The After Cancer Blog

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. As a child, I was fortunate to be a great sleeper. I liked to sleep . I liked the feeling of a warm cozy bed, soft sheets, fluffy pillows, and the cool breeze of a fan blowing the air ever so softly across my skin. I can remember as a teenager sleeping until noon or later and making my room a haven to sleep. Although I didn’t understand the importance of sleeping then, my body has always known. The importance of sleep Sleep and cancer have a dependent relationship. While lack of sleep is not necessarily responsible for the onset of cancer, it can be a contributor in healing and reducing the risk of recurrence. Sleep is usually disrupted during treatments and can continue to be affected even after cancer. When you are sleep deprived inflammation and cortisol levels rise, which can lead to insulin resistance and weight gain which can be huge factors for cancer. According to a 2004 study, up to 80% of people affected by cancer are affected by fatigue and/or insomnia, which can impact the cells of the immune system. To quote the “Cancer Revolution” by Dr. Leigh Erin Connealy , “One study showed that insufficient sleep might contribute to breast cancer recurrences among post-menopausal women and the development of more aggressive forms of breast cancer. ” The good news is consistent sleep hygiene can improve the quality of your sleep and protect and help defend your health. Studies also reveal that a disruption to your circadian rhythm may affect your body’s ability to produce melatonin. This vital hormone not only aids in your sleep quality but has increasing research to support its importance on helping stop cancer from growing. If you asked all the Marvel characters, they would tell you that sleep was their secret weapon. We don’t even have to learn how to do it. As fetuses we sleep, and our body innately reaps the benefits even before we are born. So why as adults do we play it off as a luxury and often discard the importance? Somewhere along the way our peers and society view productivity and an active body as a sign of success. We are made to believe that maxing out our days and having the ability to “function” on a couple of hours of sleep is some kind of badge of honor. This couldn’t be farther from the truth. So, what exactly happens when we sleep Just like our computers, we need constant software updates and need to clear out the malware and viruses. Unlike a computer, this update needs to happen every day. Especially when you are defending against cancer. When you sleep, your body not only rest and slows down the whole operating system, but it preforms an essential clean-up process. This is essential in repairing and removing and damaged cells including cancer! Your brain literally cleans and washes itself from all the activity of the day. The millions of cells that were created are sorted and damage cells are taken out for the trash through the lymphatic system. And God bless our liver! Our liver is a powerhouse. Toxins get an invitation to visit the liver, so that it can remove them and send them on their way. And although our digestion is active all day long, during our sleep is when the information from the nutrients is extracted and waste is made. See if you can relate to this…. It’s 3am. Why the heck do I keep waking up at 3am every single night?! It’s so frustrating. I want to sleep until 6am or even 7am, but my body is just not cooperating. I have been arguing with my husband for the last several weeks, and I am worried about the effects it’s having on my health. I talk to my functional medicine doctor, and she is concerned that I am not sleeping. Well, I am “sleeping”, but it’s not restful and my body is not getting the time it needs to restore and repair. You see for this process to happen; you need to have a minimum of 6 consecutive hours of uninterrupted sleep. This is when the magic happens. This is when your body is doing essential healing. Sleep is an important part of healing from cancer. It’s a major lifestyle intervention that often needs attention. Want to know something crazy? Sleep starts as soon as you wake up! Our gut and our brains are synthesizing and producing hormones that will affect the quality and quantity of sleep from the moment you open your eyes. Recommendations for a good sleep hygiene Let me ask you, what is the first thing you look at when you wake up? Is it your phone or is it the daylight? If you answered your phone, you may be having trouble sleeping at night. As soon as you wake up, your body is preparing for the next thing. By taking the time to expose yourself to the rising sun or natural daylight for 20 minutes, you are signaling your body to produce serotonin and melatonin that will be stored for use later that night. So, what can you do to improve your sleep hygiene and set yourself up for the best sleep? The CDC makes great recommendations. You may be asking why the heck does the CDC care about sleep? And the answer is because the Center for DISEASE Control is just that - trying to help you prevent disease. Sleep is on the forefront of disease prevention, including but not limited to cancer, heart disease, metabolic syndrome, and diabetes. Be consistent. Go to bed at the same time each night and get up at the same time each morning, including the weekends. ( backup 6-8 hrs from your wake-up time, that’s when you need to be activity sleeping. 30 mins before that is your bedtime) Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature ( use an eye mask if needed, ideal temperature is 65-68 degrees) Remove electronic devices, such as TV’s, computers, and smart phones, from the bedroom ( blue light tricks your brain into thinking it needs to be awake and a smart phone emits Electronic Magnetic Field that disrupts sleeps) Avoid large meals, caffeine, and alcohol before bedtime ( ideally last meal is 3 hrs before bedtime, all three of these things contribute to reflux) Get some exercise . Being physically active during the day can help you fall asleep more easily at night. ( light yoga before bed can relax the body and reduce stress ) I would add to this list some sort of relaxation techniques. Stress is a major sleep disruptor and culprit for diseases including cancer. Ideas include yoga , meditation , deep breathing exercises, adaptogens, melatonin supplements, detox bathes, and herbal teas. While working on sleep can sometimes seem impossible, consistently is key It won’t happen overnight (pun intended), but knowing the effects and necessity are strong arguments to consider prioritizing it. Working with a Health and Wellness Coach can make the difference. A coach will partner with you, so you can achieve your sleeping goals and improve your sleep hygiene. Together we will identify challenges, set goals, use intuitive resources and tools, and developing a strategy to implement these changes. Coaching allows you to be in control and experiment to get you to your goal.

Before Jennifer Dickenson was diagnosed with brain cancer 12 years ago, she was a busy and stressed-out lawyer. With two elementary school-aged children and a supportive husband, she vowed to do everything she could to improve her odds. Based on the tools she used for herself with miraculous results, she shares this information with others. Her book, “ The Case for Hope ”, teaches others how we can restore health. The importance of laughter One of my favorite tools I used fighting illness was prioritizing joy in my life and, more specifically, laughter. This simple practice can help us let go, relax, give ourselves a break from the challenges of our lives, and laugh-ourselves silly just because it’s fun to do! But laughter is no laughing matter. The bible says in Proverbs 17-22 “A merry heart doeth good like a medicine, but a broken spirit drieth the bones.” So, even when things are not ideal in our lives, it is important, like “a medicine”, to find some laughter somehow. Research has shown that laughter can enhance our health and mood by relieving stress and stimulating our organs by introducing more oxygen intake, thereby supporting our heart, lungs, and muscles. It also increases endorphins released from the brain which help create natural pain killers in our bodies and allow us to feel happy and relaxed. The consistent use of laughter can also improve our immune system and increase personal satisfaction as we are more able to deal with difficult situations. There are plenty of ways to enjoy good-hearted laughter. There are plenty of ways to enjoy good hearted laughter. I personally enjoy listening to and watching stand-up comedians. My favorite ones make me laugh so hard my stomach hurts and I am left with a big smile on my face. At the end of this blog I have a list of top stand-up comedians you can explore for yourself. Easy ways to find these acts are on TV, streaming services, satellite radio (like Sirius in your car), the internet, or buying their DVD’s and CD’s. Spending more time with friends and family members who are particularly funny can be a good source for more laughter. Funny board games (like Mind the Gap or Twister), movies and tv shows like Seinfeld, The Office, and Caddyshack can be hilarious too. Funny podcasts, certain humorous books, joke books and just telling jokes to each other can help us get more of this good stuff. Have you ever played knock-knock jokes with little kids? That can also be a real hoot. Listening to humorous books on CD’s can be another way to feel the joy of laughter. In fact, my friend who has a great sense of humor, bought me a bunch of used funny books on CD when I was sick. I listened to them on my way to my doctors’ appointments, at home, anywhere really, since it made me feel happy and better prepared to manage my situation. One of them , Sh*t My Dad Says by Justin Halpern (the book was a #1 New York Times Best Seller), was an instant classic for me. I’m smiling just thinking about it! It is interesting to me that we can fake our laughter and still receive the healing benefits from real laughter. Laughter yoga , is similar to yoga but incorporates the action of laughing to create energy, oxygen and relaxation in our body and mind. Those who subscribe to this technique believe that the mind and body can’t discern whether we are faking our laughter or genuinely doing it. But often the fake laughing becomes the real thing which is funny to watch. It might seem a little strange but there could be something to it. When I was in high school one of my teachers, probably sick of these annoying teenagers, started class one day by playing a laughter track. It started quietly with just a few chuckles from the track, and then more and more, until the voices on the track were filled with laughter. It was contagious for the kids, and the whole classroom, normally filled with teenage angst, was now filled with laughter as we were mercilessly powerless to stop it! My teacher clearly won that day! But really, we all did. So don’t wait to dive into yet another healing tool easy to incorporate in your life that will help you on your path to wellness, joyfulness, and balance…and start laughing! Comedians recommendations Some well-known stand-up comedians you may want to explore: Little to no profanity Some profanity Profanity Oldies but Goodie Brian Regan Sebastian Maniscalco Dave Chappelle Bob Hope Jerry Seinfeld Kathleen Madigan Bill Burr Jack Benny Nate Bardatze Wanda Sykes Eddie Murphy Red Skelton Jim Gaffigan Joan River Chris Rock Bob Newhart Ellen DeGeneres George Carlin Johnny Carson Jeff Foxworthy ​ Richard Pryor Phyllis Diller Ray Romano ​ Ron White Redd Foxx

My name is JJ Singleton I'm a colorectal cancer patient from Canton North Carolina. I was diagnosed in 2015 at the age of 27, been on chemo for life since 2016. I'm an advocate for colorectal cancer and breaking down stigmas and hurdles around screening and talking about colorectal cancer as well as mental health and the hurdles of living with cancer. Feeling I'm not alone is important, but not enough Positivity, encouragement, motivational quotes prayers, good thoughts and so on are all good things that most of the time I love seeing receiving and feeling as I go through this life with cancer and everything that comes with it. There is a huge and important need for that and to make sure individuals hear that feel it and know they’re not alone . But sometimes I don’t want to see or read or even feel those things and why I feel this way I think is important and not talked about much especially if others feel this as well. Sometimes I feel the world and society and expectations of us is to always look on the bright side, no matter what your dealing with or going through the expectation is positivity and hopefulness or to still be an inspiration or motivational tool and that’s all well and good when you feel like it and when you want to be in those things to yourself or to anyone in the world. I need to lean into my negative emotions There are times I need to stay in that feeling of sadness or anger or disappointment, depression , frustration, tiredness and any other feeling emotion or mood that comes along. I need to lean into these times to begin to process and understand what they mean to me and my mental health. Most importantly for myself is if I don’t accept and feel these and I end up pushing it all away and numbing myself to all the preconceived bad thoughts emotions and feelings, which in turn build up and will eventually blow up and land me in a dark place and spiral that scares me. We don't have to be a positive inspiration every day This isn’t meant to say don’t send positive and loving messages or gestures don’t quit putting motivation and love in the world and especially to people dealing with so much. It’s that those feelings emotions and thoughts that the world doesn’t like to hear, they can and do serve a purpose and it’s okay to lean into and feel them and experience them and to not want to be positive and outgoing and to not on the brightside everyday or be anyone’s inspiration. Note: JJ gave us permission to repost this article from his blog .

Donna is a former Hospice Social Worker, a former Elder Law Attorney, and an ovarian cancer survivor. Check out her website: www.survivingtoflourishing.net When I completed my cancer treatment, I expected myself to return to normal fairly quickly. I was quite surprised when that didn’t happen. What did happen was that I improved slowly over time, but I have never returned to what was my old normal. I have had to adjust myself to this new normal even though I didn’t know what that new normal looked like because it kept changing as my body was healing from treatment . Learning about your needs I was not the only one that had a challenging time adjusting to the new normal, those around me had a challenging time adjusting too. See, the further away I was from treatment, the more other people expected me to be able to do things the way that I used to do them. But often, I couldn’t do it and didn’t even know it until I got into situations that I couldn’t handle. Like the time I went on a Ranger led hike in a State Park only to have a complete ugly meltdown because I couldn’t keep up. So how do you take care of yourself when you don’t know what your needs are and what you can do and can’t do, and how do you express those needs to others? So not only you but also the others around you, expect you to be like your old self One of the difficulties in the after cancer is that you start to look like your old self. So not only you but also the others around you, expect you to be like your old self. But we all know in life that how we appear on the outside can be very different from how we feel on the inside, both physically and emotionally, and that is not truer than in the after cancer . You need to figure out your limitations The first part of aligning your expectations with the reality of what your abilities are at this moment in time is trying to figure out your limitations. I had to learn that I COULD do a hike in a State Park, but probably not with a Ranger or a group of others because I needed to go slower and take more frequent breaks than most people. My husband had to learn that my not answering a question immediately did not mean that I wasn’t listening or didn’t hear him. Sometimes, especially when I was tired, I needed time to either process what he was saying or to find the words to express my answer. It took and still takes patience on both of our parts. Communicating ahead of time can help keep expectations in check Now there were and are times that I didn’t know what to expect or what I was capable of, so it was difficult to directly and specifically express my needs to others. For instance, I would respond quickly with a “Yes!” when invited to something, only to realize when the time came that I was having a really bad day, or I was too fatigued to participate . Then comes the difficult part of telling people you aren’t joining them after all. It can cause hard feelings if they don’t know the reason has to do with your recovery, not them. Tell people about your recovery and set expectations I have found, and sometimes forget, that communicating that you still have trouble with fatigue or your recovery or whatever it is that you are having trouble with and that you hope to join or attend but cannot firmly commit, can spare both hard feelings and your own feelings of low self-worth and disappointment. Share as much or as little information as you feel comfortable sharing. Not everyone needs to know exactly everything about your journey and directly communicating your needs does make you vulnerable. But that vulnerability also makes you real. Realness ultimately helps you connect with others. And we do need others in so many different ways to help us get through this journey. We sometimes forget that we don’t owe an explanation to everyone For me, when invited somewhere, there is also the anxiety about how my verbal communication will come across . Sometimes I use the wrong word, or I can’t find the word I am looking for at all. Or I lose my train of thought mid-sentence. It can stop conversation in its track and make me and the other person uncomfortable. Once I realized this was happening my initial reaction was to not to attend events and to politely decline invitations. What has been healthier for me, however, has been to dip my toes in the water slowly. Join small groups for a limited periods of time with people I trust and see how it goes. I also try and let people know that I may have to leave early. This has helped me regain my confidence and realize that most of the time now, I can do okay. The verbal difficulty shows up more often when I am tired, so I try to mitigate that by making sure I am rested before events. Over time this has helped me to become more open to joining others. But it has been a process and that process has been difficult for me to communicate to others that I am not intimately familiar with. So sometimes, still, it’s a polite, “No thank you”. Period. We sometimes forget that we don’t owe an explanation to everyone. And those who know us will understand. A new normal Adjusting to the new normal after cancer can present so many challenges, not the least of which is that new normal is fluid and changes as we get stronger and learn our limitations. Managing expectations and reality requires you to have patience with yourself but also that our family, friends, and loved ones also have patience with us as we navigate the after cancer. While we don’t always like to admit our limitations, communication is the key to managing expectations, avoiding hurt feelings and disappointment, and learning and accepting what our life looks like now.

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.