What is More important than Diet and Exercise in Women’s Health? SLEEP!
How does sleep deprivation during all seasons of a woman’s life affect your health? “Catastrophic sleep loss epidemic” is how sleep researcher Dr. Matthew Walker (U of C Berkley) describes sleep challenges. The factors contributing to sleep loss are: the electrification of our homes, the electronic connectedness of our lives, the porous membrane between our home and work lives, loneliness/depression, the prevalence of alcohol and caffeine and hormonal changes. He has confirmed through research and clinical studies that lack of sleep contributes to cancer, Alzheimer’s disease, diabetes, poor mental health and obesity. We also stigmatize sleep by associating a long, restorative sleep or nap with laziness or shame.
Eight hours is still our healthy goal. But how do we get there?
Make it non-negotiable. Plan your day around sleep. Exercise must be before dinner, preferably before lunch. Light stretching or restorative yoga are good options for your evening. Reduce the size of your evening meal so that digestion is a breeze…make lunch your hearty meal! Eliminate sugar. Completely. Avoid alcohol at dinner but if you’re so inclined, enjoy it with food and strictly keep it to 5 oz. (that’s ½ c. + 1 T.)! Daytime naps should be restricted to 20 minutes maximum and be completed before 1 pm. Go to bed at the same time every night, setting your blanketed alarm for the same time every morning. Be consistent to the point of being rigid! Set a second alarm for 2 hours before your dedicated bedtime. When it rings, turn off ALL blue light emitters in your home, from your smartphone to your ipad/ereader to your laptop/TV screens.
Think of all the quieting activities that you provided for your babies in order to make sure that they (and you, the exhausted new parent) slept. Downtraining. Calming. Enjoy a warm bath or shower (unless that’s your morning wake-up call!). Savour a light protein snack (boiled egg, small piece of cheese, strip of chicken breast….no carbohydrate) to hold you through that pancreas/energy dip in the wee hours of the morning. Your bladder shouldn’t awaken you at night unless you’re over 60, then only one trip to the loo is acceptable. It is effective to reduce your fluid intake after dinner to give your bladder an opportunity to learn to behave. If you enjoy a warm drink before bed, make it chamomile tea or warm milk…..nothing with alcohol. Alcohol is pure sugar and guaranteed to keep you from falling asleep and/or to awaken you in a few hours.
Do a “brain dump”….write down all your concerns, lists and plans and leave it in the kitchen. Tomorrow will be soon enough to tackle it all and as Mom said, “It will all look better in the morning.”
Your bedroom should be a “sleep cove”….a dark and comfortable room with light restricting curtains, cool, comfortable temperature, your body kept warm (cozy quilts or blankets) and comfortable (clean, fresh sheets that invite you to sleep). A light spray of lavender has been proven as a sleep promoter. And your bedroom is not for reading, lounging, chatting, talking on the phone…..your bedroom is for sleep and intimacy. Nothing else! Your own sleep- promoting, dedicated space.
It takes time to retrain your sleep patterns. Be patient, firm and compassionate with yourself. Making sleep a priority now is an important part of your own self care and health promotion. Look forward to bedtime, enjoy the restoration that sleep brings and awake with energy for today!
Heart disease isn’t just a man’s game anymore……as women, we have achieved equality in cardiac stats! 1 in 2 of us will have a heart event in our lifetime. It is the #1 killer of women in Canada, taking the lives of 31,000 women in Canada annually. But here’s the brilliant news! 8 out of 10 cardiac or stroke events are preventable. Your healthcare provider is here to diagnose, help and advise, but your heart health is mostly up to you.
What does a heart attack in a woman look like?
We all think about that classic vice-like squeezing or fullness in the centre of the chest that lasts for a few minutes and may return. That’s possible, but here’s where women consistently describe different symptoms. We often have pain in one or both arms (not just the left side), have shortness of breath (but not always with chest pain), break out into a cold sweat and experience nausea, vomiting, back or jaw pain, neck stiffness, dizziness or extreme fatigue. As with so many conditions, women are more complex and varied.
Why are we different in our heart symptoms?
Well, it mostly comes down to hormones. After menopause, we no longer have the generous cardio-protective flow of estrogen in our bodies and our risk of a heart event increases. A natural slowing down in our activities reduces the fitness of our heart and may add weight to our bodies, especially around the middle. Arthritis/pain make it more challenging to find just the right kind of exercise. Pelvic dysfunction (incontinence and prolapse) often make it more challenging to enjoy physical fitness classes and activities.
How can we prevent 8 out of 10 heart attacks and strokes?
Set a goal to become physically active for 150 minutes each week of moderate (can barely chat) to vigorous (huff and puff) activity a week. Start with bouts of 10 minute bursts at a time. Climb up and down your stairs without stopping until your body says to take a break. Walk for 30 minutes daily or add an errand-walk into your day. Include a warm up and cool down so your heart is ready for and restored from the fun! Stretch after you exercise when your muscles are warm and ready to enjoy lengthening. Wear comfy clothes and a sports bra that is supportive but not too tight. Hydrate as you perspire and enjoy a post exercise snack of fruit or nuts. Find ways to exercise that you enjoy. Repeat.
Eat a healthy diet that is richly coloured with lots of greens, provides a variety of fibre (including legumes, beans, peas, nuts and seeds) and is delicious. Eliminate empty calorie snack foods (read the labels on those foil wrapped goodies) and sugary drinks. Enjoy a vegetarian meal to provide you with a delicious source of high fibre, low saturated fat option with lots of taste and nutrition. Make time to cook at home and sit down with your family to enjoy a meal together. Savor the flavour, enjoy the health promoting, nutritious food and precious time together.
Reduce your stress. Make sleep a priority. Meditate or have quiet time for 10 minutes every day. Balance your activities with restoration. Take time to let go, relax, enjoy, do nothing. Just be. Learn to breathe to relax….on your in-breath, take a deep belly breath that will lower your blood pressure, calm your neurological system and bring peace of mind. Don’t overlook your emotional/mental health. Access help if you’re struggling with stress, depression, anxiety or grief.
It’s about your heart, your commitment to heart health and living vibrantly through the years. Enjoy!
Fall is here in our chilly mornings, the leaves beginning to turn and our valley enjoying apple, plum and pear season. But fall brings falls…..evidenced by the an icey film on our sidewalks on the shady side of the street. Sleuthing out your bone health, understanding a Bone Mineral Density (DEXA) scan and then knowing how to help you enjoy brilliant bone health through every age and stage will help you avoid those pesky fall-induced fractures of your wrists, shoulders and hips.
Our bone health is based on our body's build, our weight management, our activity level and type/frequency of exercise, our diet, our general health and our age. All of us have our own unique blend of variables; as women, our one commonality is the reduction of bone-protective estrogen as we wander through menopause. Menopause is reached by a natural reduction and eventual cessation women's hormones in our bodies, through surgery (complete hysterectomy) or through taking estrogen suppressing medication (Tamoxifen or other aromatase inhibitors) or simply through the passage of time.
Women are typically referred every 3 - 5 years for a DEXA scan, available to us at the EK Regional Hospital in Cranbrook. DEXA is an abbreviation of Dual Energy X-ray Absorptiometry, a targeted xray that measures the bone mineral content or density of your bones, is a reliable predictor of fracture risk. A central DEXA measures the head of the hip and the mid lumbar (low back) spine (most commonly used and most reliable test). A peripheral DEXA measures the forearm, the heel, wrist and hand bones. The modern DEXAs are very low radiation scans, about 1% of a lateral spine xray. Your height is usually measured so that any loss of height is documented in relation to the xray. "Prospective Height Loss" tells us that if you lose more than 2 cm. of height over a period of three years, you may have a new compression fracture in your spine. "Historical Height Loss" tells us that, if you're over 60 and have lost 6 cm. of height or are under 60 and have lost 4 cm. over more than three years, then again, a compression fracture must be considered. An xray tech performs the test which is painless and takes about 15 minutes; from there, a radiologist interprets the results which are then sent off to your GP to discuss with you and to guide your treatment.
The DEXA test tells you 3 things about your bone mass:
1. Your bone mass in grams per centimeter squared.
2. A DEXA score comparing you to a healthy control group, often a 30 year old healthy woman, your "T score".
3. A DEXA score comparing you to your peers, your "Z score".
Complications to your DEXA score can be caused by osteoarthritis in your spine (pitting or rough joint surfaces can look like bone loss), osteoarthritis in your hip (difficulty rotating your hip inward to the best testing position), compression fractures in your spine (can look like dense bone), obesity (if you're over 350 lbs., some DEXA units can't accurately guarantee that the score won't be skewed by photon passage through extra tissue), being too thin (scores are widely variable for thin women from one test to the next) and switching machines/locations (they are all calibrated very carefully).
In the end, you'll meet your doctor again to discuss the score. We usually talk about the Tscore which will tell you a number, hovering just above or below 0.
In my clinic, I've been hearing people's increasing awareness and concurrent increasing anxiety regarding the science of climate change and our response to that. The International Panel on Climate Change 2019 is the most recent comprehensive assessment report about knowledge on climate change, its causes, potential impacts and response options. This article is a collection of how we can live a climate aware life and, at the same time, a personally healthier life too!
By living a climate change aware life……
You'd breathe in cleaner air, rushing around a little less, enjoy better work-life balance by reducing your travel in our vehicles to needs based travel only.
You'd have a level body weight, listen to the birds, the wind, the scents and notice your neighbourhood and neighbours by biking or walking.
You'd enjoy a staycation, a local, stress-free holiday, a weekend or picnic at one of our beautiful Kootenay locations, spend less and have less travel stress by stopping flying and planning a holiday near home.
You'd eat real food, mostly plants, not too much, Michael Pollan's prescription for a healthier planet and a healthier you.
You'd enjoy seasonal and local food, aware of the food miles in your meals, preserve rainforests faraway and enjoying creative cooking, food growing and storing in your own kitchen.
You'd grow some of your own food in the Victory Garden kind of way, proud of what you produce yourself with your home soil and your own hands, making the meal on the table even yummier!
You'd get to know your farmer and how they farm, supporting organic, soil restoration practices, aware of our precious pollinators and providing carbon capture by eliminating tillage/carbon loss!
If you continue to eat meat, you'd enjoy an occasional meal of grass fed, pastured beef which (check the research) contributes to soil health and is a carbon capture system, like the buffalo that roamed our prairies and the elephants on the savanna in Africa!
You'd simplify your home, manage less clutter, less stuff, less purchasing, less maintaining, less storing and dusting. Your needs reduce and there's a little more money in the bank and/or a need to earn less!
You'd reduce the plastic load in the world by reducing the plastic purchase and use in your life, from straws to shopping bags to storage items…..perhaps even not buying groceries or "things" that come in plastic packaging. Finding your personal care/cosmetics/toothpaste that have plastic microbeads in them in a next step and choosing other options.
You'd reduce your busyness, lie in a hammock more, read a book, attending to today's gift of being truly present, grateful for living in this amazingly beautiful valley!
You'd feel a renewed sense of hope by acting with compassion for those who are suffering most from weather weirding/floods/fires, especially those in the developing world and our next generations.
You'd lower your energy demands and costs by turning off lights, mowing your lawn minimally, electrifying your tools (lawnmower, chainsaw, car) insodoing making the jobs more enjoyable and less noisy, drying your clothes on a clothesline or rack, washing dishes by hands with your kids, using all your food wisely and having less food waste,
You'd help your neighbour who works in the fossil fuel industry transition over to working in alternative energy by buying less gas and oil yourself, eating locally and employing them to add alternative energy (solar, wind, microhydro, upgrading your house efficiency) to your own home.
You'd experience a sense of wonder by slowing down, walking mindfully, breathing in some clean air deeply, less rushing, consuming and spending, visiting more, enjoying life more.
You'd enjoy a sense of partnership in a healthy future, rather than living in fear of the climate crisis, leaning into a healthier future for your body, your family, our town, in our region. RDCK has signed onto the 100% Renewable Kootenays commitment by 2050 and we can enjoy being part of a climate aware region!
We live in such a beautiful corner of the world. Becoming an active force, taking personal actions, will help you have a sense of hope and a commitment to the future for our children and grandchildren.
In the previous articles in this series, we've journeyed from diagnosis to testing, surgery, chemo, radiation and now……we're onto life. How do you go onward from survivorship to thrivorship?
If you have had lymphatic challenges, remember that any exercise or exertion requires that you wear your pressure garments. It's important not to push the lymph vessels beyond their comfort level, so don't let yourself overheat. Remember to protect your skin (and the lymphatic vessels who live just under your skin) from sun, bug bites, scratches and hot tubs/steam rooms. When you're exercising, choose loose and comfortable clothing and make sure you never have a bra line visible on your skin when you take it off! "No restrictions" is the rule, so check your skin. The sensation around your bra line may be reduced from surgery, so check in a mirror. Always keep mindful of your "daily arm load", never pushing past today's budget. And keep your energy tank at least ¼ full.
Breathing is natural, right? You take 23,000 breaths per day. Some of your respiratory muscles have been interrupted by surgery and furthermore by radiation. Learning to breathe in varied ways, fully and completely can be helpful. How you breathe, how your ribs and 3 diaphragms (your throat, breathing and pelvic diaphragms) move is an intricate ballet. Asking your physio or yoga therapist/teacher to help you learn to breathe well again is wonderful!
Shoulder and arm movement is a focus during your post-surgical time. The muscles that both guide and move the shoulder are on your chest and back. You'll need some nudges to learn to find, time and strengthen the shoulder (the spine, shoulder blade, collarbone and shoulder joint). Keep in mind that your body wants to restore to beautiful movement and function.
Pelvic function (bladder, bowel, sexual, pelvic organ support) may need some attention through this time. The posture that you may find comfortable after surgery (leaning forward + curling inward) puts pressure on your pelvis. Some of the hormonal therapies reduce estrogen's lovely bouncy support of the pelvic systems. If you're struggling with pelvic function, ask a pelvic certified physiotherapist to assess you and help you along. It usually only requires a few appointments.
Are you taking time for restoration? In really big studies, 30-90% of women report loss of sleep through the first year of breast cancer. You need sleep for recovery, sleep to reduce "chemo brain", sleep to support's brain's own lymphatic (called the glymphatic) system, sleep to help your body heal and sleep to help you find the "new you". Practice consistent, sleep-supporting strategies and rest before you're exhausted. Daily calming practices may also reduce any pain you may be experiencing by reducing the general threat level under which your body is living. Know your limits and respect that your body may be on high alert. Practice deeply compassionate self care. Meditate or pray for 10 - 15 minutes per day, sitting quietly and listen to your breath. Think back on all you've been through and the resilience that you've discovered. Be open and vulnerable with your MIPs (most important people), ask for understanding and help when you need to, find peace with downtime and rest….these are new skills for many of us. Play a little and enjoy today.
Women with breast cancer have undergone surgery, experienced radiation and/or chemotherapy, then have begun hormonal therapy. Reconstruction surgery may be a next step.
How do you press restart button with this new body, new awareness, new priorities?
How to you go from survive to thrive?
We'll begin by looking at exercise in all its forms. Exercise is a key part of survivorship, reducing recurrence of breast cancer by 50% thereby boosting thrivorship, that brilliant skill of learning to live a joyful life again! A key to remember is that breast cancer survival rates, since 2010, have grown beautifully. It is now considered a chronic disease, different from diabetes and arthritis for sure, but breast cancer is a disease to live with and manage.
Research has shown that strength training is key. It must be wisely employed in order to avoid overwhelming Cancer Related Fatigue (CRF), to respect the surgical/structural changes in your body and posture and to help stave off lymphedema. While you're undergoing chemotherapy, we know that better oxygenation from strength training improves the therapy's effect, so it's good to exercise gently and consistently while undergoing chemo treatment. However, with radiation it's a time to maintain and not gain; you'll be working at holding your own through that time.
Strength training is two simple words, but do you have to go to a gym when you may be immune-compromised and overwhelmed with social interaction? No. You can do this all at home with a structured programme, some knowledge about the how-to's and some awareness around wise limitations. The first words to repeat are start low, progress slow. Learn how to strengthen your dorsal self (think dorsal fin) that has become long and weak. Learn how to stretch (gently, carefully and consistently) your front body where all the attention, surgery and radiation took place. Learn how to build your bone health again through weight bearing activities and exercises.
Your bones have been challenged by reduced activity while you went through medical/surgical interventions and rested, age/stage (menopause reduces your estrogen which is a bone-protective hormone), chemotherapy (which may have reduced your estrogen even more), radiation (to your upper arm and mid spine), corticosteroids (for nausea and inflammation) and reduced nutrition because is was difficult to eat well through this time. Bone loss can be reversible. Improve your awareness of balance and intentional movement so that you are protected from a broken bone due to a fall. Attending to bone supporting exercises and balance challenging exercises can be simple and fun. You can use your body weight, a wall, the floor or your bed to perform all the exercises that you need.
In respect of CRF, remember that you must be aware always to only reduce your energy "tank" to ¼ full. Check in with yourself, stop at ¼ tank, respect your limitations and begin again tomorrow. If you have a week off for a holiday, illness or treatment, reduce the intensity when you take exercising up again. We talk about increasing your "exercise markers": cardio (huff and puff), strength, flexibility and endurance, remembering always that slow and steady is the key.
Overexercising can bring on overwhelming fatigue, stressful inflammation and put you at risk of lymphedema. Remember we want to keep lymphedema at Stage 0, practice an immediate response to cording or Axillary Web Syndrome and awareness of those almost imperceptible symptoms of lymphedema (tingling, heaviness, density or weightiness of an arm).
An amazing resource is the APP "Untire", offered free of charge online through your favourite app store from 2 Danish researchers. It helps you navigate whether to rest or be active, to support sleep and calm your body, to be social or pull inward.....great recommendation from many in the cancer world!
Uncomfortable conversation? Toileting is an activity that we engage in about 10x per day and, yes, it's private but it's still important to talk about! There are good and bad ways to spend your time on the toilet and some of them depend on your particular body, your particular resting and active tone, patterns of movement and breath and the health of your digestive system. It depends on whether or not you've had surgery, have scar tissue, are rushing, have privacy, how you were taught about toileting as a child….so many factors.
Let's start with "normals":
It's normal to void (release your bladder, urinate or pee) 6 - 8 x per day, including night time voids. You shouldn't be voiding at night unless you're over 60 and then only once. After 80, twice is acceptable. You should never need to rush and you shouldn't leak en route. You should also be able to tell your bladder to wait. Traveling to the toilet to void every 3 ½ to 4 hours in a calm, controlled and easy manner is awesome. You should enjoy a painfree exit of clear unscented urine and never needing to push or be effortful. It should take 15 - 18 seconds and be in a Bell Curve, starting slow, building to a crescendo and ending with ease. There should be no post-void dribble, no double voiding…..wipe and go dry until next time!
It's normal to empty your bowels (BMs or pooping) 1 - 3x per day up to every 3 days. Optimum is a full, complete and satisfying BM soon after waking up/eating your breakfast. Again, you shouldn't need to rush, but you should pay attention to the nudge to go to the loo for your morning BM. Don't ignore it and don't delay it. Spend 5 - 10 minutes enjoying bowel release. Toilet position for bowel release is seated comfortably, with support, either in a slouched posture or with your elbows on your knees as if you're reading a newspaper on the floor. The posture that's just right for you is dependent on the angle of the Puborectalis muscle that slings around the Anorectal Canal. Are your knees slightly higher than your hips with a raise under your feet? Squatty Potties are trendy, but for some people they raise the knees too high, tightening up their pelvic system making release of BMs more difficult. In addition, the consistency of your BMs matters. If you have loose, liquidy BMs (5 to 7 on the Bristol Stool Chart), the message that your internal anal sphincter sends to your brain when stool lands in the rectum is "Run!". If you have normal BMs (3 and 4), the message will be a calm nudge, "It's time now." If you have stodgy, dried out stool (1 and 2), the message gets distant…..it's your job to waken it up and pay attention to the faraway call, "It might be time soon.". You can waken this up with gentle heat on your lower tummy and belly massage upon awakening/during breakfast. This doesn't move stool along the passageway, but it does awaken peristalsis, the gentle squeezes that move stool through the colon. Having a tap-hot glass of water at night while you do your last tooth brushing just before bed can keep your stool hydrated overnight. A shot glass (2 T.) of prune juice along with your water may help. Avoiding all dairy, especially cheese, can help some people, along with reducing meat and increasing nuts and beans. Increasing fibre needs to be applied with caution. Recent studies show that increasing your fibre (leafy green vegies, ground flax seeds, psyllium, whole grains) needs to be done in 10% increments per week. Too much fibre makes for sticky stool, making exit more challenging and wiping truly "a pain". Not rushing is important. Take time to breathe into your belly, teaching your pelvic floor to release, opening your anal sphincters, creating ease. If you're sensitive to sound, turn on the fan or music. If you're sensitive to smell, keep a candle/scented spray nearby.
There is no one answer to happy toileting, but it pays in good longterm health to find yours!
The bossiest, most demanding part of our pelvis is our "back passage" (our anorectal function, BMs or pooping). If your bowels aren't emptying well (full, complete and satisfying daily BMs), then your bladder, your pelvic organ support, your intimate function and your general sense of wellbeing won't be thriving either. "Back Passage First" is a rule in pelvic physiotherapy. Once you learn and/or relearn wonderful bowel release, your other pelvic issues may be addressed with ease.
What is normal for your BMs? The rule is that you enjoy a full, complete and satisfying BM at least every 2nd or in rare people, every 3rd day or as frequent as 2 - 3x per day for some people. There should always be a sense of full evacuation of your stool, not a sense of "there's still some left behind". There should be ease in release, not pushing, forcing, breath-holding or grunting. There should be ample time to get to the toilet, not making a mad dash to get there in time. There should be a clean exit with tidy wiping with ease, no skid marks in your undies or loss of stool without you being aware. There should be no straining or pushing or pain. And it should end with a sense of satisfaction of a job well done!
What should a normal bowel movement be? Perhaps surprisingly, we talk about this a lot and the smart folks in Bristol, England developed the Bristol Stool Chart. It's a handy guide to give both you and your health care providers a simple way to talk the same language about our bowel function. The scale goes from 1 to 7. Numbers 1 and 2 describe hard lumps, either separate or together…..think deer droppings and indicate a level of constipation. 3 and 4 are sausage-y like shapes, sometimes dry and cracked or smooth and snake-like. If your bowel movements look like 3 and 4, that's great as long as they're the width of a sausage, not a pencil. That indicates other issues. 5 is soft and blobby with clear edges and indicates a lack of fibre in your diet. 6 is the beginning of diarrhea, soft and blobby but with ragged, frayed edges. 7 describes full-on diarrhea….loose, watery, liquid poop with nothing solid visible. Understanding and getting familiar with the Bristol Stool Chart can help you describe to your health care providers what's going on inside you.
It's not normal to have blood or mucous. Blood can appear from a hemorrhoid and enthusiastic wiping or can be an indicator that there are more challenging problems. Mucous shouldn't be in our digestive tract and suggests that your body is fighting an infection. You need to see your doc, either way.
Your BMs should be brown, with no undigested food visible, not chalky or blackish or have a truly foul or different-from-normal odour. We're not talking smelling like roses, but healthy BMs don't smell awful! Stop and have a gander…..this is digested food that's done its job for you, feeding you and giving you nutrition, energy for your life and yumminess….be grateful and pay attention. Your BMs give you cues about your health.
Your toileting habits matter. Firstly, it's important to understand the gastrocolic reflex. This is the nudge that you receive (thanks to your lower esophageal sphincter chatting with your lower colon) when you start your day with a warm, caffeinated drink. As you swallow, your colon gets the message, "Empty out yesterday's food…..today's is coming!" Paying attention at that moment will help you establish beautiful bowel habits. Go to the loo. Spend some relaxed time, not rushing, calmly breathing into your belly, with your knees slightly higher than your hips on support, massaging your tummy and enjoying effortless bowel release. It takes opening of the pelvic floor to accomplish this, so calm, unrushed presence is really helpful. Don't wipe right away. Take a few more breaths to be sure that you're done.
Toileting habits will be in our next "chat". Bladders and bowels ask different things of us on the toilet, so clarity around the messages you receive and your response is important.
We've talked about diagnosis, treatment and lymphedema in the last 3 articles. Now let's move onto two common, manageable secondary outcomes of breast cancer, CRF and Cording, "the other stuff". These conditions are so common that every woman going through breast cancer needs to become educated on what they are and how to address them. Read on!
Cancer Related Fatigue (CRF) is experienced by 70 - 100% going through breast cancer treatment. Women describe it as a whole-body tiredness that isn't relieved by rest or sleep. We think CRF is due to many factors, including the cancer itself, radiation, chemo and stress. It may come on suddenly, isn't associated with activities or exertion and may continue after treatment is over. The thyroid may become underactive especially if the lymph nodes in the neck have experienced radiation, causing increased fatigue by reducing your ability to metabolize. The combo of radiation and chemo may lead to anemia, increasing our fatigue by reducing the availability of oxygen in our blood. Our appetite may be reduced as well, making us less likely to eat nutritiously. Some medications that are prescribed during treatment may also cause fatigue. Then, there's our emotional health as we go through medical interventions and treatments, causing stress, fatigue and sometimes depression. We know that healthy lifestyle choices can hugely impact CRF. Energy conservation is important, wisely choosing where, when and what you'll in a day. Don't try to maintain your normal daily routines. Set gentler, kinder, more compassionate goals. The CRF Golden Rule is "Never Go Below 25% in Your Tank". If you feel fatigue coming on, recognize that you simply don't have a "reserve tank" on board. Stop at the first sign of fatigue, before you're depleted, or it may take days to recover. Talk with your doctor about your thyroid function and iron levels as you may need support in these areas. When eating is a challenge, choose only the most calorie dense, colourful and nutritious foods. One wise woman taught me that adding plain yogurt to her food made it more palatable as well as easier to chew, swallow and digest. Guard your sleep and rest time with dedication and ferocity! Recognize that you are in restoration and rebuilding mode. Exercise can help by cleverly changing your metabolism and giving you more energy. It's important to "start low and progress slow" and be consistent. An important proviso is that radiation treatment is a time to maintain rather than gain.
Axillary Web Syndrome or Cording is another common outcome from breast cancer surgery and treatment, seen in between 20 to 80% of women; its incidence depends on what kind of surgery and treatment you've had. Cords look like a guitar string that pops up under your skin anywhere from your chest to your armpit, elbow, wrist or palm. Women often see it for the first time when they stretch to put on their seatbelt or coat. A cord is your lymphatic vessel tightened up. They "mate once for life" and don't heal, so helping them release and get back to work is important. If you have cording, you also have a raised risk for lymphedema down the road. Your breast cancer physio can help you reduce or lose cording with lymphatic manual therapy, myofascial release and gentle stretching. You can regain full lymphatic function, release your lymph vessels/skin tissue and find full spinal and arm movement in the mix!