How to Feel Normal After. Breast Cancer Treatment. You are not back to your normal activity levels because of fatigue and lack of energy.

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1 How to Feel Normal After LISA SCHWARTZ, MD Board Certified in Radiation Oncology and Internal Medicine My mission is to serve cancer patients by teaching them to develop the necessary skills, knowledge, and confidence to emerge from treatment as happy, healthy, whole human beings. Breast Cancer Treatment So it s been weeks or months or years and you are still wondering when you are going to feel like you again. Your friends and family don t really understand why you are not back to your usual self. After all, your treatment is done. You are not really sure what to tell them either, because you don t understand yourself. Let s fix that. Here are 5 simple strategies that you can do today to feel more normal now. You are not back to your normal activity levels because of fatigue and lack of energy. Strategy #1: Increase your physical activity. Even by just a little bit. It makes a big difference in how you feel. Do this and decrease your risk of breast cancer recurrence by 50%. Really. The fatigue that is associated with cancer therapy has many causes. Certainly, the treatment you received has taken its toll on your body. But you may also be feeling fatigued from a lack of sleep, medications, hormonal changes, depression, anxiety, and general stress. So, let s address those causes.

2 Treatment was rough and your body is still in recovery. You can help it recover by taking good care of yourself: daily exercise, healthy eating, dealing with stress, and avoiding excessive alcohol intake (or whatever your escape of choice is). I m going to address exercise, healthy eating, and dealing with stress later in this guide. Of these interventions, daily physical activity is the one that is most effective for treating the fatigue associated with cancer therapy. I know it sounds counterintuitive, but starting a gentle exercise program is the best way out of the fatigue blues. It can be as little as walking 30 minutes a day. In fact, that is a great place to start. Other things like working in the garden or playing with the dog count as well. Just make sure you are doing something active every day. And if getting rid of the fatigue is not enough to motivate you to walk every day, then hear this: according to the Nurses Health Study, 30 minutes of walking each day can decrease your risk of recurrence by up to 50%. Boom. If you are having sleep problems, make sure you are practicing good sleep hygiene: make sure your room is dark and quiet, no screens for an hour before bed (TV, computers, phones, tablets), no naps, regular bedtime and wake time (even on the weekends), and cut back on the caffeine and alcohol. If you are on medications, be sure to ask your doc if they may be interfering with your sleep or causing daytime drowsiness. Do what you can to get these changed. Hormonal changes can cause sleep problems in addition to hot flashes. Acupuncture has been an effective treatment in this situation. You can also ask your doctor for a non-hormonal medication to help with the hot flashes if they are significant. If you are still dealing with fatigue and it s been a while since your treatment, then you may think things will never get better. Hang in there. Progress is slow sometimes. Do everything listed above and stick with it. You will start to see some changes. It's such a blessing to be able to come here and vent, cry or even laugh with others who get us! No one really gets what we are all dealing with, except us! I don't know you ladies but I'm extremely grateful to be a part of this group of pink warrior sisters. P.S. 2

3 Maybe you gained a little weight with treatment and are having trouble getting rid of it. Also, you are trying to eat healthy but you re not really sure what that means. Strategy #2: Nourish your body with healthy foods. Lots of fruits and veggies. Whole, natural foods. This step reduces your risk of recurrence by 25%. Again really. It is very common to gain weight during breast cancer treatment. This is partly due to the medications and partly due to the hormonal changes. But it happens a lot. Getting rid of this extra weight can be challenging since it is probably contributing to the fatigue you might be having. As I stated above, starting a gentle exercise program like walking 30 minutes a day can make a big difference in your energy levels and your waistline. Eating well will help you lose a little weight but it will also keep the cancer from coming back. Eating enough fruits and veggies each day can decrease your risk of recurrence by about 25%. So here are some general guidelines: Avoid processed foods. You are much better off eating something that just came out of the ground or off a tree or bush. This means shopping around the perimeter of your grocery store where all the fresh foods are. Avoid preservatives, flavorings, and colorings even if the label says they are natural. Eat whole grains rather than processed grains. Get your protein from lean meats like chicken or fish. If you re a vegetarian, then choose beans, dairy, and nuts. Eat healthy fats like those in olive oil and avocados. Have fruits and vegetables at every meal. The Good, the Bad and The Ugly of Hormone Inhibitors. I thought it was neat that I didn't have to shave under my arms anymore as the hair magically disappeared. Then the hair started disappearing from my legs. Now I found where all the hair went. TO MY CHIN!!! B.S. 3

4 You may find that you are feeling more stressed in general or that your emotions sometimes get the best of you. Strategy #3: Meditate. Yes, you can. To say that breast cancer treatment is stressful is a gross understatement. Duh, right? Well, if life is going to get better for you, you need to learn how to manage that stress. I have one solution. It s not the only solution, but it is one that works. Meditate. Yes, I have heard the objections before. I can t sit still. My mind races. I fall asleep. I m telling you it works, and research shows that it works (so you don t have to take my word for it). With practice, you will get past all of these problems. I ll give you a simple meditation to get started. Ready? Sit comfortably in a chair or on the floor. Keep your back straight and your hands resting in your lap or on your thighs. Close your eyes and take a deep breath in and out. Now inhale to a silent count of three and exhale to a silent count of five. Repeat this. Keep focused on your breathing. When you find yourself thinking about something other than your breath (and you will) then just come back to your breath and the counting. Start with about 10 minutes and work your way up to 15 or 20 minutes. You don t have to do this for hours at a time to get the benefit. Just once or twice a day for 10 to 20 minutes. Give it a shot. Have any of you ladies noticed that now the operation,and radiotherapy are over nobody asks how you are feeling? They obviously think you are ok. S.F. You may be having trouble asking for help or letting those around you know how they can help you. Strategy #4: Communicate with those you care about and who care about you. Let s start with your significant other. It is common for breast cancer to put a strain on a relationship and that relationship will either come out stronger or weaker because of it. It is important that you do your best to communicate your needs to your partner while 4

5 you are getting through treatment and beyond. Your partner can t perform if he or she does not know what you expect. If you find your closest relationships changing, then talk about it. Your friend or partner may just not know what to say. He or she may be very frightened for you and have a tough time dealing with that emotion. If talking doesn t improve things, then don t hesitate to seek professional counseling. There are probably plenty of people in your life who have said, If you need anything. Well, this is your cue to say, As a matter of fact, I do. Have a list of things you need available so that you can refer to it when friends ask. Put meals, appointments, house cleanings, dog walkings, and anything else you will need help with on a calendar and get friends to sign up. Make sure you continue this even after your treatment is completed because (as you know) you won t have the time or energy for some things after treatment. Come and live a day behind my eyes. E.R. No one really knows how you feel. They haven t been through what you have experienced. They don t understand your fears. You need to talk, whine, cry, laugh, and ask questions about your cancer and its treatment with other women who can walk in your shoes. Strategy #5: Join a community of other women dealing with breast cancer. I really did save the best for last. I certainly want you to pay attention to the first four strategies, but if you do nothing else, do at least this one thing. Join a community of women with breast cancer. Studies show that a significant number of breast cancer patients are not having their needs for emotional support addressed at all as a part of their treatment and recovery. There is also a need for more information about breast cancer, its treatment, and managing side effects. This journey has been and will continue to be very personal. There are probably things that you don t want to talk about with your friends or loved ones. Fears that they might not understand. Or you just don t want to burden them with your concerns. Join a community. Everyone there is in your same boat. 5

6 I just have to say I have not started chemo yet but I am already sick of hearing stay positive be strong...i just want to be able to have real reactions real emotions and have support. Let me scream, yell,swear, cry and wallow. Then I will go back to doing what I have to do K.M. I want to help you find that community of like-minded women dealing with breast cancer and the life issues that go with that diagnosis. That is why I have opened a special community called The Breast Cancer Collective. In this community, you will have access to me, an oncologist with over 20 years of experience, to ask your questions about treatment, side effects, and whatever else strikes your fancy. In addition, you can immerse yourself in a compassionate and caring community of women who know exactly where you stand. Because they have been there themselves. This community is now open. Click here to learn more about The Breast Cancer Collective. I look forward to sharing in this journey with you. Take care and be well, Lisa Schwartz, MD The Breast Cancer Collective 6