Sunday, October 18, 2009
Thursday, October 1, 2009
Wow! It is nearly a year since I was diagnosed with DCIS (stage o-1 breast cancer). October, breast cancer month, is here - I never really took notice of breast cancer or breast cancer month as no one in my family or immediate friend circle had breast cancer. In fact, no one in my family even had any form of cancer.
Here is an update of how I am doing (so we can talk about other things when we see each other - my health status seems to dominate most conversations and I want to get on with living now!):
MY PHYSICAL BODY:
1. CANCER MARKERS:
My cancer markers are all normal. I test these myself every 3 months. Now that I happy with the results, I will start spacing the tests to every 6 months.
The main reproductive cancers to test for include:
* Breast Cancer: CA15-3
* Ovarian Cancer: CA 125
* General Cancer Marker: CEA
* Pregnancy test: this is a very old method to show to rapid division of cells somewhere in the body. Cancer is the rapid division of cells. The test can't say what type of cancer may be present, or where it is in the body, but just that there are rapidly dividing cells.
2. 2:16 HYDROXY-ESTRONE METABOLITES RATIO:
My liver is now metabolizing estrogen much better than it did in the past. The liver needs to be working optimally excrete all toxins, including hormones after they have served their purpose. It is most important that the 2 strong forms of estrogen (estrone and estradiol) leave the body directly after exerting their action to avoid re-stimulation of breast and other estrogen sensitive tissue in the body.
There are 2 main pathways in the liver along which the liver detoxifies the body: Phase I and Phase II. To facilitate these pathways, the liver needs certain catalysts (vitamins, minerals, amino acids and other substances). If either of these pathways is not working properly, a build of toxins, including estrogen, can result. Every day, I take a handful of supplements that are catalysts (facilitate reactions) for these pathways to ensure they are working optimally.
There are main metabolites (breakdown products) of estradiol that these pathways generate that provide valuable info about how the liver is excreting estrogen called: 2-hyroxyestrone and 16-alpha-hyroxyestrone.
The ratio of these metabolites is very improtant as it has been shown that 16-alpha-hyroxyestrone can stimulate breast tissue and breast cancer tissue; while 2-hyroxyestrone inhibits the this action. The ratio needs to be above 2 to be out of risk of breast cancer.
The ratio of these metabolites can be seen by doing a urine test. Currently, this test can only be done in the USA so the urine sample is sent overseas - it, therefore takes around 2-3 months to get the results.
I wish I had done the urine test last year, before I started taking all the supplements, but the lab botched my test and so I only did the test 3 months after starting the supplements.
My first reading was 3.4 and my most recent reading was 7! I am thrilled! This is in just under a year and with the help of a certain supplements each day. I would ideally like to get the ratio to 9 to be safely out a breast cancer recurrence risk zone.
As part of my breast cancer prevention 'campaign', I would like to see a future where every woman does this test from puberty (although I know most Dr's would say this is too early-my focus is on prevention and prediction of breast cancer so the further back a person starts understanding their estrogen breakdown profile amongst other things, the easier it is to take preventative steps to prevent breast cancer and other illness.
I am committed to campaigning that this test becomes as commonly accepted as a breast self-exam, an ultrasound, and a mammogram. The 2:16 hydroxyestrone ratio test may show a risk for breast cancer long before the above tests do.
3. BIO-IDENTICAL HORMONES:
While I would love to be on more bio-indentical hormones, after a diagnosis of breast cancer, there are more if's/and's/but's and Dr's get quite nervous of giving hormones until more research is available.
I have been taking bio-identical (same molecule structure as in the human body) progesterone for the last 6 months: I tried the cream for the first 2 months, and then moved onto the oral form for the last 4 months. I have almost found my ideal dose.
How I feel from the progesterone?:
Calmer and with more energy - progesterone can replinsh cortisol. Also, more peace of mind that I am opposing my body's estrogen so it remains in balance and can not just stimulate cells to divide unchecked.
I have recently added estriol (the weakest form of estrogen) as well. I want to use estriol because it is the weakest form of estrogen and is known to be breast cancer preventive. It, amongst other things, occupies the estrogen receptors, especially on breast cancer cells, so the stronger estrogen forms can’t. Western women (who have a higher incidence of breast cancer) tend to have less estriol and more estradiol and estrone, while Asian women (who have the lowest incidence breast cancer), have the highest estriol levels. Women with breast cancer have been to have low estriol levels. One theory believes, Hormone Replacement Therapy (HRT) should include estriol along with estradiol. If you choose HRT, please check out bio-identical hormones first.
How do I feel on estriol?:
Definitely better than on no estriol - less mid month 'PMT' before ovulation, and more peace of mind that I am taking something that is similar to Tamoxifen but without the harmful side-effects.
I have been taking Melatonin, post my diagnosis, for nearly one year now. I can’t say enough good about this hormone! Since I started taking it, I sleep like I did when I was a child. I have wonderfully vivid dreams and wake deeply rested.
I am also calmer in the day as melatonin reduces cortisol levels. It has helped me rest my burnt out adrenal glands. This does not happen overnight because I did not become exhausted overnight - it took 3-6 months plus supplements but has been well worth the wait!
Melatonin also opposes estrogen at the estrogen receptor site so it is a valuable aid to prevent and treat breast cancer. So many of the women I spoke to the breast cancer ward in the hospital were not sleeping properly, and had not been for sometime. Correct sleep patterns and correct circadian rhythms are so critical to a healthy body.
Melatonin is non-addictive, is claimed to have no side effects (although my plastic surgeon believes taking melatonin the night before my Feb 09 operation caused me to bleed after the op. I stopped taking it 1 week before my Aug 09 op and I was fine), it boosts the immune system and is a wonderful anti-oxidant – so many reasons to try it!
My bio-identical hormone tips related to breast health are:
* Find a doctor trained in anti-aging medicine and have them look at all your hormone levels.
* Use bio-identical hormones ONLY!! to balance your hormone levels.
* Have your estrogen urine metabolites tested to see how you liver is breaking your estrogen down.
* Remember, a female can start testing her urine and balancing hormones as young as puberty.
* Ensure your body’s estrogen is opposed with progesterone.
* The contraceptive Pill contains a synthetic form of progesterone called ‘progestin’ - this compound is not the same as bio-identical progesterone so it can sit in the cell's progesterone receptors and not allow your body’s natural progesterone to get into the cell. The Pill keeps the body in a state of delayed menopause, and that, along with progestins, have been shown to increase the risk of breast cancer. Get off the pill or synthetic HRT if you can. The risk is not worth the convenience.
4. ESTROGEN-FREE ENVIRONMENT:
I try, as much as possible, keep my, and my family’s environment as toxin and xeno-estrogen free as possible – I am always trying to find toxin-free food, toiletries, household products, and general products. This becomes easier as more brands become available on the market.
I am exercising every day or every second day. I do spinning/weights/walk or run around the block.
Just 4 hours of exercise per week can reduce your breast cancer risk and reduce your risk of recurrence.
* Helps burn fat; the place where most estradiol is made after menopause.
* Helps reduce cortisol (stress hormone) levels –> which means better sleep -> which means more progesterone and more efficacy of progesterone -> and means more melatonin opposing estrogen in the body.
* Reduced cortisol also means less cortisol occupying progesterone receptors – cortisol competes with progesterone at the progesterone receptor. Correct progesterone levels are vital to oppose estrogen - estrogen stimulates immature estrogen-sensitive cells to divide, while progesterone slows this process down and allows the cells to mature. If these 2 hormones are not in balance, estrogen is left unchecked and breast cancer can result.
* Reduced cortisol levels also help reduce blood sugar and insulin levels – vital in cancer or pre-cancer states as sugar helps feed the rapidly dividing cells of the tumour.
* Allows cells to get fresh oxygen and nutrients, and promotes a more alkaline cellular environment - cancer thrives in an anaerobic (without oxygen), acidic cellular environment.
I take a handful of supplements once or twice per day. My main focus is on my anti-oxidant levels, ensuring my liver is working properly so it can rid my body of excess estrogen, and on keeping certain other critical ingredients at optimal levels.
Shoo! Such a big topic for me! Sometimes I just want to run away and stop dreaming about my diet! My kitchen is always undergoing some experiment or other. I have eaten a 90-95% raw diet for the last 2 years now – I do still eat a small bit of fish and a few organic eggs. Right now, my focus is on maintaining balanced blood sugar levels and the protein helps me to achieve this.
My objective with food is to keep it in perspective - it is just food after all. Orthorexia is not appealing! I aim to make the most healthy choices with the food available to me at the time. The 5% of my diet I leave open to try new things and listen to my body before all else. I think raising my raw % each day will be easier once that are raw vegan restaurants and fast/snack foods available, and once my organic veggie garden starts producing produce!
I have however recently made a breakthrough about the percentages of protein, fat, and carbohydrates I need to eat every time I ingest something. I need more protein per meal/snack and I am experimenting with various raw vegan protein options. I feel much better since starting this and I find I crave the flesh foods much less.
I downed gluten overnight in Feb 2009 as an iridologist and energy healer independently both said it was carcinogenic for me. Although, I miss bread and crackers, I fortunately knew how to make raw crackers and breads so I had a new options to substitute these with. I feel so much better now and have managed to loose a few kilo’s that were very hard to shift while eating gluten.
Early next year, I plan to start teaching classes on how to increase your percentage of raw food every day. I will focus on people just wanting to increase their raw quota per day, people who want to prevent or who have breast cancer, and how to feed children more raw food. I feel strongly about teaching our children how to eat properly as prevention of degenerative disease starts from young.
Stay posted for the launch of my Heidi's Health Digest early in 2010! Join my FaceBook group to stay updated: search 'Heidi van Loggerenberg' on FaceBook.
I may drink a glass of red wine every month – but now I take 800mg of folic acid, along with my other liver detoxifying supplements, before and after to ensure my liver quickly gets rid of any harmful estrogen metabolites.
Red wine is better than any other alcohol to reduce the risk of breast cancer as it results in decreased aromatase levels and increases testosterone levles - which is another estrogen antagonist!
9. MY EMOTIONAL BODY:
Daily, I work on my emotional issues like practicing expressing my emotions more. This sometimes feels like one step forward and 2 steps back but I feel I am making progress slowly but surely. I now say ‘No’ to people, events, my kids and my own ideals without guilt. I rather want to live my best life possible and I need to be alive to do that!
After thrashing out whether or not I have the mother archetype earlier this year, I realize now that I was mostly just burnt out. Now that my adrenal glands are rested and restored, I feel like ‘mom is back in the house’!! I will never allow myself to get that burnt out again but will rather take preventative steps before I get to that point.
I am looking at my kids with new eyes. I feel so grateful to be alive and to be able to spend every precious moment with them. Yes, there will still be moments when they push my buttons but overall the are more precious wake than asleep!
10. MY MENTAL BODY:
I am very conscious about relaxing and practicing letting things go. I tend to want every to be perfect and I am learning to accept the process of life and my human imperfections.
I have wanted to meditate for so many years but could just never do it. Many of the complementary practitioners I saw said it would benefit me greatly but still I could never do it. So I did the NLP ‘Mind to Muscle’ technique and I now meditate 5 mornings a week! The state of meditation is a wonderful state to return to at any time in the day to bring me back into the present moment and to make me mindful.
11. MY SPIRITUAL BODY:
I am actively pursuing my spiritual goals – I hope this will remain life-long. This is really hard and slow sometimes. I am also learning to trust my intuition, as it is always present and always right.
I still see 2 energy healers every month. I derive so much benefit from seeing them that I will continue until my intuition tells me otherwise.
My focus for the rest of 2009 year is on moving and settling back into our house - under a month to go! Our garden has just been re-landscaped in only edible and medical plants and I can’t wait to get growing!!
I am also busy planning and putting together my practice, which I will open early next year. I will focus on sharing what I have learnted regarding breast health with others, as well as teaching people how to add more raw food to their diet. My classes will be aimed at anyone wanting to add more raw to their diet, how to add more raw to children's diets, and teaching women how to eat a diet that promotes breast health.
As I have mentioned above, my focus will be on breast cancer PREVENTION mainly as I believe every one can do so much to prevent this disease.
Wednesday, September 30, 2009
Recurrent breast cancer
- A lump or thickening in the breast, chest wall, or armpit after you have had breast-conserving surgery or a mastectomy . You may notice that the skin of your chest looks or feels different.
- A change in the size or shape of the breast or a dimple or pucker in the skin of the breast.
- Discharge or bleeding from the nipple that occurs without squeezing the nipple (spontaneous discharge).
- A change in the nipple, such as a scaly or crusty look or a nipple that draws inward (retraction or inversion).
|Breast or chest wall|
|Bones, especially the back, hips, or sternum|
|Brain and spinal cord|
Symptoms of metastatic breast cancer will depend on the area affected and how far your breast cancer has spread.
Inflammatory breast cancer is a specific type of breast cancer that involves the skin of the breast. It occurs when breast cancer cells form “nests” and block the lymphatic drainage from the skin of the breast. Symptoms include redness, tenderness, and warmth. Thickening of the skin of the breast (orange peel appearance), rapid breast enlargement, and ridging of the skin of the breast may also occur. Some women may also develop itching, bruising, or a lump in the breast. See a picture of inflammatory breast cancer .
Tuesday, September 22, 2009
HIGH levels of vitamin D in the body may improve survival rates in cancer patients.
Two new studies say that people with more vitamin D - which is produced by the skin in sunlight - when diagnosed with bowel or skin cancer were more likely to survive.
Vitamin D deficiency has also been linked to reducing the risk of multiple sclerosis.
In the first study, a team from the Dana-Farber Cancer Institute in Boston followed more than 1,000 bowel cancer patients for about nine years.
Researchers estimated the vitamin D in their blood at the time of diagnosis, and found those with higher levels were 50 per cent less likely to die from the disease.
Professor Kimmie Ng, author of the study said: "Our study shows that levels of vitamin D after colorectal cancer diagnosis may be important for survival.
"We are now planning further research in patients with bowel cancer to see if vitamin D has the same effect, and to investigate how vitamin D works."
The second study, funded by Cancer Research UK looked at patients with malignant melanoma - the most deadly skin cancer, and linked low levels of vitamin D with higher rates of relapse. High levels of the vitamin were linked to thinner tumours.
Lead author Professor Julia Newton Bishop said: "It's common for the general public to have low levels of vitamin D in many countries."
Friday, September 18, 2009
The Marie Claire magazine (South Africa) has covered my story for breast cancer month/October issue. Marie Claire kindly agreed to let me post the story on my blog on the 21.10.09 for the overseas readers.
I agreed to do the article as long as different info to the usual info was conveyed. I am satisfied that this has been done.
My story is also in the October Destiny magazine (South African) - article title: 'Life after Mastectomy'
My focus is on prevention of breast cancer, second early detection, thirdly, prevention of recurrence, and lastly, treatment during active breast cancer.
I hope this info will be integrated into the traditional medical model for breast cancer prevention and treatment in South Africa so people are more informed and have more options.
Monday, August 3, 2009
I went into hospital today to have the saline-filled breast tissue expanders replaced with silicone breast implants.
The tissue expanders have been in for about 6 months - my plastic surgeon does not feel comfortable leaving the expanders in for longer in case they rupture.
The expanders are usually inserted during the same operation as the mastectomy if you choose immediate breast reconstruction.
The 2 pictures above show the expanders - the small circle on the side of my chest is the port used to fill them with saline.
Each month, my plastic surgeon injected saline solution through the expander ports on the sides of my chest, to slowly stretch my pectoral muscle.
They sit quite high up in the chest. The silicone implants will be a little smaller, sit a little lower and will look more natural.
The saline implants feel quite hard and bumpy -like they have 'corners'. This is not sore, it just does not look smooth.
The silicone breast implants should last about 20 years or longer.
My plastic surgeon is unsure of what the patch of 'psoriasis' or 'fungal infection' spot on my right breast, where my nipple was, is. He will biopsy the skin and send to lab for analysis. I find this area quite weird as all breast tissue and nipple has been removed. Is it my nipple trying to grow back in my morphic field??
I am finding the courses I am studying so interesting. The information contained in the course on anti-aging and preventative medicine is so over-due. I am learning about, amongst other topics, the endocrine system (body's hormonal system) and how to create balance using bio-indentical hormones, therapeutic doses of nutritional supplements, diet, lifestyle changes, therapies, etc.
I love that the move towards wanting to integrate alternative and complimentry therapies is coming from allopathic doctors for a change.The boudaries between the schools of medicine are starting to disolve and there is a move towards what is best for the person, regardless of the school of medicine.
The other course, on psycho-neuro immunology and neuro-linguistic programming, is also so fascinating and valuable. These subjects look at the mind's role in the creation of disease and healing.
I hope to see the information I am learning regarding breast cancer prevention, early detection and treatment options, integrate into the traditional medical breast health model in South Africa.
After the temporary saline implants have been removed, drains are inserted. These will be in for as long as it takes to drain a certain amount of fluid - I think this is about 25ml per day.
Luckily, I managed to do this overnight so my drains could be removed at lunch time the next day.
The last pic is the final product! - after the silicone implants had been inserted behind my pectoral muscles.
(Pic orientation: My head is at the bottom of the pic - you can tell because the scar where the silicone impant was inserted, is underneath the breast).
The silicone implants are a lot smoother than the saline implants although still quite swollen, and without the ports on the sides which is the main thing!
Yeah! I can now sleep-ish on my side again without waking up in pain because the port is pressing on a rib nerve.
Next year, I will go back to have nipples sewn on using skin from my bikini line. My plastic surgeon will sewn the 2 muscles, running length ways from my ribs to my pubic bone, back together again - they got separated while I was pregnant with our 2 girls. I now have a hernia down my midline - lovely! (this does not happen to everyone so still have kids!!)
During this operation, my plastic surgeon will also take fat from my bum area and inject it into where needed in my breast area, to fill out any dents. I just never thought my breasts would end up here!!
Tuesday, June 23, 2009
1. Every person has cancer cells in the body. These cancer cells do not show up in the standard tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size.
2. Cancer cells occur between 6 to more than 10 times in a person's lifetime.
3 When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumors.
4. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental, food and lifestyle factors..
5. To overcome the multiple nutritional deficiencies, changing diet and including supplements will strengthen the immune system.
6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastrointestinal tract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc.
7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.
8. Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumor destruction.
9. When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence the person can succumb to various kinds of infections and complications.
10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer cells to spread to other sites.
11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply.
a. Sugar is a cancer-feeder. By cutting off sugar it cuts off one important food supply to the cancer cells. Sugar substitutes like NutraSweet, Equal, Spoonful, etc are made with Aspartame and it is harmful. A better natural substitute would be Manuka honey or molasses but only in very small amounts. Table salt has a chemical added to make it white in color. Better alternative is Bragg's aminos or sea salt.
b. Milk causes the body to produce mucus, especially in the gastro-intestinal tract. Cancer feeds on mucus. By cutting off milk and substituting with unsweetened soy milk cancer cells are being starved.
c. Cancer cells thrive in an acid environment. A meat-based diet is acidic and it is best to eat fish, and a little chicken rather than beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.
d. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline environment. About 20% can be from cooked food including beans. Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells. To obtain live enzymes for building healthy cells try and drink fresh vegetable juice (most vegetables including bean sprouts) and eat some raw vegetables 2 or 3 times a day. Enzymes are destroyed at temperatures of 104 degrees F (40 degrees C).
e. Avoid coffee, tea, and chocolate, which have high caffeine. Green tea is a better alternative and has cancer fighting properties. Water-best to drink purified water, or filtered, to avoid known toxins and heavy metals in tap water.. Distilled water is acidic, avoid it.
12. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remaining in the intestines becomes putrefied and leads to more toxic buildup.
13. Cancer cell walls have a tough protein covering. By refraining from or eating less meat it frees more enzymes to attack the protein walls of cancer cells and allows the body's killer cells to destroy the cancer cells.
14. Some supplements build up the immune system (IP6, Flor-ssence, Essiac, anti-oxidants, vitamins, minerals, EFAs etc.) to enable the bodies own killer cells to destroy cancer cells. Other supplements like vitamin E are known to cause apoptosis, or programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells.
15. Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, un-forgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax and enjoy life.
16. Cancer cells cannot thrive in an oxygenated environment. Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxygen therapy is another means employed to destroy cancer cells.
1. No plastic containers in micro.
2. No water bottles in freezer.
3. No plastic wrap in microwave.
Johns Hopkins has recently sent this out in its newsletters. This information is being circulated at Walter Reed Army Medical Center as well. Dioxin chemicals cause cancer, especially breast cancer. Dioxins are highly poisonous to the cells of our bodies.
Don't freeze your plastic bottles with water in them as this releases dioxins from the plastic.. Recently, Dr. Edward Fujimoto, Wellness Program Manager at Cast le Hospital, was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us. He said that we should not be heating our food in the microwave using plastic containers. This especially applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body.
Instead, he recommends using glass, such as Corning Ware, Pyrex or ceramic containers for heating food You get the same results, only without the dioxin. So such things as TV dinners, instant ramen and soups, etc., should be removed from the container and heated in something else.
Paper isn't bad but you don't know what is in the paper. It's just safer to use tempered glass, Corning Ware, etc. He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper. The dioxin problem is one of the reasons.
Also, he pointed out that plastic wrap, such as Saran, is just as dangerous when placed over foods to be cooked in the microwave. As the food is nuked, the high heat causes poisonous toxins to actually melt out of the plastic wrap and drip into the food. Cover food with a paper towel instead.
Friday, June 12, 2009
20 Symptoms of cancer women are most like to ignore:
Don't rely on routine tests alone to protect you from cancer. It's just as important to listen to your body and notice anything that's different, odd, or unexplainable.
Here are some signs that are commonly overlooked:
1. Wheezing or shortness of breath
One of the first signs many lung cancer patients remember noticing is the inability to catch their breath.
2. Chronic cough or chest pain
Several types of cancer, including leukemia and lung tumors, can cause symptoms that mimic a bad cough or bronchitis. Some lung cancer patients report chest pain that extends up into the shoulder or down the arm.
3. Frequent fevers or infections
These can be signs of leukemia, a cancer of the blood cells that starts in the bone marrow. Leukemia causes the marrow to produce abnormal white blood cells, sapping your body's infection-fighting capabilities.
4. Difficulty swallowing
Trouble swallowing is most commonly associated with esophageal or throat cancer, and is sometimes one of the first signs of lung cancer, too.
5. Swollen lymph nodes or lumps on the neck, underarm, or groin
Enlarged lymph nodes indicate changes in the lymphatic system, which can be a sign of cancer.
6. Excessive bruising or bleeding that doesn't stop
This symptom usually suggests something abnormal happening with the platelets and red blood cells, which can be a sign of leukemia. Over time, leukemia cells crowd out red blood cells and platelets, impairing your blood's ability to carry oxygen and clot.
7. Weakness and fatigue
Generalized fatigue and weakness is a symptom of so many different kinds of cancer that you'll need to look at it in combination with other symptoms. But any time you feel exhausted without explanation and it doesn't respond to getting more sleep, talk to your doctor.
8. Bloating or abdominal weight gain
Women diagnosed with ovarian cancer overwhelmingly report unexplained abdominal bloating that came on fairly suddenly and continued on and off over a long period of time.
9. Feeling full and unable to eat
This is another tip-off to ovarian cancer; women say they have no appetite and can't eat, even when they haven't eaten for some time.
10. Pelvic or abdominal pain
Pain and cramping in the pelvis and abdomen can go hand in hand with the bloating that often signals ovarian cancer. Leukemia can also cause abdominal pain resulting from an enlarged spleen.
11. Rectal bleeding or blood in stool
This is a common result of diagnosing colorectal cancer. Blood in the toilet alone is reason to call your doctor and schedule a colonoscopy.
12. Unexplained weight loss
Weight loss is an early sign of colon and other digestive cancers; it's also a sign of cancer that's spread to the liver, affecting your appetite and the ability of your body to rid itself of wastes.
13. Upset stomach or stomachache
Stomach cramps or frequent upset stomachs may indicate colorectal cancer.
14. A red, sore, or swollen breast
These symptoms can indicate inflammatory breast cancer. Call your doctor about any unexplained changes to your breasts.
15. Nipple changes
One of the most common changes women remember noticing before being diagnosed with breast cancer is a nipple that began to appear flattened, inverted, or turned sideways. Abnormal nipple discharge.
16. Unusually heavy or painful periods or bleeding between periods
Many women report this as the tip-off to endometrial or uterine cancer. Ask for a transvaginal ultrasound if you suspect something more than routine heavy periods.
17. Swelling of facial features
Some patients with lung cancer report noticing puffiness, swelling, or redness in the face. Small cell lung tumors commonly block blood vessels in the chest, preventing blood from flowing freely from your head and face.
18. A sore or skin lump that doesn't heal, becomes crusty, or bleeds easily
Familiarize yourself with the different types of skin cancer -- melanoma, basal cell carcinoma, and squamous cell carcinoma -- and be vigilant about checking skin all over your body for odd-looking growths or spots.
19. Changes in nails
Unexplained changes to the fingernails can be a sign of several types of cancer. A brown or black streak or dot under the nail can indicate skin cancer, while newly discovered "clubbing"-- enlargement of the ends of the fingers with nails that curve down over the tips -- can be a sign of lung cancer. Pale or white nails can sometimes be a sign of liver cancer.
20. Pain in the back or lower right side
Many cancer patients say this was the first sign of liver cancer. Breast cancer is also often diagnosed via back pain, which can occur when a breast tumor presses backward into the chest, or when the cancer spreads to the spine or ribs.
Tuesday, May 26, 2009
I am feeling very introspective and like something inside me is awakening. I need to block all outside chatter to listen very carefully. The whole of last year I ignored the little voice inside me that said: 'Be still, I need to tell you something'.
When something potentially life threatening is chasing you with a big stick, you sit down and listen!! Now I am doing exactly what my intuition tells me to.
So if I have not called you or made a plan to see you, please excuse me. I am not sure when next I will feel like seeing anyone.
I am seeing Patricia, the 'Soul Dr', once or twice a week. She is a sounding board for my own intuition and is helping me to trust what I am sensing. I am feeling very grounded, energised, and happy.
Patricia warned that I must not think I can just go back to the way was living just yet as I may become exhausted again (I don't think I will ever as I can see what exhaustion can result in).
I don't have any extra energy for anyone or anything. I feel irritated by the thought of seeing or doing anything so I am going to listen to this (Feels very strange I must add!!). I need all the energy I can muster to heal.
I do the body awareness technique every second day and I am slowly integrating energy held in my past back into present time. This process seems very slow indeed but I am getting better at it with each attempt.
Until next time,
Saturday, May 9, 2009
DR. JOHN R. LEE'S THREE RULES FOR HORMONE REPLACEMENT THERAPY
Use a sprinkle of common sense and a dash of logic.
by John R. Lee, M.D.
The recent Lancet publication of the Million Women Study (MWS) removes any lingering doubt that there’s something wrong with conventional HRT (see Million Woman Study in the UK, Published in The Lancet, Gives New Insight into HRT and Breast Cancer for details). Why would supplemental estrogen and a progestin (e.g. not real progesterone) increase a woman’s risk of breast cancer by 30 percent or more? Other studies found that these same synthetic HRT hormones increase one’s risk of heart disease and blood clots (strokes), and do nothing to prevent Alzheimer’s disease. When you pass through puberty and your sex hormones surge, they don’t make you sick—they cause your body to mature into adulthood and be healthy. But, the hormones used in conventional HRT are somehow not right—they are killing women by the tens of thousands.
The question is—where do we go from here? My answer is—we go back to the basics and find out where our mistake is. I have some ideas on that.
Over the years I have adopted a simple set of three rules covering hormone supplementation. When these rules are followed, women have a decreased risk of breast cancer, heart attacks, or strokes. They are much less likely to get fat, or have poor sleep, or short term memory loss, fibrocystic breasts, mood disorders or libido problems. And the rules are not complicated.
Rule 1. Give hormones only to those who are truly deficient in them.
The first rule is common sense. We don’t give insulin to someone unless we have good evidence that they need it. The same is true of thyroid, cortisol and all our hormones. Yet, conventional physicians routinely prescribe estrogen or other sex hormones without ever testing for hormone deficiency. Conventional medicine assumes that women after menopause are estrogen-deficient. This assumption is false. Twenty-five years ago I reviewed the literature on hormone levels before and after menopause, and all authorities agreed that over two-thirds (66 percent) of women up to age 80 continue to make all the estrogen they need. Since then, the evidence has become stronger. Even with ovaries removed, women make estrogen, primarily by an aromatase enzyme in body fat and breasts that converts an adrenal hormone, androstenedione, into estrone. Women with plenty of body fat may make more estrogen after menopause than skinny women make before menopause.
Breast cancer specialists are so concerned about all the estrogen women make after menopause that they now use drugs to block the aromatase enzyme. Consider the irony: some conventional physicians are prescribing estrogens to treat a presumed hormone deficiency in postmenopausal women, while others are prescribing drugs that block estrogen production in postmenopausal women.
How does one determine if estrogen deficiency exists? Any woman still having monthly periods has plenty of estrogen. Vaginal dryness and vaginal mucosal atrophy, on the other hand, are clear signs of estrogen deficiency. Lacking these signs, the best test is the saliva hormone assay. With new and better technology, saliva hormone testing has become accurate and reliable. As might be expected, we have learned that hormone levels differ between individuals; what is normal for one person is not necessarily normal for another. Further, one must be aware that hormones work within a complex network of other hormones and metabolic mediators, something like different musicians in an orchestra. To interpret a hormone’s level, one must consider not only its absolute level but also its relative ratios with other hormones that include not only estradiol, progesterone and testosterone, but cortisol and thyroid as well.
For example, in healthy women without breast cancer, we find that the saliva progesterone level routinely is 200 to 300 times greater than the saliva estradiol level. In women with breast cancer, the saliva progesterone/estradiol ratio is considerably less than 200 to 1. As more investigators become more familiar with saliva hormone tests, I believe these various ratios will become more and more useful in monitoring hormone supplements.
Serum or plasma blood tests for steroid hormones should be abandoned—the results so obtained are essentially irrelevant. Steroid hormones are extremely lipophilic (fat-loving) and are not soluble in serum. Steroid hormones carry their message to cells by leaving the blood flow at capillaries to enter cells where they bond with specific hormone receptors in order to convey their message to the cells. These are called “free” hormones. When eventually they circulate through the liver, they become protein-bound (enveloped by specific globulins or albumin), a process that not only seriously impedes their bioavailability but also makes them water soluble, thus facilitating their excretion in urine. Measuring the concentration of these non-bioavailable forms in urine or serum is irrelevant since it provides no clue as to the concentration of the more clinically significant “free“ (bioavailable) hormone in the blood stream.
When circulating through saliva glands, the “free” non–protein-bound steroid hormone diffuses easily from blood capillaries into the saliva gland and then into saliva. Protein-bound, non-bioavailable hormones do not pass into or through the saliva gland. Thus, saliva testing is far superior to serum or urine testing in measuring bioavailable hormone levels.
Serum testing is fine for glucose and proteins but not for measuring “free” steroid hormones. Fifty years of “blood” tests have led to the great confusion that now befuddles conventional medicine in regard to steroid hormone supplementation.
Rule 2. Use bioidentical hormones rather than synthetic hormones.
The second rule is also just common sense. The message of steroid hormones to target tissue cells requires bonding of the hormone with specific unique receptors in the cells. The bonding of a hormone to its receptor is determined by its molecular configuration, like a key is for a lock. Synthetic hormone molecules and molecules from different species (e.g. Premarin, which is from horses) differ in molecular configuration from endogenous (made in the body) hormones. From studies of petrochemical xenohormones, we learn that substitute synthetic hormones differ in their activity at the receptor level. In some cases, they will activate the receptor in a manner similar to the natural hormone, but in other cases the synthetic hormone will have no effect or will block the receptor completely. Thus, hormones that are not bioidentical do not provide the same total physiologic activity as the hormones they are intended to replace, and all will provoke undesirable side effects not found with the human hormone. Human insulin, for example, is preferable to pig insulin. Sex hormones identical to human (bioidentical) hormones have been available for over 50 years.
Pharmaceutical companies, however, prefer synthetic hormones. Synthetic hormones (not found in nature) can be patented, whereas real (natural, bioidentical) hormones can not. Patented drugs are more profitable than non-patented drugs. Sex hormone prescription sales have made billions of dollars for pharmaceutical companies Thus is women’s health sacrificed for commercial profit.
Rule 3. Use only in dosages that provide normal physiologic tissue levels.
The third rule is a bit more complicated. Everyone would agree, I think, that dosages of hormone supplements should restore normal physiologic levels. The question is—how do you define normal physiologic levels? Hormones do not work by just floating around in circulating blood; they work by slipping out of blood capillaries to enter cells that have the proper receptors in them. As explained above, protein-bound hormones are unable to leave blood vessels and bond with intracellular receptors. They are non-bioavailable. But they are water-soluble, and thus found in serum, whereas the “free” bioavailable hormone is lipophilic and not water soluble, thus not likely to be found in serum. Serum tests do not help you measure the “free,” bioavailable form of the hormone. The answer is saliva testing.
It is quite simple to measure the change in saliva hormone levels when hormone supplementation is given. If more physicians did that, they would find that their usual estrogen dosages create estrogen levels 8 to 10 times greater than found in normal healthy people, and that progesterone levels are not raised by giving supplements of synthetic progestin such as medroxyprogesterone acetate (MPA).
Further, saliva levels (and not serum levels) of progesterone will clearly demonstrate excellent absorption of progesterone from transdermal creams. Transdermal progesterone enters the bloodstream fully bioavailable (i.e., without being protein-bound). The progesterone increase is readily apparent in saliva testing, whereas serum will show little or no change. In fact, any rise of serum progesterone after transdermal progesterone dosing is most often a sign of excessive progesterone dosage. Saliva testing helps determine optimal dosages of supplemented steroid hormones, something that serum testing cannot do.
It is important to note that conventional HRT violates all three of these rules for rational use of supplemental steroid hormones.
A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks. Hormone replacement therapy is a laudable goal, but it must be done correctly. HRT based on correcting hormone deficiency and restoring proper physiologic balanced tissue levels, is proposed as a more sane, successful and safe technique.
Hormone imbalance is not the only cause of breast cancer, strokes, and heart attacks. Other risk factors of importance include the following:
Men share these risks equally with women. Hormone imbalance and exposure to these risk factors in men leads to earlier heart attacks, lower sperm counts and higher prostate cancer risk.
Conventional hormone replacement therapy (HRT) composed of either estrone or estradiol, with or without progestins (excluding progesterone) carries an unacceptable risk of breast cancer, heart attacks and strokes. I propose a more rational HRT using bioidentical hormones in dosages based on true needs as determined by saliva testing. In addition to proper hormone balancing, other important risk factors are described, all of which are potentially correctable. Combining hormone balancing with correction of other environmental and lifestyle factors is our best hope for reducing the present risks of breast cancer, strokes and heart attacks.
A much broader discussion of all these factors can be found in the updated and revised edition of What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About Breast Cancer.
Thursday, May 7, 2009
I asked more about my progesterone receptor result that had come back ambivalant when the estrogen receptor status was initally done. I asked whether the test could be redone. He said yes, and ordered a re-run (results will be ready on Monday).
I gathered from Gareth that the medical world does not care as much about the progesterone receptor status because they don't have a method of dealing with it.
I went home and read some more of Dr John R Lee's book 'What your Dr may not tell you about Menopause' and in which he details how having progesterone positive receptors on breast cancer cells is a good thing as this allow the progesterone into the cells. This can also happen if the receptor results come back negative as there are always progesterone receptors on breast cells.
Estrogen causes immature breast cells to divide more rapidly, while Progesterone slows the breast cell division and encourages cells to mature.
I am now waiting for my saliva progesterone, estrogen, testosterone, DHEA-S, and cortisol levels. These tests are still quite new in this country so the lab is taking it's time. I am on them!
I need these results to determine what percentage of progesterone to have mixed into the cream, and also as a marker to see what my hormone levels are before and after treatment.
I would start taking Progesterone now if I could! I am very excited that bio-identical progesterone is the alternative to Tamoxifen I was looking for!
In Dr John R Lee's book's, he pulls together most of my symptoms as being due to low progesterone levels:
- the adrenal fatigue - progesterone is a precursor to cortisol, the body's stress hormone.
- the slightly under active thyroid - low cortisol suppresses thyroid function
- the weight gain after haivng both my children - estrogen dominence
- the impaired blood sugar levels for most of my 20's and early 30's- estrogen dominence
- the low sex drive- estrogen dominence
- the suppressed immune system (zinc boosts the immune system and low progesterone levels cause a loss of zinc and a rise in copper - this can also lead to infertility)- estrogen dominence
- low oxygen levels - cancer is believed to grow in an anaerobic (no oxygen), acidic inter- and intracellular environment. Estrogen dominence reduces oxgygen levels in cells while progesterone promotes cellular oxygenation- estrogen dominence.
- the risk of gall bladder disease - this was a strange one to find. Towards the end of my pregnancy with Lily, my 2nd child, I had very itchy, yellow palms of my hands and soles of my feet. After much reading online, I determined that I had cholestasis due to pregnancy. This is temporary and is caused by the pressure of the baby on the gall bladder which hinders the free flow of bile from the gall bladder into the intesttine. The result is the back up of bilirubin in the blood, hence the yellow colour and the itchy. I never thought much of it it then but I wonder whether that was linked to low progesterone levels back then already??
If you are a woman, I urge you again, to read the books by Dr John R Lee - in them, he answers so many questions we all have but that our doctors may not have answers for.
After a close read of Dr John R Lee's website, I realise he died in 2003 so I will not be able to to email him! www.johnleemd.com
Wednesday, May 6, 2009
The Psyche-K technique uses kinesiology to test whether or not my subconscious has a belief installed. If not, we install it. Over simplification for this technique but that I feel great afterwards!
Now that I have a bit of a breather from surgery etc, I want to pick up where we left off.
Before the mastectomy, we installed the following 2 beliefs in my subconscious:
- I am worthy
- I am Heidi
The person who mentioned this theory had commented on why I had had both breasts removed when I only needed to have one removed (I had done this to lessen chance of recurrence by haivng as much estrogen senstive breast tissue removed as possible, and from a better reconstruction point of view). He questioned whether I was trying to feel more like a male??
I cast my mind back to growing up and remember being very much a tomboy. I was always playing bikes and skateboards, was crawling in rivers and storm water drains with the boys from my neigbourhood (all the kids in our neighbourhood just happened to be boys except for a girl next door who I never got along with).
I always wore a sleeveless vest under my t-shirts as I didn't like my the feeling of just the t-shirt on my chest/maybe of my nipples sticking through.
I cringed at the thought of parting with my vests when it came time for a bra so my mom gave me one for Christmas!! Very traumatic!
I was also in denial when my periods started so told my mom it was just a runny tummy.
Through my teens and early 20's, I was still very boy-ish but never thought much about it.
When I asked my parents whether they had wanted a boy, my mom said 'no'. My dad said 'no' at first, but then added that it would have been nice to have had a boy first to be assured that the family name would be continued!
Remember, there were no scans in those days to show the sex of the baby so parents had 10 months to wonder and wish for the sex they wanted. Even though we have scans today, parents could still desire the opposite sex, or feel disappointed, even if they know.
After I was born, my dad fell head over heals in love with me and didn't want anymore children!
I hate unexplored stuff so off with the lid!! During my session with Dr Lecore, she asked my subconscious whether gender was a issue for me.
My subconscious said it was an issue, back was not the main issue. We had to install the following beliefs first:
- I can relax and be myself safely
- I am confident, and therefore believe in myself fully
I feel like getting breast cancer has given me the opportunity to unpack and question all learnt beliefs, behaviours, roles, and identities I have gathered until now.
I now get to clean my slate, and take only what I want to. I am working from the bottom up. This process is quite scary at times but very rewarding.
I still don't know where it will end up. I am consciously taking ownership of every aspect of myself and this feels so good.
I realise that 'growing up' and becoming adult, happens in tiny steps, never all at once.
Tuesday, May 5, 2009
I busy reading Dr John R Lee's books: 'What you Dr may not tell you about Breast Cancer' and 'What your Dr may not tell you about Menopause' - his points are below.
(Dr Lee has also written a book called 'What your Dr may not tell you about Premenopause' which I will buy next - although I am sure the info is all pretty much the same).
EVERY WOMAN NEEDS TO READ THESE BOOKS! DOCTORS DO NOT KNOW THIS INFO. EVEN IF YOU THINK YOU ARE NOT A CANDIDATE FOR BREAST CANCER. The bio-identical progesterone also helps treat various other female problems.
To date, Dr Lee's books have been the most useful, well researched, comprehensive, and hope providing. Finding a practitioner int his country who has successfully treated breast cancer for many years is a not proving easy.
The only thing is: my breast tissue results came back as estrogen positive and progesterone ambivalent - they could not determine whether or not the breast cancer was stimulated by progesterone.
If it was stimulated by progesterone, I am not sure whether or not I can use the progesterone cream. About to email Dr Lee now.
I am questioning whether women could start measuring their estrogen and progesterone levels from 20-25yrs, correct any imbalances with bio-identical hormones, and decrease the chance of getting breast cancer. Obviously, there are other contributing factors to breast cancer and all these need to be addressed.
......Back to the lab for more info on the breast tissue results
What Dr. Lee Said About Breast Cancerhttp://www.johnleemd.com/store/hbh-081001.html#about_breast_cancer
For more than 20 years, women and charitable organizations around the world have joined together each October to mark Breast Cancer Awareness Month. Over the last two decades, Breast Cancer Awareness Month has done much to raise money and awareness levels for the disease. In our opinion, however, the event has focused too much attention on promoting the early detection of breast cancer while devoting little energy to preventing women from getting the disease in the first place.
To prevent a disease, one must understand what causes it. This is the truth that Dr. Lee understood. It was Dr. Lee's desire to know the causes behind breast cancer that led him to write his book, What Your Doctor May Not Tell You About Breast Cancer. If you have not read this groundbreaking document, we encourage you to do so this October. Here is an overview of some of the central points he made in the book.
Despite billions of dollars spent on breast cancer research, a woman's chance of surviving a malignant breast tumor has changed little over the last 50 years. It may come as a shock, but a woman's chance of surviving a malignant breast tumor today is about one in three...roughly the same rate as five decades ago. Research studies on mortality rates have shown that radiation therapy, tamoxifen, and chemotherapy are not saving more lives. At best, they prolong some lives by a few months or years, but often at the expense of painful or even deadly side effects. Moreover, the number of breast cancer cases per thousand women is much higher today than it was 50 or even 30 years ago.
While breast cancer is rarely caused by a single factor, unopposed estrogens play a central role in the formation of the disease. For decades, researchers have known that excess estrogen (i.e., estrogen that is unopposed by adequate progesterone and other hormones) increases a woman's risk for endometrial cancer. Recent research has revealed that it also plays a key role in breast cancer formation. Unopposed estrogens can break down into quinone estrogens that react with and damage the DNA in breast cells. These damaged cells can become cancer cells if the body's various defense mechanisms do not recognize and destroy them. In addition, unopposed estrogen can activate the Bcl-2 gene that frequently induces cancer-causing cell proliferation.
Unfortunately, it has become common in developed countries for both women and men to have high levels of unopposed estrogens. This condition, which Dr. Lee called estrogen dominance, has been fueled by changes in our diets and lifestyles. Another cause is our growing exposure to the estrogen-like substances–known as xenoestrogens–found in plastics, fertilizers, pesticides, and other manmade products. Unless we address estrogen dominance, breast cancer risks are likely to remain elevated.
Progesterone plays a critical role in countering the negative effects of unopposed estrogens. In the body, progesterone neutralizes many of the effects of unopposed estrogen that can lead to breast cancer. It decreases the cell proliferation that is induced by estrogen. In addition, it down-regulates the cancer-causing Bcl-2 gene and up-regulates gene p53, a gene that promotes the death (known as apoptosis) of tumor cells.
Given these findings, having adequate progesterone can be critical to preventing breast cancer. Unfortunately, progesterone levels among many women in developed countries are below normal, healthy levels. This is especially the case among older women and those who use conventional hormone replacement therapies (HRT). This is why Dr. Lee recommended natural progesterone supplementation for women suffering from estrogen dominance, not to mention the avoidance of HRT.
Besides maintaining healthy progesterone levels and avoiding HRT, women should take steps to reduce other breast cancer risk factors. These include reducing our exposure to xenoestrogens, maintaining healthy levels of other hormones such as DHEA and melatonin, reducing our intake of sugars and unhealthy fats, and managing stress levels through exercise and adequate rest.
Throughout his career as a physician and researcher, Dr. Lee was passionate about finding the causes of breast cancer and the other cancers that women face. It is therefore fitting that What Your Doctor May Not Tell You About Breast Cancer was the last book that he completed before he passed away in 2003. The words with which he opens the book speak volumes about his commitment:
"The book is dedicated to all the women who have lost their lives to breast cancer, and to all women currently fighting breast cancer."
Friday, May 1, 2009
I see Dr Gareth Edwards, my plastic surgeon, every week for saline injections into the breast tissue expanders.
Each week, Gareth urges me to go on Tamoxifen (estrogen receptor site blocker) because my breast cancer was 66% stimulated by estrogen, because I am premenopausal/35 yrs, and because there was a small bit of invasive cancer. I also need to consider having the LHRH agonist (shuts off ovarian production of estrogen) injection every 3 months. This treatment will put my body into early menopause - joy!
At first I resisted it and thought I could do it naturally but I am beginning to think I should intergrate both natural and allopathic medicine for the best survival chance.
I am slowly coming around to the fact that I may need to take Tamoxifen, but I am debating whether to take the drug to shut down my ovarian estrogen production for the next however many years or just to surgically remove my ovaries.
And while I am am doing that, should I not remove my uterus as well?? One of the possible long term side effects of Tamoxifen is uterine cancer so a hysterectomy would negate this.
This decision is not as easy as just deciding to go for the op - there may be after effects like:
- hot flashes
- vaginal dryness
- decreased libido or other sexual side effects
- sleep disturbance
- memory changes - your brain uses estrogen to think - even in men!
- mood changes
- weight gain
- urinary incontinence
- accelerated ageing - I may age rapidly
- more prone to osteoporosis
I am 35 yrs old!!! The thought of these symptoms is not very appealing. And I would want to try and treat the side/after effects with bio-indentical hormones but am not sure whehther I can take those now that I have a greater risk for breast cancer recurrence.
But the thought of dying of breast cancer is even less appealing. I am just playing a game of priorities here!
I keep looking at Glenn and my kids and crying. I want to be around as long as I can for them but the cost is huge. I feel miserable but keep trying to focus on the present moment.
It would be easier for me to die and start again next lifetime but it is more of a challenge for me to push through and live this life as best I can.
I saw another engery healer (Patricia - The Soul Dr) this week. She said the universe told her I am going to be ok and that everything I needed to get me to this point, got me here; good and bad. I need to love and accept (this again) myself completely as I am a spark of the creator and I am therefore perfect.
Maybe my issue is not about me not being a good/natural mother but more about needing to love and nature myself more. Maybe I had low self love when my kids were born. Two babies born close together and a house that needed so much of my love, time, and energy then pushed me into a energy deficit in my love and nurturing chakra (heart /breast/chest) area which resulted in a cancer. Still questioning and focusing equally on the energy issues while I look into the physical medications etc.
The decision to undergo prophylactic removal of the ovaries and tubes to lower the risk for cancer is a difficult and personal one.
Women who undergo oophorectomy prior to natural menopause will experience menopause from the surgery. Menopausal symptoms and the experience varies from woman to woman. Further, some of the consequences of menopause are more serious than others. Some women find hormone supplementation alleviates their menopausal symptoms. However, research on hormone replacement is inconclusive regarding the benefits and risks to menopausal women. Because much of the research has been conducted on women who experienced natural menopause, the applicability to women experiencing early surgical menopause is uncertain. It is important for each woman to discuss menopausal symptoms with their doctor and to weigh the potential benefits and relief from hormone replacement vs. their individual risks from hormone replacement or other menopausal treatments.
Different women experience menopausal side-effects to differing degrees. Some of the side effects reported by women include:
- hot flashes
- vaginal dryness
- decreased libido or other sexual side effects
- sleep disturbance
- memory changes
- mood changes
- weight gain
- urinary incontinence
Some of these side effects can be alleviated or resolved with medications, or improved with supplements. It is important to note that medications and supplements can have their own risks and side effects. For some individuals, low-dose hormone therapy may be an option for addressing medical or quality-of-life issues not resolved any other way.
Research of hormone replacement therapy in premenopausal women with BRCA mutations who have not had breast cancer but had oophorectomy has been limited. One study which examined short-term hormone replacement after oophorectomy in BRCA carriers indicates that prophylactic oophorectomy prior to age 50 substantially lowers the risk for breast cancer. The breast cancer risk reduction was similar in women who took hormones for up to three years and women who did not take hormones post-oophorectomy. The long term effects of hormone replacement after oophorectomy are unclear at this time.
A woman’s body can make various types of estrogen, as well as progesterone, testosterone, and other hormones. Several hormone replacement options are available for women with surgical menopause containing varying amounts of these hormones.
Hormones may be categorized by the type of hormones contained in the preparation, how the hormones are delivered to the body, and how the preparation is made. For some women the choice of hormones depends on their symptoms, for example, a woman experiencing vaginal dryness, may find an estrogen-releasing device called a vaginal estrogen ring helpful. The ring works by providing estrogen to the vaginal walls and minimizing absorption into the body. For women who retain their uterus, preparations containing progesterone are chosen to protect against uterine cancer risk.
For high-risk women, oophorectomy brings two primary benefits when performed prior to menopause: reduction of ovarian cancer risk and reduction of breast cancer risk. It may seem contrary for high-risk women to receive hormones after removing their ovaries to lower their risk for breast cancer. However, hormone levels received through medication is generally less than what is normally produced by the ovaries during the premenopausal years. It isn't entirely clear what effect estrogen replacement therapy (ERT) or combined estrogen-progestin therapy (HRT) might have on cancer risk, particularly in high-risk women or breast cancer survivors. A recent study followed premenopausal women who carry a BRCA mutation for 3 1/2 years. Women who elected risk-reducing salpingo- oophorectomy (removal of ovaries and tubes) had a substantial decrease in breast cancer risk. Hormone replacement after oophorectomy didn't significantly change the breast cancer risk in the women in this study. It is important for women to discuss the risk of hormone replacement with their healthcare team to make an informed decision.
HRT are preparations of estrogen combined with progesterone. The progesterone protects against uterine cancer and is generally prescribed for women who are postmenopausal but still have their uterus. ERT are estrogen-only preparations appropriate for postmenopausal women who have had hysterectomies. Because they have no uterus, these women have no risk of uterine cancer and therefore don’t require progesterone.
The Women’s Health Initiative is a large, randomized study for hormone replacement after menopause. It reviewed women who took HRT, ERT or a placebo after natural menopause. It is important to remember that this study did not look at women with BRCA mutations or premenopausal women who experienced surgical menopause. The study demonstrated that HRT supplementation (estrogen plus progesterone) increased the risk for breast cancer in women who went through natural menopause. The study concluded, however, that ERT supplementation (estrogen alone) does not appear to raise the risk for breast cancer in this population. The study did not specifically consider women who underwent surgical menopause due to risk-reducing oophorectomy, so its applicability to the high-risk population who undergo early menopause is uncertain.
Some attention has been given to whether certain hormone preparations are safer or more effective than others. “Bio-identical” hormones are hormone replacement preparations that are chemically identical to the hormones produced in the body; whether they originate in animals, plants, or are synthetic, they cannot be distinguished from the body’s own hormones. There is currently no conclusive evidence that "bio-identical" hormones are safer than other preparations.
Some physicians describe specially-made hormone compounds prepared by pharmacists as “bio-identical.” Compounded hormone replacement is described in more detail below.
Certain hormone preparations, (including some bio-identical compounds), have been tested by the FDA and are available commercially by prescription. Other "compounded" hormone preparations contain individualized combinations of different hormones and are prepared on an individual basis by pharmacists. Some physicians feel these "compounded" hormones are safer than commercial preparations. However, this has not been demonstrated by scientific research. There may be risks associated with compounded hormones: they are neither tested nor approved by the FDA and are unregulated. Compounded preparation methods vary from one pharmacist to another, and from one pharmacy to another, so compounds may not be consistent. Some custom-compounded preparations are not covered by insurance plans. Custom-compounded hormones may provide certain benefits, allowing individualized doses and mixtures of different hormones unavailable in commercial products. Anecdotally, some women posting on the FORCE message board reported they found pharmacist-compounded hormone preparations relieved their menopausal symptoms more effectively than commercially available preparations. A list of hormone replacement therapy products was published in a 2001 International Journal of Pharmaceutical Compounding.
Some physicians follow patients who use these compounds by testing their saliva for hormone levels. However the reliability of these tests and optimal saliva hormone levels have not been established.
One study of previous research which compared hormone types determined the conclusions drawn were compromised because the research efforts were too small or had design flaws. The study's authors suggested there was not enough evidence to recommend bio-identical hormones over conventional hormones.
The North American Menopause Society (NAMS), a professional organization devoted to promoting women's health and quality of life through an understanding of menopause, published a position statement on compounded hormone replacement. The NAMS does not recommend custom-compounded products over well-tested, government-approved products for the majority of women. Nor does the Society recommend saliva testing to determine hormone levels.
It is important for women who have undergone surgical menopause or are considering prophylactic oophorectomy to discuss menopausal symptoms and management with their healthcare team. The menopause experience is individual. Response to hormone replacement appears to be individual as well.
Osteopenia refers to loss of bone density. Osteoporosis is a more serious loss of bone density which weakens the bones. Some degree of bone thinning occurs as a natural part of the aging process. Significant weakening of the bones, however, puts a person at increased risk for fractures (broken bones). Loss of estrogen through natural or surgical menopause can lead to increased weakening of the bones.
A bone density test can determine whether a person’s bones are weakened or are of normal density. Health care providers categorize a person’s bone density as “normal,” “osteopenia,” or “osteoporosis,” as compared to others of the same age and gender. Health care providers often recommend a baseline bone density test before prophylactic oophorectomy or soon after and then on an annual or semi-annual basis after menopause.
Hormonal and nonhormonal medications can lower the risk for fractures due to loss of bone density. These medications may have side effects. Some, like hormones, may raise the risk for other cancers. Women with osteopenia or osteoporosis associated with menopause should be followed by endocrinologists or other health care professionals who are trained in managing menopausal symptoms. It is important for each woman to weigh the potential benefits and relief from hormone replacement vs. their individual risk for cancer or other risks associated with hormone replacement.
Weight-bearing or resistance exercise may lower the risk for osteoporosis in post-menopausal women. However, it is important to discuss exercise with your physician before starting any exercise routine. It is worthwhile to consult with a licensed physical therapist to assure that your exercise routine is safe and appropriate. Experts recommend post-menopausal women receive 1200 milligrams of calcium per day, either through their diet or through supplementation.
Studies show hormones and certain non hormonal medications—antidepressants belonging to a class of drugs called selective seratonin reuptake inhibitors (SSRIs), for instance—may relieve some menopausal side effects such as hot flashes. One small randomized trial found venlafaxine (Effexor) alleviated hot flashes in postmenopausal women compared to a placebo. Another study found fluoxetine (Prozac) lowered the frequency of hot flashes more effectively than placebo in post menopausal women. Research on the effectiveness and safety of supplements such as soy or black cohosh has been inconclusive.
Products such as handheld fans and "chillows," which cool the body temperature, have been helpful for some women who experience hot-flashes.
Decreased libido is often associated with menopause. Hormonal and nonhormonal options are available for improving libido in women who are surgically menopausal. Some physicians recommend the addition of testosterone replacement for women who have loss of libido with menopause that isn't alleviated by ERT or HRT alone. One short randomized, prospective study found testosterone supplementation improves libido in women who experienced loss of libido due to oophorectomy. There is conflicting data, however, about the safety of testosterone and whether it may increase the risk for breast cancer.
A small preliminary study looked at the effects of the antidepressant bupropion (Welbutrin) on the libido of individuals who were not clinically depressed. The study suggested bupropion improved sexual arousal, overall sexual satisfaction, and satisfaction with intensity of orgasm when compared to placebo. However, this study was not specific to high-risk women who experienced surgical menopause.
Some women report disruption in sleep patterns associated with menopause. Sleep disturbances may also cause menopause-related fatigue. One small randomized study compared insomnia in peri- and postmenopausal women who used the sleep aid zolpidem (Ambien) compared with those who took a placebo. Women who took zolpidem reported improved sleep over those who took a placebo.
Specialized sleep disorder clinics can sometimes assist with sleep disruptions associated with menopause.
LHRH Agonists Show Promise for Early Breast Cancerhttp://www.ajog.org/article/PIIS0002937805002814/abstract
The study reviewed here found that after surgery and other treatments for hormone-receptor-positive early-stage breast cancer in premenopausal women, treatment with the hormonal therapy medicine Zoladex (chemical name: goserelin) can lower the risk of the cancer coming back (recurrence) and improve overall prognosis.
The ovaries of premenopausal women produce estrogen. Estrogen can make breast cancer cells grow and increase the risk of the cancer coming back. Stopping the ovaries from producing estrogen or blocking the effects of estrogen on breast cancer cells can be an effective part of a treatment plan for premenopausal women.
Removing the ovaries (called oophorectomy or surgical ablation) or destroying the ovaries with radiation therapy permanently stop the ovaries from producing estrogen. But some premenopausal women may want to temporarily stop the ovaries from producing estrogen so they have the option of having children after treatment. Medicines called LHRH (luteinizing hormone releasing hormone) agonists can be used to temporarily stop the ovaries from making estrogen. This is called medical ovarian shutdown. LHRH-agonist medicines include Zoladex and Lupron (chemical name: leuprolide).
Tamoxifen, another hormonal therapy medicine, also can lower the risk of early-stage hormone-receptor-positive breast cancer coming back in both pre- and postmenopausal women. Tamoxifen is a SERM (selective estrogen receptor modulator). Tamoxifen has different effects on different types of cells. In breast cells, tamoxifen blocks estrogen receptors. Blocking the estrogen receptors means that estrogen can't attach to the cell and so can't tell the cell to grow.
In the study reviewed here, the researchers reviewed the information from more than 14 other studies involving more than 12,000 premenopausal women. All of the women in these studies were diagnosed with early-stage breast cancer. Almost all of the cancers were hormone-receptor-positive. To reduce the risk of the cancer coming back, the women were divided into three broad groups:
- some got Zoladex alone
- some got tamoxifen alone
- some got Zoladex and tamoxifen together
Many of the women also got chemotherapy to lower the risk of the cancer coming back. Doctors use the term adjuvant chemotherapy to describe chemotherapy used to lower the risk of the cancer coming back.
The researchers found:
- Zoladex and tamoxifen combined seemed to do a better job of reducing the risk of the cancer coming back and improving prognosis compared to Zoladex alone or tamoxifen alone.
- Zoladex alone or tamoxifen alone also reduced the risk of the cancer coming back and improved prognosis, but it wasn't clear if one medicine was more effective than the other.
- There was no difference in the risk of the cancer coming back or prognosis in women who got either Zoladex alone or tamoxifen and Zoladex together compared to women who got adjuvant chemotherapy with no hormonal therapy medicine. Still, the adjuvant chemotherapy caused more troubling side effects.
- Women who got Zoladex (either alone or with tamoxifen) and adjuvant chemotherapy had a lower risk of the cancer coming back and a better prognosis compared to women who got adjuvant chemotherapy with no hormonal therapy.
If you're a premenopausal woman diagnosed with hormone-receptor-positive early-stage breast cancer, you and your doctor will consider a number of treatment options to reduce the risk of the cancer coming back after surgery. Hormonal therapy and medical ovarian shutdown may be options you consider. Based on this study, you might want to ask your doctor if the combination of tamoxifen and Zoladex makes sense for you, whether or not you get adjuvant chemotherapy.In the Breastcancer.org Hormonal Therapy section you can learn more about hormonal therapy medicines used to lower the risk of the cancer coming back in premenopausal women.