Nutrition: Taking it up a notch

Those who follow my blog know that I take my nutrition pretty seriously.  Those who know me on a personal level, see on a routine basis the choices I make to best support my health.  I believe in the power of food.  After all it is ingested just like medicine, but without all of the nasty side effects.  I will gladly change my diet in order to support my health and reduce the medications I may need to take today and in the future.  Really, to me, it seems like such a small sacrifice for health.

Even though I have read numerous books, researched online endlessly, participated in seminars, and become quite knowledgable regarding the anti-cancer diet, I am NOT a nutritionist and certainly NOT an expert!  Just like I have hired a cycling coach to optimize race performance, I decided it was time to bring in a nutritional expert.  Not just any nutritionist would do.  I wanted an expert in oncological nutrition.  Through my research, I had heard of Jeanne Wallace and her Nutritional Solutions practice.  When two people suggested I look into her program over the course of a week, I decided it was time to investigate further.  What immediately attracted me to her program was her goal of working collaboratively with my medical treatment.  Unlike many "alternative" practitioners, she is not against traditional medical treatment, chemotherapy and radiation.  Her goal is to complement and maximize medical treatment while supporting a healthy environment within the body.  It seemed like a perfect fit.

So, in order to take a little pressure off myself in trying to become an oncological nutrition expert, let alone the immense amount of time and energy my research was consuming when I would rather be out riding my bike, I have started working with the Nutritional Solutions group.  So far, my expectations have been exceeded!  I have been provided a 100-page packet on Dietary, Nutritional & Botanical Support for Breast Cancer (of which I have proudly read in its entirety!), packets on Nutritional & Botanical support to complement chemotherapy and radiation, handouts on agents that interfere with, boost efficacy, and reduce side effects for each of my chemotherapy drugs (did you know that Shallots are contraindicated with Epirubicin???) and two telephone consults to come up with a customized nutritional plan to complement my medical treatment.  Thus far, I have been highly impressed with the team's professionalism, knowledge, thoroughness, and genuine concern for my well-being.  I am confident in their recommendations, as they use research to guide their practice, and phew, it takes a lot of pressure off me!

Their plan focuses on six areas: reducing inflammation, boosting the immune system, apoptosis & differentiation, anti-angiogenesis, impeding metastasis, and hormone modulation.  Perhaps someday I will write in more detail about our nutritional approach, but in the meantime,  since I have a little bit of extra time thanks to the super smart folks at Nutritional Solutions, I think I will go ride my bike!

I have just about completed my summer bucket list of high mountain rides

These old mines scatter the Park City mountains

Another day, another beautiful view.  

Seriously, I need to pinch myself.  I can't believe I live here and ride these mountains everyday!

Goodbye ponytail....

....I hope to see you in about two years!

Today was the day.  The big chop.   Honestly, it was a bit melancholy for me as I have spent the past two years growing my hair out and just a few short months ago I finally was able to pull it back into my trademark ponytail.

Knowing that chemo is right around the corner, and the fact that it is much easier to lose short hair than long hair, I made an appointment with my trusty stylist, Erika, at Evolve Salon.  The first time Erika cut my hair was the big chop back in 2011.   She has a great spirit and makes haircuts fun.  Even when you are cutting off your beloved ponytail!  Today, I gave her an idea of what I wanted and she went to town.  As usual, she did not disappoint.

So I love, love, love my ponytail, but I must admit I don't look toooooo shabby with super short hair, although as usual Dizzy dog steals the shot with his handsomeness!

No, I didn't ride off into the sunset!

You know you are overdue to update your blog when you start to get messages, "Where are you?  Did you ride off into the sunset"?

Well, I haven't exactly ridden off into the sunset, although I have been doing quite a bit of riding!, but I have also been quite busy... busy figuring out a treatment plan, busy getting all my ducks in a row before I start treatment, and busy preparing myself and my body for this unexpected and frankly undesired second round of treatment.

In my opinion, one of the most important things about a cancer treatment plan is to believe in and have confidence in your plan.  Like I mentioned in a previous post, I knew that chemo, radiation, and switching Tamoxifen to an Aromatase Inhibitor was inevitable, but I was feeling like we were stabbing in the dark in choosing a chemo regimen.  If I am going to put my body through the toxicity of chemotherapy for a second time in two years, I want to be damn sure we are choosing the best plan.  For this reason, Shannon and I sought a second opinion, all of the stars aligned, and we were able to travel to MD Anderson Cancer Center in Houston, TX.

MD Anderson has the reputation of being one of the best cancer centers in the country and people travel there from around the world to get advice and treatment.  Even the size of the facility is overwhelming.  Shannon and I estimated that the cancer center itself was larger than University of Utah Hospital and Huntsman Cancer Institute put together.

"The Tree" in Mays Clinic at MD Anderson Cancer Center

Our whirlwind trip of less than 24 hours was to attend the 2nd opinion clinic in hopes of coming up with a chemo regimen that we felt confident about.  Without going into nitty gritty details, and I could fill up pages with details, our expectations were met and we walked away with a plan!

MD Anderson has patient robes similar to what you wear at the Spa.  

Although it wasn't exactly a Spa appointment, I'll take a nice robe over an icky gown anyday!  

Yes.  Chemo, radiation, and switching to an Aromatase Inhibitor were all recommended, but the chemo regimen was tweaked a bit by the MD Anderson oncologist with reasoning and justification that made perfect sense to us.  It was a very worthwhile trip!

So without further ado, here is the plan:
1.  Chemotherapy to start ASAP at Huntsman:  FEC (5-FU, Epirubicin, Cyclophosphamide) x4 with 3 weeks between each infusion.
2.  Radiation:  Although I have NOT yet met with the radiation oncologist I am expecting radiation therapy five days/week for five consecutive weeks.
3.  Ovarian suppression and initiation of Aromatase Inhibitor.

Well that's the plan. Am I happy about undergoing treatment again?  Nope.  But I am confident in my plan, and believe that it, along with everything else I am doing to promote an anti-cancer environment in my body, will be effective.

Moving on.....

Besides figuring all of this out, I have been a very busy bee.  In the past few weeks, in addition to traveling to Houston, we have traveled to St. George, Utah to work on our condo twice and I have participated in two super-fun photo shoots; one for Deer Valley Resort and one for my race team, Epic Brewing/MTBRaceNews.com.   Then, in my "spare" time, I have been taking care of my body and mind as best as possible to prepare it for this second round of treatment.  So basically, I have been riding all of my favorite trails!

Here's some photos from recent rides that just make my soul happy:

 One of my favorite places: Shadow Lake

 Outriding an afternoon thunderstorm on the Crest

 Dropping the Spine on my Pivot 429C

 Cruising along at 10,000 feet

 Pure joy

 The mountain wildflowers are popping with help only from nature, yet I can't keep my grass alive.  Hmm....

Oh the places my bike takes me: Desolation Lake

And some teasers from our Epic Brewing/MTBRaceNews.com photos shoot:

Photo: CottonSox Photography

I'm pretty sure I was cracking up here when I saw "CottonSox" in the dirt under the bridge!    
Photo: CottonSox Photography    

Stay tuned as more updates and posts are in the works!  

I am a dandelion.

As much as I am frustrated with my body for having to undergo cancer treatment again, I am also amazed at its resiliency.  Just over three weeks ago I underwent Axillary Lymph Node Dissection.  Two short weeks ago I was not yet healed enough to ride off road-although that didn't really stop me:)  Last weekend, I rode consecutive days off-road with no issues and this weekend I raced.  Yes, you read that correctly, I raced my mountain bike and it hurt so good!

Honestly, the thought of squeezing in another race prior to starting treatment never EVER crossed my mind until last weekend after two fabulous, complication free mountain bike rides had me feeling happier and more focused and relaxed than I have been in weeks.  Not that I have been going around moping, but the prospect of racing my bike added a skip to my stride and an extra big smile on my face.  I started to tell a few friends that I was entertaining the idea and as the week passed became more and more excited.

The fact that I had done no structured training and absolutely no race-effort intensity since 12-Hours of Mesa Verde in May wasn't ideal, but I also knew that I had a solid training base and fitness doesn't just disappear.  At least that is what I hoped.....

Well, we almost didn't even make it to the race venue as there was a semi-truck on fire blocking the Eastbound lanes in Parley's canyon.  Fortunately we were able to squeeze through after being stopped for 45 minutes and made it up to Park City just in time for a short warm-up prior to the slightly delayed race start.

The race:  USCS#3-Round Valley:

The Pro Women's field was small, just me and Erin.  A few pro girls had traveled to Montana for the Pro XCT race and a few were either stuck in Parley's canyon or didn't want to deal with the interstate jam.  Regardless, Erin is a formidable competitor, she has had an outstanding season, and finished less than a minute behind me after five hours and 50 miles of racing at the True Grit earlier this year.  She is also super nice and I was psyched to be racing against her.  We started off pretty slow on a dirt road into a really strong headwind.  I tucked behind Erin for a few seconds and she tucked behind me for a few as well, but for the most part we rode fairly side-by-side into the stiff headwind.  I led into the first singletrack climb and noticed that I had a small gap by the top.  This gap seemed to open even more on the next downhill, but Erin was never far behind.  I tried to ride the next 26 miles smoothly, efficiently, and consistently never letting off the gas, but never attacking as I was not sure my lack of recent high-end efforts would allow me to recover.

Temperatures were perfect for racing

(photo: Chris See)

and the Park City backdrop is always amazing

(photo: Chris See)

I spent most of the race going back and forth with some of the Expert Men.  Normally I would just attack and try to drop them, but today's strategy was smooth, efficient, and consistent.  

Based on the amount of dirt on my face, I clearly ate a lot of their dust, but

I also got a nice draft going into the headwind on the final lap.

(Photo: Chris See)

On the final lap my legs started to cramp.  After two hours of racing, the intensity finally took its toll. 

I focused all my energy on keeping my leg muscles relaxed and turning the pedals over.  

Photo: Lisa Palmer-Leger

 After just over two hours of racing, I took the victory!  

My legs immediately seized and I couldn't walk for about ten minutes.  

Photo: MTBRaceNews.com

It was totally worth it!  

Photo: MTBRaceNews.com

After the race, a friend compared my resiliency to a dandelion.  You can tear me down, dig me out, spray me with chemicals and I just keep popping back up.  Hopefully, stronger and more beautiful than ever.  Here's to my 2013 mantra:  I am a dandelion!  

Photo Shoot

Undergoing treatment for breast cancer in 2011 was the most difficult thing I have ever done.   Recovering from treatment, maintaining my zest for life, and regaining health and fitness is what I am most proud of.  As we embark on Round 2 of treatment, Shannon and I wanted some photos, of higher quality than our typical iPhone facebook photos, to document how far we've come.  I also figured that since my beloved long hair that I have spent two years growing out is about to go, yet again, that we should document it!

So I called my friend and professional photographer, Anna Pocaro Manley, who volunteers her time to Heal Courageously, a non-profit that takes professional photos of people and their families who are undergoing treatment for cancer at NO COST.

Anna is an absolutely amazing photographer.  Somehow she was able to capture beautiful photos of two of the biggest nerds ever!  Her photos are all so good that I am having a hard time choosing favorites.  Anna has her own business so even if you are not undergoing treatment for cancer, she will take photos of you, your family, or whatever you want.  She is also quite adventurous and I am pretty sure she was ready to hike up a mountain for our photo shoot!  Fortunately we found a beautiful and accessible location right at the base of the mountains.

Some normalcy before the storm

Last weekend my surgeon okayed me doing a short mountain bike ride.  Not because I was necessarily healed enough, but because it would be good for my soul.  Both were true.  I experienced a little tightness and swelling the next day, but man did it feel good to be riding through trees.

After my short set-back, my body once again kicked into healing overdrive and I am so happy to say that I have been taking full advantage of it.  I have hit dirt five consecutive days-sans any swelling or tightness-and I am the most focused, content, and relaxed that I have been since my life took a wrong turn a month ago.

Some highlights from the past week:

 Helping teach skills at the Roxx Rides clinic. 

 I really, really, really enjoy sharing knowledge with fellow cyclists!

My trademark style

A great group of ladies show up for these rides!

 A new sign at the top of Flying Dog.  This trail is waaaay too fun to rip to slow down.

 Park City Point to Point pre-ride with my favorite riding partner

This is what I call the result of a very good day!

Up Next:  In my last post I mentioned that treatment would likely start June 18th.   It is now looking like this will be postponed.  We are awaiting results for a test that Shannon and I requested, the Caris Molecular Profile.  These results may help guide us in choosing the most appropriate and effective treatment as opposed to just stabbing in the dark.  I am hoping that the results give us some clarity as we choose treatment.  We are also working with MD Anderson in Houston for a 2nd opinion and if all works out should be traveling down there in the next week or so.  My oncology team at Huntsman has been supportive of these decisions and as usual I am blown away by their thoughtful recommendations and excellent care.  

In the meantime, I plan to take full advantage of this short delay... 

2013: The Plan

Undergoing cancer treatment...again...was certainly not the plan for 2013, but based on the events of the past few weeks it is looking like it will consume us for the rest of the year.

Here's the scoop:

Surgery went well.  I was a bit groggy the day after, but by weekend I was doing easy hikes with Shannon and Dizzy and my drain.

 I think this is totally disgusting, but this is where the drain comes out of my body.  

You can see why it is an infection risk.

 It drains into this bulb which I empty and measure a couple times daily.  

Once 25 cc or less is produced for 2 consecutive days, the drain can be removed.  

  

The drain never produced very much despite me being fairly active so it was removed six short days after surgery.

Freedom.

Actually, I still had the drain for this hike

That same day Shannon and I met with my medical oncologist.  This is what we learned:

It is suspected that my sentinel lymph node biopsy from 2011 was a false negative and based on this alone my risk of distant recurrence is statistically increased.

My oncologist had two theories for why these axillary cancer cells survived my first round of treatment:

1- The cancer cells were already established in the lymph nodes back in 2011.  Decreased bloodflow to the area due to the nearby surgical site reduced the effectiveness of chemotherapy and the cells were either too well established for Tamoxifen to be effective or my body is resistant to Tamoxifen.

2-The original cancer is resistant to treatments that have been given.

If #1 is the case, surgery and radiation is most likely curative.  If #2 is the case, new treatments are needed as there may still be rogue cancer cells lurking around in my body waiting to find host in distant organs.

Based on my young age, good health, and potential to live a long, cancer free life, the consensus is for me to undergo chemotherapy followed by radiation followed by changing Tamoxifen to an Aromatase Inhibitor.

This decision was not taken lightly by anyone, especially me.  It takes more than one hand to count the number of oncologists I have consulted with.  With additional treatment there are always risks, some life threatening and some that could significantly affect my quality of life, and it is scary as hell.  That said, there are some folks who love me too much for me to risk the gamble of not undergoing additional treatment.  You can bet that I will be doing everything I can to protect my health through this round of treatment.

On top of that, I had to get tested for Hepatitis A because I have been eating the Costco organic frozen berries involved in the recent Hep A recall.  Thankfully, the test came back negative.  I also had a pelvic ultrasound that came back negative.

Now that my body has been poked, prodded, and scanned in just about every way possible, I am ready to start the next step of treatment.  Chemo is scheduled to start June 18th.  Exactly 2 years from my final Neulasta shot in 2011.

My plan is not to hunker down and just 'get through' the rest of the year.  Instead, I plan to enjoy life as much as possible.  Maybe I'll even try some new things.  I did already declare 2013 the summer of skirts!