Patient Perspective: Carole Ann Webb
Patient Perspective: Carole Ann Webb April 15, 2015. The fact that it was tax day was far from the worst thing about this afternoon. “You have early stage breast cancer.” This news was certainly not what I expected to hear one week after my first ever mammogram. I had turned forty ten months before, and I had made a promise to myself to not turn forty-one before my initial screening. At first I was confused. Breast cancer didn’t run in my family. I was healthy, an active middle-aged (barely) woman who loved to go on long hikes and was just learning to mountain bike. Really? I had breast cancer? After more tests, it appeared that a lumpectomy and seven weeks of radiation were to be my summer. Before my surgery, I headed out to California for a two-week vacation, taking on tough hiking challenges in the state’s many national parks. I knew it would be awhile before I felt like hiking again. Two weeks after my surgery, I noticed that the painful swollen area under my left arm (where the sentinel node biopsy had been performed) persisted. I was diagnosed with a seroma, and during radiation, I noticed tightness and decreased range of motion in that left arm. I started physical therapy, but the feeling in my arm didn’t improve – in fact, it got worse. It was suggested that I see someone for a lymphedema assessment since my arm was definitely swollen, and I was continuing to experience pain. It was as simple as googling “breast cancer rehabilitation Atlanta.” If I wasn’t hooked by the inviting TurningPoint website (which I was), then my first appointment sealed the deal. What a welcoming place! My therapy team Jill, Anita and Jyoti educated me and developed a complete treatment plan, https://neurofitnessfoundation.org/ambien-zolpidem/. The staff and volunteers always had a smile and a kind word to offer. I will be forever grateful for the excellent care I received. I felt that TurningPoint treated the whole me – my body and spirit felt revitalized after each visit. My lymphedema is stable at a low level and I know how to manage it myself and when to go back for reassessment – and I no longer have pain! I wasn’t able to do most of the physical activities I enjoy for most of 2015. But 2016 is here, and I have taken up boxing! This new interest is going to get me in the best shape of my life, but I couldn’t have made it this far along in my journey without the care, wisdom, and genuine support I received from TurningPoint. I offer sincere thanks for making this chapter in my life so much easier to bear.
Nutrition Q&A: Grilling Meats
Is eating grilled meat safe? The American Institute for Cancer Research (ACIR) expert report says there is not enough evidence to show that grilled meat increases your risk of cancer. But we do know that cooking meat at high temperatures, like grilling, creates cancer-causing substances called polysyclic aromatic hydorcarbons (PAHs) and heterocyclic amines (HCAs). PAHs form when fat from the meat drips onto the hot coals or grill element. They’re then deposited on the food courtesy of flame-ups and rising smoke. Unfortunately, that desired charring that forms on meat can contain PAHs as well. HCAs, meanwhile, are produced when red meat, poultry and fish are exposed to high-heat cooking, like grilling, broiling, or charring. Both PAH and HCA can cause changes in DNA that may lead to cancer according to AICR. Risk of these carcinogenic formations is higher from red and processed meats – like hamburgers and hot dogs. Evidence is clear that diets high in red and processed meats, contribute to an increased risk of colorectal cancer. Based on the evidence, AICR recommends limiting red meat to 18 ounces of cooked meat per week and staying away from processed meats. Guide to Safe Grilling Marinate: Studies have suggested that marinating your meat before grilling can decrease the formation of HCAs. Scientists theorize that the antioxidants in these marinades block HCAs from forming. Pre Cook: If you are grilling larger cuts, you can reduce the time your meat is exposed to the flames by partially cooking it in a microwave, oven or stove first. Immediately place the partially cooked meat on the preheated grill. This helps keep your meat safe from bacteria and other food pathogens that can cause illness. Lean Cuts: Trimming the fat off your meat can reduce flare-ups and charring. Cook your meat in the center of the grill and make sure to flip frequently. Mix It Up: Cutting meat into smaller portions and mixing with veggies can help shorten cooking time. Go Green: Grilling vegetables and fruits produces no HCAs and plant-based foods are actually associated with lower cancer risk. Try this marinade recipe for any kind of meat. Tangy Yogurt-Spice Marinade (Yield: Makes about 1 2/3 cups.) 1.5 cups low-fat yogurt 2 Tbsp. fresh lemon juice 1/4 tsp. cayenne pepper 2 tsp. minced garlic cloves 2 tsp. ground coriander 1 tsp. ground turmeric 2 tsp. minced fresh ginger (or 1 tsp. dried, ground ginger) Salt and white pepper, to taste Place all ingredients in a blender and combine at low speed. Pour into large, wide and shallow non-metal casserole dish or mixing bowl. Add food to be grilled and turn to coat all sides. Cover and refrigerate at least 1 hour. When ready to grill, drain and discard marinade. Thread skewers with food. Grill, turning often to prevent charring. If desired, make additional marinade for basting (but do not baste with used marinade to avoid food poisoning from raw meat juices). Per serving: 23 calories, 0 g total fat (0 g saturated fat), 3 g carbohydrates, 1.5 g protein, 0 g dietary fiber, 22 mg sodium
Evidence Update: Lymphedema At Risk Activities: Fact or Fiction?
Many of the precautionary guidelines related to lymphedema provided to breast cancer patients are anecdotal and not based on research. Unfortunately, many of these guidelines place a large burden on patients and clinicians who go to great lengths to abide by them. The avoidance behaviors can often be more impactful on quality of life than actually having lymphedema! A recent study, published in March 2016, was the first large scale, prospective study to investigate whether there is an association between certain activities and increases in arm volume in patients treated for breast cancer and screened for lymphedema. These activities include blood draws, injections, blood pressure readings, trauma, cellulitis (infection) in the affected arm and air travel. Subjects were 632 patients (760 at-risk arms) with newly diagnosed breast cancer. Bilateral arm volume measurements were performed preoperatively and postoperatively at 3 to 7 month intervals using a perometer. At each measurement, patients reported the number of blood draws, injections, blood pressure measurements, trauma to the at-risk arm(s), and number of air travel flights taken since their last measurement. Arm volume was quantified using the relative volume change and weight-adjusted change formulas. In the total of 3,041 measurements carried out on the 632 subjects, there was no significant association between change in arm volume and undergoing one or more blood draws, injections, number of flights, or duration of flights. As has been previously found in other studies, factors significantly associated with increases in arm volume included weight gain (body mass index), axillary lymph node dissection and regional lymph node radiation and infection/cellulitis. This study suggests that although cellulitis increases risk of lymphedema, blood draws, injections and blood pressure readings on the affected side, as well as air travel, may not be associated with arm volume increases. The results of this study will provide clinicians and patients with much better evidence regarding risk factors and triggers of lymphedema. The clear risk factors for lymphedema are the number of lymph nodes removed, radiation to regional lymph nodes and higher BMI. Infection, or cellulitis, of the arm may be a trigger for lymphedema. Simple infection precautions make sense, such as using gloves when gardening and topical antibiotics for small cuts on the affected arm, https://suriaplasticsurgery.com/valtrex-valacyclovir/. Patients may prefer to continue to have blood draws and blood pressure taken on the unaffected arm, but should understand that these do not appear to trigger lymphedema based on this study. The issue of I.V.s was not addressed in this study and patients may want to continue to avoid these in the affected arm since, unlike a blood draw, fluid is being added to the limb. Flying does not appear to be a trigger to lymphedema; however, for women at moderate to high risk, TurningPoint physical therapists advise patients to travel with compression garments, in case swelling or lymphedema should become apparent while out of town. Ferguson CM et al. Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer. J Clin Oncol. 34;7: 691-698.
Nutrition Q&A: Sugars
Q: Can eating sugar cause cancer or increase my chance of recurrence? A: I get asked this question on a daily basis. Presently there is no scientific evidence that directly links sugar consumption and increased risk of cancer, increased tumor growth or increased risk of recurrence. To say sugar causes cancer would be the same as saying sugar causes diabetes. Both are false statements. The data regarding sugar and cancer risk draw their conclusions on information from preliminary studies done with animals and in test tubes, not on human subjects. Recent research has been looking at an individual’s diet along with sugar intake to see how it may affect cancer risk or survivorship outcomes. There has yet to be any randomized, controlled trials showing that sugar causes cancer. What we do know about sugar it that it has no nutritional value. It provides us with nothing but calories. Increased consumption of calories in the absence of physical activity can lead to weight gain. Excess weight has been linked to increased risk of the following cancers: esophageal, pancreatic, colon/rectal, breast (postmenopausal), endometrial, kidney, thyroid and gallbladder. The American Institute for Cancer Research states the following: “Foods and drinks that are high in refined carbohydrates, added sugar, and fat contribute to obesity, a major risk factor for cancer.” Eating too much refined sugar can also cause chronic low-grade inflammation which has been linked to increased cancer risk as well. When we talk about sugar consumption, we are talking about refined sugar, not sugar found naturally in our food, ie lactose in milk or fructose in fruit, so cutting back on these foods is not warranted. Keeping refined sugar to a minimum is hugely important for overall health. The current recommendations are to keep refined/added sugar to 6 teaspoons per day for females and 9 teaspoons per day for males. Americans currently consume 3 to 4 times that much. When reading the food label of your favorite sugary treat, keep in mind the following equation to help you determine how many grams of sugar you are consuming per serving: Take grams of sugar and divide by 4 and it will give you teaspoons per serving. Say for instance the soda you’re about to drink has 44 grams of sugar. 44 divided by 4 = 11 tsp of sugar, which is 1 tsp shy of a ¼ cup. That’s not to mention any other added/refined sugar that shows up in the rest of your food throughout the day. Spend your sugar budget wisely, and when it comes to processed sugar, less is always better. Simply start by cutting out sugary foods such as pies, cookies, candies and eliminating sugary beverages such as soda, sweet tea, and sports drinks.
