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FREE A M AGAZINE FO R W OM E N ' S H E A LT H
SO YOU DON'T COOK HOME-GROWN SPA
Contents 20
SUMMER/ 2013
Five Important Advances in Breast Cancer
02 So You Donât Cook 05 Understanding Hereditary Illness 09 Committed to Care 12 Home-Grown Spa
12
14 The Next Big Thing 18 RFTC News 22 The Sandwich Generation 24 More Than Skin Deep
22 Run for the Cure® Foundation is a registered NPO with the Tokyo Metropolitan Government since 2004. Our mission is to eradicate breast cancer in Japan as a life-threatening disease through education, timely screening, and treatment. Through our activities, the Foundation funds education initiatives, clinical examinations and mammography machines; donates funds to organizations that promote activities specific to the mission of the Foundation; and develops and executes community outreach programs. We have donated six mammography machines to six clinics in areas where women are underserved, more than 14,000 women have benefited from mammograms, with over 3,600 funded screenings. The Foundation holds three annual events open to the general public to raise funds in support of our cause. PiNK is Japan's one and only magazine dedicated to breast cancer. Some 18,000 copies of this quarterly magazine are distributed free-of-charge nationwide through medical institutions, cooking studios, sports shops, libraries and sponsoring companies. Please contact inquiries@runforthecure.org for subscriptions. ®
For more information about how to donate, become a sponsor, and/or volunteer for Run for the Cure Foundation, please visit www.runforthecure.org
PINK ⢠SUMMER 2013
1
SO YOU DONâT COOK By Paulette Lambert, RD, CDE Director of Nutrition, California Health & Longevity Institute
O
ften I hear, âI want to eat healthfully, but I
If you find yourself cooking-challenged for whatever
donât cook.â The reasons vary, but lack of
reason, know that you can really improve your overall
cooking skill, lack of time, and lack of interest
nutrition by becoming proficient at âfood assembly,â or
generally top the list. Most of us recognize,
making a meal without going through the steps and the
often by our expanding waistlines, that not cooking isnât
time commitment typically associated with traditional
exactly the healthiest way to go. Whether weâre replacing
cooking. Kitchen technology has made it easier to
home-cooked meals with a frozen entrée and a bag of
assemble healthy food, and you can stock your pantry
chips or with a large portion of restaurant food with added
with healthy foods that require little cooking.
fat and a basket of bread, not cooking can make healthy eating a bit more challenging.
Keep in mind that, generally, the more real, whole food you consume, the healthier your diet. Less-processed
TOP 12 FOODS TO KEEP IN YOUR KITCHEN TO IMPROVE YOUR HEALTH 1 CANNED BEANS
4 FOIL-PACKED WILD SALMON
Keep a variety of canned beans
Use salmon in place of tuna to avoid mercury and for
on hand (kidney, black, pinto,
a full dose of healthy omega-3 fats.
cannellini) for a quick and easy
No need for refrigeration or a can
source of vegetarian protein.
openerâjust open the package and
Rinse and drain them, then eat with brown
use in sandwiches, salads, and pastas.
rice and salsa, use to make your own hummus or bean spreads, or add to pasta, salads, and soups.
2 FROZEN VEGETABLES Look for âsteam freshâ varieties for quick and easy
Keep calories under 130 to control sugar content. Add to smoothies, mix with fruit and
veggie sides. Add to take-out, pasta, salads,
nuts, or top with crunchy cereal. Itâs a great
and low-sodium canned soups to incorporate a
source of protein and probiotics.
variety of veggies year-round.
3 FROZEN FRUIT Frozen fruit is better than imported when fruits are not in season. Use frozen berries, mangoes, and peaches in smoothies, oatmeal, and desserts.
2
5 ORGANIC NONFAT GREEK YOGURT
PINK ⢠SUMMER 2013
6 NUTS Eight walnut halves or 12 almonds equal one serving of nuts. Add to salads or pair with fresh fruit for a filling dose of protein, fiber, and healthy fat.
foods have less added unhealthy fat, sugar, and sodium
onion, garlic, and reduced-sodium organic chicken broth
and are higher in vitamins, antioxidants, and fiberâall of
and blend well. Pour the mixture into a bowl, sprinkle with
which promote health.
a tablespoon of Parmesan cheese, and heat the purée in
One can assemble many meals that are noteworthy for their good nutritional value. The following tips can help
the microwave for a healthy, delicious vegetable soup.
move you toward healthier, home-based mealsâwithout
Think Salads and Sandwiches
very much cooking at all!
Salads and sandwiches make easy, complete meals. If
Use Your Blender
youâre in the mood for a salad, buy bags of prewashed greensâdifferent varieties of lettuce, baby spinach,
Smoothies can serve as great one-stop meals and can
or kale, for exampleâto use as your base, and add
also add a nutritional boost to a larger spread. For a basic,
preshredded carrots, red cabbage, cherry tomatoes,
healthy smoothie, throw into a blender some frozen,
leftover grilled chicken, canned tuna or salmon, low-fat
unsweetened fruit; a banana; low-sugar, nonfat Greek
shredded cheese, canned beans, or other healthy toppers
yogurt; and Œ cup of organic soy or nonfat milk and whirl
to create a balanced, delicious meal. Fruit, such as dried
away. Throw in a handful of spinach, a carrot, or a red bell
cranberries, raisins, or fresh sliced apples or pears, are
pepper, and youâve just added a serving of vegetables.
also great additions, as are chopped almonds or walnuts
A spoonful of nuts, flax seeds, unprocessed bran, or raw
(limit to 1 tablespoon) to increase antioxidants, vitamins,
oatmeal can add whole-grain goodness and fiber.
and omega-3s. Add lite salad dressing, oil and vinegar, or
Another great way to use the blender is to steam frozen veggies like broccoli: toss them in the blender with a little
7 DOUBLE-FIBER ENGLISH MUFFINS Fiber helps keep us full, regulate blood sugar, and manage body weight. Use these muffins for sandwiches, pizza, or breakfast to
lemon juice, and youâre good to go. If you like sandwiches, nothing is healthier or easier than
10 SHREDDED WHEAT WITH BRAN Add this to your morning routine. Shredded wheat is as unprocessed as it gets; it
help reach your daily fiber quota
contains no additives and only two ingredients
(25 to 30 grams). One whole
(wheat and bran).
English muffin is equal to only one carbohydrate serving.
11 TOMATOES Get tomatoes any way that you
8 FROZEN SHELLED EDAMAME (SOYBEANS)
can. Use fresh, sundried, or boxed tomatoes in soups, sauces, and pasta.
For a quick and easy source
Boxed Pomi tomatoes do not have the
of vegetarian protein, use
harmful BPA (Bisphenol A) found in
edamame in soups, salads,
canned tomatoes. Add fresh tomatoes to everything, and
and snacks.
try cocktail tomatoes by the handful for a sweet snack.
9 OATMEAL Real, whole, unprocessed oats are
12 APPLES
a great option for breakfast; add
Buy organic apples and leave the peel on. The peel provides much of the fiber found
fruit, nuts, and cinnamon for extra
in apples; just be sure to wash well before
flavor and nutritional value. (Avoid instant packets due to sugar and sodium content.)
eating. Add diced apples to your oatmeal, slice thinly for salads, or enjoy whole as a quick snack.
PINK ⢠SUMMER 2013
3
Add fresh tomatoes to everything and try cocktail tomatoes by the handful for a sweet snack. Use the Microwave Truly a valuable piece of kitchen equipment, the microwave does not alter the value of nutrients any more than any other cooking method. Most markets now have a variety of frozen, healthy, whole foods that take just a few minutes to get from freezer to plate. natural peanut or almond butter on whole-grain, high-fiber
Frozen veggies have the
bread with sliced banana for a simple meal thatâs high in
same if not better nutrient
fiber, omega-3s, vegetarian protein, and antioxidants. Foil
content than fresh and can be added to
packs of wild salmon, also high in omega-3s, are a great
pastas, brown rice, soups, and take-out food to increase
alternative to canned tuna, which can be high in mercury.
the nutritional content. Try the steam-fresh packages from
Mix the fish with a little olive oil mayo and a teaspoon of
the freezer: top with pasta sauce and low-fat cheese for a
capers and spread it on whole-grain bread with some
meal that delivers several servings of vegetables and 500
sliced tomato and a handful of greens for an easy, delicious
fewer calories than a pasta entrée. An 8-ounce yam or
mealâand itâs great paired with a vegetable soup and cut
baking potato can be cooked in six to seven minutes (just
fruit. Nitrate-free deli turkey on whole-grain bread with low-
make sure you first pierce with a fork a few times to let
fat cheese and sliced apple or pear makes another great
steam escape); add steamed broccoli or spinach with low-
combo. For a vegetarian option, try hummus with sliced
fat cheese or cottage cheese and a spoonful of salsa for a
raw veggies in a whole-grain pita.
filling meal. For an easy, healthy breakfast in five minutes, make real oatmeal in the mircowave with frozen fruit and organic
Get a Grill Pan
soy or nonfat milk; add cinnamon and a tablespoon of
Invest in a grill pan and use it to grill chicken breasts
chopped nuts for a complete meal. Or spray a glass
once a week. Try making three to four at a time and
measuring cup with nonstick cooking spray, crack an egg
use the leftovers for salads, sandwiches, or to add to
or egg whites into the cup, beat with fork, cover with a
cooked pasta. Combine with fresh vegetables, a couple
paper towel, and microwave for one minute for the perfect
tablespoons of teriyaki sauce, and frozen, precooked rice
scrambled egg. Serve on a high-fiber English muffin with
for an easy one-dish meal. Or grill three to four turkey
low-fat cheese or a veggie breakfast pattie for an easy
burgers at one time; add barbeque sauce to one for a
breakfast sandwich.
yummy burger, keep one plain to be added to pasta sauce, and combine one with salsa for quick taco
Focus on Real, Whole Foods
or burrito filling.
By increasing fruits and vegetables and whole grains and choosing lean proteins, you can greatly improve your overall nutritionâno major culinary feats required! m
4
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Hereditary Illness Understanding genetic legacy can help families manage risk or cope with inherited conditions. By Mia James
Along with our height, build, eye and hair color, and other physical traits, the genes that were passed from our parents to us and that we may pass to our children can also determine aspects of our health.
G
enes are made up of DNA
be entirely determined by genes or can
include autosomal dominant, autosomal
and contain information
be the result of a combination of genetic
recessive, X-linked, and mitochondrial
that determines specific
susceptibility and environmental or
inheritance as well as chromosomal
traits. We have two copies of each
lifestyle factors that trigger the disease
abnormalities.
geneâone inherited from our father
or disorder. (Conditions that run in
and one from our mother. Inherited
families can be complex, involving
Autosomal Dominant Inheritance
mutations (abnormalities) in genes
multiple genes and other factors. For
With autosomal dominant inheritance,
can cause certain health conditions
the sake of clarity, this article focuses on
only one copy of the abnormal gene
or increase the likelihood that we will
inherited mutations in single genes.)
must be passed down to a child for
develop particular diseases or disorders.
the disorder to appear. Even though
How Genetic Inheritance Works
we get most of our genes in two
There are several ways in which a
copies (one from our mother and one
counselor at the Stanford Center for
genetic abnormality is passed from
from our father), only one mutated
Inherited Cardiovascular Disease,
generation to generation. These
copy is needed for a child to inherit
describes hereditary illness as âany
patterns of inheritance determine
an autosomal dominant disorder.
health condition that we can inherit and
the likelihood that a child will inherit
âAn autosomal dominant disorder
that other people who share our genes
the genetic abnormality or condition,
is a condition in which having one
[other family members such as siblings
and they explain the path a mutation
nonfunctional gene, or a mistake in
and children] may also be at risk to
takes from one family member to the
the gene, is enough to give you the
have.â These conditions, she says, can
next. Different types of inheritance
disorder,â explains Ada Hamosh, MD,
These are known as hereditary illnesses. Colleen Caleshu, MS, CGC, a genetic
PINK ⢠SUMMER 2013
5
MPH, a professor in the department
If two carriers of the same autosomal
of pediatrics at the Institute of Genetic
recessive condition have a child
single mitochondrion in that egg has
Medicine at Johns Hopkins School of
together, thereâs a 25 percent chance
the same mutationââwhich is referred
Medicine.
that the child will have the condition
to as homoplasmy. Itâs also possible
and a 50 percent chance that the child
that only a portion of the mitochondria
disorder has a 50/50 chance of passing
will be an unaffected carrier (meaning
have the mutation, which is known as
the disorder to each of his or her
that he or she will inherit one copy of
heteroplasmy. When the egg divides to
children. An example of an autosomal
the abnormal gene). This risk applies to
make multiple cells (daughter cells),
dominant disorder is Marfan syndrome,
each pregnancy. Examples of autosomal
the daughter cells will have a greater
a connective tissue disorder that affects
recessive conditions include cystic
or lesser degree of homoplasmy or
the skeletal system, cardiovascular
fibrosis, a disease that causes mucus to
heteroplasmy, depending on how the
system, eyes, and skin. People with this
build up in the lungs, digestive tract,
mitochondria are dispersed among
disorder tend to be tall and have long
and other areas of the body, and sickle
them.
legs, arms, and fingers.
cell disease (or sickle cell anemia), a
A parent with an autosomal dominant
Different types of cancers can also
Dr. Hamosh says that mitochondrial
condition in which red blood cells form
diseases tend to affect tissues that
have a genetic link, such as breast
an abnormal sickle or crescent shape
consume a lot of energy, such as
and colon cancer, and specifically be
instead of a normal disc shape.
muscles, the brain, and the liver, and
the result of an autosomal dominant
complications can include vision and
mutation. âA good example would
X-Linked Inheritance
hearing loss as well as stroke, diabetes,
be breast cancer,â explains Allison W.
In X-linked inherited conditions, the
and other conditions. One particular
Kurian, MD, MSc, a medical oncologist
nonfunctioning gene is located on the X
type of mitochondrial disorder is
and assistant professor at Stanford
chromosome. Because women have two
triggered by exposure to a class of
Medicine. âA small minorityâbut an
copies of the X chromosome and men
antibiotics called aminoglycosides and
important subsetâof breast cancer
have one X and one Y chromosome,
can result in hearing loss.
cases are caused by inheritance of
X-linked conditions are more likely in
basically a single gene mutation,â
men. âIn general, conditions that are
Chromosomal Abnormalities
she says. Specifically, these include
X-linked manifest either only in boys or
Chromosomal abnormalities can
mutations in the BRCA1 and BRCA2
far more severely in boys because they
occur when there is an extra whole
genes. âWomen who inherit those,â says
donât have a second X chromosome to
chromosome or there are missing or
Dr. Kurian, âhave a very high risk of
protect them from the gene not working
extra pieces of a chromosome, which
developing breast cancer.â
on the one X chromosome they have,â
can be an inherited trait or occur for
Dr. Hamosh explains.
the first time in an individual. They
Autosomal Recessive Inheritance
Duchenne muscular dystrophy, which
can occur when thereâs an error in cell
âAn autosomal recessive condition,â
is the most common form of muscular
division. âIn general, big pieces [of
explains Dr. Hamosh, âis a condition
dystrophy, is an example of an X-linked
missing chromosome] are new in a
in which both parents are carriers.â As
condition. People with Duchenne
patient and not inherited from either
carriers they donât have the condition,
muscular dystrophy develop muscle
parent,â Dr. Hamosh explains, whereas
but they carry the genetic trait because
weakness that gets worse very quickly.
âmany smaller [missing pieces] may be
they have one copy of that particular
6
mitochondrial diseases where every
inherited from a parent.â
gene that works. âBut,â she says, âif
Mitochondrial Inheritance
you have two copies of the gene not
Our mitochondria (cellular structures,
a condition caused by a whole extra
working, then you have a problem.â
or organelles, that primarily produce
chromosomeâa person with this has
The so-called problemâan autosomal
energy for the cell) come from our
47 chromosomes instead of the usual
recessive conditionâarises if two
motherâs egg, or, as Dr. Hamosh
46âand it affects physical, mental,
carriers have a child together and each
explains, âthe egg that made us.â This
and social development. (Though
passes on to their child a gene that
egg contains about 5,000 mitochondria
Down syndrome can be inherited, most
doesnât work.
and, she says, âthere are certain
cases occur at random.) Examples of
PINK ⢠SUMMER 2013
Down syndrome is an example of
Know Your Rights Genetic Information Nondiscrimination Act of 2008 Under the Genetic Information Nondiscrimination Act (GINA), which took effect in November 2009, you are protected from discrimination from employers and insurers based on genetic information. In other words, if you are found to have a genetic risk of a health condition, itâs unlawful for you to be treated unfairly by your employer or health insurance provider as a result of these findings. â Though GINA does provide some protection against discrimination, itâs also useful to know that there are areas in which the statute isnât effective. Protection does not cover, for example, life insurance, disability insurance, or long-term care insurance or require that any particular test or treatment is covered. As well, employment protection under GINA may not take effect for employers with fewer than 15 employees. To learn more about how GINA works, visit ginahelp.org.
conditions associated with missing
illness they have or that runs in their
to handle the resulting information. In
pieces of chromosomes include Williams
family to discuss the issue with their
some cases, patients may determine not
syndrome, a developmental disorder
doctors. âI think itâs always reasonable
to go forward with genetic testing; she
that affects many parts of the body, and
for people to ask their healthcare
explains that there are circumstances
22q11.2 deletion syndrome, a condition
providers if there could be a genetic risk
in which other medical evaluations
with widely varying symptoms that can
and [if this] should be evaluated,â she
may be more appropriate than genetic
include heart defects and a cleft palate.
explains.
testing, such as conditions that are
Dr. Kurian also emphasizes the
âpartly genetic, partly lifestyle, partly
Coping with Genetic Risk
importance of family history when
environmentââdiabetes and coronary
For many people who have a known
determining if thereâs a genetic
artery disease, for example. In these
genetic condition or may be at risk,
component to a diagnosis and if genetic
cases, blood tests, imaging, or a
a genetic counselor can help them
counseling and testing are warranted,
thorough family history may answer
navigate the many complex issues
particularly in cancer genetics. âFor
questions and guide health decisions
surrounding their health; this may
cancer itâs very much driven by a family
more effectively than a genetic test.
begin with genetic counseling and,
history of a specific pattern of cancers,â
Before a patient begins genetic
if determined appropriate, genetic
she says, adding that early-onset disease
testing, Caleshu says that there are
testing. According to genetic counselor
can also be a reason to look into a
several important things to consider. âI
Colleen Caleshu, genetic testing may
genetic cause. âOne thing thatâs really
think itâs really important that someone
be appropriate âanytime that thereâs a
helpful is if a patient can assemble as
understands what a genetic test can and
hereditary condition in an individual
much information as possible about the
cannot tell them,â she says, explaining
or in their family memberââso long as
family history,â she says. âHaving an
that itâs important to be realistic and
thereâs a test available for the condition
accurate, multigeneration family history
know that a test result might not deliver
in question. Testing may also be
can help us think about what [type of]
absolute answers. âTheyâre often not as
considered when a patient has a health
testing is going to be most helpful.â
simple as positive or negative,â Caleshu
event or family history that suggests a hereditary link. Dr. Kurian encourages patients who feel there may be a genetic link to an
Caleshu says that genetic counseling
says, and she suggests that you consider
is done in conjunction with genetic
the impact that various results could
testing to help patients understand what
have on your medical and personal
to expect from genetic testing and how
choices as well as those of your family.
PINK ⢠SUMMER 2013
7
A genetic counselor may be your best ally as you face a hereditary illness. Caleshu recommends finding a counselor who has expertise in the particular condition that runs in your family. Managing Your Risk
genetic counselors can âtailor our
Because not all genetic abnormalities
screening and prevention strategies
inevitably cause illness, screening and
accordingly.â
Coping with hereditary illness can also present emotional challenges, as
prevention can be effective, especially
For example, whereas a woman at
for those hereditary illnesses that are
average risk of breast cancer will begin
whether or not to have childrenâmay
the result of a genetic predisposition
screening mammography around age
be raised; a genetic counselor can help
combined with environmental or
40, a woman with a known genetic
you handle your emotional response
lifestyle triggers. For example, a person
risk for the disease might adopt an
and find appropriate additional support
at risk of an inherited cardiovascular
escalated approach. In this case, Dr.
if needed. He or she may connect you
condition could trigger that illness
Kurian says, âWe would add to her
with local, in-person support groups as
by smoking. By testing for genetic
screening with a more sensitive testâ
well as national advocacy organizations.
mutations, itâs possible to establish
so not just mammogram but also an
FORCE (Facing Our Risk of Cancer
protective measures with the goal
MRI of the breast.â Other preventive
Empowered, facingourrisk.org), an
of preventing the onset of illness.
strategies might also be considered, she
organization devoted to hereditary
As well, a positive test for a genetic
says; possibilities include medication
breast and ovarian cancer, and the
abnormality does not mean you will
to reduce risk, as well as preventive
Genetic Alliance (geneticalliance.org), an
definitely develop the related condition;
surgery, such as removal of the breasts
advocacy group that includes more than
a genetic counselor can help determine
before cancer develops.
1,000 disease-specific organizations,
the chances that youâll develop that condition. Also understand that a negative test
intense personal questionsâsuch as
are examples of resources that a genetic
Caring for Yourself and Your
counselor may recommend.
Family
for a genetic mutation doesnât mean you
A genetic counselor may be your
A Call to Action
canât get the related condition. It only
best ally as you face a hereditary
If you have or are at risk of hereditary
means you donât have the very high
illness. Caleshu recommends finding
illness, it may appear like thereâs
risk associated with a mutation. For
a counselor who has expertise in the
nothing you can do about the
example, a woman who does not carry
particular condition that runs in your
situation. After all, youâre born with
her familyâs BRCA mutation can still
family. In addition to guiding you
it, right? Not necessarilyâthe fact is
get breast cancerâshe just doesnât have
through the genetic-testing process by
that with education, support, and the
the same high risk that family members
determining what tests may be done,
expert guidance of physicians and
who do carry the mutation have.
who in the family may be tested, and
genetic counselors, thereâs a lot you
whoâs at risk, he or she can help you
can do to manage your condition and,
when we know about a genetic mutation
with some other significant issues
in some cases, protect yourself from
that conveys a high risk of disease,
surrounding genetic risk. Some areas in
developing a disease or disorder. In
is to be able to fit our preventive
which you may want guidance include
this way a family history of a disease
management to the level of risk,â Dr.
how to talk to family members about
or known genetic risk is a call to
Kurian says. With an early warning that
risk or a condition, changes to make
action, and the resources are in place
someone is at high risk for a particular
in lifestyle or medical care (such as
to help you face the challenge and
disease, she explains that doctors and
screening measures), and how to learn
manage your risk. m
âThe whole goal of genetic testing,
8
more about your risk or condition.
PINK ⢠SUMMER 2013
awomanshealth.com
Committed to
Care
Years spent caring for her mother taught one young caregiver important lessons about both herself and providing good care. By Tory Zellick
The Beginning of the Long Road
radiation, and a double mastectomy.
For almost two years, I built the
The day of her diagnosis was typical
My dad, my brother, and I were with
life I had always dreamed of: I had
of so many fall days in northern
her every step of the way. I quickly
a fun, stimulating job; I owned a
California: the weather was mild, with
moved into the role of primary
condo right across the street from
a slight breeze that lightly plucked the
caregiver, trading toga parties for
a dog park (and the dog to go with
red and gold leaves from the massive
hospital gowns and escorting Mom
it); I paddled outrigger canoes for
trees that lined the streets of our
to her doctorsâ appointments and
a local canoe club; and I was in a
small town; the morning air smelled of
treatments.
happy, committed relationship. I was
dry dirt tinged with lingering moisture.
Almost a year after her diagnosis,
As far as I was concerned, life was
it looked as though she may have
pretty darn good. I had enrolled at a
beaten this nasty disease we call breast
local college as an agriculture major,
cancer, and life could move on.
and I certainly looked forward to all that college life had to offer.
living life on my own termsâuntil the phone rang. By the tone of my dadâs voice, it was obvious that something was wrong. To this day I will never forget
Exit Stage Left
what he said: âItâs your mom. The
With my momâs health stable, I took
cancer is back. She only has a few
school on this particular day, I
the time to reevaluate my priorities.
months to live.â
immediately knew that the day was
Seeing my mom face cancer at such
anything but typical. My mom was
a young age motivated me to live my
contacted a real estate agent to sell
sitting on the couch with a book, but
life according to my own rules.
my condo, I knew what I needed to
But when I arrived home from
it was obvious she was only staring
Determined to live out the
By the end of that day, I had
do to ship my dog back to California,
at the pages; she wasnât actually
adventure I had always dreamed of,
and I was seeing an inevitable end to
reading the words. It was then that
I boarded a one-way flight to Maui
my relationship. At nine the following
she told me the lump she had found
with a few hundred dollars in my
morning, I boarded a one-way flight
in her breast was malignant. Wanting
bank account, a backpack full of
home to California.
desperately to know why, I knew that
clothes, a sleeping bag, and my best
What the doctors said would
wasnât the question to ask; instead it
friend by my sideâwith no intention
be a few months turned into three
was now about Whatâs next?
of returning to the Mainland. I wanted
and a half yearsâyears filled with
to surf; I wanted to kayak; and, most
numerous doctors, several treatment
important, I wanted to live.
facilities, and countless medications,
The following nine months saw Mom endure chemotherapy,
PINK ⢠SUMMER 2013
9
a loved one face illness (see
⢠Mobility and walking
sidebar âThe Medical Day
⢠Hygiene
Plannerâ).
⢠Housekeeping
The following tips emerged from this period of reflection.
⢠Cooking ⢠Driving and transportation ⢠Finances
Establish a âcare team.â You
Tory Zellick
may initially feel as though
medication
you need to be the sole
It is important to include the
caregiver. Maybe you feel you
patient in the assessment process
are the only one available to
and allow the patient to retain as
care for the patient, or you
much independence and dignity
may be overwhelmed by the
as possible. Once it has been
number of people willing to
established which daily tasks will
help care for the patient. But
require intervention, distribute tasks
it is important to know that
accordingly among the care team.
no single individual is capable
Someone may be capable of mowing
of keeping a sane, present
lawns and grocery shopping, while
mind while caring for an ailing
someone else might live at a distance
patient all on his or her own.
but is capable of tracking financials
Eventually, you will require
and paying the patientâs bills online.
treatments, tests, scans, and
some time off or away from the
Assign care tasks accordingly;
alternative modalities. Throughout,
patient. If people are willing and able
allowing everyone to be involved
my momâs prognosis was grim and
to help provide care, donât hesitate to
in the process while bringing their
there were few therapies available
engage their help and create a care
individual strengths to the table will
to treat her advanced disease.
team.
avoid any one personâs becoming
As caregivers our family became
When you create your team, first
overwhelmed.
focused on maintaining her quality
establish who will be the primary
of life.
caregiver. It will be the primary
Stay organized. Information may be
We never imagined the journey we
caregiverâs responsibility to oversee
flying in your direction at what seems
would experience as caregivers, and
the care team. A care team could
like light speed, but caregiving does
I never knew how quickly I would
be made up of family members
not need to be a test in memorization.
be transformed. Upon hearing my
and close friends who are willing to
Find a system that works for you
momâs diagnosis as an 18-year-old
help in any way they can. The team
and that allows you to track and
girl, my instinct was to ask, Why?
could also include professionals who
document all important information
But the end of our journey saw me
can assist with legal and financial
related to the patientâs care:
asking, What next?
mattersâan attorney, an accountant,
⢠Physicianâs contact information
and an insurance broker, for instance.
⢠Medications
Lessons Learned
These professionals, along with
⢠Treatments
In the wake of my momâs death
medical staff, will help you navigate
⢠Tests and scans
and the reflection that followed, it
any unforeseen hurdles you may
⢠Procedures
became clear that what was next for
come across.
⢠Hospitalizations
me was to transform my personal
10
⢠Ability and awareness to take
⢠Appointments
journey for the greater good. As I
Assess the patientâs needs.
spent time thinking about how my
Take the time early on to discuss
familyâs experience could have been
the delegation of daily tasks and
made easier, I was motivated to help
responsibilities with the patient and
Take care of yourself. Many
other caregivers learn to navigate the
the care team. Some common tasks
caregivers find themselves
overwhelming experience of helping
that will need attention include:
overworked, with little to no sleep
PINK ⢠SUMMER 2013
⢠Insurance information and explanation of benefits
or personal time. Running your own
flight at the airport, you have two
you come in contact with on this
body into the ground is of little help
options: you can get worked up
journey. Treating individuals as you
to the loved one you are caring for.
and angry about a situation that can
wish to be treated will (almost) always
If you do not treat your body like a
no longer be controlled, or you can
improve communication. Learning to
temple, it will soon fall to ruins.
politely address the flight receptionist
breathe and remain calm will improve
Pay close attention to the following
at the desk next to your empty gate
your odds of accomplishing the
wellness points:
and work through the situation. This
task at handâand maintaining
⢠Take private time. Take time off or
is true with nursing staff, physicians,
your sanity. m
away from the patient to recharge.
facility staff, or any other individual
⢠Get a full nightâs sleep. When possible, do your best to get consistent, uninterrupted sleep. ⢠Exercise. Even if it is only a few
The Medical Day Planner
minutes of walking a day, take the time to move your body. ⢠Eat well. Keep healthy snacks on hand and do not skip meals. ⢠Find a therapist. Address your own emotional needs to maintain wellness. Know the patientâs final wishes. Final wishes are a difficult conversation to have with a loved one but are important nonetheless. The fear of not knowing what your loved oneâs wishes are should far surpass the fear of asking these tough questions: ⢠What life-sustaining medical intervention would your loved one want or not want? ⢠Whom would your loved one want to make healthcare decisions once he or she is not competent? (Consult an attorney
The minute a cancer diagnosis enters the picture, so too does a constant flow of information: doctorsâ names, clinic locations, medication dosages, treatment schedules, test resultsâthe list goes on. As though coming to grips with the news of a diagnosis were not enough, patients and families realize quickly that it is essential to track and manage critical information to ensure that treatment, financial and insurance information, and side-effect managementâ among other thingsâproceed as efficiently as possible. Tory Zellickâs experience managing this influx of information as the primary caregiver for her mother inspired her to create a comprehensive planning resource for patients and caregivers: The Medical Day Planner: The Guide to Help Navigate the Medical Maze (Victory Belt, 2012; $34.95). The hardcover spiral-bound planner is divided into sections that include âPatient Information,â âMedication,â âAppointments,â âTest and Scan History,â âHospitalization,â and âProcedure Historyâ and provides formatted space to record and track personal information, as well as educational material and definitions of the various stages and aspects of care. The Medical Day Planner is a well-thought-out tool that offers patients and caregivers a place to consolidate essential information and maintain records throughout treatment and recovery. For more information visit allthingscaregiver.com/the-book.
for the proper documentation.) ⢠Would your loved one prefer to pass away in a hospital, a skillednursing facility, or at home? ⢠Would your loved one like to be buried or cremated? Where would he or she like to be buried or have his or her ashes remain?
PRESCRIBED READING Understand that anger gets you nowhere. Our familyâs favorite analogy for this is âthe plane has
The Medical Day Planner: The Guide to Help Navigate the Medical Maze (Victory Belt, 2012)
already left.â When you miss your
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11
Home-Grown Spa Look no farther than your own kitchen for fabulous skin treatments. By Ann Bloom
If a visit to the spa isnât in your budget, donât despairâyou can have a spa day at home without spending a dime. Look no further than your kitchen. You probably already have many ingredients on hand to make fabulous scrubs, masks, and moisturizers. So rummage through those cabinets and get out the whiskâyouâll have radiant, glowing skin in no time.
12
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Why Homemade?
Homemade products are tailor-made just for your skin.
There are plenty of reasons to try homemade skin care
You can adjust the recipe to meet your unique skin care
remedies, budget notwithstanding. Homemade skin
needs. Furthermore, you can make a small amount each
care recipes are free from the chemicals that lace many
time you need itâyour skin will reap the most benefits
consumer products on the market. These chemicals are
from fresh ingredients.
deemed necessary to make products shelf stable or to produce suds, but their long-term effects are unclear.
Ingredients
Some chemicals approved by the US Food and Drug
Suspend disbelief (or disgust) for a moment to realize
Administration are known carcinogens, and others have
that the best skin care ingredients donât come from a
been shown to disrupt the endocrine system. Many
factoryâthey come from a farm. If you have honey,
people believe that we shouldnât rub anything on our skin
avocados, oatmeal, milk, eggs, bananas, yogurt, vinegar,
that we wouldnât be willing to eatâthe skin is our largest
and other common ingredients on hand, youâre ready to
organ after all. While this may seem drastic, a little caution
start concocting. The following are a few simple masks to
never hurt anyone.
get you started.
Banana Avocado Mask
This moisturizing mask leaves your skin looking fresh and feeling soft. Mash one very ripe banana with one very ripe avocado. Add plain yogurt (2 to 4 tablespoons) and a dash of olive oil. Apply liberally to face and neck and leave on for about 20 minutes
Lemon Exfoliating Mask
Mix the juice of one lemon with Œ cup of olive oil, jojoba oil, or almond oil and leave on for 15 minutes. The lemon has an exfoliating effect while the oil moisturizes.
before rinsing with warm water.
Vinegar Rinse
Egg Mask
Apple cider vinegar is natureâs toner. Mix 2
Although you may shudder at the thought of smearing raw
tablespoons of apple cider vinegar with 2 cups
egg on your skin, this is a proven remedy for toning the
of water. After cleansing, splash your face with
skin. Beat an egg white until stiff, then smear over the face
the mixture for a toning, tightening effect.
and allow to set for about 20 minutes before rinsing. For oily skin, add a drop of lemon juice to the egg white; for dry skin, add honey.
Oatmeal Mask
Mix 1/3 cup cooked oatmeal with one egg white. Add a dash of olive oil, a few drops of lemon juice, and a spoonful of honey. Mix until smooth and
Honey Mask
This is an easy, cleansing, antibacterial mask suitable for just about everyone, even those with sensitive skin. All you need is warm (not hot), runny honey. (Place a tub of honey in warm water or the microwave to get the right consistency.) Spread the honey on your face and wait for a pulling, tugging sensation (2 to 5 minutes).
then spread over face; leave on
Rinse with warm water and then
for 15 to 20 minutes before rinsing
follow with a cold-water rinse. m
with warm water. This mask helps moisturize and tone the skin, and the addition of lemon helps reduce blackheads.
PINK ⢠SUMMER 2013
13
THE NEXT BIG THING When cancer patients transition from active treatment to survivorship, many find that they are at a loss of how to manage ongoing physical and emotional challenges. Providers hope that increased resources and comprehensive survivorship programming will help these survivors thrive. By Diana Price
C
hristy Stickney was 42 years
recovery. It was after her treatment was
doing whatever was needed to beat
old, newly married, and a busy
complete, when she was supposed to
this monster. So why now was I in this
mom to five kids when she
move on with her life, that Christy found
dark place, ready to end it all?â
was diagnosed with breast cancer in
herself in a deep depression, not sure
2010. Determined to fight the disease,
how to move forward.
Christy says, she faced the challenge
14
âHere I was, five months out of
It was the transition from active treatment to recovery that presented a chasm Christy didnât know how to
head-on. âAfter my diagnosis it was
chemo, my main surgeries behind me,
bridge: âMy prognosis was good, yet
game on,â she says. âThere was no
and all I could think about was going
I felt like the life preserver I had been
way that cancer would beat me.â
to sleep and never waking up,â she
using for the past year and a half had
Christy underwent a double
says. Christy had come through the
been taken away. I was told to swim
mastectomy, breast reconstruction,
challenges of diagnosis and treatment
to shore, yet I had no arms. I should
and chemotherapy. She experienced
only to find that it was recoveryâ
be able to do this, yet I was drowning.
side effects that included hair loss,
physical and emotionalâthat seemed
My surgical team and oncologist were
fatigue, and âchemo brain,â but she
the biggest hurdle yet. âDuring my
some of the best in our area, yet here I
kept fightingâright up until the point
cancer battle, I never considered giving
was, so completely ill-prepared for the
she was supposed to be on the road to
up,â she says. âI was laser-focused on
next part of my journeyârecovery.â
PINK ⢠SUMMER 2013
The Road through Recovery Is Not
Facing these challenges at a time when
âThe number of cancer survivors in
Always Easy
family and friends might assume that
the US has increased from 3 million
Unfortunately, Christyâs post-treatment
the most difficult stage of the journey
in 1971, when the National Cancer
survivorship experience is not unique.
has been completed can leave survivors
Act was enacted, to over 12 million
Many cancer patients push through
feeling misunderstood and guilty for
today. Over 70 percent of children
treatment, keeping their eye on the
continuing to struggle at a time when
affected by cancer survive more than
prize, only to realize that the end of
they are expected to thrive.
10 years, and most are cured. Most
active treatment can present its own set
Fran Zandstra, BSN, MBA, RN,
cancer survivors are adults, with two-
of physical and emotional challenges
executive director of the Cancer
thirds of them 65 years of age or older
that require an entirely different
Survivorship Program at MD Anderson
and two-thirds alive at five years.â With
approach and a new set of tools.
Cancer Center, says that a patient of
this growing population of survivors,
hers once described the challenge of
managing ongoing care and side effects
BC, a nurse practitioner at the UCLA-
Often, says Amy Jacobson, RN, NP-
transitioning from active treatment to
is becoming a major concern among
LiveSTRONGSurvivorship Center of
recovery this way: âThe second-worst
providers.
Excellence, âsurvivors face the sense of
day of my life is when they told me, âYou
not knowing where to go from hereâ
donât have to come back,â because
at the University of California, Los
here being the end of treatment. During
during treatment, when youâre getting
Angeles (UCLA) Schools of Medicine
treatment itâs clear what the plan is,
medicine, thereâs something keeping
and Public Health and a researcher
but once active treatment ends, many
the cancer away; but when treatment
at UCLAâs Jonsson Comprehensive
survivors feel unsure about what tests
is over, everyone thinks, Sheâll be just
Cancer Center, says that the need
they need, who is managing their care,
like she was, but thatâs just not the
for addressing survivorship care was
and who they should go to if problems
way it is.â
officially presented to the oncology
arise.â
Patricia A. Ganz, MD, professor
community in a 2005 Institute of
Transforming the Survivorship Care
Medicine (IOM) report titled From
patients face at this juncture include
Model
Cancer Patient to Cancer Survivor: Lost
fear of recurrence, ongoing physical
According to a recent review of
in Transition. The report described the
side effects from treatment, emotional
survivorship statistics, the number
lack of best practices and guidelines
distress, ongoing financial and
of patients facing issues related to
for survivorsâ ongoing care and
insurance issues, and the lack of a
the transition from active treatment
recommended the use of survivorship
comprehensive long-term care plan.
to long-term survivorship is growing:
care plans, which would summarize
Some of the most common issues
MORE TIPS FOR SURVIVORS TRANSITIONING TO RECOVERY ⢠If possible, while still in active treatment, ask, âWhat happens next?â ⢠At the end of treatment, ask for a survivorship care plan or summary of care so that you have a pathway that says what your life is going to look like moving forward. ⢠Once youâve completed treatment, reestablish your healthcare team at home and ask questions to understand the role of each provider moving forward: What is my oncologist going to do? My primary care doctor? ⢠Make sure you have access to your records so that you have a permanent reference for your treatment history. ⢠Set manageable goals to help you make steady progress forward. Goals can be as simple as Today Iâm going to walk around the block. From Fran Zandstra, BSN, MBA,RN, executive director of the Cancer Survivorship Program at MD Anderson Cancer Center
PINK ⢠SUMMER 2013
15
Christy Stickney
w
it outlines their diagnosis and treatment and provides recommendations for their care moving forward.â The MD Anderson and UCLA survivorship programs serve as excellent examples of the good that has come from the increasing recognition of need among survivors, and there has been improvement in addressing the challenge, Dr. Ganz says. âThere has been modest progress, mostly at major cancer centers and in some community cancer centers,â she says, âand the American College of Surgeons cancer program accreditation process has now adopted this as a standard, which should result in greater uptake.â Still, she says, we have work to do to ensure that patients are provided with the the history of a patientâs cancer care
to respond to the various challenges
care they need after treatment ends.
and be passed along to any providers
that patients face during the transition
âIt takes a long time to disseminate
who care for the patient after he or she
from active treatment to recovery.
quality-of-care activities such as this,
completes active treatment.
âAt MD Anderson weâre addressing
and many barriers are raised to do this.â
Dr. Ganz says that it was in response
For patients who have not been
effects of treatment, risk reduction and
treated at a major cancer center
Society of Clinical Oncology (ASCO)
screening for second cancers, and
or community cancer center that
and the European Society for Medical
psychosocial issues. Our survivorship
has implemented components of
Oncology (ESMO) created a consensus
program is constructed around those
a survivorship program, Zandstra
statement on quality cancer care,
four domains.â Providers help patients
recommends proactive self-assessment
released in 2006, which included a
access resources across the four
and seeking out services in their own
goal for âsurvivorship care planning.â In
domains, Zandstra says, coordinating
communities. Most important, she
addition, many cancer centers heeded
medical and complementary therapies
says, is to communicate regularly with
the call for increased survivorship
to âmove from the illness focus to the
providers about any questions or issues
resources, developing survivorship
wellness focus, asking always, âHow do
that arise. âAfter treatment patients
programs and implementing the use of
we optimize wellness?â
should make a list of questions they
survivorship care plans to help patients
At the UCLA-LiveSTRONG
may have about what comes next,â
and providers navigate recovery (see
Survivorship Center of Excellence,
she says, âand they should continue
sidebar âMake a Planâ).
Amy Jacobson says, programming is
to communicate with their care team
Today, six years after the ASCO-
16
surveillance for the disease, late
to the IOM report that the American
built around the survivorship care plan.
about any symptoms.â Sometimes just
ESMO statement, a range of
âThe cornerstone of the program is the
talking about the issues that ariseâand
comprehensive survivorship program
Treatment Summary and Survivorship
hearing that they are a normal part of
models that seek to bridge the
Care Plan, which is generated from
the recovery processâcan be helpful.
gap between active treatment and
an initial visitâduring which a patient
âYour healthcare team really wants you
long-term recovery are in evidence
sees a psychologist or social worker,
to be your own advocate,â Zandstra
across the country. Zandstra says
a medical oncologist, and a nurse
says. âSaying it out loud is not going to
that the survivorship program she
practitionerâand is provided to the
make you have cancer, and your team
oversees covers four distinct areas
patient as well as their medical team;
really needs to know whatâs going on.â
PINK ⢠SUMMER 2013
Striving for More Positive Stories
to an established survivorship program,
other survivors avoid the hardship she
of Survivorship
she did ultimately find support through
faced. âMy daughter, who is eight, was
The important work being done at
her recovery by seeking counseling,
studying her spelling recently and asked
cancer centers around the country to
working with a naturopath to manage
me the meaning of the word despair,â
provide survivorship programming and
the effects of treatment-induced
Christy says. âI told her it means to give
to increase awareness of the issue
menopause, getting support from
up, to lose hope. She walked over to
is making a difference in the lives of
her church, and turning to family and
me and gave me a big hug. She told
survivorsâas are patients like Christy
friends.
me she was glad that never happened
Stickney, who by sharing their stories
Now Christy hopes that by sharing
to me. Someday I will tell her, but in
are offering hope to others navigating
her experience and describing the
the meantime my goal, my passion, is
this challenging phase of the cancer
difficult time she endured, she can
to bring awareness to this issueâto
journey.
help bring awareness of the challenge
hopefully help at least one person not
of this phase of survivorship so that
end up where I did.â m
Though Christy did not have access
MAKE A PLAN Jennifer Hausman, MPH, public health program director at WellPoint, says, âSurvivorship care plans, completed by the survivorâs oncology team, give clear steps for care after active treatment.â Hausman says that the plans begin with a treatment summary and offer guidelines for monitoring future care, including important information about monitoring for possible secondary cancers and late- or long-term effects of cancer treatment: âA care plan relieves a survivor of having So, youâre finishing up treatment and youâre wondering
to recall all the details of treatment and ensures all future
whatâs next. Who will oversee your treatment? When should
healthcare providers are working as a team for the survivorâs
you schedule follow-up appointments? Is counseling a
care.â
good idea? What kind of long-term side effects should you
There are a variety of survivorship care plan templates
look out for? Many of these questions can be addressed
available to patients and providers, but Hausman says
through a survivorship care planâa document that you can
whatâs most important is that the patient and his or her
create together with your healthcare team, which will outline
entire care team have a copy of the completed document
your diagnosis and treatment history and help guide future
so that healthcare can be coordinated and monitored after
medical care.
treatment ends. She adds that these are the important
Survivorship care plans have become increasingly
components of a plan:
popular, as cancer treatment centers strive to support
⢠Patient diagnosis and concise treatment summary
survivors through recovery. In the wake of the 2005 IOM
⢠Best schedule for follow-up tests
report outlining the need for more-standardized and
⢠Information on late- and long-term effects of cancer
comprehensive survivorship care, several organizations came together to promote the use of survivorship care plans among patients and providers. The result of the initiativeâa
treatment ⢠Psychosocial assessment and recommended interventions
partnership of the National Coalition for Cancer Survivorship,
⢠List of symptoms to watch for
the UCLA Cancer Survivorship Center, the Oncology
⢠List of support resources
Nursing Society, WellPoint, and Genentechâwas Journey Forward, which encourages patients and physicians to work together to plan for ongoing care and support.
For more information about survivorship care planning, visit journeyforward.org.
PINK ⢠SUMMER 2013
17
Run for the Cure ® News
R un for the C u re ® News
2013 SUMMER NE W
S
R
NEWS
C
R F T C
F T
PiNK Beauty Party Vol.2 in Kagoshima be held at an adjacent room to the annual Kagoshima Women's Medical Forum that attracts 5,000 guests every year. Survivors who attend have the chance to receive a free session on make-up, nail care, or hand and arm massage. The âopen classroomâ offers demonstrations by professionals
O
on hand and face care. All sessions are in n Sunday, July 7, we will be hosting
Japanese. Details at www.ann.or.jp
our second Beauty Party, this time
This year marks the 10th Kagoshima
in Kagoshima. Co-organized by Run ®
Womenâs Medical Forum, which will
for the Cure Foundation and the NPO
celebrate with a fundraising event, "Think
Anatadakeno-nyuugan-dewanakuïŒããªã
Pink", where Run for the Cure® Foundation
ã ãã®ä¹³ããã§ã¯ãªãïŒ, the Beauty Party will
has been invited to speak.
Photographs from the first Beauty Party in Tokyo. © Katsutoshi Okazaki
Tokyo Run for the Cure®/Walk for Life 2013
O
ur annual fundraiser will be held on Saturday, November 30. Please join us for
a day of great entertainment, face painting, oneof-a-kind raffle prizes and delicious food trucks at Hibiya Park â along with a 5K/10K run or walk around the Imperial Palace. Lots of fun for the whole family and all your friends! Registration and details at www.runforthecure.org/en/runwalk Photographs from the 10th annual run. © Said Karlsson/Tokyofaces.com
First Casino Night to be held at The Westin Tokyo!
W
e are very excited to announce our first Casino Night to be held on Friday,
October 4 and Big Six wheels, along with slot machines. A dinner buffet of the best Cajun food in town will be available throughout the evening, and DJ music to get you on the dance floor. Sign up at www.runforthecure.org
18
PINK ⢠SUMMER 2013
Run for the Cure ® News
Across the nation
Letâs build our first Mammo for the Cure⢠Bus! Run for the Cure® Foundation is a nationwide organization, and weâre well on our way to raising 80 million yen to build â and maintain â our first Mammo for the Cure⢠Bus that comes with mammography equipment and delivers ultrasound screening capability. Weâll be traveling on the bus to provide free screening for anyone who needs it, especially in medically underserved areas. If you, your friends, your company or organization is interested,
Mammo for the Cure Run for the Cure Foundation ®
please check out the details at www.runforthecure.org or drop us a line at inquiries@runforthecure.org
TOKYO BOSOM BUDDIES : Survivor Group in Tokyo for foreigners and English-speaking Japanese. Gatherings at Franciscan chapel center in Roppongi once a month. For details, please contact Run for the Cure Foundation at pink@runforthecure.org ®
Pick up your free copy of PiNK Magazine at the following locations. Medical Institutions Hokuto Hospital 7-5 kisen Inada-machi Obihiro-shi Hokkaido 0155-47-7799 Matsubara Women's Hospital 2018-7 Arakawa-hongo Ami-machi Inashiki-gun Ibaraki 029-830-5151 Kensei Hospital 4-524-2 Makuhari-cho Hanamigawa-ku Chiba-shi Chiba 043-276-1851 Chiba Insurance Foundation 32-14 Shin-Minato Mihama-ku Chiba-shi Chiba 043-246-0350
Other New Balance Tokyo 5-50-3 Jinguumae Shibuya-ku Tokyo 03-5774-8576 New Balance Osaka 1-6-2 Kitahorie Nishiku Osaka-shi Osaka 06-6578-9040 Tahibo 3-10-15 Izumichuo Izumiku Sendaishi Miyagiken 022-772-6201 B&D Sports Shop 2-7-1 Ichigaya Sadobaracho Shinjuku-ku Tokyo Yoga Studio Lotus 8 3-3-17 Nihonbashi Chuo-ku Tokyo 03-6825-6888 Japan Esthetic Association 2-12-4F Koujimachi Chiyoda-ku Tokyo 03-3234-8496
Rurban Clinic 138 Soufuke Inzai-shi Chiba 0476-40-7711 St. Luke's Hospital 9-1 Akashi-cho Chuo-ku Tokyo 03-3541-5151 Waseda Eye Clinic 1-1-7 Nishi-Waseda Shinjuku-ku Tokyo 03-3207-8101 Showa University Breast Centre 1-5-8 Hatanodai Shinagawa-ku Tokyo 03-6426-3905 Tokyo Kyousai Hospital 2-3-8 Nakameguro Meguro-ku Tokyo 03-3712-3151
Ginza Plastic Surgery Clinic 1-26-6 4F Minami-Ikebukuro Toshima-ku Tokyo 03-5914-0471 Nomura Hospital 8-3-6 Shimorenjyaku Mitaka-shi Tokyo 0422-47-4848 Hachiouji Nyuusen Clinic 4-8 4F Misakicho Hachiouji-shi Tokyo 042-655-5355 Mukaihara Ni-chome Clinic 2-1-19 2F Mukaihara Higashi-Yamato-shi Tokyo 03-5914-0471 Hasuda Yotsuba Clinic 2163 Magome Hasuda-shi Saitama
Niigata Cancer Centre Niigata Hospital 2-15-3 Kawagishi-machi Chuoku Niigata-shi Niigata 025-266-5111 Fujikake Hospital 876 Hiromi Kani-shi Gifu 0574-62-0030 Itouji Hospital 1-1-6 Nishi-Kagaya Suminoe-ku Osaka-shi Osaka 06-6681-2772 Toyonaka Hospital 3-1-8 Hattori Nishi-machi Toyonaka-shi Osaka 06-6864-2301
Temple University Japan Campus 2-8-12 Minami Azabu Minato-ku Tokyo 03-5441-9800
charm form (reservation only) 1-3-18 #A-90 Shibuya Shibuya-ku Tokyo 03-6418-7218
Tokyo American Club 2-1-2 Azabudai Minato-ku Tokyo 03-4588-0670
Jamrock Cafe 1-21-15 4F Jingumae Shibuya-ku Tokyo
The Westin Tokyo 1-4-1 Mita Meguro-ku Tokyo 03-5423-7000
Shibuya Corazon (manicure/ hairdresser) Shizen Yoga 40-5 B1 Kamiyamacho Shibuya-ku 201-2-5-9 Kichijouji-minamimachi Musashino-shi Tokyo Tokyo 03-3481-5888 Garasha-tei (Japanese restaurant) imageMILL Office 2-7-20-204 Sakaiminamicho 3-38-11-703 Jinguumae Musashinoshi Tokyo Shibuya-ku Tokyo 0422-31-9971 Las Chicas Aoyama
Sunroom YOGA ~Yoga Le Ciel~ 3-27-4 Kamimeguro Meguro-ku Tokyo NOS Ebisu (Bar/ Dining/ Event space) 2-3-14-B1 Ebisu-minami Shibuya-ku Tokyo 03-5773-1727 JZ Brat (Bar/ Dining/ Event space) Cerulean Tower 2F 26-1 Sakuragaokacho Shibuya-ku Tokyo 03-5728-0168
Run for the Cure Partners
Kaizuka Hospital 3-10-20 Hori Kaizuka-shi Osaka 072-422-5865 Breastopia Namba Hospital 2-112-1 Maruyama Miyazaki-shi Miyazaki 0985-28-9616 Sagara Breast Centre 3-28 Tenokuchi-cho Kagoshima-shi Kagoshima 099-224-1811 Kaneko Clinic 8-6 Kamiaratamachi Kagoshimashi Kagoshima 099-214-2800
hair Stola Giulietta Garden 2-13-7 Kichijojihonmachi 17-22-803 Chigasaki Chuo Musashinoshi Tokyo 0422-20-2273 Tsuzukiku Yokohama Kanagawa 045-943-9661 hair Cenote 1-2-1 2F Kichijojihonmachi United Airlines Lounge Musashinoshi Tokyo 0422-27-2777 Kansai International Airport
5-47-6 Jinguumae Shibuya-ku Tokyo 03-3407-6864
Delta Air Lines Executive Lounge Narita International Airport
Nail Salon Future Nail 5-47-1-1F Jingumae Shibuya-ku Tokyo 03-6427-3030
United Airlines Red Carpet Club Narita International Airport
Aroma and Yoga Salon 2-5-12-205 Chuo Kureshi Hiroshima 090-9060-1578 AKO Bandana 1-9-26 Matsuyama Miyazaki-shi Miyazaki 0985-28-9535 Hair Make Natural (hairdresser) 4-4152 Totoro-machi Nobeoka-shi Miyazaki 0982-37-7144
(Alphabetical order)
PINK ⢠SUMMER 2013
19
Five Important Advances in Breast
Cancer
How breast cancer patients are benefitting from a decade of progress By Mia James The outlook for patients diagnosed with breast cancer has been changing for the better over time, with several significant advances coming through in the past 10 years. Along with more-effective therapies with fewer side effects than traditional treatment, a greater understanding of risk and accessible preventive measures has given women everyday tools to protect themselves against the disease. Five particular advances have made a notable impact on the lives of breast cancer patients during the past 10 years. These include HER2-directed therapies, gene expression testing, hormonal therapy, lessinvasive surgery, and healthy lifestyle choices aimed at prevention.
1 HER2-Directed Therapies
reduce this risk. Specifically, these tests help determine
Wendy Chen, MD, MPH, medical oncologist at the Dana-
which patients are more likely to benefit from treatment
Farber Cancer Institute, says that therapies targeted
with chemotherapy in addition to hormonal therapy.
at HER2âhuman epidermal growth factor receptor 2,
âThese [tests] have been very effective in helping us see
a protein that promotes the growth of cancer cellsâ
who would most benefit from chemotherapy and who
have had an important impact on breast cancer survival.
would most benefit from just [hormonal] therapy,â says
Though not all breast cancers overexpress HER2, those
Jennifer Litton, MD, a medical oncologist and assistant
that do (about one in five) can be effectively treated with
professor in the department of breast medical oncology at
drugs that target this protein. These include Herceptin®
the University of Texas MD Anderson Cancer Center.
(trastuzumab), Tykerb® (lapatinib), and the recently approved Perjeta⢠(pertuzumab). âHER2-directed therapies have revolutionized the
3 Hormonal Therapy Hormonal therapy, which is used to prevent estrogen from
treatment of HER2-positive breast cancer,â says Dr.
binding to the estrogen receptorâpositive disease (cancer
Chen. She explains that because these drugs are used
that is stimulated to grow by estrogen) is not new to
for both early- and late-stage breast cancer, they can
breast cancer; tamoxifen, for example, has been available
benefit a wide range of patients (so long as the cancers
for more than 30 years. Continuing refinement of this type
overexpress HER2) and can help reduce recurrence risk in
of treatment, however, has given patients more options.
early-stage disease.
With these improvements, says Dr. Litton, âweâre able to really effectively block estrogen synthesis and effectively
2 Gene Expression Testing
treat many cancers using [hormonal] therapies without
Tests to determine the types of genes that a cancer
having to use chemotherapy.â
expresses (also known as assays) have allowed doctors
20
to tailor therapies to a patientâs individual needs. In breast
4 Less-Extensive Surgery
cancer doctors are using two assaysâOncotype DX®
It now appears that some women with early-stage breast
and MammaPrint®âto help determine a patientâs risk
cancer may be candidates for less-extensive surgery to
of recurrence or spread (metastasis) based on the types
stage the disease. To determine whether and to what
of genes that the cancer expresses (a process known as
extent cancer may have spread to a womanâs lymph
gene subtyping) and to plan treatment to most effectively
nodes, nodes are removed for evaluation. Surgical options
PINK ⢠SUMMER 2013
include an axillary node dissection, in which many nodes may be removed, and a sentinel node biopsy, in which only the sentinel nodes (those most likely for cancer to have spread to first) are removed. Women with no evidence of cancer in their sentinel nodes may be able to skip further axillary node dissection as well as the side effects associated with more-extensive surgery. Though not every breast cancer patient is a candidate for less-extensive types of surgery, these approaches have become more widely used. Dr. Chen says that there
Advances Made, Lives Saved Two breast cancer survivors share their stories.
V
alerie Tabak of Albany, New York, didnât think her outlook was good when she was diagnosed
with Stage IIIB inflammatory breast cancer in 2002.
is a âgeneral trend toward less-invasive surgeries.â She
âI left thinking that I was going to be dead,â she
explains that surgeons, for example, âdo more sentinel
says of her reaction to the diagnosis of aggressive
node biopsies instead of axillary node dissections.â She
disease. And with two children, ages 15 and 20
adds, however, that not all patients are eligible for sentinel
the time, Valerie was particularly concerned about
node biopsies alone and that some need the more-
the prognosis. Her own mother had died of ovarian
extensive surgery to determine the extent to which the
cancer, so Valerie knew what it was like to lose a
cancer has spread; only those without cancer found in
parent.
a sentinel node biopsy are eligible for the less-extensive
Twelve years later, however, Valerie is in good
approach (sentinel node biopsy only). Dr. Litton also
health. She credits much of her survival to receiving
stresses that trial findings indicate less need for extensive
Herceptin for the HER2-positive disease. She says
surgeries in some breast cancer patients but that more-
that, at the time, the targeted therapy was given
extensive approaches are still indicated for others.
to patients with more-advanced (Stage IV) disease but not to Stage III patients like her. Dr. Chen, who
5 Exercising and Maintaining a Healthy Weight
treated Valerie at the Dana-Farber Cancer Institute,
âOver the past five to 10 years, there has been increasing
Herceptin in Stage III breast cancer. Now, in addition
understanding of the role of overweight and obesity and
to seeing her children become young adults, Valerie
physical activity in terms of breast cancer risk,â says Dr.
is helping a friend who is undergoing treatment for
Chen. The benefits of these healthy lifestyle measures,
inflammatory breast cancer. âItâs really amazing,â she
she explains, apply to survivors, as they can reduce the
says. âIâve been the luckiest person.â
risk of recurrence, and also to people who have not been diagnosed, as maintaining a healthy weight and exercising appear to help prevent a primary diagnosis. âThereâs no magic diet,â Dr. Litton explains, âbut across
recommended that she enroll in a clinical trial using
W
hen Erin Oian of East Texas was diagnosed with breast cancer at age 29, she was
determined to enter her next decade with a clean
the board weight loss and exercise have been shown
bill of health. âMy one wish for my thirtieth birthday
to improve outcomes, and obesity has been shown to
was to be cancer-free,â she says, a goal she met
worsen outcomes.â These findings are significant because
just before she turned 30. âI actually finished my last
they give survivors and those looking to prevent breast
treatment the day before my thirtieth birthday.â
cancer a way to control risk with everyday choices.
Because Erin was diagnosed with Stage I invasive ductal carcinoma that was both estrogen receptorâ
Todayâs Outlook
positive and HER2-positive, she received two of
With the past 10 years of progress in breast cancer
the advances highlighted in this articleâhormonal
treatment and research, women facing the disease today
therapy and HER2-directed therapyâin addition
have many promising options as therapies become more
to a lumpectomy. As hormonal therapy, Erin, who
tailored to particular disease types and are designed to
was treated at MD Anderson, received tamoxifen
minimize side effects. And with greater understanding of risk
to block the effects of estrogen on cancer growth;
factors and preventive lifestyle choices, women are gaining
sheâll continue to take tamoxifen daily for about three
more ways to reduce the risk of diagnosis and recurrence on
more years. And for HER2-directed therapy, she
a daily basis. All in all, itâs progress worth celebrating. m
was given Herceptin.
PINK ⢠SUMMER 2013
21
THE SANDWICH GENERATION By Denise King Gillingham, MSW, CPCC
R
ecently, I was speaking with a friend and
family landscape. Before car and airline travel became so
mentioned that I was part of the sandwich
accessible, many families lived in multigenerational homes
generation. She asked me what I meant by that.
or at least within the same community. Grandparents cared
I explained that the term sandwich generation, which
for grandchildren, adult children cared for their parents,
was coined by Dorothy A. Miller in 1981, refers to those
and children lived in houses with or near extended family.
who are taking care of their parents and their children,
And there was something more: stories, recipes, dialects,
simultaneously. In fact, one out of eight Americans
and values were passed from generation to generation.
between the ages of 40 and 60 is both raising a child and
Traditions were carried on.
caring for a parent. She replied, âIsnât that what it has
creating new ways to engage in family life, as we often
That is what it has always been about.
balance caregiving long-distance with parenting and other
But the truth is, family patterns and structures have
22
Today changes in travel and technology mean weâre
always been about?â I paused. Yes. She is right, I thought.
daily obligations. Despite this new familial landscape,
changed in this country. People are living longer and
being a part of a family in meaningful ways continues to
are more mobile. These two factors have changed the
add to the richness of the lives of each generation. As you
PINK ⢠SUMMER 2013
consider the ingredients of your own family sandwich â
to provide yourself with the essential oxygen you need to
whether you live in a multigenerational home or see your
survive and provide care.
extended family only occasionally â here are five ideas to help you savor the many flavors of family.
Appreciate humor. When youâre caring for family â whether elderly parents
Interview senior family members about their lives.
or grandparents or young children â there will inevitably
This is a wonderful way to engage family in meaningful
be periods of stress and tension. At these times keep in
dialogue. Younger members will learn family history, and
mind that a good laugh relieves tension and stress and
older members will feel valued. One way to approach this
makes everyone feel better. Injecting humor into the
is to assign a topic to each family member and have each
situation can provide a welcome break from seriousness
person prepare questions on his or her topic. Consider
and can be just what is needed to reframe a situation and
recording each session for an oral history project or keep
get a different perspective.
written records. If available, have family members bring a family tree to each interview session and ask questions about it. Once the interviews are complete, consider creating a family book or documentary. There are many meaningful ways to record your familyâs unique history.
Choose your perspective. Recently, my daughters and I were supposed to go on a multigenerational family vacation. Unfortunately, my mother fractured her kneecap and needed to be in a rehab, so the trip was canceled. At that point I had a choice to
Remember what flight attendants always say: secure your own oxygen mask first before helping others. Ask yourself, Is my mask in place? If the answer is no, do what is necessary to provide yourself with the essential oxygen you need to survive and provide care.
make: If we did not go on a fun vacation, my children would be disappointed; if we did not see my parents, they
Donât be afraid to ask questions.
would have to cope with the injury alone.
If you find yourself facing a major family transition â a
Or, I could see this is an opportunity to help my parents
move, a new school, an illness, or a change in caregiving
and teach my children. My decision to take this last
roles â donât make assumptions. If there is something
route â to visit my parents so that we could help them
that you do not understand, ask for clarification. For
through this challenge â ultimately became a valuable
example, if you are hiring someone to help with an aging
teaching experience and a great vacation, as friends invited
parent, clarify the hours to be worked, responsibilities and
us to a sunny, fun place on the way home. By choosing to
expectations, and payment terms; if youâre considering
see our change of plans with a positive perspective, I was
a new school for your kids, be sure to consider all of the
able to embrace my role of caregiver and provide a great
implications to your schedule, their activities, and all of
experience for my kids.
the other family members who might be affected by the change. Discussing these things upfront will avoid difficult
Take care of yourself. If you are not taking care of yourself adequately, you will
situations in the future. It is both enriching and challenging to deal with
not be able to maintain your internal resources to take
aging parents and children simultaneously. Choose your
care of others. Taking care of yourself can mean different
perspective. Remember that you have a choice in how
things to different people. Perhaps it means watching your
you approach each situation and that you are teaching
diet, avoiding excess sugar, and walking daily; or it could
your children how to engage with family each time you
mean taking time to journal daily and going to a movie
make a decision in your role as a caregiver. If we are to call
once a week. Consider what activities fill you up physically,
ourselves members of the sandwich generation, letâs do
emotionally, and spiritually and help you cope. Remember
our best to savor the flavors of the sandwich and fill it with
what flight attendants always say: secure your own oxygen
delicious moments weâll always remember. The memories
mask first before helping others. Ask yourself, Is my
you create in these busy, fulfilling years will be part of your
mask in place? If the answer is no, do what is necessary
familyâs heritage. m
PINK ⢠SUMMER 2013
23
MORE THAN SKIN DEEP BY DEBRA JALIMAN, MD
T
hough it may seem that dermatology today
Wash your face correctly.
revolves around lasers, radio-frequency
In my practice we always teach patients how to cleanse
treatments, and other sophisticated skin solutions,
their faces. The first thing they learn is that their fingers are
learning the value of proper basic skin care is still
not enough and will never get their skin really clean. Fingers
important. In my practice I devote considerable time to
canât exfoliate and, besides, bacteria lurk under fingernails.
educating patients about two essential areas in particular:
So use cotton pads or rounds or a fresh washcloth every
how to cleanse the face correctly (the first thing I teach
time you wash your face. Donât scrub; just rub gently,
patients) and how to choose the right sunscreen. My
particularly around the nose and on the neck. Try it;
patients are always delighted to find that even minor
youâll be surprised by how much cleaner your skin feels
changes in their skin care routines can make a big
afterward. Use lukewarm water, not hot or icy cold.
difference. For even better skin, pay attention to what you
Clarisonic Sonic Skin Cleansing System, which truly does
early to get a full-body check for skin cancer.
remove more makeup, dirt, and oil than manual cleansing
Here are five tips I include in my new book, Skin Rules:
24
If youâre into gadgets, one of my favorites is the
eat and drink. And remember, itâs never too late or too
alone. Because it leaves skin cleaner and more exfoliated,
Trade Secrets from a Top New York Dermatologist
serums and treatment products penetrate better. Just
(St. Martinâs Press, 2012; $22.99).
be sure to change the brush head every two or three
PINK ⢠SUMMER 2013
months and choose the appropriate brush for your skin
babies, although adults may find it a little oily. For acne-
type; when in doubt, use the one for delicate skin. If
prone skin, EltaMD UV Clear SPF 46 or Neova Z-Silc SPF
the Clarisonic is not in your budget, Olayâs Professional
30 are very good alternatives.
Pro-X Advanced Cleansing System can be found in many
Look for a moisturizer with a sun protection factor (SPF)
drugstores and makes an acceptable alternative. Always
of at least 30, even if youâre going to be sitting in an office
use a mild cleanser with any machine.
or a classroom. Keep in mind that UVA rays penetrate glass, so your skin can be damaged even when youâre
Skin changes with the seasons and with the years, and skin care should change, too.
sitting near a window or driving a car.
Keep in mind that a cleansing routine that works in winter you a couple of years ago may no longer be effective
That suspicious-looking mole should be checked by a dermatologistâso should the ones that donât look suspicious.
because of age or changes in hormone levels reflected
It takes a trained eye to pass a verdict on moles. This
in your skin. When it comes to skin care, you should
can be a matter of life or death, so go straight to a
be observant and adaptable. For example, you need to
dermatologist. Even a few monthsâ delay can make a
change your regimen when you find yourself using blotting
difference. A pinpoint dot that most would dismiss may
papers throughout the day. I remember having lunch with
be diagnosed as skin cancer. If it has to be removed,
a friend and by chance found myself staring down into her
think how much smaller the scar will be if the cancer is
tote bag. It was a mess of crumpled facial blotting papers,
caught earlyâitâs just common sense. This is why a yearly
a sure sign that she needed to change to an exfoliating
body check is a good idea. I know that the thought of
cleanser and toner and reconsider her use of moisturizer.
standing naked in front of a dermatologist makes many
I sometimes tell my patients that if they absolutely feel
people squirm, but the reality is nowhere near as bad as
compelled in the heat of summer to use the same
they think. In my practice we do everything to make the
moisturizer they used in winter, they should at least refrain
experience as quick and comfortable as possible, and so
from putting it on their already-shiny noses.
will any good dermatologist.
may not work so well in summer. Plus, what worked for
Remember: dark skin and a family history free of skin
Choose sunscreens carefullyâand learn which ingredients are right for you.
cancer are no guarantee, so get checked.
Sunscreens come in two general types: chemical and
Eat right to look good.
physical. Chemical sunscreens are effective, but some
People need to eat protein for healthy skin and hair, but
people are allergic to the main ingredients. If you do opt for ®
this does not mean huge quantities of ribs and steak.
a chemical sunscreen, look for one that contains Parsol
Eating small amounts of lean protein like fish, egg-white
1789 (avobenzone) or Mexoryl⢠(ecamsule). In Europe,
omelets, and turkey will improve skin, hair, and nails
®
Tinosorb (bis-ethylhexyloxyphenol methoxyphenyl
without increasing weight. Skin needs healthy fats too,
triazine) is a widely used ingredient that seems to do an
like those found in fish, extravirgin olive oil, and nuts. I
excellent job, but it has yet to be approved for use in the
also recommend that everybody take a 1,000 milligram
United States. One that is available here and that my
omega-3 supplement daily.
patients like is Anthelios SPF 30 Lotion by La RochePosay, whose active ingredient is Mexoryl SX. I prefer physical sunscreens that contain zinc oxide
Eat lots of fruits and vegetables. Pick the more colorful varieties, as they are usually more beneficial. For example, a pink grapefruit has 50 times more vitamin A than a white
and titanium dioxide. They block more of the spectrum
grapefruit. Fresh or frozen berries are also an excellent
and have less potential to cause an allergic reaction. For
choice, especially blueberries. Resist the temptation to
people with rosacea or sensitive skin, physical sunscreens
have them with milk, as it blocks the absorption of the
have an added benefit: zinc oxide soothes irritation (thatâs
antioxidants.
why itâs used on babies with diaper rash) and reduces
If you have acne, keep in mind that consuming dairy
redness. The same thing goes for people with eczema.
products and sugar can make it worse. If you do eliminate
There are many excellent physical sunscreens on the
dairy, be sure to take calcium supplements.
market, and most moisturizers now have a good degree
Remember, you can use the most expensive products
of sun protection. One of my favorites is Vanicream
in the world and have the best dermatologist, but if you
Sensitive Skin SPF 30, which is gentle enough to use on
are not eating correctly, your skin will show it. m
PINK ⢠SUMMER 2013
25
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PINK ⢠SUMMER 2013
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Contents E V ERY WOM A N'S HE A LTH ã²ãšãã²ãšãã®å¥åº·ã®ããã«
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