Healthy Living Winter 2017 by Tri-City Herald

Winter 2017

Tri-City Herald’s Guide To

PEACEFUL RESISTANCE OPEN MIND, BETTER HEALTH

Real women reveal how they recovered without a ‘fight’

Why mindfulness matters

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How avoiding alcohol reduces breast cancer risk

Blending Your Way to Health •Sick of Cancer Treatments - A Guide to Side Effects

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Blending Your Way to Health

What juices and smoothies can do to help reduce cancer risk, and improve heart and brain health. By Jesse Darland CTW Features

hy eat your fruits and vegetables, when you can drink them? While some have promoted juices or smoothies as a way to loose weight, they can be an incredibly effective way to improve your health. That’s because making juices or smoothies at home can boost the vitamins, minerals, antioxidants and phytochemicals from fruits and vegetables in your diet. The USDA now recommends that women age 51 and older eat one and a half cups of fruit and two cups of vegetables per day. Men age 51 and older should eat two 4

cups of fruit and two and a half cups of vegetables each day. And if you’re worried about investing money in a bunch of fancy equipment, you can likely just get started with the blender that you have in your kitchen cabinet. “Drinking fruits and vegetables may be beneficial for older adults who may be experiencing changes in taste, decreased appetite or difficulty chewing or swallowing raw produce, preventing them from consuming the recommended daily amount for optimal health,” Laura Dilz, a registered dietitian/nutritionist in Cincinnati, says. “Juicing should be integrated into a well-balanced diet that includes fresh fruits and vegetables, lean

proteins, and heart healthy fats.” But first, a word of clarification: Making juice and making a smoothie is not the same thing. “Juicing” is the practice of extracting juice from fruits and vegetables, while smoothies are made in a blender and retain shredded fiber from the ingredients. Sonya Angelone, spokesperson for the Academy of Nutrition and Dietetics, recommends smoothies that use whole fruits (including most of the fiber rich skins) and vegetable over juices ,which are just eliminate the fiber. “A very important aspect of good health is maintaining a good gut microbiome,” she says. Healthy gut bacteria feed on fiber to produce gut health promoting Healthy L i v i ng Wi nter 2017

chemicals, and juicing eliminated that fiber. Fiber is also key nutrient to healthy digestion, controlling blood sugar, and keeps you feeling full for a longer amount of time, Dilz adds. Most any blender works just fine, and they’re ideal if you’re making a smoothie. If you’re serious, though, Agelone recommends blenders from a NutriBullet and Vitamix. Other than price (they do cost more), the main difference is the strength of the motor. A stronger motor means a shorter time to blend and a smoother finished product, she says. If you’re interested in just juicing, know that there are three main A sup p l ement of the Tri -Ci ty Hera l d

methods used to make juice: cold press, centrifugal and masticating. “Machines vary in quality and price, with centrifugal typically being the least expensive and most common in stores,” Dilz says. “Cold press and Masticating juicers work great with extracting juice from leafy vegetables, but tend to cost more.” No matter which machine or method you choose, the process is fairly simple: select fresh, colorful and minimally processed fruits and vegetables, switch on your machine, and then drink a glass full of refreshing, delicious goodness. If you’re juicing (and not making blended smoothies) one word of warning: consuming

adequate dietary fiber is still essential. “Therefore juicing can be incorporated into a healthy diet, but should not replace fresh whole produce full of fiber,” Dilz says. In addition to introducing more fruits and vegetables into your everyday diet, juices or smoothies can also help deal with chronic health conditions. The naturally occurring nutrients in fresh fruits and vegetables can help decrease oxidation and inflammation, “which is a common thread in most all chronic diseases,” Angelone says, including breast cancer. Strawberries and raspberries, in particular, are a potent source of ellagic acid, a phytochemical that has been shown 5

to prevent cancers of the breast, skin and lung in lab studies, according to the American Institute for Cancer Research. Kale and spinach both have super-high levels of carotenoids, a type of antioxidants that protects against free radical damage that contributes to cancer development. For those living with diabetes, experts recommend smoothies and not juices, because the higher fiber content of smoothies can help manage blood sugar levels. “They also can be filling which can lead to a lower calorie intake when eaten before meals or as snacks,” Angelone says. If juicing, Dilz says that, because fruits have more sugar in them than vegetables, “Individuals with diabetes require a juice with more vegetables and fewer fruits to control their blood sugar.” Because some vegetables are good sources of calcium, juices and smoothies can a long way towards promoting bone health and lessening the risks of osteoporosis. Dilz recommends leafy greens such as kale, collard greens, mustard greens and bok choy

as great ingredients for reducing the risk of fractures. Broccoli and cabbage are also great sources of calcium. If heart disease is a concern, juicing and smoothies can help. The American Heart Association wants all Americans to consume a variety of fruits and vegetables to maintain health and prevent or delay the development of cardiovascular disease, so boosting your intake through juicing or smoothies goes a long way. “The concentrated source of nutrients can help decrease inflammation, which can help prevent heart disease and also provide plenty of potassium which can lower elevated blood pressure,” Angelone says. Adds Dilz, “Beet root juice is getting a lot of attention right now for its potential to improve blood pressure and heart health.” It is important to note that certain nutrients may interfere with certain medications. For example, Vitamin K (found in green, leafy vegetables) may interact with blood thinners, and grapefruit may interact with statins. “If you are taking medications I would advise meeting with

your doctor and/or a registered dietitian to play it safe and choose a juice that is right for you,” Dilz says. The experts recommend checking out eatright.org, an online resource that contains tons of information about nutrition in general and juices and smoothies in particular. We also asked our experts their favorite recipes. “One of my favorite juice recipes includes kale, apple, celery, cucumber, lemon and ginger,” Dilz says. Angelone takes more spur-of-themoment approach. “Basically, I see what vegetables I have in the crisper that need to be eaten, including some fermented vegetables for a rich source of probiotics,” she says. A good blend for her is a combination of cucumber, tomato, a few carrots, a beet, handful of spinach or kale, coconut water and the juice of a lemon. For a kick, add some hot sauce, salsa or chili pepper.

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recovery (MBCR) or supportive expressive group therapy (SET). The women detailed their emotional state before and after the interventions and were followed-up 6 and 12 months later. Women in both groups showed improvement, but the women in MBCR reported greater reductions in fatigue, anxiety, confusion and stress

symptoms and better quality of life than those in SET and most benefits were maintained over 12 months of follow-up. Mindfulness is beneficial because it allows people to be more awake and aware, according to Linda Carlson, corresponding author of the study, professor, Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Ca. “It can contrast with what people are often doing–having regrets about the past, or having their minds racing off to the future and everything that could go wrong,” says Carlson, co-author of “MindfulnessBased Cancer Recovery” (New Harbinger Publications, Inc., 2010). © CTW Features

HOW TO START BEING MINDFUL Mindfulness isn’t a natural state, according to Linda Carlson. It takes mental training for your mind to be present. Although you’ll find guides through a number of sources, including online sites, health experts recommend enrolling in a class to start. The group can help with any problems you encounter, says Carlson. Having the support of others may help you stick with the practice. The Moffitt Cancer Center study went on for 12 weeks, with most women practicing mindfulness all 12 weeks, according to Richard Reich. The women received the training that allows them to use the strategies in the future, according to Reich. Mindfulness classes are offered at many hospitals, especially those that work with cancer patients.

A Beautiful, Peaceful Mind Mindfulness helps breast cancer patients reduce anxiety, depression and fear. By Bev Bennett CTW Features

s you recover from breast cancer, you may still be overwhelmed by catastrophic thoughts. It’s not uncommon to be worried about the future even though your prognosis is excellent. But being mindful – paying attention in the present moment to whatever you’re doing in a way that’s nonjudgmental – may be even more effective in reducing negative emotions than some traditional therapies, according to recent research. 8

Mindfulness is shown to reduce anxiety, depression and fear of recurrence in breast cancer survivors, according to Richard Reich, Ph.D., biostatistics core facilities manager, Moffitt Cancer Center, Tampa, Fla. For the cancer center’s research, Reich, Cecile Lengacher, PhD., principal in the study, and a team looked at the efficacy of mindfulness-based stress reduction for breast cancer. They placed more than 300 breast cancer survivors in either a mindfulness program or a group that received the usual care. Those who learned mindfulness techniques showed extended

improvement when compared with the control group in their psychological symptoms, including fear of recurrence and physical symptoms of fatigue. Breast cancer survivors with the highest stress levels at the start experienced the greatest benefit from mindfulness. A Canadian study compared mindfulness with well-accepted supportive group therapy in which women address their fears and offer mutual support. For the research, about 250 distressed Stage 1-111 breast cancer survivors were randomly assigned to either mindfulness-based cancer Healthy L i v i ng Wi nter 2017

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Four women reveal why they didn’t like using battle metaphors during breast cancer treatment and recovery.

Aniela McGuinness

B y D awn K lingensmith CTW F eatures

From the Mouths of Survivors:

Don’t Call It a Fight

Healthy L i v i ng Wi nter 2017

ancer patients almost always use metaphors when talking or writing about their experience. The most common metaphor casts the patient as a fighter or warrior and the experience as a battle. The second most common metaphor frames the experience as a journey, according to a UK analysis of online cancer forums. The battle metaphor has fallen under fire of late because it suggests that patients who “lose” to cancer didn’t fight hard enough. The journey metaphor seems preferable but doesn’t resonate with patients who define a journey as an adventure willingly embarked upon. While the UK analysis shows that many cancer patients embrace battle and journey metaphors, not all current or former patients identify with them. Here, four women discuss their choice of metaphors, symbols and storytelling devices to A sup p l ement of the Tri -Ci ty Hera l d

Janet Loveland frame their experience with breast cancer. Aniela McGuinness, 34, Hollywood, Fla. Having lost her mother to ovarian cancer the year before her breast cancer diagnosis, McGuinness recoiled the first time someone called her a survivor. Her friend Nora McMahon didn’t like the term, either, so the two came up with a whole new cancer glossary and founded CancerGrad.org. “What else can you call a person who’s finished with cancer? We came up with ‘cancer grad’ and spent about six months refining the metaphor and the terminology. Cancer sucks. We aren’t trying to make light of it. But if you go into it thinking of it as an education or a series of lessons, instead of a battle, it might help. What we came up with is the idea of going to college: It’s scary; it’s expensive; it’s hard. ‘Survivor’ is a really heavy word that connotes war or major trauma. My other problem with it is, the moment my mom died, that

title was revoked. So we changed all the language. Survivors are graduates. Mom is studying abroad. Your major is the type of cancer you have. As most cancer grads will tell you, when you meet a grad with your major (diagnosis), it’s the same feeling you have when you find someone who went to your alma mater, and you end up reminiscing about throwing up from chemo cocktails. All the parallels are there, right down to debt you graduate with.” Janet Loveland, 56, Southaven, Miss. When a well-meaning doctor gave Loveland a binder full of information about her “cancer journey,” the metaphor rubbed her the wrong way. It wasn’t so much the metaphor itself as the presumption of defining her experience. She thinks of breast cancer as just part of her life story. It was a pivotal chapter, though. She even has a title for it. “I called it ‘My summer on the front 11

me shoes. It became a thing. I ended up with 25 pairs. For me, stilettos became a metaphor for having the power to stand on my own two feet – although sometimes I couldn’t put them on unassisted. There’s one picture of me looking like death warmed over with one person on each side of me for support. I stood up for a few seconds – just long enough to take the picture – and sat right back down. It gave me, and those around me, a little bit of hope. I’ve since passed along 21 pairs of shoes to other women who have cancer. For my last treatment, I was so ready to move on. I wore a pair of Old Navy dollar flip flops.”

“For me, stilettos became a metaphor for having the power to stand on my own two feet...”

Dixie Henderson, 65, Memphis Henderson has had breast cancer twice. Her odds of survival the second time were initially only 15 percent but rose to 40 percent with stem cell transplantation. She got through the treatment using visualizations and a series of metaphors that started when a nurse told her one of her medications was derived from an Amazon plant. “I had this little tape player in my hospital room to listen to calming music, and the tape I’d popped in was called Sounds from the Amazon. When the nurse told me my medicine was from there, I thought, ‘This is perfect.’ I pictured myself floating on a canoe in the Amazon, and I imagined the medicine moving through my body the same way, taking away all the cancer. After that, I began to visualize different things. I imagined billy goats chomping up all the cancer cells and I’d cheer them on – ‘Go, billy goats, go!’ My dad had a dairy goat farm and loved that analogy. The next one was Ms. Pac-Man. I’d picture her going in and chomping all the cancer cells. I kind of keep all this stuff to myself because it sounds crazy, but it worked for me. I ended up finishing the stem cell treatment a day early and, obviously, I’m still here 20 years later.”

AnnMarie Giannino-Otis porch.’ One of the biggest blessings of my experience is it forced me to slow down. It was humbling but necessary. I had eight rounds of chemo over four months, and during that time, I couldn’t do much physically. But I could get out of bed, and by leaning on the wall I could inch along and make it to the front porch. I had a beautiful view. I put out suet cakes and birdseed, and I used a book to learn how to identify birds. It sounds so weird to say it, but having cancer was a positive experience for me. Through it all, I found something I loved, and still do, which is bird watching. I learned that I was more deeply loved by more people than I had any idea. It was definitely lifechanging, but it was all for the good.” Janet Loveland 12

AnnMarie Giannino-Otis, 45, Syracuse, N.Y. At 4’11” tall, Giannino-Otis says she has “no choice” but to wear high heels, so it’s a good thing she enjoys them. Fittingly, shoes became symbolic as she went through breast cancer treatment, and she became known at the hospital as “the diva in high heels.” She chronicles the experience in her blog, Stupid Dumb Breast Cancer. “My friend’s daughter, Riley, always used to go to my closet and try on my shoes. She started it all by bringing me a pair of sparkly pink stilettos to wear to surgery. Here I am in this horrible hospital gown about to have a mastectomy, but I have on 6-inch stilettos and a smile. After that, people started bringing me shoes. They didn’t bring me casseroles; they brought Healthy L i v i ng Wi nter 2017

AnnMarie Giannino-Otis A sup p l ement of the Tri -Ci ty Hera l d

Don’t Drink Up Daily alcohol consumption tied to increased risk of breast cancer. B y B ev B ennett CTW F eatures

n the past having a glass of wine or a cocktail every evening was a ritual that alleviated stress, provided a bridge from work to home or simply gave you pleasure. As you recover from breast cancer you may look forward to that nightly drink as part of your return to normal life. That’s not in your best health interests, say cancer experts who recommend reducing your alcohol intake to lower your risk of breast cancer recurrence. Instead learn what the experts consider acceptable levels of consumption, develop strategies for getting to that point and otherwise take steps to improve your health. If it’s hard for you to imagine doing without an alcoholic refresher, you’re not alone. “Some people have been habitually having a glass of wine every night for a decade or two. It’s difficult to comprehend 14

why they should change their habit,” says Kelly Hogan, registered dietitian, clinical nutrition and wellness manager, Dubin Breast Center, Mount Sinai Hospital, New York City. Despite the challenge, you can adjust. An alcoholic drink a day increases breast cancer risk by 5 percent in pre-menopausal women and by 9 percent in postmenopausal women, according to a report from the American Institute for Cancer Research (AICR) and the World Cancer Research Fund. What about women who are recovering from breast cancer? The AICR’s 2014 Breast Cancer Survivor Continuous Update report didn’t find enough evidence to link alcohol to recurrence or mortality, but that doesn’t mean there isn’t a link, according to Alice G. Bender, registered dietitian nutritionist, head of nutrition programs, AICR, Washington, D.C. “It does seem intuitive that if alcohol increases risk for primary breast cancer, it would also increase risk for Healthy L i v i ng Wi nter 2017

recurrence, but we just don’t have enough science to say that,” Bender says. Still, her advice to individuals is to drink less. “The bottom line is, keeping alcohol intake to less than 1 drink a day for women [if you drink at all], is a good strategy to reduce risk,” Bender says. Other research has found a connection. Regularly consuming three to four alcoholic drinks or more a week compared with no drinking was associated with an increased risk of recurrence in post-menopausal and overweight/obese women who were previously diagnosed with early-stage breast cancer, according to a study published in 2010 of close to 2,000 women published in the Journal of Clinical Oncology. A sup p l ement of the Tri -Ci ty Hera l d

Based on her work Marilyn Kwan, Ph.D. recommends reducing your intake. “The results of our study support that women previously diagnosed with breast cancer should consider limiting their consumption of alcohol to fewer than three drinks per week,” writes Kwan, researcher on the cancer recurrence study, research scientist with the Division of Research, Kaiser Permanente North California. Alcohol’s role in cancer recurrence is that it “can possibly influence the risk of primary breast cancer by increasing estrogen metabolism and circulating estrogen levels in pre- and postmenopausal women,” writes Kwan in an email interview. When it comes to potential risk, Kwan’s research didn’t exempt wine. However, the link between alcohol and especially wine, and breast cancer

recurrence may surprise patients, according to Hogan. “People can get focused on foods and not what they’re drinking. It’s a balancing act. If you’re having a glass of wine or beer every night it’s something to think about,” she says. Changing your drinking habits can be a gradual process and one that doesn’t have to lead to total abstinence. “For many people eliminating alcohol does not fit in with their lifestyle,” writes Dr. Susan K. Boolbol, clinical director, Mount Sinai Health System Cancer Network, Chief, Division of Breast Surgery. “I prefer to ask patients to decrease their alcohol intake. I find this is a more reasonable approach and works much better,” writes Dr. Boolbol in an email interview. Dietitians who work with cancer 15

patients can help. “I generally advise patients to cut back to two glasses a week or less. If it’s a bottle a night, switch to a glass a night,” says Natalie Ledesma, registered dietitian, clinical nutrition specialist, Smith Integrative Oncology and senior dietitian, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, Calif. You don’t need to pour a standardsize glass of wine to enjoy it. “If you’re going to drink make the drink smaller. Maybe instead of 5 ounces, cut back to 3 ounces,” Bender says. Be discriminating in what you drink. “If you taste something and it’s not fantastic, don’t drink it,” Ledesma says. At events where everyone is drinking start with a full glass of water or 16

sparkling water before having that first glass of wine, beer or cocktail. Then before a second drink, have another glass of sparkling water, Ledesma says. You’ll be hydrated and less likely to reach for another drink. You can also plan ahead for special occasions. Skip alcohol on six nights and toast the bride with Champagne on the seventh. Although cancer experts focus on alcohol because it may be easier for patients to manage, you can take other steps as well to enhance your health. Being obese was associated with breast cancer recurrence in Kwan’s study. “For some individuals having one glass of wine may not be as big a factor as losing weight if you’re obese,”

Ledesma says. Bender, who advocates for a better diet, recommends you try to avoid weight gain and eat more vegetables and whole grains. And don’t overlook the value of physical activity. “Exercise offers all-around health benefits, including cardiovascular benefits as well as stress reduction. Get outside and take a walk or go for a hike. You can’t go wrong,” Kwan writes. © CTW Features

Healthy L i v i ng Wi nter 2017

A Touchy Subject

eing told to drink less is a touchy subject for some people, says Kelly Hogan, registered dietitian. “A lot of people rely on it as a stress reliever. It can create a little panic,” she says. If that’s the case identify why you’re drinking. Perhaps drinking is triggered by anxiety or depression. Treat the cause, says Natalie Ledesma. “If you understand [why you’re drinking] you can say no thank you or have sparkling water instead,” Ledesma says. You can toast, celebrate and unwind without alcohol in your wine glass, say dietitians specializing in cancer treatment. Emphasize the ritual of having a festive drink, sitting down and relaxing, not the alcohol, Ledesma says. Bring out your special occasion champagne flute or wine A sup p l ement of the Tri -Ci ty Hera l d

glass and sip something healthful. Kelly Hogan recommends kombucha, a fermented tea. “Its fizziness and variety of different flavors can hit the spot, and bonus! You’re also doing something healthy for your gut,” says Hogan. Create non-alcoholic versions of your favorite drinks, says Ledesma, who suggests a virgin mojito with sparkling water, lime and mint. “You feel you’re enjoying yourself,” she says. Experiment mixing sparkling soda with lime, berries cucumber. Something enjoyable, Ledesma says. She also suggests cold herbal teas as an after-work drink. © CTW Features 17

‘Sick’ of Cancer Treatments

A basic guide to the most common types of medicines, their side effects and the most effective ways to cope with the downsides. B y B ev B ennett CTW F eatures

eing declared cancer-free is the most important goal for someone being treated for breast cancer. However, that doesn’t come without an enduring struggle

with side effects resulting from a prescribed drug protocol. Different treatments may be associated with certain side effects. However, the likelihood, type and severity vary greatly with each patient, according to healthcare experts. By being informed, you can talk to your physician about managing any challenges that arise. Tools for relief include Healthy L i v i ng Wi nter 2017

other medications, vitamins and stressalleviating techniques along with exercise – the remedy for many ills. Although it’s helpful to know you could have side effects, it’s not beneficial to focus on potential issues, especially before you take a medication, according to Dr. Tara Sanft, assistant professor of medicine (Medical Oncology) at the Yale School of Medicine, New Haven, Conn. A sup p l ement of the Tri -Ci ty Hera l d

“Most people deal with side effects pretty well. I tell patients they don’t know whether they’ll suffer a side effect until they take the medication,” Dr. Sanft says. Your drug treatment may fall into one of three categories: hormone-blocking therapy, chemotherapy or targeted drugs. Hormone-blocking therapy may be

used to treat breast cancers that are sensitive to hormones. Younger women who are treated with these drugs go into menopause. Antidepressant drugs can be prescribed for hot flashes that may accompany menopause. The drugs may not eliminate the hot flashes, but make them more manageable, according to the pharmacist. 19

Breast cancer patients who are past menopause may be treated with aromatase inhibitors. “Joint pain can be very common in women on aromatase inhibitors,” Dr. Sanft says. Finding medications to relieve the pain is difficult; tolerating pain is the goal, she says.

Massage therapy and exercise are possibilities. Along with joint pain, decreasing bone density is associated with aromatase inhibitors. “We can treat women if they get into a dangerous zone. Weight-bearing exercise staves off bone loss and helps improve quality of life,” Dr. Sanft says.

Vitamin D may have the potential to both reduce joint pain and to promote bone health. All women going through treatment should have their levels checked. Chemotherapy uses drugs to destroy cancer cells. Hair loss may be your worry if you’re undergoing chemotherapy. Healthy L i v i ng Wi nter 2017

The good news is that your hair does grow back, though the texture and even color may be different after treatment is concluded. Many women report they experience “chemo brain,” the perception of not being as sharp as before, according to Dr. Sanft. “Fatigue is common and women may underestimate it. Women think the treatment is over and they should feel normal. It can take months; up to a year for women to resume their energy levels.” Dr. Tara Sanft Assistant professor, Yale School of Medicine A sup p l ement of the Tri -Ci ty Hera l d

Learning techniques for focusing and taking art therapy classes for mind stimulation may help. Fatigue may be harder to deal with. Dr. Sanft says. Counter-intuitive as it seems, exercise is an antidote. “Exercise can actually improve fatigue and may speed up recovery,” Dr. Sanft says. Physical activity is also being studied for its role in helping while chemotherapy is still going on. Again, as with vitamin D, the key is finding the optimal amount of exercise for each patient. Targeted drug treatment, which works against specific cancer cell

abnormalities, is an interesting and growing area. Symptoms vary, but the more common complaints include diarrhea, headaches and heart muscle changes, she says. Many doctors recommend over-thecounter medications to combat diarrhea. But be prudent using an OTC headache remedy. It could mask a fever that’s part of an infection. Changes to heart muscle cells may require regular consultations with a cardiologist. Prescription medications are available to help with this, too. © CTW Features 21

Tips and strategies for managing the cost of cancer treatment B y J esse D arland CTW F eatures

breast cancer diagnosis can be devastating enough. But after wondering how the cancer will be treated, many patients find themselves asking a second, just as distressing question: How will I pay for it? It’s especially true for younger women, many of whom are unused to navigating the world of healthcare. According to a recent study, the costs of breast cancer treatment for younger women can be much higher than similar treatments for older patients. That’s because breast cancer in younger women is often diagnosed at a much more advanced stage. Women aged 21 to 44 pay on average $97,486 more in the first year of treatment after a breast cancer diagnosis compared to women the same age without cancer. In

comparison, women aged 45 to 64 with breast cancer pay $75,737 more in the first year. Treatment can include multiple lab tests, clinic visits, radiation treatments, surgery, drugs and radiation treatment. In addition to these costs, patients in treatment often need to take long absences from work, which could result in the loss of a job and with it the loss of insurance. There also can be other costs, such as transportation or hotel if patients have to travel for treatment “I think one of the first things is to take a deep breath and begin to gather information,” says Susan Brown, senior director of education and patient support at the Susan G. Komen Foundation. Brown knows patients can sometimes be unsure about what to do next. She encourages people to take time to speak at length with their doctor

to understand the nature of the cancer and how to treat it. This should include getting a copy of their pathology report and seeking out a second opinion. “Their doctor should talk to them about the stage of their breast cancer, and the test that will be required to gather the information to make those treatment recommendations,” she says. Patients can educate themselves on different treatment methods so they know what to expect. It’s also important for patients to discuss specific treatment options with their treatment team. Find out from your doctor how much each treatment will cost, how much time off from work will be required and which costs health insurance will cover. “Realize that it’s OK to ask for help,” Brown says. “There are resources for financial information and assistance.”

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10 Questions to Ask Your Doctor 1. Which of these treatments are you offering for me? 2. What are the different options? 3. How much will they cost? Who in the office can I ask to find out? 4. If you recommend one, why is that? 5. What are the side effects? 6. How long will treatments last? 7. How will this treatment affect my work? 8. What is the plan to manage side effects from treatment? 9. How much time will I spend in the hospital and away from work? 10. When I resume work, will my activities be restricted?

9 Questions for Your Insurance Provider (For a more detailed list of questions to ask, see the sidebar.) “People of all socio-economic statuses will have some sort of financial impact from the cost of treatment, Brown says. “There’s no stigma with asking for more information.” Often a doctor’s office can provide that guidance. Some practices have a dedicated financial counselor on staff or a social worker who can also answer questions. These staff members also can gather information about the patient’s insurance and give some information about what the out of pocket cost might be. Brown suggests patients ask to be put on a payment plan to spread out their out-of-pocket costs. The Komen foundation also maintains a phone helpline at 1-877-465-6636 for live answers to questions. The American Cancer Society website also maintains an extensive set of pages on paying for 24

cancer treatment (https://www.cancer. org/treatment). Patients also can educate themselves on the terms of their health insurance plan. They can start by getting a copy of their health insurance policy from human resources. “The written policy itself is really important,” Brown says. “It’s a legal document, and that patient should really read that policy so that they understand what the insurance company is obligated to cover.” People should ask their HR department questions, and they also can go directly to their insurance company. Insurers want to hear from patients. “Healthcare providers have a sensitivity to this issue that they haven’t had in the past,” Brown says. Insurers know patients in financial difficulty won’t be able to follow their treatment, which can lead to bad outcomes. To help with this, many insurers have “navigators” within

the walls of the company to help patients understand the process and what happens next. When talking with an insurance company, take time to learn about your individual policy and follow the procedures the insurance company requires. “If there’s a sequence where things should occur, follow that sequence,” Brown says. She also advises asking lots of questions, especially whenever anything is unclear. (See the sidebar for some suggested questions.) Keep a written record of whom you talked to and when, and keep that log in a designated place along with letters, claim forms and other insurance documents. Above all else, she says, ask questions, don’t be embarrassed and find all the resources available. © CTW Features

Healthy L i v i ng Wi nter 2017

1. Is my doctor considered an in-network or out-of-network provider? 2. What costs are covered for office visits, and how much? What about blood draws? Chemotherapy? Hospital stays? 3. What co-pays will I be responsible for? 4. What is my deductible? 5. What is the process for reimbursement? 6. Is there a cap on my coverage? What happens if I reach it? 7. How do pharmacy discount cards impact my coverage? 8. Is getting a second opinion covered by insurance? 9. If I choose to join a clinical trial, what costs would be covered?

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misconception that finishing cancer treatment is similar to getting dental braces off. In the case of braces, one day you are limited in what you can eat, and the next you can eat all the caramel apples you want. When cancer treatment is completed, patients often feel pressure to immediately resume the lives they had before cancer. But the diagnosis and treatment of cancer—even curable cancers— can have such a profound impact on patient lives, that the eventual transition from “cancer patient” to “cancer survivor” can often last months to years. Physical side effects from treatment that breast cancer patients commonly report to me include discomfort or pain at the surgical site, fatigue, peripheral neuropathy (numbness, tingling or pain) of the hands or feet, lymphedema (swelling of the chest wall or arm due to surgery or radiation) and vaginal dryness. The mental effects from treatment include anxiety, depression, worries about recurrence as well as changes in body image and sexuality.

Surviving cancer has its own unexpected challenges B y L isa C.S. R ootvik , ARNP

atalie was diagnosed with Stage IIA breast cancer. Luckily for her, the cancer was caught early enough that her cancer care team, which included specialists in breast surgery, medical oncology and radiation oncology, felt certain she could be cured. She was given a plan, and for the next six months she diligently attended each of her appointments. Her family and friends rallied around her, providing support by calling her each day, bringing food and encouraging her every step of the way. On her last day of cancer treatment, they even threw her a huge party to celebrate. And then, just like that, her life 26

became quieter. Natalie had appointments to see her cancer care team in approximately three months for follow-up, but her daily routines were no longer dominated by her cancer and its treatment. She no longer had frequent appointments to attend. Friends stopped coming over as often as they had been, and her immediate family went back to their usual pre-cancer-diagnosis routines. She received advice about “getting back to normal” and “moving on” after cancer. But as much as she wanted these things for herself and her family, she was having trouble knowing how. To begin with, she didn’t feel like

the same person. This new version of Natalie had a body that looked different and was experiencing side effects from cancer treatment that the old version didn’t have. This new version also had worries about cancer recurrence, finances and her future that the old version didn’t have. Despite feeling incredibly grateful that her cancer had been caught early, she found herself struggling to get to know her new self. This struggle, in turn, impacted her selfimage, her relationships and her outlook on life. Natalie’s experience is not unusual in the breast cancer patients I see in the Survivorship Clinic. There is a common Healthy L i v i ng Wi nter 2017

In addition to these side effects, patients may also be facing issues with finances resulting from the cost of treatment and are often struggling with basic overall health issues like getting enough exercise and quitting smoking. The kicker is that all of this is in addition to the everyday life stressors and challenges that patients had before they were diagnosed with cancer. There is no one-size-fits-all way to transition into being a cancer survivor, which is part of what makes the process so complex. When Natalie came to see me at the Tri-Cities Cancer Center Survivorship Clinic, we discussed her diagnosis and her treatments in detail. We reviewed and assessed all of her side effects and concerns. Then we talked about the future, including how to monitor for cancer recurrence and other cancers, how often to receive imaging, how to take care of herself and how often to see her health care providers. Together we created a plan that addressed her concerns and future health. With her permission, I shared all of this information with her primary care

provider so that they knew how best to support her going forward. Natalie did not walk away from the Survivorship Clinic with all of her problems solved. But she did walk away with a better understanding of what she had been through, what she was experiencing and how to transition from cancer patient to survivor. She also left with a whole bunch of resources in her tool belt to help her achieve the best quality of life after cancer treatment. During this Breast Cancer Awareness Month, I would like to extend the warmest congratulations to our local breast cancer survivors who are working every day to get to know their new selves. I know there will be good days and tough days, but if you stay strong and seek out additional help and support if you need it, you will create new healthy and happy lives long after your cancer treatment is over. Lisa C.S. Rootvik, ARNP, is the survivorship nurse practitioner at the Tri-Cities Cancer Center Survivorship Clinic.

Your Tri-Cities Cancer Center NAPBC Accredited Breast Center Team Our medical team which includes over 30 area physicians and ancillary staff from Kadlec, Lourdes Health and Trios Health, who have partnered with the Tri-Cities Cancer Center to create a nationally accredited Breast Center.

Dr. John Droesch, BPL Dr. Richard Long Dr. Amy Backer Dr. Tom Maroldo Dr. Brian Staley Dr. Kevin Weeks Dr. Chet Hunter Dr. Dwane Brittain Washington Dr. Sean Koskinen Breast Specialist Dr. John Gowdy Dr. Timothy Gormley Dr. Laurie Evans, BPL Dr. Tomas King, BPL Medical Director of Dr. Eric Gamboa, BPL Breast Program Learn more on our website Dr. Arun Patel at tccancer.org/ Dr. Basir Haque breast_oncology_program Dr. Rangaswamy Chintapatla Dr. Ying Zhuo 2017-2020 Dr. Ahmad Fora Heather Johansen Dr. Anderson Grigg Paul Alderson Dr. Amer Khouri, BPL Alison Perkins Megan Greenough *BPL signifies participating Michelle Froh, ARNP member of the Breast Karen DuBois, ARNP Program Leadership Team

A sup p l ement of the Tri -Ci ty Hera l d

Cindy Miller, BPL Michele Caron, BPL Michael Novakovich, BPL Gretchen Saunders Dr. Sue Mandell, BPL Rainy Larson Dr. Juno Choe Margaret Ley Dr. Guy Jones Leann Anderson Chuck DeGooyer, BPL Lisa Rootvik, ARNP

“I am so very proud of our medical team, which spans specialties and hospital systems. By coming together, we have created world-class cancer care right here in our community where patients can receive comprehensive quality care minutes from their homes.” Dr. Laurie S Evans PC, FACS, Medical Director Tri-Cities Cancer Center Breast Center

“No Offense Doc, but I hate going to the dentist!”

of the following, sedation is likely a good option for you: Do you have anxiety from worrying about a dental visit several days before it happens? Do you have physical signs of nervousness related to seeing the dentist, such as shaking, nausea or vomiting? Do you cancel dental appointments because you can’t face them? There are several types of sedation, depending upon your anxiety level as well as your preference. Nitrous Oxide Dental Sedation This is a common method that is used with children as well as adults. You may know it as laughing gas, but the technical name is nitrous oxide. If you want something with few side effects and that has a short recovery time, then this would be your best option. The amount of gas given can be easily adjusted to suit your needs. You won’t be asleep, but you will be in a relaxed state. When the dentist is finished, the gas concentration will gradually be changed back to

pure oxygen, and you will be free to leave shortly after the procedure is completed. Oral Sedation For a deeper sedation, one should consider oral sedation. Typically, you will be given a pill to take the night before your appointment (to help you sleep) and then another one an hour or so before your appointment time. While you are relaxed, the dentist will begin the procedure you are to have done. You should not drive home because you will probably feel drowsy. IV Sedation Similar to oral sedation, this is a process where you will be almost completely sedated while in the office. Medications will be given through an IV to help you relax. Advanced Technology When was the last time you went to the dentist? If it’s been a little while, remember that modern technology has changed the field of dentistry dramatically. Most of the tools the dentists use are quiet, small and minimally invasive. Nearly any treatment offered by your dentist now is

able to be completely pain-free! Finding the Right Dentist The right dentist will be someone who’s caring and compassionate, especially with regard to your dental anxiety. He or she will ask about your previous dental experiences and will listen intently as you share your concerns. Next, your dentist should remind you that you are not alone in this struggle and that neither are you “a wimp” nor do you need to “just toughen up.” Your past experiences are real and are valid. Then he or she ought to discuss with you the options that seem to best suit your situation. Finally, the two of you, together, will formulate a plan for moving forward. Conclusion With today’s technological advances and multiple anxiety-reduction methods, dentistry is more comfortable than ever. Couple such advances with a caring dentist and the right approach, and you are well on your way to better oral health!

No waiting period, immediate treatment

No insurance? Join our in-office dental plan and save! B y D r . J ames C arey F amily F irst D ental

f you suffer from dental anxiety, you’re not alone. An estimated 40 million Americans do, too. As you can imagine, this fear often causes people to skip checkups and forgo treatment. Some will avoid going to the dentist at all costs, even if it means putting their teeth and gums at severe risk. They might only visit the dentist when they have an emergency, such 28

as an infection or severe pain from a toothache. (This sounds like it would be the same person, not 2 different people.) Dental fear is often caused by a poor past dental experience, even from as far back as one’s childhood. These fears are real and ought to be discussed freely with your dentist. In turn, your dentist should listen closely and share the latest options available to assist with anxiety reduction. You don’t have to let dental anxiety damage your health. There is much that can be done to greatly alleviate, and

No deductibles No exclusions

often eliminate altogether, dental fear. Here are some options your dentist will likely discuss and other points to remember: Sedation Dentistry Sedation dentistry is the practice of using medication to help you relax during your visit. Is Sedation right for me? Sedation dentistry is not for everyone. If you tolerate your dental appointments without a great degree of anxiety, you are probably better off without sedation. However, if you answer “Yes” to any Healthy L i v i ng Wi nter 2017

Quality care in a comfortable setting

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Physical therapists: The unsung heroes of cancer recovery

B y S ara A. N elson , PT, DPT, WCS, CLT-LANA/V odder

ears ago, I had a patient with breast cancer come in for her physical therapy (PT) session having difficulty breathing. I asked why she came to her PT appointment rather than going straight to the emergency room or her medical oncologist, and she said that she felt I could be the greatest help. We talked a bit, I thanked her for the vote of confidence, and I sent her to the emergency room. Why did she feel this way about physical therapy? I think it is because the physical therapist is uniquely qualified to empower people going through tough physical challenges. We understand the underlying pathophysiology to illness and how to work with it to improve health. We understand how to rebuild physical capacity with everyday common-sense tools of exercise, nutrition, stress management, rest, self treatment and manual-therapy methods. We know how to educate and motivate people through their illness and injury. We help people reach their maximum capacity so 30

they can participate in life as they desire. When I first started working extensively with breast cancer survivors, I noticed a gap in care. That gap was how to empower individuals to not only survive but thrive after cancer. Since that time 20 years ago, survivorship programs have developed and are filling in those gaps. The physical therapist remains an important part of the team for all cancer patients. At the Seattle Cancer Care Alliance, physical therapy referrals are automatic for breast cancer patients; they don’t wait for glaring problems to develop. They recognize that PT can help people go through the process of treatment and recovery and have better days. We can help people thrive and not merely survive. These are areas the physical therapist who focuses on cancer rehabilitation looks at: 1. Impairments These are physically limiting symptoms that interfere with the individual’s ability to move through his or her day.

• Pain. There are cognitive and selftreatment skills that will help people manage pain without the use of medication, or with much less medication. Pain medications have their own negative health effects. Learning practical and simple methods of pain reduction will help. And manual therapy can be very helpful. I had a patient referred to me because of severe chest wall pain and limited shoulder motion after breast cancer treatment. She spent five days in the hospital (with excellent care!) but no change in symptoms. Once discharged, she came to me and in one session she was more that 50 percent better. She had much less pain and was moving her arm. This is physical therapy at work! (I have colleagues with similar accounts.) Think how much money would have been saved if she had received this care first. • Swelling. Lymphedema is chronic swelling due to a change in the lymphatic system. Cancer patients who have surgery removing lymph nodes, or radiation that can damage the lymphatic Healthy L i v i ng Wi nter 2017

system, are at risk. Although medical treatments have been improved to reduce the risk of lymphedema, they have not eliminated it. Prior to these changes, more patients had swelling in the arm. These days we see more swelling in the breast and chest area. Manual lymphatic drainage is a specialized manual therapy that, when done well, stimulates the lymphatic system to take up fluids that have collected in the tissues. It is also pain-relieving and calming, two qualities that are very helpful to healing. • Fatigue. This is a symptom that has many causes. The physical therapist can help tease out some of the causes and develop an exercise and self-care program that doesn’t drain but actually helps the individual feel refreshed and stronger. • Limited motion. Free mobility in all the joints, including the spine, shoulder girdle and arm, are important for full function. Physical therapy helps evaluate the particular limitations of the individual and all that contributes to those limitations. They then devise a plan that is practical and effective in regaining motion and thus use in daily life. 2. Movement training. Physical therapy is the profession that works with people going through injury and illness. Using knowledge of the condition, we can appropriately select and choose the right amount of exercise at any stage of recovery. We help people find a movement hobby that they enjoy doing for the rest of their life. We know through research that exercise helps to address all A sup p l ement of the Tri -Ci ty Hera l d

the impairments listed above and helps in cancer recovery. It helps individuals have the capacity to do the things that matter to them. Group classes are very useful but don’t replace individual guidance.

3. Education. The physical therapist can take time to sit with you, answer questions and help you find a way through what you are going through. 4. Body awareness. Cancer can feel like the ultimate betrayal for some people. “My body let me down.” Regaining trust between mind and body through the experience of illness is an important aspect of rehabilitation. After years of helping people through cancer, I have come to realize that the best treatment for cancer is prevention, and of course physical therapy can help individuals develop healthy lifestyles that will prevent illness. But what is often overlooked is the critical role that physical therapy plays in cancer rehabilitation itself, from reducing physical symptoms to improving mental well-being. The popular word in cancer recovery is survivorship; I like the word thrivorship. A physical therapist can help individuals weather the storms of their illness and thrive! Sara Nelson is a doctor of physical therapy at Therapy Solutions in Richland.

Expert Integrative Care for the Whole Person

Offering Solutions with Specialized Care for: • Cancer Related Rehab Needs

- Methods of self-care to maximize the healing potential from cancer. We cover several areas including relaxation, exercise, lymphedema management, custom garmet ﬁtting and fatigue management.

• Pelvic Floor Dysfunction for women and men

- Assisting with incontinence, pain, pregnancy, postpartum and the effects of menopause.

• Non Pharmacological Pain Management

- Empower yourself by learning to change your pain using simple methods that are low cost and have no harmful side effects.

www.therapy-solutions.us 1455 Columbia Park Trail, Ste. 102 Richland, WA | (509) 396-3707 31

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