know in the
understanding the cancer experience
Living with, through & beyond cancer
SURVIVOR STORIES Follow-up care Healthy habits
Edward C. Saltzstein, M.D Surgeon and Cancer Survivor
Issue 31 complimentary magazine
in BOARD OF DIRECTORS Gordon L. Black, M.D., Honorary Michele Aboud Robert Ash Patricia Carter, RN Ted Edmunds Sam Faraone Monica Gomez Youn-mi Jaquez Dan Olivas Irene Pistella Shelly Ruddock Ruben Schaeffer Ken Slavin Katie Updike Polly Vaughn Steve Yellen EXECUTIVE DIRECTOR Patricia Tiscareño PROGRAM OFFICER Jutta Ramirez PROGRAM COORDINATOR Cindi Martinez ADMINISTRATIVE ASSISTANTS Maggie Rodriguez Rachel Juarez
in the
know
this issue: The survivor issue
The acclaimed children’s poet, Bill Dodds summed it up so nicely. “Labor Day” he said “is a glorious holiday because your child will be going back to school the next day. It would have been called Independence Day, but that name was already taken.” Welcome to the fall issue of In the Know: Understanding the Cancer Experience. One could argue that the month of September is in tribute to survivors. It is the culmination of having survived summer home with the children, borne up under triple digit El Paso heat, and persisted in the constant adjustment battle of the refrigerated thermostat. But, as we all know, survivorship is an ongoing process, and a whole new series of endurances greet us; like the survival of the traffic which was so luxuriously absent along with the students. We are delighted to feature the individually unique stories about three cancer survivors in this issue. Our sincere thanks to Ed Saltzstein, M.D., Rachel Juarez and Ladonna Apodaca for sharing their inspirational cancer journeys with ITK readers. Each of these people has experienced cancer from diagnosis and treatment (living with) to adjusting to
a new normal (living through) and embracing their survivorship (living beyond cancer). The number of cancer survivors in the United States continues to steadily increase. In 1971 there were 3 million cancer survivors. By 2001, that number had increased to 9.8 million, according to a report released by the Centers for Disease Control and Prevention and the National Cancer Institute. The good news of survivorship was no more evident than at the Rio Grande Cancer Foundation’s 6th Keep on Dancing Cancer Survivor Conference. Over 200 survivors convened to learn how to lead long, productive and healthy lives after a cancer diagnosis. We are grateful to the many supporters and sponsors who made the event possible. Mostly, however, we applaud the attendees. Your smiles, enthusiasm and commitment to learning about this chronic disease and understanding ways to live beyond the diagnosis are our motivation for creating this annual event. On behalf of the volunteers and staff, we thank you for modeling the creed that “Cancer is just a misstep; you have to pick up your shoes and keep on dancing!” Patty Tiscareño Executive Director
FEATURES
5 page
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is published by the
Rio Grande Cancer Foundation 10460 Vista del Sol, Suite 101 El Paso, TX 79925 (915) 562-7660 fax (915) 562-7841 www.rgcf.org by
Snappy Publishing ted@snappypublishing.com El Paso, Texas 79912 (915) 820-2800
The great Beyond
What’s your story?
Follow up care
Living with, through and beyond cancer are phases of treatment that present unique experiences. Here we take a closer look at each stage and offer sound advice for patients.
While each patient’s cancer experience is personal and unique, there are universal lessons to learn from their stories. Meet our three survivors and get to know what they have learned.
Getting on with life after a cancer experience can be challenging. Many patients experience a fear of recurrence and some may not know how to proceed with their healthcare. Here we offer some ideas.
Those submitting manuscripts, photographs, artwork, or other materials to In the Know for consideration should not send originals unless specifically requested to do so by In the Know in writing. Unsolicited manuscripts, photographs, and other submitted materials must be accompanied by a self-addressed overnight delivery return envelope, postage pre-paid. However, In the Know is not responsible for unsolicited submissions. ©2014 Rio Grande Cancer Foundation. All rights reserved. No part of any article or photograph contained in this magazine may be reproduced in any way without the written consent of In the Know. In the Know assumes no responsibility whatsoever for errors, including without limitation, typographical errors or omissions in In the Know. Editorial or advertising content in In the Know does not necessarily reflect the opinions of the publishers. In the Know assumes no responsibility for the products or services advertised in this magazine. Publisher reserves the right to edit any material or refuse any advertising submitted.
MORE THAN
YEARS
FIGHT CANCER When you’re treated at Texas Oncology, you can be sure you’re getting world-renowned cancer care right here in El Paso. Our physicians provide compassionate patient care, offer the latest treatment innovations and share one goal: to be the best at what they do. With more than 150 locations and 350 oncologists throughout the state, every Texan can receive recognized cancer care close to home. Maria C. Aloba, M.D. • Byron Chesbro, M.D. • Jesus A. Gomez, M.D. Nanda K. Gopalan, M.D. • Anuradha Gupta, M.D. • Stephanie C. Han, M.D. • Juan Herrada, M.D. • Arsenio Lopez, M.D. Raul Portillo, M.D. • Ragene Rivera, M.D. • Ines Sanchez-Rivera, M.D. • Panagiotis Valilis, M.D.
EL PASO CANCER TREATMENT CENTER GATEWAY 7848 Gateway East El Paso, TX 79915 915-599-1313
EL PASO CANCER TREATMENT CENTER GRANDVIEW 1901 Grandview Avenue El Paso, TX 79902 915-544-6750
1-888-864-I CAN (4226) • www.TexasOncology.com
HOW TEXANS FIGHT CANCER.
EL PASO CANCER TREATMENT CENTER JOE BATTLE 3270 Joe Battle Boulevard, Suite 312 El Paso, TX 79938 915-849-2700
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living with, through, &
BeyonD CAnCer
By Sallie Damron
L
iving with cancer is the biggest challenge some of us will ever face. Getting through this challenge takes courage, emotional and physical strength, and the support of friends and family. Cancer survivorship is an ongoing process that begins with a diagnosis and continues through the rest of a person’s life. There are three stages to survivorship—living WITH, THROUGH, and BEYOND cancer. Living with cancer refers to the experience of receiving a diagnosis and the treatment that may follow.
Know more>
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living WITH cancer
What to Expect A diagnosis can invoke many feelings such as shock, fear, disbelief, anger, sadness, guilt, and even hope. These feelings can change frequently especially as you go through this first stage which focuses on your care. Determining your care is a huge part of living with cancer. Gather as much information as possible in order to make decisions regarding your treatment plan. Rest assured you will not be alone in the decision making; your healthcare provider will offer options based on your individual case. Your cancer care team will also help you make informed decisions. Do not hesitate to ask your doctor or care team as many questions as you have, this is your welfare and it is important. Surgery, chemotherapy, and/or radiation therapy may be necessary to eliminate or control the cancer. For many types of cancer, surgery offers the greatest chance for cure. If chemotherapy is part of your treatment plan your doctor will explain how you will receive chemo, as it depends on the type of drug you will be taking. If your treatment includes radiation therapy your doctor will provide a structured schedule with frequent progress reports regarding the state of your cancer and its reaction to the radiation. No matter what your treatment plan, ask your doctor about the benefits, risks, and side effects expected during and after your treatment. Take notes during your visits with your doctor and care team and consider bringing a friend or family member to help you understand and remember what is said.Your loved one may also have questions of their own to ask on your behalf. Preparing for a Lifestyle Change A cancer diagnosis can make you feel as though your life is completely out of control. Consider at this time the things you can control such as how you live your life. Healthy choices in diet and
During this first stage of survivorship it is important to tell your friends and family about your diagnosis. Talking with others about your treatment can help you handle the emotions you are experiencing and help you feel less alone in dealing with your cancer. physical fitness will help you feel as well as possible and are encouraged in every stage of survivorship. Immediate lifestyle changes that can also impact your life positively include quitting smoking, establishing better sleeping habits, cutting back on alcohol and managing stress. Living with cancer may force you into a different lifestyle regarding your relationships, work, and finances. You may not be used to relying on others for help; this can be a difficult lifestyle change for those who consider themselves to be self-sufficient. Before your treatment you may need to designate a friend or family member as your primary caregiver although it is a good idea to have the support of multiple caregivers. Fostering healthier relationships by spending more time with your loved ones is one way to make relying on others much easier. You may continue to work or decide to take time off while undergoing treatment. Preparing for this lifestyle change may mean asking your employer for a more flexible schedule to accommodate your doctors’ appointments. The cost of your care may also dictate a change in your financial lifestyle. It is important that you learn about the medical and non-medical costs of your treatment so you can identify and ask questions of your healthcare team. Determining how to manage the cost of care may also mean researching
your insurance coverage, managing debt, and setting monthly savings targets. Although this will be a time of budgeting, it is important to treat yourself on occasion—this could be in the form of a manicure or massage, dinner out with friends or enjoying a decadent dessert. Coping with Family and Friends During this first stage of survivorship it is important to tell your friends and family about your diagnosis. Talking with others about your treatment can help you handle the emotions you are experiencing and help you feel less alone in dealing with your cancer. Your friends and family will learn how to support you; in fact, they might surprise you with their willingness to assist you in any way you need at this time. There is the chance you will encounter unexpected challenges of others not knowing how to respond to your diagnosis. Do not be discouraged by others' inability to cope; focus on getting through your treatment and surround yourself with loving and understanding individuals. You may seek support and understanding from a survivor support group. Meetings can be attended in-person or online. There are also many cancer discussion boards online where, at any time, you can connect with other people going through similar cancer experiences.
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living THROUGH cancer
The second stage of survivorship of living through cancer refers to the experience immediately after treatment. This is a time of recovery. Your treatment and its side effects may have affected you physically and emotionally and a period of healing and rejuvenation is needed. The risk of cancer recurring is relatively high at this stage and a legitimate concern for you and your loved ones. You may continue to see your oncologist every few months. Not seeing your doctor on a regular basis may make you anxious; this is common among patients living through cancer and can be addressed during a visit with your doctor. There are also common late effects your cancer or treatment can cause such as chronic pain, fatigue, cognitive dysfunction, among others. Your doctor may prescribe a new medication or therapy or alternative options to help you cope. Ask your doctor for a wellness plan that includes ways you can take care of your physical, emotional, social, and spiritual needs. Your doctor may recommend reevaluating your lifestyle and making positive changes for a healthier and happier life. Reevaluating Your Lifestyle While in recovery the way you live your life is particularly important so use this as an opportunity to reevaluate your lifestyle. Focus on making changes with your long-term health in mind. You may have already made dramatic changes to your lifestyle before or during your treatment and are still adjusting. If that is the case, avoid slipping back into old habits. Committing to a healthy diet and regular exercise will only positively impact your long-term health. If you haven't already quit smoking or cut back on alcohol consider doing so now. Managing stress and establishing better sleeping habits are also recommended. The American Cancer Society offers diet and fitness guidelines to help reduce the risk and recurrence of cancer.
These guidelines include eating a plantbased diet with at least five to nine servings of fruit and vegetables daily, eating whole grains, choosing foods low in fat and salt and getting to and staying at a healthy weight. Moderate exercise such as biking, swimming, and walking for about 30 minutes every day will help reduce anxiety and depression, improve mood and boost self-esteem as well as reduce fatigue, nausea, and pain. If exercise is more difficult for you now just remember to be kind to your body
Committing to a healthy diet and regular exercise will only positively impact your longterm health. If you haven't already quit smoking or cut back on alcohol consider doing so now.
and give yourself time to adjust to the way your body is now. Consult your doctor before starting an exercise program, then begin slowly and increase activity over time. Making Positive Changes Living with cancer may have already influenced positive changes in your life, such as becoming responsible for your own health or realizing the importance of friends and family. Different things are now more important, your relationships with family and friends have changed or perhaps you view every
day as a gift and treat it as such. Your experience may have made you more understanding and compassionate towards others. Maintain these positive changes by living them every day and take this opportunity to perpetuate the positive in your life. Enjoying your life as the gift it is can only help in your recovery. Set aside time for fun and leisure activities alone and with others. Take up a new (or old) hobby, join a book club, take singing or dancing lessons, simply do something you have always wanted to do that you know will make you happy. Another positive change you can make is to give back. Volunteering can improve your community as well as yourself; join an organization or a cause you believe in whether it’s working with animals, in arts and culture, or supporting survivors who are on a cancer journey of their own. Giving back to those who have supported you during your diagnosis and treatment is also an excellent way to make a positive change in your life. Show your family and friends how much you appreciate them in your own way. Letting others know they have made a difference in your life will make a difference in theirs. For a more permanent positive outlook pursue goals that will nourish your spirit and help you find meaning in life. There are many ways to develop your spirituality--organized religion, yoga, meditation, journaling, traveling, or spending time in nature. Regardless of the type of positive changes you choose to make in your life, be patient with the process and yourself. These changes may need to be gradual in order to take root. They may also require deliberate thought and action to maintain.
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MY PLAN:
BEAT BREAST CANCER Las Palmas Del Sol Healthcare strongly recommends a breast-health program of annual mammograms starting at age 40. Detecting breast cancer in its early stages can greatly increase your chances of survival up to 98 percent. We’ve made a lot of progress toward beating breast cancer, but we still have a long way to go. • About 12,100 new cases of invasive breast cancer
are diagnosed in Texas women each year • Breast cancer is the most common cancer among
women in Texas, regardless of race and ethnicity • Among Texas women, breast cancer accounts for
30 percent of all cancer cases Call your doctor today, get screened and encourage others to do the same.
To schedule a mammogram, call Las Palmas Medical Center at 915.521.1150, or Del Sol Medical Center at 915.595.9267.
L P DS H E A LT H C A R E .CO M
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living BEYOND cancer
The final stage of survivorship, living beyond cancer, refers to post-treatment and long-term survival with a focus on quality of life. For many survivors their lives return to normal but one-third report continuing physical, psychosocial, or financial consequences. Unfortunately survivors are at risk for a wide range of ongoing symptoms which can be longterm or late effects. Long-term symptoms arise during treatment and remain problematic whereas late effects symptoms surface months or even years after treatment has ended. Both types of symptoms can include chronic pain, fatigue, cognitive problems, infertility, and decreased bone density, among others. To be as healthy as possible within your personal circumstances may be something you have to work on from day to day. Coping with Fear of Recurrence Fear of cancer recurrence is also a symptom which affects many survivors. This fear is normal and reasonable for survivors particularly during the first few years of remission. You cannot control whether your cancer returns but you can control how much you let your fear affect your life. Educate yourself on the chances of your cancer recurring. Meet
with the oncologist who is familiar with your history and ask about the chances of recurrence and symptoms to look for if the cancer were to recur. More than likely your care will move back to your primary doctor at this time. It is important to also share your concerns with your primary doctor. You may even request that your doctor create a plan for your follow up care. Having a plan will help you feel in control of your health care decisions. Accepting your fears as realistic and finding ways to manage your anxiety will also help you cope. You may share these feeling with a friend or counselor or simply write them down in a journal. Often talking and thinking about your fears can help identify underlying issues. Joining a support group where you can share your thoughts and feelings with others who understand what you’ve been through will help you feel less alone. You may even be able to exchange practical information and helpful suggestions. Reducing stress and anxiety in your life will also help to alleviate fears of recurrence. Avoid unnecessary stress such as committing yourself to responsibilities you do not have the time or energy for or involving yourself in the
stressors of others. Be aware of your limits and allow yourself to say “no” when you are asked to take on tasks you cannot manage. Try to enjoy the simple things in life such as spending time with friends and family, watching a funny movie, or taking a walk in nature. Schedule social activities as well as daily leisure time and above all, do things you enjoy. Other ways to work through your fears, as well as feelings of depression or anxiety, include therapies which focus on the mind, body, and spirit. Learning and practicing relaxation techniques such as deep breathing, visualization, progressive muscle relaxation, and biofeedback may also be effective in reducing your fear and anxiety. A yoga or meditation class is a good place to learn these techniques as well as put them into practice. Develop a Wellness Perspective During this stage it is important to move away from an illness perspective and into a wellness perspective. This perspective will help guide you through the rest of your life. Similar to the first and second stages of survivorship, positive lifestyle changes are important to maintain in this final stage. Adopting a healthy lifestyle goes a long way to helping you feel better physically and emotionally. It will also lower your chances of developing other health problems. If you find yourself struggling with anger, frustration, anxiety, or depression consider sharing your feelings with a friend or family member. This may be all you need to feel less burdened by your feelings. If your negative emotions are more deepseated seek the help of a therapist or counselor. A support group may also provide the positive outlet you need for venting your emotions and resetting your outlook on life. You cancer journey may have changed you as a person in many ways but it is up to you to look to the future with hope and wellness in mind.
10 What is follow-up cancer care, and why is it important? Follow-up cancer care involves regular medical checkups that include a review of a patient’s medical history and a physical exam. Follow-up care may include imaging procedures (methods of producing pictures of areas inside the body), endoscopy (the use of a thin, lighted tube to examine the inside of the body), blood work, and other lab tests. Follow-up care is important because it helps to identify changes in health. The purpose of follow-up care is to check for recurrence (the return of cancer in the primary site) or metastasis (the spread of cancer to another part of the body). Followup care visits are also important to help in the prevention or early detection of other types of cancer, address ongoing problems due to cancer or its treatment, and check for physical and psychosocial effects that may develop months to years after treatment ends. All cancer survivors should have follow-up care. What should patients tell their doctor during follow-up visits? • Any symptoms that they think may be a sign that their cancer has returned • Any pain that bothers them • Any physical problems that interfere with daily life or are bothersome, such as fatigue; difficulty with bladder, bowel, or sexual function; difficulty concentrating; memory changes; trouble sleeping; and weight gain or loss • Any medicines, vitamins, or herbs they are taking and any other treatments they are using • Any emotional problems they are experiencing, such as anxiety or depression • Any changes in their family medical history, including any new cancers
Follow-up cancer care: Know what to expect, how to proceed with healthcare plan Provided by the National Cancer Institute (NCI)
It is important to note that cancer recurrences are not always detected during follow-up visits. Many times, recurrences are suspected or found by patients themselves between scheduled checkups. It is important for patients to be aware of changes in their health and report any problems to their doctor. The doctor can determine whether the problems are related to the cancer, the treatment the patient received, or an unrelated health issue. How are follow-up care schedules planned? The frequency and nature of follow-up care is individualized based on the type of cancer, the type of treatment received, and the person’s overall health, including
11 possible treatment-related problems. In general, people return to the doctor for follow-up appointments every 3 to 4 months during the first 2 to 3 years after treatment, and once or twice a year after that. At these follow-up appointments, the doctor may recommend tests to check for recurrence or to screen for other types of cancer. In many cases, it is not clear that special follow-up tests improve survival or quality of life. This is why it is important for the doctor to help determine what follow-up care plan is appropriate. The doctor may not need to perform any tests if the person appears to be in good physical condition and does not have any symptoms. It is important for the patient to talk with the doctor about any questions or concerns related to the follow-up care plan. When planning a follow-up care schedule, patients should consider who will provide the follow-up care and who will provide other medical care. They should select a doctor with whom they feel comfortable. This may be the same doctor who provided the person’s cancer treatment. For other medical care, people should continue to see a family doctor or medical specialist as needed. Some people might not have a choice in who provides their follow-up care, because some insurance plans pay for follow-up care only with certain doctors and for a set number of visits. In planning follow-up care, patients may want to check their health insurance plan to see what restrictions, if any, apply to them. Are there doctors or clinics that specialize in follow-up care? There are clinics that specialize in longterm follow-up cancer care for adult and pediatric cancer survivors. More information about these clinics can be found through the National Coalition for Cancer Survivorship Exit Disclaimer, which can be reached by phone at 301–650–9127 or by e-mail at info@canceradvocacy.org. For assistance in Spanish, call NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and follow the prompts to speak with a bilingual information specialist. For children and adolescents, the Association of Cancer Online Resources, a cancer information system that offers access to electronic mailing lists and websites, provides a list of long-term followup care clinics on its Ped-Onc Resource Center Exit Disclaimer page. NCI’s Office of Cancer Survivorship also maintains a directory of post-treatment resources, including where to get follow-up care after cancer treatment.
What should patients talk to their doctor about once cancer treatment ends? Every cancer survivor should request a comprehensive care summary and followup plan from their doctor once they complete their treatment. Patients should ask their doctor the following questions once cancer treatment ends. The answers can help inform the patient about their care and what to expect next. (See Question 7 for more information about plans for followup care.) • What treatments and drugs have I been given? • How often should I have a routine visit? • Which doctor should I see for my follow-up cancer care? • What are the chances that my cancer will come back or that I will get another type of cancer? • What follow-up tests, if any, should I have? • How often will I need these tests? • What symptoms should I watch for? • If I develop any of these symptoms, whom should I call? • What are the common long-term and late effects of the treatment I received? • What should I do to maintain my health and well-being? • Will I have trouble getting health insurance or keeping a job because of my cancer? • Are there support groups I can turn to? Many patients find it helpful to write these questions down and take notes or tape record their discussions with the doctor to refer to at a later time. How can patients deal with their emotions once cancer treatment is completed? It is common to experience stress, depression, and anxiety during and after cancer treatment. Many people find it helpful to talk about their feelings with family and friends, health professionals, other patients, members of the clergy, and counselors or therapists. Being part of a support group can provide another outlet for people to share their feelings. Relaxation techniques, such as guided imagery and slow rhythmic breathing, can also help to ease negative thoughts or feelings. Reaching out to others by participating in volunteer activities can help people to feel stronger and more in control. However, people who continue to experience emotional distress should ask their doctor to refer them to someone who can help determine what may be causing or contributing to their distress and how to deal with it.
What kinds of medical information should patients keep? It is important for people to keep a copy of their cancer treatment records. Ideally, this should include a comprehensive care summary and follow-up plan from your doctor. Patients may not always see the same doctor for their follow-up care, so having this information available to share with another doctor can be helpful. In particular, it is important to keep the following information: • Results of any diagnostic test • Specific type of cancer (diagnosis) • Date(s) of cancer diagnosis • Details of all cancer treatment, including the places and dates where treatment was received (for example, type and dates of all surgeries; names and doses of all drugs; sites and total amounts of radiation therapy) • Contact information for all doctors and other health professionals involved in treatment and follow-up care • Side effects and complications that occurred during and after treatment • Supportive care received (for example, pain or nausea medication, emotional support, and nutritional supplements) • Identifying number and title of clinical trial (research study), if the patient participated in a clinical trial What other services may be useful during follow-up care? Other services that may be helpful not just during cancer treatment but also as part of follow-up care include support groups, couples counseling, genetic counseling, fertility/sexual counseling, home care services, nutrition counseling, physical therapy, pain management, and occupational or vocational therapy. Some patients may also need financial aid or assistance with transportation to and from appointments. Information about these and other services is available from local and national cancer organizations, hospitals, local churches or synagogues, the YMCA or YWCA, and local or county government agencies. Patients can also ask their doctor, nurse, or social worker how to find these services. To get the most from these services, it is important to think about what questions to ask before calling. Many people find it helpful to write down their questions and to take notes during the conversation. It is also important to find out about eligibility requirements for these services. Organizations providing many of these services are listed in the “Resources” section of the NCI publication Facing Forward: Life After Cancer Treatment.
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Life beyond cancer is different for everyone. We talked to three survivors each with their own perspective about life beyond cancer.
a I am a
SURVIVOR
R
13
Edward C. Saltzstein, M.D
hether or not he wants to be in the spotlight, Edward C. Saltzstein, M.D., has a lot of great things to claim as professor of surgery at Texas Tech University Health Sciences Center at El Paso and medical director of the Sadie and Annabelle Garbar Breast Care Center. And as a survivor himself, he has even more to celebrate, having remained cancer-free since his diagnosis and treatment in 2006. Dr. Saltzstein’s dedication to the Breast Care Center has borne much fruit just over the past year alone. The most significant and recent milestone is the Center having been approved by the National Accreditation Program for Breast Centers (NAPBC). “We’re the only program in the area to be so approved,” Dr. Saltzstein clarifies. “That’s a national accreditation that we’re very proud of.” Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care
W
and that undergo a rigorous evaluation process and review of their performance. Also in 2013, the Centers for Medicare & Medicaid Services (CMS) recognized Dr. Saltzstein with inclusion in its prestigious database of physicians and other healthcare professionals who have been awarded money by Medicare for providing services to Medicare beneficiaries. Another big step towards Dr. Saltzstein’s commitment to providing the best care for El Pasoans was the Center’s recruitment of a breast oncologist, Dr. Zeina Nahleh. “She brought a level of expertise to the medical management of patients with breast cancer that we didn’t have before she got here,” Dr. Saltzstein says. On a personal level, In the Know last caught up with Dr. Saltzstein in 2007, just a year after his own cancer diagnosis and treatment, which included a six-month leave of absence from work to undergo a left upper lobectomy followed by radiation therapy and chemotherapy. “Certainly my own treatment and
and this is my
my care of patients are totally separate things,” he says. It’s an ethos that has not changed for him since his diagnosis in 2006. “I guess I’m about eight-and-a-half years out now and so far as I know I’m doing well, knock on wood,” he continues. “I get a CT scan of my chest once a year and talk to my oncologist and just plug along.” Dr. Saltzstein says that he doesn’t focus on his own battle with cancer nor think about the fact that he’s a survivor unless it’s brought up to him. “But I don’t run away from it,” he clarifies. “I do what I’m supposed to do and I’m lucky so far to be disease-free.” But since doctors are, essentially, human beings, Dr. Saltzstein acknowledges that the word “cancer” is still “a very scary word. He felt that fear himself in January 2006 when his annual chest x-ray led to a diagnosis of lung cancer. >
STORY by lisa garabay
I am a
> Since then, he has been most empowered by a realistic attitude – neither positive nor negative, but “certainly hopeful”. The expert physician’s unflinching dedication is making it easier for locals to find out about and get treatment from the Center in the hope of becoming survivors. Over the years, he has come to learn that everybody looks at cancer differently. Advice that the good doctor has kept close over the years despite everchanging technology, patients coming and going, and evolving medicine includes keeping one’s self informed and proactive. “In my dealings with patients, I try to let them know that their prognosis is very good and that they need to follow closely with their oncologist because the treatments that are available will give them a great outlook.” Decades as a medical instructor – both at Texas Tech and, before that, running a research and residency training program in his hometown of Milwaukee – has helped him become a good teacher for patients, too. Thirty years ago, Texas Tech recruited the Yale and Northwestern University Medical School graduate. Dr. Saltzstein has chaired the Department of Surgery from 1977 until 2002, beginning his Breast Care Center directorship in between in 2000. Since then, Dr. Saltzstein has invested much of himself in this city and is proud that, since its inception in 1994, the Center
SURVIVOR and this is my STORY
has helped to diagnose and treat more than one-third of the breast cancer patients in El Paso. And the thousands of patients that have come through the Breast Care Center are forever grateful that an examiner for the review committee that evaluated Saltzstein’s residency program in Milwaukee just happened to be with the faculty at Texas Tech University Health Sciences Center School of Medicine Department of Surgery – a seemingly random connection that eventually led to Dr. Saltzstein’s recruitment as chairman of the Department of Surgery in El Paso. When he’s not holding down the fort at the Breast Care Center, Dr. Saltzstein plays golf, loves to read, and joins his wife Phyllis in bridge games or going to the movies. His family is a strong foundation for him. “I’m fortunate to have a very supportive wife,” he says. “We have six children and 11 grandchildren and they’re a real source of joy.” Looking forward, the future holds more good things for both Dr. Saltzstein and the Breast Care Center. “We’re moving on to the next step and the next level of care, recruiting either a fellowship-trained breast surgeon or a surgical oncologist,” he explains. In the meantime, the 82-year-old is not stopping.
Rachel Juarez
Rio Grande Cancer Foundation Administrative Assistant Rachel Juarez not only works with cancer, she lives with it daily. As a melanoma survivor, Rachel shares her experience with the patients who walk through the Foundation’s door, finding kinship with them and what they are going through no matter their specific lifestyle or diagnosis. The 69-year-old was not happy about having to return to work in 2012 after declaring her retirement. Financial need was what seemingly called her to do so, but after walking through the Foundation’s door, she knew she had been led to that point for a much greater reason. Rachel was working at a jewelry store when she was diagnosed with melanoma in 2000, but had settled into retirement after treatment. It was just a year later that she realized she was not going to be able to make it solely on Social Security. She went to AARP for job training and employment networking. “I was so upset that I had to go back to work,” she says. “I was really down. Then AARP sent me in to the Foundation. When I opened the door and walked in, I said, ‘Thank you, Lord!’ You can’t imagine how many people walk in and say the same. You feel so welcome in here.” Throughout her life, Rachel felt she had to watch out for cancer given that her maternal grandmother died of cancer of the uterus while her paternal great aunt, father and mother all battled breast cancer. Despite that family history, she agrees that no one can ever be truly mentally or emotionally prepared for what comes with a cancer diagnosis “But I think that living with my very strong parents and seeing what they went through helped. They took it in stride,” she says. Rachel’s father lost movement in his right arm as a result of his treatment while her mother had all lymph nodes removed from her left underarm before that same arm was rendered paralyzed after the nerve was damaged during surgery when the cancer came back. “She was in almost constant pain, but she and my father never complained,” Rachel says. “From
At this age, you realize that you can’t worry about things,” she says. “You make plans and say, ‘This is what I’m going to do,’ but that’s not what the Lord has for you. Life changes. It takes getting older to appreciate that.
them, I learned that I had to be strong. They had cancer and they survived with it.” After Rachel’s diagnosis, she says she didn’t let it bother her mentally, even though she was told melanoma was very serious. What did affect her was the aftermath. As part of her treatment, one of Rachel’s big toes was amputated and lymph nodes removed. She was 55 at the time and still wore high heels and panty hose. Suddenly, she had to re-learn how to walk and begin wearing compression stockings. “That was fun,” she says with a laugh despite remembering the initial hour-long challenge of putting on the stockings. That fighting spirit has kept her cancerfree. “It wasn’t supposed to be that way,” Rachel says. “They were supposed to find residue left on the toe when they amputated it; they were supposed to find some traces of the cancer in the lymph node and there was nothing. They had told me, ‘You’re never a melanoma survivor.’ But I’ve been surviving for 14 years now!” Rachel had great role models in her parents and is now working to be a role model for those battling cancer that she comes into contact with at the Foundation. Since the majority of patients who come through the door and up to her desk have breast cancer, she bonds with them using the story of her niece. “What she did before she started getting the treatments was have her husband shave her head. I asked, ‘Why did you do that?’ and she said, ‘Because this is my choice. I wasn’t going to watch my hair fall out.’ So when people come in and they’re trying on wigs – and of course they’re very upset about their hair,
especially the younger ones – I tell them that story.” Rachel continues, “A lady walked in one time and said, ‘I’m disfigured.’ I told her, ‘My mother had both [breasts] removed and to me she was the most beautiful woman that ever lived,’ and then she laughed. That’s an in with the patients who come in.” Rachel is also up front about her own cancer battle. She tells the Foundation visitors about having melanoma, having her big toe removed, and having to learn to walk again. But for her, it’s a positive story. “I got to use a whole new set of muscles on my foot to learn how to walk,” she says. “So then we get going and have a connection.” Through her daily work, Rachel proves that the most important part of coming out the other side of something as life-changing as cancer is the human connection. After all of the medical treatments and surgical procedures, people like Rachel bring the humanity back to living with cancer. The cancer is there, but it’s not all of life for Rachel. She goes out with friends and sees family on occasion while also being kept busy by her two cats. Rachel has put cancer in its place and it doesn’t drive her life. She vigilantly keeps up visits to both a dermatologist and oncologist, but isn’t anxious when waiting for check-up results. “At this age, you realize that you can’t worry about things,” she says. “You make plans and say, ‘This is what I’m going to do,’ but that’s not what the Lord has for you. Life changes. It takes getting older to appreciate that.” Her experience is of value, even more so that she has the strength to share it and be
part of a support system for others. She definitely feels that this is her purpose on this earth. “I’ve lost my parents and my brother and I never had any children,” she says. “I feel there’s a reason why I’m still here, why [God] didn’t take me instead.’ When I started working at the Foundation and people would visit, I said, ‘I get it now.’” Rachel is living proof of higher purpose, having been sent to the right place at the right time. “Let me tell you, the Foundation is a Godsend,” she enthuses, remembering the circumstances that led her to its door. “I know why I needed the money – because I needed to be sent here!”
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Ladonna Apodaca with Dr. Gary Schabacker
17 I am a
SURVIVOR and this is my STORY
Ladonna Apodaca Interior designer, event planner and creative woman-about-town Ladonna Apodaca is grateful to have just celebrated a belated birthday along with another year of her family’s tradition spending the summer in La Jolla, California, where she first began her battle with cancer. Ladonna was undergoing a routine annual check-up at the Scripps Clinic – part of the family tradition during their Southern California vacations – in July 2006 when suspicions arose that led to a diagnosis of Stage One Ductal Carcinoma in Situ. Luckily, her doctor at Scripps recommended that Ladonna come back home to El Paso for treatment. She was matched with Dr. Gary Schabacker, who immediately clicked with her and, given the specifics of her tumor, got her on track for what was then a new form of radiation therapy called MammoSite. Ladonna was not only elated to be able to keep her breast, she was in awe that the post-lumpectomy treatments would be able to be done in only two short, sixminute sessions a day for five days. It was a gift to be able to have such cutting-edge treatment in her hometown. Key to what Ladonna believed got her through cancer not just that first time, but also its recurrence earlier this year, was that she never allowed herself to get negative. “I never believed I would not be fine,” she says. To that end, she has overhauled her life to be much more conscious of what’s going into her body. “When at all possible I buy organic. I’m not a vegan, but my consumption of meat is very limited, particularly red meat. I read everything I can now on things that I can do to keep the disease at bay. And I feel great.” Hence, Ladonna recommends that others maintain close awareness of their own bodies. After all, doctors can’t perform miracles when someone hasn’t been paying attention to what’s going on and a condition has been allowed to go unchecked. “For as many people as I know who have successfully battled a cancer diagnosis, unfortunately far too many people I know also didn’t listen to the warning signs,” she says. “And when they did go in it was more advanced to a point of being scary or more advanced to a point where there weren’t options.” Her coaching as a twice-over survivor extends to recommending that people go
I never believed I would not be fine,” she says. To that end, she has overhauled her life to be much more conscious of what’s going into her body. “When at all possible I guy organic. I’m not a vegan, but my consumption of meat is very limited, particularly red meat. I read everything I can now on things that I can do to keep the disease at bay. And I feel great. see as many doctors as it takes until they hear what they feel best about and only settle for a course of treatment that they’re comfortable with. “I think that’s just so vital,” she urges. “I’ve talked to several people over the past couple of years who had symptoms that, had they been proactive, would have greatly minimized what ended up a severe form of treatment.” Above all, working in tandem with a medical professional is the most life-saving tip she can offer. “Don’t be ashamed or afraid to go to the doctor; be afraid to not go to the doctor.” The 56-year-old was blessed with a great network of friends and family, including her son and “favorite exhusband,” who is still a close friend. “It was great to know that if I needed anything it was always made available to me.” Based on what she had faced back in 2006, both Ladonna and her support system were ready with a battle plan when her diagnosis of Ductal Carcinoma in Situ, Stage 0, came up this year. “Because [the tumor] was so small, my doctors said it was my choice to do another lumpectomy, but the likelihood of it coming back was pretty strong,” she recalls. “Emotionally, you weigh all of those things: Do I wanna go through this again and again? A double mastectomy with reconstruction was the recommendation, which is what I chose to do.” That “Stage 0” is important because it proves the benefit of early detection. All this proactivity does pay off. “If they’d caught it any earlier it wouldn’t exist,” she says with a laugh. Through this much more serious and thorough procedure, Ladonna’s mindset stayed the same. “Having a positive attitude has been at the forefront of anything about my treatment,” she says. Being positive made it easier for her to be helped, too. “People are scared; they
don’t know what to do, they don’t know how to help, they don’t know what to say. So if you demonstrate inner strength to the people around you, that’s going to give them the comfort that they need to be able to move forward to help you however they can.” Ladonna is a great ambassador for this kind of thinking. It’s almost striking how open she is about discussing all that she went through and how doable she makes it all sound despite the challenges. She was recently referred to a woman who had just received a diagnosis of breast cancer. Recalling their conversation, Ladonna says, “The woman is scared to death, rightfully so, and her depression right now knows no bounds. One of the things that’s happened with her is that her friends have pulled away. I was trying to explain to her, ‘They’re not pulling away because they don’t love you, but with your depression, they don’t know how to help you, and the way that you can help them is to reassure them that you have hope.” It’s a beautiful cycle that comes out of something so scary and difficult to go through. Ladonna believes that divine forces help people come into one’s life at just the right time and she is happy to hopefully be one of those for someone who is new to cancer. Whenever she can, she is happy to offer to sit with someone at a doctor’s appointment or hold their hand through treatment. “I say to people, ‘You don’t have to go through this alone because you know me now!’ And I know they’ll pay it forward when they get through with their treatment, too.” Clearly, Ladonna can’t speak enough about the importance of having good people around you. And she’s living proof that being one of those good people means a prognosis for a healthy, long future.
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bHealthy Habitsd Exercising During Cancer Treatment
If you have been recently diagnosed with cancer or are undergoing treatment, it's important to take special care of yourself. Studies show that one of the best ways to do this is to stay physically active. That doesn't, of course, mean you should run a marathon or scale a mountain. But it's wise to add some form of regular exercise to your daily life--even during cancer therapy. Moderate aerobic exercise, such as riding a stationary bicycle or taking a daily walk, coupled with the use of light weights for strength training, can enhance physical well-being and spur recovery. Exercise reduces fatigue Research has found no harmful effects on patients with cancer from moderate exercise and, in fact, has demonstrated that those who exercised regularly had 40% to 50% less fatigue, the primary complaint during treatment. (See Fighting Cancer Fatigue.) Engaging in regular exercise increases muscle strength, joint flexibility and general conditioning, all of which may be impaired by surgery and some therapies. Exercise is
known to improve cardiovascular function and to protect bones. It also elevates mood, offering drug-free relief for the feelings of depression that may accompany a cancer diagnosis. Finally, exercise helps control weight -- a crucial factor, as studies have shown that gaining weight during and after treatment raises the risk of a cancer recurrence, particularly for breast, colon and prostate cancers. When to begin The sooner you start exercising, the better you'll feel, the fewer medications you're likely to need, and the lower your risk will be for complications, says Andréa Leiserowitz, physical therapy supervisor at the Seattle Cancer Care Alliance, an affiliate of the Fred Hutchinson Cancer Research Center. She recommends implementing an exercise routine before treatment gets underway - especially if you have been inactive. Leiserowitz advises asking your doctor for a referral to a physical therapist who works with cancer patients and can design an individualized exercise program. For example, exercises can be prescribed
to improve range of motion and prevent lymphedema, a chronic arm swelling that affects some breast cancer patients after lymph node removal. Exercise with impact An effective exercise program has three components: • An aerobic workout that pumps up your heart rate. Examples include brisk walking (outdoors or on a treadmill), jogging, swimming, or bicycling. • Strength training to tone and build muscles. This includes lifting weights or working with a machine circuit or resistance bands. (Be sure to get instruction if you're new to this type of exercise; light weights are sufficient to maintain strength.) • Stretching to keep muscles and joints limber. Proceed with care It is important to discuss with your doctor or physical therapist the type of exercise you are considering to ensure it will be safe. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related
Fatigue advise starting slowly and progressing incrementally. Depending on fitness and comfort level, some people may want to start with a 10-minute walk around the block; others may find they can exercise for 20 minutes (or longer) right away. Your goal should be at least 30 minutes of aerobic exercise five days a week or more. But be cautious: if you try to do too much, you may become discouraged and stop exercising altogether. On the other hand, if you were a regular at the gym before cancer, you may have to lower the intensity of workouts for awhile.
Thank you!
The Rio Grande Cancer Foundation would like to recognize the sponsors that made our Survivor Conference a huge success.
Here are some additional suggestions: • If you don't have the energy to exercise a full half hour, break it up; try three 10minute walks during the day. • Make exercise enjoyable; recruit a walking partner or listen to music with headphones while on a recumbent bike or treadmill. • Dress comfortably and drink plenty of water. • Warm up by swinging your arms or marching in place and cool down with gentle stretches. • Do some gardening or house cleaning – both provide physical workouts. • Consider yoga and tai chi; though not aerobic, they integrate movement and meditation and enhance wellness. • Look for programs designed for cancer patients. Some health clubs and hospitals offer exercise classes that address the challenges and needs of people with cancer. • If on radiation therapy, avoid swimming pools; they can expose you to bacteria that may cause infections and the chlorine may irritate radiated skin. • Listen to your body; don't exercise if you're not feeling well or running a fever.
Liz Rios-Carl, HFP Benefit Solutions Keep on Dancing In-Kind Support Mesa Street Grill Ardovino’s Pizza Tosca’s Oven Pizzeria Nuovo Cappetto’s Restaurant Evolution Hair & Nail Studio Pot Au Feu Restaurant Denis Rochford and the Great American Land & Cattle Company Mister Hot Shine Nails Glamorous The El Paso Club Debbie’s Bloomers David Villanueva and Galeria Zia Pizza Properties Your Personal Look, Nancy Look Pelican’s Restaurants Patricia Electrolysis Clinic Michelino’s Italian Restaurant Anita’s Flowers & Gifts Myong Beauty Supplies UTEP Department of Athletics Monica Gutierrez and Premier Jewelry
Jordan Foster Construction
Deb Benedict Keep on Dancing Scholarship Donors Marshall Carter-Tripp Jeanne Foskett Flo Buchmueller Sharon Carr-Leamon Maureen Henry Jutta Ramirez Patti Wetzel Ceci Miles Mulvihill and RMPersonnel Maria Sanchez Harris and Kay Hatfield Kathleen Peyton Linda Cobbs Patricia Carter Vk Melarkod Maria Kostal Celia Smith David Villanueva Patsy Slaughter Helen Ornelas
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bHealthy Habitsd
Smoothies Quick, easy and nutrient dense, these drinks are ideal for cancer patients
Not only is making a juice or a smoothie simpler than cooking a meal from scratch but it also provides you with a nutrient dense glass of deliciousness. Think of it as a direct deposit into each and everyone of our cells. If you are dealing with cancer or are implementing a cancer-free lifestyle balancing your meals is top priority. Here are some favorites that are full of anti-oxidants and cancer fighting properties.
2 cups of pea shoots (sprouts) ½ inch of ginger Benefits: anti-inflammatory, antioxidant (lycopene), chlorophyll, vitamins (A, C), folic acid and alkalizing properties 2 cups of kale 1 apple ½ lemon ½ inch of ginger
3 stalks of celery 1 kiwi 4 romaine leaves ½ inch of ginger Benefits: anti-inflammatory, antioxidants, vitamin (A, B, C), chlorophyll, calcium, potassium, iron, folic acid, magnesium and alkalizing properties Smoothies
Juices 1 medium mango ½ cup of pineapple 2 cups of spinach Benefits: anti-inflammatory, antioxidants (mangiferin, quercetin), vitamins (A, C, D, K), chlorophyll, iron, folate and alkalizing properties 1 cup of watermelon
Benefits: anti-inflammatory, antioxidants (quercetin), vitamin (A, C), chlorophyll , calcium, iron and alkalizing properties 1 medium cucumber 1 cup of honeydew melon 4 romaine leaves Benefits: anti-inflammatory, antioxidants, vitamin (B, C), chlorophyll, beta-carotene, potassium and alkalizing properties
2 large handfuls of kale 1 cup of strawberries 1-½ cups of coconut water 2 tablespoons of chia seeds Benefits: anti-inflammatory, antioxidants, vitamin (A, C, K), chlorophyll, omega-3s, potassium and alkalizing properties 2 large handfuls of broccoli 1 banana
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eat, live and be well 1 apple 1-½ cups of alkaline water Benefits: anti-inflammatory, antioxidants, vitamin (A, C), chlorophyll, potassium and alkalizing properties 1 orange 1 cup of pineapple 1 cup of spinach 1-½ cups of home brewed green tea Benefits: anti-inflammatory, antioxidants, vitamin (A, C), calcium, folic acid, iron and alkalizing properties 1 cup of papaya 1 cup of strawberries 1 banana 1-½ cups of coconut milk 1 pinch of bee pollen Benefits: anti-inflammatory, antioxidants, vitamin (B, C), folate, lauric acid, potassium and alkalizing properties 1 cup of blueberries ½ cup of almond yogurt 1 cup of almond milk 2 tablespoons of chia seeds Benefits: anti-inflammatory, antioxidants, vitamin (B, C), omega-3s and alkalizing properties
Green Smoothie Prep time 3 mins Total time 3 mins A creamy, sweet vegan green smoothie with banana, peanut butter, spinach, flaxseed, berries and almond milk. The perfect healthy breakfast or afternoon snack. Author: Minimalist Baker Recipe type: Breakfast Cuisine: Vegan, Gluten Free Serves: 1 • 1 medium banana, previously peeled, frozen and quartered • 1/2 cup mixed frozen berries • 1 Tbsp flaxseed meal • 1 heaping Tbsp natural, salted peanut butter • 1/2 - 3/4 cup unsweetened vanilla almond milk • 2 cups fresh spinach Instructions • Place all ingredients in a blender and blend until creamy, adding more almond milk or
frozen berries (or bananas) to thin/thicken, respectively. Serve immediately or freeze to enjoy later. Although, it is best when fresh. Nutrition Information Serving size: 1 Calories: 357 Fat: 15 g Carbohydrates: 48 g Sugar: 25 g Sodium: 222 mg Fiber: 15 g Protein: 11 g 3.2.1753
My Favorite Smoothie By Chef SukiKoda Ingredients: • 1 1/2 cups liquid aloe vera • 1 cup fresh blueberries • 1 cup fresh raspberry • 1 scoop of unsweetened powdered soy protein concentrate • 1 celery • 1/2 cucumber • stevia artificial sweetener Directions: • Combine all ingredients in a blender EXCEPT sweetener. • Blend til smooth. • Add sweetener to taste. Berry Almond Smoothie From: Kicking Cancer in the Kitchen: Kendall Scott, CHHC and Annette Ramke, CHHC Smoothies were our go-to food during chemotherapy when we were too tired to make a meal or felt too nauseous to get anything solid down. We are excited to share one of our favorite, simple smoothie recipes from Kicking Cancer in the Kitchen: the Berry Almond Smoothie! This smoothie is energizing, filling and super tasty! Bananas offer potassium to help replenish lost electrolytes, and berries give a boost of antioxidants, those awesome little cancer fighters. You get your protein and some fabulous nutrients, like iron, calcium and magnesium from the almond butter. Anemia is common for those undergoing chemotherapy treatment and in many other people, and iron can help to treat this. Almonds are also helpful in relieving constipation. Ingredients: 12 ounces almond milk 1 banana 1⁄2 cup fresh or frozen raspberries 1⁄2 cup fresh or frozen strawberries 3 tablespoons raw almond butter Combine all ingredients in a blender and mix at medium speed for about one minute or until mostly smooth. If a thinner smoothie is desired, add more water or almond milk and blend for a few more seconds. Yield: makes 24 ounces.
know on the go! in the
understanding the cancer experience
events & happenings Keep on Dancing Survivor Conference
Two hundred cancer survivors gathered together at the El Paso Wyndham Hotel on Saturday, August 23, 2014 to attend the 6th annual Keep on Dancing Cancer Survivor Conference. The full-day event featured presentations on food, fitness and survivorship, including interactive workshops from Jackie Cordova of The Green Ingredient and Veronica Ortega of The Wholesome Body. Fitness and exercise was the key message delivered by the YMCA Livestrong™ cancer survivor program, Spectrum Fitness and Casa de Yoga. Physicians Anuradha Gupta and Raul Portillo talked about the controversies in breast cancer diagnoses and treatment to a full house, and Louisa Ornelas shared insight about recognizing the signs of memory loss. Comedian Patrick Candelaria had survivors laughing at the networking lunch and the wrap up included the awarding of 22 themed baskets created and donated by the Keep on Dancing Committee. The Rio Grande Cancer Foundation is deeply indebted to our major sponsors who made this annual event possible. • Texas Oncology, P.A. • The El Paso Community Foundation • Hoy Fox World Automotive • Western Refining • Price’s Creameries • Genentech • CIMA Hospice • Spectrum Imaging • Spectrum Fitness • Jordan Foster Construction • West Star Bank • Liz Rios-Carl, HFP • Benefit Solutions • Molina Healthcare • Glazer’s Fine Wines & Spirits
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