Basic banana body builder

If your appetite is suppressed, if you need to build up muscle, if you need to put weight on, or if you are worried about insufficient protein.

4ozs (100g) plain tofu (silken tofu makes a smoother drink)

1 pink (500ml, generous 2 cups) soya milk

2 bananas

2 tablespoons organic maple syrup

1 tablespoon slippery elm powder

2 teaspoons vanilla essence

Whizz together in a goblet blender or food processor until smooth and creamy

If you have difficult drinking from a glass, use a teaspoon and eat it from a small bowl like dessert, or add more soya milk to thin it and use a pretty straw.

 

Try any of these additions or flavour variations

2 tablespoons ground almonds

2 tablespoons cooked brown rice/millet/oats

Any fresh fruit – try mangoes for a real treat

Soaked or cooked dried fruits

1 teaspoon honey or concentrated apple juice

1 tablespoon organic, sugar-free preserves

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

 

What is normal?

Let’s normalise a few things right now:

• There is no “right way” to make sense of what a cancer diagnosis means in anyone’s life
• We can’t expect everyone to react in a similar way, or say the same things as anyone else – each person is unique and of course their response to their cancer treatment will be individual as well;
• It’s very common for people to feel confused, disbelieving or angry when newly diagnosed, but this is not true for everyone;
• Sometimes our bodies even respond to the stress and shock with physical responses – headaches, nausea, diarrhea, sighing, poor sleep patterns etc; and
• Often people look forward to the end of treatment, but sometimes folks feel fearful, uncertain, or more emotional than they did during the treatment.

Blog by Clare Manicom, Oncology Social Worker

The importance of psycho-social care

First up, let’s be clear that our precious family members and our special friends cannot be our therapists.  The honest ones among them will tell you that they really don’t want to be our counsellors either – they just want to be their normal selves – mom, friend, cousin etc.

Then, while we’re being honest – most of us try to protect the people we love from the ugly, ungrateful, hurtful, or dark thoughts that we have around the topic of cancer, its treatment or an uncertain future.  Which makes it hard to truly share with any one person exactly what we’re thinking or feeling.

• We edit what we share
• We filter what we hear
• We are selective about what we remember

So suddenly it’s very clear that actually, it’s pretty tough chatting through our deep emotions with people who are important to us.  We might not have the words to say what we’re feeling, we might not know what to think.  We usually don’t even know where to begin with our emotional “stuff” that we’re told we have to “deal with”.

And that, very simply, is why it is so helpful to meet with a neutral, objective, trained and skilled person when you’re feeling scrambled, low, overwhelmed or plain pissed off.  It is a huge relief to offload on someone whose job it is not to judge you, but to listen to you.  Their job is to calmly provide a safe space where you can say what’s on your heart, cry or rant without hurting anyone’s feelings.

There will be times when that professional needs to challenge your opinions or perceptions, or may need to provide you with clear information that will help set you on a better path.  There are times that your listener may probe a little deeper, or may ask you questions that make you think and reflect more carefully – all this is part of your healing journey.

Seeing someone for emotional support might mean having a few sessions to examine different issues or concerns, or practice new skills in between sessions.  You will not always come away from a session smiling and jumping for joy – sometimes we need to have a “heavy session” that may include tears or rage, as a catharsis.  What you should feel every time is that you have been heard and acknowledged as an individual.  Often you will feel a sense of relief or lightness that you’ve been able to speak your mind – you’ve been brave and honest enough to express yourself and that is an important beginning point…

A social worker with medical or oncology experience will be able to provide emotional support with an understanding of the psychological impact of cancer and its treatment, as well as having insight into some of the practical challenges that people face.  Most State oncology departments employ social workers, and some private practices offer this service as well – ask your oncologist and ask again if you’re not given names to contact!

Some people are keen to join a support group when facing their illness and treatment.  As these groups are run in different ways by different organisations, ask your local clinic about what may be available in your area.  Remember that groups run for the purpose of sharing information are not designed to provide in-depth emotional support, so make enquiries about the purpose of the group, and about who runs it to help you decide whether it’s a comfortable place for you to be or not.

Social media may also be a source of general support but it’s advisable not to risk your in-depth personal emotions in a public forum, or to take advice from people who may not have the professional skills or training to provide psychological support.

Blog by Clare Manicom, Oncology Social Worker

Targeted biological therapies

Approximately 20% of breast cancers are known as HER2 positive. This means that a gene mutation has caused the cells to have an over expression of HER2 receptors and this protein signals the cancer cells to grow and divide.

The HER2 receptor can be tested for by:

1. Immunohistochemistry (IHC)- which shows how much of the protein is on the cell surface
2. In-situ hybridisation (ISH)- which tests the number of copies of the gene inside the cell..

HER2 positive breast cancers tend to be more aggressive than HER2 negative cancers.

Trastuzamab (Herceptin) is a biological therapy that has been designed to specifically target the HER2 receptor in HER@ positive breast cancer. It reduces the risk of recurrence and death in women with HER2 positive breast cancer and prolongs survival in women with HER2 positive metastatic breast cancer.

Lapatinib (Tykerb) is another “HER receptor blocker” that is sometimes used in combination with Herceptin

Side effects:

Although Herceptin has been shown to have greatest benefit when used in combination with chemotherapy, it is not in itself a chemotherapy treatment. Chemotherapy treatments affect all rapidly dividing cells whether they are cancer cells or healthy cells.

Herceptin, however, targets only those abnormal cells with increased display of the HER2 receptor and it spares the healthy cells.

For this reason the side effect profile is substantially less.

Its main possible side effect is on the heart and the use of Herceptin in some patients may require baseline and periodic cardiac function tests. This side effect is usually reversible. In some cases hypersensitivity or allergic reactions can occur and for this reason it should be given in an appropriately equipped facility by staff who are trained to manage a possible reaction. Other less common and mild side effects may include fever, throat irritation and runny nose.

It is an intravenous therapy administered via a peripheral drip into a vein ideally every 3 weeks for one year.

However, it is unfortunately extremely expensive, not yet available in State hospitals and not covered by many Medical Aid schemes.

For those who can afford it, or those whose medical aids will cover it, Herceptin has significantly improved the prognosis and survival of patients with HER2 positive breast cancers to the extent that the outcomes are even better than some patients with HER2 negative breast cancers!

This blog was kindly supplied by Ronelle de Villiers at http://www.capebreastcare.org

 

Keeping cool in the tough times

It is hard to imagine feeling hot and bothered in our chilly winter weather, but cancer treatment can play havoc with our normal body temperature.

And even if you are not feeling the heat, you can always do with a fruity vitamin boost!

Two Coolers
When you feel hot and bothered or sore try these to soothe and refresh.

Strawberry and Citrus Sorbet

Fresh juice of 2 big oranges
Fresh juice of 1 pink grapefruit
Fresh juice of 2 tangerines
Zest of 2 organic oranges, finely grated
10ozs (250g,2 cups) fresh strawberries or raspberries, cleaned
5 tablespoons maple syrup

Whizz together in a goblet blender or food processor. Pour into a shallow dish and freeze for 2-3 hours. Break into chunks and process again (using a sharp blade) until smooth and creamy. Return to the freezer for 30 minutes before serving. If you want to leave it longer in the freezer put it into little ice-lolly moulds at the final freeze and get them out as you feel the need.

For a change with added food value, try adding:

4ozs (100g, ½ cup) plain silken tofu
2 tablespoons more of maple syrup
2 teaspoons vanilla essence

Include frozen bananas at the final whizz stage before the second freeze.

Frozen Bananas

The simplest soother ever! Just peel ripe, firm and perfect bananas, wrap them individually in kitchen wrap/film and freeze overnight. Nibble on them whenever you fancy something cool and creamy. Don’t keep them in the freezer for too long, just do a few at a time.

If you can find sugar-free carob drops (try health food shops) melt them like chocolate in a ‘bain-marie’ (double saucepan) and dip your bananas in for an iron fortified, luxurious treat.

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

Rice porridge for the tough times

Creamy rice porridge

Delicious, nutritious and comforting. Traditional oat porridge is good too but try this one for extra food value. It is well worth the investment in a small ‘slow cooker ‘as it will be perfect at breakfast time. It keeps for 2 or 3 days in the fridge. Re-heat with a little extra soya milk or enjoy it cold with maple syrup, a chopped banana and a sprinkle of sesame seeds.

2ozs (50g, generous ½ cup) brown rice

2 pints (1 litre) soya milk

Handful of dried fruits (optional)

Cook overnight in an electric slow cooker. If you do not have an electric slow cooker then just bring to the boil in a nice heavy casserole, lower heat to barely simmering, cover and cook for 2 ½ hours. You may need to add a little more soya milk. You can also pop it into a low oven for about 3 hours.

Serve with a little maple or date syrup or compote of fruit.

You can add any dried fruit you like – it is especially scrumptious with apricots or dates.

Thanks to Dr Rosy Daniel, who has generously shared The Cancer Lifeline recipes with us. This recipe is for the Tough Times, for use when you are very ill, during treatment, while the appetite is poor and the weight low.

Staying active and healthy

We’re on a mission to help you to live an active and healthy life during cancer treatment, to empower you actively to cope with the cancer journey.

The recipies we are sharing are part of that, and here is a great list of things to do (and not to do) to make your journey easier.

Do’s:

• talk with your loved ones about your feelings of loss, speak to other breast cancer survivors, find support online
• get adequate pain medication
• contact your doctor or nurse when you develop problems
• massage the scars daily, dry or gently with a non-irritating skin oil. There’s a good video here to help you.

• get information of breast prosthesis and options (cansa.org.za, www.reach4recovery.org.za)
• eat healthy, stay active
• do shoulder exercises

Don’ts:

• push yourself: be mild and accept the pace your body is healing at
• lift or carry anything heavy for the first few weeks after surgery. This includes vacuuming, shopping and lifting a full kettle or a child.

Watch out for:

Wound infection

If your operation site becomes red, inflamed, or painful, or there is a fluid (discharge) leaking from your wound site, you may have an infection. Contact your surgeon or breast care nurse immediately. If you have an infection, you will need antibiotics to clear it up.

Fluid collecting around the operation site (seroma)

Sometimes fluid continues to collect near the wound after your wound drains have been taken out. This is called a seroma. It causes swelling and pain and can increase the risk of infection. The fluid usually goes away on its own. Sometimes a nurse needs to drain the fluid off with a needle and syringe. They may need to do this a few times.

For some women, the fluid takes a long time to go. It can take up to a few months after your surgery.

Nerve pain

You may have numbness or tingling in your upper arm, particularly if you had your lymph nodes removed. This is normal and happens because some nerves are cut during the operation and need to repair themselves. It can take a few weeks or months to go. If it continues, get in touch with your breast care nurse or surgeon.

Swelling of your arm or hand

You may have some swelling in your arm or hand after your operation. This is normal. But it should start to go away as you do the exercises (see below) to get back the movement of your shoulder and arm.

If you continue to get a lot of swelling, heaviness, pain or tenderness in your arm or hand, let your breast care nurse or surgeon know as soon as possible. After surgery or radiotherapy to the armpit, there is a risk of developing permanent swelling called lymphoedema. Once you have lymphoedema it can’t be cured but early treatment can effectively control it. Look at the information about lymphoedema page for ways of preventing lymphoedema.

Scar tissue in the armpit (cording)

Some women develop scar tissue in the armpit (axilla), which forms a tight band. This can happen 6 to 8 weeks after the operation. The scar tissue is called cording or banding and can feel something like a guitar string. Cording is harmless but can be uncomfortable. It can get better after some time if you massage the area of the scar tissue. Your specialist nurse or a physiotherapist can teach you how to do this.

This great advice was shared with us by the fabulous physiotherapist Liesbeth Raymakers

 

 

Keeping the balance

Over the next couple of weeks, we will be posting a series of recipies that will help you as you go through treatment. The Cancer Lifeline recipies are divided into three phases:

• Tough Times, for use when you are very ill, during treatment, while the appetite is poor and the weight low.
• Clean Machine, for detoxification of the body, post cancer treatment, or to kickstart a holistic health creation programme.
• Eat Right, to set the right style of eating for the rest of your life to generate optimum health.

The recipies have been created by celebrity chef and nutrition consultant, Jane Sen, for the nourishment and healing of people with cancer. The recipies are part of the Cancer Lifeline Kit by Dr Rosy Daniel, which she has generously shared with us.

Reconstruction after mastectomy

There are various types of reconstructions that can be offered to a patient after a mastectomy. There are many factors that need to be considered before one can decide on a reconstruction and this needs to be discussed between the patient and the surgeon. Each person is different and the type of reconstruction is based on many various factors including:

1. The choice of the patient as discussed with the surgeon and multidisciplinary team
2. The type of cancer
3. The location of the cancer
4. The build of the patient
5. Involvement of the nipple
6. Whether the patient will still need radiotherapy or not

 

There are many types of reconstruction, most of which are available in South Africa. Reconstruction can be done as an immediate reconstruction or a delayed reconstruction.

1. A flat chest: many people will request a flat chest. Women will often choose this procedure as it is a fairly quick operation with minimal pain post operatively and has a low risk of complications. A prosthesis with a special mastectomy bra can be fitted a few months after the operation. The patient can also have a reconstruction a few years after having a flat chest mastectomy, this is known as a delayed reconstruction.
2. A reconstruction using expanders: this is where an expander is placed beneath the muscle in the chest wall. It is then inflated every few weeks until it reaches the appropriate size. An operation to remove the expander and replace it with a prosthesis will follow.
3. An immediate reconstruction using prosthesis: this is done in certain cases where a skin sparing mastectomy is performed and the tissue is immediately replaced with a prosthesis.
4. Reconstruction using body tissue:
5. A flap from your back (latissimus dorsi flap) – the surgeon will make a new breast by using the muscle, skin and fat from your back.
6. A flap from your abdomen (a TRAM flap) – the surgeon uses part of the muscle with its skin, fat and blood vessels to make a new breast.
7. A flap from your abdomen (a DIEP flap) – the surgeon takes only the fat and skin from the abdomen to make a new breast. This procedure often has a very good outcome as the breast looks and feels natural as it consists of fatty tissue.
8. A flap from the thigh (TMG or TUG) – the surgeon will use the fat, skin and muscle from the thigh, either making use of the outer or inner thigh.

Once a mastectomy with reconstruction has been performed, a nipple can also be made. This would be done only once the reconstruction has entirely healed and would involve small procedures. A tattoo can be done to give the nipple areolar its colour.

Reconstruction is a very personal decision and the patient should not be rushed into something that they do not feel comfortable with having. It is important as a patient to look into the various options that are offered before making a decision.

 

Sr Lieske Wegelin

Finding out more about surgery

Surgery for breast cancer includes surgery to the breast and surgery to the axilla (armpit).

Surgery to the breast. 

Although there are many operations that we do, they fall into two groups: breast conservation surgery (wide local excision, lumpectomy) and mastectomy.

Breast conservation means removal of the cancer and some surrounding tissue.  It is important that there is no cancer or precancer in the surrounding tissue. (We refer to the normal tissue around the cancer as the margin.  A negative margin means all the cancer has been removed and normal tissue surrounds the tumour). Breast conservation surgery is generally followed by radiotherapy.  If it is not possible to have radiotherapy, breast conservation is not generally advisable.

Mastectomy means removal of the breast.  It may be done with or without reconstruction.

On some occasions, the outcome for an individual is better if a mastectomy is performed. Indications for a mastectomy include:

1. Patient preference
2. Widespread pre cancer (DCIS)
3. More than one cancer in the breast
4. A strong family history of breast cancer
5. If the cancer is large/the breast small, the cosmetic result may be better after a mastectomy with reconstruction than after breast conservation.

Axillary surgery

Axillary surgery refers to the management of the lymph nodes. The reasons to do axillary lymph node surgery are:

1. To see if the cancer has spread. This is very important as we generally base our adjuvant treatment of breast cancer on the behavior of the cancer rather than only on the size or grade.  The commonest way to do this is with a sentinel node biopsy.  Before surgery, the breast is injected with a dye.  At the time of surgery, the lymph node containing dye is removed and is tested.

There are several variations on the techniques used

1. The dye used may be blue dye or radioactive dye or both
2. There may or not be a preoperative scan
3. The lymph nodes may or not be tested at the time of surgery.
4. To remove the lymph nodes if they are involved with disease.

Commonly used terms:

Simple mastectomy: removal of the breast

Modified radical mastectomy: removal of the breast and the axillary lymph nodes

(Radical mastectomy is rarely done any more: it involves removal of the underlying muscle).

by Jenny Edge