How life goes on…

How life goes on…

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

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

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

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

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

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

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

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

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

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

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

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

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

Aloha ❤

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 ❤

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!


Move Your Body

Move Your Body

Happy Aloha Sunday, friends!

I’ve been feeling much better the last few days and was able to work a little bit over the weekend. I’ve been lucky to keep working my “COVID” job (giving good news to patients who’ve tested negative), and I can’t say enough how grateful I am to work with such a supportive rehab team, COVID team, and organization!

Yesterday, I went for a walk around the neighborhood by myself. It feels so good to get outside and have some time to process everything. I’ve been using the Calm App recently, and I used their mindful walking exercise yesterday which was soothing. It helped me stay more conscious in the moment, rather than letting my overactive brain run wild.

I also used one of my favorite apps called Charity Miles. This app tracks your distance using GPS, and their sponsors donate so many cents per mile walked/ran/biked to a charity of your choice. It may be a small way to give back, but I am grateful I can have even a little bit of impact just by taking my daily walks. I hope you’ll try it, too!

Workout with a view!

As a physical therapist, I have seen how significant the impact of regular exercise can be for anyone, let alone someone going through cancer treatments. There are some general guidelines that are good for everyone, but for those with cancer, the exercise type and intensity may need to be monitored more closely.

For example, for people undergoing chemotherapy, it’s important not to overexert themselves during exerce in order to protect the heart! It is equally important not to be a couch potato in order to keep the heart strong. During chemo, the American College of Sports Medicine (ACSM) recommends 150 minutes per week of moderate intensity aerobic exercise like walking, biking, or swimming. That’s about 30-60 minutes, 3-5 days per week – not so bad, huh?

Interestingly enough, these are the exact same guidelines they recommend for a “regular” person too! Aerobic exercise is a great way to improve cardiovascular health, aid sleep, and boost the immune system along with many, many other things!

Personally, I am trying to stay at about 30-40% of my maximum heart rate to avoid too much strain on my heart (normally I would walk at about 40-60% of my max heart rate), which is why I’ll likely stick with walking and light hiking for aerobic exercise over the next few months. I’ll miss you spin class (*sobs*)!

I also had my husband help me perform a baseline treadmill test so I could know where I started from, and I plan to repeat this test mid-chemo as well as after treatments, so I can be sure to catch any significant deconditioning as early as possible.

Strength, or resistance, training is also part of my routine, but usually only 2-3 times per week. I prefer Pilates, yoga, or bodyweight training. Resistance training improves mood, helps build lean muscle and reduces body fat, but it also becomes extremely important for helping to balance blood glucose & insulin levels (here I go again, I know…). Also, doesn’t it just feel gooddd when you can lift heavy things?!

Exercise (especially during cancer treatment or for an injury) should always be tailored to a person’s individual preferences and goals. Working with a physical therapist can be extremely helpful to prevent cancer-related fatigue, muscle atrophy, and functional decline, and if you need help finding a provider in your area, reach out to me or check out this handy tool through the American Physical Therapy Association!

*I would highly recommend any patient undergoing active care for cancer to have a physical therapist or exercise physiologist follow them throughout treatment to keep you as safe, strong and active as possible.
ALWAYS check with you doctor before beginning a new exercise program.*

Remember, * Exercise * IS * Medicine *


Food for Thought

Food for Thought

This blog post is going to open up a whole can of worms for me. I feel so passionately about nutrition and I have soooo much to say so I’ve delayed writing this post because I wanted to do more research before I put just any old information out there.

Before I dive in, I want to give you a little history about my diet and health pre-cancer. I’ve been vegetarian (…well, “flexitarian”) since 2010. I chose this out of personal preference but also because there’s some decent history of heart disease in my family and I (always) like to be proactive.

“An ounce of prevention is worth a pound of cure.”

Benjamin Franklin

Last February, I also went off my birth control pill which I had been on for 12 years (OMG, I know!). I have always suspected that I had polycystic ovarian syndrome, or PCOS (symptoms can include irregular menstrual cycles, infertility, acne, excessive hair growth on the face/chest/back, and weight gain), since high school and the pill helped me to manage most of those symptoms for a long time. PCOS also goes hand in hand with insulin resistance as it is primarily a condition of hormonal imbalance.

This is where it gets juicy, guys. Insulin is a hormone that lowers our blood sugar and helps us to use those delicious carbs that we eat as fuel.
If a person has insulin resistance, their body has difficulty using blood glucose for energy/metabolism and blood glucose levels stay elevated or we begin to store it as fat. When blood sugar keeps increasing, the body produces more insulin, and on and on we go….

It sort of works like this:
If I eat a donut, or a bowl of pasta, my blood sugar increases. Then, my insulin levels go up to try to reduce my blood glucose. If my body has a limited number of insulin receptors in certain cells, the blood insulin level stays high and, in the long term, can increase my risk for developing diabetes (if I don’t already have it) or obesity.

Borrowed from:

There have been many studies about the link between insulin resistance, especially in people with diabetes or metabolic syndrome (yes, we’re talking about the same insulin), and cancer. As it turns out, those with high blood insulin levels are at an increased risk for tumor development and for more rapid tumor growth.

Here’s the funny thing, though – this doesn’t only happen when we eat carbohydrates (FYI all “sugars” are carbohydrates). It can also occur when we eat animal products like meat, dairy, or eggs because those foods have something called insulin-like growth factors which are similar to insulin in that they have some ability to lower blood glucose, but they primarily promote cell growth.

Now, for someone with cancer, their tumor/s, just like every other normal cell in their body, also have insulin receptors (IR) and insulin-like growth factor receptors (IGFR). It seems that for those with insulin resistance, the IR and IGFR are more sensitive, and the tumor can grow more quickly dependent on what we eat!

If I haven’t bored you to death already, then you may be starting to understand why Justin and I have chosen to be very strict about diet during my cancer treatments. We are eating primarily vegan (no dairy, no eggs, no meat, no poultry), limiting the “bad fats,” and eliminating alcohol and processed sugars. We are far from perfect at this, and I do occasionally sneak a dark chocolate peanut butter cup from Trader Joe’s, but if I am going to kick cancer’s butt, then I need to make my body the most inhospitable place for it to live!

I’ve also been doing intermittent fasting (I fast for 16 hours, then eat all my usual daily calories in the remaining 8 hours) to help regulate my blood sugar and metabolism. I’ll save you and write about the benefits of intermittent fasting in another post!

We’ve been working with a local MD who specializes in nutrition and has recently moved his practice toward working mostly with patients with cancer.
Check him (& his delicious cookbooks) out here:

I’ll let you digest this totally fascinating information, but before I do, I just want to mention one more time how important it is to know your own body! Be curious, ask your doctors questions, and if something doesn’t seem right check with your doctor – your life could depend on it!

Thanks for coming to my TED talk!