Oh, hey!

Oh, hey!

It’s officially been a minute (or a few months, but who’s counting?)! I had every intention of continuing to write, but in all honesty, I just needed a break from the cancer updates and info sharing.

Recently, Justin and I have been super busy! We were finally able move into our new home a few weeks ago (thanks, mom & Malia!), and then we immediately left on vacation to Montana and Washington, leaving our cute new place a mess with unpacked boxes and mismatched furniture. We are so grateful to have a new space where we can start fresh after navigating so much uncharted territory in 2020. I’m looking forward to lots of memories made here ❤

While traveling, we were able to visit with all of my family, celebrate the 4th of July in Butte, America (there’s no better place to be on the 4th – don’t knock it til you’ve tried it!), catch a few fish on the Big Hole, reconnect with our best buds from PT school, and even witness one of them get married (Congrats, Riki & Anthony!). I was so elated to be able to hug everyone and see all my favorite kiddos. Hawaii is great y’all, but it’s times like this when you realize living on an isolated island in the Pacific isn’t always all it’s cracked up to be! I cried so hard before we came back home because I know I truly have such special relationships with all of you.

Besides our recent adventures, all is well down here. I’ve been working heavy part-time and I’ve realized that I’m now able to help my oncology patients on a much deeper level. I’ve always tried to empathize as much as I could, but the reality is that, unless you’ve gone through cancer yourself, you probably can’t relate. This isn’t to discourage anyone from working with oncology patients, but rather a reminder that what they’re going through is far more than just physical discomfort.

As far as my health goes, I had an ultrasound on my left breast a few weeks ago due to a suspicious spot I found while doing one of my way-too-frequent self-checks. It turned out to be just scar tissue (as expected), but they also found a small cyst-like area above it, and I’ll go for aspiration next week just to be safe “because of my history.” I wonder if it will ever get easier hearing that, but likely not…

I’ve continued to work with my naturopathic doctor to get to the root cause of my autoimmune thyroid dysfunction. I completed a urine test to determine heavy metals toxicity and the results indicated high levels of mercury and platinum and moderately-high levels of lead. Mercury is linked to many environmental sources, but is primarily associated with high levels of dietary fish. The platinum levels are residual from the platinum-based chemotherapy (Carboplatin) that I received over 12 weeks last year, and lead is also find in many environmental sources including water, pipes and paint. So I will treat it with a chelating agent which will strip the metals from their sneaky hiding places in my body….after I eat one last giant poke bowl!

I also completed a food sensitivity test and will get those results back in a few weeks. Again, I am a huge believer in holistic care. If there are things I can do to optimize my health going forward, then it’s worth a shot to me. I still go to acupuncture about once a month and have continued seeing a mental health professional. It truly takes a village to make it through a cancer diagnosis, and you are all part of that team for me!

I’ll try to be more consistent at posting updates and sharing helpful information, but for now, I’m just going to keep focusing on LIVING and finding joy in each day. Sending you all my love!

Aloha ❤

Radiation Fibrosis

Radiation Fibrosis

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

What is Radiation Fibrosis?

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

Who is at Risk for Radiation Fibrosis?

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

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

How does Radiation Fibrosis Present?

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

Some of the symptoms include:

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

What Treatments are Available for Radiation Fibrosis?

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

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

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

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

Aloha ❤

References:

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

Saving your Fertility during Cancer Treatment

Saving your Fertility during Cancer Treatment

When the last thing you expect is to be diagnosed with breast cancer at age 30 (or under 40, honestly), your desire to have (or not have) future children becomes very clear suddenly. I may have been the person who was in no rush to have kiddos, but I took it pretty hard knowing I was about to start chemotherapy that would significantly affect my ability to reproduce, possibly even making it impossible to conceive naturally.

In all the rush of my initial diagnosis, I wasn’t able to write about options to preserve fertility during chemotherapy. Honestly, it was some of the most emotional decision-making I had to do at the time, so maybe I put it off because it was all very overwhelming! Ultimately, I made two important decisions in order to help save my fertility, which I’ll share below with a few other important concepts regarding fertility preservation.

Chemotherapy & Its Effect on the Ovaries

First, you may wonder how exactly chemotherapy affects your ovaries. Chemo medications are designed to target and kill rapidly dividing cancer cells. Unfortunately, those meds can’t differentiate between rapidly dividing cancer cells and rapidly dividing normal cells in the skin, digestive tract, and reproductive organs. Just as you’d expect to see some side effects like skin/nail changes or mouth sores, we expect to see some attack on the ovaries as they also have a known cycle of cell turnover (a.k.a. ovulation). Thus, if you’ve never had children, and your cancer is stable enough to delay treatment for a few weeks to a month, your doctor should recommend all of the fertility-preservation options they have available. If they don’t offer, you better ask!

Egg Preservation Prior to Active Treatment

I was referred to a fertility specialist/reproductive endocrinologist who was excellent. I had the option to extract eggs (unfertilized) or embryos (fertilized) which would be frozen by a process called vitrification until I need them at a later date. I chose to freeze eggs as research now shows no major difference in later IVF success rates whether an egg or embryo is used, per my physician.

The whole process is timed with the menstrual cycle, so specific hormones are injected during the follicular phase (when the ovarian follicles that store the eggs begin to grow and mature) beginning on day 2 or 3 of menstruation. The fertility specialists monitor follicle growth and count every few days with a pelvic ultrasound and bloodwork. As the follicles mature, indicating ovulation to be close, a different medication is given to delay ovulation until the mature eggs can be retrieved.

The retrieval process is done under light anesthesia in the fertility office. A needle is directed into each ovary through the back of the vaginal vault. Suction is used to retrieve the mature follicles, and after inspection of all eggs to determine which are viable, the eggs can be fast frozen (“vitrified”) and stored in an egg bank until needed. Voila! Now, I have a back-up option post-cancer if I’m unable to conceive naturally! Thank goodness for modern medicine.

Throughout all of that, the worst side effects I had were some moderate bloating and cramping after the egg retrieval. I was also given a separate hormone during the follicle-stimulating phase that helped to avoid an estrogen spike so my mood remained stable throughout (I’m sure my husband appreciated that I wasn’t a hormonal monster through it all). Despite having to delay chemo about 4 weeks to complete this process (remember, they like to time it with your natural cycle), I have no regrets on completing this first for peace of mind alone.

The Cost of Fertility Preservation

Whoever my future kids are, I hope they know I reallllllyyyy want them, because fertility options are not cheap! Most insurances do not cover egg/embryo preservation if you do not have a diagnosis of “infertility” even if you get cancer that you never wanted which might render you infertile… (I’ll refrain from saying any more). The egg retrieval process alone usually costs somewhere around $10k which doesn’t include the annual storage fee for the eggs (mine is about $700 per year).

Fortunately, there is a great option for cancer thrivers through the Livestrong Foundation. My fertility specialist had me begin paperwork to apply for their grant which covers about 1/3 of the total cost if you qualify (most cancer patients do unless your insurance covers). Ask your fertility doc if this is an option for you!

Only a Pelvic PT would have their very own pelvis model at home! #SaveTheOvaries

Options to Preserve Ovarian Function during Chemo

Besides the pre-treatment egg retrieval, my medical oncologist also recommended that I go on a gonadotropin-releasing hormone (GnRH) agonist called Zoladex during chemo. This is a monthly injection that essentially halts ovarian function by blocking GnRH (a hormone released from the hypothalamus in the brain that triggers the release of follicle-stimulating and leutinizing hormones which act directly on the ovaries). The cancer community “lovingly” refers to this state of no periods as “chemopause” because it is essentially a medically-induced menopause complete with joint aches and hot flashes. I have been lucky that my side effects have been mild, and I’m very thankful to give my reproductive system this brief pause while I kick cancer’s ass.

After treatment, once I get the ok from docs, I’ll still be able to try to conceive naturally. The chances of conceiving naturally are lower for those of us who’ve gone through chemo or radiation, but it’s definitely possible! If I need a little help, then I’ve got a few tiny frozen eggs lined up for further fertility treatments down the line.

It’s Okay to Be Concerned about Your Fertility

I’m thankful that my OB/GYN and oncology team were very supportive about fertility preservation prior to starting active treatment. For many women, hearing your plans for a family will likely have to change after cancer is devastating. I didn’t expect to be so emotional about this whole process, to be honest. I’ve always wanted kids some day, but I wasn’t a person who constantly planned my life around it. Even still, early into my diagnosis, I found myself mourning the loss of my potential fertility more than the fact that I could die from cancer. I don’t believe it does anyone any good to stop planning for the future and let cancer have all the control, so be sure to tell your doctors how important saving your reproductive health is to you!

My heart goes out to anyone reading this and going through the same decision-making process. My heart goes out to those of you reading this who are struggling to conceive even without a cancer diagnosis. I’m so thankful to have so many options to consider and know that, in the right time, children will be a part of my journey, too. For those of you just starting out on your cancer and fertility journey, be sure to ask your doctors what the best options are for you!

Aloha ❤

Intermittent Fasting for Health

Intermittent Fasting for Health

Hello! I hope everyone had an excellent Labor Day weekend!

I wanted to make good on my promise to write about intermittent fasting as I hope it’s something that will benefit at least a few of you out there! For the past 5-6 years, I’ve included some type of intermittent fasting (IF) in my routine. I can honestly say that I notice a huge difference in my energy levels and metabolism compared to periods when I don’t intentionally include IF in my regimen.

In the past few years, fasting has become rather trendy. However, IF has quite a bit of research behind it, which pulls it out of that “fad diet” category (not to mention many religious groups have practiced fasting over long periods for centuries and it’s working for them). IF changes the body’s metabolic processes on a cellular level and therefore has important effects for both the body and brain – cool!

Here’s how IF works:

Normally, when the body needs energy, it uses glucose first as a rapid energy source. Once the available glucose has been used up, the body begins to break down fat to fuel our metabolism. Protein is the last to be broken down and is usually not utilized unless the body is under extreme conditions (i.e. starvation).

During a period of fasting/caloric restriction, the body is able to use up it’s glucose stores and begins to break down fat for energy. We can use fat from any part of the body that has excess fat stores like subcutaneous fat (a.k.a. “that stubborn belly fat”), visceral fat (fat that builds up around your abdominal organs), and intramuscular fat.

By significantly reducing calorie intake during IF, our body is able to use the spare energy to boost its processes of detoxification in the liver and kidneys. Waste removal from our cells also increases, and our body as a whole is able to operate more efficiently.

Some of the many benefits of IF include1:

  • Optimized cell functioning and cellular repair (this is called “autophagy” which literally means “self-eating” – eating the bad stuff, anyway)
  • Decreased insulin resistance = lower risk of type 2 diabetes mellitus
  • Reduced oxidative stress and inflammation in the body
  • Increased fat loss while maintaining lean body mass
  • Improved brain function and neuroprotective effects

Types of intermittent fasting include:

  • Weekly fasting (5:2)
    • Limit calorie intake to 500-600 calories for 2 days out of the week.
  • Daily fasting (16:8)
    • Eat all of your normal daily calories within an 8-10 hour window and fast (0 calories) for the other 14-16 hours. 16:8 is the most common, but for females and those with difficulty regulating blood sugar, a 14-hour fast can be more ideal.
  • 24-hour fast
    • Only 0-calorie liquids allowed for a 24-hour period. Can be done several days per week, but best to alternate fasting days with healthy eating days.

With all of that being said, IF is appropriate for most people. Be sure to consult your doctor, registered dietitian, or physical therapist before trying intermittent fasting. It is important to eat an adequate amount of calories in a balanced diet for all of your meals. It’s also extremely important to maintain proper hydration (water & electrolytes), especially with longer fasts.

I have continued to do 14:10 fasting during my chemotherapy, most days of the week. There is some research that IF can reduce chemo side effects2 and I continue to feel very strongly about making sure my insulin/blood sugar regulation is under control to prevent this tumor from taking advantage of any opportunity to grow! I am very aware of my overall calorie intake as my body needs plenty of nutrients to stay strong during treatment. This is NOT a time for me (or any cancer thriver) to be in a calorie deficit!

Please feel free to leave questions about IF in the comments section below! Stay tuned for more updates on my personal journey later this week as I complete taxol/carbo #6!

Aloha!

Warning Signs of Cancer

Warning Signs of Cancer

It’s September 1, everyone! Time to do your preventative screening!
I encourage you all to perform your breast self-exam or schedule your annual mammogram, pap smear, skin check, colonoscopy, PSA test, or whatever it is you’ve been meaning to do!

Early in my cancer diagnosis, I would often be asked “How did you know to go to the doctor?” or “Did you have any other symptoms besides finding a lump?” Because early detection is of utmost importance with a cancer diagnosis, I wanted to point out a few of the warning signs I recognized as well as a few others that might warrant getting things checked out by your physician.

In December 2019, I had my annual OB/GYN appointment with a new doctor. She did a thorough breast exam as part of the usual routine and all of my test results came back normal otherwise. At that time, there was no palpable lump in my left breast.

In early February, I took a quick weekend trip to Seattle to see my bestie. I had worn a mask on the plane because the first whisperings of COVID were happening, but on my first night there I still had some mild flu-like symptoms. I took my temperature and had a low-grade fever. The fever broke by the next morning, but the rest of the day I had an annoying nausea – enough that it convinced me to buy a pregnancy test! Turns out, I wasn’t pregnant, thankfully!

Over the next several weeks, I would leave work and continue to have these feverish symptoms, but they would come and go. At one point, there had been a small rash over the area of my unknown tumor but that disappeared, too. It wasn’t until mid March that I felt the lump. To be honest, I was not a regimented self-checker, but I couldn’t miss it, and I didn’t wait long before making an appointment with my OB/GYN to get it checked out.

I want to emphasize here that when I got into my OB/GYN (who squeezed me in her usually packed schedule), she sent me for imaging and biopsy immediately. Not every woman under 40 with breast cancer has been this lucky, and many are told “you’re too young to have cancer” or “let’s just watch it.” I can’t stress enough that if you feel like something’s not right, you must be your own advocate. YOU have to be responsible for your own health. Get 10 other opinions if you have to, but find a provider who listens to you!

So, yes, looking back there were other signs that should have alerted me even sooner, but it was actually the cumulative symptoms (& my own intuition) that made me seek an appointment so quickly.

Here are a few cancer red flags you should be aware of:

Systemic Changes:

  • Unexplained weight loss (>10 pounds in a short period of time)
  • Extreme fatigue that doesn’t improve with rest
  • Fever (especially if worsens at night) or night sweats with no other sign of infection
  • Pain that does not resolve with repositioning or medications, ALSO pain that wakes you up at night

Localized changes:

  • Skin changes (check out the ABCDE method to monitor your skin)
  • Lumps, bumps, or thickening of the skin
  • Unusual bleeding or slow-healing wounds
  • Changes in bowel or bladder habits (slowed urine flow, blood in urine/stool, etc.)
  • Difficulty swallowing or persistent indigestion
  • Persistent cough or hoarseness

I’m not posting these warning signs to create panic, but to bring awareness. Many of the signs and symptoms listed above relate to other, more benign conditions too, so don’t freak out! I truly believe that the more we know our bodies, the sooner we’ll be able to recognize when something’s off.

Hope you’re all having a great week & taking care of yourselves!

Aloha,
B

Round 8

Round 8

Today is an exciting day! I have officially completed HALF of my chemo, and I’m celebrating every little victory as you know! Eight more treatments to go sounds a bit daunting, but I think I’m figuring out the taxol and have most of my side effects well-managed so hopefully I can breeze through it.

While I sat in my infusion today (a little loopy from my benadryl drip), I couldn’t help remembering my friend Dana crossing the finish line at her first 100-MILE ULTRA MARATHON in January. Really? What a badass! She told us that at her half way point they started singing “Living on a Prayer” which is appropriate for today too, but now that song is stuck in my head…

A true 80’s masterpiece….

The human body is capable of truly amazing things, and so I look to Dana for inspiration that my body can heal itself just as she pushed hers to those extreme limits.

In more good news, my oncologist is recommending only one Zarxio injection to boost my white blood cells this week since my counts have been a bit more stable. Wish me luck that it stays that way!

Hawaii just began another 2-week shelter-in-place order so… if you need me, I’ll be at home! Truthfully, this is a bad sign because it means our hospitals are full and will not be able to care for all of our state’s critical patients if the trend in COVID cases continues. Please say some extra prayers that quarantine brings our numbers down significantly and that our frontline healthcare providers (including my wonderful coworkers) stay safe & healthy!

I have a few educational posts lined up for the future, but I wanted to know what you all would like to learn about most this week:

Sending you all love this weekend! Stay healthy and practice gratitude ❤

Aloha,
B