Reducing Cancer Risk – Practicing What I Preach

One of the most common questions I get asked by patients is, “Is there anything I can do to reduce my chances of getting cancer?”  My response is always the same, “Live a healthy lifestyle. Eat healthy and exercise.”  Now, that won’t necessarily mean that you won’t get cancer, but it is one of the few things you can control to reduce your risk of getting cancer.  The majority of my patients are overweight and that is definitely a risk factor for breast cancer as well as a whole host of other diseases that can kill you.  Also, being healthier allows you to recover sooner from necessary surgeries and tolerate treatments better.

But it’s easy for me to tell someone to lose weight, be healthy and exercise.  I myself have never had a weight issue so I don’t know the struggles that come with trying to lose weight.  But after living at my dad’s house for 3 weeks where I had no control over what there was to eat and a road trip where every meal was either fast food or eating out, I ended up in Houston feeling completely disgusted with myself and ready for a fresh healthy start.  After all, shouldn’t I practice what I preach?

Cover of "This Is Why You're Fat (And How...

Cover via Amazon

I recently read Jackie Warner’s “This Is Why You’re Fat” book after having bought some of her workout videos.  Her book talks about how the foods you eat affect the hormones in your body, including human growth hormone, testosterone, estrogen and insulin.  It made me realize that although I am not fat, I would still benefit in many ways by eating in a manner that would keep others thin.

Let’s face it, us women have a hard time taking care of ourselves.  I often ask my patients, “How come you haven’t come for a mammogram in 4 years?”  Has it been that long?  I’ve been so busy I didn’t even realize!  As I remind my patients the importance of taking care of themselves first so they can continue taking care of others, I am now realizing that I too need to do the same thing for my family.

So let me share some of the things I am doing to take that step towards healthier living:

1. Always eat breakfast and have some sort of protein at breakfast. (This usually means eggs or a protein shake.)  Breakfast is the most important meal.  Studies have shown that by adding breakfast into your eating regimen you can increase your metabolism.

2. Don’t have any junk food in our pantry.  That means no cookies, no chips, etc.  I do still indulge in Healthy Choice fudge bars (100 calories, 5 gm of sugar) and 25 calorie fruit bars made with Splenda.  Those make my kids happy enough not to complain.

3. Eat more protein and less white carbs (potatoes, white rice, pasta).  This is supposed to help balance your insulin levels.  In college I had started the Zone diet which was based on balancing your insulin levels.   Prior to starting the diet, I always fell asleep in my afternoon lectures.  But after the diet, I was able to stay awake no problem!  I totally believe that the post lunch sugar crash was the cause of my inability to stay awake in the afternoons.  As a result, I have been incorporating whole wheat bread, whole wheat tortillas, whole wheat pasta, brown rice and quinoa as my carbohydrate staples.  I can’t give up carbs completely!

4.  Eat fish at least once a week.  This is a source of protein in my diet and provides the healthy Omega 3 fatty acids which are good for your heart.

5.  Take a daily vitamin.  For some reason, I just keep forgetting to pop those pills.  I don’t know if I subconsciously don’t like the idea of having to take a pill.  But I do it for my kids, so why shouldn’t I do it for myself?

6.  Drink lots of water.  I am just really bad at doing this.  If it’s not in front of me, I don’t think to go and get it and I can go a whole day without drinking much.  I literally need a bottle attached to my arm…

7. No more excuses about working out. I am going to try to devote 15-20 min to some form of exercise every day.  Jackie Warner has a great DVD with 15 min workouts you can do at home.  Jillian Michaels 30 Day Shred workouts are 20 min long.  When you think about 15-20 min, it doesn’t seem like much time, does it?

8. Get a good night’s sleep.  I like to stay up late at night.  In fact, several of my posts have been written close to midnight.  It’s the only time I have to myself.  Unfortunately, I am still getting up when my kids get up.  Ultimately, I am depriving my body of its time to recover from the stresses that it goes through on any particular day.  After a while, it will take its toll…

Just so you know, I have been trying to implement these for the past 2-3 weeks.  I am doing well with 1-4 but still working on 5-8.  It’s not easy to make so many changes but I already feel better doing some of the above.  Eventually, I hope to be able to say I do everything above.  It’s okay if it takes time to get there, as long as I get there.  By then, several of those should become second nature.  But until then, I will have to remind myself of those goals and what it will do for my well being and how that will make me a better mother, wife and doctor.   That is the best motivation.

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Is Breast Cancer Awareness Overhyped? – First part of the response to Peggy Orenstein’s article

Probably.

In the past month or two, I saw three young girls for a lump in their breast.  One was 19 years old, the others 15 and 12.   The mother of the first girl was recently diagnosed with breast cancer and was finishing up chemotherapy.  I put the ultrasound probe down and saw a benign appearing mass, most likely a fibroadenoma.  I told them that just that.  I looked into both their eyes and there was no sense of relief.

Ok, maybe they need more than that.

Not entirely sure what it is they needed to hear, I continued on:

“The options for management include watching it in 6 months or biopsy.  I am not sure if you would want to consider biopsy, given your own personal experiences and that way you will have a definitive answer.”  The mother breaks down crying.

Oh shoot.  I said the wrong thing.

I gave the mother a moment.  She apologized.  It was okay.  By now I have gotten used to cancer patients having moments where they just need to break down and cry.  Finally, when she was able to gather herself, I tried again:

“I am 99% sure that this is not cancer.  It would be incredibly unlikely in someone of this age to have a mass that looks like this end up being cancer.  If she were my daughter, I would opt for watching it, just to make sure it does not rapidly grow.”  Finally, I see some relief in my patient and her mother’s eyes.

I don’t know know why I even mentioned biopsy as an option.  I almost never suggest biopsy in someone of this age because it is so unlikely to be something abnormal.  If it were my own daughter, I wouldn’t have even worried for a second.   Now, in this situation, the patient’s mother had breast cancer, and that probably contributed largely to their fear, and probably to some degree mine.  But the mother of the second girl I saw did not have cancer.   The mother of the third, 12 year old girl, repeatedly asked me if the several benign cysts were normal.  I couldn’t help but to wonder if this is just a normal parental response, or is there so much hype around breast cancer that we are now making our teenage daughters check their breasts for lumps.

I see the look of fear almost every day in my patients’ eyes.  For many patients, if I offer six month follow up, I get this look of “are you sure?”  I have actually done biopsies when I didn’t think someone needed them because the patient wanted it.  Many women can’t stand the thought of waiting, as though there was a ticking time bomb in their breast.

Awareness is a good thing.  It helps people take initiatives to get preventative services that might actually save their life.  But all of this awareness has instilled a great deal of fear, in not just patients, but their doctors as well.  We have to live up to the notion that early detection will save our patient’s life.  Don’t miss that breast cancer when it’s early!  If you don’t biopsy and something turns out to be a cancer, be ready to explain that to your patient (and possibly their lawyer)…  And it’s not just radiologists who fear it too.  When my partner and I felt that we could safely follow certain things in a year, we received some nasty responses from referring physicians who basically told us that that was not the protocol and we were putting them at risk for lawsuit.  They would no longer send us patients unless we forced people to come in at 6 months for followup.

I agree with Peggy Orenstein about how the “awareness” aspect of breast cancer is borderlining on hysteria.  We, as a community, need to have a rational outlook on breast cancer so we can better focus our energies on prevention, detection and treatment, and make sure that what we are doing is really helping women.