One of the nurses who is currently finishing her treatment for breast cancer came back to work last week. We chatted about her peach fuzz, how she was feeling, compared radiation tattoos and then started chatting about nutrition. We discussed the lack of research on GMOs, avoiding soy protein isolate and she mentioned that she was on an aromatase inhibitor and not tamoxifen and that her doctor told her she couldn't eat flaxseed. I told her that I had heard nothing of it and that I would fact check it. Rundown:
Like all nutrition studies it is hard to tease out if the one thing that people are eating, in this case flaxseed, is truly what is effecting outcomes.
In short term studies 1 to 4 tbsp altered estrogen metabolism that may protect against breast cancer, and these effects are heightened in overweight and obese individuals and post menopausal woman
Could flaxseed interfere with tamoxifen? There are no human studies currently reporting. But, in mice studies where the mice were injected with ER+ breast cancer flaxseed meal maintained the effectiveness of tamoxifen.
Aromatase inhibitors have not been studied
Flaxseed may slow or decrease absorption of medications
Bottom line:
Flaxseed may be beneficial. I'll continue to add it to my granola and banana bread. And I'll tell the nurse that the studies are still out for her and flaxseed.
Source:
Collins, K. Flaxseed and Breast Cancer. American Institute for Cancer Research. March 2010.
I think that there are very distinct stages in survivorship. The first year is spent with the fear that the scans will not come back clean. This leads to crazy amounts of research and sometimes willing to believe a friend's facebook post about aluminum from deodorant being found in breast cancer tumors. This might then make you bananas about having to wear the natural deodorant that doesn't work so great when your a super sweaty girl. This means you are willing to take plausible interweb stories over actual science. Even if you are well trained in epidemiology and one of your favorite past times is dismantling studies to see if they really are worth the peer reviewed journal they are in. The first year out is spent searching for causes that might not every be found.
Funny thing happens when you switch over from counting survivorship in months and switch to years. Funny thing happens when you don't remember every 27th of a month that it officially puts you another month into survivorship. You start to move back over to the side of science. You start to analyze the source of information and you may need to start fact checking yourself. Luckily, there are also people who devote their full time work to this.
Thanks to this blog post from Dana Farber I switched back to an non natural antiperspirant/deodorant. One cannot have a wacky internal thermostat and not need some help from a little bit of aluminum. This post helps me feel better about using it. (They also have a great post about the 5 myths of Breast Cancer, further evidence against Soy Protein Isolate).
Because I switched back to mainstream deodorant does not mean I don't think something in my environment contributed to my developing breast cancer. I will absolutely continue to filter my water with a carbon filter, eat organic for the dirty dozen, and try to avoid flame retardant materials. A great fact sheet from a study done at the Silent Springs Institute for the Exposure Biomarkers for Suspected Breast Carcinogens confirms this (well the water and the flame retardant topic). But for now, I am going to enjoy that my brain has switched over from months and is now thinking in years. A fellow survivor did tell me that at some point you wouldn't think about having had cancer multiple times in a day and that gradually their will be days you don't even think about it. I'm not there, nor do I think I'll every have those days, but for now I am enjoying the fact that my thoughts about having cancer are much, much less frequent.
Generally, people don't like to ask for help. Many of the women I talk too, we discuss how that after being raised to be strong, independent women allowing others to assist you seems like a failure. I find this as a reoccurring theme when I talk to people who are just starting their cancer journey, many of my friends who are new moms, and really, any woman, has felt that way at some time in their life.
However, one of the greatest lessons that cancer taught me was that it is not failure to allow others to help. It is not a reflection upon my independence and doesn't make me any less of strong. Allowing others to help you, even with the smallest of items, is a mutual beneficial experience. And I have Tina Fey to thank for this. Yes, Tina Fey.
I read Tina Fey's BossyPants three times while going through treatment. I have read it multiple times since. My favorite chapter is "The Windy City Full of Meat", and this is because Tina outlines the rules of improv. And oddly enough incorporating these rules into my everyday life allowed me to let others assist me when I need and also step outside my comfort zone.
According to Tina Fey "The rules of Improvisation that Will Change Your Life and Reduce Belly Fat". I can only vouch for the "change your life part".
Rule #1. Always Agree and Say Yes. This doesn't mean that I have to agree with everyone else's opinions or choices, but it means that I start in an open minded place. It also means that you step out of your comfort zone. It means when someone offers to something nice for you, you say yes. It also means that if your invited to a friend from grad schools wedding and you only know her out of the 180 people invited, you go. It can also lead to your month of June being amazing; trips to visit college friends and their families, the ultimate 80's weekend, Journey and Billy Joel concerts and multiple trips to Fenway park. My saying yes needs to work on my scheduling abilities.
Rule #2. Say Yes, AND. This is my favorite rule.
"To me Yes, AND means don't be afraid to contribute. It's your responsibility to contribute. Always make sure you're adding something to the discussion"
It means you need to really hear what people are saying to actively participate in conversations and relationships. It means that you put down the gawd damn cell phone and actually talk to people. It means that you can't shut everyone out. I found that this meant that I really gave people an answer to "How are you doing?" when they would ask when I was going through treatment. I think it might also be why I awkwardly overshare my experiences too. It's also the reason I continue to blog.
I still violate this rule often, but I am better at catching myself doing it. Last week my roommate was trying to talk to me about something and in the middle of the conversation I got distracted by Jack Bauer throwing people out the window. I realized it, a couple of moments after she did, and apologized and walked away from the tv to finish the discussion.
Rule #3. Make Statements.
"In other words: Whatever the problem, be part of the solution......[This] also applies to us women: Speak in statements instead of apologetic questions"
Don't just point out what is wrong, try to fix it. I use this one at work all the time and work on not saying sorry before I do things. I do things with purpose I should also speak with purpose. Pantene (yes, the shampoo people) made a great ad to this point.
Rule #4. There are no mistakes, only opportunities. Enough said.
So, just do a little improv when someone asks you if they can do something for you. Say Yes, And.. .
Citation:
Fey, T. (2011). Bossypants. New York, NY: Reagan Arthur Books/Little, Brown and Company.
I love when food manufacturer's listen to consumer feedback. Post Grape Nuts eliminated soy protein isolate from their cereal. As I am living in a cereal world and I am just a cereal girl, I am happy to have this back in the weekend cereal rotation.
I was browsing the cereal isle (which I might spend more time in than any other isle) when they Soy Free sticker jumped out at me. Yay! I know that this isn't a big thing, but it made me happy.
I ate them hot with organic milk and fresh organic strawberries this morning. : )
Last week at work Dr. Henry Lim, Dermatologist, of the Henry Ford Medical Center came and presented on vitamin D. And his findings were super interesting to this nutrition nerd.
Did you know that UVB rays are what your skin uses to make vitamin D? I didn't know either. This is another reason why tanning beds are terrible. Tanning bed only emit UVA rays. So all you are doing is damaging your DNA in a tanning bed. Your not even getting vitamin D. Also, Dr. Lim did a study to see if the UVB rays damaged your DNA (and can eventually lead your cells down the pathway to cancer) and his findings were, YES! This means that sunlight is not a good way to get your vitamin D needs. That photoprotection: sunscreen, hats, long sleeves, is more important than getting your vitamin D from the sun.
Dr. Lim fact checked many studies and mentioned at this time that there was not enough evidence to relate vitamin D intake to all cancers or even specific cancers. Here is where I find a large dichotomy between my professional self and my personal self. My professional self practices only evidence based recommendations to my patients. My personal self is willing to use correlations and single studies as recommendations for some of my actions (see organic milk, glass containers, etc). My professional self lives by the moto "a single study does not a recommendation make". My professional self is very Yoda like.
The end product of all of Dr. Lim's research is this: use sunscreen and take a vitamin D supplement with food to average 600 IUs of Vitamin D3 everyday. I have since changed my everyday moisturizer to one that has SPF 15 in it and then have SPF 70 that I can put on for stronger sun days. I take 1000 IUs Monday through Friday. I average 700 IUs a day. That will work for me. And maybe, sometime there will be enough scientific evidence so that professional me will tell patients that vitamin D will help keep cancer away. Until the next study comes along...
Today was the Lahey Health 5K Cancer Walk and Run. It was a great day full of sunshine, sweat, smiles and fundraising! Above are the Team NED runners. Left to Right in the photo: One of my fellow dietitians who is working her way back into running with a 6 month old. She raced last year pregnant. My current roommate and high school and currant track teammate. She is working her way back from an injury, but has still made it out the last two years. Two track club teammates decided to come on out and smoke the course. They ran really strong races. And both made sure they had pink tops to wear! #14 bib is me. Then my good friend from the 3rd grade and her sister. Both whom I've known for most of my life and have been amazingly supportive through everything. Very happy they were both there.
My parents, my aunt and my cousin's daughter all walked. My legs were a little to achy to walk after the run, but I was very grateful for their attendance.
Our team raised $2,392! Pretty great. Almost half the money came from our killer bake sale at the hospital for which I learned how to make baked donuts. My colleagues are amazing bakers and homemade granola, congo bars, gluten free cookies, rice krispie treats, cake pops, you name it, they made it and we sold it. The other half came from generous donations from family, friends, friends of friends and even a donation from our department.
At the walk they do an opening ceremonies after the run and before the walk. During it the Lahey Chief Medical Officer and Head of the Oncology department speak and talk about all the exciting things going on at Lahey Cancer Centers. They discussed the new lung cancer screening where they do low dose radiation CT scans for smokers and other high risk patients. They have caught 30 lung cancers at an early stage since starting it in 2012. That is pretty darn awesome. One of the lung cancer survivors, whose cancer was identified this way, spoke about his experience and how grateful he was to be cancer free. The second survivor that spoke was a 29 year old man who had stage IIIb colon cancer, but was back to run the race for his second consecutive year after running last year during treatment. His team name is team ; (semi colon). His team has raised $24,000 in the past two years. Yes, that comma is in the right place. Pretty great.
After running I put my survivor shirt on and as I was hunting for snacks and freebies I ran into the Chief Medical Officer's sister in law whom he had mentioned was being treated for breast cancer. I spoke with her to let her know that I was a survivor and that I was rooting for her. We spoke about being burned from radiation and how much we love Aquaphor. I told her that her hair looked amazing (she had full scalp coverage of silver peach fuzz). She told me she was so excited to not have to wear the wig anymore. We chatted about chemo and related about how much breast cancer survivorship really is a sisterhood. She said this is her second bought of breast cancer and they were 24 years apart. I wished her luck and told her not to put that wig back on, to own her peach fuzz.
I am pleased with my overall 5K today. I ran 20:54. Ten seconds slower than last year, but way faster than I thought I would be able to. I also didn't vomit. Another win. My legs started to tighten and ache 5 minutes in and when I got to half way I knew I had gone out way to hard. But, coming around the corner and heading for home with my oncology NP, parents, and fellow dietitians standing at the finish line and cheering their heads off made it hard not to smile when being done. That and I got to put on my purple survivor t-shirt.And maybe a little laughing at myself because when they announced my name they mentioned I was the 2012 winner and I started "pageant" waving to the crowd. I'm such a nerd, but I'm a happy nerd.
The GoGo's were right. Vacation, all I ever wanted. Vacation, had to get away. Vacation, where I talk about Tamoxifen side effects in laundry list form and am not even aware of it. Wait a minute....
Around Tuesday, while hiking Camelback Mountain, when I was "boot scootin'" {sliding down rocks on my bum on the decent} I was explaining to my brother that I preferred to go down in more of a crab walk version than facing the rocks because my feet cramp so often now I wanted a heal strike instead of pushing off on my toes. I explained that one of the side effects of tamoxifen . We had already started our ascent early in the morning because as well documented my internal thermastat is way broken. And when the week's weather was this:
And at 7 am it was already high 80's. And I was already purple and slathered in sunscreen. My brother looked at me because I had already explained my muscle tightness and joint soreness that has seriously hamstringed my outdoor track season and that made our climb not very pretty on account of the tamoxifen. My ridiculous internal temperature and inability to cool off he already knew was attributed to tamoxifen. And despite the fact that I exercise I still feel out of shape and run out of steam about 20 minutes into anything and have to take more breaks than I like. I attribute this to tamoxifen. We turned these breaks into photo ops on the mountain. The decent I was able to do in one solid piece.
The last comment about my foot cramps, led my brother to ask me "How many side effects are there"
"Not many. I know it seems like I am blaming everything on tamoxifen. But, it's fine" Then I looked down out my fingernails, which I am now painting because the black spots have returned to my nails from the tamoxifen. Hmm...perhaps I am having a few more side effects than I usually own up to and perhaps I really do blame everything on tamoxifen.
I am happy to be home and back in 57 F, my system seems to enjoy that a little bit better. I am still thoroughly heat rashed. However, because my father also came down with a severe case of heat rash I am NOT going to blame that on tamoxifen. For now...
