Cancer care for everyone. Treatment that’s right for you. A cancer diagnosis will change your life. Having someone you trust with you every step of the way will help you get through it. Providence Cancer Center has the broadest scope of cancer services under one roof in Alaska. Our expert team of cancer specialists and support staff help you navigate all the important decisions and overwhelming emotions that come with cancer. We work with you and your family to develop an individualized treatment plan for the best possible outcome.
alaska.providence.org/cancercenter 3851 Piper St., Anchorage, AK 99508 907-212-6870
At Anchorage & Valley Radiation Therapy Centers we continue to offer cutting edge cancer technologies, allowing our patients to remain comfortably in Alaska for treatment. Our belief is the best cancer therapy treatment combines highly trained physicians and staff with advanced technologies in an environment of hope and compassion. We have achieved the Radiation Oncology Center of Excellence accreditation – reflecting the importance we place on providing the highest quality level of care to our patients. We are also the only Center in Alaska offering the non-invasive Gamma Knife Perfexion® option of treatment.
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Banished from your bedroom?
Help for Snorers and CPAP Users By: Owen Mandanas, DDS Do you or a loved one snore? Have you had enough of your CPAP device? There can be an end to the loud noise that banishes you from your own bedroom and there is a more comfortable alternative to your CPAP. Snoring can be a sign of obstructive sleep apnea (OSA), a sleep disorder that causes a lack of energy and affects 1 in 5 adults in America. As a dentist, I never thought that I could save marriages and people’s lives, but that is literally what can be done with oral appliance therapy.
Q
What exactly is sleep apnea?
A: Sleep apnea is defined as a cessation of breathing for 10 seconds or more during sleep. Apnea literally means “without breath.” Obstructive sleep apnea (OSA) is characterized by a collapse in the muscles of the upper airway that limits air flow to the body.
Q
If I snore, does that mean I have sleep apnea?
A: Not necessarily, but snoring can be a sign of sleep apnea, especially when it is accompanied by a loud, disruptive gasping. This is literally your body’s way of waking you up so that you can breathe.
Q
So something I wear in my mouth at night can help me stop snoring and help with sleep apneas?
A:
Yes, the oral appliance is similar to a sports mouth guard, but it is much more durable. It works by keeping the airway open during sleep by preventing collapse of the tongue and soft tissues of the throat. They are custom fit by trained dentists.
Q
Do I have to have a sleep study to treat my snoring?
A: Only a physician or nurse practitioner is qualified to diagnose sleep apnea, therefore a sleep study is highly recommended. Treating snoring without one assumes there is no sleep apnea and that can be dangerous. You may no longer need to go to a sleep lab for testing as home sleep studies have become more prevalent, even in dental offices. They can often provide enough information to move forward with treatment.
Q
I already have a CPAP device, will an oral appliance help me?
A: CPAP therapy has always been the gold standard for treatment of OSA, but many people cannot tolerate it and have stopped using their CPAP completely. If you are no longer able to use your CPAP, oral appliance therapy can be a great alternative. Some people also find the appliance useful for travel on airplanes or hunting and camping trips.
3D
MAMMOGRAPHY IS HERE.
Everything is sharper and clearer in 3D. PROVIDENCE IMAGING CENTER Tomosynthesis is the most exciting advancement in breast cancer detection in more than 30 years. This innovative new technology allows doctors to see breast tissue detail in a way never before possible to help find breast cancer at its earliest stages, when it is most treatable. Call us today to learn more and schedule your 3D mammogram. (907) 212-3151 direct or (888) 458-3151 toll-free 3340 Providence Drive Anchorage, AK 99508
UNDERSTANDING THE BREAST CANCER GENE SUSAN and AUDREY COMPLEMENTARY THERAPIES BUILDING STRENGTH, MAKING FRIENDS CHANGING PACE COMFORT FOOD
provimaging.com/3D-mammo
LET’S NOT PUT YOU ON A DIET A NEW NORMAL DOs and DON’Ts TEA and EMPATHY
PUBLISHER Alice Rogoff
Cosmetic and Reconstructive With sincere appreciation Plastic to our Surgery. staff in outstanding patient care. Callproviding us today to schedule your consultation. Jana Manuel, Cole, MDMD, Michael Michael MD Daniel Manuel, Suver, MD, and Daniel MD and Jana Suver, Cole, MD Appointmentsor orQuestions QuestionsCall Call FFor Appointments For
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EDITORIAL DIRECTOR Maia Nolan-Partnow EDITOR Jamie Gonzales jgonzales@alaskadispatch.com PRODUCTION COORDINATOR Viki Spiroska ART DIRECTOR Joshua Genuino LAYOUT Kelly Day-Lewis CONTRIBUTORS Amy Armstrong, Amanda Compton, Michaela Goertzen, Sarah Gonzales, Amy Newman, Tyrone Potgieter, Kerry Tasker, Nina Wladkowski Copyright ©2015 Alaska Dispatch News P.O. Box 149001, Anchorage, 99514
REVITILIZE >> Genetic Testing for Breast Cancer
by SARAH GONZALES
HEN IT COMES TO understanding cancer risks like smoking or toxic chemical exposure, most people comprehend the associated dangers of these things. But when it comes to other risk factors— like genetics—some may find the information harder to decipher. For the last couple of years the term “breast cancer gene” has been trending, partly thanks to the openness of celebrities like Angelina Jolie and Christina Applegate who— as a result of genetic testing—have publicly shared their decisions to undergo bilateral mastectomies to reduce their ongoing cancer risks. And while their bravery has certainly helped to promote education about genetic testing, using the term “breast cancer gene” isn’t quite correct, said Maggie Miller, certified genetic counselor at Providence Cancer Center in Anchorage. There are actually a few of these so-called “breast cancer genes” but the BRCA1 and the BRCA2 genes are the ones most often tested because they more frequently cause inherited breast cancer. Normal functioning BRCA genes “are called tumor suppressors or ‘spell checkers’ because they look for mistakes in our DNA and flag them to get them fixed,” explained Miller. It’s when the BRCA genes mutate and can’t do their jobs that the cancer risk goes up. These mutations are what the “breast cancer gene” test is looking for. The presence of a mutation in these genes
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not only signals an increased risk for developing breast cancer, it also indicates a higher chance of developing ovarian cancer in women and breast and prostate cancers in men. Women who have tested positive for the BRCA1 or 2 gene mutations are three-to-seven times more likely to develop breast or ovarian cancers in their lifetimes than those who do not carry the gene mutations. According to the American Cancer Society, “In some families with BRCA1 mutations the lifetime risk of breast cancer is as high as 80 percent, on average this risk seems to be in the range of 55 to 65 percent. For BRCA2 mutations the risk is lower, around 45 percent.” As a genetic counselor, Miller is available to speak with patients who are considering the BRCA gene test and also with those who have already tested positive for the gene mutation and are now weighing their resulting options. “There’s a fair amount of my patients who already have cancer and are concerned about getting it again or their families getting it,” said Miller of why some people opt for testing. “They are concerned that it might be hereditary and want to know if there is something genetic going on.” The BRCA1 and 2 genes were discovered in the early 1990s, and then patented and sequenced by a single lab that charged $4,000 a pop for the test, a fee that posed an economic barrier for many patients. In 2013 the United
Genetic Testing for Breast Cancer << REVITILIZE
States Supreme Court invalidated most gene patents, ruling that genes could not belong to companies. Today the BRCA1 and 2 tests are widely available at much more reasonable prices, a win for women who now have an affordable option for further diagnostic testing. Some labs, said Miller, will conduct the test for as little as $375 for patients paying cash. So who should get tested? Those whose doctors have identified an elevated family history risk (two or more family members diagnosed with breast or ovarian cancer, especially before age 45) or are Jewish of Ashkenazi (Eastern European) heritage should discuss further testing options with their doctor. Those patients who have already been diagnosed with breast or ovarian cancers may also be tested. “Maybe 5 percent of cancer patients have the mutations,” said Miller, and they are now faced with the decision to remove one or both breasts and their ovaries, too, or to continue with their planned course of action. Miller said some cancer patients who do test positive don’t always take the bilateral mastectomy route, instead choosing to undergo radiation after removing a lump. These patients must commit to regular screening such as imaging by digital breast tomosynthesis and MRI, as well as regular ovarian cancer screening. Some patients diagnosed with BRCA1 or 2 mutations over the age of 35 who are done childbearing will opt to have their ovaries removed, added
Miller. This preempts ongoing ovarian cancer screenings which are only able to catch 6 out of 10 cases. “One thing to remember is that most people test negative,” said Miller, continuing to explain that among those who do test positive “some get cancer at 20, 27, others never get cancer at all and live to be 96.” If there’s any good news associated with cancer it’s that testing is improving all the time. As Miller said, “I’ve seen so many situations where cancers have been caught and our ability to do genetic testing is just going to keep getting better and better,” allowing more prevention and better outcomes for patients of all ages.
Resources: Providence Cancer Center: http://alaska.providence.org Genetic testing for breast cancer facts: http://www. breastcancer.org/symptoms/testing/genetic
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Survivor Story << REVITILIZE
by AMY ARMSTRONG
F YOU WERE TO WATCH the energy level at which Audrey Chapman, the principal of Gladys Wood Elementary School, engages with students in the classrooms and hallways and on the playground, you would never guess that more than a decade ago she was in a battle for her life against breast cancer. Ditto for Susan Schmidt. After retiring from her elementary school principal post with the Anchorage School District, she took over as the executive director of staffing and operations in the ASD human resources department. Just weeks before school began this fall, Susan was working overtime to fill key teaching positions as Anchorage—like many other large school districts around the country—faced a significant shortfall of qualified candidates. Yet both women are indeed 10-year plus survivors of not just the emotional rollercoaster of being diagnosed with breast cancer, but also the draining effects of chemotherapy, radiation, reconstruction and physical therapy. Their friendship, which preceded breast cancer, has only been refined and strengthened as each one—Susan first and then Audrey about three years later—got the news she had a rare form of breast cancer: invasive lobular carcinoma.
WHAT IS ILC? ILC begins in the milk-producing glands of the breast. The “invasive” part of its name means that it breaks out of the lobule where it began and has the potential to spread to the lymph nodes and other areas of the body. According to the American Cancer Society, of the 180,000 women in the United States diagnosed with breast cancer each year, only 10 percent have this form. It is difficult to detect through mammograms because it starts deep in the breast tissue where milk production begins, not in the actual milk ducts closer to the surface, as is the case with other more easily detected cancers. That fact the two friend each had the same less common form blew their minds. But it also gave Susan insight into the challenges Audrey faced when she was diagnosed in 2005. TRUE EMPATHY “Susan just took care of me,” Audrey said of the critical adjustment period after diagnosis. “She guided me through all of this and thought of things that nobody else would have thought to ask.” Susan knew exactly what her friend would need. She gathered catalogs for Audrey to order wardrobe items a woman in recovery from a double mastectomy would need. Susan brought Audrey the camisoles she used that are designed to accommodate having a permanent chemotherapy shunt in her chest during treatment. She gave her journals to write down the unending thoughts and questions she knew Audrey would experience. It was the least she could do for her friend who had been there for her in a different way. When Susan’s diagnosis came, she was principal of Wonder Park Elementary. Audrey was her teacher-in-charge when Susan was out of the building. Audrey made sure things ran smoothly in Susan’s treatment absences. She took care of the never-ending Title I paperwork for Wonder Park’s large population of students from low-income families. She trained the teachers and oversaw implementation of the program, reporting back to Susan on a regular basis.
LOOKING BACK Back-to-school is a strange time for Audrey. She was diagnosed in August the week school principals are back to work prepping for teachers to show up the following week. “Each year, it comes around and often I am so busy with getting ready for school that I might not think about it right away,” Audrey said. “But then it always comes back and I think, oh yeah, that’s right.” Both women were determined to not let breast cancer define their lives. Audrey especially was near militant about this. She rarely missed work, opting to undergo chemotherapy on Thursdays after school hours so she could get through Friday before hitting the wall. She spent her weekends with the eventual tiredness and plain old crappy feeling that followed each treatment. Come Monday, she felt rested enough to get back to her school, Ravenwood Elementary School in Eagle River, and back to her students. “I rarely sit behind my desk when school is in session,” Audrey said. “I want to be in the classrooms engaging with the teachers and the students.” Susan’s cancer treatment took a different course than Audreys. Susan’s tumor was so large that doctors wanted to shrink it first before surgery. She did chemotherapy first and had to take leave from April to October of that year because she was just too sick. “Audrey was so blessed because she was able to work through her chemotherapy,” Susan said. “Not everyone can do that.” Audrey agrees and she also emphasized that no woman going through breast cancer treatment should measure her experience against that of another. “It impacts everyone differently,” Audrey said. “Just because I was able to work does not mean that someone else should expect that for themselves. Everyone is different because everyone’s body is different. Each woman has to do this the way that her body needs her to.” And if you can have a true friend by your side, so much the better.
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REVITILIZE >> Complementary Remedies
While chemo and radiation attack cancer cells, these therapies help alleviate side effects. by AMY NEWMAN
HEMOTHERAPY, radiation and surgery are standard cancer treatments. But while they kill cancer cells and prevent their spread throughout the body, these treatments also cause a series of side effects that deplete a patient’s energy and leave them feeling ill and weak. That’s where complementary treatment comes into play. Yoga, acupuncture, massage and other complementary therapies may help alleviate some of the side effects that accompany cancer treatment, as well as improve the patient’s overall sense of well-being.
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“There is a wide array of therapies that a lot of conventional providers haven’t been trained to use, but are increasingly becoming more mainstream,” said Dr. Cora Spaulding, an integrative medicine and family physician and owner of Synergy Integrated Medicine in Anchorage, which will begin providing integrative medicine consultations on Nov. 1. “The challenge is to customize these therapies to fit the preferences of the patient, and any other constraints that they might have.” Before trying any treatment, make sure to check with your medical provider and discuss any precautions you should take.
Complementary Remedies << REVITILIZE
YOGA “Yoga can be infinitely therapeutic,” said Margi Clifford, a licensed professional counselor, registered yoga instructor and owner of Yoga for Mental Health in Anchorage. While undergoing treatment, classes with a mindfulness or meditation component can help promote relaxation and reduce stress while promoting gentle exercise. Yoga also helps patients become more in tune with the changes their body experienced as a result of treatment. “Managing cancer isn’t just managing the growth of cells in your body, but managing what body you’re left with,” Clifford said. “It reinforces people’s sense of themselves.”
DIET MODIFICATION Good nutrition isn’t always given enough attention when it comes to treating cancer, Spaulding said. Modifying the diet to ensure that patients are getting adequate nutrients such as protein, fruits and vegetables and fiber, can be helpful in elevating energy levels and easing treatment side effects such as constipation and weight loss. There’s even growing evidence that following a ketogenic diet, which is low in carbohydrates and high in healthy fats, can improve the outcomes of chemotherapy and radiation, as well as reduce the side effects associated with treatment, said cancer researcher and licensed professional counselor Lyn Freeman, Ph.D., owner of Mind Matters Research LLC in Anchorage.
AROMATHERAPY Aromatherapy uses essential oils to promote relaxation, prevent or reduce nausea, or alleviate some of the other symptoms associated with chemotherapy, Spaulding said. Oils can be used topically in conjunction with a massage, or diffused into the air.
MASSAGE Massage promotes relaxation, short-term pain relief and a general sense of well-being, said Jamie Elswick, licensed massage therapist and owner of Northern Raven Therapeutics in Anchorage. Cancer patients should seek comfort massage that utilizes mild to moderate pressure, rather than deep-tissue massage, which can take energy away from the patient or cause bruising due to low blood cell counts. Massage can also have a positive effect on the patient’s body image. “It can really give the patient a light at the end of the tunnel that their body can feel good again, can feel whole again,” she said.
SUPPLEMENTS The use of botanicals and herbal supplements can help alleviate many different side effects of cancer treatments, Spaulding said. But some supplements may interfere with the effectiveness of treatment, so check with your medical provider prior to taking any.
ACUPUNCTURE Acupuncture can help alleviate side effects such as nausea, gastrointestinal issues, vomiting and fatigue, as well as improve a patient’s a sense of well-being, said Rande Lucas, a licensed acupuncturist with Alpenglow Acupuncture LLC in Anchorage. Acupuncture also calms the sympathetic nervous system, which is responsible for the fight-orfight response, helping to decrease a patient’s anxiety and stress. The acupuncturist inserts thin needles into precise points on the patient’s body to release the flow of energy, called Qi; these insertion points vary depending on the location of the cancer and the patient’s symptoms. Lucas said most patients have weekly treatments, and the result is less reliance on medications to help control side effects. “What I find is it actually has a cumulative effect, so over time when they come back, they have (fewer) symptoms over all,” she said. “They still have it, but don’t seem to have as much trouble with it.”
EXERCISE Chemotherapy and radiation often cause extreme fatigue, so it seems counterintuitive to exercise during treatment. But exercise actually helps combat fatigue, can improve a patient’s overall quality of life and lead to better sleep. Providence Alaska Medical Center offers a 10-week oncology rehabilitation program that utilizes a mix of aerobics, muscle strengthening and relaxation, but even exercise that requires little energy expenditure, such as Tai Chi or yoga, can be beneficial, Spaulding said.
REPLENISH >> Rehabilitate
by NINA WLADKOWSKI
HEMO AND RADIATION can leave cancer patients feeling fragile and and physically weak. Providence Alaska Medical Center’s Cancer Center has a solution: the Oncology Rehabilitation Program. The program provides those currently undergoing cancer treatments the opportunity to safely exercise, helping their bodies regain strength and, maybe even more importantly, finding a lifelong network of supporters as part of the Survivorship Program. Established in 2005 by physical therapist Meaghan Pennino, the program began as a small trial within the Cardiac and Pulmonary Rehab Department at Providence and has flourished in the last 10 years. Today, patients undergoing cancer treatment enter the program to build their bodies back up from the effects of various cancer treatments. Once referred by a health care provider, patients complete an hour-long evaluation process with a physical therapist. They discuss their detailed medical history, including what type of cancer they are battling and the scope of their treatment from surgery through radiation. The physical therapist then tests each patient to determine range of motion, strength and vitals. “We want to reduce the side effects of the treatment that they’re going through. Having the background of knowing how all of their treatments affect their entire body system and then progressing them at a safe pace is how we are successful in getting these people through their treatment,” Pennino said.
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Pennino and fellow physical therapists Fran Lange and Patty Beals understand the importance of matching exercise to patients based on how their treatment affects them and their progress through recovery. “Some people say they feel great the day of (treatment) and then by day three they feel horrible. Others the day of they feel horrible and by three days they feel better,” Lange said while explaining the program’s flexibility with scheduling, working alongside a patient’s treatment and personal timetable. “We meet you where you’re at and we build you up from there,” Pennino added. “It’s finding that therapeutic level of exercise. People end up completing their program feeling good, still having strength, still having mobility, not completely wiped out. We’re able to fight back against a lot of the side effects that people are experiencing from their cancer treatment.” The group program lasts for approximately 10 weeks and classes are held twice weekly. Each class lasts two hours and includes an array of activities including strength building, muscular endurance, expanding a patient’s range of motion, stretching to enhance flexibility and meditation for relaxation. As the 10-week program comes to a close, another overall assessment is completed, allowing the patients to appreciate the program’s impact on their physical status, “It’s really exciting for the patients and for us to see what their gains are. It’s a big confidence builder. They’ve been going through one of the toughest times in their lives and to see something positive coming out of it, it’s a wonderful transition,” Pennino said. Once patients complete the program, they are encouraged to continue visiting and using the Oncology Rehabilitation gym during open gym hours. Patients who use the open gym to their advantage become part of the Survivorship Program, and can use the gym and program’s resources for as long as they like. “There is a group that meets consistently and they plan around ‘When are we going to open gym?’ That’s one of the things that is a huge success for this program; people are continuing to exercise, some of them eight years after they
Rehabilitate << REPLENISH Judith Casey, a patient at Providence Alaska Medical Center
went through their treatment,” said Lange, while Pennino added that she still sees people coming into the facility that were active with the program at its inception 10 years ago. Part of the program’s success can be chalked up to the overall knowledge patients gain from the physical therapists about how to take care of themselves, making sure they are getting the correct amount and style of exercise, along with the general knowledge of how to use the equipment.
As the treadmills and rowing machines begin to fill up with people, another large contributing factor to the program’s success becomes apparent. There is an incredible sense of camaraderie and a closeness that is palpable throughout the room because each person using the space has been through a similar experience in their battle with cancer. Every person has cheerleaders in the room nudging them to keep going as the classes move into their second hour, and, in turn, they are encouraging other patients to do the same. Discussing the placement within the Cancer Center and the patients that enter into the program, Pennino explained, “That’s something that’s unique—there are other cancer rehabs, but a lot of the times they’re going to an already established Physical Therapy or Occupational Therapy department.” While the program is open to anyone currently in treatment for any type of cancer, Pennino noted that much of the program’s population is female and approximately 70 percent of their patients are being or have been treated for breast cancer. “We never close our doors and we encourage people to keep coming,” said Pennino. “We have some people who do resume back to their normal exercise regime outside of here, but there’s a huge majority that this is where they want to be. This is where they want to keep coming.”
W W W . K AT M A I O N C O L O G Y. C O M
Providing high quality cancer treatment for Alaskans for over 30 years. Jeanne Anderson, MD • Dennis Beckworth, MD Ellen Chirichella, MD • Susan Delgalvis, MD Shannon Smiley, MD • Dale Webb, MD
2 Locations: 3851 Piper Street Suite U340 Anchorage Alaska
Exclusively for patients in 2015:
907.562.0321
247 N Fireweed Street Suite B Soldotna, Alaska
907.562.1310
M A S S A G E • A C U P U N C T U R E • D I E T I T I A N • S O C I A L W O R K E R • PA L L I AT I V E C A R E
REPLENISH >> The Importance of Fitness
Joy Schmitz with her grandkids.
How one Juneau woman prioritized fitness during and after cancer treatment by AMANDA COMPTON ODY SCHMITZ’S FAMILY moved around a lot when she was a child, eventually settling in Juneau when she was in middle school. She married her high school sweetheart, raised two children, and worked as an accountant for the state. After a lump was discovered during a routine mammogram in 2005, Schmitz traveled to Seattle for a biopsy. The results suggested there was no cause for worry. She resumed her life in Juneau. “You forget about it, right?” Not for long. In a subsequent mammogram it appeared the lump had changed in size. She returned to Seattle for additional investigative procedures. She waited close to 90 minutes to get a new set of biopsy results. The appointment was delayed because the staff was trying to schedule an additional appointment for her. “With whom?” she asked the receptionist. “The radiation oncologist.” The sky fell, Schmitz said. She collapsed into a mess. She was confused and scared; none of her close friends or family had been through this. It was uncharted territory. The tumor was on the left side of her heart. Schmitz had to inhale to move her heart so the surgeon would have
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enough room to work. Breath by breath, bit by bit. Back and forth she traveled from Juneau to Seattle for various surgeries and treatment, including seven weeks of radiation. Schmitz smiled when she recalled her outlook on the grave prognosis. “You have to have a sense of humor,” she said. “I pretended I was away at a spa and I had a personal trainer, all these people waiting on me. “ Fitness had always been a mainstay through Schmitz’s life. Luckily, the treatment program in Seattle had an associated “active program” which provided patients with facilities and supervised training. “That was a huge outlet,” Schmitz said. “I was thinking, ‘Take that, cancer!’ with every stride.” She took to walking the city, and got to the point she could answer people asking about directions. After spending the majority of that fall undergoing treatment in Seattle, Schmitz returned to Juneau feeling “like a zombie.” Instead of resting and recuperating, she overdid it, trying to stay active. She had to take some time at home to recharge. “You have to kick yourself in the rear end to get a jump
The Importance of Fitness << REPLENISH
start again,” Schmitz said. “We all have peaks and valleys.” Treatment, Schmitz said, can prohibit many people from having an active lifestyle. It caused lethargy and depression, which she admittedly cycled through. But her fitness was a quality of life choice. She knew she had to continue working out for mental survival. “I know how I feel when I’m done versus when I started,” Schmitz said. “It’s a feeling of accomplishment. You know you treated your body well; you did something for the future. It’s like an investment. Your mind clears. You’re not (going on a run)—you’re solving problems, having conversations; you’re in a whole other land.” She also had grandchildren, and wanted to keep up with them. She knew she had to change her outlook on activity; she didn’t have to run, she could walk. She could hike. She taught herself how to swim, and found other women to join her, advancing from a dog paddle to two hours of lap swimming. She didn’t feel like she had to continue playing softball and basketball; she could do things like garden. “I consider gardening an activity,” Schmitz explained. “It’s
a lot of weight training. I’m a dig-it-up-move-it kind of gal. You may say, compared to my earlier life, I’ve slowed down, but I’ve just kind of changed pace.” Schmitz said she still tires easily, but she regained most of her energy. It’s been more than 10 years since her treatment and she regularly goes to a fitness club where she takes spinning classes three times a week. Having workout buddies was a key to her success for accountability as well as enjoyment. Schmitz is quick to admit that treatment—and if you’re lucky, recovery—varies wildly depending on the individual and that she speaks purely from self-experience. What is important and worked for her may be different, difficult or not applicable to another woman. “Not everyone gets a second chance at life or a ‘do-over’ after they are diagnosed with cancer,” Schmitz explained. “But I did...You have to do a bit of soul searching to find truly what matters to you, hold onto that and let the rest fall by the wayside.”
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NOURISH >> Comfort Food
by NINA WLADKOWSKI
ITH SO MUCH on their (metaphorical) plates already, families of those battling cancer don’t want to worry about what to put on their (actual) plates during mealtime. After a long day of school, work, doctors appointments and physical therapy, the gift of a home cooked, comforting meal delivered by a thoughtful friend can be just the thing to relieve the burden. Lindsay Kucera, head baker at Anchorage’s Rustic Goat, has just the right thing for those craving a hearty, soothing meal during the fall and winter’s harsh chill with her Brown Butter Pumpkin Mac and Cheese.
Overflowing with seasonal flavors in a surprisingly light cheese sauce, the dish is simple to make and can travel easily to bring to those in need of a moment of peace. Want a better way to start the day than in front of a bowl full of cold cereal? Kucera’s Spinach and Tomato Breakfast Pie is the perfect thing to whip up in the early morning and drop off to friends needing an extra boost before the day begins. Follow these recipes and deliver a robust, home cooked meal along with a hug from a supportive friend.
SPINACH & TOMATO BREAKFAST PIE Yields one 9-inch pie
2 cups shredded hash brown potatoes ½ cup shredded mozzarella cheese, divided 1/4 cup cheddar cheese 2 tablespoons olive oil 3 cups fresh spinach 2 garlic cloves, minced 1 cup cherry tomatoes 4 eggs ¼ cup milk salt and pepper, to taste red pepper flakes, optional Directions: Preheat oven to 375°F. Spray a 9-inch pie plate with cooking spray; press the potatoes into an even layer in the pan. The potatoes should come up the sides of the pan, like a normal pie crust. Bake for 8-10 minutes; remove from oven. Top with the 1/4cup shredded mozzarella and the cheddar cheese, set aside. In a skillet on medium high heat, add olive oil. Add spinach and tomatoes; cook for 2-3 minutes, stirring constantly, until spinach is wilted. (If you want to add bacon or breakfast sausage to this dish, crisp them in the pan with the tomatoes and spinach.)
Add garlic and continue to cook for an additional minute. Remove from heat and spread the vegetables evenly over the potatoes. In a mixing bowl, whisk together the eggs, milk, salt and pepper, and the red pepper flakes, if adding them. Whisk until thoroughly combined. Pour egg mixture over the spinach and tomatoes. Sprinkle the remaining shredded cheese over the pie. Bake for 30 to 35 minutes, or until top is golden brown. Let cool for 10 minutes before cutting and serving.
When we bring gifts of comfort food to friends, family and coworkers, we often overlook breakfast foods in favor of big dinner dishes. But breakfast is important too, especially when facing a potentially daunting day. This dish is essentially an easy quiche, with hash brown potatoes for the crust. You can make your own shredded potatoes, or use frozen. If you do use fresh, be sure to squeeze as much liquid as you can out of them, otherwise they will not cook correctly, and mix in some melted butter, salt and pepper to taste. If you use frozen, be sure to thaw it slightly before using, or it won’t bake properly.
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Comfort Food << NOURISH
BROWNED BUTTER PUMPKIN MAC AND CHEESE Yields 6 small portions, or 4 generous portions.
8 ounces dry penne pasta 1 ounce unsalted butter, plus more for the pan 2 tablespoons all-purpose flour 3/4 cup milk 3/4 cup unsweetened canned pumpkin 3/4 cup shredded aged white cheddar cheese, plus 2 Tbsp for topping Dash nutmeg Salt and pepper, to taste Unseasoned breadcrumbs for topping
Optional Add-ins: Bacon, Caramelized Onions, Cherry Tomatoes, Spinach Directions: Preheat oven to 350°. Lightly butter an 11”x13” baking pan, or four ramekins. Cook pasta in salted boiling water according to package directions. While pasta cooks, start the roux for the cheese sauce: Melt the butter in a saucepot over medium heat. As soon as it begins to lightly brown (it will have darker brown flecks and smell nutty), add the flour and whisk until you have a very sticky dough. Add the milk in a steady stream while whisking constantly to form a creamy white sauce. Continue whisking as you add the pumpkin and 1/2 cup of the white cheddar. You should have a very creamy, light orange sauce.
Season with nutmeg, salt and pepper. (Add mustard, red pepper flakes or sriracha at this point as well, if you want some heat.) Drain the pasta and return it to its pot. Use a rubber spatula to scrape all of the sauce over the pasta and stir to coat the pasta evenly. Stir in any add-ins desired at this point. Scrape the sauced pasta into the prepared pan(s) and top with the breadcrumbs, reserved cheddar plus more salt and pepper. (Additionally drizzle some olive oil over it all, no more than a tablespoon.) Bake for 18-22 minutes, or until the cheese is very bubbly and lightly browned on top. If wanting a crispy top, put the dish under the broiler, on high, for a few seconds until it’s bubbling away. Serve hot.
This dish was actually given to my family during a tough time in our lives, by my father’s office manager. After I tried it, I asked her for the recipe. I was willing to beg, but she gave it happily. This is one of those super-indulgent recipes that you can rely on again and again. It’s simple, rich and extremely adaptable. It’s easy to prepare, to give and to eat.
* More comfort food recipes online at adn.com/section/special-sections
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NOURISH >> Nutrition
Nutritional therapy for oncology patients by MICHAELA GOERTZEN
UTRITION IS AS MUCH A PART of an oncology patient’s recovery as the cancer treatment itself. For oncology patients, whose typical ailments include inflammation and blood sugar control, nutritionist Danielle Kalbfleisch
and naturopathic oncologist Markian Babij, both of Alaska Cancer Treatment Center, recommend staying away from refined foods as a general rule. Beyond that, they work with patients to develop tailored diets: some will become lactose intolerant or develop food allergies. “Chemo is wrecking your gut,” Babij said. Learning a patient’s symptoms, side-effects and lifestyle helps Kalbfleisch and Babij to create custom meal plans and identify supplements that will alleviate, nourish and heal. Avoiding refined carbohydrates and sugars, in addition to getting adequate sleep and plenty of water, are the only rules they employ. “Let’s not put you on a diet,” Babij tells his patients. “Let’s put you in a lifestyle place. Let’s break the rules once in awhile.” A bend in the rules comes in the form of what Babij calls “transitional foods.” For example, Babij has a recipe for vegan cheesecake that he says is wonderful, if not calorie-free, and Kalbfleisch suggests zucchini or black bean brownies as an alternative to less wholesome recipes. These foods are a part of their plan to transition patients from high calorie, low-nutrient diets to high-nutrient, low calorie ones. To help patients get there, they suggest some grocery cart staples and basic meals and supplements to get started. YOUR GROCERY CART Getting enough protein is fundamental, Kalbfleish said, suggesting less inflammatory sources such as fish, organic beef and legume-based proteins. In addition, since a patient’s gut is often compromised, protein powders for smoothies are another good option, she said. Add to your proteins a variety of cruciferous vegetables, and those should make up the majority of your food staples. Kalbfleisch also encourages maintaining a snack supply to include olives, organic beef jerky, nuts, seeds, applesauce and protein bars (with less than five grams of sugar, at least 10 grams of protein and plenty of fiber). She said green tea is great not only for hydration but for its antioxidants, and dark
chocolate even gets an okay for the same reason. While Kalbfleish recommends buying organic products all around, she suggests choosing organic animal products if you need to prioritize based on your budget. YOUR GO-TO MEALS Stir-fries are a simple way to incorporate the proteins and produce from your newly stocked kitchen into your diet, Kalbfleisch said. Choose an organic meat, fish or tofu; add some broccoli or bok choy; stir fry in olive or coconut oil, and season with turmeric powder, an anti-inflammatory. Keeping a bag of vegetables from Costco in the freezer makes this meal even quicker and easier, she added. One of Babij’s favorites is a warm bowl of porridge. For maximum nutrients, he recommends steel-cut oats cooked in a dense milk and substantiated with your choice of almond butter, maple syrup, cinnamon, sunflower seeds, pumpkin seeds and berries. Another breakfast option or meal replacement is Kalbfleisch’s smoothie: She suggests using a protein powder of your choice, canned coconut milk for extra calories and energy, adding additional fiber with flax or chia seeds, an avocado or banana to add creamy texture, berries to sweeten, and water to thin to desired consistency. For a snack or dessert, both are fans of chia pudding. The recipe has only two ingredients—coconut milk and chia seeds— and its preparation is as simple as letting them sit together overnight in the fridge. With virtually no calories and lots of fiber, it’s a comfort food and nutrient-rich. Treatment and recovery is a process that requires patience, consistency and establishing new dietary habits. “Everything in life is cumulative,” Babij said, referring to patients who get frustrated with themselves over a diet backstep. He encourages them to give themselves a break and remember that no one changes their lifestyle overnight.
For more ideas on social strategy and supplements, read Alaska Pulse extended content online at adn.com/section/special-sections.
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Anchorage Young Cancer Coalition << NURTURE
by AMY NEWMAN
OSS OF FERTILITY. Dating after a mastectomy. The fear that your children will grow up without you. A cancer diagnosis is devastating at any age. But receiving a diagnosis as a young adult, which oncologists define as age 40 or younger, brings with it a unique set of concerns, many of which aren’t always addressed in cancer support groups. Anchorage resident Carey Carpenter discovered the scarcity of resources available for young adult cancer patients in July 2011 when she was diagnosed with an aggressive form of breast cancer at age 34. She was the youngest member of her cancer support group and, with two young children and a full-time job, found herself unable to completely relate to the other attendees. So she formed the Anchorage Young Cancer Coalition (AYCC) in January 2013 to connect with other cancer patients at a similar stage in life. “I just wanted to talk to somebody else who was young and had been through it,” she said. Molly Ridout was one of the people she found. The single mother was diagnosed with breast cancer in July 2012 at age 42. The support groups she attended were comprised mostly of retired woman, none of whom could relate to her struggle of trying to keep up with the normal demands of life while dealing with cancer. The AYCC, she said, serves a “vital need...for support for the women who receive a diagnosis when they’re in the prime of life.” Though the group is geared toward “young adult” cancer patients, Carpenter said it is really more a stage of life group, and anybody
who can relate to the issues group members face are welcome. Members range in age from 9 to 55, and while men are welcome to join, Carpenter said most don’t attend group meetings. Instead, she puts them in touch with other male cancer patients, and they often connect outside the group. The AYCC isn’t a structured support group, and there is no group leader facilitating discussion. The group’s goal is to foster friendship through shared experience. The group meets twice a month at Far North Yarn Co. in Spenard, and holds numerous events throughout the month—walks, dinners out or weekends away—that allow members to have fun in a supportive environment. Conversations about cancer come up organically, and sometimes not at all. The support Tracie Timmerman has received from the group has been a lifesaver. Diagnosed with breast cancer in November 2014 at age 43, the mother of two said the diagnosis left her feeling lost. “Like most women, you feel kind of lost and like you’re the only one going through it,” she said. Her doctor referred her to the AYCC and, with some heavy convincing from her husband, she attended a meeting, for which she is grateful. “Without this group I’d still be searching for other people that are just like me,” she said. “I’m not abnormal, but I’m not what I was before. But I’m 100% normal when I’m with them.” To learn more about the AYCC or attend a meeting, visit the group’s webpage at www.anchorageyoungcancer.com, or e-mail info@anchorageyoungcancer.com.
Pictured above: (L to R) Annie Smith, Megan Oot, Mandy Seymour, Samantha Sheets, Tracie Timmerman, Carey Carpenter, Veronica Carlos.
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NURTURE >> Support Network
DO... Be open to what they need. Every person reacts differently to the diagnosis. Some may want to talk all the time, while others may not want to talk at all. And even that may change from day to day. So be patient, understanding and open to what they need, said Carey Carpenter.
compiled by AMY NEWMAN
VERYBODY WANTS TO LEND THEIR SUPPORT when a friend or family member has been diagnosed with cancer. But sometimes the fear of doing—or saying—the wrong thing stops people from doing anything at all. To help, Anchorage Young Cancer Coalition (AYCC) members shared their “Dos and Don’ts” for how to support someone going through treatment.
Realize it’s not a short game. Dealing with cancer doesn’t end when treatment ends, said Molly Ridout. For many people, especially young adult cancer patients, the really hard part begins when treatment ends—dealing with the loss of fertility, wondering how the cancer will impact their dating and/or sex life, or going through early menopause. But the end of treatment is when most of the support falls away. So make sure to check in long after treatment has ended. Send food. Proper nutrition is important when fighting cancer, but treatment leaves many patients fatigued and not wanting to cook. Food, whether homemade meals or gift certificates to favorite restaurants, is always appreciated. Offer to babysit. Caring for children, especially young children, is exhausting even for people in the best of health. Offering to babysit, even for just an hour or two, so your friend can spend an evening alone or with a significant other is priceless, said Veronica Carlos. Be a chauffeur. Some patients aren’t physically able to drive after treatment. Offer to take them to and from their appointments, Carlos said.
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Organize the volunteers. Save the patient the stress of having to field offers of help by stepping up to organize everybody who volunteered, Carpenter said. Create a webpage to coordinate meal deliveries. Schedule dates and times for people to go help with laundry and housecleaning. Assign everybody a week to call or send cards or care packages. Anything that lets her know she’s being thought of and cared for helps.
DON’T... Pretend it’s not happening. A cancer patient will never forget what she’s going through, so neither should you, Carpenter said. Share horror stories. “We know the realities of cancer,” Carpenter said. “We are grasping on to straws and hope that we will beat it. We know the realities. You don’t need to point it out.” So keep the stories of your sister’s co-worker who lost her fight against the same type of cancer to yourself. Be afraid to talk about your life. Sometimes hearing about the trivial things in other people’s lives, like the office gossip or the run-in with another parent in the school drop-off line, can help provide a light at the end of the tunnel and lets the patient maintain a sense of normalcy, Carpenter said. Be afraid to have fun. Whether it’s a night at the movies or a quiet get together for dinner, don’t be afraid of humor and laughter, Carlos said.
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by JAMIE GONZALES
T’S 3:30 P.M. ON A SUNDAY and everyone at the Enchanted Mermaid—Margy Johnson’s home—is wearing a hat for afternoon tea. Hats with peach chiffon rosettes, black feathers, yellow grosgrain ribbon and white wool with black netting are perfectly in sync with auntie’s and grandmother’s china carefully laid on the table. This is the second “sisters’ tea” for Rebecca Hubbard and her sister Cheri Gillian. “Margy was really a great support for Rebecca when Rebecca was diagnosed [with breast cancer],” said Cheri. “The first tea we had here was with our older sister, who is also a breast cancer survivor. We had tea and hats and the whole bit. It was a real boost to the spirit.” “Even with my funky wig, we still found a hat that worked,” added Rebecca with a laugh. She had been diagnosed with breast cancer right before Christmas, undergone a bilateral mastectomy with reconstruction in January 2013 and begun chemotherapy in February. In April, the story of the three-sister support network made its way to Margy, herself a breast cancer survivor. She arranged for the trio to have tea with her, one of many such gatherings Margy, who also serves as executive vice president of Alaska Dispatch News, has hosted in the last few years for women with breast cancer. A NEW TRADITION In the hallway of the Enchanted Mermaid there’s a framed sketch of three women—Margy and her sisters. Atop the glass, she’s added a tiny pink ribbon over each of their hearts. Her younger sister was diagnosed at 27 and her other sister shortly thereafter. “My sister had been sick for quite a while and when we took her in for her fifth check-up—we were in Seattle—we learned it had metastasized to her lungs and we were just breathless,” said Margy.
“We just walked out of there going, ‘Oh my gosh.’” They wandered into the Four Seasons in downtown Seattle. “They were having tea and we sat down and went, ‘Let’s just do this,’” she said. It became a tradition whenever they got bad news. “Everybody has got auntie’s china or silver, so this whole beautiful custom came of that,” she said.
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NURTURE >> Empathy
L to R: Cheri Gillian, Rebecca Hubbard and Margy Johnson
to get better or I’m going to die. That’s it. But to try and tell your mom and dad, that was definitely the hardest part for each of us.” Rebecca waited to tell her own parents—her mom is also a breast cancer survivor—until after Christmas. But she told her husband and she told Cheri, the two people who would become her local support pillars in the months that followed. “I had a lot of support from both, but it was different: I cried on my husband’s shoulder and Cheri made me take singing lessons with her,” Rebecca said, smiling at her sister across the table. THE ROLE OF THE ‘CANCIERGE’
NOT YOUR TYPICAL TEA TALK Holding a coffee table book about tea, Margy ushered everyone from the sitting room to the tea table and read a quotation: “What better way to suggest friendliness than to create it with a cup of tea.” Everyone sat and admired the china with gold leaf accents, the tiny silver teaspoons and the fresh scones with strawberry jam. Margy gestured to the pot of jasmine tea and continued, “Find yourself a cup of tea—the teapot is behind me—now tell me all about a hundred things.” And they did. Rebecca and Cheri talked mammograms and family history. Rebecca was the seventh woman in her family to receive a cancer diagnosis. Because of her family history, she had started getting annual mammograms at age 30. “Knowing we had all the breast cancer in our family, in the back of my mind, I thought it was going to get me someday,” she said. It didn’t soften the blow when something turned up on her mammogram, though. She went back for a second mammogram, then an ultrasound, then a biopsy. “I was thinking, ‘What do I do? Who do I tell?’” she said. It was just days before Christmas and she wanted to protect everyone from holiday-ruining bad news. Margy empathized. “The hardest part about all of it, for all of us, was telling our parents,” she said, referring to herself, her two sisters and her brother, who had non-Hodgkins lymphoma. “Once you figure out your own course of action, it’s like, I’m either going
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When their mother was diagnosed with breast cancer some 25 years ago, Cheri found herself devouring research and insisting that she accompany her mother to doctor appointments to ask questions. “Like with our mom, Cheri was the one going to doctor’s appointments with me, asking questions and writing stuff down,” Rebecca said. “I was just sitting there, like OK.” Cheri added, “We asked all the questions. Margy had suggested that. She said, ‘Get your stuff together. Keep a log.’ And I thought, I can do that. I can’t fix this, but I can do that.” She likened her role to that of a bridesmaid—someone who isn’t at the center, but who’s there to facilitate, a role others have termed “cancierge.” “Cheri went with me to pick out the wig, to buy the [button-up] shirts because I couldn’t raise my arms,” Rebecca said. “She did all those girl things, those womanly things, that my husband wouldn’t have been able to do.” And in the midst of it all, they took singing lessons with Peggy Monaghan of Arctic Siren Productions. Their debut performance was at the Tap Root, where they sang Venus, by Shocking Blue. “At first I thought Cheri was being a pushy a big sister, but then I realized she was doing it to get me out and distract me,” Rebecca said. One of the scariest things about being a cancer survivor, Rebecca and Margy agreed, is the fear that any day it could come back. Is this a cold or is this cancer? “I live with that every day,” Rebecca said. As teacups were cleared and the last crumbs of chocolate on
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china were whisked away, Margy invited the ladies to her walkin closet (and fancy hat storage area) for one last photo op in their borrowed scarves and hats. By the end, everyone was mugging and laughing. “Cancer is a club that no one wants an invitation to, but once you get it, you’ve got it,” said Margy. “It’s just up to us to keep reaching out and helping others.”.
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