Latest / The Body Pod / Lifestyle Medicine with Breast Cancer Oncologist Dr. Amy Comander - Insights on Prevention & Treatment

Transcript

Lifestyle Medicine with Breast Cancer Oncologist Dr. Amy Comander - Insights on Prevention & Treatment · The Body Pod

0:00
Speaker 1: Hey everyone.
0:00
Speaker 2: This is Hayley and I'm Laura and welcome to the
0:04
Speaker 2: Body Pod. Welcome back everyone to the Body Pod. Today
0:13
Speaker 2: we have the privilege of speaking with doctor Amy Commander,
0:16
Speaker 2: who is a breast cancer oncologist on the Harvard Medical
0:21
Speaker 2: School faculty, and she is board certified in not only oncology,
0:27
Speaker 2: but lifestyle medicine, and that is what we are bringing
0:30
Speaker 2: her on today to speak about during Breast Cancer Awareness Month.
0:35
Speaker 2: So let's get into the show, all right. Welcome back, Amy.
0:45
Speaker 2: We are thrilled to have you back for part two
0:48
Speaker 2: and we are in Breast Cancer Awareness Month.
0:51
Speaker 3: Thank you so much. It's great to be back with you.
0:54
Speaker 2: Is this this is also Menopause Awareness Month. I feel
0:58
Speaker 2: like we should have broken those somebody should have broken
1:00
Speaker 2: those up into different months because they're both like heavy hitters.
1:04
Speaker 4: They deserve their own month.
1:06
Speaker 3: Yes, sir, but hey, let's just go women's health. We're
1:09
Speaker 3: just glad to raise awareness and provide education. So that's awesome.
1:14
Speaker 1: Yes, great.
1:15
Speaker 2: And I was talking to last year at this time,
1:17
Speaker 2: I was talking to doctor Jessica Shepherd, and we were
1:20
Speaker 2: talking about how we need to have like a color,
1:24
Speaker 2: you know, because breast cancer has like the light pink,
1:26
Speaker 2: and then we were like, well, menopaus should have a color.
1:29
Speaker 2: Clearly nothing happened. Maybe someone's named to color by now
1:32
Speaker 2: and I don't know, but anyhow, here we are. So
1:37
Speaker 2: a few things that I wanted to ask you kind
1:40
Speaker 2: of before we dive into this, you know, lifestyle medicine,
1:44
Speaker 2: which is kind of our topic for today. I'm fascinated
1:48
Speaker 2: by it. I love that the you know, the greatest
1:51
Speaker 2: of the great are getting on board with educating patients
1:55
Speaker 2: around this because I tell you, every time I have
1:58
Speaker 2: someone on and obviously it has something to do with
2:01
Speaker 2: lifestyle help nutrition, everyone is saying the same things. I'm like, okay,
2:07
Speaker 2: so we see a pattern and you know, all of
2:10
Speaker 2: these things, which doesn't it's not new information, but it's
2:14
Speaker 2: clearly we have work to do from where, you know,
2:19
Speaker 2: to get this into mainstream still, which we just maybe
2:23
Speaker 2: I just hear it all the time. So I'm like, Okay,
2:25
Speaker 2: we're saying the same things in every field, but there's
2:28
Speaker 2: still a lot to learn. So that's really exciting. So
2:31
Speaker 2: I want to start with kind of some just some
2:35
Speaker 2: basic facts. So we talked about the different kinds of
2:38
Speaker 2: breast cancer. Last time I was just reviewing so one
2:42
Speaker 2: and there's a one in eight chance of getting breast
2:45
Speaker 2: cancer and there's over three hundred thousand cases a year.
2:50
Speaker 3: Yeah, so thank you so much for inviting me back.
2:53
Speaker 3: By the way, I love chatting with you both. And
2:56
Speaker 3: I just want to say it is Breast Cancer Awareness Month,
2:59
Speaker 3: but I like to call it Breast Cancer Action Month,
3:02
Speaker 3: which what are we doing to actually raise awareness, make
3:06
Speaker 3: it impact, help improve women's lives. So that is our
3:09
Speaker 3: share and goal. So I just have to say that.
3:11
Speaker 3: But you're absolutely right. For women living in the United States,
3:15
Speaker 3: we all have a one in eight lifetime risk for
3:18
Speaker 3: development of breast cancer. It is what it is, and
3:21
Speaker 3: some of us it may be higher because of family
3:23
Speaker 3: history or other factors. We can talk about that, and
3:26
Speaker 3: you're right. The statistics from the American Cancer Society, which
3:29
Speaker 3: were recently updated, do state that this year it is
3:33
Speaker 3: expected they're about over a little over three hundred thousand
3:37
Speaker 3: cases will be diagnosed in the US of invasive cancer.
3:40
Speaker 3: That also includes doctal carcinoma insight too, which is essentially
3:45
Speaker 3: like a stage zero breast cancer.
3:47
Speaker 1: Oh my goodness.
3:49
Speaker 2: I was actually shocked when we start to go over
3:51
Speaker 2: like the risks. Is breastfeeding a risk?
3:56
Speaker 3: Actually, breastfeeding is protective. Breastfeeding what I.
3:59
Speaker 1: Thought, yeah, decreases your risk.
4:02
Speaker 2: Okay, you must have read that wrong because I was like, wait,
4:04
Speaker 2: what this is great.
4:09
Speaker 3: But I don't want someone Obviously, we know so many
4:11
Speaker 3: women have a tough time with breastfeeding, so again taking
4:15
Speaker 3: that away, don't beat yourself up or feel bad. You
4:19
Speaker 3: know many women have challenges with that. But it does
4:21
Speaker 3: actually decrease risk, so that's good, not increase risk.
4:24
Speaker 1: Okay.
4:24
Speaker 2: I was like, wow, I shouldn't have stuck it out
4:27
Speaker 2: the first run. My my youngest did not was was
4:31
Speaker 2: all was all formula fed, and I mean he was
4:36
Speaker 2: my easiest baby, so I have nothing to say.
4:38
Speaker 1: There, eat, best sleeper, all of that.
4:41
Speaker 2: But yeah, I was like, wait a second, Okay, got
4:43
Speaker 2: that that fact straight. So as we look for these
4:48
Speaker 2: risk factors, and obviously we know genetics is at the
4:52
Speaker 2: top of the game, but what are the other risk
4:54
Speaker 2: factors that that we're looking for when we're approaching this
5:00
Speaker 2: this type of cancer.
5:02
Speaker 3: Great question, and I think it is good to highlight.
5:04
Speaker 3: You're absolutely right, genetics it's so important to think about
5:08
Speaker 3: in family history, but actually in the US of all
5:11
Speaker 3: breast cancers diagnosed in this country, only five to ten
5:15
Speaker 3: percent are dude had genes that we can currently test for.
5:18
Speaker 3: In twenty twenty four, there may be another ten to
5:22
Speaker 3: fifteen percent due to like familial factors which maybe we
5:25
Speaker 3: can't find the gene yet, maybe it's a few genes
5:28
Speaker 3: working together that increase risks. But the majority of breast
5:32
Speaker 3: cancers are not due to genes that we can test for.
5:35
Speaker 3: So that's why I encourage everyone who listens to your
5:38
Speaker 3: podcast to like, know your family history, make sure you're
5:41
Speaker 3: on top of screening, and recognize that even if you
5:45
Speaker 3: don't have a family history, unfortunately, you're still at risk.
5:47
Speaker 3: So then we talk about other risk factors. Great question,
5:50
Speaker 3: what are some factors that we can potentially change, which
5:55
Speaker 3: are what we call modifiable risk factors, and what are
5:58
Speaker 3: some factors that we can't change, you know, like our
6:00
Speaker 3: age for example. You know, so we would we could
6:02
Speaker 3: change that way, but anyway, exactly right, So thinking about
6:06
Speaker 3: the non modifiable risk factors. Yeah, so being a woman
6:11
Speaker 3: and increasing age are your biggest risk factors. So it
6:16
Speaker 3: is what it is. And then thinking about when I
6:19
Speaker 3: see a new patient, you know, we ask about other
6:22
Speaker 3: risk factors related to exposure to hormones over the course
6:26
Speaker 3: of a woman's lifetime. So we ask about what was
6:29
Speaker 3: your age of menarchy, when your period started. If a
6:33
Speaker 3: woman's gone through menopause, what was her age of menopause.
6:36
Speaker 3: If a woman's been pregnant, when did she have her
6:39
Speaker 3: first full term pregnancy? How many pregnancies did she breastfeed?
6:43
Speaker 3: Did she take you know, exogenous hormones, like we asked
6:46
Speaker 3: all of these questions. Did she have chest wall radiation
6:48
Speaker 3: for any reason? Sadly, some people have a cancer diagnosis
6:52
Speaker 3: at a young age and need radiation to their chest.
6:53
Speaker 3: So these are all the questions that we ask someone
6:56
Speaker 3: that are sort of These are like facts about someone's
6:59
Speaker 3: medical history that potentially can influence risk. But then there's
7:03
Speaker 3: the modifiable risk factors that we can all talk about
7:06
Speaker 3: what can women do to help reduce risk? And those
7:09
Speaker 3: refer to things like what is her exercise level, how
7:13
Speaker 3: much alcohol does a person drink, what does her body weight,
7:16
Speaker 3: does she smoke? You know those types of factors. So
7:19
Speaker 3: all of these come together to play a role in
7:22
Speaker 3: a person's risk. So I hope that helps address her question.
7:26
Speaker 4: I have a question about the hormone, the hormones, do
7:29
Speaker 4: you see an increase in risk for anyone who's done IVF,
7:34
Speaker 4: like several rounds of IVF, so they are pumping all
7:37
Speaker 4: of these hormones into their body.
7:40
Speaker 3: That's a great question. And certainly we know that many
7:43
Speaker 3: women need to consider techniques such as IVF to pursue pregnancy.
7:48
Speaker 3: And I would say, for the most part, the data,
7:50
Speaker 3: you know, the data suggests that IVF is safe. So
7:53
Speaker 3: I don't want someone who's thinking, oh my god, I
7:55
Speaker 3: had IVF, I'm at such great risk. Like you know,
7:59
Speaker 3: the modern techniques that are used for in future fertilization
8:02
Speaker 3: are felt to be safe. And I think if a
8:04
Speaker 3: woman wants to pursue pregnancy, she should do that. And
8:08
Speaker 3: if a woman does have a strong family history of
8:10
Speaker 3: breast cancer or if she's had breast cancer, the reproductive
8:14
Speaker 3: endocrinologist does take that into account and may use it
8:17
Speaker 3: modify the protocol that they use. So if someone said IVF,
8:20
Speaker 3: it's okay, I guess that's what I would say.
8:25
Speaker 2: Well, I'm kind of interested in the if we look
8:29
Speaker 2: at obviously we're all aging, and when you ask about
8:34
Speaker 2: like the age of monarchy and the age of menopause.
8:38
Speaker 2: What does that like does a later menopause help or hurt?
8:42
Speaker 2: And does a later menarchy help or hurt?
8:46
Speaker 3: Right, So, actually it's thinking about our body's exposure to hormones,
8:51
Speaker 3: like estrogen is the number one over the course of
8:53
Speaker 3: the lifetime. So actually earlier age of menarchy, so having
8:57
Speaker 3: a period at eight or nine actually is a greater
9:01
Speaker 3: risk factor for breast cancer later in life. And a
9:05
Speaker 3: prolonged like a later age of menopause, so that's more
9:08
Speaker 3: years of exposure to hormones that is a risk factor.
9:11
Speaker 3: So we look at all of these factors into account.
9:14
Speaker 3: It's not like they're just all pieces of the puzzle.
9:17
Speaker 3: It's a puzzle that we're always trying to put together
9:20
Speaker 3: when we're trying to help understand risk. But for an
9:23
Speaker 3: individual patient, it's actually we don't really comment particularly on that.
9:27
Speaker 3: It's just we ask these questions, but it's really it's
9:31
Speaker 3: just good to understand what potentially contributes to risk.
9:38
Speaker 4: But breast cancer is the most preventable or one of
9:41
Speaker 4: the most preventable cancers. Correct.
9:44
Speaker 3: Well, obviously I wish we knew all the reasons, oh
9:47
Speaker 3: why someone would get breast cancer. I mean, I saw
9:49
Speaker 3: a patient yesterday and her forties, healthy exercises, takes good
9:52
Speaker 3: care of herself, healthy body weight, eats healthy and unfortunately
9:56
Speaker 3: she's in my office. Right. So there's so many factories
9:59
Speaker 3: don't stand and I think that's just what's hard about
10:02
Speaker 3: medicine in general. With any medical problem, whether that's cancer
10:06
Speaker 3: or some other things that we infections, we get whatever,
10:09
Speaker 3: you know, sometimes we don't fully understand all the risk
10:12
Speaker 3: factors and why a person may get a certain diagnosis.
10:15
Speaker 4: Well, and environmental takes a big role in this, right.
10:20
Speaker 3: Yeah, we're learning more and more about environmental factors and
10:23
Speaker 3: cancer risk and you know, thinking about things like air
10:27
Speaker 3: pollution and I hate to say it, our food environment
10:31
Speaker 3: when we think about you know, our exposure to ultra
10:34
Speaker 3: process foods, particularly here in the US with our sad
10:39
Speaker 3: diet a diet. I know, both are writing education about that.
10:45
Speaker 3: So you know, there's lots of environmental factors that potentially
10:48
Speaker 3: are playing a role too, plastics too, we're learning more
10:50
Speaker 3: and more about that.
10:52
Speaker 2: Does the USA have higher breast cancer rates than other countries?
10:58
Speaker 3: Well, breast cancer is the most common cancer diagnosis in
11:02
Speaker 3: women now worldwide, so in developed nations in particular, breast
11:06
Speaker 3: cancer is still you know, after skin cancer, or when
11:09
Speaker 3: I say skin cancer, i'm you know, including like basil cell,
11:12
Speaker 3: scave of cell, and melanoma, but like you know, basil
11:15
Speaker 3: cell and squin to sell those types of skin cancers
11:17
Speaker 3: are obviously very common, but breast cancer is really the
11:21
Speaker 3: second most common type of breast cancer, and it is
11:24
Speaker 3: really worldwide the number one cancer and used to you know,
11:28
Speaker 3: so I think that's important for people to recognize too.
11:31
Speaker 4: Yeah, well, what have you seen a correlation to your
11:38
Speaker 4: dental health, like the health of your gums and in
11:44
Speaker 4: relation to breast cancer or infection or cancer of any kind.
11:51
Speaker 3: Yeah, that's such an interesting question thinking about oral health
11:54
Speaker 3: and cancer risk. Oh, I'm not particularly aware of a
11:56
Speaker 3: risk with breast cancer per se, but I do think
11:59
Speaker 3: if you think about it, I mean oral health. Are
12:02
Speaker 3: we also thinking about our microbiome, which certainly is in
12:06
Speaker 3: all aspects of our gi track, including our mouth and
12:09
Speaker 3: all going, So, you know, I think we're that's an
12:12
Speaker 3: emerging field, like learning about the gut microbiome and certainly
12:17
Speaker 3: risks for many chronic diseases, including cancer. So I wonder
12:21
Speaker 3: in the next ten years if we're going to learn
12:22
Speaker 3: more about that. So it's so exciting breast cancer. Yeah,
12:27
Speaker 3: it's very exciting.
12:29
Speaker 2: Yeah, I love the whole gut microbiome. I mean, everyone's
12:32
Speaker 2: kind of coming to the party for it. But it's
12:35
Speaker 2: it's just like in its infancy. I mean, we're just
12:38
Speaker 2: really scratching the surface of how that plays a part
12:41
Speaker 2: in everything. So I read this on one of your
12:47
Speaker 2: I don't know, in a blog or either listen to
12:49
Speaker 2: it in a podcast, but forty percent of the risk
12:52
Speaker 2: factors for breast cancer are lifestyle related.
12:56
Speaker 1: I mean that's almost half.
12:58
Speaker 3: It's huge. Yeah, So reputable organizations like the American Cancer Society,
13:04
Speaker 3: American Institute of Cancer Research, you know, when you look
13:08
Speaker 3: at large population data and try to understand contributing risk
13:12
Speaker 3: factors for breast cancer and other cancers, it is felt
13:15
Speaker 3: that up to forty percent may actually be due to
13:19
Speaker 3: lifestyle factors. So these are risk factors that we can control.
13:24
Speaker 3: And so I think it's really important to highlight this
13:26
Speaker 3: and actually a great resource which is on the American
13:32
Speaker 3: Institute of Cancer Research's website AICR dot org. They have
13:37
Speaker 3: they list this figure with like the top ten recommendations
13:41
Speaker 3: for cancer prevention, and these are all lifestyle related. So
13:45
Speaker 3: what can each of us do, What can we do
13:47
Speaker 3: to take action to hopefully lower our risk of cancer?
13:50
Speaker 3: And I'm happy to talk about those and a lot
13:52
Speaker 3: of it is stuff we've already talked about, but I
13:56
Speaker 3: think it's really important for us to be aware that
13:58
Speaker 3: our lifestyle does potentially play a significant role in risk
14:02
Speaker 3: for cancer.
14:03
Speaker 1: Well that's just alone.
14:05
Speaker 2: I mean, I'm like, if I have a forty percent
14:08
Speaker 2: less chance of getting breast cancer or any type of
14:12
Speaker 2: cancer just from my lifestyle, that's like, you know, good
14:16
Speaker 2: good bets that if you're kind of on the fence
14:20
Speaker 2: of like, well I may you know, I may I
14:23
Speaker 2: know that substance abuse or you know, alcohol intake and
14:26
Speaker 2: smoking is probably not great.
14:29
Speaker 1: Well we all know it's not great, But like if.
14:31
Speaker 2: Somebody were kind of on a borderline there, it would
14:34
Speaker 2: be really easy if I heard these statistics to be like,
14:36
Speaker 2: all right, how important is this and how important it's
14:41
Speaker 2: going to be in fifteen twenty years, you know, if
14:44
Speaker 2: I keep going at the rate. We all have our vices,
14:48
Speaker 2: and it can be different things for different different women.
14:51
Speaker 2: But let's talk about those areas of the lifestyle medicine
14:55
Speaker 2: and how we are helping you know, prevent, but then
14:59
Speaker 2: also helping, you know, with the cancer survivorship after and
15:05
Speaker 2: really seeing how that goes with your patients once they
15:09
Speaker 2: have come through breast cancer treatment and what that looks like.
15:13
Speaker 3: The American Institute of Cancer Researchers recommendations. The first one
15:16
Speaker 3: is being at a healthy body weight. We can, by the way,
15:19
Speaker 3: go into greater detail all these We know that's a
15:22
Speaker 3: challenging one. Being physically active. Thank you for all the
15:26
Speaker 3: work you do to help us with that. But that
15:28
Speaker 3: isn't when we think about cancer risk reduction. And then
15:31
Speaker 3: thinking about our diet, and there are many recommendations. Eating
15:35
Speaker 3: a diet rich and fresh fruits and vegetables, fruit lagoons, beans,
15:42
Speaker 3: whole grains so important. Limiting the ultra processed foods that
15:46
Speaker 3: are so prevalent in our diet, the fast foods, all
15:50
Speaker 3: these things out here that we're exposed to in our
15:52
Speaker 3: environment here in the US, which are things we need
15:55
Speaker 3: to cut down on. Limiting red meat consumption and really
15:59
Speaker 3: eliminate a lot of these process meats that we consume.
16:03
Speaker 3: And then thinking about limiting consumption of these sugar sweetened beverages.
16:07
Speaker 3: I know we all love to go to Starbucks, but
16:09
Speaker 3: like being mindful of what you're ordering there is so important.
16:12
Speaker 3: And then of course alcohol is key limiting alcohol consumption.
16:17
Speaker 3: And then the last two are really focusing on you know,
16:20
Speaker 3: supplements unfortunately do not prevent cancer. We can talk a
16:23
Speaker 3: whole thing about that, and then breastfeeding is protective. So
16:27
Speaker 3: those are all listed on the AICE our website, and
16:30
Speaker 3: these are all steps we can all take to help
16:32
Speaker 3: optimize our health in terms of our lifestyle to reduce
16:35
Speaker 3: risk of cancer, and they're also important for cancer survivors.
16:40
Speaker 3: So to follow these particular recommendations as well.
16:44
Speaker 1: It's it's tough.
16:45
Speaker 2: We just had a nutritionist on that lives in New Zealand,
16:49
Speaker 2: and you know, she was like, our environment is just
16:52
Speaker 2: not set up for success. And I'm like, well, I've
16:54
Speaker 2: been to New Zealand and it's way better than what
16:57
Speaker 2: we're dealing with in America.
17:00
Speaker 4: Life.
17:00
Speaker 2: So true all of these things, and I feel like,
17:04
Speaker 2: you know, where a lot of women may be like yeah, yeah, yeah,
17:07
Speaker 2: we get you know, we get the message, we get
17:08
Speaker 2: the message, but you know, it's also hard.
17:11
Speaker 1: I see the other side.
17:12
Speaker 2: We're working one on one with women and in these
17:15
Speaker 2: groups where you know, the healthy relationships and the poor
17:19
Speaker 2: sleep and the stress. It's like, yeah, great, I don't
17:24
Speaker 2: want to have any of those things, but I have them. Yeah,
17:27
Speaker 2: And that's where it gets a little bit trickier to
17:30
Speaker 2: really work on that, because that not only helps with
17:33
Speaker 2: obviously reduction of cancer risk, but that helps with body
17:37
Speaker 2: composition and that helps with you know, our our lifestyle
17:41
Speaker 2: there and how we're going to either lose weight or
17:44
Speaker 2: gain muscle. I mean, so it really comes full circle
17:49
Speaker 2: with everything that we do. So what do you tell
17:53
Speaker 2: your patients when you know they're struggling with any of
17:57
Speaker 2: these issues that are harder to tack goal.
18:01
Speaker 3: Right, I mean you raise such important points. Oh my goodness,
18:04
Speaker 3: you're absolutely right. I'm just gonna When I first wanted
18:08
Speaker 3: to start some type of lifestyle medicine based program for
18:10
Speaker 3: my patients with breast cancer, I actually wanted to just
18:13
Speaker 3: you know, think about let's talk about the diet and
18:15
Speaker 3: the exercise, and but you're so right. There are so
18:18
Speaker 3: many components of our lifestyle, which is really what lifestyle
18:21
Speaker 3: medicine focuses on, that are key when we think about
18:24
Speaker 3: that as you do in your programs too, Like again,
18:27
Speaker 3: restorative sleep so important, so many of us struggle with
18:31
Speaker 3: that thinking about social connection the community, and you do
18:35
Speaker 3: that so beautifully with your programs, and I love that
18:37
Speaker 3: that is so key to help anyone affect behavior change.
18:42
Speaker 3: Limiting risky substances such as alcohol. We could talk more
18:45
Speaker 3: about that. That's a tough one, but we really should
18:48
Speaker 3: focus on that since it is unfortunately a risk factor
18:51
Speaker 3: for cancer as well. And then talking about stress management,
18:55
Speaker 3: which you just alluded to, which is a challenge for
18:57
Speaker 3: so many of us, in particular women were juggling so
19:00
Speaker 3: many balls at the same time, and so we really
19:02
Speaker 3: need to address that too. And so all of these
19:06
Speaker 3: factors social connection, you know, I just highlight that again.
19:09
Speaker 3: I think it's so important and sometimes overlooks. So all
19:12
Speaker 3: of these factors are absolutely key to help us optimize
19:15
Speaker 3: our health. And really, like where do you start? And
19:17
Speaker 3: I think like what you would probably say, just pick
19:20
Speaker 3: one thing to start one, say that's sleep, or let's
19:23
Speaker 3: say it's trying to get more protein in your diet.
19:27
Speaker 3: Maybe just for breakfast, start with breakfast. But like, just
19:29
Speaker 3: pick one thing because you obviously can't tackle it all
19:32
Speaker 3: at the same time.
19:34
Speaker 2: Well, what would you say is too much? How much
19:36
Speaker 2: is too much of alcohol, because that's going to be
19:39
Speaker 2: the question.
19:39
Speaker 1: I feel like we.
19:40
Speaker 2: Live in this this lat last decade where you know,
19:45
Speaker 2: and especially since COVID, where we started having like women
19:49
Speaker 2: started having like these wine online wine parties, and you know,
19:54
Speaker 2: it's pretty much alcohol is at every almost every event
19:57
Speaker 2: that you go to for adults.
20:00
Speaker 3: Uh.
20:01
Speaker 2: Anyway, that just reminds me of a Seinfeld episode where
20:04
Speaker 2: George is trying to bring pepsi and he's like, why
20:07
Speaker 2: can't I bring pepsi?
20:08
Speaker 1: Because we're adults, George.
20:11
Speaker 3: So I mean, it's kind of just like.
20:15
Speaker 2: It's like it embedded into our all of our activities
20:18
Speaker 2: in our social life. But there is this pull kind
20:22
Speaker 2: of pulling back over the last I've seen it a
20:25
Speaker 2: lot over the last couple of years and still very
20:28
Speaker 2: new of like these you know, non alcoholic clubs opening
20:33
Speaker 2: and a lot of mocktails on the you know. So
20:36
Speaker 2: I feel like there is this kind of trend shifting.
20:40
Speaker 2: Where have we been using this for a crutch a
20:43
Speaker 2: little bit for some women?
20:44
Speaker 1: So what would you say?
20:46
Speaker 2: And I try to tell people like, Okay, well, it's
20:48
Speaker 2: not like you have to eliminate everything. It's you know,
20:50
Speaker 2: everyone thinks they have to come in. Okay, I can
20:51
Speaker 2: have no, I can't have sugar anymore, I can't drink
20:55
Speaker 2: like this is going to be the you know, great
20:57
Speaker 2: fun life for me for the rest of the you know,
21:00
Speaker 2: second you know, second part of my life.
21:03
Speaker 1: But how much is too much? Or is there any
21:05
Speaker 1: guidelines there?
21:06
Speaker 3: Yes, such an important and timely question since it is
21:10
Speaker 3: Breast Cancer Awareness Month or Action Month. And actually just
21:13
Speaker 3: recently another BAVE organization, the American Association of Cancer Research AACR,
21:20
Speaker 3: another reputable organization, came out with this Cancer Progress Support
21:24
Speaker 3: for twenty twenty four and it did really highlight not
21:27
Speaker 3: to be a downer, but that alcohol is a significant
21:30
Speaker 3: risk factor for six different types of cancer, including breast cancer,
21:34
Speaker 3: and also highlighted that over fifty percent of Americans are
21:38
Speaker 3: not even aware that alcohol unfortunately is a risk factor
21:43
Speaker 3: for cancer. And we think about women you mentioned, like,
21:46
Speaker 3: you know, certainly for the pandemic and people socializing you know,
21:49
Speaker 3: even zoom alcohol parties things like that, Like you know,
21:52
Speaker 3: so many women are so focused, like you know, on
21:54
Speaker 3: like eating organically and getting the exercise, but maybe drink
21:59
Speaker 3: two or three glasses of wine a night and don't
22:00
Speaker 3: even think of anything of it. So I think it's
22:02
Speaker 3: important that we spread the message that alcohol is a
22:05
Speaker 3: cancer risk factor. It is what it is. So I'm
22:08
Speaker 3: going to cite one recommendation from another organization. I like
22:12
Speaker 3: the AICR W Diority Reference American Institute of Cancer Research.
22:16
Speaker 3: You can drink, but just think before you drink. Why
22:19
Speaker 3: are you having that glass of wine? So I'll just
22:22
Speaker 3: share it a personal example. The other night, I was
22:24
Speaker 3: at a special dinner at an Italian restaurant honoring a
22:28
Speaker 3: colleague who unfortunately is leaving our hospital for another opportunity.
22:32
Speaker 3: And we were all celebrating and there's a glass of
22:34
Speaker 3: red wine being poured for everyone, and I was like,
22:37
Speaker 3: I'm going to have this glass of red wine. I'm
22:39
Speaker 3: celebrating my colleague. It's a special occasion and so I
22:42
Speaker 3: enjoyed it. But would I do that like every single
22:45
Speaker 3: night when I'm at home having dinner. No, I don't
22:48
Speaker 3: think that's a good idea. So, especially for women, we
22:50
Speaker 3: really do need to be mindful of our alcohol intakes.
22:53
Speaker 3: So I think that's a really important message that we
22:56
Speaker 3: can spread through this podcast today.
23:00
Speaker 4: That's a good tip to be mindful.
23:03
Speaker 3: Yeah, And do I need to have a second glass.
23:07
Speaker 3: Do I really need a second glass? And I love
23:11
Speaker 3: Haley that you mentioned mocktails. They are having a moment
23:14
Speaker 3: and there's so many like fun mocktails out there. Like
23:17
Speaker 3: I'll be honest, I have not really made one yet,
23:19
Speaker 3: but like I'm always inspired when I see someone showing
23:22
Speaker 3: how they make their mockdown, I'm like, oh, that looks
23:24
Speaker 3: really good. I should make that. Yeah.
23:27
Speaker 1: Yeah, it's nice to have options there.
23:30
Speaker 2: But you know, I've been seeing a theme in again
23:34
Speaker 2: just from this week in the podcast that we filmed
23:37
Speaker 2: and the nutrition course, where we've talked a lot about
23:41
Speaker 2: disassociation and really how women especially have gotten to this
23:47
Speaker 2: point where we just like disassociate. We don't even subconsciously
23:52
Speaker 2: maybe even you know, think about pouring the drink at
23:55
Speaker 2: night or eating the extra food or something of we're
24:00
Speaker 2: you know, we're living in this high stress. We're trying
24:03
Speaker 2: to do all the right things, and usually there is
24:06
Speaker 2: something obvious that I always say, if I, you know,
24:09
Speaker 2: if me or even you could go and be a
24:11
Speaker 2: ghost in someone's house for twenty four hours and watch
24:15
Speaker 2: everything that they did, it would probably be easy to spot,
24:17
Speaker 2: but they might not even know it because we're just
24:20
Speaker 2: like robotic a lot of the time, especially when we're
24:24
Speaker 2: so busy, that these things are just getting missed because.
24:28
Speaker 1: We're not present.
24:29
Speaker 2: And it's really hard to be present when we have,
24:33
Speaker 2: you know, everything going on all the time.
24:36
Speaker 3: I totally agree, and that's why I think. I just
24:39
Speaker 3: think about the programs you offer, which I'm so fortunate
24:42
Speaker 3: to be involved with right now. The power of the community,
24:45
Speaker 3: Like if you have obviously you're not going to have
24:47
Speaker 3: someone in your house with you all the time saying
24:49
Speaker 3: do you really need to eat those chocolate chips right now?
24:51
Speaker 3: But like, you know, the community support. I mean, we
24:54
Speaker 3: can provide all the education about every health and wellness
24:58
Speaker 3: topic in the world world and make it as evidence
25:01
Speaker 3: based and amazing as possible. But if we are not
25:05
Speaker 3: also focusing on what are the steps we need to
25:07
Speaker 3: do to help an individual make these behavior changes like
25:11
Speaker 3: eat more fruits and vegetables, eat more protein in her diet,
25:14
Speaker 3: strength train three to four times a week, whatever it
25:17
Speaker 3: might be, you know, we are not going to make progress.
25:20
Speaker 3: So that is really hard. As a doctor, I can
25:21
Speaker 3: tell you. Was I taught, like how do you coach
25:24
Speaker 3: your patient on behavior change? Like I wasn't really taught
25:27
Speaker 3: the coaching strategies that you have that expertise, and I
25:30
Speaker 3: think I've actually learned some of it along the way
25:33
Speaker 3: since then, but I will say that is so important,
25:35
Speaker 3: so the coaching piece and the community piece to help
25:38
Speaker 3: people make these changes because it is really hard, especially
25:41
Speaker 3: when we have so much going on.
25:44
Speaker 4: I'm so glad you bring up social health because I
25:46
Speaker 4: think it's something that is not talked about enough, and
25:51
Speaker 4: I really think that social skills are off balance. And
25:56
Speaker 4: I mean it's a proven fact that social connection helps
25:59
Speaker 4: you live longer for sure, and living a healthier and
26:03
Speaker 4: happier life creates longevity too. I just have to commend
26:07
Speaker 4: you that I was so impressed with this the first
26:10
Speaker 4: time we interviewed you, that you really focused on asking
26:15
Speaker 4: your client about their lifestyle. Because I find that a
26:19
Speaker 4: lot of doctors it's okay, you have this, this is
26:24
Speaker 4: X is wrong, and this is what we do to
26:27
Speaker 4: correct it, and they're not examining and taking a glimpse
26:31
Speaker 4: of the whole big picture. And I just I am
26:36
Speaker 4: so glad that you are doing this, and I just
26:40
Speaker 4: have to commend you.
26:41
Speaker 3: Thank you so much, and I agree that we all
26:43
Speaker 3: need to have there's this like a buzzword now and
26:46
Speaker 3: the literature it's called like whole person care, and it's
26:49
Speaker 3: like this new thing, like take care of the whole patient,
26:52
Speaker 3: ask about her lifestyle, how she's sleeping, how she eating,
26:55
Speaker 3: how she exercising. To me, I'm like, how haven't we
26:58
Speaker 3: been doing this? Like this should be like very bread
27:00
Speaker 3: and butter medicine one oh one. And it's interesting that
27:02
Speaker 3: you say that, Laura. I guess I hate to say it,
27:05
Speaker 3: not first of all, to defend my colleagues. We are
27:08
Speaker 3: very limited in time and a real tea to visit
27:11
Speaker 3: and it's just a fact. And also I will say
27:14
Speaker 3: when it comes to the lifestyle piece, a lot of
27:16
Speaker 3: us we're not really educated in medical school, residency, fellowship,
27:20
Speaker 3: whatever about all these lifestyle factors to the degree that
27:24
Speaker 3: we feel super comfortable talking and counseling our patients about it.
27:27
Speaker 3: So these are all things that I think are going
27:29
Speaker 3: to change. But you raise some really important points that
27:32
Speaker 3: as a medical field, you know, we're wondering. It's great
27:34
Speaker 3: that we can work with a wonderful team, but we
27:36
Speaker 3: also need to be doing a better job addressing all
27:39
Speaker 3: of these concerns for our patients.
27:42
Speaker 4: Yeah.
27:42
Speaker 2: Absolutely, well, if we look at a patient after treatment,
27:48
Speaker 2: so say that they are kind of in recovery, they're
27:51
Speaker 2: in a recovery period, and you know you're coaching them.
27:55
Speaker 2: What does the return to exercise look like? Now, obviously
27:59
Speaker 2: I would treated to someone who had any surgery or
28:03
Speaker 2: injury or a long time off of fitness regular movement,
28:09
Speaker 2: But are there any things that you would stay away from?
28:14
Speaker 2: Obviously I'm thinking anything chest related, But what does that
28:18
Speaker 2: look like for women that maybe out there that Because
28:22
Speaker 2: I get asked all the time like do you have
28:23
Speaker 2: a breast cancer kind of recovery program of where to start?
28:28
Speaker 2: And it's just made me pause and think about the
28:31
Speaker 2: importance of that. And I know that you offer something
28:34
Speaker 2: as well, so let's dive into that.
28:37
Speaker 3: Yes, so such an important question, because I promise you
28:40
Speaker 3: I talk about exercise with all of my patients. Many
28:43
Speaker 3: of them are listening. They know I do, and I've
28:46
Speaker 3: shared your amazing program and I will continue to do
28:48
Speaker 3: so too. So exercise is absolutely important for women with
28:54
Speaker 3: a history of breast cancer. In fact, studies show that
28:57
Speaker 3: doing regular exercise, and we can talk about what those
29:00
Speaker 3: basic guidelines are can help reduce risk of recurrence and
29:04
Speaker 3: improve outcome from breast cancer. So right there, exercise can
29:09
Speaker 3: improve an woman's outcome from her breast cancer. So that
29:13
Speaker 3: is the most important thing, right when it comes to
29:15
Speaker 3: treating my patients and helping them optimize their health, well
29:18
Speaker 3: being and wellbeing. So what are the basic guidelines? Again,
29:22
Speaker 3: let's just start with the basics, and it really is
29:25
Speaker 3: similar to what the CDC would recommend for all Americans
29:28
Speaker 3: on one hundred and fifty minutes of moderate aerobic activity
29:32
Speaker 3: each week or seventy five minutes of more vigorous activity.
29:35
Speaker 3: But let's just focus on the one hundred and fifty number,
29:38
Speaker 3: and that could be walking, jogging, cycling, kayaking, vacuuming, zoomba,
29:44
Speaker 3: whatever that may be. And two sessions of strength training.
29:48
Speaker 3: I know it's not a lot, but two sessions is right,
29:50
Speaker 3: very good, yeod. But I will tell you, and you
29:54
Speaker 3: know this from your work, like the majority of people
29:58
Speaker 3: do not meet those right and certainly when we think
30:01
Speaker 3: about the cancer survivor population, the majority do not meet
30:05
Speaker 3: those very basic guidelines. So that is where I often
30:09
Speaker 3: start with a patient, of course, probably like you do
30:11
Speaker 3: with the people you work with, Like where are you
30:13
Speaker 3: starting from? What are you doing at this time, what
30:15
Speaker 3: are you comfortable with? And really, for me, it's helping
30:18
Speaker 3: my patient. Maybe she's going to start with walking, Like
30:21
Speaker 3: I actually said this to a patient yesterday. We set
30:23
Speaker 3: a smart goal together. Maybe you can walk for fifteen
30:27
Speaker 3: minutes three times this week and see how you do.
30:30
Speaker 3: Because she's someone who doesn't exercise at all, So start
30:32
Speaker 3: with that and then gradually introduce more aerobic activity, introduce
30:38
Speaker 3: the strength training. And you do raise really great questions
30:41
Speaker 3: what if a woman just had to mastect me, like
30:44
Speaker 3: what are her limitations? What can she do? When can
30:46
Speaker 3: she start lifting weights? What is safe for her? What's
30:49
Speaker 3: a warning sign? And I will tell you I'm very
30:52
Speaker 3: fortunate where I work to work with physical therapists who
30:56
Speaker 3: have specific training and how to work with women who
30:59
Speaker 3: have had history of breast cancer. But I will tell
31:01
Speaker 3: you that many studies show that lifting weights is safe
31:07
Speaker 3: and very much important for our patient population for all
31:11
Speaker 3: the reasons you talk about muscle mass, bone health, metabolic health,
31:15
Speaker 3: and can go on and on. And there is a
31:17
Speaker 3: condition called lymph edema where a woman can have swelling
31:21
Speaker 3: of her arm on the side where she had her
31:23
Speaker 3: breast cancer, especially if she had many lymph notes removed
31:27
Speaker 3: in her surgery or if she had radiation on that side.
31:30
Speaker 3: And exercise does not increase the risk of lympho dema,
31:33
Speaker 3: it can actually help it. So it is we do
31:36
Speaker 3: get into some of the technical aspects of how a
31:38
Speaker 3: woman should be assessed, etc. But in general, exercise is
31:42
Speaker 3: good and beneficial and should be strongly encouraged for everyone.
31:47
Speaker 2: Yes, and I just want to plug this and I
31:49
Speaker 2: feel like I've been plugging it and I'm like.
31:50
Speaker 3: A broken record, so I'm.
31:52
Speaker 1: Gonna say it again.
31:54
Speaker 2: I think as women when they're coming into the field,
31:56
Speaker 2: because I have obviously all levels, but the one sort
32:00
Speaker 2: are really beginner, Like they've received the message, they're ready
32:04
Speaker 2: to go. It's there's so much information out there that's
32:09
Speaker 2: good information that's thrown at them, but that we peel
32:13
Speaker 2: back and just be like, it doesn't matter what you
32:17
Speaker 2: start with, Like just start. Don't worry about the guidelines
32:21
Speaker 2: for optimal body composition or optimal fitness or taking you
32:25
Speaker 2: know yourself to this high level. Yes we can, we
32:29
Speaker 2: can program that over time, but we start with just
32:32
Speaker 2: like what makes you happy, what gets you out the door.
32:35
Speaker 2: I mean, none of those should ever be discounted and
32:39
Speaker 2: then it's like, well, once you're there, now do you
32:42
Speaker 2: want to add something? Is there something else we can
32:44
Speaker 2: add there? But the the you know, exercise in general,
32:48
Speaker 2: there's a lot of specifics, but I want women to
32:53
Speaker 2: know that, like you start with what you can do
32:56
Speaker 2: and what you can manage, and it doesn't it's it's
32:59
Speaker 2: it's meaningless of what you know and someone else is
33:03
Speaker 2: recommending on their journey or what's optimal. If for you,
33:07
Speaker 2: this is what is making you feel okay and be
33:12
Speaker 2: active and do that. So anyhow, I mean there's a
33:16
Speaker 2: place for everyone. There is a place for everyone, and
33:19
Speaker 2: it's usually the very beginners that are very timid and
33:23
Speaker 2: just feel like, you know, they don't have the confidence
33:27
Speaker 2: yet to really get get out there and do a
33:29
Speaker 2: lot of things. So they should be doing just the
33:31
Speaker 2: bare minimum of what they can that they feel comfortable with.
33:34
Speaker 1: So let's talk about your your path to the path.
33:40
Speaker 1: What is a path to pavement? Something in pavement?
33:49
Speaker 3: I actually have a book.
33:50
Speaker 1: I didn't know you had a book, but.
33:52
Speaker 3: Actually I want to say one thing because it's actually
33:54
Speaker 3: in the beginning of this book and it's totally related
33:56
Speaker 3: to what you just said. And you're welcome to use
33:58
Speaker 3: this quote. It's not my quote, it's from like this
34:01
Speaker 3: Chinese philosopher Lao Zoo. But the journey of a thousand
34:06
Speaker 3: mile begins with a single step. So I love what
34:09
Speaker 3: you just said. Just love the first step is so key.
34:13
Speaker 3: So I love that you just talked about how the
34:16
Speaker 3: beginner struggles so much, just take that first step. So yeah,
34:21
Speaker 3: paving the path to wellness. So this is a wonderful
34:23
Speaker 3: collaboration that began with my colleague, doctor Beth Frady's five
34:27
Speaker 3: years ago. It's like hard for me to like fully
34:29
Speaker 3: wrap my head around really five years that's gone by
34:31
Speaker 3: really fast. But it's a lifestyle medicine based survivorship program
34:36
Speaker 3: for women with breast cancer who really want to learn
34:40
Speaker 3: about what we've been talking about, the evidence based recommendations
34:42
Speaker 3: in terms of nutrition, physical activity, sleep, stress management, all
34:48
Speaker 3: of these topics after diagnosis of breast cancer. So we
34:51
Speaker 3: meet virtually and each week and go over each of
34:53
Speaker 3: these topics in great detail and also work together in
34:56
Speaker 3: the community setting to help people make these behavior changes.
35:00
Speaker 3: And it's really been such a wonderful undertaking. And we've
35:04
Speaker 3: also talked about the power of community, and that's been
35:07
Speaker 3: such a key benefit of this program as well.
35:10
Speaker 4: So this program is for people that have breast cancer
35:14
Speaker 4: and then are learn living with it afterwards, like after
35:18
Speaker 4: they got that live.
35:19
Speaker 3: Offering is specifically for breast cancer survivors and thrivers. They
35:24
Speaker 3: like to call themselves that, and I love that. But
35:26
Speaker 3: I will tell you that doctor Fradie's when she first
35:29
Speaker 3: came up with this program, she was offering it to
35:31
Speaker 3: stroke survivors who at a hospital called Spaulding Rehabilitation Hospital,
35:36
Speaker 3: which is here in Boston at Philly with Harvard Medical School.
35:39
Speaker 3: So she was first offering the program there and I
35:42
Speaker 3: met with her many years ago to learn about lifestyle medicine,
35:45
Speaker 3: and then we adapted this program and I started offering
35:48
Speaker 3: specifically for women with breast cancer. But I know doctor
35:51
Speaker 3: Fradi's and colleagues, we actually have a nonprofit and we're
35:54
Speaker 3: hoping to bring this program to lots of populations, not
35:57
Speaker 3: just women with breast cancer. But my passion, of course
36:00
Speaker 3: is helping the breast cancer survivor community, and that's that's
36:03
Speaker 3: really my why.
36:06
Speaker 1: I love that.
36:08
Speaker 3: What.
36:09
Speaker 1: So you're a vegan, right.
36:11
Speaker 3: I'm I would say I've been having some salmon, like
36:14
Speaker 3: once in a while, to get my omega threes in.
36:16
Speaker 3: But like I do otherwise follow a very much on
36:19
Speaker 3: plant predominant diet, I call it that. But I was
36:23
Speaker 3: realizing I needed to find some ways to get in
36:26
Speaker 3: my omega threes, which we know are so good for
36:28
Speaker 3: our cardiovascular health.
36:29
Speaker 4: How long have you been vegan?
36:31
Speaker 3: Well, I mean I go back and forth. Right now,
36:33
Speaker 3: I'm not totally vegan. I should say i'm but gosh,
36:37
Speaker 3: when I become like essentially vegetarian a long time ago,
36:41
Speaker 3: I don't even remember. That's honestly the truth. Like, I
36:44
Speaker 3: don't even remember. I guess my daughter was nine because
36:47
Speaker 3: she she became a vegetarian at that time too, so
36:49
Speaker 3: I can do the math. So she's now, so it
36:51
Speaker 3: was eight years ago. Does she know she on the
36:57
Speaker 3: bandwagon too?
36:58
Speaker 1: Yeah, that's great.
36:59
Speaker 2: Well, I like how you talk about the plant based
37:01
Speaker 2: diet here, and this is where it's going to be, like, okay, well,
37:06
Speaker 2: we hear protein, and even with the importance of protein,
37:10
Speaker 2: that's never going away, or I don't foresee it ever
37:13
Speaker 2: going away. But if we look at the importance of that,
37:17
Speaker 2: it's hard for some women who start to change their
37:21
Speaker 2: diet and then it's really protein you know, muscle like
37:25
Speaker 2: a muscle centric approach, which is a lot of protein
37:28
Speaker 2: to support the training, but then a lot of the
37:31
Speaker 2: good fruits and vegetables might get lost in the mix
37:35
Speaker 2: because we're so pro protein. So do you have any
37:39
Speaker 2: advice on that, because you know, ideally we're all getting
37:43
Speaker 2: the thirty fruits and vegetables in a week and we're
37:45
Speaker 2: all having the right number of protein. But I mean,
37:48
Speaker 2: in like real world, it's freaking hard.
37:52
Speaker 3: It is. I know. In fact, my colleague and I
37:56
Speaker 3: shout out to my colleague, chef Laura Client. We taught
37:59
Speaker 3: a Coen medicine cooking class on Wednesday to a group
38:03
Speaker 3: of women with breast cancer, and we tried to do
38:05
Speaker 3: some education about nutrition along the way, and we talked
38:08
Speaker 3: about our favorite topic, got microbiome, protein, fiber, and we
38:12
Speaker 3: did really talk about the challenge of getting in those
38:14
Speaker 3: thirty plants, getting in your protein. So one of the
38:17
Speaker 3: things we made was this soup with lentils. Lentils are
38:21
Speaker 3: pretty awesome, by the way, my colleague Chefflara showed there's
38:25
Speaker 3: like five different types of lentils, all these different colors.
38:28
Speaker 3: I don't even know if you know, there's black lentils,
38:30
Speaker 3: yellow lentils. I was like blown away. I'm like, I
38:33
Speaker 3: need to go buy all of these pretty lentils because
38:35
Speaker 3: packed with protein. Like one cup of lentils has like
38:38
Speaker 3: eighteen grams of protein and they're packed with fiber. So
38:42
Speaker 3: you're getting fiber and protein when you have lentils, which
38:45
Speaker 3: are so yummy in a soup or you can put
38:47
Speaker 3: them in a salad, so many things you can do.
38:49
Speaker 3: So that was a tip and trick we did share
38:52
Speaker 3: with our group because we all need to get at
38:54
Speaker 3: least thirty grams of fiber a day, and most of
38:57
Speaker 3: us are not getting that either. Not to struggle, we
39:00
Speaker 3: talked about those, but it's important.
39:03
Speaker 2: Very important, and that's the hard transition is like that's
39:06
Speaker 2: what I see with women that go into like a
39:09
Speaker 2: fat loss.
39:10
Speaker 1: You know.
39:11
Speaker 2: Course with me is is the fiber takes the hit
39:14
Speaker 2: because the plant and vegetables, like all of the plants
39:16
Speaker 2: take a hit.
39:17
Speaker 1: And so if we're just like it really is, it.
39:21
Speaker 2: Seems like it's simple information have a lot of variety
39:24
Speaker 2: of fruits and veg and like have protein. We're like, okay, cool,
39:29
Speaker 2: but it's really hard to get all of those balances.
39:34
Speaker 2: But again, start somewhere. If you're eating three vegetables a week,
39:38
Speaker 2: the same ones, then maybe out of fourth. I mean,
39:40
Speaker 2: that's how I'm doing it, because it's it's tricky to
39:43
Speaker 2: do it, especially when you're in limited time.
39:46
Speaker 3: You know, Yes, I definitely agree, it's tricky, and that's
39:49
Speaker 3: why I love that. There's also you have this wonderful
39:51
Speaker 3: community so people can support each other and share ideas
39:54
Speaker 3: with each other in strategies.
39:56
Speaker 2: Yeah, I love that. And you know we're running out
40:00
Speaker 2: of time here. I'm so sad. I feel like, where
40:03
Speaker 2: does the time go? I would we can't have been
40:05
Speaker 2: talking for forty minutes.
40:06
Speaker 4: I know, I just thought the same thing. But I
40:09
Speaker 4: do want to just touch on one thing because it
40:11
Speaker 4: does breast cancer awareness. One, just to remind people, so screening,
40:17
Speaker 4: you're supposed to get a mammogram once a year, correct, correct, And.
40:22
Speaker 3: Aren't recommendations starting at age forty unless you have a
40:27
Speaker 3: strong family history or other significant rest factors, and then
40:30
Speaker 3: you would talk with your doctor about potentially starting earlier.
40:33
Speaker 3: But a woman of average risks should be starting at
40:36
Speaker 3: age forty and doing it every year.
40:38
Speaker 4: What do you think of the Pronovo scan? Am I
40:41
Speaker 4: saying it correctly, the full body pro nova scan if.
40:48
Speaker 3: You're referring to like I'm not sure specifically about that
40:52
Speaker 3: particular one, but if you're thinking about.
40:53
Speaker 4: Full body, yeah, the avagen like that.
40:56
Speaker 3: Again, I do not recommend testing like that because I
41:01
Speaker 3: will tell you anytime you order as a doctor, anytime
41:04
Speaker 3: I order a scan on any patient, I have to
41:06
Speaker 3: have a good reason why am I doing this? Because
41:08
Speaker 3: often there are incidental findings and what does that mean?
41:11
Speaker 3: Something you find that you were not looking for, and
41:14
Speaker 3: now you're going to go down that rabbit hole of
41:16
Speaker 3: chasing it and it may or may not turn out
41:18
Speaker 3: to be anything of clinical significance. I'll give a common example,
41:21
Speaker 3: and I know we're short on time. Lung nodules. Lots
41:24
Speaker 3: of us have lung nodules. They're usually super tiny, five millimeters.
41:29
Speaker 3: You see it on someone's scan, you're going to follow it.
41:32
Speaker 3: So now she's getting a scan maybe initially every six
41:34
Speaker 3: months for one or two years to make sure they're
41:36
Speaker 3: stable and nothing's growing or whatever. But now that patient
41:40
Speaker 3: is getting all these extra scans and extra exposure to
41:42
Speaker 3: radiation that she did. So I am not a fan
41:46
Speaker 3: of doing scans on people when you don't have a
41:48
Speaker 3: really good reason why you're doing it.
41:50
Speaker 4: Okay, that's great advice. I just wanted to ask, yes,
41:53
Speaker 4: since we're in this, but mammograms, yes, okay, yeah.
41:58
Speaker 2: Oh that's I didn't even think about that, But that's
42:01
Speaker 2: I'm going to do the regular one that is not
42:03
Speaker 2: as fun, but.
42:04
Speaker 1: At least it's not positating. That understand.
42:07
Speaker 2: Is there anything new since we talked to you last
42:10
Speaker 2: about six months ago in the breast cancer treatment world,
42:15
Speaker 2: Any new information that you can share or something that
42:20
Speaker 2: you found interesting.
42:22
Speaker 3: Oh gosh. In the breast cancer world, the things are
42:24
Speaker 3: always evolving, always changing. That's why my job is very
42:28
Speaker 3: exciting because there's always new research studies with new treatments
42:32
Speaker 3: and new findings that are being released. And I'll just
42:35
Speaker 3: think of one that you know is super interesting. Recently
42:38
Speaker 3: at my hospital, we had a retreat to actually focus
42:42
Speaker 3: on the role of artificial intelligence and cancer care. And
42:45
Speaker 3: that's obviously a feel and your field too. That's really
42:48
Speaker 3: taking off the power of these tools to enhance whether
42:52
Speaker 3: it's health and wellness or maybe in the breast cancer field,
42:55
Speaker 3: helping us identify cancers earlier on mammograms using all these
42:59
Speaker 3: really cool AI algorithms. I do not claim to be
43:03
Speaker 3: an expert on this, but it's super interesting. So that's
43:06
Speaker 3: an area that I think we're going to really see
43:07
Speaker 3: takeoff in the next few years.
43:10
Speaker 1: AI Get In or Get Out.
43:14
Speaker 2: I just watched that at Tesla with my son this
43:16
Speaker 2: Morning's like, Mom, look at these robots. You can you
43:19
Speaker 2: know you're gonna be able to buy one in twenty
43:21
Speaker 2: twenty six. I'm like, I feel like that's we're in Halloween.
43:23
Speaker 2: My son loves animatronics. I feel like it's an animatronic
43:26
Speaker 2: walking around the house.
43:28
Speaker 1: I don't think I'm comfortable with that quite yet, but
43:31
Speaker 1: you know, I guess you know.
43:33
Speaker 2: The AI world is, it's not going away. So it's
43:38
Speaker 2: quite interesting on all spectrums there, but fascinating information. I
43:43
Speaker 2: think I love the lifestyle approach and I love that
43:46
Speaker 2: there's so much power in lifestyle medicine and that it's
43:51
Speaker 2: kind of getting into the main medical stream and getting
43:56
Speaker 2: talked about because it really is we're all working together
44:00
Speaker 2: for someone's health, I mean, and there's lots of participants
44:03
Speaker 2: in a client's journey that you know, we all we
44:07
Speaker 2: all benefiting each other by helping out with our specific area.
44:11
Speaker 2: And so there's there's lots of good. It's an exciting
44:14
Speaker 2: time to live.
44:15
Speaker 3: Pres Surely I haven't agree with you one hundred percent.
44:19
Speaker 2: So Amy, can you tell us about is your book available?
44:24
Speaker 2: I didn't know that there was an actual book same.
44:27
Speaker 2: I'm like, we got to get the book.
44:29
Speaker 3: So this is a wonderful workbook that I was fortunate
44:32
Speaker 3: to collaborate with with doctor Beth Frady's and doctor Michelle Tollison.
44:36
Speaker 3: It's called Paving the Path to Wellness Workbook. It is
44:39
Speaker 3: on Amazon or on the publisher's site healthy learning dot com.
44:44
Speaker 3: And by the way, the proceeds do not go to
44:46
Speaker 3: meet They go to our nonprofit called Paving Wellness, and
44:49
Speaker 3: that's Paving Wellness dot org. But bottom line is, this
44:52
Speaker 3: is a great workbook that goes with our program. And
44:55
Speaker 3: I am working on one focused on breast cancer, and
44:58
Speaker 3: we also have one already written by my amazing colleague,
45:02
Speaker 3: doctor Tollison. She was the first author focused on menopause.
45:06
Speaker 3: And by the way, you would love it. It's all
45:08
Speaker 3: about it's somewhere over there palpit, but it's focused on
45:14
Speaker 3: lifestyle strategies to optimize our health during menopause, which is
45:19
Speaker 3: something that you are already an expert on so but
45:21
Speaker 3: I think you would love it because a lot that
45:23
Speaker 3: she does focus a lot, We focus a lot about everything,
45:25
Speaker 3: but certainly exercise is key in that too.
45:28
Speaker 2: All Right, I'm getting it.
45:31
Speaker 1: I feel like I order more books from podcasts.
45:34
Speaker 3: And I know it's going to be a gift for me.
45:36
Speaker 3: I'm sending it to you so, oh all of us.
45:39
Speaker 3: I am sending it to you. So I will do
45:41
Speaker 3: that because you will absolutely love it.
45:43
Speaker 2: Oh, I'm so excited. Well, thank you so much for
45:46
Speaker 2: your time, doctor Commander. We is always just a special
45:50
Speaker 2: treat to have you, especially during the month of breast
45:54
Speaker 2: cancer awareness and menopause month as well, so we kind
45:58
Speaker 2: of tackle too big women's health.
46:00
Speaker 1: Yes, women's health.
46:02
Speaker 2: So thank you so much for your time and we
46:05
Speaker 2: will catch up with you soon.
46:07
Speaker 3: Thank you so much for the opportunity, and thanks for
46:09
Speaker 3: all the amazing work you do today.
46:11
Speaker 1: Thanks for listening.
46:13
Speaker 4: If you enjoyed this episode, please consider giving us a
46:16
Speaker 4: five star review and sharing the body Pod with your friends.
46:20
Speaker 1: Until next time,