Living in Wonderland

There’s always something new around the corner; Just like Alice, you can only go forward. Circumstances constantly change around you and you still have to figure out where to go next, what to eat, and how to live boldly despite your diagnosis.

This has been a difficult couple of weeks.  I started on a new chemo regimen. My bowels are unstable. Sometimes they are fine, other times, not so much.  I have unpredictable nosebleeds in the middle of the night. I’ve had to put a temporary hold on some of my regular medications to avoid interactions while my doctor figures out the timing of when each medication hits my system.

Need I continue?

One tip I’ve learned is to slow things down.  Take a warm bath, take a nap, read a book, listen to some gentle music, go outside and take a short walk in the sunshine. Try sipping a soothing cup of ginger tea.  Or have a warm bowl of carrot ginger soup.

I want to tell you something I tell myself in moments like these…

I am strong and can get through this. This is a temporary problem that can be managed.

What are some things you do to overcome discomfort?  Please add a comment with your ideas. You are not alone in your journey and you can help someone else by adding to this discussion.

Metallic taste causing loss of appetite

When you are undergMetal Mugoing treatment for breast cancer, one of the side effects you may experience is loss of appetite or taste changes.  Some people get a “metallic” type taste in their mouth, which can affect the flavor profile of many foods.

Sweet might help mask the metallic taste

Sometimes sweet will taste better and help you to eat better if you are having side effects from your treatment.  Try adding a little sugar to foods and see if it helps.

Have you ever eaten a little cranberry relish with your meat or chicken, even if it’s not Thanksgiving Day?  Try it now — it might help mask the metallic taste.  Throw some raisins or chopped prunes into rice or other grains.  Eat sweet potatoes, butternut squash or cooked carrots drizzled with a little honey or maple syrup to get your taste buds going.

You can also try making sweetened fruit smoothies or whey shakes as an option.  If you  add some green vegetables (such as spinach, kale, swiss chard or parsley), the smoothie or shake can also help you reach your daily goal for 5 or more vegetables as part of a healthy diet.

Add seasonings to change the flavor profile

Herbs like rosemary, basil, oregano or mint can help with taste changes. If you have acid reflux, stay away from the mint.

You may need to experiment a bit. For example, meats may taste better if you add some ketchup, mustard, hoisin sauce or mild barbecue sauce.

Flavor your water if it doesn’t taste good to you

Try adding a little lemon juice and honey or sugar to make a mild lemony drink.  Experiment with my recipes for Strawberry Basil Water or Cinnamon Cherry Sparkling Mocktail.  You can also try adding other sweet fruits or vegetables to water to give it a little flavor. Throw some cut up apples, cucumber slices and pineapple or slices of orange, to make plain water taste better.

It’s especially important to stay hydrated when you are undergoing treatment for breast cancer, so you need to find something you can drink throughout the day.

Have questions? Post them in the comments and I’ll be in touch to help you get the answers you need.

 

 

Reduce heartburn and acid-reflux with a few simple tips

During your treatment for breast cancer you may end up with an occasional incident of acid-reflux (also called GER- gastro esophageal reflux) or heartburn. For some patients, this can become a more frequent side effect that they need to learn to manage in order to be more comfortable as their treatment progresses.

If it becomes more serious and constant, you may find yourself with a diagnosis of GERD (Gastro Esophageal Reflux Disease).

 

Your digestive system

The basic anatomy of your digestive system is that your mouth empties into your esophagus.

The esophagus is connected to your stomach and has a series of muscles which contract in a wave-like motion to move the food from your mouth down to the stomach.

There is a sphincter at the bottom of your esophagus (think of it like a valve). Under normal conditions this “valve” keeps the food and stomach acid from coming back up into the esophagus. Sometimes, during your treatment for breast cancer, the medications or radiation treatments you receive can affect this valve and some of the food and stomach acid can leak back up into the esophagus.

The pH of your stomach acid is very low (1.35 to 3.5 pH) which means it is a very strong acid.  This is why you will get a burning feeling in your esophagus if the sphincter (valve) doesn’t keep the contents of your stomach down where it belongs.  This is acid-reflux; heartburn is the resulting pain that you feel in your chest when the strong acid has come up into your esophagus.   Having acid-reflux is very unpleasant and you will want to know what to do when it happens.

Tips to help manage heartburn and acid reflux

There are a few simple ways to help manage heartburn and acid-reflux at night, which is when it often occurs.

  • First, try to avoid foods that will set it off.
  • Second, try to eat dinner early enough so that much of your digestion is well underway before you get into bed
  • Third, try raising your head while you sleep. I have a triangular-shaped wedge pillow that I keep close by my bed when I am undergoing chemotherapy. That way it’s easy to grab and I don’t have to go looking in the closets for it in the middle of the night.sleeping on a wedge pillow may help with acid-reflux

 

 

If your acid reflux or heartburn persists, or gets worse, contact your physician for assistance.

 

 

 

 

 

 

 

Breakfast for Dinner during Chemotherapy

Whole Wheat Banana Pancakes

 

If you have an upset stomach after a day of chemotherapy, and can’t find anything you want to eat, have you ever made  “breakfast for dinner”?  Foods like pancakes or eggs.  You might want to try making something like my banana pancakes recipe for dinner.  Often, people find breakfast foods are more appealing than dinner foods,  if their stomach is a little queasy and their sense of taste has been affected.

Bananas for when you’re queasy

One advantage of banana pancakes is that they include bananas. Bananas are one of the foods we recommend if you are feeling a little nauseous (along with white rice, applesauce and toast). This is the “BRAT” diet you may have heard of if you’ve ever had an upset stomach during a hospital stay.  So if you are a bit queasy, these pancakes might taste good on a night when you feel like you just can’t eat.

When you’re hungry for simple carbs

Pancakes for dinner can also help you satisfy your hunger for foods like doughnuts, bagels, cookies and cakes,  etc. if you find yourself craving these things after your treatment.  If you’ve been given steroids, this might be one of the side effects you experience as you start to head home after your day of treatment.

Other “breakfast for dinner” choices

If banana pancakes aren’t for you, try simple scrambled eggs and some lightly buttered toast, a small bowl of oatmeal with a bit of butter and a little sugar or maybe a piece of french toast. If you are used to eating rice in the morning, try making a rice congee for dinner if you are feeling a little “off”.  The idea is that you want to try to find something that is mild and will be soft and easy to eat.

The sugar in the oatmeal (or if you put maple syrup on french toast or pancakes) may help offset taste changes you might have.  Some people get a metallic taste during or after certain chemotherapies, eating something that is a little sweet can sometimes help. Or, if foods that are sweet are not appealing, add some lemon or lime juice to your food.  You may have to experiment a bit to find something you like. What’s important is that you try to find something that appeals to you since your body needs the energy from food to help keep you strong.  If you can manage to add a glass of skim milk to your meal, that will also add some additional protein which helps round out the meal (8 grams of protein in one cup of skim milk).

Many people feel o.k. after a day of chemo

Many people feel o.k. after a day of chemo. For instance, when I’ve had an upset stomach during a chemo week,  it generally has been 2-3 days after treatment, not the day of chemo itself.  And, it’s not a side effect I’ve had every time I’ve had treatment.

So keep this idea in your bag of tricks in case you ever need it.   Remember, when you are going through treatment for breast cancer, you want to try to maintain your weight — not lose too much, and not gain too much.

Let me know if you need help finding foods that will work for you.

 

 

Breast cancer treatment and weight loss

Samurai
When you are diagnosed with breast cancer, consider yourself at war with the disease.  Once you’ve gotten over the shock of your diagnosis and have selected your healthcare team, you need to figure out how and what you are going to eat while you are on this journey.

Maintaining your weight while undergoing cancer treatment can be a challenge. However, it can be a very important part of how you feel and how well you can continue your normal activities while you are undergoing treatment.

Weight changes during breast cancer treatment

Excessive weight loss can hinder your ability to complete your treatment regimen, may lead to a poorer outcome and quality of life, and can increase your chance of recurrence.  Excessive weight gain during treatment is not a good thing either.

The problem is that it may be difficult to eat during some aspects of your treatment due to side effects and other issues. However, depending on your circumstances, you will often need to eat A FEW MORE CALORIES and MORE PROTEIN than you did before the diagnosis, just when you don’t really feel like eating. STAYING HYDRATED with extra water is important too (ask your doctor if you have any fluid restrictions).

If you are suffering from certain side effects, you may not want to eat much, but with careful planning and monitoring it is possible to maintain your weight.  

How much more?

Let’s make this easy by using an example.  If you are a healthy woman and weigh approximately 150 pounds and are moderately active, depending on your circumstances, you typically need to eat around 1,400-1,700 calories per day and 50 – 60 grams of protein to maintain your weight. To put this in perspective, 3 oz. of chicken breast provides around 140 calories and 26 grams of protein, without any sauce or additions.

If you have been diagnosed with breast cancer, depending on your specific situation, the same 150 pound woman may need to eat around 1,700 – 1,900 calories per day and 75 – 100 grams of protein while on treatment. If you have other conditions, such as kidney disease, heart disease, obesity/overweight, or diabetes, be sure to consult with your physician and a qualified Registered Dietitian Nutritionist about the right amount of calories and protein for you.

How do you know if you are eating the right amount?

Weigh yourself every few days.  Your weight will fluctuate due to the effects of some of the medications you take during your breast cancer treatment. After a chemo treatment, it will typically be up a few pounds due to the extra fluid you receive during the infusion.  However, if the overall trend is either up or down, speak with your physician, and find out what you can do to maintain a “healthy” weight.

Have a question for me?

Give me a call at (609) 252-0877.

 

Coffee or Tea? What to drink while you are on chemotherapy

Some chemotherapies can be a little rough on your digestive system and are not really compatible with coffee or tea, which are both thought to contribute to acid reflux.  There is some evidence that it is the caffeine in these drinks that may cause the problem, it could also be the somewhat acidic nature of both coffee and tea.

Speak with your doctor for advice about whether you need to avoid both these drinks altogether while you are on treatment.  It can vary for different people and different treatment protocols, but in many cases you will probably be more comfortable if you can forego the coffee and tea during the weeks you are in treatment.

However, most of us like to enjoy a warm cup of coffee or tea in the morning to help us start the day. So what to do?

If you’ve spoken with your doctor about this topic, and he/she is recommending you avoid these drinks, it is usually easier to cut back over the course of a few days before you go “cold turkey.”  You can also ask if you can switch to decaffeinated tea, but please don’t drink peppermint or mint tea, as they too can trigger acid reflux.  Finally, don’t go for any “health” teas which act like a supplement unless you have cleared it with your doctor first. Supplements in general are not recommended when you have breast cancer (or other cancers).  More on this topic soon.

Some people are able to tolerate some teas during breast cancer treatment, so after you’ve spoken to your doctor and been cleared to try some alternatives in the morning, take notes and see how you do. That way you’ll be ready to get into a new morning routine when you start chemotherapy.

Any day with hair is a good day

Colored WigsI often joke with my friends that  “any day with hair is a good day.”

When you have breast cancer, you have a lot to think about and a lot to do. Over the years I have found that many women end up focusing on hair loss,  and they will direct a lot of their fear and anguish into this issue.  Never mind that they have a serious disease, or that they’re going to have to possibly go for surgery, chemo, radiation or other treatment.

It is often all about losing their hair.

 

This plays out in many oncology offices and support groups around the world, when this is one of the first concerns that many women will ask about when initially diagnosed.

“Will I lose my hair?”

This is a question for your doctor. You should also ask the follow up question about if your hair will grow back.  In my personal experience, so far it always has, but there is always the chance that sometime it might not.  Or, it might grow back quite differently than your original hair (curlier, straighter, thinner, grayer, etc.).    Sometimes, when it grows back differently, it eventually changes yet again, and may look more like your original hair. This could take some time, and it doesn’t always happen.  In fact, the last time I lost my hair and it grew back, it actually looked better after coming in than it had before I’d had any treatment.

At the end of the day, either your hair will grow back or it won’t. (And, usually, it does.)  We don’t have a crystal ball to predict, but it is not the end of the world, and many, many women with alopecia wear wigs. According to one estimate, 20 million women have female pattern hair loss (for various reasons including chemotherapy, but not exclusively due to chemotherapy).*

You are not alone.

There are several ways to handle the hair loss problem, and you’ll have to decide what is right for you.  The typical options that most women choose from is to wear a scarf or hat to cover up the problem, get a wig, or go proudly bald.

I’ve tried the scarf/hat option and the wig option. I was never bold enough to walk around bald – just not for me.

In any case,  the next time I lose my hair (assuming I might), I’m going with a good well-made wig. After all, any day with hair is a good day.

 

*Papadakis, M and McPhee,S. Current Medical Diagnosis & Treatment, 2015, McGraw-Hill, 2015.

What’s chemo like?

ChemoOne question I often get from people is “what’s chemo like”?  If you haven’t already started chemotherapy, let me warn you now that you will probably get a lot of questions from family members and friends who will ask “what is chemo really like” and “is it as awful as it sounds?”  Then they’ll sometimes make “the face” – pity, fear, or anxiety over your illness.

I’ve had chemo several times, and here I am living to tell the tale.  Chemo can be a scary concept when you first hear about it – your doctor tells you that you must succumb to having toxic chemicals sent into your body on a weekly, bi-weekly, monthly or other basis.  You’ve probably spent days (or nights) scanning the internet to read the tales of others who have gone before you.  You often don’t know where to turn for help – everyone is an “expert”, whether they’ve personally experience chemotherapy or not, and many people seem to have a visceral reaction to the whole idea of chemotherapy.

Let me dispel some of the mystery…first, understand that this is your personal journey and you may react well or poorly to chemotherapy. Second, no one can predict in advance what it will truly be like.  For me, the best way I can describe it is that it’s usually kind of boring.  Yes, boring.

You go to your doctor’s office, get a short physical exam, and then your doctor or his/her nurse will test your blood to make sure you are healthy enough to have chemo that day.  Next, you get sent to the infusion room which is where the actual treatment will take place.

You pick a chair (or get assigned a chair), and wait until the chemo nurse is ready to start your infusion.  While you wait you can read, snack, listen to a podcast or music, talk to others who are there for treatment, or talk to your friend who came with you for this momentous occasion.

If you are getting an infusion, you will get a catheter placed in your arm, which is how they get the chemo into your veins, unless you have a port. Getting the catheter started feels similar to getting a shot or when someone draws your blood for a lab test.  One quick pinch and then it’s done and taped down.  After that I generally don’t feel it for the rest of the time I’m there.

That’s it.  Depending on how you react, and what type of treatment you are receiving, you might fall asleep, you might feel a little cold (or a little hot), or you might get a funny taste in your mouth.  Sometimes you might have an adverse reaction, but your doctor and the chemo nurse will be closely monitoring you for any signs of a problem and will take care of it quickly.

When you are done, the nurse removes the catheter, puts a bandaid over the spot where it had been, and sends you on your way.

 

On Losing Your Hair

Hair Loss

If you have chemotherapy, you will quite likely temporarily lose your hair.  The first time this happens to you, it can be quite traumatic.  Until it happens to you, you don’t really realize how important hair is to your total look.

For most of us, appearance is important and hair is an important part of what people see when they look at us.  When we have breast cancer and lose our hair from chemotherapy or other treatments, it can become a problem for our self-esteem and general level of happiness.  When we’ve lost our hair and look in the mirror we suddenly don’t recognize the person staring back at us.  In fact, you might see your mother or your grandmother or some other cancer patient you once knew, and it can be a very distressing moment.

When we go out in public, it can be even worse, because depending on how you handle your hair loss, your appearance announces to the world that you have cancer.  As a result of the fear that the “C” word instills, many people may suddenly start treating you as a “victim”, not as the person you are who just happens to have a disease.

 

The first time I lost my hair I started with the scarf/hat option and when I look at the old pictures from those days, I am embarrassed at how poorly I looked when I went out into the world.  I felt betrayed and like a victim – hence I looked like a victim and got treated accordingly.

After a while I bought a wig.  A really bad wig.

I bought it because it was cheap and was more or less the color of my own hair. I didn’t want to spend a lot of money on a decent wig because I think I was partly in denial about the whole thing. At the time, I felt like a victim and it didn’t feel right to spend a lot of money on my appearance.   In my mind I told myself I was going to die anyway, so why bother trying to look good?

I wore the bad wig exactly once.

It was to a women’s business networking meeting.  Everyone stared and I was mortified at their reaction.

After I got home from the event, I put the wig in the back at the very top of my closet, and went back to the scarf/hat option with a “halo” of hair.  I wasn’t happy about my look, but I didn’t know I had other options.

A “halo” of hair is basically a circle of hair that is primarily bangs in the front and you wear it under a scarf or hat.  I loved my “halo” of hair – you could tell it was a wig but at least it looked decent enough for most situations.

Soon enough my hair grew back, I got it cut and colored.  And when I looked in the mirror a few months later, I no longer saw the victim I had been.  I was back, and feeling good.