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Fatigue is a significant problem for many people both during and after cancer treatment. There can be many causes for fatigue in cancer survivors, including the cancer itself and the treatment for the cancer. Other causes include pain, emotional distress, sleep disturbance, anemia, nutrition, activity level and medication side effects.

To sort out the cause and to get relief, the first step is to discuss it with your doctor. Your doctor can review your specific situation and possibly identify a treatable contributing factor. In addition, there are helpful, general strategies for addressing cancer-related fatigue. One is energy conservation. This means postponing and/or delegating nonessential activities, deciding which activities are most important, and pacing oneself to rest before and after an activity. Sometimes a daily or weekly diary helps. A second strategy is regular exercise and physical activity. Although the logic may seem backwards, regular physical activity is the most effective way to reduce fatigue, improve energy level, sleep better and feel better. One can start with as little as five minutes once or twice a day and gradually work up to 150 minutes per week. Continue Reading →

Well, I’m sure you’ve heard the news by now. Angelina Jolie, a celebrity in every sense of the word, has undergone a double, or bilateral, mastectomy and breast reconstruction to prevent the development of breast cancer in the future. This news brings up many issues, and several thoughts occur to me.

First, Angelina Jolie’s story reminds us that no matter what our station in life, we are all vulnerable to disease. We spend a lot of time talking about that vulnerability in our society. This is especially true for breast cancer, where public events aimed at educating the public about the importance of prevention, early detection and expert care are relatively commonplace. And, in spite of this exposure, Ms. Jolie’s experience will no doubt spur additional discussion about breast cancer risk. While the discussion rages, I think it’s important to point out a few things.

First, Ms. Jolie does not have breast cancer. She made this decision after considering HER risk for breast cancer and how that risk affected HER perspective on HER life. It turns out, based on the reports, that she carries an abnormal gene (a mutation in BRCA1) that made her risk for breast cancer extraordinarily high. Based on that information, she pursued a strategy that drastically reduces her risk. Her choice was not the only one available to her, or to other women in her situation, and it certainly is NOT the main strategy for reducing breast cancer that fits MOST women. In fact, most women will NOT get breast cancer, so no one specific prevention strategy is necessarily helpful. So what can women learn from this?

I think these are some important lessons:

1. Take an active role in your health care and ask your doctor to perform a comprehensive breast cancer risk assessment for YOU and explain YOUR risk of breast cancer. With this information, you can assess how YOUR risk compares to the average woman’s risk of developing breast cancer.

2. Based on YOUR risk level, ask your doctor what strategies are available to prevent and detect breast cancer.Then consider how these options and your risk level fit into YOUR priorities in life.

3. Finally, commit to and pursue a plan that matches YOUR risk level and YOUR needs.

Thinking about the risk of breast cancer can be a nerve-wracking process for many, but with good information and open communication between you and your doctor, you can find an effective strategy for breast cancer that will give you peace of mind.

Dr. Brian McKinley is a surgical oncologist and medical director of Greenville Health System’s breast health program.

Some men with prostate cancer need to take medicines that act against the cancer by lowering the testosterone level in the blood. One bothersome side effect of these medications is hot flashes. Like hot flashes that women experience, they can be an unpleasant and intense and include the sensation of hot skin in the face, neck and upper chest that lasts a few seconds and then subsides into sweating. For some men, the hot flashes can be a mild nuisance; for others, they are a disabling misery.

To get relief from hot flashes, a man can wear loose-fitting clothes and keep the air around him moving with open windows and fans. Regular exercise (150 minutes per week) and a low-fat, low-sugar, plant-based diet are helpful. Meditation, acupuncture and relaxation techniques, such as breathing exercises, can also be helpful. Finally, medications like venlafaxine, megestrol and gabapentin reduce hot flashes for most men. Megestrol is generic and inexpensive. The starting dose is 20 mg once or twice daily.

If you have hot flashes, how do they affect you and how do you cope with them? Please feel free to share your experience. Prostate cancer survivors can come to the Center for Integrative Oncology and Survivorship for a survivorship care plan and to get help with symptoms such as hot flashes. Call (864) 455-1346 for an appointment.

Dr. Mark O’Rourke is a medical oncology cancer specialist and medical director of GHS’ Center for Integrative Oncology and Survivorship.

Have you ever heard someone say this? Perhaps you said it yourself to your doctor, dietitian or spouse. Odds are most people have said something like this about healthy food choices. As a dietitian, I hear many food confessions, things like “I know I shouldn’t eat this, but …” or “I know I should eat that, but …” So, instead of giving you one more lecture on the importance of eating your fruits and vegetables, I’m going to give you some ideas on how to eat more fruits and vegetables.

First, plan on having fruits or vegetables at every eating occasion, including breakfast and snacks. For most of us, increasing our plant-food intake won’t just happen, we have to make it happen. In this case, the old saying, “if you fail to plan, you plan to fail,” is true. However, you can plan for success by keeping easy-to-grab, easy-to-eat fruits and vegetables available, starting with breakfast. Need ideas? Try veggies in an omelet, apple slices or berries with yogurt, or whole-grain toast with peanut butter and banana slices. A smoothie with yogurt, berries and a handful of spinach or kale makes a great breakfast when you’re on the go.

Second, fill half your plate with vegetables at meal-times. Increasing the portion size of fresh and cooked vegetables at regular meals goes a long way to increasing your fruit and vegetable intake. Also, nuts and fruit mixed together makes a perfect sweet treat for dessert or snack.

Third, taste new foods. As we age, our tastes can change. We might like a food now that we never liked before. I was a terribly picky eater as a child and would turn my nose up at lots of fruits and vegetables. Sometimes it was the taste I disliked, and sometimes it was the texture of it. I have learned that I am more receptive to new foods when I am in a good mood, relaxed and happy. Try this when you’re having a great day: take a single bite of a new fruit or vegetable and no more. The next time you’re up to it, take two bites and so on until you are able to eat that food regularly.

Many times we want more of what we are used to eating. Adding more fruits and vegetables to our diet will increase our desire to have more.

For more tips on the importance of eating a plant-based diet, check out the following links:
https://www.caring4cancer.com/go/cancer/nutrition/eating-well-nutrition
http://www.choosemyplate.gov/food-groups/downloads/TenTips/DGTipsheet2AddMoreVegetables.pdf
http://www.choosemyplate.gov/food-groups/downloads/TenTips/DGTipsheet3FocusOnFruits.pdf

Franella Obi is a registered and licensed dietitian/nutritionist with the Center for Integrative Oncology and Survivorship.

Many cancer survivors need help from their doctor to start exercising, eat healthy, lose weight or to quit smoking. The stakes are high because these changes can decrease the risk that a previous cancer will recur, improve quality of life and increase the chances of avoiding heart disease or cancer going forward. How can the doctor best help a person make these lifestyle changes? Some doctors merely tell the patient what to do and scold them when they don’t do it. Some doctors avoid these topics and leave it up to the patient to change or not.

In recent years, many doctors started using a technique called “motivational interviewing” to help patients improve their health habits. In motivational interviewing, the doctor asks the patient what changes they are willing and able to make and encourages them to take small, realistic steps toward achieving their goals. For example, a cancer survivor trying to achieve five or more servings of fruits and vegetables per day might set an initial goal of adding just one colored fruit or vegetable to their diet each day. If they mark on their calendar each time they achieve this goal, they can look back weeks or even months later and reflect on their success.

Alternatively, the doctor might ask the patient what goals are important to them in making a change in diet and exercise habits. For one person, the goal might be living to see children or grandchildren grow up. For another, the goal might be fitting into a particular size clothing. For a breast or prostate cancer survivor, the goal might be to reduce hot flashes. With the patient’s goal in mind, the doctor can help the patient choose initial steps that meet the patient’s needs.

At the Center for Integrative Oncology and Survivorship, a team of doctors, nurses, nutritionists and social workers help cancer survivors change their lives and improve their health habits. How about you? How do you want your doctor to help you achieve a healthy lifestyle? What has worked and what has not? Feel free to share your experiences.

Dr. Mark O’Rourke is a medical oncology cancer specialist and medical director of GHS’ Center for Integrative Oncology and Survivorship.

I am a cancer survivor and the doctor is prescribing meditation? Am I crazy? The answer is, no. Not crazy, but maybe stressed. In more and more medical centers, meditation is being prescribed by doctors for various conditions, including stress, depression, hypertension and chronic pain. The form of meditation getting the most attention is mindfulness meditation, in which the person meditating sits quietly for as much as 45 minutes per day, being “mindful” of the present moment, often focusing on the sensation of breathing in and breathing out. As distractions arise, the person patiently puts them out of mind and refocuses on the present and the breathing process. With training, time and practice, the person meditating is less bothered by random thoughts. As simple as it sounds, good medical studies have shown that meditation can reduce stress, relieve pain and improve quality of life. GHS’ Center for Integrative Oncology and Survivorship will begin offering classes in meditation this month. For more information, call (864) 455-1346. How about you? Do you practice any form of mediation? How has it made a difference for you? Feel free to share your experience with us.

Dr. Mark O’Rourke is a medical oncology cancer specialist and medical director of GHS’ Center for Integrative Oncology and Survivorship.

We’re at the end of the first year of medical school in our new school, the USC School of Medicine Greenville. Here is one of the things we love about our school, our home in the Health Sciences Education Building on the campus of Greenville Memorial Hospital. It’s so light and airy, the outside seeming so close you can touch it, that it’s easy to stay motivated even when you’re dragging after hours of studying.

Atrium of HSEB

In 2012, the American Cancer Society updated its Guidelines on Nutrition and Physical Activity for Cancer Prevention (CA Cancer J Clin 1012;62:30-67). The main recommendations were:

Achieve and maintain a healthy weight throughout life.
Be as lean as possible without being underweight.
Perform at least 150 minutes of moderate intensity physical activity or 75 minutes of vigorous intensity physical activity per week.
Limit time spent sitting.
Choose a healthy, plant-based diet.
Limit consumption of red and processed meat.
Eat at least 2.5 cups (five servings) of vegetables and fruits each day.
Limit alcohol consumption.

These guidelines are based on accumulating scientific evidence and the experience of experts. What do you think of these guidelines? Do you discuss these topics with your healthcare providers? Do you have anything to add or subtract?

Dr. Mark O’Rourke is a medical oncology cancer specialist and medical director of GHS’ Center for Integrative Oncology and Survivorship.

Kyle Townsend

One of the cool things about medical school—despite the stereotype—is that we have each other’s backs. Sometimes that means helping someone understand some material, and sometimes it means staying late in anatomy lab to finish cleaning because your partners have to go. Other times, it means hoisting people up an eight-foot wall while covered in mud.

In the first week of Neuro module, one of my classmates called me over during a lecture break and asked, “Do you want to do a mud run?” This was puzzling to me. It is a well-known fact with my classmates that I don’t like running. I play keeper for our soccer team. I play tennis and volleyball. If I have to move any further than about ten yards, I am not interested. Last time I “ran” a 5k I didn’t move from my recliner for the rest of the weekend. Despite all of these things, I handed over my $20 and said, “Sweet, when is it?”

I had four weeks to train. I knew I wasn’t in shape for a mud run, so I worked out as much as I could (remember, we were in Neuro module; most spare time was spent studying). The training I did was not the right kind of training. I did a lot of bike riding, so that I could read and work out simultaneously. As it turns out, riding a bike is not running. One prepares you for a mud run, and the other lends you a false sense of security that comes crashing down around you as you run on and on chasing your gazelle-like teammates through 3.2 miles of mud and trees.

 There is one thing that can make a mud run even more miserable than its basal level of misery; that thing is weather. If it is too hot, it’s miserable. If it’s too cold, it’s miserable. One would think that a mud run scheduled for April 20 would be safe from a temperature problem. One would be wrong.

We arrived at Heritage Park in Simpsonville at 9 a.m., shivering in the 45-degree air. We ran around, warming up our muscles and stretching, waiting for our 9:34 start time. As that time approached, we moved to the start line, and I saw the pit of mud that was the first of 25 obstacles. I shivered harder. Our time came, and off we went. Our team arrived at the pit, and I decided to set the tone, jumping right in. One of the things about muddy water is that when you look at it, you have no idea how deep it is. It was deep and exceptionally frigid. I moved through the mud using a sort of army crawl/doggy paddle/swimming maneuver that I’m told was entertaining to watch, and hauled myself out the other side. My team and I then started jogging, overcoming obstacles as we came to them and suffering together. Or at least I was suffering. My teammates were all runners; during school we’ll be studying and any one of them might “go run a quick six miles to burn some energy.”

 Most of the race is a blur of pain for me. I trudged along, and my teammates took turns running with me to make sure I didn’t fall behind. It said a lot about how good of friends we’ve all come to be this year. They knew just what to say to keep me going, I cared about them enough to keep running, and at the end of the race we crossed the finish line together. Medical school has a stigma of being extremely competitive and cutthroat; and it can be. However it also helps form great friendships, and teaches lots of lessons about teamwork. Medicine isn’t a profession of independent operators anymore. We have to work together. We have to have each other’s backs. It was cool to see how that happens even outside the classroom, running through the cold and the mud.