:

My BCAM Action Plan

This October, I’ll be focusing on holding the American Cancer Society accountable for their recent change in recommendations to delay annual mammogram screening for those age 45 and older. This is a recent change in recommendations and adds insult to injury to prior recs that both breast self-exams (BSE’s) and clinical breast examinations are not indicated for early detection of breast cancer. These recommendations are based off a study out of Shanghai in 2018 that indicated that more benign lesions were found on BSE’s than malignant ones, and therefore led to unnecessary procedures like imaging and biopsies. In case you can’t guess who benefits from these recommendations, let me spell it out for you…INSURANCE COMPANIES.

For adolescent and young adult (AYA) cancer thrivers (ages 15-39) who are ineligible for annual mammograms, the only way for us to detect cancer early is through BSE’s. The more frequently we do these screenings, the earlier we can seek care for any abnormal findings, and the better our prognosis if we should be very unlucky to find a malignancy. I found my lump on a BSE and it saved my life. I will advocate for BSE’s until my lungs give out. Should you feel so inclined to support this cause with me, please reach out to the American Cancer Society via phone/chat or social media to let them know how you feel about this!

I’ll also be sharing a bit on social media about how PT can be helpful before, during, and after cancer treatment because October is also National Physical Therapy Month. Follow me on Instagram for more – @bri.d.pt!

Beyond that, October is my favorite month, so I’m going to get some Halloween decorations out and get ready for Spooky Season! Maybe I’ll pull out the old purple wig for Halloween this year, too! Stay well, friends!

Aloha ❤

Hopeful Updates and a Quick PSA!

Hopeful Updates and a Quick PSA!

by bridewitt ♥ 0 Leave a Comment

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

by bridewitt ♥ 0 Leave a Comment

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

by bridewitt ♥ 4 Comments

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 ❤

The Final Round

The Final Round

by bridewitt ♥ 7 Comments

Celebrating with tears of joy today after finishing my last chemo yesterday. 16 rounds over 20 weeks. Conquering the Red Devil and getting through taxol without neuropathy are major victories, and I’m feeling so relieved to be DONE! I could not have done it without all of your support.

There’s still more treatment ahead, but I’m feeling I can manage anything now that chemo is behind me. I am so grateful to God and for all of the love of my family and friends and this great little breast cancer community I’ve found on Instagram that have gotten me through the past 5 months.

Last infusion day!

I will still receive two GCSF injections to boost my white blood cells this week as my oncologist doesn’t want me too immunocompromised in this COVID life we’re all living in. Then, I’ll re-test my labs in two weeks including a thyroid panel and vitamin D screen that I asked for. My oncologist has been really great about letting me lead my care to some extent and not just telling me what we’re going to do each week. Honestly, I wish every doctor were like that. I am so grateful for her and my whole team of docs who’ve listened to my concerns and took action immediately throughout this whole process.

Next week, I am scheduled to repeat my breast ultrasound, mammogram, and MRI to see where I’m at post-chemo. I am still unable to feel the tumor, but that doesn’t mean I don’t still have a bit of “scanxiety” about the slight possibility that there’s still something there or that the tumor will grow again being off chemo for several weeks before surgery. Please send prayers for good results!

No more ice booties & mittens! Bye taxol. Not gonna miss you.

I’ll meet with my surgeon on November 9, and will hopefully be able to get in for surgery before Thanksgiving. I’m still leaning toward breast-conserving surgery (a lumpectomy) which means I’ll do radiation for several weeks after recovering from surgery. I’ve done a lot of research on different types of surgeries and, besides my intuition telling me not to go for the more aggressive approaches, the research actually backs me up on that decision. For women with similar early-stage cancer to mine, the 5-year survival rate is 94.3% for breast-conserving surgery, 93.3% for mastectomy alone, and 83.7% for mastectomy with radiation.1

I am also biased in that I know that recovery from a mastectomy is really challenging and the complications can be much greater. To have further breast reconstruction on top of that would take multiple surgeries, and honestly, I’m just ready to move on from cancer in so many ways. I know it will always be a part of me, but treatment can end sooner than later if I go this route!

Celebrating with a little lemon crunch cake from Diamond Head Market – heaven! Cute hair, huh?

For now, I’m going to rest and celebrate being done with the hardest part of this little bump in the road. My mom will finally be down to visit in a few weeks and I’m looking forward to that! I wrote down a few things I want to remember from this experience so far and I’ll share a few of them with you here:

  • Faith in God is all you need to conquer anything.
  • The people you love are the most important thing in your life – tell them you love them often and mean it.
  • Find the immense joy in your daily life – there’s no need to search far and wide for it.
  • Spend time in nature – in quiet, being active, barefoot if you can.
  • Know and trust your body. Know that it’s strong and demands to be respected and understood.

Learning you have breast cancer at age 30 isn’t in anyone’s plans for life, and being diagnosed with one of the most aggressive forms of breast cancer doesn’t make it any easier. I want to remind you all that if you think something is off with your body, get it checked out. Don’t take no for an answer from your doctor. You’re not “too young.” You’re not overreacting. YOU are the only one that knows your body well enough to decide if something is off.

I love you all. Thank you for being with me on this ride.

Aloha ❤

Lymphedema after Breast Cancer Surgery

Lymphedema after Breast Cancer Surgery

by bridewitt ♥ 1 Comment

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!