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By Dawn Oswald Dawn Oswald joined SBC at the LBBC Thriving Together: 2023 Conference on Metastatic Breast Cancer through SBC’s Educational Grant Program. Read below for Dawn’s takeaways from this incredible event! I attended the 2023 conference in person for the first time. I attended via Zoom last year. The reason I chose to attend in person is because I believe it is more personal and I learn more in person. LBBC and SBC offered grants to help me attend the conference. I am greatly thankful for the support. On Saturday, I attended “Ask the Expert: Diet, Physical Activity, and Sleep” with Rachel Beller, MS, RDN, and Pallav Mehta, MD, where we learned about the importance of fiber and ideas of how to incorporate it, plant-based foods, and oncology-specific exercises (see more in Liz Mover’s LBBC’s takeaways ). I also went to the session “Recently Approved Therapies and Promising Approaches for the Future” by Nancy U. Lin, MD. In this presentation, Dr. Lin shared information about gene mutations and applicable therapies, MBC-specific treatment options for improved survival rates, treatment resistance, and different therapies based on hormone receptor status. Some of the many drugs discussed in Dr. Lin’s presentation included: Piqray, Afinitor, and capivasertib for the P13K mutation Trodelvy for triple-negative breast cancer Neratinib, tucatinib, and Margenza for HER2-positive breast cancer Antibody-drug conjugates: Trodelvy and Enhertu Targeted therapies: Kisqali, Verzenio, Lynparza, Talzenna, and Piqray Endocrine therapy for estrogen-positive breast cancer Everolimus, elacestrant, alpelisib, and fulvestrant as second-line therapies for estrogen-positive breast cancer Chemotherapies: Xeloda, Taxotere, Gemzar, Ixempra, Halaven, and Abraxane Chemotherapies for HER2-positive breast cancer: Herceptin, Perjeta, Tykerb, Afinitor, and Ibrance I participated in a movement class, “Reclaiming the Body’s Healing Power Through Movement & Dance” with Nancy Herard-Marshall, MS, LCAT, BC-DMT. In this activity we were asked to consider some introspective questions about our own cancer experiences, our connections with the community, and understanding the power of our own story. We did some exercises and then we just danced any way we wanted. We were trying to throw the cancer out of our bodies, if only we could. I had a great time dancing. Exercise is very important. I try to walk at least a couple times a week with my puppy and do my lymphedema exercises. Check out Project Life MBC for upcoming events. I attended an evening play called “IV: Our Lives,” and it was very good. The play was about men and women learning that they have metastatic breast cancer. It was based on interviews with 100 men and women asking them how they felt when they were told they had metastatic breast cancer. The play was in their own words. Let’s just say it had a lot of adult language. The hope is that recording this and getting it out there for others to hear will help get the awareness out there about MBC. Their mission is to educate family, friends, oncology teams, colleagues and those newly diagnosed with MBC. It was a little emotional and lasted for 1.5 hours. Thank God they gave us tissues. On Sunday I went to a panel called “Shared Voices: Learning from Each Other,” with four speakers with MBC: Thomasina Butler, Sheila Godreau, Cheryl Law, and Deb Ontiveros. One of the panelists, Thomasina Butler, has been living with MBC since 2005. If that doesn’t give us hope, then I don’t know what will. I am not losing my hope or my faith. The panelists answered MBC-related questions for an hour. We all have our own experiences with MBC. It is always good to share. The conference ended with “Living Well with Metastatic Breast Cancer,” presented by Stephanie Broadnax Broussard, LCSW, ACHP-SW and Don S. Dizon, MD, FACP, FASCO. The presenters discussed sexual intercourse and ways to approach sex as someone who has experienced breast cancer and treatment. It might be something as simple as vaginal dryness. They recommended oils. My suggestion is, if you're having problems in that area, to see a sex therapist or at least tell your doctor. In conclusion, I highly recommend attending the LBBC MBC conference next year. This year’s conference was full of information, and it gives me hope that there are people out there to help us. If you want to attend next year, you can visit the LBBC website and subscribe to receive information as it becomes available. Thank you, Dawn, for attending the LBBC conference with SBC and sharing your takeaways with the SBC community! SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Hormone receptor-positive (HR+) breast cancer accounts for a significant percentage of breast cancer diagnoses, characterized by the presence of hormone receptors—estrogen and progesterone receptors—on cancer cells. Understanding HR+ breast cancer and the latest treatment updates is pivotal in offering tailored therapies for improved outcomes. Understanding Hormone Receptor-Positive Breast Cancer HR+ breast cancer is defined by cancer cells having receptors for estrogen, progesterone, or both. These receptors fuel the growth of cancer cells, making HR+ breast cancer sensitive to hormonal therapies. Diagnosis and Subtyping Diagnostic Techniques: Immunohistochemistry (IHC) and other laboratory tests detect hormone receptor status. Subtyping HR+ breast cancer helps guide treatment decisions. Hormonal Therapies: Cornerstone of Treatment Endocrine Therapy Options: Selective Estrogen Receptor Modulators (SERMs) like tamoxifen block estrogen's effects on cancer cells. Aromatase Inhibitors (AIs) prevent estrogen production in postmenopausal women. Combination Therapies: Combining hormonal therapies or pairing with targeted agents enhances efficacy. Latest Treatment Updates CDK4/6 Inhibitors: CDK4/6 inhibitors (e.g., palbociclib, ribociclib, abemaciclib) are game-changers in HR+ metastatic breast cancer. Combined with hormonal therapies, they significantly prolong progression-free survival. Extended Endocrine Therapy: Recent studies evaluate the benefit of extended hormonal therapy beyond the standard 5-year duration. Offers potential for reducing recurrence risk in HR+ early-stage breast cancer. Precision Medicine: Tailoring Treatments Genomic Profiling: Advancements in genomic testing aid in identifying HR+ breast cancer subtypes and predicting response to treatments. Personalized medicine directs therapies based on individual tumor characteristics. Challenges and Emerging Research Resistance Mechanisms: Development of resistance to hormonal therapies remains a challenge. Ongoing research explores mechanisms of resistance and novel treatment strategies. Immunotherapy in HR+ Breast Cancer: Exploring the role of immunotherapy, including immune checkpoint inhibitors, in HR+ breast cancer treatment. Management Beyond Treatment Side Effect Management: Addressing side effects of hormonal therapies, such as hot flashes, bone health issues, and menopausal symptoms. Patient Support and Survivorship: Importance of patient support programs, survivorship care plans, and psychosocial support for HR+ breast cancer survivors. Advancements in HR+ Breast Cancer Treatment The landscape of HR+ breast cancer treatment is continually evolving with innovative therapies and precision medicine approaches. Latest updates in hormonal therapies, combination strategies, and precision medicine offer new avenues for improved outcomes, emphasizing the importance of tailored treatments and ongoing research to combat HR+ breast cancer effectively.

At SBC we received a heartfelt, brilliant note from community member and MBC Leadership team participant Kathleen Friel, regarding how to properly listen to and respond when speaking with someone with a speech impairment. (See her email below).   Kathleen’s memo got me to thinking about how I can personally improve and develop effective listening habits, and after some quick research I came up with the following:   Effective listening is a crucial skill that goes beyond simply hearing words; it involves fully comprehending and interpreting the message being conveyed. One key aspect of effective listening is providing the speaker with your undivided attention. This means putting aside distractions, such as phones or other electronic devices, and maintaining eye contact to signal that you are fully engaged. Furthermore, active listening involves non-verbal cues, like nodding or mirroring the speaker's body language, to convey understanding and encouragement. In addition to non-verbal cues, paraphrasing and summarizing the speaker's message demonstrates that you are not only hearing but also processing the information.   This reflective aspect of listening ensures that both parties are on the same page, fostering clarity and preventing misunderstandings. It's essential to refrain from interrupting and allow the speaker to express themselves fully before responding. This patience and respect contribute to a more open and communicative environment, where individuals feel heard and valued.   Ultimately, effective listening is a skill that strengthens relationships, promotes understanding, and facilitates successful communication.   …the message from Kathleen Hi Friends, I am writing to share a tip sheet that may help you feel better prepared to interact with people who have a speech impairment. Some people, like me, have a lifelong speech impairment. Others may be experiencing extreme fatigue, dry mouth, or mouth sores. I’d love to make SBC groups more inclusive of people with speech impairments. This TNT training is a great start!   In essence, it’s simple: we all  want to be heard. Think of your own experiences in SBC groups – don’t you love it when we all have time and space to be heard! Everyone should be able to speak. Interruptions and repeating are generally seen as demeaning. I answered a question on Sunday saying if you want to repeat what someone said, ask. I want to step back a tad. Perhaps first, ask if they want to use the chat to share. During such chat-writing time, it would be ideal for the group to quietly wait. (Like, 2 min or less, not forever! Most people will type small bits of info, hit enter, then type more, which is more like the beat of a conversation.)   Common things I’ve encountered •           Assumption that I’m mentally impaired. Someone’s speech does not correlate with intellect.   •           People finishing my sentences or interrupting, often with something wildly different from what I was trying to say. Give people the chance to speak for themselves.   •           People not recognizing that those with disabilities have lives just as complex as everyone else. People often seem shocked when I talk about dating, work, the fact that I live alone and drive… most people don’t have to hear, ”Oh WOW you’re so inspiring,” when they drive to the store.   •           Folks unaware how carefully I plan when I’m going to talk, and unaware of the unease I feel when the plans don’t go smoothly. It’s not that different from the planning that other people with disabilities do. Imagine arranging ahead to have a ramp at the restaurant you’re meeting friends at. You may feel proud of your master plan. Then of course, no ramp at the restaurant. The planning and organizing that people with speech impairments do are not as visible, but just as important. Examples: resting before gathering, typing out things in a Word doc that I think I might want to put in the chat.  If you call on someone with a speech impairment and we need a second to take a drink or sit up straight, be patient. We’ve got a LOT going on behind the scenes! 😊   •           I know this shouldn’t need to be said, but no teasing! I grew up being teased, as most people with disabilities do. I’m over it. Teasing is painful, not funny, and not cool.   I hope this all helps!! Kathleen

By Wendi Gwaltney What do you do when one of your best friends calls you to tell you she has stage 2 breast cancer ? I will call her Mary for the sake of privacy. She was 52 years old at the time. We had been friends since we were 12. I wanted more time. The emotions flowing through your body are immeasurable. What do you say ? What do you do? How can I help you? As a nurse, I knew her prognosis was good, but I was still scared.  The desire to run to her house and hold on tight ran through me. In 2020, to hold someone tight was out of the question. Amid a pandemic, cancer strikes! Covid-19 was breaking records globally. Vaccines were not yet available. People were dying! How can I help  without making it worse? I am a nurse. Although my time at the bedside was limited, I was still at risk of contracting this contagious disease.  Mary is a humble soul. She appreciates offers of assistance. She asks for nothing. We talked and texted frequently during this time. She said she would listen to music on her phone during her treatments but did not have earbuds.  As a fan of Amazon Kindle, I ordered her a Fire tablet and a set of Bluetooth earbuds. I shared with her different books that I was reading or listening to. I told her about Amazon Prime’s benefits, including books, music, and videos. It gave us something to talk about other than her cancer and treatments.  Mary would discuss her cancer. She talked about how the cancer treatments made her feel.  She told me about recommendations from her care team to help her manage the side effects   of chemotherapy and radiation. I think it was during her second round of chemotherapy that she became ill with a respiratory infection. No, it was not Covid. Pneumonia was bad enough in her weakened state. She was hospitalized in September 2020 for a week. This was just a couple of weeks before her birthday.  Due to Covid quarantines, a social gathering for her birthday could not happen. My husband and I put together a celebration. We delivered dinner, a cake, flowers, and balloons. The items were placed at her door, and we quickly moved away. Pictures were taken. She was thinner and wearing a scarf. She was beautiful! At one point, her care team decided to stop chemotherapy. After a few weeks of recovery, she had radiation and a lumpectomy. She continues to take Tamoxifen.  Today, her beautiful hair has grown back. She even has to get it trimmed to keep it tidy. She maintains her weight. She enjoys spending time with her husband and son.  I asked her recently if I had tried to do too much with the Amazon gifts. I admitted that I did not know what to do to help. In her usual modest self, she expressed her appreciation that I was there for her.  Mary, I will always be grateful for your steadiness in my life. You are a survivor and a leader! Thank you for being my friend! Read More: Supporting Loved Ones with Breast Cancer: How to Offer Meaningful Help Cancer Etiquette: How to Talk With Loved Ones About Their Breast Cancer Navigating Relationships After a Breast Cancer Diagnosis Navigating Cancer Treatment: Top Tips from an Oncology Pharmacist On the Podcast: Breast Cancer Conversations Granting Wishes Brings Joy with Elesha Snyder & Jan Hillman Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Guest Blogger, Cora ( @boobambassador on Instagram), weaves a delightful yarn dealing with the myriad issues of Breast Cancer. What follows is a collection of, and/or excerpts of, blogs that may help one navigate the rough waters of that most heinous diagnosis. You can find her blogs and vlogs here : Scared is what you’re feeling. Brave is what you’re doing.” Emma Donoghue Scared is what you’re feeling. Brave is what you’re doing.” Emma Donoghue I’m human. Contrary to beliefs that I’m a Super Warrior chick (which I kind of am), I still struggle with a lot of things these days. Not sure if it’s post cancer angst, old age, menopause, or just the way the fecking stars are aligned. Which ever…..it’s been a funky week for me, and I needed to get that off my “foobs”/chest. I woke up this morning with the thought that…..holy shite….it’s already half way through the year. Winter is coming!!!!!Reference to Game of Thrones for those of you that don’t watch it. But seriously…..I almost had a panic attack. Like….Christ on a bike…..I’m NOT ready for another Winter ALONE!!! My hopes for even a second date have been dashed….the dude has dropped off the face of the earth. Hopefully he hasn’t dropped off the face of a cliff in the White Mountains (which was the last text I got from him over a week ago as he set off to go hiking ). More likely, he met someone closer to where he lives….which is perfectly fine and TOTALLY understandable. Just wish he had the balls to drop me a text, and not just disappear. So…..back to the drawing board I go. Man, is it EXHAUSTING!! I may have to just throw in the towel, and join the Nunnery, because at this rate, I’m a born again virgin anyway!!! Plus another upside would be that there would be more help with schlepping in the wood!!!! LMArseO!!! Not EVER going to happen. Now I know what your thinking. Cora…..be positive. Don’t wish or worry your life away. To which I would answer….tell me to be more positive than I already am 98% of the time…..and I will punch you in the head. Not literally. Figuratively….but there may be a wee slap if you were in front of me. Just a gentle one, because I love you. And I work VERY hard at not worrying too much….but sometimes it gets the better of me. Like when I was in the shower this morning doing my self Breast exam (#Buddy2buddy)….low and fecking behold….Louise had what felt like a lump on the medial aspect of my foob. Can you say PUKE!!! Which I almost did. But after poking and feeling the shite out of her pretty much ALL day (in between patients of course)…..I have come to the conclusion that it is just a wrinkle in my implant that when in a certain position, feels like a small lump. Menopause Ain’t for Sissies…. Holy crap….it happened again!! Not AS bad as the first time….but still disconcerting none the less. And in the bloody car AGAIN! I just got the heating fixed today. Should have left if stuck on arctic freeze instead!! Figured this would be an appropriate time to share the FB post I wrote about the first time I experienced one of the joys of being a woman, to the people out in Blog land. Enjoy So….a funny thing happened to me on me way to work this morning. Not funny “ha ha”, but funny “weird”! There I was, driving along, minding me own business, when all of a sudden…..me ears are on FIRE!! I mean….hot enough to fry a bloody egg..on fire !!! And I’m thinking…WTFeck! Am I having a reaction to my cancer fighting drug Tamoxifen (cause that’s the only medicine I’m taking).?? And that makes me panic slightly because then I’m up Shite creek without a paddle…or a way to fight my cancer. So I get to work, and start to take off me jacket & gloves (‘cause of course it’s cold enough outside to freeze the balls off a brass monkey ), and I recoil in fear and slight disgust at what I’m seeing in front of me!! I have this “rash” spreading up from me hands towards me shoulders . So now I’m thinking….Christ on a bike…..What. The. Feck. Is. Going. On!!!!! I solicit an opinion from my nice coworker….who upon taking one look at me….ever so briefly….steps back away from me. Which I don’t blame her…..because I looked slightly hideous. Or contagious. Or a combo of both . So….I’ll try to cut this ramble short, and say I made an appointment with a wonderful nurse practitioner in the clinic where I was working. But by the time I got in to see her…..my hideous bubonic plague like “rash”, had subsided to a rosy glow. Kind of like when you have something wrong with your car, and you go and tell the mechanic “there’s a clunk & a rattle”, and they look at you like you have ten heads and say “yah….right!” And the car behaves perfectly FINE for him. That’s how it was for me. BUT….we think we figured it out. It was most likely NOT a bad reaction to my cancer fighting drug (thank the Sweet Jesus!!!! ), but more likely a side effect of it…..my first HOT fecking FLASH!!! Welcome to almost 50 Cora!!!! Me Mum never told me about THIS!!! SO….if you are in my company, and all of a sudden me ears are glowing and hot enough to warm your hands on a cold day, and I develop a rash that spreads from my hands up to my shoulders….DO NOT BE ALARMED!!! Do not run in the opposite direction fearing for YOUR skins integrity. I am NOT contagious. I’m just having a fecking HOT FLASH with accompanying HEAT RASH!! #welcometomenopause #sideeffectsofcancertreatmentscansuck #thejoysofbeingawoman Ps…..not sure this post will help my dating prospects too much….what do you think. LMArseO. Carry on tribe. Hope you are having a lovely evening. I’ll shut up now Dating at 50….. With a Breast Cancer Diagnosis and Foobs to Boot…… Dating at any age can be interesting. But dating when you’ve turned 50, is like biking up Cadillac Mountain on a 3 speed. Slow and painful THEN you add the extra layer of breast cancer boob/foob stuff…..well then shit gets real! PLUS….when you live at the end of the universe, chance meetings are, well….few and far between. So Match, or some such dating site is what we are left with. And let me tell ya…..I would rather be back at the Sisters of No Mercy getting beaten across the back of the head with a bible (true story)……than be on those sites. BUT…spending the rest of my days on this earth without that special man in my life, is NOT an option, so here I am. Cyber dating, and sucking at it. Not that I haven’t met some VERY nice men on Match. Over the past 5 yrs (with a hiatus of a few years because of the cancer thing), I’ve been on approx 10 dates. First dates mind you. No one was horrible, but they were not “second date worthy” in my mind. That’s sounds pretty harsh once it’s written down…..but what I mean is that as nice as they were, I just didn’t want to waste anyone’s time (including my own) on pretending there was something there. I’ll know it when I see it. And at this time, I haven’t. Seen it. Cancerversary…… Yes, There Is Such A Thing Cancerversary , like a cancer experience, is unique. It is a milestone defined by you. It could be the day that a loved one was diagnosed. It might be your own last day of treatment. Or it might be several important dates that occur throughout someone’s cancer journey. I’m on the last day of several that have caused me some angst this year. And they probably will for some years to come. April 21st, 22nd, and 23rd will ALWAYS stand out in my mind, as the days leading up to one of the most challenging of my life. Not THE most challenging (because I’ve had worse), but it’s definitely up there in the challenging scale. On a scale of 0 to 10……we are talking about a 7. My family dropping off like flies, that’s a 10. My husband divorcing me (at the same time as my house renovation was going on), that’s a 9. I guess, because of all those other challenges, cancer was a WEE bit easier for me to handle. April 21st, 2015 I found my lump, or more accurately, my lump found me. Jumped right out at me when I went to free the girls at the end of a trying day. Wasn’t there in the morning when I put me bra on. April 22nd, was the day I got in to see my surgeon. I remember seeing her face when she examined me. I think we both knew it wasn’t just my “usual” cysts, as she performed a biopsy in her office. April 23rd, was the day she called me with the results. It didn’t come as a surprise. I think instinctively my body and mind knew, and were preparing to go in to fight mode. I remember her voice, and how very sad she sounded as she gave me the news. I actually felt worse for her than I did for myself. She had done EVERYTHING possible over the years that she had been monitoring my lumpy, bumpy, cyst filled Boobs, to NOT let me get to this moment. I wanted to reach down the phone, and hold her hand to let her know that this, this devastating news, did not break me. We formulated a plan for me to come in the next morning (even though it was her day off), and we would come up with my plan of care. I also remember the feeling’s and thoughts that swept over me when I put down the phone and sat in my kitchen, alone. I believe the words “OH fuck” popped in to my mind first. Actually it was more like “FUCK, fuck fuck fuck fuck!” Then, it was like a sucker punch to me guts……how am I going to tell Sean that yet another sibling is so very sick. Now THAT almost broke me. Backstory for those who don’t already know, parents….dead. Brother, Gabriel…..dead of a heart attack at 44. Sister, Stephanie…..dead of a diabetic coma at 53 (after surviving a breast cancer diagnosis at 50). Brother, Stephen…..barely alive after being on life support in January of 2015. You get the picture, right. But the thing was, my brother Sean had JUST left Ireland for a 4 day vacation to France with one of my cousins. And I sure as shite, was NOT going to ruin that for him. My cancer would still be there on Monday when he got home. And I would have a concrete plan of action by then also. So, I waited until then to tell him. In the meantime, as I sat there with my thoughts and my kitty cat, I knew I needed my friends. I knew I couldn’t bare the burden of this news alone. So my friends Chandra, Stephanie, and Tamara came to my home and “circled the wagons” so to speak. They wrapped me in as much love and comfort as they could. I’m not sure they know how MUCH that meant to me. I needed them SO VERY much that night. And as always. They were there for me. As was my friend Dave and his new girlfriend Jen, who had been diagnosed with breast cancer the year before me. I called Dave to let him know the news, and even though I had not met Jennifer, she wanted to come with me to my Drs appointment the next day, to help me navigate through all the information that would be coming at me. Her act of kindness is what has inspired me to reach out to newly diagnosed women……to be their “Jennifer” at such a devastating time. To pay it forward to the breast cancer community. I’m writing this blog post at approximately 3am. Sleep has eluded me over the past 3 days, but I know it will get better once Tuesday comes. In the meantime, I will sit with the pain (as the Buddhists teach), because trying to deny its existence will make it come out sideways. I won’t wallow in it. I’ll just let it wash over me, and then continue my journey forward. So if you happen to see me today, and I’m slightly out of sorts, a hug would be appreciated. But just knowing that my tribe has always had my back through this shit storm…….that’s been priceless. And healing. And what’s given me the strength to get through it. I think I might be able to get some sleep now……maybe.

By Michelle Stravitz, Co-Founder, 2Unstoppable As I moved beyond active treatment and into that murky post-treatment phase, I attended many classes and webinars on a variety of topics – chemo brain, the emotional rollercoaster of survivorship, nutrition and healthy living, emotional well-being, and more.  Do you know that every single one of them told us to exercise ?  It really amazed me. The more I looked into it, the more I realized that exercise has been shown to improve cancer outcomes in many ways.  Regular exercise has been demonstrated to significantly lower recurrence rates and increase survival rates for women with breast cancer.  Exercise helps fight so many side effects that I learned about and experienced throughout treatment, and many that I didn’t even realize until after treatment was over – including lower bone density, lost muscle mass, new feelings of anxiety (even PTSD), tight tissue in my arms and chest area, balance, notable chemo brain, potential heart damage, and lingering fatigue.  In one class I attended, I learned something about our muscles that truly shocked and mobilized me: We normally lose about 3-4 pounds of muscle mass over 10 years of aging; we lose the same amount of muscle mass in just 6 months of chemotherapy!  That fact alone got me to barre or another exercise class on many a morning! … and never mind the emotions that kicked in after treatment! The more I learned, the more I decided to make physical activity a priority in my life – finding what worked for me, but trying to address each of the different side effects.  My personal routine includes active yoga, barre, cardio exercise classes, brisk walking, and even a bit of running.  I’ve also tried belly dancing, cardio drumming, and Qigong.  And I can’t say I regretted a single time that I dragged myself out of bed or out of the house to exercise.  It has helped me tremendously, from fighting fatigue and chemo brain to building back muscle and confidence . And truly, if exercise only fought the cancer-related fatigue … that would certainly be enough.  Seriously, “you had me at fatigue.”

All too often we hear the story of breast cancer survivors whose loved ones couldn't cope with the diagnosis, treatment, surgery, radiation, side affects, scarring etc., and were so overwhelmed that they left the relationship. What follows is a brief descriptive characterizing the role of a care giver and the value it represents to the patient. This precedes the narrative of breast cancer survivor Krystle Hansley, whose relationship with her loved one fell apart due to the onset of Breast Cancer. In the future we will follow up with a more extensive Caregivers Guideline. Characteristics of care giving There are many characteristics of life as a caregiver.  The support that one provides to a cancer patient/survivor includes many of the following: emotional, physical, intellectual, financial, social, spiritual, nutritional, and motivational aspects to name just a few.  But you are never alone.  There is help and assistance everywhere.  I found the following links to be quite helpful in coming to terms with my role as a caregiver.   https://www.cancercare.org/tagged/caregiving http://www.breastcancer.org/community/acknowledging/caregivers https://www.cancer.org/treatment/caregivers.html From diagnosis onward the responsibilities associated with caregiving kick in.  There are meetings and discussions with your oncological and surgical teams.  Options and alternative courses of action are proffered and weighed. Decisions have to be made in short order so it’s best to prepare yourself ahead of time by performing as much due diligence as you can. Do your research on the various options as spelled out by your team. Once a course of action is agreed upon and plotted take particular care to stay on top of developments, I.e. scheduled appointments, pain/emotional management, medications, coordinating and communicating information to the extended caregiving family, and helping with chores. At all times be aware that you are there to assist the patient.  This isn’t about you.  Involve yourself with the patient’s emotional issues.  You do not need to be a medical professional.  Common sense and responding through the lens of caregiving should provide you with enough tools to deal with the myriad emotions that arise, such as fear and depression/sadness.  There are many support groups that you can reach out to, including hospital care groups, psychiatrists, social/media pages, # survivingbreastcancer.org . Guest Blogger Krystle Hansley, At the start of the summer in 2016, I was in the “prime” of my life. I had a prestigious research fellowship working on a HIV vaccination project at Tulane University; I was entering my last semester of graduate school, and I spent my weekends strolling down the lively streets of New Orleans. Everything was perfect, or so it seemed. Little did I know that a storm was coming. Within a few weeks, everything would change -- forever. On July 15, 2016, while sitting on the same bed where I had spent countless hours studying some of the world’s deadliest diseases, I received a phone call that would throw my whole world into disarray. That day, at the ripe age of 27, I was diagnosed breast cancer. One of my very first phone calls was to my then-boyfriend. We had been together for a year, spent holidays together, and even discussed what we would name our future children. I imagined that he was going to be my primary support system; compassionate, understanding, and an impenetrable presence. A minute into the phone conversation, he hung up on me, frustrated at the notion that I might not come home to North Carolina to be treated. That should have been my first red flag, but I had seen The Fault in Our Stars and I knew we would be okay. He even promised that he would never leave me. That means something, right? Unfortunately, this isn’t Hollywood and I wasn’t Hazel Lancaster. Our relationship started to spiral downward, and very quickly. In fact, deep, down inside I knew as soon as a month after my diagnosis that “forever” wasn’t going to happen, but I held on. -Even after he laughed at me and called me pathetic when I had trouble getting into the car a week after my 10-hour mastectomy surgery, drains distending from my sides, I held on. -Even after our fight because I had to shave my head when my hair wouldn’t stop falling out, I held on. -Even after sitting through a 5-hour chemo, crying, because a fight had gotten so bad that he shoved me into the car door, 10 minutes prior to walking through the cancer hospital door, I held on. -Even after he told me he would rather not spend New Years with me because I wouldn’t be any fun due to a chemo infusion I had a few days before, I held on. In retrospect, in the beginning, I do think he cared. However, ultimately, it was too overwhelming for him. Cancer is messy. It’s dark and scary It forces you to face your own mortality. Want to know a secret? It’s like that for you AND the people around you. It is, indeed, something that not everyone can handle and you know what? That’s okay. However, over the past two years, I’ve learned that I would rather surround myself with people who CAN handle it. I would rather be with a man who understands that I’m worth more than a phone call, two days before a surgery, telling me that he no longer wanted to be in a serious relationship because the past 6 months had been too hard on him and he was too young to be going through such a trying ordeal. I WAS worth more than that and just to be clear; YOU are worth more than that. You are worth someone who will lay on the bathroom floor with you when the chemo starts to kick in, but your nausea medications don’t. You are worth someone who will parade you around a college basketball game with your bald head like a full moon shining. You are worth someone who brings you your favorite snacks during chemo, even if you end up hating them after (it’s the thought that counts). You are worth someone who tells you they will not leave you, and means it. The situation with my ex devastated me. It broke me into a million little pieces. In fact, it thrusted me into a dark depression; one I thought I’d never get out of. But you know what? Two years later, I’m still here. Thanks to people who didn’t give up on me, and still don’t. Thanks to friends who broke into my apartment when I was so sedated on Oxy that I couldn’t get off the couch, much less communicate with anyone for 24 hours. Thanks to my family and closest friends who WILL sit on the bathroom floor with me when I think I’m dying. And last, but definitely not least, to a newfound Faith in God and the blessing that He bestowed upon me when He removed my ex from my life. I still have “those” days; those days when I wallow in self pity, but at the end of the day, I know a brand new one is coming. So, I pick myself off the floor, straighten my crown, and keep it moving. I haven’t done a health update lately so here is the latest after my appointment with my oncologist today: As I’ve previously mentioned, neither one of my oncologists want me to carry a baby due to several factors including my hormone status and BRCA mutation. My BRCA mutation not only gave me a higher chance of breast cancer, but also, a much higher chance of ovarian cancer (mine is 40%, the normal population is around 1%) Ovary removal is recommended for BRCA+ mutants. After careful consideration, I’m contemplating getting mine out sooner rather than later. Sooner being May of this year. If I decide to do this, I will be giving up the chance to ever conceive naturally. I’m asking that you all please pray for guidance because this is a huge decision and one that would change my life, forever.

By Bria Mackay, South Wales The 2016 Annual Pink Fundraising Luncheon. Pictured: Joanne’s mother Maureen Eades , Jo’s daughter Bria Mackay, Jo’s sister Elisa Eades and Leanne Reed Jo’s friend and JMBCF director. Joanne Mackay was a vibrant and caring woman who lived with nothing but love to give to those surrounding her. Her zest for life, love for others and faith in a higher power outweighed all obstacles that she faced. This is the story of her battle with breast cancer and how her vision of creating a support network for Breast Cancer patients came to fruition. In the year 2000 the Mackay family were settling back into sunny beachside life after a year of living in England. Brad Mackay had just finished a successful NRL (Rugby League) career and hung up the footy boots for a more laid-back family lifestyle on the beautiful shoreline of Stanwell Park, Australia. Joanne, a former midwife and nurse was focusing on mothering her two children Angus, 7 and Bria, 5. She was expecting her third child later that year. On the 22nd of December 2000 the family was blessed with the delivery of Tully. Things were blissful in the Mackay household until one morning whilst breastfeeding Tully, Jo noticed an unusual lump in her left breast which caused her concern and she immediately phoned to make an appointment with her local doctor. Intuition told her that something was not right. It was late February and Tully was not even nine weeks old. The doctor arranged tests to be conducted immediately and on Tuesday 6th March 2001 Jo received a phone call that would forever change the lives of the Mackay family. Joanne was diagnosed with stage IV aggressive breast cancer at the prime age of just 36 years old. “It’s now just over three weeks since I was diagnosed with breast cancer and had a mastectomy on my left breast. My first chemo session was eight days ago and since then I have felt tired, sick and lethargic. That is just the physical side! The first chemotherapy session. Pictured; Joanne Mackay with her nurse. Emotionally I cannot begin to express the roller coaster ride I have been on since that horrible Tuesday afternoon that the breast surgeon rang me with the news. One minute I’m living in my perfect world, Stanwell Park in summer with the sound of the waves crashing on the shore, the parrots squawking, the sea salt air, my two oldest children playing happily, my gorgeous husband about to become a fireman and me, mother for the third time to little angelic Tully…then a freight train from out of nowhere hits me at 100 miles an hour and completely wipes out my picture perfect world.” (exert from Joanne’s diary entry on 25th March 2001). Joanne bravely underwent a double mastectomy and had multiple rounds of chemotherapy. It was during this treatment that Jo became aware of the various struggles other breast cancer patients around her were facing. Whilst she had an abundance of support from her dedicated friends and family and was in a comfortable position financially, Joanne’s heart broke for the women she met who did not have these things. Jo began speaking about the idea of a foundation; one that would work at a very hands on level. She wanted to be able to provide women with the support that she felt so lucky to have. Jo had met single mothers who had to give up work to undergo treatment and therefore could not afford to pay their utility bills or buy groceries to provide for their children. She met one woman who had just moved countries with her husband and didn’t have her immediate family nearby for support. She met women who did not have the means to afford the gap payment of their chemotherapy. Another woman she met had to catch a public bus to and from treatment as there was no one close to her who could drive. All these things broke Joanne’s heart. She wanted to create a centre for women who needed extra support. She dreamt of the day that she would be well again so that she would be able to dedicate the rest of her life to caring for this community of women. Tragically, Joanne lost her battle on the 11th of July 2002 surrounded by her family and loved ones. The last Mackay family photo before Jo’s passing. Pictured: Joanne, Brad, Bria, Angus and baby Tully. Joanne was survived by a group of passionate women whose goal became realising her vision and so in her honour the Joanne Mackay Breast Cancer Foundation (JMBCF) was created. JMBCF, otherwise known as Jo’s Helping Hand has since been supporting the breast cancer community in New South Wales, Australia. For over sixteen years the foundation has operated entirely off kind donations and has been run solely by a small and dedicated team of volunteers. The Directors include Joanne’s mother Maureen Eades, close childhood friend Leanne Reed and as of 2019 her daughter Bria who took on the role at the age of twenty-two. JMBCF’s mission is to ease the burden placed on one’s life after the initial diagnosis of Breast Cancer. Patients are referred to the foundation through many oncologists and nurses working across four different hospitals in Sydney, Sutherland Shire and Wollongong. JMBCF offers transportation for patients, cleaning services for their homes, premium quality wigs and financial aid to cover excess treatment costs, utility bills and groceries bills etc. Until recent years the foundation provided patients with prosthetic breasts however this has since become a service covered by Medicare. The foundation has to date supported over 1,300 women and their families, averaging a total of 81 women each year since it was founded in 2002. The Foundation has always worked as a small charity allowing them to form individual relationships with each patient. Incredibly, Joanne’s Mother Maureen personally phones and writes to each patient regularly throughout their personal journey. In recent months the foundation has undergone a re-brand with the intention of gaining more awareness and expanding their network to support breast cancer patients Australia wide. The Team are working hard at launching new fundraising events and forming partnerships with other breast cancer organisations. Jo’s Helping Hand will be carried throughout decades to fulfil her inspiring legacy. For more information please visit: https://www.joannemackaybreastcancerfoundation.org/

By Kristie Konsoer Empathy : the ability to understand and share feelings with another. I recently read a blog written by an older woman who had a cancer scare that she had to deal with on her own. Her husband had passed away from cancer and she had had enough of it in her life. Her feelings are understandable. Two mammograms directed her to an ultrasound. The ultrasound triggered a biopsy. Her timeline read very much like mine did. One test after another was given with heightened urgency. Everything was fast tracked for this woman because the doctors were worried about the outcome of tests. She didn’t know how she would do cancer alone. Thankfully, this woman did not have breast cancer. Of course, I am glad it turned out this way for her. She said her experience gave her empathy for people who are alone. Hello? I’m sure this fellow writer is a lovely woman. Supporting someone through illness is hard. Losing him/her to that illness is excruciating. I do not diminish her pain because I know it’s real. I can empathize with her because I have lost my people in my life. Cancer takes too much. I am confused though why empathy needs to be directed toward people who are alone. Is aloneness somehow lesser than togetherness? Do my experiences when I spend time with friends, family, or a group of people give me empathy for people with partners? They do not. I may at times feel a little thankful to be back home and away from some of the stimulation and unwelcome opinions, but I do not have empathy for people in a relationship. It sounds absurd when the shoe is on the other foot. Somehow the comment rubbed me the wrong way. It seemed more bothersome to me that she felt empathy for people who are alone than for people who have cancer. I just kept scratching my head. It felt like pity or that someone was feeling sorry for me. I don’t want someone’s sorrow. Her remarks made me feel like she was saying, “Thank goodness I didn’t have cancer and the double whammy of being by myself!” This is more of an inner reflection than what was likely intended. I guess being on my own is a bit of a touchy subject for me, mainly of how I feel society perceives it as something less. I feel like I’m regularly defending my status. Sometimes I feel forgotten. Having cancer and being on my own really isn’t so hard. For one thing, I am reliant on myself and can organize appointments, etc. in a way that works best for me. I don’t have to check with others when I need to change my plans. I know how I feel and I don’t need to try to convince or explain those feelings to someone else. Sometimes it’s hard. Sometimes I wish I had a little more help and didn’t have to figure everything out. And I do have help. I have plenty of support. I ask for what I need. I feel connected to so many and have nurtured meaningful relationships. Technically, yes, I am doing cancer on my own, but I’m also not. It’s complicated. “Empathy is simply listening, holding space, withholding judgment, emotionally connecting and communicating that incredibly healing message of ‘You’re not alone.’” ~ Brené Brown I am not sure I’ve done all those things in my reaction to what I read. This post itself has been difficult for me to write. I have felt angry and questioned those feelings. However, it is completely okay, in fact it is fine, more than fine, for me to feel anger. I feel misrepresented. I feel there are indirect implications that are at my expense while someone else is expressing gratitude. Gratitude is not gratitude if someone (or another group) is put down in order for another individual to feel grateful. Nor is it empathy. Empathy means a lot to a person whether they have someone at their side or they are on their own. Empathy is a universal yearning we all need and we all have the capacity to give. You are putting yourself in someone else’s shoes. It still isn’t quite the same because at the end of the day you put your own shoes back on. Still . . . there are moments when you almost get it. The important part is that you try to get it. I have beloved friends who try to get it. One of my goals with this blog is to change perspectives on cancer, particularly advanced stage cancer. When I read something that feels a little, “Oh, that poor person has cancer and is alone,” I don’t like anything in that sentence because that feeling of pity permeates whatever sentiment is trying to be conveyed. It doesn’t feel good. What feels good is being welcomed to a group. I’d rather hear a compliment about something amazing I accomplished instead of a question on whether I went with anyone while achieving it. It feels good to be appreciated for my other qualities. It feels good to be included in things. If I’m unable to do something, then I may need to pass, but I appreciate being included. I like it when people remember things about me and respect my thoughts and opinions. I like it a lot when I’m not constantly asked about my health and truly treated like one of the gang. A small bit of thoughtfulness goes a long ways. It is how I believe we all can treat one another respectfully and compassionately. Empathy in action is a lifestyle choice. Taken at the UW-Arboretum in Madison, WI. It’s possible I’m confusing empathy with sympathy, but I don’t think I am. In fact, I think some other people are. I certainly don’t want anyone’s sympathy or sorrow. It belittles and demeans if directed at me because I’m living with cancer. I want an even playing field. Don’t give me something or take something from me because of my health. Don’t give me something or take something from me because I’m single. I didn’t ask for your sorrow or pity. I’ve asked for your encouragement, support, and friendship. These are the things I offer. There is something else you can give me: caramel. If someone were to offer me a caramel, I would not say no. Really good caramels are an entirely different story. It just might be an edible form of empathy. Empathy is feeling as sad for a friend as if the event were happening to you. It’s understanding your friend is in a lot of emotional or physical pain. Empathy is understanding a perspective that’s the polar opposite of yours. Parents and teachers demonstrate empathy every time they know that something that isn’t a big deal at all really is a huge deal to a child. You show empathy to me when you understand that I may cancel plans, not feel one hundred percent, and don’t ask me a laundry list of questions. It means a lot to me when you share something hard in your life rather than me always explaining my latest hurdle that I try to embellish with a little humor thrown in for good measure. Empathy is not making comments along the lines of “It’s too bad you had to get cancer.” Yeah, I just don’t know what I was thinking when I was in the cancer store. It isn’t empathetic to tell someone what he/she feels. Neither is telling someone what he/she needs to do to fix what is deemed not right (health, job, loss, etc.). Empathy is not putting someone down or saying things could be worse or that he/she should feel grateful. The words “at least” aren’t used at all. Please don’t tell me to live life to the fullest because tomorrow I could get hit by a bus. What many people don’t understand is that I’m running from that stupid bus every day. These things seem obvious to me, but I’ve heard them all. Perhaps the intention isn’t to show empathy, but to show something far less kind. I can’t figure it out. And empathy definitely is not knowing what it might be like to have cancer and be alone because you had a scare and everything turned out just fine. You put your own shoes back on and walked on. Empathy is something we all need and we all have the ability to give. At best, we understand what it’s like to be scared, perhaps terrified about our health and our future. We understand all the “what ifs” that run wild in our thoughts. We understand that disease can be a very lonely place to live. We can relate to one another that our upsetting news, event, or circumstance may be completely different from another person’s struggle, but that they are the same in that they are unsettling, frightening, and possibly very lonely feelings. We understand people are doing the best they can with what they have. Empathy connects us to one another. Through empathy we can share with and support one another. I can empathize with those feelings. I am not alone. You are not alone either. Consider replying: Where have you seen empathy alive and well in your life? How do you best handle situations when someone is not empathetic? Here is the link to my site: https://www.kristiekonsoer.com

By Dr. Carole Weaver In my early 60's, with a lifetime of adventure in travel, single parenting and fund-raising--and a few side trips into musical comedy, I was ready for a new exciting chapter. My kids grown and gone to Hollywood, I aimed at Broadway, or at least auditions for bit parts (the older woman—an extra decked out in colorful rags in Sweeny Todd ). Wham! Fate however dealt me two surprises: a new boyfriend-- an art appraiser--and... breast cancer. Complications ensued (read about it in my memoir, SIDE EFFECTS: The Art of Surviving Cancer ) especially with the cancer, but, hey, a Cinderella romance ensued even for this aging feminist. One problem: It takes a village, as we all know, to help a cancer patient through treatment. But my village looked more like a ghost town. Family was 3000 miles away. Boyfriend suffered sick people as energy drains. Shrink only interested in "authenticity," not pain. And girlfriends, while valiant, soon became exhausted with the regimen of driving, shopping, calling and, well, caring. A few pieces of art stepped into the breach. The “side effect” I discovered as an antidote to an e-coli infection in the operating room, a nasty reaction to chemo, and multiple surgeries, was how a handful of beautiful objects distracted, comforted, delighted, and ultimately gave me a deep healing perspective which got me through my ordeal. I was no art expert, no art major; didn’t even especially like museums for more than 45 minute visits. I just let my own frame of mind (pun intended) move me toward a statue, a painting, a piece of music, even an object artistically sewn. Most of the individual pieces had something to do with the stage of my treatment. For example, when I was going through chemo, my appetite was horrible. I could barely get anything down. I dreamed of eating clouds. Then I discovered this large Turkish plate-- a reproduction of a fifteenth century ceremonial ceramic. It was gorgeous with the special calligraphy dedicated to the Sultan and his distinctive Tughrah, his signature in the middle. This plate was never meant to be laden with food. It was strictly an object of magnificent craft to be looked at and appreciated. I loved that plate during those days when the Nausea Imp waited next to my cheek. It was the opposite to what I saw at work when people would bring in gigantic sandwiches for lunch; or at the Chinese buffet, the food dangling over the over-burdened plates. The Turkish plate told me my aversion to food was rewarded with grace, with the masterly strokes of the anonymous hands that filled the background of the Tughrah like a movie set or a musical accompaniment I could not hear. Basically, this is the way it worked: If I saw something in my boyfriend’s house that I liked and came back to it to stare, hold it in my hand, and wonder at its creation, I stayed with it for a while. It made me happy. Eventually, I would understand that it did more than that to my physiology. I learned that art can heal. The Tughra of Mehmed the Second, 1432-1481 Neil MacGregor calls the Tughra “a badge of state, a stamp of authority, and a work of the highest art. ” From A History of the World in 100 Objects, p. 458 (Viking, 2011).

Mindfulness: A mental state achieved by focusing one's awareness on the present moment. By guest blogger, Michelle Stravitz from 2Unstoppable My cancer diagnosis, and the months and years that followed, have taught me the incredible value of mindfulness, particularly for combating the emotional rollercoaster of cancer treatment and survivorship . In many ways, it has saved me and restored my emotional well-being! Exercise – in almost any form – is a great way to achieve mindfulness, and thus it can help with the anxiety, depression, and fatigue that often accompany a cancer diagnosis. And, as a bonus, physical activity combats so many side effects – for me it has helped loosen up tight tissue resulting from radiation and surgery, increase bone density and muscle mass lost during chemotherapy, and improve balance and brain fog caused by chemo and worry. I have found that I can often achieve a state of mindfulness through exercise, whether I’m focusing on form and muscles during a barre class, on rhythm and dance steps in a cardio exercise class, or, most effectively, on flow and breath in a yoga class. Staying ON MY MAT is a lesson I have learned after many years of yoga practice, and most of the time I can forget about the grocery list, appointments, or fear of recurrence (!) and stay in the moment when I’m on my mat . I can also achieve mindful meditation while walking, by focusing only on putting one foot in front of the other. One-step-at-a-time provides an ideal metaphor for the one-day-at-a-time and one-phase-at-a-time approach to cancer treatment. I can even find my mindful state when jogging. The thump-thump of my feet hitting the pavement keeps my mind only on the step ahead of me. And in that way my mat is my-feet-hitting-the-pavement, and nothing else. “Cancer is known to cause high levels of anxiety and depression in patients and survivors, and mindfulness is a proven method for combatting these emotional states.” What does this really mean? Anxiety is defined as worrying about the future, and it’s hard not to do this when you’re thinking about where a cancer diagnosis might take you. Depression is associated with looking back at the past, and it’s also hard not to go there when wondering what caused the cancer in the first place, reliving when it was discovered, and grieving for what life was like BEFORE. Mindfulness reminds us to stay in the present moment … on our mats, on the pavement, or in our breath, where we are still very much alive, taking care of our bodies, doing everything we can to improve our outcomes and our quality of life … right now . So … when your mind wanders ahead of you, or strays behind you … bring it back to your mat , whatever that mat looks like for you. Find your mat … your favorite form of movement … and stay with me, right here, right now. I’ll meet you there.

By Jeff Neurman https://itsinmyblood.blog/ I recently celebrated my sixth anniversary of having been diagnosed with cancer by not having yet died from it. Similarly, it is a little less than a year since I, in an effort to accomplish the not dying part, subjected myself to months of chemotherapy, from which I also did not die (but experienced a couple of episodes when that looked like the preferable outcome). And while I am of course immeasurably grateful to still be vertical, I must admit that I think the years of living with cancer and the ramifications of the treatment for it are starting to grate on me. In the last couple of weeks, I have written blog posts in this space that I believe reveal my increasing annoyance with cancer. The first, On (Cancer) Language ( https://itsinmyblood.blog/2019/07/11/on-cancer-language/ ), was a bit of rhetorical flourish for the uninformed that seem to inhabit every cancer-ites orb. Similarly, but with a bit more bite, last time out I wrote about things not to say to those of us with cancer. It occurred to me that merely telling people what was okay to say was not going to be adequate. Let’s face it: Some people just need practical advice. Consequently, I posted Silence Is Golden ( https://itsinmyblood.blog/2019/07/17/silence-is-golden/ ). Unfortunately, not everyone seems to read my vital blog, including certain people who are close to me. (When I say close, I may or may not mean that they are blood relatives. Hint, hint, wink, wink.) This is not necessarily their fault as I am not confident that some of these unnamed people know how to actually use a computer. Technological savvy is not a prerequisite to be in my circle, as I don’t hold others to a standard that I cannot maintain for myself. I only realized belatedly, however, that my essential posts above were not getting through to all of the right people when I received a message from one such person. This message, which arrived in the form of an email (so I guess someone does know how to use a computer after all), was an unsolicited missive directing – not suggesting or even requesting – that I look into some unheard of doctor. Helpfully, the instructions provided not only the doctor’s website but his phone number, which I quickly realized was not a U.S. phone number. I have nothing against non-U.S. doctors whatsoever, but I happen to be based in the United States. So there is some element of a convenience factor at play. The message went on to “inform” me that this doctor is really more of a consultant. I was puzzled by that terminology. What does that entail? Does that mean the doctor actually just charges one for thinking about one’s issue but actually does nothing? You know, consulting. Although I feel as though I already spend way too much time with doctors (U.S.-based) as it is, I do like a bit more of a hands-on approach. I think an occasional lymph node check or a look at my lingual tonsils (which is really just another form of lymph node check), although physically awkward, is probably a good idea. Of course, the directive did not end with the instructions to make my international phone call. I was also informed that this doctor’s big thing is “diet.” I realize this is a touchy subject with many cancer sufferers. Some people swear by a diet change while others think it is a red herring (and I am pretty sure herring is a fatty fish and thus not on the approved diet). I must confess I am a bit skeptical that merely by changing my dietary habits I am miraculously going to be cured of my otherwise incurable cancer. And while I am not the world’s best eater, I already eat a pretty healthy diet. Tonight, in fact, I think we will have tofu on the grill. Of course, too much soy can apparently cause cancer as can grilling, so maybe I am not too healthy after all. Nonetheless, if diet were the key to being cancer-free, I think I eat well enough that I should be. But, as you may have noted, I am not. If I were, I would have much less to blog about. Finally, perhaps to further attempt to persuade me of the prudence of this approach, the email sender informed me that a good friend is a dietitian who could create a diet for me. I do not doubt the motives of this undisclosed directive giver, but I can’t help but wonder if s/he thought this could be a win-win: I can cure Jeff of cancer and get my friend a new client! Joy! What my unsolicited message writer seems to fail to notice is that I am already surrounded by countless people who do actually know what they are doing. This group includes MDs, DOs, PAs, NPs, RNs, LPNs, MAs, RDs, and the occasional PhD and LCSW, the last for when I have had too much of dealing with all of the prior. Each of the above has his or her place, even if the occasional MA did not know my right arm from my left – I get it, it’s confusing because it is backwards when facing the patient. Like looking in a mirror and having a cancer patient staring back at you. Do these people have all of the answers? No, sadly. But have they collectively put me into remission for the time being? Yes, happily. Thus, when someone close to me comes along and acts as if s/he has a solution that I did not think of that would be so much better than what I have done already (note also that these suggestions might have been more useful before I underwent treatment), it is a most unwelcome message. As this person well knows, my wife is a doctor, we live in New York where there are many specialists in my type of cancer and, surprising as this may seem, we actually did give some thought to my options before deciding on them. And as delicious as a diet comprised solely of turmeric-coated non-GMO kale and green tea with organic Meyer lemon sounds, I am pretty sure that if I had used that as my silver bullet for cancer it would have had the same impact on me as any other bullet. It may be hard for those without cancer to understand since, of course, people who care about you only want to be helpful. And one can’t fault them for that, nor should one. Certainly this particular person loves me and wants nothing but the best for me. But before firing off half-baked schemes involving international doctors and facile fixes, consider perhaps how much thought has already gone into getting me to this point. If you are not sure, then perhaps just keep it to yourself. As I said last week, silence is golden.

These last few weeks have been a bit confusing so I wanted to break down my understanding of what it means when you are told you may need more chemotheraphy. The path was pretty clear since my diagnosis: I was going to receive neoadjuvant chemotheraphy (i.e., chemo prior to surgery), undergo surgery, have 6 weeks of radiation, and end with hormonal therapy. However, my path changed based on the biopsy results from my surgery. We have now added adjuvant chemo (i.e., chemo after surgery) to my treatment plan. I want to take a moment to breakdown what this means and my experience with round 1 of Xeloda (Capecitabine). When you undergo neoadjuvant chemo, you and your doctors are not only aiming for the possibility of the size of the tumor to shrink, but also, for there to be no active cancer cells remaining in the breast tissue, or lymph nodes (if the cancer has spread there). One of the ways your care team is able to evaluate how well you respond to neoadjuvant therapies is by looking at the tissue that was removed during surgery to see if there are any actively growing cancer cells present. If there are no active cancer cells present, this is referred to as a “pathologic complete response” (pCR). It is important to note that the definition of pCR is still debated; some studies conclude that a pCR is achieved when only looking at the breast tissue while other scholars look at the breast tissue and auxiliary nodes combined. As such, it all depends on how your care team is defining and measuring the successful of neoadjuvant chemotherapy. While I am disease-free post surgery (yea! Cancer is removed and all scans came back clear!) doctors did find that there was “residual disease” remaining in the tissue that was removed. While there was success in my neoadjuvant treatment, it was not 100%, and therefore, we want to continue our aggressive treatment plan and proceed with adjuvant chemo, Capecitabine (Xeloda). Luckily, patients with incomplete response to neoadjuvant chemotherapy benefited from Capecitabine ! Capecitabine are pills I take twice a day and follow a “cycle” of two weeks on, one week off. After two week on the new chemo, I am happy to report that I am feeling ok. I can confirm that the rumors of this being an “easier” chemo are true. Easier in the sense that you can take the pills in the comfort of your own home. However, I don’t want to undermine the power of this chemo. Overall, I am feeling well but a few noticeable side effects include: Tiredness and fatigue Upset stomach / cramps Overall sense of not feeling well but cannot place your finger on what exactly is wrong Upset GI track Wrist Pain (this could be because of the Aromatase Inhibitors I am on like Anastrozle/Arimidex) The only time I felt nauseous was when I took the pills without food! Remember to take Capecitabine with food! Honestly, these symptoms are manageable. I am still working full-time and able to continue with my health and fitness exercise routine which is my sanity. One of the side effects I continuously monitor for is Hand and Foot Syndrome. This is the most common side effect, but so far, after completing round 1, I am in the clear!

Prior to having my port placed, I had a brief discussion with others about the difference between receiving chemo intravenously verses through a port. Everyone has an opinion and what works well for one, may not work well for someone else. I have complete faith in my doctors and care team so when they recommended I go with the port placement, I wasn’t going to question the decision. Even though I got an infection early on and was on a “port holiday”, that wasn’t going to stop my team from staying on track with my chemotherapy treatments! However, instead of administering it through my port, we were going to do it intravenously! (insert fainting right about now!) Needles are not my friend and I do not handle pain well at all so when I found out that this was how I was going to receive my infusion for the next two rounds, I had a really hard time. I am not saying this is for everyone, but this definitely wasn’t for me. However, I didn’t have a choice, the chemo show had to go on! The verdict: Now that I have experienced receiving chemo through both the port and the veins, I’m going with the port, for the win!

Are You Getting Enough Calcium? By Sue Cimino My name is Sue Cimino and I am a Breast Cancer Survivor. As with many of you, my journey was difficult. Whatever could go wrong did and whatever side effects there were, I was sure to get. My monthly focus is to help others by sharing something that helped me and continues to do so. Throughout my journey and now, I am a firm believer of proper nutrition and the benefits it lends. I truly believe that I was able to recover quicker and continue working throughout my 2+ year journey, which is still ongoing. Since I have not been able to work-out (heading in for my eighth and final surgery), I focus on eating healthy. However, I understand that although eating healthy is beneficial, it is impossible to get all of the nutritional needs from my food source. Many of the nutrients are lost during the cooking process and many fruits and vegetables are picked pre-ripened in order to ship to the stores for purchase. Not to mention that our soil has gone from over 80 minerals and now depleted to 2! Like many of you, my chemo has resulted in me developing osteoporosis. In addition to going every 6 months for a Zometa infusion, I am working hard to stop and reverse my this side effect from treatment. In addition to eating as many plant based foods that contain more calcium than milk, I add a calcium supplement to my diet. While everyone assumes that milk is the best source of calcium, I've got news for you! Excellent sources of calcium are found in green leafy vegetables such as broccoli, kale, spinach, watercress. Dried fruits, nuts (almonds), seeds (poppy, sesame, and chai), peas, beans and lentils I have researched several calcium supplements and found a superior delivery system. My calcium supplement is in an isotonic format , meaning, “same pressure” bearing the same chemical resemblance of our body’s blood, plasma and tears. This isotonic state allows nutrients to pass directly into the small intestine where they are rapidly absorbed into the bloodstream. By taking this in an isotonic state, it allows the maximum absorption of nutrients (98%). Most pills take anywhere form 40 minutes to 4 hours to turn into and isotonic state. Depending on binders and fillers they only allow for 10-20% absorption! Calcium exists in bone primarily in the form of hydroxyapatite. Hydroxyapatite accounts for approximately 40 percent of bone weight. The skeleton has a structural requisite and acts as a storehouse for calcium. Apart from being a major component of bones and teeth, calcium supports normal muscle contraction, nerve health, heart rhythms, blood coagulation, glandular secretion, energy production and immune system function. Sufficient daily calcium intake is necessary for maintaining optimal bone density, healthy bones and teeth. When the body does not get enough calcium per day, it draws calcium from your bones. The best form of calcium is calcium carbonate which is utilized by the body more efficiently, due to the fact that it increases the absorbability. Additionally, calcium is more readily absorbed by the body when in combination with magnesium, vitamin C, vitamin B2, boron and potassium. I have found Isotonix Calcium Plus is formulated with calcium carbonate and the additional vitamins and minerals needed in an isotonic form which allows for maximum utilization and absorption of calcium by the body and reduces the nutritive loss found in many calcium tablets or capsules. Everyone needs calcium. Practically no one ingests enough calcium in their daily diet. Besides being helpful in supporting and maintaining bone integrity, calcium serves a dynamic role as a mineral. It's very important in supporting the activity of many bodily enzymes and maintaining proper fluid balance. Isotonix Calcium Plus also promotes the normal contraction of skeletal and muscle. Learn more about the Isotonix Calcium Plus . By purchasing the Isotonix Calcium Plus, you enjoy the health benefits and at the same time you are contributing to Surviving Breast Cancer.

As states begin opening up and people start to emerge from weeks and months of sheltering in place, one must ask “is it safe to go back out”? In Boston, it was surreal to walk the desolate streets, sans cars, signs taped to storefront windows with bold black letters that held the same message "closed until further notice", and parking was available everywhere. Walking During Cancer Looking back at the time of my Dx I would get out and attempt to take walks. For walking seemed to have been the level of exercise I was able to engage in. I did so through chemo, post surgery, and, despite the fatigue from, radiation. Some days it would be less than 1000 steps. Other times I hit my 10K goal. Walking was meditative. It gave me structure during a time when there were many unknowns. Strutting down the uneven sidewalks of Boston somehow grounded me, allowing my mind to quiet down and take in the sites and sounds and beauty. Walking During COVID-19 Nowadays the lines of working from home and home-life have gotten blurry. Before COVID-19, I would wake up on Monday mornings, fight with my wardrobe before settling on something to wear, lather on concealer and then run out the door - only to sit in traffic for 45 minutes. Initially, working from home was exciting. I would wake up Monday, enjoy a hot cup of coffee, and mosey on to the kitchen table. There I would open my laptop and start my day, all the while being comfortable and cozy, in my yoga pants and possibly a nice top if I had meetings on Zoom. I knew I had to figure out a way to create structure so I turned to what I did during times of concern, of unknown, and anxiety. Walking. Just like then, on some days I had the energy and time to walk 5 miles while other times I was lucky enough to escape during a lunch break to do a lap around the block. During my recent daily walking routine, I have started to notice that more and more people were stepping out. We are on the brink of summer and everyone is longing for the warmth and just to be outdoors. More and more cars are on the road as families head to the Cape for a long weekend, or an escape up north to their lake house or mountain retreat. Slowly people are losing their concerns over COVID-19 as the news reports encouraging declines in new cases and deaths. Life After COVID-19 Most states have now begun to open up. Restaurants are starting to prepare for outdoor seating and companies are diligently working on their reopening operations/strategies. But by no means is COVID-19 gone. I wonder what life will be like after a global health pandemic: Will we continue to stand in lines before entering a grocery store? Will wearing face coverings become the norm? Will we ever shake hands or hug and kiss again?  What Is Your Comfort Level as States Reopen? People will certainly have different levels of comfort as we emerge from sheltering in place. Imagine the scenario: A friend invites you over to her home for an outdoor BBQ. Before COVID, it would have been an automatic "yes" and you would offer "what you can I bring". This still may be the natural response from most people. However, after months of practicing social distancing, I have to ask myself, am I ready to be social again? We will all have different levels of tolerance as we navigate this new path: Life post COVID. It's critical that as we begin to return to social gatherings and the luxuries of dining out, getting your hair blown out, or visiting with grandparents, there are still healthy and safety practices that are strongly recommended, like wearing a face covering, continuing to wash your hands frequently, and remaining a respectable 6ft distance from others. When I asked a colleague how she felt about going back out and seeing friends and family, she expressed similar concerns but suggested the tactic of utilizing a color scale to talk about comfort levels. This is a way for friends and family members to discuss the delicate topic that has the possibility of making someone feel uncomfortable if they decline to grab a dinner out or return to the shopping malls. If you are open and don't mind jumping on a plane or hugging your friends as a gesture of hello, you could say you are "Green" and ready to, though some experts would not advise this unless it is necessary to travel and you should still wear a face covering! On the other hand, you may be comfortable meeting up with 2 or 3 friends while all wearing a mask, exercising social distancing, and gathering in an outside space. We'll call this "Orange" or "Yellow". Using the sliding color scale lets you and your friends know where you are emotionally and mentally as we begin to open up and resume some sense of normalcy. Andrew Noymer, a public-health professor at UC Irvine states that “going for a walk with a friend in a park is probably better than hanging out in your friend’s living room,” and the same health and safety measures apply. Below is a roundup of tips and recommendations from the Atlantic , Today , Southshore Health , and the Boston Globe : If you are returning to a physical office take the stairs instead of a small and crowded elevator. If you are on the 17th floor, wait for the next elevator to arrive so it's less crowded. If you normally take public transportation, speak with your manager to see if you can adjust your hours and commute during non-peak hours. When dinning out, bring your own disinfectant wipes to clean the tables, chairs and menus. Refrain from eating with your hands and try to dine in outside areas when possible. Stay updated on your state's reopening strategy. Remain flexible to the phased approach knowing that things are still subject to change. Communication is key. if you are a business that is reopening, share your plans with your staff and clients. If you find yourself feeling ill, don't try and be the hero, take a sick day or see if you can work from home. There isn't a switch we can flip to return back to the way things were in 2019. We have a new line in the sand that has been drawn which we have crossed. There's no turning back. As we know all too well with our own cancer diagnoses, we have an ingrained moment in time when we recall life B efore C ancer . Similarly, the world is striving to fight off disease, develop a vaccine, and return to life B efore C OVID-19. To all of my friends who recall the 90's feminist, expressive, and relatable indie rocker Alanis Morissette, we now have two defining moments of life B.C. isn't it " Ironic " P.S. A recently published peer viewed article in the journal of Nature states that the s hutdowns prevented 60 million coronavirus infections in the U.S., and estimated that the it saved about 3.1 million lives in 11 European countries and dropped infection rates by an average of 82 percent.

By Kim Bowles President & Founder, NotPuttingonaShirt.org Every year, 250,000 women are diagnosed with breast cancer in the United States. Despite the prevailing narrative that breast cancer is a disease of older women, roughly 15% of those diagnoses are under age 40. I was 35 years old and nursing my second baby when I was diagnosed. I felt like I had entered a nightmare world and might never wake up. And I was one of the lucky ones - 10% of all breast cancer diagnoses are what's called "stage IV de novo" (metastatic breast cancer, or MBC) with no chance of a cure right out of the starting gate. And 30% of early stage breast cancers eventually metastasize. Since my own stage 3 diagnosis, I have watched in horror as handfuls of my MBC sisters have passed away, one by one. It's relentless and every October I urge people to choose to target their BCAM donations towards MBC research by supporting organizations like Metavivor. After six rounds of chemo, I chose to have a bilateral mastectomy without breast mound reconstruction. I made this choice for two reasons: I wanted to optimize my chances of never having to deal with chemo ever again (BMX), and I wanted to get back to my normal life as quickly as possible (FLAT). Being done in one surgery was critically important to me, so I brought on a plastic surgeon to ensure a smooth flat closure and minimize the risk of needing revision later. Unfortunately, that's not what I got . On surgery day, as I was lying on the operating table, I heard the plastic surgeon say "I'll just leave a little extra in case you change you mind" (to which I said, "no, make it flat"). I awoke three hours later to pockets of skin remaining on my chest - not smooth and flat like we had agreed. I knew that my chance to be done in one surgery had been stolen from me. I was devastated. The trauma of making peace with your surgical decision only to wake up to something completely different, is hard to describe. And it happens to women who are already at their most vulnerable, enduring cancer treatment. I struggled for weeks to fully accept what had happened to me. I felt violated, dehumanized, and alone. People would say things to me like "it can be fixed," or "at least they got the cancer," invalidating the trauma. I decided I wasn't going to stand for it. Over the past three years I have gone from protesting topless on the street (yes, you heard that right) to founding Not Putting on a Shirt , a 501(c)(3) organization that empowers women with tools and resources to protect their choice, and works with institutional stakeholders to build a coalition that will end "flat denial." The fact is that one in twenty women who choose to go flat is denied a flat closure by a surgeon who wants to push them towards breast reconstruction. There are many contributing factors that allow this to continue: paternalism, protectionism, lack of a standard of care, suboptimal reimbursement, and unclear language. We've made some great progress. Earlier this year, the National Cancer Institute took the historic step of defining the term " aesthetic flat closure " as rebuilding of a smooth, flat chest wall contour. Now patients know exactly what to ask for - and there's no ambiguity about what we have agreed to for unscrupulous providers to leverage against us. The term also enables advocates to push for better training and reimbursement to support providers in developing and delivering an optimal standard of care for women going flat. If you are facing mastectomy and have decided to go flat, be sure to ask your surgeon for an "aesthetic flat closure" as defined by the National Cancer Institute. Make sure it's in your medical record. And if your surgeon isn't supportive, get a second opinion. This is your body, your life, and your decision. Aesthetic flat closure is a beautiful, healthy, legitimate reconstructive choice! To learn more about aesthetic flat closure and how to advocate for your choice, access our Flat Friendly Surgeons Directory, print or order brochures to use at your consult, read about our strategic plan and how you can help, and more, visit NotPuttingonaShirt.org . #putflatonthemenu #aestheticflstclosure #notputtingonashirt Website: NotPuttingonaShirt.org Facebook/IG: @NotPuttingonaShirt Twitter: @not_shirt

I always say that my radiation therapy gives me that special kind of "glow"! And it does. After all, you are getting exposed to high-energy rays to kill cancer cells. My radiation came towards the end of my active treatment plan; after I completed 6 months of neo-adjuvant chemotherapy and my surgery. I used to think that if you had a mastectomy, you wouldn't need radiation. However, depending on where the tumor is, and even how close it is to the chest wall or lymph nodes, or if there is a chance that cancerous cells may be left behind even after surgery, oncologists may recommend radiation regardless of a lumpectomy or mastectomy. What to expect during radiation: Prior to my first radiation appointment, I went in for an hour long visit with the radiation oncologist. During that visit she explained the goals of treatment, what I could expect, what I should and should not do while undergoing treatment and how to manage side effects. For example: Don't put on lotions or deodorant before treatment. Avoid chlorine (which was hard as I love swimming laps!). Avoid certain vitamins which may interfere with the effectiveness of the radiation treatment. During this initial visit, they positioned me on the radiation table to take exact measurements of where the external radiation beans were to be positioned. To ensure that I lay in the exact same position each time, they used a mold form to shape my upper torso. They also gave me 3 permanent tattoo marks the size of a ball-point pen which were used to align the rays. The tattoo only hurt for a moment and now I have bragging rights that I do in fact have a tattoo, I call it my radiation constellation! I was surprised to learn that radiation treatment was a Monday-Friday ordeal! While the therapy treatment itself was at most 15 minutes (getting into the Johnny, getting positioned, receiving the radiation dose and getting dressed again), the time it takes to commute, find parking, and figure out all of the logistics with work seemed to take up more of my time! If possible, I recommend trying to schedule your treatments for first thing in the morning or late in the afternoon to avoid work conflicts if you are able to still work during treatment (I did). Radiation Side Effects: My radiation was 6 weeks total. 5 weeks of full breast radiation with one week of a radiation boost where they targeted the exact area of where my tumor was. The first two weeks were pretty smooth sailing. Radiation itself doesn't hurt, but there is a cumulative effect from the doses. Over time, my skin got red and itchy and my fatigue was through the roof! There were days I hardly had the energy to carry groceries, put away laundry, or walk further than the bedroom to the couch. My skin was so hot and red I often wore oversized jersey tank tops when I didn't have to go into the office. Generally speaking, my skin responded well. While it was red and irritated, I moisturized like crazy, literally three times a day. Since my appointments were first thing in the morning, it was easy to apply Aquaphor late morning, after lunch and before bed! However, be aware that Aquaphor is quite greasy and ended up staining some of my clothes! Longer Term Side Effects: I am positive my radiologist informed me of the longer term side effects from radiation, but like most things during treatment, I couldn't fathom all of the information. Despite the side effects, I didn't feel in a position to refuse radiation treatment either. We took an aggressive approach from the beginning so why change course now? Now that I am 4 years out from my radiation treatment here's what I've learned: Radiation can shrink the size of your radiated breast and even change the direction of your nipple if you had nipple sparing surgery Radiation increases your risk for developing lymphedema Depending on the side in which you had radiation, it can increase your risk for cardiovascular disease (ask your doctor if you should see a cardio-oncologist) Want to learn more about my experience with Radiation? Check out the videos below where I documented my experience.

By Matilda Flanagan (11 years old) It will be OK She will be OK Hair isn’t everything It will grow back I can’t pretend everything is OK When it’s not She might not get better I hate the color pink And the ribbon that I now constantly see I need her She is everything to me She can’t get out of bed But soon she will walk Not a lot but At least she will walk If I cry I will not stop So don’t cry I need to focus But I can’t I need her What would I do without her I love the rain because We would listen to it And fall asleep in my room But now it’s pouring and I’m not sure If I like it anymore

By Matilda Flanagan (11 years old) I cry as someone holds me Trying to calm me They rock me Just like my mom did Before she got sick I love her and she is safe She is home sleeping But I dare not think Of the chance that She not wake For I love her She can’t leave If she does I most certainly will grieve I cry at night But always stay quiet For I fright She might not like Waking up and seeing Her daughter crying I love her They whisper in my ear It will be OK My swelling eyes look up And see my dad holding me tight I love him but I forgot He has something to lose two Everyone has something to risk Their happiness So how lucky are you If You have something That makes saying goodbye So hard

By Traci I’m currently in the radiation phase of my treatment for stage 3 breast cancer. The technician, "let’s call him Rick because that’s his name," was not friendly and curt in his manner. I was 4 weeks in, with 2 weeks to go, and had been having a hard time. My type of radiation requires me to hold my breath while treatment is being administered. I’m not very good at this as a rule and especially under pressure. The other day, Rick decides he is going to give me a lecture on holding my breath and how that is making it hard for him to do what “he” needs to do. He went on and on while I stood there with no shirt on (I still have one breast) and feeling quite uncomfortable. I was shocked and didn’t react. I left there with tears forcing their way out and tried to make it to the hospital parking lot before I broke down. This was hard enough and him being impatient with me on a regular basis was making it even more difficult. My first thought was, I’ll tell the Doctor I’ve had enough of him. Then, I decided to calm down and think on it. So I did. I’ve changed through this cancer journey and have become more patient and understanding. I promised myself this journey would make me better, not bitter. I talked with a dear friend and she suggested I talk to Rick about it. That is not what I originally had in mind. I was thinking I would just say nothing and after two more weeks, never see him again. The last thing I wanted right now was to confront someone who I would have to see 10 more mornings. Then, I gave it more thought and decided to have a heartfelt conversation with him. When I went in the next day, I asked Rick, “Can we talk a minute please?” He looked hesitant as he had no idea where I was going with this. I said I’m sorry that I can’t hold my breath properly. It’s hard enough to come in here as I don’t feel well, plus it gives me anxiety and makes it hard for me to hold my breath. I’m not trying to make your job harder, and I’m doing my best. Then the tears came. He looked me in the eyes, and said Traci I’m so sorry, I didn’t mean to make you feel that way. I was just trying to explain how things worked. I responded, “I need you to be gentler and more patient with me. I’ve been in treatment for a year now, and it’s hard." I could tell he felt badly. Surprisingly, the session went smoothly and he was quite pleasant, unlike the technician I was used to dealing with. The next day, I went back in and he was kind and gentle, patiently walking me through the treatment. Better still, I also noticed that he was warmer to the patients in front and behind me. In retrospect, I think Rick had just lost his way at work and wasn’t seeing us as people anymore. This “new” technician I’m finishing up my radiation with is a completely different one. I’m so glad I had the courage to talk to him and be my own advocate. I’ve learned it’s terribly important to speak up for yourself as the staff administering my care sometimes forgets we are a person and not a number. Thank you for sharing your story, Traci. SBC loves you! SurvivingBreastCancer.org Resources & Support: Listen to our podcast Online Support Groups Virtual Events

By Tamera Hi, I'm Tamera. I am now proudly certified in Yoga 4 Cancer. Diagnosis I was diagnosed with breast cancer just after the New Year of 2015, at the age of 44. I had gone in about 6 months prior for an annual mammogram and the results came back suspicious. That led to more testing, monitoring, and a biopsy in December, which resulted in my being positive for DCIS in the right breast. It was believed my cancer was being fed by Estrogen, and I opted for a double nipple and areola sparing mastectomy due to have a family history of female cancers. I later learned my left breast was also showing unusual tissue changes, but was not yet cancerous when I removed the left breast tissue as well as the right. A Learning Experience ​A few years earlier in 2011, I had a hysterectomy and had my uterus removed, as it was looking as if I was headed for endometrial cancer. It has been a roller coaster of both positives and learning experiences. I have had many individuals in my family impacted by cancer or who have passed. This January after the New Year, we learned my husband who had just turned 49 was diagnosed with early prostate cancer. Again, a learning experience for myself and my family. I have two children who have had to learn about cancer as a teen and adolescent. They are learning to be more proactive in regard to their own health as a result. Yoga Teacher Training A lifesaver was that in 2015, when diagnosed with breast cancer, I was two weeks into yoga teacher training. It was so helpful. It was challenging as I had to be driven to classes for almost three months, but it gave me time to bond with my new body emotionally, spiritually, and physically . I had setbacks after diagnosis such as an infection which put me back in the hospital and ultimately delayed by exchange surgery. I had expanders put in in January and did not have my first surgery for implants until June. In regards to my yoga, I modified everything and learned a lot about benefits of meditation, breathing, and movement under fire you could say. This led to my obtaining a scholarship by Lululemon to become trained one year later in Yoga 4 Cancer. I am now proudly certified in Yoga 4 Cancer and began teaching it about 6 months after being trained. Giving Back I have a supportive friend who owns a Judo Club where I offer private sessions off and on, but it has been a regular home for Yoga 4 Cancer Miami for almost two years now. I did some fundraising with support from a lovely client and this allowed me to offer some of the programming for free for individuals in financial need in 2019. My business Wellness, Therapy, & Yoga has funding and support from Pink Luminous Breast and LympheDIVAS to offer the free programming. I have brought on the help of other Y4C trained teachers. I work full-time as a Licensed Mental Health Counselor and provide Addiction and Rehabilitation Counseling, but supporting Yoga 4 Cancer and offering Private and Corporate Wellness along with Life Coaching is something I have fun with and doesn’t feel like work. I am not sure what my future holds. I write for Cure Magazine and have published a chapter in Experts in Pink addressing the benefits of Yoga and Meditation during and after Breast Cancer. I may eventually complete my goal of providing a resource for mental and physical thrivership following a cancer diagnosis by publishing my own book. I can retire from my full-time job after 20 years of service with my current agency and have the incredible opportunity to work in the private sector for another employer. I would love to provide corporate wellness programming someday. My objective is to enjoy my children who are growing and are now in college and preparing for college. Both are studying in the medical field. I look forward to doing more traveling and enjoying friendships and connections. I love being anywhere near water where I can take out my Kayak or enjoy other water sports. If you’re in Miami or plan a visit, I would love for previvors, survivors, and thrivers to attend Yoga 4 Cancer Miami or elsewhere if you find a class in another area where you live. Not all classes are free, but yoga teachers such as myself learn how to modify the classes to support the needs of those impacted by cancer. You can find classes at Y4C.com under find a teacher for locations and instructors. Lymphedema and other conditions are all part of the consideration in how classes are run and how poses are modified. If you’re interested in connecting with me you can contact me at www.wellnesstherapyyoga.com My articles with Cure are free at https://www.curetoday.com/community/tamera-anderson-hanna. Part of my work is now also educating more individuals on the importance of conducting a monthly self-breast exam . To support the exam, you can use a new free app by Pink Luminous Breast and learn about the device which helps you see into your breast using infrared technology to visibly see any concerns or changes you would need to speak to your health professional about. I am using it to teach my teenage daughter about the importance of breast health.It is an important topic for me due to family history and wanting to teach my daughter to be proactive about her health. My Tips Have a survivorship care team. My team includes my regular health professionals, but I have added a dietician, lymphedema specialist, acupuncturist, and I exercise of course with the help of yoga and walking. I have exercises I do while walking and practicing yoga to help against Lymphedema. As a mental health professional, I maintain mental health with positive self-talk and maintaining healthy sexuality post cancer. I invite others to find a good support system that works for you. ​No matter what you face in life, may your smile always be brighter than any obstacle you face! Thank you for sharing your story, Tamera. SBC supports you! SurvivingBreastCancer.org Resources & Support: Resources for Families Fitness Tips Positive Thinking for Healing Our Weekly MeetUp Online Support Groups

By Liz Benditt, President, The Balm Box I like to think of myself as a medical miracle . Between 2009 and 2017, I survived four cancers over 8 years. Melanoma It started in 2009 at a weekend summer trip to the pool. My daughter was almost four years old and bumping around the baby pool in her little floaties with my husband, while I lounged on a deck chair with my baby boy, napping in a sweet, sweaty mess on my chest. My mother noticed a mole on my upper thigh and nagged me to get it checked. I rolled my eyes at her. She called the following week to see if I had made an appointment with a dermatologist – I had not. I succumbed to her nagging and made an appointment . The dermatologist immediately wanted to biopsy the spot. A few days later, I got a call from the Doctor personally, with the news that it was melanoma , over 1mm and ergo too large for Mohs surgery. It was made clear to me that this was MELANOMA – a very fast-moving cancer – and it was imperative to remove the affected area and check to see if it spread to the lymph nodes. If it spread – I’d have maybe a year to live. If it had not spread – no big deal. This all happened over the course of 6 days . It was totally surreal. Live or die. The only two options. We got the call – clean margins, no spread to the lymph nodes. Score 10 points to mothers knowing best and forcing me to make that dermatologist appointment. I stocked up on floppy hats, sunscreen, and SPF 50 swim shirts for my family and tried to go back to ‘normal’ life. Thyroid Cancer Eleven months later, I had an irregular mammogram requiring a biopsy . While the surgeon was probing all around the boobie-area, her hands started snaking up my neck. She noticed a small lump that was clearly bothering her. She sent me off to radiology to get an MRI . I got a “two-for-one” deal that time around – a breast AND neck biopsy. The same week the breast biopsy came back clear, we got the bad news that I had Thyroid Cancer . Cancer #2 – less than one year after the first one. After my experience with Melanoma, I was shocked at the lack of urgency from the medical establishment . I was given a long and complex checklist that had to be completed before I could schedule the surgery, including labs and endocrinology referrals. It took weeks to complete. I was frantic – where was the big rush to GET THE CANCER OUT from the year before?? The surgery was finally scheduled, childcare was in place and I was ready to get ON with it. I ended up in a teeny-tiny category of patients with a very rare side effect from that surgery – It happens to less than 2% of patients – the surgery rendered me hypoparathyroid . For those of us without endocrinology degrees, the hypoparathyroid glands process calcium in the bloodstream. This bought me a bonus 2 weeks in the hospital, where teams of doctors created a complicated drug cocktail that would regulate my calcium. It was not fun, nor was I very stable when I finally was released to recuperate at home. It took me years of ER visits, trial and error with various doctors, drug combinations and a drastic change to my diet / nutrition to get me back to feeling ‘healthy’. I started early morning runs with a group of friends and the sport ‘stuck’. Over time, I went from a panting 1-mile run to long-distance 10-mile weekend runs with a close-knit group of girlfriends. I completed a half-marathon in 2013. I was back – I was fine – kids were fine – life went on. Basal Cell Carcinoma By 2015 I knew my dermatologist well – after all – she saw me quarterly for five years after Melanoma, vigilantly checking every inch of my naked body during regular “full body” checks. Many an errant freckle was removed during those visits. But in 2015, the spot on the bridge of my nose was problematic . Basal Cell Carcinoma. While not life threatening, the placement on my face meant for a tricky removal and plastic surgery. This being my THIRD cancer, and not Melanoma-level-scary, I took my time to interview plastic surgeons to determine which one would give me the best odds of keeping my face intact. I chose the doctor known in our community as being “great with faces” and agreed to a two-part surgery that would be terribly painful but give me the best odds of looking like myself. It was both painful and productive – to this day, my scar is barely noticeable, brilliantly placed along the shadow of my nose. Three strikes, and you’re out Cancer! RIGHT?! Breast Cancer In 2017, I was diagnosed with Breast Cancer. As my FOURTH cancer I was angry - not panicked. I approached the surgery full of questions and skepticism. What could go wrong? What are the potential side effects? Give me the numbers! I asked for more data than any patient ever. I was going to CONTROL this cancer, and take my time determining the treatment plan that worked for me. I chose my medical team based on the doctors willing to discuss (humor?) me with a real conversation about options, medical outcomes, statistics focused on women under 50, and likelihood for recurrence . I agreed to a lumpectomy followed by radiation treatment. After all this experience and research, I was going to be a rock-star patient and fly through treatment and recovery like a BOSS. Although the melanoma was by far my most potentially lethal cancer, and the facial plastic surgeries for basal cell were incredibly painful, the breast cancer experience and treatment were the absolute worst . Perhaps I was overconfident about my youth and ability to fight it, or it is possible my fair skin was destined to react badly to radiation – it is impossible to know. Regardless, despite thinking I would knock out radiation and be able to continue working full time, leading girl scout troop meetings, and running half-marathons my body failed me and I was flabbergasted by my situation. I am a planner! I was proactive dammit! The Challenges There were two concurrent issues: 1. It was incredibly difficult to predict what tools I would need to go through and recover from radiation until I was in the middle of it, scrambling for bra-alternatives, aluminum-free deodorant, and burn salves. A nurse made me a mini-pillow to hold between my seatbelt and breast so that the belt wouldn't chafe. There was no central resource, website, or retailer known for all this 'stuff' and I found myself up late at night researching page 20 searches on google and amazon looking for solutions. Most of the cancer-treatments and gifts online were pink ribboned cute/sassy t-shirts and mugs – I wanted relief not stuff . 2. Friends and neighbors all want to DO something ... and they predominantly bring food/cook. It was incredibly kind and appreciated, but honestly my husband and son are super picky eaters and would have preferred takeout. I was not able to exercise and would have preferred lighter / lower calorie fare. It was honestly frustrating because it was all so WELL MEANING but in reality, not awesome to receive. The challenge with most cancer treatments is that patients do not know what they are going to need to help them self-soothe until they need it RIGHT AWAY. I wondered – where is the resource for cancer patients to proactively plan for treatment and recovery side effects? It didn’t exist. The Balm Box The idea for The Balm Box started in 2017 – but it wasn’t until 2020 that the moons aligned and gave me a quiet few months at my desk at home during the Pandemic to really build out the idea into a legitimate business plan. I started by sending out a survey to friends and family to validate the idea – the survey went viral and collected almost 600 responses. My market research revealed that I was most definitely NOT alone in my frustrations and there was a huge level of interest from both cancer patients and caregivers who were looking for functional self-care and gifting options. Their feedback was invaluable, and to this day, gives me great confidence in the curated products featured on our website. A few weeks after finishing radiation treatments my girlfriends threw me a “Finish Line” party. It was a magical night , filled with cocktails and cake and laughter. The evening was made even more special by friends who flew into town from New York and Los Angeles to attend. The cumulative trauma of the past 8 years had caught up to me, and rather than simply ‘get back to normal’ I am so very grateful that my friends and family gave me a moment to celebrate all I had overcome. The “Finish Line” party was where the seed for The Balm Box started. Maybe there is some crazy kismet in the universe; the years of cancer treatments leading me to the launch of something great. I certainly hope so. Sometimes the finish line is actually the starting line. Thank you for sharing your story, Liz. SBC loves you! SurvivingBreastCancer.org Resources & Support: Virtual Events, Webinars , and Meetups Positive Thinking for Healing Our Weekly MeetUp Online Support Groups

By Gloria Exactly a year ago – August 31, 2020; I was given a diagnosis of Invasive Lobular Breast Cancer .... The Diagnosis This diagnosis rocked my Spirit to the core. My partner, who had come with me to my dermatologist appointment to get my stitches removed from my surgical biopsy, gently held me in the parking lot and we both cried. My General Practitioner (GP) called me within 15 minutes of my receiving this news. She immediately booked an appointment for the next day to get my pap smear test done, referral to get another mammogram done (even though I had a mammogram approximately a year earlier that showed nothing), and a referral to a surgeon. Lump in Arm I had found this pinhead lump in my underarm (which I have now come to understand is the tail end of the breast) back in 2018, and I had shown it to my GP who sent me to get an ultrasound done. We both thought it was a cyst and so we agreed to monitor it after the ultrasound came back clear. The following year my mammogram, showed nothing either. The Start 2019 was a year of many challenges – it started with a swollen right knee that was initially diagnosed as a Baker’s Cyst. Being unable to walk on it for a couple months allowed me to research the causes of a Baker’s Cyst and so I chose to change my diet and eliminate the foods that causes inflammation. In July 2019, my 94 year old Dad who I looked after for 12 years after he suffered a stroke passed. Around the same time my mammogram was due. It showed nothing. In August 2019, I found out I had a full macular hole in my right eye. I underwent a vitrectomy surgery to repair my macular hole and replace the lens in that eye on October 1, 2019. Anyone who has been through this surgery knows that you have to lie face down for a week 24 hours a day, if possible. It was great news when I found out I could read again in that eye – the tears of release and gratitude flowed . Fast forward, toward the end of February 2020, I started with headaches around the temple of my operated eye. A call to my ophthalmologist had me go to my optometrist to check the blood pressure, etc. behind the operated eye. The reason I share this is so that you can understand the full sequence of events . There was no problem with my operated eye, but the temple headaches continued over 3 days straight. So, I contacted my GP who saw me and was concerned that it could be Giant Cell Arteritis – so she prescribed a small dosage of prednisone and ordered blood work. The next day, we got the results of my blood work that showed high inflammation levels – so she again increased the prednisone. In the meantime, she had discussions with a rheumatologist and vascular specialist and ordered a temporal artery biopsy. This is the only way that they can eliminate that it wasn’t giant cell arteritis. Thankful and grateful that it wasn’t!!! My Whole World Changed Now, March 2020 and COVID 19 global pandemic is announced. I did notice that the so-called “cyst” had grown and the consistency was different . So, I booked an appointment with my GP when possible around June 2020. She immediately sent me to the dermatologist to have it removed. That is when my whole world changed – the dermatologist explained to me that an ultrasound is not a definitive tool, plus it was since December 2018. He shared with me that he can tell from the biopsy if it is a cyst and if it is he had prepped the area to remove it but if it wasn’t he would do a surgical biopsy. That was August 16, 2020, and 2 weeks later, I had an appointment to get the stitches removed, and that’s when I got the diagnosis of ILC (Invasive Lobular Carcinoma). The Tests Ultrasounds and mammograms on August 31, 2020 still did not show any inconsistencies or abnormalities . My pap smear came back negative. So all good in that respect. The surgeon's first visit occurred that week also and a number of tests were orders – CT Scan with contrast of chest, abdomen, and pelvis; Breast MRI and Radioactive Tracer full body bone scan . These tests would provide further results as to what the surgery and treatment plan would look like. So, for the next couple weeks I underwent these various tests.... all use very toxic chemicals so they had to be staggered to ensure that the chemicals were no longer in my system. The Surgery Great news considering everything – it was a single tumor and so surgery was scheduled for September 29, 2020 at 8am EST for a lumpectomy. I knew that all will be well since 8 is the sign of infinity, and September 29 was one of my dear brother’s birthday’s who had transitioned 7 years earlier. My surgeon and I had agreed that if the sentinel nodes were clear that she would only do 1 auxiliary lymph node dissection . Surgery was successful – nothing in the safe margins of the lumpectomy, nothing in the lymph nodes (sentinel nor auxiliary) and so next treatment post healing of the surgical area was radiation. Active and Informed During this entire time – from August 31, 2020 to October 30, 2020 – I did as much research as was possible. I chose to be an active informed participant in my health and wellbeing – so I researched Mayo Clinic and Breast Cancer.org around ILC. In addition, I registered with Wellspring, Ontario, Canada, a non-profit organization that provides numerous services and programs for any Canadian Cancer Patient and their main caregiver. I initially registered for both Reiki and Therapeutic Touch (TT). Being a trained Reiki Master – I was open to receiving energy healing and I had had 1 TT treatment when my Dad was in Hospice back in July 2019 – and I remembered how calming and peaceful it felt after the treatment. Therapeutic Touch Treatments I continued to have TT treatments remotely by a retired nurse who I called my Earth Angel.... before each test, day before surgery, during surgery, day after surgery, and each day after my 10 radiation treatments. TT is so healing that it is now taught based on it’s evidence-based research at a number of teaching hospitals for nurses and doctors. I believe in my heart of hearts that it is due to TT that I didn’t require any pain meds at all post surgery and other having to have a table tennis ball aspirated 2 weeks post surgery no other additional interventions were required. Remember – the tumor and all the lymph nodes that were removed and dissected were all in the same area in the underarm – a 4.5in incision. I opted, after my research, to do the Accelerated Radiation Treatment Plan – I read all the papers available at the time on this – The Lancet, Breast Cancer.org, and Yale before making an informed choice. I'm so happy and thankful this was an available choice!!! For anyone who isn’t aware of it – please check with your radiation oncologist and have the discussion if it is a possible treatment plan for you. Again, I contribute no broken skin in the radiated area to TT which I had each and every day after radiation remotely by my Earth Angel!!! Treatment Plan and Side Effects The next step in my treatment plan was an AI (Aromatase Inhibitor) since the pathology of the tumor indicated that it was ER/PR+, HER2 -, Stage 2, Grade 1 (less than 10% of cells were abnormal), and my ONCO Score was 11. Being a 63 soon to be 64 post menopausal woman at the time, I would have had to have an ONCO Score of 26+ for chemo to be even suggested/recommended. Another thankful moment in the journey!!! I was able to complete my radiation on December 4, 2020 and commence the AI (in my case Letrozole was prescribed) on December 12, 2020. Unfortunately, I experienced all the 3 most severe side effects possible from this AI. Night sweats, hot flashes, and joint pain and stiffness in my fingers – to the point it disrupted my sleep in the wee hours of the morning – the REM sleep time 2am-6am. My MO suggested after the first month to take it in the morning versus night – the side effects continued without a break.... After 2 months, my MO suggested taking a break and once the side effects subsided that he will start me on another AI – Exemastane. Unfortunately, the side effects continued like clock-work for 6 months even after stopping the AI. In those 6 months, I went back and reviewed all my reports from my various tests to again make another informed decision – and since my CT Scan had shown a NAFLD (Non- alcoholic fatty liver disease) I decided to do some research on this . Thankful and grateful that with the right diet and exercise this is the one organ that can rejuvenate itself but it takes approximately 3 years. Internal Guidance I have made an informed decision to not take any AI since an AI for 5 years with debilitating side effects would then require me to have possibly every 6 months bone injections for 3 years and that also has it own set of side effects. As I meditated daily and asked Great Spirit what was best for me – I kept getting the same intuitive knowingness – I don’t need an AI. BTW – my onco score also showed that even taking an AI for 5 years it will only probably result in improving a possible recurrence from 1 in 10 (which is the national average of breast cancer) to 1 in 33. My internal guidance was shouting no to me – so I chose to follow my internal guidance and instead focus on myself as a whole being!!! Living in Gratitude I live each day in gratitude as I walk the journey of my life in daily meditation, journaling, putting healthy boundaries, eating healthy foods, and daily walks in nature while chanting . I'm very grateful for Alistair Cunningham who was guided to write the book entitled “A Healing Journey” and all the workbooks that go with all the various modules and run by Wellspring Canada!!! I have made changes in all areas of my life – physical, emotional, mental, and spiritual and work on all of them daily. I am currently completing the Healing Journey 5 module and registered for both Healing Journey 6A and 6B to commence mid September 2021. I have also felt guided to complete TT Level 3 so I can volunteer with the following organizations – Wellington Hospice Guelph, Groves Memorial Hospital (where I already volunteer on the Board of the Volunteer Association and has been for the last 2 years), and Wellspring Canada!!! Living my best life possible every day as I seek and act on the internal guidance given to me by Great Spirit/God/Divine Matrix – call it what you will!!! Thank you for sharing your story, Gloria. SBC loves you! SurvivingBreastCancer.org Resources & Support: Affirmations & Meditations Guide Nutrition Guide Breast Cancer & Journaling Free Virtual Movement Classes Online Support Groups

By Liz Cooper, NC native currently living in Chattanooga, TN and breast cancer survivor since January, 1998 Rising to face another day, I stare at my face in the mirror and begin to pray, Father I stretch my hand to Thee, my Helper and Provider today help me to stand, renew my strength and take all my tears away. Mirror, mirror before you I stand, facing a reflection of a new “ME” Changed on the outside and transformed on the inside, I never knew this would be. I recall the look on my doctor’s face as sad and somber on that winter’s day It seemed for a moment the words he spoke took my breath away. “ I regret to inform you, you have CANCER,” the words echoed in my mind I lay speechless, unwilling and unable to move, suddenly frozen in time. At first filled with disbelief, thinking surely there must be some mistake My mind was ill at ease, nervously aware this would be more than I could take. Fear and doubt reared their ugly heads, What does it mean? What can I do? I felt my Heavenly Father place His hand in mine and say “I will be with you.” Words of comfort, whispered ever so softly in my ear, Words I needed to hear and with those words instinctively I dried my tears. God ‘s word says “ Lean not to your own understanding ” “ Believe and trust in me ” The greater the problem—the closer He will be. I began to pray and meditate upon His word, With faith comes healing -- I knew my prayers would be heard. The Holy Spirit had begun His work and I began to understand, There is a time and purpose God has prescribed for every man. I was assured I would be healed and bear witness of His love I knew my deliverance would come from above. By the blood of Jesus and by His stripes I am healed, Even more, I have learned to surrender and accept His will. Like the woman with the issue of blood, she kept the faith, she never gave up. I kneeled before the Lord as I drank from that bitter cup. This earthly affliction may have caused me pain With Jesus as my Peace and Comforter, my life will be renewed again. Lord, you knew me, even as I was formed in my mother’s womb, And by your mercies, oh God, I will proclaim your goodness to my earthly tomb. This temporary trial will always be my testimony, this was a test of my faith, Lord you see inside me, with just one touch I am healed and my sins are erased. I could have been dead and gone down in my grave Lord you healed me, you saved me and made death behave. Standing before this mirror staring at a reflection of what human eyes can see, Realizing these eyes are blind to the new life that you have created in me. My Bible tells me “they that wait upon the Lord, shall renew their strength,” Jesus I am filled with thanksgiving to You for saving me from what might have been. You took away my sickness and You removed my disease, I have a new walk, a new talk, a new life and my mind is at ease. Old things are passed away, everything has become new, Thank you, thank you, thank you Jesus, I owe it all to you! Now as I stand facing the mirror I see God looking down with love and grace, And I humbly walk away with an uplifted spirit and a smile on my face. This journey has taught me well that no matter what I may go through, God cares, will never leave me and will always bring me through.