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Diet and Nutrition By popular demand our nutritional message board. This board will be monitored by a Registered RD who is certified in oncology by the American Dietetic Association

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Old 11-09-2009, 08:05 AM   #41
TanyaRD
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Re: Breast cancer, and seeking advice

This is so true. The fact that all cancers are grouped under one disease title is entirely misleading. I have to admit that I have never thought of hormone sensitive breast cancer as an endocrine disease but I believe you make a very good point. I want to discuss this with our internist today. Thank you.
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Old 12-13-2009, 02:36 PM   #42
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Re: Breast cancer, and seeking advice

Hi A.A.! How are you? Have you considered using a boxing "speed bag"? You know, one of those tear-drop shaped bags that you hang at about head level and punch around. They're great for burning calories and developing/maintaining your hand/eye co-ordination. I mean, you're already jumping rope. A speed bag can be installed in the corner and takes up no floor space.
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Old 12-14-2009, 02:30 PM   #43
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Red face Re: Breast cancer, and seeking advice

Hi Bill,

I didn't know it was called a speed ball but it does sound like a good idea to add to my routine, especially with the winter ice making it harder to exercise outdoors, where the roads are icy and drivers have more trouble keeping the cars on the road. I need to work on strengthening my shoulder and both arms (which get a workout with the work I do, but always only in one position at the computer). I also think that having some exercise that forces me to look a bit upward helps in terms of aging and posture.

We have just started having temps low enough for some skating here, so I'm hoping for a few more days of it to harden up the lake top and hoping it won't snow on top of the ice. We just finished traveling last week and are happy to be home in time for the holidays.

I weighed in at 20 pounds overweight, and Christmas and New Years are dead ahead. For the office potluck party I am making a low-carb/cal , green and red cabbage dish.

My insurance company also once again is blindly refusing to pay for the visit with the RD that is so key to working on keeping the weight off that leads to recurrences. (It seems they would prefer to pay for the eventual recurrence....!)

Thanks for coming up with another good suggestion to look into.

A.A.
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Old 12-14-2009, 02:42 PM   #44
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Unhappy Status quo

Hi Tanya,

As mentioned to Bill, I am slowly losing ground, now being 20 pounds over mid-range of my recommended BMI. Equally frustrating, my mostly high quality insurance has refused to pay for my visit with the RD in Seattle, who is completely professionally qualified and experienced and affiliated with my cancer center, even though the same insurance paid for the naturopath visit several years ago without blinking. I will appeal.

As I read the comments about the latest breast cancer conference I am disappointed that the focus continues to be on infintely tiny pieces of the larger puzzle of breast cancer, with application of one drug or another that may "work" briefly before cancer finds another way around it. I still think breast cancer is an endocrine disease that calls for endocrine analysis and solutions.

Here are 2 trials that to me would provide more help to breast cancer patients (one as you can see was stopped):

http://clinicaltrials.gov/ct2/show/N...+cancer&rank=1

In another clinical trial, interestingly patients who had chemo and patients who did not were stratified, which should provide some very interesting info:

http://clinicaltrials.gov/ct2/show/N...+cancer&rank=4

How did your chat with the internist turn out?

-A.A.
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Old 12-14-2009, 02:48 PM   #45
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Post Re: Breast cancer, and seeking advice

Is anybody else besides me thinking that obesity may be significant at least for HR+ patients, in that slow weight gain over the years may be a key factor in late recurrences?

Copied from Lani's post on the main forum today:

http://www.her2support.org/vbulletin...ad.php?t=42815

Obesity linked with poorer breast cancer outcomes

Breast cancer patients with a high body mass index (BMI) have a poorer cancer prognosis later in life. Specifically, their treatment effect does not last as long and their risk of death increases.
"Overall, women should make an effort to keep their BMI less than 25," said Marianne Ewertz, M.D., professor in the Department of Oncology at Odense University Hospital, Denmark. "Those who have a high BMI should be encouraged to participate in mammography screening programs for prevention efforts."
Ewertz and colleagues examined the influence of obesity on the risk of breast cancer recurrence and mortality in relation to adjuvant treatment. She presented study results at the CTRC-AACR Annual San Antonio Breast Cancer Symposium, held Dec. 9-13.
Using the Danish Breast Cancer Cooperative Group database, they evaluated health information — such as status at diagnosis, tumor size, malignancy grade, number of lymph nodes removed, estrogen receptor status, treatment regimen, etc. — from almost 54,000 women. Ewertz and colleagues were able to calculate BMI for 35 percent of the women, whose information about height and weight was available. A healthy, normal BMI score is between 20 and 25; a score below the normal range indicates underweight and a score above indicates overweight.
After 30 years of follow-up (from 1977 through 2006), the researchers found that women with higher BMIs were older and had more advanced disease at diagnosis compared with those who had a BMI within the normal range. The risk of distant metastases increased the higher the BMI. However, BMI played no role in loco-regional recurrence.
Women with a high BMI had an increased risk of dying from breast cancer, a finding that remained constant over the study period. Further, adjuvant treatment seemed to lose its effect more rapidly in obese patients, according to Ewertz.
"More research is needed into the mechanisms behind the poorer response to adjuvant treatment among obese women with breast cancer," she said.
^^^^^
SABCS 2009: ABSTRACT #18: Effect of Obesity on Prognosis after Early Breast Cancer

Background: Obesity is associated with an increased risk of dying from breast cancer. There may be several explanations for this such as obese women being diagnosed at a more advanced stage of disease or that treatment is less effective in obese patients. The aim of this study was to examine the influence of obesity on the risk of recurrence and death from breast cancer or other causes in relation to adjuvant treatment.
Material and methods: From the database of the Danish Breast Cancer Co-operative Group (DBCG) we identified 53816 women who received treatment for early breast cancer according to the DBCG protocols between 1977 and 2006 with complete data on follow up. Information was available on age and menopausal status at diagnosis, tumor size, number of lymph nodes removed, number of positive lymph nodes, deep fascia invasion, histological type, grade of malignancy, estrogen receptor status, treatment regimen, and protocol version (year), while data on height and weight to derive the body mass index (BMI, weight in kilograms divided by the square of height in meters) were available for 18967 patients or 35 % of the patients. The chemotherapy regimens included cyclophosfamide, metotrexate, and fluorouracil (CMF) up to 1999 and cyclophosfamide, epirubicin, and fluorouracil (CEF) from 1999 onwards. Endocrine therapy included mainly tamoxifen of durations from one to five years depending on time period. Associations between BMI (<25 vs ≥25,<30 vs ≥30) and other prognostic factors were analyzed by using the chi square test. Cause specific survival and invasive disease-free survival (type of first failure) were analysed by univariate and multivariate methods using Cox proportional hazards regression models.
Results: Compared with patients with a BMI less than 25, those with a higher BMI were older, more often postmenopausal, had larger tumors, more lymph nodes removed and more positive lymph nodes, more often invasion into deep fascia (all p<0.0001), and more often grade III tumors (p=0.04). Univariate analyses showed that the risk of a loco-regional recurrence was not related to BMI while the risk of distant metastases increased with increasing BMI after 3 years of follow up. The risk of dying from breast cancer remained elevated for patients with high BMI throughout 30 years of observation. Adjusting for the effect of other prognostic factors, multivariate analyses confirmed an independent prognostic effect of obesity. Within the first 10 years of follow-up chemotherapy and endocrine treatment were equally effective in lean and obese patients. However, after 10 or more years of follow-up, the treatment effect did not last in obese patients who had a poorer survival despite treatment.
Conclusion: Results: from this population-based cohort of almost 19000 patients followed for up to 30 years confirmed that obesity is associated with a poorer prognosis after breast cancer. This is likely to be due to obese patients having a higher risk of developing distant metastases than lean patients and that adjuvant treatment seems to loose its effect more rapidly in obese patients.

Last edited by AlaskaAngel; 12-14-2009 at 02:52 PM..
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Old 12-14-2009, 03:54 PM   #46
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Re: Breast cancer, and seeking advice

While we are cross referencing, here is a link to the thread I posted in the Meeting Highlights, containing information about the deleterious effects of chemotherapy on insulin resistance: http://her2support.org/vbulletin/sho...eferrerid=1173

Clearly, BC treatment (and the premeds for the treatment) are contributing to on-going weight issues for patients, which in turn contribute to recurrence. Considering how many of these treatments are given to early stagers as risk management against recurrence, it is not clear exactly what risk is being managed.

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Old 12-15-2009, 12:48 PM   #47
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Re: Breast cancer, and seeking advice

AA,
I agree with you 100%. We need a lot more studies like the ones you sited in regards to healthy lifestyle changes after a cancer diagnosis and also in the eye of prevention. I am always excited to see these studies. Of course, drug studies remain important but I believe these types of studies to be equally as important.

As a Registered Dietitian, I share your frustration with the lack of insurance coverage for our services. If you haven't already done so I would recommend talking to the RD and seeing if they will work something out with you if the charge is financially burdensome. If that doesn't work continue to push your insurance company and consider providing some evidence such as that in the WINS trial.

Lastly, I wanted to comment on the connection between breast cancer and obesity. The connection is real. A greater amount of adipose tissue, especially abdominal, increases estrogen levels thus the link to hormone sensitive breast cancers. I just did a literature review on this very topic last week and found the following.

Pre-diagnosis body mass index, post diagnosis weight change and prognosis among women with early stage breast cancer. Cancer Causes Control.2008 Dec; 19(10): 1319-28
Concluded that being obese before diagnosis was associated with increased risk of recurrence and poorer survival, corroborating results from previous studies.

WHI study results state "the pricipal options for the reduction of breast cancer risk in postmenopausal women are the prevention of overweight and obesity to avoid the developement of hyperinsulinemia, the medical treatment of insulin resistance..."
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Old 12-15-2009, 01:07 PM   #48
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Connections between excess dietary management and breast cancer

Tanya,

Thanks for the response and information. The insurance company paid for the first visit with the RD that I made on my recent trip but not the last one. In looking closer, on the back of the denial they asked that other documentation be provided, so I have asked my RD to work on it with me. I will be providing them with copies of the studies as well.

I am still hoping to eventually be seen in coordination between my RD and an endocrinologist because I think that is really key to working on the roadblocks I've had with diet and exercise.

As I see it, the real change that is needed most of all is changing the way treatment is organized and planned at time of diagnosis. As long as the only people who sit on tumor boards at that time are surgeons and oncologists and radiologists, treatment will not address the obvious changes brought on through those modes of treatment alone, that then continue to contribute to recurrence. We need coordinated care from the start, not just aftercare. We need endocrinologists and dietitians to take the initiative themselves in approaching this, and being recognized for the role of endocrinology in dealing more effectively with breast cancer prevention as well as at time of diagnosis.

AlaskaAngel
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Old 12-15-2009, 01:30 PM   #49
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Re: Breast cancer, and seeking advice

AA, I meant to mention that the internist agreed completely regarding the role of endocrinology. You are right. Our model of care is not set up to deal with these issues. In fact it reminds me of the push the IOM made in 2007 with their release of "From cancer patient to cancer survivor: lost in transition". It is an area I am passionate about and we are working very hard at providing such services in our center.
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Old 12-15-2009, 01:48 PM   #50
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Re: Breast cancer, and seeking advice

Just thinking out loud, here - since most endocrinologists make their living treating insulin resistance (i.e., diabetes), would the emerging information on the effect of insulin resistance in bc treatment, as well as being a long term side effect of adjuvant treatment, be the way to get them to the table?

The fact that all of the endocrine pathways can potentially be involved in one way or another for signaling purposes could be worked in later.

Hopeful

Last edited by Hopeful; 12-15-2009 at 01:50 PM..
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Old 02-03-2010, 10:07 AM   #51
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Re: Breast cancer, and seeking advice

I just saw this today and it reminded me of our discussion on this thread. Maybe the gap will finally close...

The Endocrine Society's New Journal, Hormones & Cancer, Bridges Gap
Between Endocrinology and Oncology

http://www.newswise.com/articles/view/560834/
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Old 02-03-2010, 10:26 AM   #52
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Re: Breast cancer, and seeking advice

Tanya,

Fantastic catch, thanks! I signed up to get the free table of contents for each issue e-mailed to me; figure I can pay for individual articles that look pertinent. Normally, access to the abstracts is free.

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Old 02-03-2010, 12:40 PM   #53
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Thumbs up Endocrine/cancer Journal

Tanya,

I too am very happy to see your post about this new journal, and the clear professional statement of recognition in the announcement itself about the need for it.

Like Hopeful I am going to pursue this on a personal basis, but also since I will soon have the chance to be at my cancer center again, I hope to actively and promptly pursue it with the educational center there for cancer patients as well as with the medical personnel involved in my care. I am planning to see an endocrinologist in coordination with my registered dietitian and my PCP's nurse practitioner, and your post is very timely for me. If I am able to set up genuine coordination among these 3 medical providers and document it with my insurance company, perhaps I will then see someone again from oncology to pursue it as well.

With appreciation,

AlaskaAngel
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Old 02-09-2010, 11:47 PM   #54
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seeking coordinated care

Just an update --my insurance panel refused to cover my 2nd visit with RD, as I do not have lab results indicating that I have either thyroid disease, diabetes, etc.

The question involved here is the one I mentioned earlier. Why are my lab results normal, including blood sugar, if, just like a person who has diabetes and high blood sugars, I too have to stick 100% to an ADA diet and consistently exercise to avoid gaining weight? Why is dietary counseling covered for a diabetic, but not for chemopause patients like me?

I am still working on meeting with an endocrinologist.

A.A.
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Old 02-10-2010, 02:11 PM   #55
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Re: Breast cancer, and seeking advice

AA, I appreciate your frustration with lack of coverage for RD services. Amazingly enough the coverage that is available is a significant improvement from 5 years ago and I believe it will continue to improve but not fast enough. I don't know why your labs are normal. The ADA diet is a general, healthy diet that would benefit most people. As we have discussed before, the endocrine changes after breast cancer remain a poorly understood area that needs significant attention.
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Old 02-10-2010, 10:07 PM   #56
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Re: Breast cancer, and seeking advice

AA,

So glad your 'numbers' are normal.

It is amazing how the mindset is still focused on 'treatment' instead of 'prevention'. Don't they know that preventive medicine is so much more cost-effective?

I'm fighting a similar battle as well. My oncologist wanted me to wait for another two weeks because they couldn't see anything on the ultrasound. Based on the fact that they had misread my mammograms and missed my recurrence for four year, I don't think I'm going to wait. I'm going to call my oncologist tomorrow...
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Old 02-11-2010, 09:41 PM   #57
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Wink Re: Breast cancer, and seeking advice

Has anyone suggested dancing as a means of exercise? Valentine's Day is almost here. Grab the nearest partner and dance !! It is a great exercise that moves most parts of the body during the dance.
Also housework can be good exercise. Put on some peppy music that moves you. You might find the housework gettting done faster and with more fun than you ever imagined. These are two kinds of exercise than can be done indoors during the cold winter season.
Have fun !!!!!!!!!!
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Old 02-12-2010, 12:13 AM   #58
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prevention

Hi Jackie and Elaine,

You know, I keep thinking that it maybe we would have made more progress toward a less controversial health care plan if it would have started with just funding preventive health care for everyone as a first step, and then worked out any bugs in that before adding more to it....

A BIG yes to dancing! It does all kinds of good things -- improves balance and flexibility of the whole body, encourages creativity, and doesn't require much for equipment....

A.A.
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Old 03-21-2010, 12:29 PM   #59
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Visit with endocrinologist

I have re-read every post in this thread. I have seen the endocrinologist, and want to share what I've learned from it. In addition, 2 new threads that are relevant to this discussion about this issue have started on the main forum.

This post will be a long one and I apologize for that. And this quote from Tanya's earlier post summarizes what I learned:

WHI study results state "the principal options for the reduction of breast cancer risk in postmenopausal women are the prevention of overweight and obesity to avoid the development of hyperinsulinemia, the medical treatment of insulin resistance..."

Those who are overweight at time of diagnosis and treatment are at higher risk for recurrence, and I hope some explanation might help them to understand why.

I suspect that those bc patients who are much younger at time of treatment, or who have gone through natural menopause rather than chemopause, are less likely to have to deal with these problems because their metabolism has been less severely (or perhaps less permanently) affected.

I think it might help to summarize and use my history as an individual, just as an example:

At time of breast cancer diagnosis, I was premenopausal at age 51 with the upper limit of normal BMI of 24.6 at 155 pounds. I exercised twice a week for 20 minutes to not gain weight. If I went out to dinner and ate more calories, I had to increase my exercise for a single week to 5 days to lose the added weight, and then I could maintain my weight again.

At completion of treatment for breast cancer (CAF x 6, rads, tamoxifen x 1 3/4 years) I weighed 178 pounds with a BMI of 28.3 (overweight but not obese), and needed to drop the weight I had gained.

Physiologic changes from treatment included:

1. Sudden severe reduction in estrogen levels and in testosterone level. The lower testosterone level and the repeated immobility from 6 episodes of nausea and vomiting + significantly reduced muscle tone and muscle bulk, which (combined with weight gain) resulted in increased clumsiness and less ability to exercise.

What we aren't told before doing treatment is that the permanently lower testosterone level means that the balance of our body composition of muscle and fat changes permanently. Testosterone works for building and maintaining muscle. With less of the testosterone, the exercise that you used to do that worked for you previously is not going to produce the same results.

Research into testosterone supplementation for breast cancer patients continues. Since testosterone also helps with bone health, it could mean that some supplementation may help to prevent recurrence. Testosterone is also a hormone that influences gender and libido.

2. Fatty liver by ultrasound, with mildly increased ALT and AST
3. Continuing low blood counts. (I never used any blood stimulator during treatment, such as Procrit or Neupogen.) Low blood counts reduce oxygen-carrying capacity of blood, and thus also reduce the ability to exercise.
4. Radiation treatment effect that continues long after actual exposure, with increased fatigue that reduces the ability to exercise.
5. Slowed metabolism, but normal blood glucose levels.
6. Significantly increased weight from both the use of steroids given with chemotherapy and from repeated periodic immobility due to nausea and vomiting.

Permanent dietary changes I made, to try to help with weight management:

Gave up all standard sugars, and substituted stevia. Presently the only glucose I eat is 1 teaspoon of honey once a day (20 calories), and the sugar in 2 squares of dark chocolate (100 calories), and whatever glucose I get from fresh fruit
Gave up all caffeine
Gave up all forms of products containing white flour, changing to whole grain
Gave up all forms of corn and potatoes entirely
Dropped rice consumption to 2 to 3 times a month, using brown rice only
Cut dairy intake by 2/3
Cut egg consumption to 2-3 eggs a month
Cut red meat consumption to 2-3 times a month
Increased cold water fish consumption
Added 2 tablespoons of daily freshly ground flax seed
Maintained fresh vegetable and fruit consumption
Limited alcohol consumption to 1/4 cup a month of beer or wine

With making all those changes, I couldn't understand WHY I wasn't losing weight, especially since I was doing the same amount of exercise I had always done that had always worked for me. Eventually I resorted to not eating all day every day until 4 PM and then only having dinner, with medium portions and a single helping, and going away from the table still hungry. It took 6 years of steady effort and I lost 23 pounds, but it took enduring staying hungry constantly with or without adding more exercise.

I found it very difficult to try to work and stay constantly hungry. I wanted to be able to eat more than 1 meal a day, so I joined 2 others from HER2support in recording everything I ate for 2 weeks and what exercise I did (jumping rope 30 minutes a day). I was eating 3 meals a day, 1000 calories a day or less, and there was no weight loss. One of my partners from HER2 did significant exercise and ate over 2,000 calories a day with no weight loss, and the other was walking for exercise and eating 1000 calories or less each day like me, and having the same problem I was having.

I then had a visit with the registered dietitian at the cancer center and gave him my 2-week diet record. On his scale I weighed 153 pounds in October, 2008. The RD used a device called a MedGem, which measures one's breath for a period of time and calculates the calories that person can take in per day without weight gain if they do no exercise. That number for me was 1440 calories per day. I was advised to increase my caloric intake to 1350 calories a day and to continue jumping rope 30 minutes a day. Theoretically this meant I would be eating 90 calories less per day than it would take not to gain weight even if I didn't exercise, and by adding daily exercise to this I would lose weight. The RD told me that even thought I had been doing 30 minutes a day of significant aerobic exercise, I had not been eating enough calories to get my metabolism working faster.

I continued the exercise and increased diet for 3 months without missing a single day of exercise, and did not lose any weight at all. Clearly the calculation and recommendation for daily caloric consumption was not accurate for me. I then tried jumping rope faster and ended up with back problems, and had to drop the exercise for a month or so, but I continued the same diet. I gained weight steadily, even though I was still eating 90 calories less than the calculated caloric allowance for a sedentary person based on the MedGem test. The theory that I was not eating "enough" calories to burn proved to be objectively false because I did not lose weight.

I had a visit with the RD and asked him if there was any way my care could be coordinated by contact and sharing of information between my PCP, the RD, and a visit with an endocrinologist. Why an evaluation like this isn't done as a standard practice to begin with at time of diagnosis and treatment planning is absurd. If treatment planning can include the spendy services of an oncologist, a surgeon, and a radiologist there is no reason why it cannot include an initial evaluation by both a registered dietitian and an endocrinologist. Having an evaluation prior to treatment would document the body condition prior to treatment, and would make it less likely for patients to be dumped by professionals after completion of chemotherapy and radiation and left with a dysfunctional metabolic problem that promotes recurrence. Breasts are an endocrine gland, and breast cancer is an endocrine disease.

The RD promised that once I actually scheduled an appointment with an endocrinologist, the RD would send the Seattle endocrinologist and my PCP in Alaska the most recent RD note for me. My PCP had been following my situation and weight, and agreed to refer me to an endocrinologist.

I learned that endocrinologists are booked solid months in advance. In addition, several refused to see me, and said that they "limited their practice to conditions like diabetes and thyroid issues", and since my labs for those conditions were completely within normal limits, they would not see me . These specialists specifically listed "metabolism" as an area of their specialization and they still would not see me. Maybe they are so booked solid with just diabetes and thyroid kinds of conditions alone that they don't have to take on other metabolic problems. However, cancer treatment causes major changes our metabolic system, and as a direct result of that we need specialists who are educated and available to help us deal effectively with those changes.

Eventually I was able to get an appointment with an endocrinologist, who received both the clinic note from my annual physical exam with my PCP and the note from my most recent visit with the RD. That meant that an endocrinologist (who is trained in metabolism in ways that an RD is not, and who is able to order labs to establish whether a person is truly dieting and exercising or not) was able to order current labs that included both metabolic and endocrine values. Using those lab values, the endocrinologist was able to analyze and see objectively that I have been exercising and dieting without losing weight. The endocrinologist explained to me that my metabolism has become more efficient and that I am using insulin differently than I did in the past.

I think maybe what the endocrinologist is saying is that if there were 2 identical twins who ate exactly the same thing, but one had bc and been treated for it, the one who had treatment would digest every last shred of the food and the one who never had treatment would only be actually digesting some of it, with the rest zipping on by and out. I know that when it is said that the "metabolism is slowing down" it means that the metabolism isn't burning "hot enough", but since I stuck to the diet of added calories in order to have my metabolism "burn hot enough" AND I added more and more types of exercise and still gained weight, that was objectively proven not to be true for me.

I know I am using insulin differently than I did prior to treatment and that is one part of the problem breast cancer patients like me face. A second genuine cause is the permanently reduced testosterone level that keeps the muscle system from working like it did prior to treatment. These are not imaginary problems; they are very real permanent body changes.

Analytically speaking as a patient, I have no idea why any oncologist would consider themselves qualified to manage what is an endocrine disease after completion of oncologic treatment, without the help of an endocrine specialist as well as an RD to work with the patient. That seems like more of a historical artifact based on limited resource allocation than quality patient management.

As yet there is no magic answer for me. I asked the endocrinologist whether or not I could use a small dose of metformin to help. The endocrinologist is not opposed to trying that, although is working with me at present without it.

Again, it may be true that those bc patients who are much younger at time of treatment, or who have gone through natural menopause rather than chemopause, are less likely to have to deal with these problems because their metabolism has been less severely (or perhaps less permanently) affected.

But by going through all of the documented steps in seeking further treatment I have documented that the metabolism of a person who has been treated for breast cancer with standard therapies and who is chemopausal and has no other known disease is not likely to be successfully treated over time with just steady restricted diet and added exercise, regardless of the type of exercise. The reason is not a lack of reasonable effort on the part of the patient. It is because there is zero tolerance permanently for any deviation from strict diet and exercise. My impression is that this could be why HR positives eventually recur. It goes back to one of my original questions. How can weight maintenance or loss occur in spite of occasional exceptions such as having the flu, or having to spend a day sitting in a plane, traveling, etc. There is simply no flexibility at all for that. When I injured my back by trying to jump rope faster so that maybe I could actually lose some weight, and then had to reduce the exercise, the weight gain came flooding back,even though I maintained the strict diet. It requires genuine daily starvation for me to lose any of it again, just like it did during the first 6 years after treatment. I could not figure out why diet and exercise were not working. They were only working to avoid further weight gain, and they only worked as long as I didn't have any interruption of any type at all. Even the RD didn't realize this, and put me on an increased caloric diet.

In this situation this is a major change from previous experience, and the patient genuinely needs an explanation. Extensive daily exercise 7 days a week would work if nothing additional was eaten (i.e., one would still have to go hungry and in effect, starve most of the time, day after day, to actually achieve the weight loss), and never miss a day of exercise and diet once the desired weight is achieved. For the majority of these people, who lead lives that usually include other commitments and interruptions, it is not practical.

We need some kind of an readjustment of our endocrine system to be successful long-term to avoid recurrence. It is known that weight gain increases risk for recurrence.

Because of the fact that this problem is affecting us all in this way, I continue to question whether the extensive use of steroids that encourage weight gain during treatment is reasonable, if in actual effect it promotes eventual recurrence.

Remember that for stage I bc patients the recurrence rate is quite low to begin with. How many of these patients would never recur at all if they did not havethe increased weight gain from steroids and the inability to achieve the proper waist measurement or BMI? On the other hand, are the steroids providing significant reduction of recurrence due to their action in reducing inflammation? If stage I patients chose to decline chemotherapy (and the steroids that go with it) and instead followed an anti-inflammatory diet with exercise, what would their recurrence rate be?

http://well.blogs.nytimes.com/2008/0...st-measure-up/

http://www.cdc.gov/healthyweight/ass...alculator.html

http://well.blogs.nytimes.com/2010/03/16/doctors-and-patients-not-talking-about-weight/
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Old 03-21-2010, 01:09 PM   #60
Soccermom
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Re: Breast cancer, and seeking advice

Dear A.A.
Thank you for taking time to post your experience and research. I too am struggling.
My "problem" seems to be a Catch-22 situation. I LOVED to work out prior to BC and TX and even walked daily during the recon process to regain stamina and maintain weight.BUT i crashed this year ..suddenly no energy.
It just not working anymore. My blood counts are OK, RBC low,I asked for B-12 shots and my PCP wont do it.I take vitamins etc but as you said my whole metabolism seems to have changed.
I was premenopausal at DX as well. Very disheartening and discouraging when one seems to make no headway!
Are you familiar with the WISER sister study?
http://bmic.upenn.edu/wiser/

and also this one
http://www.wiserwomen.umn.edu/default.htm
I sat in on a webinar a couple of weeks ago and some of the ongoing study results were presented. It compares the relationship between exercize,estrogen and breast cancer diagnosis. I am hoping that these studies will yield more information that will help us/Physicians plan the roadmap for Survivorship and healthy lifestyle.
Hugs,
Marcia
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