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Surgery is a Standard Component of Treatment for Most Breast Cancer Patients Surgery is often used in combination with other forms of treatment, which may include chemotherapy , immunotherapy, endocrine therapy, and radiation therapy . Sometimes surgery is recommended before other therapies. In other circumstances, chemotherapy will be recommended before surgery. This decision depends on the specific subtype of breast cancer as well as the breast cancer stage among other factors. Surgery involves removing the breast cancer with an operation and oftentimes involves surgical evaluation of the lymph nodes under the arm. In most scenarios, there are two options for surgery: breast conserving surgery or mastectomy.   Different Surgical Options: Breast Conserving Surgery, Mastectomy, and Axillary Lymph Node Surgery Breast conserving surgery Breast conserving surgery (BCS), also known as lumpectomy or partial mastectomy, is surgery to remove breast cancer and a small amount of normal, healthy breast tissue that surrounds the cancer. The goal of BCS is to remove all the breast cancer and preserve the remaining health breast tissue. BCS is an option for most early-stage breast cancers. Studies indicate that BCS followed by radiation therapy results in equivalent survival and is as effective in preventing a recurrence of breast cancer as removal of the entire breast (mastectomy) for early-stage breast cancer. It is important to understand that not every breast cancer patient is a candidate for BCS. Specifically, patients with large cancers, multiple cancers, prior breast or chest radiation, specific genetic mutations, or history of a chronic inflammatory conditions such as systemic lupus erythematous or scleroderma may not be good candidates for radiation. In BCS, patients retain most of their breast tissue including the nipple in most scenarios as well as sensation to the skin of the breast.   Mastectomy Mastectomy is a surgery to remove the vast majority of tissue from a breast, including the cancer site. Classically, a mastectomy includes removing the breast tissue as well as breast skin and the nipple. In these settings, closure is generally performed by the breast cancer surgeon in a flat fashion. More recently, newer surgical techniques allowed for preservation of the breast skin and nipple. In these settings, surgery is most commonly performed in conjunction with a reconstructive plastic surgeon. It is important to know that the reconstruction may involve more than one surgery. Patients may elect to have removal of just the breast with cancer in it, which is called a unilateral mastectomy, or they may elect to have both breasts removed, which is called a bilateral mastectomy. In many cases, patients that undergo mastectomy for the breast cancer may not require radiation. Scenarios where radiation may still be recommended are if there is cancer in the lymph nodes, the tumor is very large, or if there is cancer at a margin on the mastectomy specimen. It is important to understand that a mastectomy, even with reconstruction, is different from a breast augmentation. Sensation to the breast skin and nipple will be permanently altered. In most scenarios, a drain will be placed as well to prevent fluid accumulation. The drain tubes are sewn into place, and the ends are attached to a small drainage bag or bulb. These stay in place about 7-14 days on average and help speed the healing process.   Axillary lymph node surgery The first place that a breast cancer spreads in most cases is the lymph nodes that live beneath the arm in a space call the axilla. Surgical evaluation of lymph nodes is a common secondary component to breast cancer surgery. For many breast cancers, the surgical team may recommend a “sentinel lymph node biopsy.” In this procedure, the surgeon will remove between 1-4 lymph nodes. These nodes will then be sent to the pathologist (another physician) who will assess the lymph nodes under the microscope to make sure that the cancer has not spread. If a patient elects to proceed with BCS, a separate small incision is usually required to access the lymph nodes. If a patient is undergoing a mastectomy, usually no additional incision is required. Sometimes, if the cancer has spread to the lymph nodes, a “complete axillary dissection” may be recommended. This involved removal of more lymph nodes from the same area.   How to Prepare for Breast Cancer Surgery Before surgery, patients meet a breast cancer surgeon. The surgeon explains treatment options and what to expect from surgery. Patients can prepare for this meeting by creating a list of questions to ask. Below are some examples: What are options for breast cancer surgery? How much breast needs to be removed? What are the options for reconstruction? Can the reconstruction be started at the same time as the cancer surgery? How will the breast look after surgery? Will the breasts look the same? How much time will be spent in the hospital? How much time is needed for recovery? What are the activity restrictions after surgery? When is it safe to return to work? Additionally, optimizing sleep , nutrition , and emotional well-being before surgery can benefit the recovery process.   What to Expect with Breast Cancer Surgery For BCS, patients generally spend about a half day at the hospital before going home (“outpatient surgery”). Patients meet with the nursing staff, the anesthesia team, and the surgeon prior to going back to the operating room. In many cases, patients also will need to meet the radiology team to have the cancer “localized” prior to surgery. Localization means that the radiologist will place a wire or device into the cancer location so that the surgeon can find it easily in the operating room. The surgery itself lasts between 1-2 hours and then patients will recover in the post-operative recovery area prior to being dismissed to go home. For mastectomy, patients will either be able to go home the same day or may stay in the hospital overnight, depending on your surgeon and hospital’s policies. Like with BCS, mastectomy patients will meet with the nursing staff, the anesthesia team, and the surgeon prior to going back to the operating room. The mastectomy itself is variable in terms of time and depends on if the case unilateral or bilateral, if it is skin-sparing or nipple-sparing, and if there is a reconstruction portion with the plastic surgery team. For either surgical approach, patients will need to stop eating prior to the surgical date. In most cases, a patient will be asked to not eat after midnight before surgery. It is also very important to inform the healthcare team about any medicines, vitamins, or supplements being taken as these can sometimes interfere with the surgery. In many scenarios, patients will be asked to stop their blood-thinning medications to decrease the risk of bleeding. It is also very important to arrange a transportation plan for after surgery, as patients who have undergone surgery are generally recommended against driving for a period of time. After surgery, the surgical team will call once the final pathology results are available. This takes about 1-2 weeks.              Risks of Breast Cancer Surgery While breast surgery is overall lower risk than many other surgeries, there are still some risks of which to be aware: Bleeding. For BCS or mastectomy, this presents usually within 24 hours after surgery. Large swelling, increased pain, and bruising are signs and symptoms to watch for. Rarely, the surgical team has to take a patient back to the OR to stop the bleeding. Collection of fluid at the operative site, called a seroma. Infection. Pain. Scar. Anytime an incision is made in the skin, a scar will be present afterwards. Problems with wound healing. Risks related to anesthesia include confusion, nausea and vomiting. For lymph node surgery, patients may notice a change or loss of sensation on their inner arm and potentially arm swelling (called “lymphedema”) Positive margins. It is possible that the surgeon may recommend returning to the OR to remove more tissue if cancer is close or involving one of the margins after surgery. About Dr. Robert Pride Dr. Robert Pride is a breast surgical oncologist specializing in breast cancer, high-risk breast lesions, and benign breast disease. He was a Division I athlete at Dartmouth College before attending the University of Central Florida College of Medicine for medical school . He completed his general surgery residency at the prestigious Mayo Clinic in Rochester, MN. He then completed fellowship training in breast surgical oncology at the Harvard Medical School hospitals in Boston, MA which included Massachusetts General Hospital , Brigham and Women's Hospital , and the Dana Farber Cancer Institute . He has published numerous articles and book chapters about breast disease and has presented at several major national breast conferences. He was born and raised in Colorado and joined Western Surgical Care in 2023. He practices at Sky Ridge Medical Center in Lone Tree.

Discovering my family's BRCA 2 mutation In April 2023, I clutched my father’s hand in a sterile surgical waiting room, as a doctor informed us that they found a tumor in my mother’s fallopian tube. It had tested positive for ovarian cancer. During her diagnostic process, we discovered that my mother carries the BRCA 2 mutation and, thus, it was recommended that all blood relatives undergo testing as well. Six weeks later, on my 39th birthday (and two days before my mom was scheduled to begin chemo), my results arrived. I, too, carried the same mutation. At the time, I was nine months postpartum with my son and my two daughters were 7 and 5. I worked full time, my family was spread out all over the country, and my world was crumbling around me. Life as I knew it, would never be the same And it wasn’t.  Given my age and that I had no plans to have additional children, every doctor I met with recommended a prophylactic double mastectomy and a hysterectomy/bilateral salpingo-oophorectomy (BSO). The reality that the same reproductive organs that had nurtured and brought my perfect baby boy into the world could now pose a potentially life threatening  risk was difficult to comprehend. The removal of my ovaries also meant facing certain and immediate menopause ; a phase of life I had yet to even consider. After a few agonizing weeks of feeling afraid and sorry for myself, I decided to turn the negative energy into something productive.  I started by gathering information. I met with every doctor possible: gynecologists, primary care physicians, breast oncologists, gynecologic oncologists, general oncologists, and all kinds of surgeons. I did every exam recommended: mammograms, MRIs, bone density scans, skin checks, vision checks, blood work after blood work after blood work. I connected with genetic specialists in North Carolina, hormone experts in Israel, menopause care providers in New York, and fem health leaders in Amsterdam. I admit that this sounds overboard but I took comfort in my proactiveness. I needed to feel armed with information before making any decisions about my body.  Talking with others In time, I told my inner circle what I was up against and started accepting offers to chat with other women who had been in my position. I found that the women, often complete strangers, speaking from their own experience was more impactful than meeting with the doctors. They were able to acknowledge the pain that comes with the uncertainty of this diagnosis and laid out how they were able to make their own decisions with regard to surgery selection, timeline, and recovery management. They shared examples of how their bodies reacted to the surgeries, how they got through the emotional rollercoaster, and what their life was like now having been through it.  Nothing Pink Somewhere along the way, I discovered NothingPink . This local organization offers support to people at high risk of hereditary breast and ovarian cancers. Among their many programs, NothingPink hosted monthly zoom support groups where we could come together to share experience and advice with women at various stages of their preventative journeys. There were many sessions where I cried the whole time or had to log out early because it all felt so overwhelming.   Eventually, the anxiety of it all was too much to bear. Every pain, bubble, or tinge that was somewhat near my abdomen had me convinced that the “silent killer” was coming for me next, so I accelerated my timeline. Six months after my mother’s diagnosis and the week of her last chemo treatment, I had my hysterectomy/BSO. Three months later, in January 2024, I had my double mastectomy, an unplanned procedure from a minor complication in February 2024, and my final exchange surgery in April 2024. Throughout each surgery, the NothingPink army was along for the ride. They provided detailed advice on what to expect before, during, and after surgery while serving as a constant reminder that I had a team of women cheering me on.  Taking control of your health I was able to get through the surgeries knowing that I had a privilege that many others did not. I was able to choose. I could take control of my health and mitigate risks on my terms. While I knew the surgeries would be hard on me and my family, I saw firsthand how much harder it is to recover from surgery  and  undergo cancer treatment. I knew I had so much to live for and, when I needed a reminder, I would hug my kids, snuggle my dogs, and admire my doting husband. They needed me and they needed me healthy. Equally important, I saw it as a profound opportunity to model courage and strength for my children who might one day have to face a version of this journey as well. I wanted them to see their mommy as a fighter.  And they did.  Going back to "normal" Today, I’m back to my “new” old self, but with a sharper focus on what truly matters and the people who are most important. I’m exercising daily, traveling the world, lifting my children high in the air, and paying it forward whenever the opportunity arises.  When I stumbled upon posts like this one - often in the middle of the night, wide awake with worry and fear - I craved advice, hope, and a dose of positivity. With that in mind, here are a few things that worked for me:  I allowed myself to be vulnerable and connect with anyone willing to share their experience and advice. I spoke with friends of friends of friends, neighbors, coworkers, grandmothers — literally ANYONE. If they were willing to make the time for me, I made the time to listen to and learn from them. I took something away from every single conversation. I researched, studied, examined, and ADVOCATED . I realized that the surgeons do this day in and day out but the area specialists have unique insight and detail - be it genetics, hormones, menopause care, or risk management. I figured out what the important questions were for me to ask and made sure I always had clear answers. When they weren’t clear, I sought out other ways to get the information I needed.  Community.  The NothingPink organization and the FORCE message board offered firsthand experience and support in a way that only women who have been through it can. They were open, honest, and offered unique insight into this all-consuming shared experience. Empowered women empower women.  Asked for help.  When I was ready, I allowed myself to accept outside support. People from all walks of my life showed up in ways I never could have imagined. My neighbors organized a meal train, my friends took my kids on playdate adventures, our children’s school delivered groceries to our front porch - I was in awe. Our extended family took turns rearranging their lives to be there for us in our darkest hours, sometimes with 24 hours notice. The pain and loneliness slipped away with each and every act of kindness. Gratitude.  Despite everything, I had so much for which to be grateful. Unlike my mother, I was in the driver’s seat. I was so afraid that my kids would be scarred for life seeing their mommy down and out but they adapted (almost too) easily. They played barbies in my bed or read books snuggled next to me. Oddly, my six year old loved helping me clear out my mastectomy drains. My husband was the ultimate teammate on this journey, the best friend I could ever ask for, and the rock of our family. I loved him more and more every single day of this experience and still can’t believe the lengths he went to to show the depth of his love for me.  I took things one day at a time.  You can only do what’s right in front of you. Some days I researched until my eyes watered from staring at my computer screen and my throat hurt from talking so much about my situation. Other days, I lost myself in work or playing with my children. I took each surgery as it came, prepped as best as I could, recovered as patiently as possible, regained my strength wherever possible, and proved to myself that if I can do this, I can do anything.  And I can.  About Marissa Bailey Marissa lives in Charlotte, North Carolina with her three children (Olivia, Emma, and Cameron) and her two doodles (Mila and Kaia). After years of working in media and entertainment, she is taking a professional break to focus on the next phase of her recovery: prioritizing her physical, emotional, psychological, and spiritual growth. As she starts thinking about her next chapter, however, she is confident it will involve supporting and empowering women.

Inevitable physiological changes As women, when we enter our 40s we start to mentally prepare for the inevitable physiological changes that await us in the upcoming years. We’ve known since we started getting our periods as teenagers that someday down the line, we’d eventually stop getting them. Those with particularly uncomfortable periods may have even looked forward to this day, not realizing that the transitional time of perimenopause can bring on even worse symptoms. Perimenopause Perimenopause literally means “around menopause,” referring to the time when our bodies prepare to enter menopause, the official end of a woman’s reproductive years. During perimenopause, our periods may become irregular, but it’s not until a woman has stopped getting her period for 12 consecutive months that she is considered to have reached menopause. Drop in progesterone Though perimenopause typically begins in our 40’s, for some women it can start earlier. During this time, estrogen (the predominant “female” hormone) can fluctuate, as can ovulation, and we may experience menopausal symptoms such as insomnia and hot flashes . But the first sign of perimenopause is usually marked by a drop in progesterone. Estrogen Dominance This drop in progesterone during perimenopause can lead to estrogen dominance (this does not mean estrogen is abnormally high, but rather, high in relation to progesterone levels). Estrogen dominance can cause irregular periods, not only in terms of frequency, but also in length and heaviness. Estrogen dominance can cause a host of other unpleasant symptoms and more serious conditions, including cyclical headaches, weight gain, mood swings, brain fog, insomnia, fibrocystic breast tissue, uterine polyps or fibroids, and even an increased risk for breast cancer. [Source: Biomedicine & Pharmacotherapy 102 (2018) 403-411] It’s no wonder that, for as much as we “can’t wait” to stop menstruating, we quickly begin to dread perimenopause, and for good reason – heavy periods, irritability, and insomnia ?! It’s not much fun, and to make matters worse, it can last up to 10 years! The symptoms of perimenopause are well documented, but the remedies are not. I want you to take comfort in knowing that this transitional time is not something to dread - it can be managed, especially if we care for ourselves and get on top of perimenopausal symptoms. 3 Key Strategies for Perimenopause Since many of the unpleasant symptoms of perimenopause can be traced back to low progesterone, the key to braving perimenopause is to create a healthy diet and lifestyle that naturally boosts progesterone and helps balance estrogen. To do this, there are three lifestyle factors that are essential to address. 1. Get serious about managing stress Perimenopause often hits at a time when we are already overwhelmed with our career and caring for children or aging parents (or both). At this stage we are prime for irritability, and the last thing we need is to add more irritability, sleep disturbances, and heavy periods into the mix. Perimenopause can do just that, and stress makes symptoms worse. Progesterone is produced in both the ovaries and the adrenal glands. Cortisol (our stress response hormone) is also produced in the adrenals, however, cortisol takes priority in the hormonal hierarchy. When we are under stress, the adrenal glands will prioritize the production of cortisol at the expense of progesterone. During perimenopause, when progesterone is already low, stress can cause progesterone to fall even lower. Taking steps to reduce your stressors, prioritizing self-care , and really looking at your reaction to stress and how you can improve it will make a huge difference here. Working with a trusted Coach can help you identify your stressors, set boundaries, and reframe how you view and handle stress, in turn, helping to reduce stress’ impact on your body. 2. Detox estrogen When your digestive system is functioning properly and you have a healthy gut microbiome, excess estrogens are metabolized by the liver and excreted from the body. There are many factors that can inhibit this process, however, and cause estrogens to be reabsorbed. This can further disrupt the balance of estrogen and progesterone and lead to more symptoms of estrogen dominance. Establishing a healthy gut and a diverse microbiome is key to moving estrogens out of the body and keeping them from being reabsorbed. When most people think about a healthy microbiome, they think about taking probiotics. Probiotics can certainly help, but there is often more that we need to do to heal the intestinal lining and create a healthy diet that feeds our beneficial bacteria. Working with a healthcare practitioner or Coach who understands both gut health and hormonal balance can really help here. It’s also important to reduce your exposure to xenoestrogens - chemicals that mimic estrogen in the body and bind to estrogen receptors. Some xenoestrogens include BPAs, found in plastics, and phthalates and parabens, which are found in personal care products like shampoo, deodorant, lotions, etc. Exercise can also help remove excess estrogen, while at the same time, produce more beneficial estrogen metabolites that can help prevent breast cancer. Exercise helps toxins move out of the body. 3. Prioritize sleep Quality sleep is essential for hormone balance. We naturally produce the most melatonin between 11pm and 2am while we’re sleeping, so getting to bed early has great health benefits. Melatonin lowers estradiol levels and helps with the overall balance of estrogen and progesterone. However, getting more sleep can be a challenge when we’re trying to juggle career, family, and staying on top of our health. There just never seems to be enough time in the day! As a result, many of us may even engage in a form of self-sabotage referred to as Revenge Bedtime Procrastination , forgoing sleep in order to have free, quiet, or alone time. That blissful time after the kids are asleep and all the chores are done may feel like the only time we have to unwind, but when we sacrifice our sleep, for any reason, we wind up doing ourselves a great injustice. One of the best things you can do for yourself is prioritize sleep. Establishing a sleep routine may be necessary at first, until it becomes a regular habit. Just as children have a “winding down” routine (snack, bath, story book) before it’s time for bed, adults are no different. Your routine may include turning off all electronics an hour before bed, taking a bath, drinking herbal tea, and/or reading a chapter from your favorite book. Start to train your body that it’s time for bed, and pretty soon you’ll reap the benefits of more restful sleep. What I want you to take away from this is that, while perimenopause is inevitable, the discomfort associated with it is not . Often when we feel there is nothing to be done, we resign to the symptoms and become complacent. However, complacency is an enemy to health. We don’t have to live with all of these symptoms. By proactively making the time and effort to attend to our diet, lifestyle, and supplementation, we are able to navigate and manage perimenopause naturally and smoothly. About Merritt Tracy Merritt Tracy  is a National Board Certified Health and Wellness Coach. Her mission is to empower women to live a healthy and happy life, naturally balance their hormones, and prevent cancer or a recurrence of cancer.

For as long as I can remember, cancer has impacted my life. When I was a kid, my grandmother was fighting breast cancer. I remember playing dress-up in her room – she had a closet full of clothes, shoes, jewelry and purses. My cousins and I always loved playing there. One day my mom came in as one of my cousins was prancing around the room sporting fake boobs and high heels. We were having a blast, but my mom was horrified and angry. The fake boobs were my grandmother’s prosthetic breasts that she needed because of the double mastectomy. My mother’s reaction to our innocent playtime was a projection of her own fear and she instilled that fear in me early on. Those fears weren’t unfounded. When I was in high school, I lost my grandmother to metastatic breast cancer and my great grandmother to ovarian cancer. When I was in college, my aunt was diagnosed with both ovarian and uterine cancer. When I was in my thirties, my mom was diagnosed with breast cancer and just a few years ago when I was 50, she was diagnosed with breast cancer for the second time. From worry to wellness I spent a good bit of my life worrying about my risk of cancer. I could see the train barreling down the tracks and it seemed to have me in its sights. Then one day I heard someone say, “Worry is a waste of energy. If you are consumed by worry, there are two things you can do to overcome it. You can let it go or you can do something about it.” I realized then that I needed to do both of those things. I needed to let go of the fear, and I needed to take action. Shifting my mindset to focus on the things I could control to reduce my risk was a pivotal moment for me. I was able to let go of my feelings of helplessness and instead embrace a sense of empowerment . I started eating healthier and I found that I truly enjoyed eating cleaner, fresher foods. I made a conscious effort to slow down and reduce my stress . I learned about endocrine disrupters and reduced my exposure to environmental toxins . I became fascinated with hormone health and gut health. I did a lot of soul-searching and self-discovery. With every step I took, I felt better physically, emotionally, and even spiritually. Sharing it with others I enjoyed the wellness journey so much that I started exploring ways I could share what I had learned with others. I completed my training at the Institute for Integrative Nutrition to be a Health Coach and went on from there to become a National Board Certified Health and Wellness Coach . For nearly twelve years, I have been seeing clients who want to find balance in their lives and hormones and prevent and recover from cancer by lowering their stress and improving their diet and lifestyle. I am happy to be in a place where I can help others strengthen their bodies and minds so they too can let go of worry and take action. About Merritt Tracy Merritt Tracy  is a National Board Certified Health and Wellness Coach. Her mission is to empower women to live a healthy and happy life, naturally balance their hormones, and prevent cancer or a recurrence of cancer.

Lean, Clean, and Green: Increase green foods for cancer prevention and improved health It can feel overwhelming to think about changing your diet and lifestyle! We all get accustomed to our regular routine, so cutting out foods or considering drastic shifts in our diets, can make anyone resistant to change. Why not start with a smaller step that feels more realistic, like incorporating powerhouse “green foods” with anti-cancer properties that you may already enjoy? Specifically, I’m talking about dark leafy greens, cruciferous greens, and green tea . Let’s explore the benefits of these lean, clean, and green foods and why you should consider boosting them in your everyday meals.  Studies show that people who regularly consume dark, leafy green, and cruciferous vegetables have a lower risk of cancer , but most Americans are deficient in both . Increasing these green vegetables in your diet is a great place to start making a shift. Green tea joins the ranks of these cancer-fighting greens with its rich antioxidants and polyphenols. These three types of green foods are not only important for cancer prevention, but they also have benefits in weight loss, hormone health, and reducing inflammation. Pretty cool, right?! Let’s take a closer look. Dark, Leafy Greens Loaded with vitamins and minerals, yet low in calories, leafy greens are the epitome of nutrient-dense foods. Dark, leafy greens contain fiber, folate, iron, magnesium, calcium, vitamin C, vitamin A, and plenty of other phytonutrients. Carotenoids, which give these greens their deep, dark color, are powerful antioxidants that have been shown in research to boost immunity and help protect DNA from free radicals that can cause cancer. Try a variety of dark, leafy greens such as: Spinach Bonus! These dark, leafy greens are also considered cruciferous vegetables: Kale  Arugula  Swiss chard  Collard greens  Turnip greens  Cabbage  Bok choy  Mustard greens One of the fantastic benefits of dark, leafy greens is that you can add them to almost anything. Try a variety of dark, leafy greens in smoothies, salads, soups, fresh-pressed juices, sautés, wraps, omelets, and stir-fries.  Be sure to check with your doctor if you have kidney stones or if you are on blood thinners. Dark, leafy greens may be a concern in these cases.  Cruciferous Greens Cruciferous vegetables are known for their cancer-fighting compounds, and they can be a delicious addition to your diet. Cruciferous vegetables contain different types of compounds including indoles and isothiocyanates that are activated with chewing, digestion, or cooking. These compounds have been shown in laboratory studies to reduce inflammation, cause cancer cell death (apoptosis), and stop tumor blood vessel formation (angiogenesis). Human studies have had mixed results , but research continues on these superfoods.[4]   Another benefit of cruciferous vegetables are their hormone-balancing effects. They contain diindolylmethane, or DIM for short. DIM helps to regulate estrogen in the body and has been shown to be beneficial in women with PMS, PMDD, perimenopause, and breast cancer. This property of cruciferous vegetables may also benefit those with thyroid or prostate cancers . In addition to the cruciferous greens listed above, try these options: Broccoli Brussels sprouts Kohlrabi While technically, these cruciferous vegetables aren’t green, they have many of the same benefits: Cauliflower Turnips Radishes My favorite way to eat cruciferous vegetables is to roast them. Try roasting some cruciferous vegetables on the weekend and enjoying them throughout the week.  Rosemary Roasted Vegetables Preheat oven to 425 degrees.  Cut a variety of cruciferous vegetables such as broccoli, cauliflower, and Brussels sprouts in large pieces and spread them in a single layer on a baking sheet (or two depending on how many you have). Drizzle with avocado oil and add salt, pepper, and rosemary. Use a large spoon to toss them so the oil is evenly distributed.  Bake for 25 minutes or until the edges of the vegetables are browned.  Green Tea There are so many benefits to green tea! Green tea contains the catechin, epigallocatechin-3-gallate or EGCG for short. This powerful antioxidant has been researched for its potential benefits in multiple health conditions including heart disease, cancer, diabetes, metabolic syndrome, and Alzheimer’s. Sipping a cup of tea is soothing and has a calming effect on the nervous system. It’s a great way to relax and unwind. That’s benefit enough, but it may also help women with one of their biggest complaints – abdominal fat. A 2022 study found that women with high consumption of green tea had a 44% lower chance of abdominal obesity. Green tea comes in a variety of options. Experiment with some of these favorites to find what you like best: Jasmine  Sencha Matcha Gunpowder Dragonwell Enjoy a hot or iced cup of green tea in the morning or afternoon as a refreshing alternative to regular tea or coffee. You can also experiment with green tea-infused recipes such as matcha smoothies.  Embrace the power of green foods! Making small, sustainable changes to your diet can have a significant impact on your health and wellbeing. By embracing the power of green foods, you not only enhance your nutrition, but you also take a proactive step to improve your health and reduce your risk of cancer. Remember, it’s about progress, not perfection. So, whether you’re sipping on green tea or savoring a kale salad, each positive choice contributes to a healthier lifestyle. Cheers to a lean, clean, and green journey to better health!  About Merritt Tracy Merritt Tracy is a National Board Certified Health and Wellness Coach. Her mission is to empower women to live a healthy and happy life, naturally balance their hormones, and prevent cancer or a recurrence of cancer.

Meditation offers an abundance of research-based  health benefits. Certainly, stress relief and a desire for peace of mind are primary reasons why people become interested in meditation in the first place. Some other sought-after benefits include lower blood pressure, decreased inflammation, less pain , and stronger immunity. Despite all the good reasons to meditate, many people find it extremely difficult to sit and calm a busy, overactive mind. There is a scene in the movie   Eat, Pray, Love  in which Julia Roberts plays a woman who is going through some significant life changes. In one scene, she is trying to sit and meditate with closed eyes. After what seems like an eternity, she opens her eyes to peek at the time, and is quite disappointed to see that only two minutes have passed. She comically gives up in frustration. If you can relate to that struggle, you are not alone!  The good news is, there is a solution! The benefits of mindful movement for cancer survivors. Mindful movement can bring about many of the same benefits as sitting meditation.  A state of peace (and even bliss) can be created without the need to sit still.  Slow-paced movement practices such as Qigong  and Tai Chi  are often referred to as Meditation in Motion, or more recently as Medication in Motion, because of their calming effects. When the body is moving slowly, the thoughts in the mind will naturally slow down as well.  There is focus on synchronizing physical movements with the inhales and exhales of the breath, while the mind pays close attention to the movements and to the breath. The harmony of body, breath, and mind creates a meditative state. Other benefits of moving meditation  include gentle exercise that increases coordination, balance, and flexibility.  Calming the mind and loosening up the body improves circulation and has an uplifting effect that eases depression and supports a peaceful night’s rest. A unique system of self-care. Mindful movement using Qigong and Tai Chi brings together meditation and exercise into a unique system of self-care.  Choreographed sequences consist of gentle stretches that are coordinated with the breath and intention.  They are peacefully energizing, restorative, and supportive to healing. Practicing mindful movement creates a meditative state and is a win-win experience that improves physical, emotional, and mental health and easily fits into a daily schedule. About Marie Theriault Marie Theriault  is a yoga, qigong and tai chi instructor. The prevalence of cancer if her family led her to study approaches to complement traditional treatments.

Understanding Hot Flashes Hot Flashes are unpredictable! They arise suddenly and cause a feeling of warmth or heat, especially in the upper body. One moment you feel fine, the next you are sweating and peeling off layers. As the hot flash subsides, the body may feel chilly for a bit, and you find yourself reaching for those layers once again. These pesky vacillations in body temperature can range from mild and occasional to a daily occurrence that can be much more intense. The fluctuations of estrogen and progesterone levels are at the root of these temperature swings and can also trigger other problems such as anxiety and irritability, sleep disturbances, fatigue, depression, fluctuating moods, and an erratic menstrual cycle. While hot flashes are commonly experienced during menopause , they can also arise as a side effect from chemo or hormone therapy and radiation treatments. An estimated 60 percent of women do experience menopause-related problems, says Rowan Chlebowski, MD , of the Harbor UCLA Research and Education Institute in Torrance, California. About 25 percent report almost no disruption in their daily lives, while approximately 10 to 20 percent suffer severe and often debilitating symptoms. Supplements and prescription medications can be helpful for some people, but their use should always be under the supervision of your doctor. Let’s look at some Natural Solutions for Hot Flashes. Plant Medicine – Clary Sage Essential Oil Clary Sage is renowned for balancing female hormones and is sometimes referred to as “the woman’s oil.” It is the best oil for clearing menopausal heat, soothing menstrual cramps, and calming hot flashes. This oil can be applied topically but must always be diluted first. It can also be included in creams and lotions, added to a bath, through direct palm inhalation, or diffused into the air. Essential oils are commonly used in hospitals to assist with managing side effects of cancer treatment, but it is recommended to discuss their use with your cancer support team prior to using them. This informative article by David Crow, L.Ac . discusses the therapeutic qualities of Clary Sage and includes recipes. Dietary Considerations Foods such as apples, cucumbers, berries, broccoli, eggs, and green tea are considered cooling foods . As an added bonus, they are rich in nutrients and disease-fighting chemicals. There was a recent study that showed a significant reduction in the frequency and severity of hot flashes by adding soybeans to a low-fat, vegan diet. During the 12-week study period, many intervention-group participants became free of moderate-to-severe hot flashes. It is also important to stay hydrated by drinking water throughout the day. Adequate water intake will help your body flush out toxins, better absorb nutrients, and support a healthy weight. Avoiding spicy hot and fried foods, alcohol, and caffeine can also help with reducing the hot flash flame. Yoga Pranayama Many people think of Yoga as exercise that involves unique positioning of the body into a pose, but did you know that Yoga also includes breathing techniques that can be used for a variety of health concerns? Prana means Breath, Life Force, or Energy. Yama means to Control or Direct. Therefore, Pranayama is a type of breathing that directs the flow of breath to have specific effects on the body and mind. There are different styles of Pranayama that are easy to use. Here are two that can help with hot flashes. Video demonstrations can be viewed here . Sheetali Pranayama – The Cooling Breath This style of Pranayama initiates the calming and cooling mechanisms of the body. Sheetal is a Sanskrit word used to describe something cool and soothing. Think of a cool breeze on a summer evening, or cucumber slices over sore eyes. This Pranayama has a soothing effect on the nervous system and mind and a cooling effect on the skin and body temperature. It is also a wonderful way to wind down or prepare yourself for meditation or sleep. Chandra Bhedana Pranayama - Chandra (Moon) Bhedana (to Pass Through) Chandra Bhedana Pranayama invokes a cooling and calming energy. Breathing in through the left nostril while the right nostril is gently blocked affects the right hemisphere of the brain and activates the parasympathetic nervous system. This is our relaxation response which creates calmness and contentment. Breathing out through the right nostril releases body heat and will cool hot flashes or fever. Chandra Bhedana can also be helpful for heartburn, high blood pressure, and tension. It refreshes and steadies the mind. General guidelines for practicing Pranayama: It is best to practice on an empty stomach. Take a few cleansing breaths and make yourself comfortable before getting started. You can begin with 3 to 5 minutes (about 8 to 10 rounds of breath) practiced several times per day. It does not take long to do, and consistent practice will have a cumulative effect. Practicing before bedtime can help you get a good night’s rest and minimize night sweats, and that is something that everyone who is experiencing hot flashes truly wants and deserves! Remember, your breath is always with you. You don’t have to pack it or wait for it to arrive. You can use these cooling breaths to bring sweet relief and tame the hot flash flame whenever you need it. About Marie Theriault Marie Theriault is a yoga, qigong and tai chi instructor. The prevalence of cancer if her family led her to study approaches to complement traditional treatments.

Learning to live after the diagnosis I was diagnosed with Colon Cancer on June, 16 2016. On July 6, I received the unsettling news that after removing 12 inches of my ascending colon, cancer was found on my liver. Enter, Dr. Austin, my current Oncologist, who told me I had a 9 month life expectancy. Well, how about that folks. Hmmmm. Today, I am writing my blog from a lovely room in Padua, Italy. I just completed 6 miles of walking in the city. I attended mass in the Basilica di San Antonio and loved breathing the air, listening to the Priest speak in Latin, watching the heartfelt response of the congregation and so much more. A beautiful moment in my life. Positive psychology practitioner You see, after cancer, I learned how to live . I was running out of time, and I had to get things done. I have learned to love more deeply, belly laugh , savor more, and ruminate in negativity less. In 2021, I attended The Flourishing Center and received my certification in Applied Positive Psychology. As a Positive Psychology Practitioner, I have learned to embrace, practice and grow using the PERMA model, founded by Martin Seligman in 1999, later adapted to the PERMAV model by The Fourishing Center Founder, Emiliya Zhivotovskaya. My career as a Public Health Administrator, Executive Leader, and now, Life Navigator have prepared me to inspire you on your journey. Cancer is hard , cancer sucks, and cancer throws us a curve ball that none of us want to catch. I am confident that my purpose after cancer is to serve you. My goal is to serve as a confidential thought partner, life navigator, and guiding light, helping you thrive after cancer. The PERMAV model pathways are, Positivity, Engagement, Relationship, Meaning, Achievement and Vitality. We will use these pathways to review your strengths, develop tools and review what you have inside that you can use to live your best life. Together we thrive. About Lisa Caughman Payne Lisa Caughman Payne  is a life coach and stage IV colon cancer survivor. With a background in positive psychology, her  mission is to walk alongside you on your journey of healing and rediscovery.

This Positive Psychology exercise will guide you through the practice of journaling through the holidays over 42 days from Thanksgiving to New Year’s Day, so that you may explore your thoughts and feelings surrounding the holiday season. Download the booklet here: What is Positive Psychology? “Positive psychology is the scientific study of optimal human functioning. It aims to discover and promote the factors that allow individuals and communities to thrive.” (Seligman, 2002) The late Dr.Christopher Peterson (also one of the founding fathers of positive psychology) described positive psychology in this way: “Positive psychology is about helping people move ‘North of Neutral’. Peterson was also famous for saying, “I can describe positive psychology in 3 words: Other PeopleMatter.” Simply Put: Positive psychology is about building what’s right, not just fixing what’s wrong. About the booklet You are receiving a total of 42 journaling prompts. Please note that you determine the pace of writing. Write when it feels right for you and feel free to skip prompts. If you wish to skip a prompt, leave the journal pages empty and return to them in your own time. Before you begin writing, take a few moments to relax and pay attention toyour breath. Breathe in slowly through your nose and hold for 3-5 seconds.Now, gently exhale through your mouth and hold again for 3-5 seconds.With each inhale and exhale, notice the air as it flows in and out of your lungs. Notice your chest as it gently expands and contracts. As you write in your journal, remember to: Create a comfortable, safe space for your journaling where you are unlikely to be disturbed by others. Turn off your phone. Do not censor yourself. Be honest - you are writing only for yourself. No one else will have access to your journal unless you want them to. Be kind to yourself. If you begin to feel overwhelmed, take a break and resume writing when you feel ready to do so. There is no wrong way to journal; you can write however it feels right to you. For example, you might prefer to write in complete sentences, short paragraphs, or a continuous flow of thoughts. Journal writing empowers you to express your difficult feelings safely and privately. It allows you to come to terms with cancer at your own pace and in your way. Your journal is always there to receive your thoughts and feelings. In addition, it gives you the chance to express yourself and reduce stress. Remember, you do not need to worry about spelling, grammar, or even writing full sentences. This journal is for you; you can write however feels right to you. About Lisa Caughman Payne Lisa Caughman Payne  is a life coach and stage IV colon cancer survivor. With a background in positive psychology, her  mission is to walk alongside you on your journey of healing and rediscovery.

Embracing Life After the Storm: A Survivor's Tale Once upon a time, in the City of Asheville, NC lived Lisa – a courageous woman who had triumphed over the storm of stage IV colon cancer . However, amidst the joy of survival, Lisa found herself grappling with a shadow that lingered in the corners of her mind: survivor's guilt. In the quiet moments of reflection, Lisa acknowledged the presence of this unwelcome companion. She understood that survivor's guilt was not a sign of ingratitude but a complex emotional aftermath of her journey. Determined to heal, she embarked on a quest to let go of this burden and embrace the life she fought so hard to preserve. Lisa began by accepting her feelings with open arms. She realized that survivor's guilt was not a flaw in her character but a natural response to the unpredictable nature of life. With this understanding, a weight was lifted, allowing her to breathe more freely. One day, while sitting in her “she shack”, Lisa decided to practice self-compassion. She spoke kind words to herself, acknowledging the strength within that had carried her through the storm. Self-compassion became a daily ritual, slowly transforming guilt into acceptance.  Lisa found great comfort in using Dr. Kristin Neff’s research to assist on this journey.   As she looked back on her journey, Lisa reflected on the diverse realities of survivorship. She understood that each person's path was unique, shaped by a myriad of factors beyond her control. This realization helped her let go of the comparisons that fueled her guilt. To reinforce her newfound perspective, Lisa integrated positive affirmations into her routine. Each morning, she affirmed her resilience, celebrated her achievements, and embraced the present moment. These affirmations, by Louise Hay, became the foundation upon which she built her self-esteem.   Embracing a spirit of gratitude, Lisa developed a daily practice of acknowledging the positive aspects of her life. This intentional focus on the good helped shift her perspective, allowing her to appreciate the beauty in every moment.   As Lisa continued her quest for healing, she explored various therapeutic outlets. Journaling, art, writing, and music became channels through which she could express the complexity of her emotions. Creative expression became a bridge to understanding and releasing the tangled threads of survivor's guilt.   Supported by a loving network of friends, family, and fellow survivors, Lisa found comfort in setting realistic expectations for her continued recovery. Patience became her ally as she navigated the ups and downs, forgiving herself for any perceived role in the guilt that lingered. In the end, Lisa's story became a testament to the power of letting go. Through self-compassion, gratitude, and the support of others, she transformed survivor's guilt into a stepping stone toward a life filled with purpose, joy, and the promise of a brighter tomorrow.   This is my story, and I trust it resonates with yours. We share the common thread of survivor’s guilt. Through sharing my journey, my hope is to assist you in letting go of your own survivor’s guilt. While there will inevitably be stories of loss that may trigger these feelings, with intention, I believe these moments of guilt pangs can become brief.  Tips for letting go of survivor’s guilt Letting go of survivor's guilt can be a challenging but crucial step in the healing process for cancer survivors. Here are some tips to help you release these feelings: Acknowledge and Acceptance: Begin by acknowledging that survivor's guilt exists and accepting it as a natural part of the emotional recovery process. Read about Expectations and Reality . Self-Compassion: Practice self-compassion. Understand that it's okay to feel a range of emotions, and you deserve kindness and understanding, just like anyone else. Dr. Kristin Neff - Self Compassion . Reflect on Realities: Reflect on the realities of survivorship. Understand that cancer journeys are unique and influenced by a variety of factors beyond one's control. The Serenity Prayer Positive Affirmations: Incorporate positive affirmations into your daily routine. Remind yourself of your strength, resilience, and the positive aspects of your journey. Affirmations - Louise Hay Focus on the Present: Practice mindfulness to stay present and avoid dwelling on the past or worrying about the future. Mindfulness techniques can help you appreciate the current moment.  Read about Mindfulness After Cancer. Celebrate Your Achievements: Celebrate your achievements and milestones, no matter how small. Recognize and acknowledge the progress you've made in your recovery. Read about Perspective and Celebration . Share Your Story: Consider sharing your story with others. Sharing your experiences not only helps you process your emotions but also creates awareness and understanding among those around you.   Set Realistic Expectations: Set realistic expectations for yourself. Understand that recovery is a journey, and it's okay to face challenges along the way. Be patient with yourself. Lower the Bar - Gretchen Rubin . Volunteer or Help Others: Channel your survivorship into positive action by helping others. Volunteering or supporting fellow survivors can provide a sense of purpose and contribute to letting go of guilt. Health Benefits of Volunteering . Professional Support: Seek professional support from therapists, navigators, coaches, and counselors experienced in survivorship issues. They can provide guidance and tools to navigate complex emotions. Check our Care Team at The After Cancer . Gratitude Practice: Cultivate a gratitude practice. Regularly express gratitude for the positive aspects of your life. This can shift your focus from guilt to appreciation. Read about  The Power of Gratitude. Forgiveness: Consider forgiveness, both for yourself and for any perceived role you played in survivor's guilt. Understand that you deserve to live a fulfilling life without carrying unnecessary guilt. Create a Support System: Surround yourself with a supportive network of friends, family, or fellow survivors who understand your journey and can encourage you.  Therapeutic Outlets: Explore therapeutic outlets such as journaling, art, or music. Creative expression can help process and release complex emotions.  The Artist's Way Remember, letting go of survivor's guilt is a gradual process. Be patient with yourself and celebrate the progress you make along the way. Reach out to Professionals as needed. Positive psychology can be a valuable approach for cancer survivors dealing with survivor's guilt, offering tools and perspectives to promote emotional well-being and post-traumatic growth. About Lisa Caughman Payne Lisa Caughman Payne is a life coach and stage IV colon cancer survivor. With a background in positive psychology, her mission is to walk alongside you on your journey of healing and rediscovery.

Cancer is a horrible disease It robs people of their health and sometimes of their loved ones. My dad was a healthy 59-year-old when he was diagnosed with stage IV lung cancer. His good health and the fact that he was a non-smoker disguised his illness. He lived for one year, fighting constant nausea, awful side effects from the clinical trial he was on, and overwhelming sadness. We are a close family and it was very hard on all of us. I was his medical advocate , fighting like hell for the best care, the best options, for hope. When he died, we tried to focus on the wonderful, happy life he lived and not our anger towards the cancer that took him away from us. All too often, cancer happens to those really special people in our lives, those people who don’t deserve it, those people we can’t live without. Not that anyone deserves a scary diagnosis of cancer. I have seen all types of people with all types of cancers in my almost 20 years as an integrative physical therapist. Each one waged a battle in their head and their body. “Will I live or survive?” “Will I get past my cancer or will it be what kills me?” “Can I keep doing this?” Cancer brings difficult emotions alongside pain Cancer brings difficult emotions… sadness, grief, despair, frustration, exhaustion, anger, feelings of being overwhelmed, and disbelief to name a few. Sometimes people experience persistent physical pain . Oftentimes underneath the physical pain lies a well of unresolved emotional pain. One of the things I like to teach people with persistent pain is just to sit with their emotions. It makes them not seem as bad when we acknowledge that these emotions are perfectly normal . Being fearful, angry, sad, scared, and frustrated is okay. I let them know that anyone in that situation would feel the same way. Sometimes our brains perpetuate chronic symptoms and pain because of these difficult emotions. The good news is that the brain is neuroplastic. I teach people how to change their brains to change their pain. This coaching, in combination with physical therapy, leads to lasting healing and cures chronic pain or symptoms. What is integrative physical therapy? I am an integrative physical therapist so I look at all aspects of my patient’s lives and figure out how to make them as well as possible. We talk about fitness , nutrition , sleep , meditation, pain, breathing, and general level of contentment while taking into account the client’s medical history. I genuinely want the best for everyone that I have the honor of treating. I want everyone to feel their best and live their best lives. After all, we only have one life to live. I try to honor my Dad, Larry, every single day by living my best life and helping others to do the same. About Katie Estridge Katie Estridge  is a physical therapist, specializing in yoga therapy and pain management. Her mission is to help people achieve their health goals, feel better and cure chronic pain and symptoms.

Sandy wants to work out. She wants to feel more physically fit but she is just so tired. She’s been to hell and back fighting breast cancer for the past several years. She has been through chemo, multiple surgeries, testing, waiting and worrying, pain, countless doctor’s appointments and phone calls, needle sticks, hard life decisions, more worrying, and even more pain. She’s been telling herself “I’m strong” for years as she goes through this battle but the truth is she feels weak. Weak in body, mind, and spirit. She’s exhausted and worn down. How can she even begin to think about fitness and working out when she’s so fatigued, foggy, and still has lingering pain ?  1. Shift your mindset. What should Sandy do? Step one is to start with shifting your thoughts.  Acknowledge that it’s okay to feel weak and exhausted . Sandy has been through so much. All of Sandy’s feelings are perfectly normal.  She tries replacing one negative thought with three positive ones. For example, Sandy might say “I don’t think I can do this. I am depleted.” She chooses to replace that with “I have the tools to get stronger. I can start small. I survived cancer. I can do this.” The three-to-one ratio can rewire our brains by shifting from the negative to the positive.  2. Ask yourself: What is your “why?”  Why do you want to improve your fitness ? Do you want to have more energy? Feel happier? Sleep more soundly? Lose weight? Gain weight? Write down your goals. Put your goal on a sticky note and put it on your mirror to remind yourself of your “why” every day. 3. Express self-compassion. We tend to be harder on ourselves than on others. Sandy imagines if her daughter had just been through everything she went through. She would have far more compassion for her daughter than she has for herself. She would tell her daughter that even though she feels weak, she is still strong. She has overcome so much. You have overcome so much. Maybe you are feeling like Sandy and that’s ok. Think of your workout as self-care.   4. Start small and be intentional.  What activity do you enjoy? Do you like to be outside in nature? Go for a walk if you can. Try to increase your time incrementally every day. Start small but aim big. Do something active every day. Measure your steps and try to increase your number every day or on most days. If you have a dog, take your dog for multiple small walks. You and your dog will enjoy the benefits of a change of scenery. 5. Get creative. Caring for a vegetable garden can be a great way to get outside in nature and do something active. Plus, you can enjoy the benefits of healthy, fresh-tasting food. Start researching now so you can plant a spring garden.  6. Get outside! Being in nature is therapeutic. Ride a bike, go for a hike, swim. Do what you enjoy because that is what you will stick with. Try to aim for cardio or light weights to increase strength on most days of the week even if you can only set aside 10-20 minutes. Many apps and workout videos are easy and free.  7. Be more active throughout the day. You can also incorporate a higher level of activity into your daily activities.  We tend to try for the closest parking spaces when walking into a store. Park farther away. Not only will you get more steps, but you may not be crammed next to other cars and have more space.  When you have the option and if you can, take the stairs instead of the elevator or escalator. Get those steps in. Instead of taking that phone call lying down on the couch instead, walk around your house while on the phone.  8. Think about this as a lifestyle change. Little things add up. Starting small will make a big difference. Don’t just tell yourself you are strong. Act strong.  Get an accountability partner to keep you in check or book a session with one of our professionals on “the after cancer” who will give you a simple plan and encouragement.  Listen to an inspirational audiobook or podcast as you walk. It will make you want to walk further. Think about living a more active lifestyle to build strength.  Treat yourself with love by nourishing your body with healthy activities and healthy food. You can start this year with a new mantra of strength. We have wonderful nutrition coaches on The After Cancer. 9. Tune into the good feelings of gratitude. Enjoy that post-workout high. Be mindful about how you feel afterward and it will make you want to keep doing it. Let the positive vibes be your reward. Feel the feels. Notice if you sleep more soundly or have more energy throughout the day. Notice what you are grateful for in your body. If we are so busy noticing what we don’t love about our bodies we can’t appreciate what we do love about our bodies. Your body is an amazing thing. Take a few moments a day to really appreciate that.  10. Set a New Year's intention. One word you can come back as your mantra throughout the year. Gratitude? Strength? Resilience? Hope? Remember Sandy? She sets her word of the year as “resilient” because that’s what she intends to be this year.  You are strong. You can do this. We only have this one life to live. We might as well live it as healthy and happy as we can manage.  About Katie Estridge Katie Estridge  is a physical therapist, specializing in yoga therapy and pain management. Her mission is to help people achieve their health goals, feel better and cure chronic pain and symptoms.