The After Cancer Blog

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.

Dr. Lisa Jervis, MD, is part of The After Cancer's Care Team. She's board-certified in both Obstetrics/Gynecology and Integrative Medicine. If it’s not one thing, it’s something else! Congratulations…you have been through a lot both physically and emotionally to get to this point. This is definitely something to appreciate, if not celebrate. Menopause will come eventually—whether by natural progression of the aging process or by “early invitation.” Many survivors don’t purposefully send that early invitation, but either by surgical intervention, chemotherapy , or anti-estrogen treatments, the door is opened sooner than anticipated. Menopause affects everybody differently. Some women breeze right through with minimal symptoms; some women are miserable day and night, but most women fall somewhere in between those scenarios. The good news is that there are many integrative approaches to lifestyle choices and options to help with symptom management. No matter the cause of menopause, healthy lifestyle choices are always recommended when possible. The changes can affect how we feel almost immediately The changes associated with menopause are mostly due to decreasing levels of female hormones (estrogen and progesterone) and male hormones to a lesser degree. These changes can affect how we feel almost immediately with common symptoms of hot flashes , night sweats, anxiety , sleep disturbances as well as genito-urinary dryness, discomfort, and decreased libido . Not only do we experience these irksome symptoms, but the decreased hormone levels (which were once protective of our health) are now setting us up for an increased risk of cardiovascular disease, stroke, bone loss (osteoporosis) as well as changes in brain health, skin and gut health. The big picture of your health I always like to start with the “big picture” of overall health, as that’s what this is all about! An “Anti-inflammatory” or Mediterranean style eating pattern is beneficial for almost any condition or ailment. With regard to menopause and survivorship, I would encourage ample intake of plant-based (not necessarily vegetarian) and whole foods (avoiding/limiting simple sugars and processed foods). Emphasize foods rich in calcium, Vitamin D, omega 3 fatty acids, anti-oxidants (fruits, vegetables, green tea, etc), fiber (whole grains, beans, legumes), whole soy foods, and consider adding fermented foods (for the microbiome) and cooked Asian mushrooms. I cannot stress the importance of some form of activity/movement or exercise to help with everything from decreased risk of cancer recurrence , bone loss and dementia as well as protection of cardiovascular health and alleviation of many of the menopausal symptoms discussed previously. Integrative treatments for symptoms of menopause By definition, integrative treatments for symptoms of menopause can incorporate both conventional medical and more natural (non-pharmaceutical) options. The most effective known treatment for symptoms of menopause is hormone therapy, which may be appropriate for some women. However, for many survivors of breast cancer, especially hormone receptor-positive cancers, systemic hormone therapy is not an option. Fortunately, there are many options to help you that are safe in this setting. Consider the following summary of integrative options to manage menopausal symptoms (focusing on hot flashes): Limiting intake of alcohol, sugar, and spicy foods may be helpful for some people’s hot flashes. Using fans, weighted cooling blankets and pillows are simple changes that may be successful and easy to implement. Herbal supplements such as Black Cohosh and Purified Pollen Extract have been used. Other herbs include: Valerian, kudzu, hops and sage leaf. Essential oils: Clary Sage and Rose Geranium. Studies have demonstrated that acupuncture can be beneficial in lessening hot flashes and anxiety associated with menopause. Mind-body modalities such as guided imagery and clinical hypnosis are useful adjuncts. Conventional non-hormonal medications such as venlafaxine (Effexor) and neurontin (Gabapentin), that may help reduce hot flashes, are some of the first line options recommended by oncologists. These medications are traditionally used for other purposes such as depression, anxiety and pain modulation. They can be associated with a fair amount of side effects and are not always tolerated. Recent developments 2 fairly recent developments of conventional options for menopausal symptoms have been published. In May 2023, the FDA approved a successful non-hormonal treatment called Fezolinetant which helps control the thermoregulatory center in the brain, significantly reducing the amount of hot flashes experienced in subjects. Also good news with regards to genito-urinary syndrome of menopause (aka vaginal dryness or discomfort) was published in the most recent Journal of Obstetrics & Gynecology. A large analysis did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for their symptoms. This included women with estrogen receptor positive cancers. Although we can’t stop menopause from finding us—we can work together to take control and move forward in health, peace, and comfort.

Rebecca C. Walden is a writer/speaker on breast cancer, faith, mental health, and parenting good humans. My body is still working out. I would love to tell you with certainty what breast cancer surgeries, chemotherapy and estrogen therapy will do to your menopausal status. But the truth is, my body is still working out the details. Just as surely as I think I know what’s what, I’m thrown for a loop (which means just in case supplies are stashed in every purse and my car console – and also means these tend to last a long time, because early menopause is nothing if not erratic). My Gynecologist told me I was menopausal Until Labor Day 2022, I was quite confident – even in the face of my oncologist betting I was wrong – that chemo-pause had sealed the deal. I had clocked a full 23 months with not so much as one sign of a menstrual cycle. I’d even had initial bloodwork at my (now retired) gynecologist’s office, which confirmed my FSH level as clearly in menopausal range. “Your ovaries took the hit,” she texted me, after sharing the findings. “But that’s good because you don’t have any estrogen production which will complicate everything.” Fine by me. I’d already been enjoying one of the few silver linings of cancer treatment – a faster getting ready routine and the savings on haircare while my hair took its time growing out. Why not add saving more without having to buy feminine products to the list? And getting to swim anytime without extra hassle or worry? Hmmm.... maybe not Back to Labor Day 2022 – the joke was on me. My husband might’ve heard these words from the beautifully appointed master bath of our Texas Hill Country Airbnb: “Are you freaking kidding me?!” Pro tip – don’t travel without essential supplies, even if you think you’re beyond essential supplies season. Trust me on this. As though my body were making up for lost time, I didn’t even get a full 28-day reprieve. Of course I didn’t pack any essential supplies (see above) for a major business trip in Atlanta at the end of the month because the thing had just happened. Right call, right? Wrong, wrong, wrong. This is how you find yourself in an Uber with three male work colleagues (who happen to be some of the greatest humans on the planet) who are not only willing, but happy to make an Uber stop at the nearest pharmacy so you can get what you need (again, see above #essentialsupplies…to borrow from a famous credit card campaign many moons ago, don’t leave home without them). That’s when it got scary. I couldn’t stay on top of the bleeding. Think trips to the restroom every 10 minutes or so. Think ruined clothing. Think “Am I even able to lose this much blood and be ok?” I lost count of how many times I thanked the good Lord that I’d chosen black pants and a long tunic for that plane ride home. A CBC panel the next day revealed that I was A-OK and that this was likely my body trying to regulate itself after months of intense cancer treatment. Gosh that would’ve been good to know before I thought I was hemorrhaging. It also would’ve been good information to know before I subjected myself to the painful procedure that is an endometrial biopsy. Vaginal bleeding can be a sign of endometrial cancer, which I’d been told I am now at slightly higher risk of developing through Tamoxifen treatment. Not that I regret the decision. If cancer taught me anything, it’s that you don’t bury your head in the sand when unusual for you symptoms make themselves known. Praise be it wasn’t endometrial cancer (though the report said the sample wasn’t ideal – to this I tell the medical community, “Find a better way to do that procedure!” Ha. But also I’m not kidding). Tracking my cycle has become an exercise in futility I’m now almost a year out from that and tracking my cycle has become an exercise in futility. I’ve had a period twice since then, with no predictability or pattern. I’ve also noticed some really pronounced and unpleasant symptoms that make me think I’m inching ever closer to (albeit early) menopause. As an active and otherwise healthy 45-year-old, there is no reason why my hip joints should hurt to the point that it’s hard to walk. Adding a scoop of powdered collagen to my morning coffee has actually helped this tremendously, much as I doubted it. But things just ache in a way that shocks me, given the amount of exercise I typically fit in during a given week. Is it post-chemo? Is it middle age? Is it Tamoxifen? Is it menopause? I suspect it’s a little bit of all these things, but only time will tell. The tears sometimes take me by surprise, and the things that can make me irritable on a moment’s notice are a source of embarrassment. I do hope this season hurries up and takes care of what it needs to; in the meantime, I’ll rely on God’s grace and my family’s good humor. After all, this too shall pass .

We are delighted to share our experience at the Making Strides event in Cary, NC, in October 2023. This event was a significant milestone for The After Cancer, marking our second event participation in a Making Strides event by The American Cancer Society. Engaging with the Triangle Community of Cancer Survivors The day was filled with enthusiasm, hope, and an overwhelming sense of community. We had the incredible opportunity to meet many wonderful women from the Triangle area, each with their own powerful stories of resilience and strength. These interactions were not only heartwarming but also underscored the immense need for comprehensive support for cancer survivors, reinforcing our mission . Engaging with the local community in the Triangle allowed us to better understand and address their unique needs. Introducing The After Cancer Resources to the Triangle based Cancer Survivors Our booth attracted numerous visitors eager to learn about our resources designed to help survivors manage treatment symptoms, adopt healthy behaviors, and reduce the risk of recurrence. The genuine interest and positive feedback we received were truly encouraging. Many of these amazing women decided to join our group sessions , where they can find a supportive community and access the personalized care they need. Our presence in the Triangle highlighted the importance of local engagement and support. Building a Supportive Community for Breast Cancer Patients in North Carolina Attending the Making Strides event in the Triangle, NC, in October 2023 was a profound experience for The After Cancer team. It allowed us to connect with survivors, share our vision, and lay the foundation for lasting relationships within the breast cancer community. We are grateful for the warm reception and look forward to continuing our journey, providing the support and resources survivors need to thrive. Our involvement in the Triangle area has strengthened our commitment to making a difference locally and beyond. By participating in events like Making Strides in the Triangle, The After Cancer aims to raise awareness and offerinvaluable support to cancer survivors. We are excited to grow our presence in the Triangle and help more individuals on their journey to health and wellness.

Rebecca C. Walden is a writer/speaker on breast cancer, faith, mental health, and parenting good humans. The stigma of Depression Breast cancer is a socially acceptable disease. Mental health not so much. And that’s exactly why I’m talking about it. When active treatment ends, things don’t just go back to normal (whatever that word even means). In my case, it was a full year before I felt my mental clarity, short term memory , and overall sharpness return. Not being able to engage in your usual witty banter or recall simple words that are part of your everyday vocabulary really sucks. Even if you understand that it’s just a temporary dulling of the senses, it’s upsetting. It can also trigger depression , something I’m all too familiar with. I debated about whether or not to even post on a topic like this. There is absolutely a stigma attached to mental health. There are also people on different paths in their life journey, and they may judge me or look at me differently for what I’m about to share. A Divine Intervention: An Unexpected Conversation But then this morning, while waiting for the beach attendant to set up our chairs, I found myself in a casual turned serious conversation that could not be taken for anything other than divine intervention. He casually asked me “How are you doing today?” I answered as a person fully immersed in a relaxing vacation would, adding that when we were here two years ago I was beginning the biggest health battle of my life. “So after that, man, every day is a good day.” I then asked him the same. The rote “I can’t complain” came next, but I sensed there was more he wanted to say. So I took the earbuds off and really took the time to look at him and be fully present. “I’ve struggled most of my life with depression,” he began. “Mostly mild, you know, but then it got worse.” I held his gaze. “I mean, I understand it and I deal with it, but people have really serious things, like you and cancer. I don’t have anything to complain about!” Horse poop, I thought, listening to hear what he would say next. “But I mean, for like 10 years there every day I would wake up and think about killing myself. I mean, I’d come here and help the kids set up the chairs first because I don’t want to leave them hanging. And then I would think about going home and doing it afterward.” I kept listening, blinking back the tears welling in my eyes. “You know I have a lot to be thankful for. I love God. I get to work in the most beautiful place in the world. Remember Kurt Cobain? I watched this show about him and they said that most people who kill themselves don’t wanna die. They just want the pain to stop.” He waited for me to respond, and there in the sunrise hour at my favorite beach on earth, with only a heron and a few seagulls to hear us, this is what I said. Finding Hope in Shared Experiences “I have depression too. I take medicine for it. I understand everything you have just said. You matter. Nothing is worth dying for.” I continued. “Never compare your struggles to others and think yours aren’t as bad. That is bullshit. Pain is pain. I used to think I was somehow deficient, like my depression was this dark and shameful thing. I didn’t want to take medicine because I thought it was a sign of weakness. Then one day someone said it to me like this: It’s a chemical imbalance. You didn’t *do* anything to cause it. And you taking medicine is no different than a diabetic who needs insulin. I could see him brighten, so I kept going. “The best thing you can do is be your own advocate. Get yourself some therapy . One of the best things I’ve ever done for myself was to find and attend a 10-day outpatient clinic focused on helping people with depression. We met each weekday from 10 am to 4 pm and got raw and real on all sorts of topics, from brain chemistry to the importance of maintaining boundaries from toxic people. We learned about the physical and physiological changes that happen when anxiety and panic set in, and how to stop it. We explored the very real and very damaging affects of stress on the body and the mind. We practiced coping skills to use when depressive thoughts start to creep in, and put in the unglamorous work to retrain the go-to, unhelpful talk tracks in our heads. You matter. Thank you for talking with me.” He nodded quietly, wished me a good day, and returned to his work. I swore I’d never disclose any detail of my own mental health struggles, but that’s such a selfish and insecure position to take. People are suffering and need to know they are not alone and that they don’t have to just live with the gremlins in their head. Breaking the Silence Kate Spade. Anthony Bourdain. Naomi Judd. We talk openly about mental health and suicide when it’s a celebrity. But when it hits closer to home, we tend to talk in smaller circles and hushed tones. In my own community there are heartbreaking stories of such loss, and if you think our children are too young or innocent to know what suicide even is, you are so terribly mistaken. I’ve mentioned before a little nugget of wisdom shared by a personal hero I was able to meet back in June – Robin Roberts of Good Morning America. She is known for saying “Make your mess your message.” Dear readers, cancer is but a fraction of my mess. As I have the energy and bravery to share more of my mess/age, I will. In the meantime, love those in your midst well, and be a light to those who are placed in your path. We need each other.

Taffie Lynn Butters is a board-certified health coach at The After Cancer. She's a breast cancer survivor and is passionate about helping others recovering from cancer with lifestyle interventions. Exploring the Emotional Roller Coaster of a Cancer Diagnosis Being diagnosed with cancer is like being on an emotional roller coaster. The initial stage being shock and disbelief. Later comes anger, sadness, depression, bargaining, and eventually a form of acceptance. But even after the acceptance, there is often a sense of anxiety and sometimes unexplained emotions that carry on beyond treatments. It is very common for people who receive a cancer diagnosis to experience depression and/or anxiety , especially after treatments conclude. If these feelings persist or interfere with daily life you may need to consult with your primary physician. The Connection Between Cancer and Depression So, what exactly is depression and why are cancer patients affected? Depression is defined as a persistent depressed mood that can cause feelings of loss of interest in activities you normally enjoy and is common among people with cancer ( 1 ). Just being diagnosed with cancer can feel depressing, but it may not necessarily be the true emotion. Instead, it may be more based in uncertainty or fear ( 2 ). While understandable, it’s important to manage the effects of stress on the body and mind that may be attributing to feelings of depression. Self-care can play an active role. As you think back on your situation, has there been a time in your life when you have felt stressed or depressed before? It’s important to look back on past experiences, and how you may have overcome them. While your circumstances may be different now, there may be some clues that may have helped you through this tough time. In Rebecca Walden’s blog about depression, she is able to recall a time in her life when she needed clinical help. She was able to share her experience and reflect on how she was able to overcome her depression. Mindfulness is most powerful when we understand what is motivating us internally. While the man on the beach in Rebecca’s story was seemingly externally motivated to keep his depression in check, Rebecca had discovered and built on her internal motivation. She had made time for herself, and she had learned the power of social connection. Through the help of her care team and therapist she could articulate what were the most impactful actions that she had taken to bring her relief. She had learned that her “normal” may look different than the man on the beach, but that if depression creeps in you must be your own advocate. What makes the biggest impact will be unique to you. Understanding what factors are playing into your feelings is a great first step. Working with a health coach can help you discover your motivations and put into action powerful lifestyle interventions to manage this stressful time in your life. Strategies for Managing Depression and Anxiety in the Cancer Experience Here is a list of evidence-based lifestyle therapies that have a proven impact on overall wellbeing ( 3 ). Mindfulness Meditation Moderate Physical Activity Yoga Tai Chi Music Therapy Hypnosis Acupuncture Changing thoughts and behavior does not require being perfect. It just takes commitment to self and consistent actions. Here are a few coaching tips to get you started: Identify specific activities and times to actively relax. Use a method to measure your progress that speaks to you (i.e., check list, journaling, calendar reminders). Experiment with different therapies. Every moment is an opportunity to change your perspective. Creating a plan for wellbeing when depression creeps in starts with small actionable steps. As Rebecca says, “There is no such thing in anyone’s life as an unimportant day.”

Rebecca C. Walden is a writer/speaker on breast cancer, faith, mental health, and parenting good humans. I dreaded starting this medicine Article research and chatting with friends didn’t boost my confidence either. Most notably, I had stumbled upon an article about Harry Connick Jr.’s wife and former Victoria’s Secret model Jill Goodacre . The piece noted that she’d finished her five-year Tamoxifen regimen, not without its side effects, most notably weight gain. When you gain weight , everyone is so quick to say, “Oh, but you look beautiful at any size!” I know this because the year I was turning 40, I ate right and strength trained, and ended up shedding 60 pounds. People are delicate with their words so as not to imply you were somehow deficient before you got fit. While that’s a nice and supportive thing to say, I could totally relate to Jill’s comments about how the weight gain had diminished her self-confidence . You bust your butt to take good care of your health – all of it, your physical body, your emotional state – and then this medicine that you’re strongly advised to take wreaks holy havoc on your hormones and your sense of self. And, if someone like Mrs. Harry Connick Jr. was struggling with it, given all the resources she can access (I’m riffing here, but I bet personal chefs and personal trainers are part of the norm at that level of wealth and stardom), what chance did I have to keep fit? Now I’m 13 months in, and I’m glad I didn’t give up on Tamoxifen. While the first few months were no picnic (embarrassing brain fog , hot flashes all hours of the day, and feeling weepy for no reason), I understand the risk percentage of recurrence and why this estrogen modulator is necessary in my particular case. Battling weight gain on tamoxifen I’ve gained a total of 7 pounds, but I can’t blame it on Tamoxifen alone. During the year of active treatment, I either wasn’t allowed to exercise or I was too exhausted to even consider it. That was when I knew treatment was starting to take a toll. Way back in the beginning, I remember being gently scolded by my breast surgeon for walking four and a half miles a few days after the first lumpectomy. At my post-op visit, she shook her head, laughed and then looked me square in the eyes and said: “Rebecca! When I told you to walk, I meant a little bit around your living room!” But as additional surgeries, biopsies, prep procedures and chemo treatments accumulated, that inner drive to move seriously waned, and all the lean muscle I’d built during that mega weight loss year turned to flab. While my breast surgeon did acknowledge that Tamoxifen is working against any weight loss efforts, she still encouraged me to try, and not to surrender to the rising tide of online opinion that this medicine “makes you gain weight.” So I’ve heeded her advice, including getting rid of my size 2 and size 4 jeans (on this topic, she was like, “Come on, woman! Don’t waste your precious energy on ridiculously tiny sizes!”). If I haven’t already said so, I love this woman. She is skilled and salty and prayed over us and with us before every surgery. I’ve also returned to a keto-ish lifestyle , emphasis on the “ish.” KIND Frozen Bars have my heart, especially those Dark Chocolate and Peanut Butter ones, holy moly. Resilience in the face of medication challenges Strength training could be more consistent, but I’m doing it. It’s actually a need to do these days, rather than when it was a nice to do before. Chemo weakened my bones, and I’ve got osteopenia. To prevent any chance of it progressing to osteoporosis, weight-bearing exercises and calcium supplements are where it’s at. Thankfully those early side effects subsided, and relatively quickly. I would encourage anyone taking it and considering throwing in the towel to work with your healthcare provider first. Give it enough time to see if your system adjusts and if the life-disrupting side effects level out. For now, I am comforted by the fact that I am doing everything I can to minimize any risk of recurrence, and I am happy with my decision to stay on Tamoxifen.

The role of tamoxifen in breast cancer treatment Tamoxifen has been used to treat breast cancer for over 30 years. It is a “SERM” (selective estrogen receptor modulator), that works by attaching to the estrogen receptors in breast cells so that estrogen cannot bind to them. Tamoxifen slows the growth and reproduction of estrogen-sensitive cancer cells. At the same time, it instantly and abruptly puts females into menopause which can be startling to say the least. There can be an associated weight gain in some women on Tamoxifen but is it the drug, the instant menopause caused by the drug, fluid retention caused by the drug, decreased mobility during treatment, or a combination of any or all of the above that can cause the weight gain? Weight gain and tamoxifen: unraveling the factors For the sake of this blog, the answer really does not matter. What does matter is that this weight gain is troublesome and real if it happens to you. When you get a cancer diagnosis so many things are out of your control. So, let’s talk about something that is in your control- How You Fuel Your Body. I like to tell people to begin to think of eating as an opportunity to nourish your body and not just feed it. Every meal you eat is a chance to lean into this opportunity by eating nourishing food and in my opinion the best way to take control back and begin to tackle that pesky weight gain. Taking Control of Your Health Through Nutrition So what does properly fueling your body really look like? It is simple really but definitely not how we typically eat in our country. The products that are marketed to us are convenience foods, ultra processed foods, and manmade foods. Rarely do you see any advertisement for natural real foods but that is exactly what we should be eating. These real foods are important not only to fuel our body properly for our best health and healing, but they also will fill us up with natural fiber and therefore we are less likely to over consume empty calories. A “calorie is not a calorie” for many reasons but in this case because it matters if you feel full after eating those calories or not. Food rich in natural fiber will tell your body that it is full and it will keep you full longer than empty calories. Okinawa, Japan is one of the Blue Zones where a large percentage of their population live very healthy lives well into their nineties. In addition to eating mostly plants, they also have a wonderful tradition of only eating until they are 80% full. What an easy way to take control of your health, and Michael Pollan says it best when he says, “ Eat Food, Not Too Much, Mostly Plants.” I agree with his simple statement and propose that this is a good place to start if you are struggling with weight gain from Tamoxifen or the resulting menopause that it has abruptly put you in. If your diet looks very different from this, start slow and take a few steps in this direction and start listening to your body. It will tell you how it feels and you will see the difference. Stay in touch. About Cheryl Hoover Cheryl Hoover  is a breast cancer survivor and a nutrition coach at The After Cancer. Her mission is to encourage patients to embrace the opportunity they have to nourish their body for their best health and healing.

Rebecca C. Walden is a writer/speaker on breast cancer, faith, mental health, and parenting good humans Challenging myself during cancer treatment For fear of being judged, I didn’t talk much about this during active treatment. “This” being thoughts about my appearance. “This” being what breast cancer surgeries and treatments had done to my self-image. “This” being the shock and reckoning I went through every time I looked in the mirror – seeing a hairless, swollen version of my former self, with sallow skin and stark eyes. I felt sick, ugly and weak, and I was not ok with that. I considered the things that I could and could not control. Beyond my control? Seeking control and acceptance How fast my eyelashes and eyebrows would return (though Rodan & Fields and Brian Joseph products helped; more on this in another post); When my body would stop feeling old and brittle and broken; The rate at which random head hairs would grow in more evenly (no one talks about how unflattering and physically uncomfortable this part actually is); The (in)ability for me to move and exercise the way I could before treatment, and the way I still wanted to, all while, deafeatingly, my pants grew too tight (not due to laziness, mind you, but thanks to months-long exercise restriction and then being too sick to prevent all the lean muscle I’d worked so hard to build from turning into flab). With no hair to style, and my face looking, quite frankly, silly and naked and off-balance, I wanted so badly to find a way to feel feminine and lovely. I craved the sense of joy and self-confidence and uniqueness that can come from the way we express ourselves through the outfits we wear. But this was at the height of pandemic shutdown. Nobody was really going much of anywhere, and when they did leave the house, pocketed yoga pants and a mask were just about all that was required. Rediscovering femininity and confidence Myself included. I only ventured out for chemo treatments and doctor’s appointments, always donning a pair of leggings, sneakers, a cozy sweater, tee and cardi or sweatshirt, and earrings. EARRINGS! That was my eureka moment. Around this time, Beaded Earrings were having quite a moment (I think they still are, but even if not, who cares? I love mine and wear the dickens out of them). I was (and still am) here for it. I bought my first pair – a set of vibrantly colorful butterflies – to channel the emotions I wanted to bring into that first chemo infusion appointment. And ever since, I’ve been on the lookout for sets that make me feel the way that first pair did. Breast cancer survivor with her beaded earring collection. Beautifully Girly. Bright and Hopeful. Optimistic. Faith-Filled. Vulnerable. Resilient. Graceful. Classy. Bold. And just a little bit Sassy. That first pair brought me so much joy; to this day, the Butterflies spark friendly conversation with strangers who compliment me every time I wear them. So I’ve grown the collection, and that has been its own little joyful hobby. I’m always “on the hunt” for not just any pair, but for the next worthwhile addition. Any contenders must be lightweight, colorful, unique-ish, and well-made (don’t even bother with the ones on Amazon; trust me on this). They have to have just the right amount of personality to fit my vibe. This is how I came to own a pair of Texas flag tall boot earrings, and a set of “Howdy Honey!” ones, which I wear as often as possible, because they are awesome. A signature look: Beaded earrings and headbands It has become something of a signature look, which I feel so silly even saying, but it’s true. During treatment and in the months of nowhere hair or awkward hair regrowth since, Beaded Earrings of all things helped me express a little dose of individuality. They helped me remember I hadn’t lost my spark entirely. These last two years, I’ve paired them with the Knotted Headband trend, which I am also here for and loving. In a matter of five minutes, whether it’s a wash and dry or dry shampoo day, I can pull together a look that is practical (pesky layers stay out of my face), polished, professional and also unmistakably me. Fun-loving, sometimes silly, occasionally salty, and always hopeful me.

We are thrilled to share our experience at the Making Strides Charlotte event in October 2023, a significant milestone for The After Cancer as it marked our very first event participation. Making Strides Charlotte was an inspiring event organized by the American Cancer Society to raise awareness and funds for breast cancer research and support. Connecting with the Charlotte Area Breast Cancer Survivors Community The morning was filled with energy, hope, and an overwhelming sense of community. We had the incredible opportunity to meet many wonderful women, each with their own powerful stories of resilience and strength. These interactions were not only heartwarming but also highlighted the immense need for comprehensive support for cancer survivors, reinforcing our mission . Being in Charlotte allowed us to connect with locals and understand the unique needs of this vibrant community. Introducing The After Cancer Resources to the Charlotte based Cancer Survivors Our booth attracted numerous visitors who were eager to learn about our resources designed to help survivors manage treatment symptoms, adopt healthy behaviors, and reduce the risk of recurrence. The genuine interest and positive feedback we received were truly encouraging. Many of these amazing women decided to join our group sessions, where they can find a supportive community and access the care they need. Our presence in Charlotte underscored the importance of local engagement and support. Building a Supportive Community of Breast Cancer Survivors in Charlotte Attending Making Strides Charlotte 2023 was a profound experience for The After Cancer team. It allowed us to connect with survivors, share our vision, and lay the foundation for lasting relationships within the breast cancer community. We are grateful for the warm reception and look forward to continuing our journey, providing the support and resources survivors need to thrive. Our involvement in the Charlotte area has strengthened our commitment to making a difference locally and beyond. By participating in events like Making Strides Charlotte, The After Cancer aims to raise awareness and offer invaluable support to cancer survivors. We are excited to grow our presence in Charlotte and help more individuals on their journey to health and wellness. About Mariana Arnaut Mariana Arnaut  is the CEO and Co-Founder  of The After Cancer. She has a family history of different cancers (lung, melanoma, esophageal) and a background in digital & innovation. You can reach out to her at mariana@theaftercancer.com .

Challenges of negative body image after breast cancer diagnosis When I was diagnosed with cancer, I struggled with a negative body image as I lived with one breast for over a year, then several years and several surgeries later until I reached the completion of my reconstruction process. Over the last 12 years, working with breast cancer survivors, I have come to understand that a negative body image can happen with any degree of diagnosis, whether dealing with a partial, full, or prophylactic mastectomy. Whether reconstructed or flat. But also, for those who do not have breasts removed. For some, it is the loss of feeling secure in your own body or losing trust in the body’s ability to function properly. The tendency to not feel like a whole person after a breast cancer diagnosis and intense feelings of loss can lead to a negative self-image. Tools to re-gain a positive body image Here are some of the things associated with a negative body image. (As shared by my clients over the years and some of which I’ve experienced as well) Having a hard time looking at a photo of yourself. Choosing loose clothing to hide your figure. Feeling anxious when going to a social gathering. Being uncomfortable in your body, especially with a shift in body shape and/or weight through treatment. Feeling that people are staring at you, particularly at your breasts. Developing a forward slump, to lean in to protect the area of the breasts. Understanding and being authentic with exactly how you feel about your body is a first step to gaining or re-gaining a positive body image. If you are grieving, allow yourself to feel the grief without trying to mask it for others. If you are angry, it’s important to acknowledge the anger to get to acceptance. Embracing self-love and acceptance Give yourself time, feelings of loss can come in waves. Even when you think you are ok! It is not as simple as flipping a light switch or saying, “I choose to have a positive body image”. It is a process with specific steps to take. Have a soft landing, a safe place, someone you can talk to who loves you unconditionally and will allow you to express exactly how you feel without judgement. A safe space to explore feeling of loss is integral to getting back to a positive self-image. Here are some of the tools that can help you regain a positive body image: Redirect negative thoughts with a chant such as “Cancel! Cancel! Cancel!” Develop a set of words that you can repeat when you realize you are saying or feeling negative thoughts about your body. Create and practice Affirming Statements about your body. Two goals here: 1. Focus on how functional your body is and what it does for your physical health and well-being. 2. Acknowledge and respect your body’s new unique qualities. “I am whole and beautiful and choose to honor my new body as it continues to heal and support me.” Make Self-Care a priority. (learn more HERE ) Take time in your day for a long hot bath. Take time for a daily gentle walk in nature. Build an integrative routine with massage , acupuncture, Tai Chi , etc. Make an appointment with a health coach at The After Cancer. Start a gratitude journal. Take a positive inventory of all the things you love about yourself and record them on the first page. Revisit often. Invite a loved one to do the same. Read them out loud. Record at least one thing each morning for which you are grateful. Give yourself permission to NOT step on the scales every day in efforts to lose or gain weight. Weight is not the end goal; a healthy attitude is the priority, how you feel and building a healthy immune system are the cues to follow. Give yourself grace. Understand that you may sometimes have a bad day. You’re not going to fall off the proverbial wagon of doom. Each positive step forward is getting you closer to where you want to be, even if today is a hard day. With practice and patience, soon you will be filled with self-love and seeing your beautiful essence in the reflection. Listen closely, she may be saying, “Hello Beautiful!!!!!” With love and understanding, Cheryl Lecroy. About Cheryl Lecroy Cheryl Lecroy  is a breast cancer survivor and has been supporting cancer patients for over 10 years. Her mission is to offer tools to reignite inner joy, purpose, and help reconnect survivors to their true essence; the after cancer paradigm.

Reimagining fitness after breast cancer diagnosis I considered myself to be in good fitness health the day I was diagnosed with breast cancer . Well, certainly all that changed as I went through multiple biopsies and surgeries. It was a roller coaster of emotions waiting on final test results in addition to not being able to move parts of my body post operatively, and friends and family wanting to lift my spirits by feeding me awesome homemade southern comfort foods. So, when I was given the green light to get fit again, I had to rethink of how to achieve fitness. The meaning of fitness can be tied to being healthy. And to be healthy means to be disease free. Well, that was my goal…I wanted to be cancer free. Another definition of fitness may be the ability to perform work or leisure activities without an issue. Again, I wanted to be able to work and play without limitations. I set out on my mission and researched how to get fit. Changes in your fitness journey No matter what level of fitness you have when you are diagnosed with cancer, your fitness level will change as you undergo further testing and treatment. First thing I learned is to listen to your doctors and ask what you can do and be specific about the activities. Your doctor may not want you lifting anything heavy or even raising your arms but this will change you recover. Start out with simple activities such as walking . Resistance training is a great way to regain strength and it does not increase your risk for lymphedema . If you have a favorite workout, definitely ask to be sure you don’t have any setbacks with your recovery. Your body goes through a lot of changes after surgeries and treatments so also listen to your body and be mindful of any aches and pains and don’t start out too hard. Your endurance will not be at the same level but will get there slowly. Be patient with yourself and your body’s current abilities. Your fitness level will improve with time and consistent effort. The thought of going to the gym, taking a class, lifting weights, or going for a run or bike ride may be daunting. Pick one activity and start there. Although I had been training for a marathon prior to my diagnosis, I started with walking around inside my house and then progressed to walking in my yard. I did not even think about going anywhere because I got tired after just a few minutes. But slowly my endurance improved and my confidence in my body to hold up also improved. The power of exercise for physical and mental well-being Exercising not only helped my physical fatigue but also mental fatigue. This mind-body connection came to life because as I was able to do more physically, my mental game got stronger in handling the stressors of more doctor’s appointments, awaiting test results, and making hard decisions. During cancer treatment and even after your mood is affected. Being active has been shown to decrease depression and anxiety associated with cancer diagnosis. In addition, it may help decrease the side effects of some of your treatments. Working out may also help with sleep which we all know plays a key role in our overall health . Being fit and cancer free means you have to eat healthy. But this can be difficult depending on your treatments and the side effects of medications you may be required to take. Again, talk with your doctors and ask what’s best to eat to strengthen your body or when you’re not feeling well. You need to fuel your body well in order to move it well. When you are exercising or moving your body regularly, you are more motivated to stay on plan with eating a healthy diet full of cancer fighting nutrients. Once your doctor releases you to do certain activities, devise a fitness plan so that your body can be as strong as possible in your recovery process and beyond. Exercising (after breast cancer diagnosis) has been shown to be associated with longer survival. Seek a trainer who listens to you and understands your potential limitations and how to work around them. Taking care of your body to be fit as possible in turn make you as healthy as possible. Here are the fitness guidelines according to the American Cancer Society : Avoid inactivity Take part in regular physical activity . Start slowly and build up the amount of physical activity over time. Build up to 150-300 minutes of moderate (or 75-150 minutes of vigorous intensity) activity each week. Exercise several times a week for at least 10 minutes at a time. Include resistance training exercises at least 2 days per week. Do stretching exercises at least 2 days each week. About Dr. Maria Cayelli Dr. Maria Cayelli  is a breast cancer survivor and a physician specializing in integrative medicine and survivorship care. Her goal is to partner with you on your journey to achieve optimal health and wellness.