I’m very excited to start discussing real topics that come up during my practice. Please check back under the Q and A section frequently for more real world topics.
A patient asked me about a topic I was completely unaware. She asked if anyone who has had a personal history of breast cancer should start doing a 16 hour fast.
Until researching this topic, I actually had not heard of fasting in dealing with cancer.
I discovered that there could be some benefits from Intermittent Fasting in terms of Breast Cancer Survivor-ship. There is a potential benefit from fasting while being treated for breast cancer.
Before delving too deeply into this topic, I have a few of my own caveats. I typically don’t recommend intermittent fasting in patients who don’t have a PRISTINE diet. If I have patients that are following a nutritionally sound diet, that are not diabetic, and not being treated with medications that lower their blood sugar, I think Intermittent Fasting can be beneficial.
Patients that are Diabetic likely can’t perform intermittent fasting. Several diabetic medications cause the body to release insulin in an uncontrolled manner. If you aren’t eating and take these medications, blood sugars may drop unexpectedly.
If you don’t regularly consume a healthy quantity of fruits and vegetables daily, fasting means you will become further deprived in necessary nutrients.
I was able to find the article, Prolonged Nightly Fasting and Breast Cancer Prognosis. This link will take you the article which can be accessed by the public. Breast cancer survivors were asked to keep track of their diets for up to 4 years. The researchers collected data on how long these women fasted overnight. The researchers discovered that women that fasted less than 13 hours per night had an increased risk of breast cancer recurrence.
“…prolonging the length of the nightly fasting interval could be a simple and feasible strategy to reduce breast cancer risk recurrence”
Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049–1055. doi:10.1001/jamaoncol.2016.0164
This study excluded diabetic patients. Prolonged overnight fasting (ie, not eating late at night) was not associated with weight loss, but there was a drop in inflammatory markers in the blood.
I stumbled across a related article concerning short-term fasting while being treated with chemotherapy. The researchers here examined the role of short-term fasting while receiving chemotherapy. The theory here is that cancer has a higher metabolism than normal tissues, and will take up more of the chemotherapy than regular cells. Human cells tend to go into a quiet state during fasting. The researchers found that short term fast while receiving chemotherapy in certain cancer types (HER2-Negative) had less markers of DNA damage during chemotherapy treatment.
Summary and Recommendations
If you are a breast cancer survivor, consultation with a nutritionist can play an important role in your future care
If you are a breast cancer survivor, you may want to consider avoiding late night eating.
If you are a Breast Cancer Survivor with Diabetes, discuss with your doctor dietary changes that may prevent recurrence.
If you are undergoing treatment for Breast Cancer now, discuss with your Oncologist, General Surgeon, and Nutritionist if you should consider short term fasting. Keep in mind, you nutritional status affects healing, and your doctors may not wish for you to to this.
Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049–1055. doi:10.1001/jamaoncol.2016.0164
de Groot, S., Vreeswijk, M. P., Welters, M. J., Gravesteijn, G., Boei, J. J., Jochems, A., … Kroep, J. R. (2015). The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study. BMC Cancer, 15(1). https://doi.org/10.1186/s12885-015-1663-5
December 10th and May 2nd will be
dates that will forever remain burned in my memory. December 10th was the date my son
was born and then 19 years later on May 2nd he moved out of my house
and into his own apartment. Those two dates are huge due to the enormous impact
my son made on my life. He bounced into this world with tons of energy and
love. He immediately taught me things as a mother such as being compassionate,
patient, loving and caring. He also kept me on my toes and reminded me I had
someone else to always fight for besides just myself.
May 2nd was emotional as he utilized that
assertiveness once again and moved himself into his first apartment with some
friends. He had saved up money and had a good job. He remained steadfast to his
word that he would remain in college and pursue a career for himself. (Today he
is entering his sophomore year.)
Suddenly the house was empty and quiet! What was I do to?
The dogs moped around and sighed heavy sighs when no one came by to rub their
bellies. My stepchildren had moved out years earlier but my son was still
around to fill the space with sounds of laughter. He was in Band for many years
so many times my living room was full of other band kids laughing and playing
their instruments. There was never a dull moment.
So, I set out on a journey to fill that empty space. Yoga
seemed most appropriate for me. I shifted and changed the back bedroom so that I
could provide private yoga sessions in my home and have my own space for a yoga
practice. I decided during the early morning hours, which usually meant
hustling around getting ready for early morning band practice, now was my Yoga
time. Me time!
I began by setting my morning routine with a cup of coffee and then a 30 minute yoga practice followed by a 10 minute meditation. Sometimes I would take my mat outside and listen to the birds while I grounded myself in meditation. Other times, I would light my candles, turn on my diffuser and music and find a beautiful yoga flow in my yoga space while the dogs looked on in wonder. Either way Yoga allows me to fill gaps that are missing because Yoga is about expanding, joining, nurturing, and learning. Maybe I am learning more about myself in this moment without my child physically here in my home. Certainly I am learning more about nurturing myself in this very moment.
Finding something positive to fill that void was most important to me. What will you do for yourself in time of need?
As I continue on my path of researching Yoga both personally
and professionally, I have realized how closely related the two fields are.
There are so many similarities in fact that we really should be combining both
worlds at the same time. When we are emotionally
well, not only do we connect with others better, but we also become more
creative, motivated, focused and attentive to our bodies.
Many people come to yoga or counseling initially because of
some health issue whether it be physical, spiritual or mental. Most individuals
are looking for outside help because he/she has exhausted each of his/her own
Clients learn in Yoga as well as in Counseling, that there
is a fine line in finding balance between “letting go” and “gaining control”.
In both forms of treatment, we look to let go of what no longer serves us, and in
turn strive to gain control of a healthier lifestyle. For example, letting go
of negative thought patterns in counseling, so as to gain healthier more
positive thought patterns.
According to Judith Hanson Lasater, PhD, PT, and Yoga
Therapist, “with yoga we want to relax the mind and body so that tension can be
released and healing can begin.” By letting
go or relaxing certain muscle groups in Yoga we can begin to gain control in a
different muscle group such as our breath or reducing our thoughts. For
example, in Tree Pose we want to ground down through our feet while at the same
time lifting through the crown of our head. Therefore, two different actions
simultaneously acting together to create one goal.
Yoga and Counseling could complement each other beautifully
if practiced together. Many clients find while in counseling that they aren’t
even connected to their physical body because they are so wrapped up in what is
going on in their head. Same thing can happen in Yoga and then injuries could
occur because we are not practicing awareness. Being aware of where our body is
currently placed is just as important as understanding where our thoughts are
driving our moods and behaviors. Deep Breathing relaxes the physical body by
lowering blood pressure and heart rate, which then in turn continues to relax
So, take a moment and stop what you are doing and just take
notice of where your body is currently. Is it sitting in a chair, or standing
in line? What do you feel? What do you notice? Without judgement, just try and
slow down the breath, by breathing in through your nose to the count of three,
and out through your mouth to the count of four. Do this 3-5 times until you can
begin to notice a warmer more relaxed state in the body and mind. Continue to
this until you feel better and more relaxed. Then you can move on with your
task and focus. This moment of
relaxation might even change your mind!
Yoga in Sanskrit means “union” of the mind, body and spirit.
So it makes sense that I myself being a
licensed mental health counselor, also practice yoga. With my yoga practice I
feel I am joining my mind, body and soul to becoming a whole and complete
being. I feel there is so much more to healing than talk therapy although it is
useful. The body stores energy whether positive or negative and stress, a form
of energy, can be held in the body causing pain and illnesses.
I was probably first introduced to yoga as a small child as
I watched my mother stretching down in the floor in front of the TV in the
evenings after supper. As a child I was full of energy and probably was difficult
to keep still. My mother could tell you stories about me dancing in the pews at
church. Dance became my first love. I found I could escape any negative thought
or feelings through dance and release excess energy. I also felt whole and
complete when I danced, as if nothing could tear me down. It became a source of
resilience for me.
Then once I became older and a dance injury kept me out of
dance, I began to try other things. I found yoga again after my divorce. On Tuesday
nights I would take my very young son to spend time with his dad while I would
attend a very crowded yoga class. I immediately reconnected my mind with my
body and spirit again. If you have ever been through a divorce you understand
how emotionally draining it can be and how overwhelmed with feelings you can
become. Yoga gave me a peace of mind through not only the poses, called Asanas,
but also through the breath, or Pranayama.
Three years ago I decided to become a certified yoga
Instructor with the intentions of combining it with my private practice
therapy. Today in my private practice, I teach my clients how to breathe and
reclaim their Yoga which we are all born with, but must find.
As I look up from my mat and open my eyes, the bright blue
sky of the early morning envelopes my view. With the birds singing and the
locust croaking, my hearing is completely engulfed as well. This moment takes
me back to a more simple time as I slowly draw in a deep breath through my nose
and exhale slowly through my mouth. I have begun taking my yoga practice
outside on purpose. That purpose, total
My mind’s eye craves moments of silence, just like my body
craves rest and stillness. We all live
in a fast paced, busy society, but I also work in job that requires my full
attention and awareness; mental health counseling. If I don’t learn to take
care of myself first, I am no good to anyone else that walks into my office. This
moment of stillness and silence leads me to my mat where I feel most calm and
secure. I recognize when I have not been spending enough time on my mat by the
way my body aches and my mind races.
Throughout the years, I have learned to spend more time on my mat each day not as a way to be selfish, in fact, quite the opposite. It is a way for me to remain healthy and mindful. Many times I have utilized my yoga practice as a way to gain a different perspective on an issue I am having. I have even found it useful to practice some yoga during stressful times or times when I am angry to assist myself in releasing those negative emotions and changing my view on my situation. I may not be able to change what is going on around me, but I can change the way I think and feel about the situation through my yoga practice.
My yoga practice includes starting with a mindful breathing exercise to calm my nervous system and then slowly transitioning to larger and deeper yoga postures, or Asanas. Then I close with a restful pose to once again slow down my breathing and nervous system. Maybe that pose is Legs up the Wall, or Childs Pose. Take a moment for yourself! You deserve it!
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I first practiced Yoga in my apartment while in Medical School. While studying at a Starbucks within a Barnes and Nobles, I picked up a book about Yoga and bought it.
18 years later, Yoga is now part of my vocabulary and has been one of the most important self care tools I use.
I frequently advise patients on doing poses at home, or even starting Yoga at home. You can start with no equipment at all. Just the floor can work, but having a few simple pieces of equipment can set you up for a fulfilling, healing self care regimen at home.
I encourage beginning Yoga Students to consider starting at a studio with a well trained instructor. This may not be available for many reasons (time constraints, money, location), so equipping yourself at home is a great alternative.
Additionally, your Yoga practice is an individual experience. It is a journey of self discovery, with the ultimate goal of bringing you back to yourself. There are luxuries of being in a Yoga Studio, but being able to access your practice on a regular basis is the most important.
Yoga Supplies for a Home Practice
If you don’t own any of these, and your planning to start practicing at home, the initial investment will pay off for years to come. The above picture are examples from my home practice.
Yoga block have multiple uses during a practice. The term I’ve heard frequently during a class is the blocks can be used to “bring the floor closer” to you hands. They are best used during a pose such as Forward Bending, but help with lunges. There are several types of blocks available, but I recommend foam that are softer and more versatile. You can use Yoga blocks at work for a foot support, or an impromptu lumbar support.
Yoga Blankets have nearly limitless uses in your home practice. They can be a mat alone (although they don’t provide the sticky surface your after). folding 1-2 Yoga Blankets make a great cushion for seated postures. The blankets can be placed under the knees for cushion. They are excellent after for outdoor activities, especially as beach blankets or cover ups in the cold.
This is where it gets fun when your shopping. Other than you cute tights, you can go wild with you mat. Some recommendations I have, if your home space is carpeted, you may enjoy a thinner mat. Consider a thicker mat on hard floors. Try to get a sticky mat for extra support. I like colors and patterns. The mat has a special place in your practice. You’ll likely take it with you to classes if you choose to attend one. You’ll find the more you practice Yoga that every time you unroll your mat, a deep sense of calm and centering will enter you. Buy a mat in a color you may have dreamed of decorating your home with.
The Yoga Bolster is optional. 4 Yoga blankets equal one bolster, so consider starting with blankets if you don’t want to spend the money. I purchased round bolsters, but I think the rectangular shapes would be nice. The Yoga Bolster Make a great seat for meditation, knee support during Savasana (or Corpse Pose). The bolster can be used for support in various Yoga poses as well. If you are limited on storage room, consider using Yoga Blankets which can double for other uses.
Blue Tooth Speaker or Headphones
An overlooked aid in a home yoga practice is your sound system. I usually use a Bluetooth speaker since I don’t like to have anything in my ears during my practice. Likely, you’ll either have music, or a class your taking on your phone or tablet. Of course, if your using your television, you won’t need this.
I also recommend Yoga Straps, which can assist with any forward bend or leg extension. These aren’t recommended, but they really aid in your home practice.
Most of all, if you’ve committed to starting Yoga, have fun shopping! I had so much fun searching for my equipment. I now have my own little oasis at home.
The above recording is mostly an a brief educational opportunity for physicians and nurses, but it brings up an important topic. Breast size is a real barrier for many women who want to engage in a physical activity, in particulary a team sport, but feel support is so low in typical bras that they are embarrased to move around.
The Bra Queendom falls under the realm of fashion. This is nice for ladies as far as colors, or wanting a certain contour such as more cleavage or minimizing.
I’ve noticed an increase in women asking for consideration for plastic surgery to reduce their breast size. When I examine them, I usually see the problem is a poorly fitted bra.
Signs of a poorly fitting bra include:
Pain in the neck an upper back
Bra Straps that cut into the shoulders leaving creases
Rashes underneath the breast
Inability to run (or jump) in a bra meant for being active due to breast pain
Needing frequent adjustment throughout the day
Ideally, its best to be fit by a seamstress or professional who is experienced in bra fittings.
It is possible to fit yourself. Here is a nice video that can walk you through the process:
Once you have corrected your size, consider haivng different bras depending on activities. I personally wear a T-back or Razor back for high impact activities. In a sports bra, you want wide straps that distribute the weight of your breast better.
With the beginning of every yoga class I like to remind my students to set their intention for class. Maybe it’s a desire to release something that no longer serves, or it is a desire to gain something. Maybe the intention becomes a way to honor someone or something. It can also be an alignment towards our higher power.
When I perform an intake session with my counseling clients,
I will ask the same questions. What is your intention or hope for this session?
What do you want to let go of, or gain with this session? How do you want to
feel once completed with this session? Or how will you know you have made some
progress with this session?
Setting intentions are like setting a goal, or aim, or
attitude. It gives us a purpose or a reason for us to pay attention to this exact
moment. I would like to believe most of us have goals and goals tend to keep us
motivated in life. Intentions also tend to help keep us focused. Our
brains are extremely powerful and tend to overwhelm us at times with thoughts,
memories, desires, etc. With intentions we can narrow all of this and become
more focused on the here and now, in the present moment.
Deepak Chopra, MD, defines Intentions as being “a starting
point and creative power.” Everything begins to happen when we set an
intention. He goes on to further explain that an intention “is a directed
impulse of consciousness or seed”. Intentions
should come from the heart and should align with your personal values.
Intentions are a way to align the heart with the mind by connecting what
matters most to you.
The best time to set an intention is during meditation or
stillness. Take a deep breath in, let it go with a big sigh. Do this several
times while at the same time relaxing your body. Set an intention and then give
it to the universe and let go of any anticipation or desired outcome. Let the
universe do with it as it will.
Intentions are a wonderful way to begin your day and help
keep you grounded. What is your
Disclaimer: I am board certified Internal Medicine. Please follow the recommendations of your obstetrician if you are considering using essential oils or aromatherapy during your pregnancy.
I was recently asked what essential oils to use during pregnancy. I thought I could answer the question easily, since I’ve used essential oils for a few years now, and I’ve often recommended essential oils without much thought. I recently read Bottle of Lies, a chilling reminder not to take drug safety for granted. I decided that before I would answer her, I should check some references. There is always a concern about safety of a chosen drug or treatment. Even more so, pregnancy is a unique time. Fetal development can be affected by many factors, and there many historical reminders of assuming at treatment is safe during pregnancy when it really isn’t.
I was surprised to find that most of my trusted references concerning aromatherapy, essential oils and use in pregnancy are sparse, with very little information. I decided to search the database Pubmed for answers. .
I approach this subject with caution because throughout the history of medicine, treatments deemed to be safe initially are later to be found unsafe. There are many blogs and post that will give a list of essential oils to use during pregnancy, but I caution readers not start any therapy while pregnant without speaking to your physician. Essential oils are natural, but like any treatment, they are highly active within the human body.
Pregnancy is typically a time of many symptoms. Women are often seeking relief from nausea, vomiting, fatigue, insomnia, and postpartum depression. I did a general search term of essential oils/aromatherapy and pregnancy. I initially reviewed 39 medical journal articles seeking some guidance. I was able to narrow my search to a few relevant articles, any my search list can be found here.
Nausea and Vomiting Relief
This is the most common symptom pregnant women must cope with. Pregnancy related nausea and vomiting is unfortunately not very well understood. Prior to actually researching the topic, I assumed, like many people, that peppermint, ginger, and lavender are the best essential oil to relieve nausea.
When peppermint oil was tested in a small study consisting of 56 pregnant women suffering from nausea and vomiting in the first and second trimester, it was found to have the same effect as placebo for relieving nausea and vomiting(1).
I found another study here also showing that peppermint is not likely to reduce pregnancy related nausea and vomiting. A systematic review of the effects of complementary medicine conducted by researchers also confirmed that peppermint was not effective at relieving nausea (2).
Lemon essential oil was found to be effective in relieving nausea and vomiting related to pregnancy in two of the articles I found (2, 3).
My recommendations with the information I have available is that Lemon Essential Oil is a good idea to relieve nausea. I would recommend to use the aromatherapy by inhalation only, breathing the oil in on a tissue or cotton ball a few times a day to relieve pregnancy related nausea.
Aromatherapy for Easing Labor Pain
Treating labor pain is likely going to be of the utmost concern. Many women these days are opting to forgo traditional anesthesia techniques and use holistic care to assist during labor. Women choosing to forgo regional anesthesia such as epidural injections may opt to use aromatherapy during the labor process.
A study consisting of 104 young women in labor with uncomplicated pregnancies showed that overall pain levels throughout early labor were reduced in those that received aromatherapy. (4).
A small, double blinded study of pregnant women, many who were at risk of postpartum depression tested the efficacy of using Rose and Lavender essential oils to reduce the incidence of postpartum depression. This particular study I found interesting because the subjects were chosen that had risk of depression, which made gathering a large sample size difficult. Most studies tend to select subjects with no history to simplify gathering date. The researchers tested a combination of rose and lavender essential oil again sesame seed oil and sweet musk oil, and no oil at all. According to the results of the present study, it seems using aromatherapy has a significant effect on reducing depression after delivery (6).
Consider trying Lemon Essential Oil used by inhalation. I would not recommend it topically since it may cause photosensitivity (sun sensitivity). I recommend inhaling Lemon essential oils using a diffuser of choice or applying a drop to a cotton ball.
Peppermint essential oil is not shown by my evidenced based search to be effective at relieving nausea or vomiting in pregnancy, however, if you find using it helps, consider using only inhaled forms.
Consider using Rose Essential Oil or Lavender Essential Oil for improving your mood. Lavender essential oil tends tobe reasonably priced. Rose essential oils is expensive, and I would recommend investing in the purchase form a company with a good track records such as Doterra. Doterra makes a ready made Rose Essential Oil.
During my research, I discovered the National Association for Holistic Aromatherapy. I bookmarked this wonderful online resource. This organization is primarily for professional aromatherapists but has some wonderful resources. This link will take you to the websites recommendations on aromatherapy use in pregnancy.
Please see the citation list below. Please post any additional questions in the comments. Thank you for reading!
fatigue is often overlooked in our field. Sometimes even completely ignored. We
try to balance work and life by carrying heavy caseloads, maintaining copious
amounts of paperwork that professors never tell you about in graduate school,
all the while still taking care of ourselves, our health, households, etc. We counselors have learn to care for ourselves
just as well as we care for our clients.
If not even more, perhaps!
are taught to be “containers” of others thoughts, feelings and beliefs. We are
taught to hold things and keep them confidential. These thoughts, feelings and
beliefs of our clients are often a result of traumatic life events and they may
simply not align with our own thoughts, feelings and beliefs.
The energy transferred from our
clients to us in a session can leave us feeling exhausted or even depleted
emotionally. Therapists are encouraged to educate our clients about healthy
lifestyles, self-awareness, and emotion regulation. But what about our own
stuff that we carry with us each day? Sometimes Counselors feel that we should
have all of the answers and therefore don’t reach out for help at times when we
may need it the most.
cultivates a welcoming attitude for all that arises in the mind, whether it be
positive or negative. Yoga not only brings the mind and body together but
relieves stress, increases moods, and assists in work-life balance. Yoga helps increase our awareness of our
physical bodies and souls if we just take the time out to listen. The best
thing about Yoga is that you can take it with you and do it anywhere! At your
desk, in the airport, or even standing in the grocery store check-out line.
time you have a few moments alone and in a quiet space, make sure your feet are
firmly placed on the ground. Now, place your right hand on your belly and your
left hand on your heart and just pay attention to your breath. What do you
notice? How does it feel? Does it come in through your nose rough or soft? Is it
cool or warm? Try not to change the breath, but just notice it and see if you
can’t slow things down for yourself for a moment.