fitness for survivors

Another Mammogram Response

julie@life-cise.com (julie) — Tue, 08 Dec 2009 16:43:00 +0000

I continue talking and thinking about the recent mammogram debate. With it looking like legislators will step in and protect women's rights to screening, the subject may be fading into the background for many people. However, for myself and most other survivors, the subject is still fresh and worthy of discussion. For those of us whose lives have been saved by a self exam or mammogram, it is hard to set this aside as just another news story.

So, to the chorus of opinions on the subject, I add one more survivor's response: mine. You can read my latest article on the subject of mammograms on GALTime. (and check out GALTime anyway; it's a terrific online women's magazine!)

Julie

Oops, Correction

julie@life-cise.com (julie) — Fri, 04 Dec 2009 18:59:00 +0000

I made a mistake and I need to issue a correction. In my Nov. 22 post on mammograms, I wrote that there were approximately 135,000 mammograms given for women under age 50. That was taken from the Breast Cancer Surveillance Consortium. Unfortunately, I didn't notice that that number is just a sample, not the total number of mammograms. Thank you to my sister for pointing that out to me.

I apologize for the mistake. I had been swimming in breast cancer statistics for days as I tried to understand the recommendations of the task force.

So the number of women under age 50 whose lives would be saved by mammograms is actually larger than I stated. I believe my point still stands and is even stronger with larger numbers. However, I don't have the correct number. I have been unable to find the actual number of mammograms done per year for women under age 50. This seems like a straightforward thing to find, but I have not found it in any of the usual places. If anyone has the number or a good source for it, please let me know.

But the fast pace of the health care debate has overtaken this issue. On Wednesday night, the US Senate agreed to accept an amendment proposed by Senator David Vitter (R-La) to health care legislation requiring the federal government to ignore the new recommendations by the USPS Task Force. And on Thursday, an amendment by Senator Barbara Mikulski (D-Md) also was introduced which would allow doctors to determine whether mammograms are medically necessary and would require insurance to cover the screening.

These two amendments take away, for now, the specter of younger women being denied screening that may save their lives. However, it does not address some of the very real concerns raised by the task force.

Unnecessary biopsies and over-treatment are a concern. But we should not sacrifice a group of women in trying to fix the problem. We know that mammograms are an imperfect tool. We need more effective screening for younger women whose breast tissue is denser. Some research indicates there may be harm to young women with certain genetic mutations from the radiation from repeated mammograms. We need better tools for detecting which cancers are likely to spread. We should encourage younger women whose cancers are more likely to be aggressive and fast-growing to continue to do self exams. We should tailor screening recommendations to the appropriate population: older women tend to have slower-growing cancers, so possibly do not need mammograms as frequently; younger women generally have aggressive cancers, so waiting 2 or 3 years may be a death sentence.

While I am pleased that women's rights to appropriate screenings appear now to be protected, I hope that does not signal an end to discussions about mammograms. I repeat my call that what we need is better, more accurate, affordable tools for the detection of breast cancer.

Julie

It's Flu Season - Want to Boost Your Immune System?

julie@life-cise.com (julie) — Mon, 30 Nov 2009 22:40:00 +0000

We're in the midst of flu season. Just how many news features have you seen on H1N1 virus? How many conversations with friends and neighbors? How many FaceBook updates about the flu?

There are two things you can do to give your immune system a little boost (and these are really good reminders as we head into the holiday season): exercise and relax.

Moderate exercise is linked with a boost to the immune system. The boost is short-term; it may only last for a few hours after exercise.

In the cancer field, we've known for a few years now that exercise can help boost the immune system of people going through chemotherapy. Studies have shown that moderate exercise reduces the number of infections and hospitalizations during treatment, as well as improving the rate of adherence to treatment protocol. And a study by Andrea Mastro, of Penn State University, and colleagues, which was published in Medicine & Science in Sports & Exercise, found that regular moderate exercise helps the immune system of patients undergoing chemo to bounce back faster after chemo is finished.

Well, what's good for cancer patients is also good for everyone else. According to MedlinePlus, which is an online service of the US National Library of Medicine and the National Institutes of Health, it may not be clear exactly how exercise boosts the immune system. But they have a few theories:
*Physical activity may help by flushing bacteria out from the lungs (thus decreasing the chance of a cold, flu, or other airborne illness) and may flush out cancer-causing cells (carcinogens) by increasing output of wastes, such as urine and sweat.
*Exercise sends antibodies and white blood cells (the body's defense cells) through the body at a quicker rate. As these antibodies or white blood cells circulate more rapidly, they could detect illnesses earlier than they might normally. The increased rate of circulating blood may also trigger the release of hormones that "warn" immune cells of intruding bacteria or viruses.
*The temporary rise in body temperature may inhibit bacterial growth, allowing the body to fight the infection more effectively. (This is similar to what happens when the body has a fever.)
*Exercise slows down the release of stress-related hormones. Stress increases the chance of illness, so physical activity could reverse this factor.
(You can read the whole MedlinePlus article that this is from by clicking here. And MedlinePlus is an excellent resource for medical and health information, for those of you who are not familiar with it!)

This may seem counter-intuitive. It might seem like the best option is to rest if you are concerned about your immune system. But it turns out that the best thing might just be to get moving.

The key, as with so many things, is moderation. Very intense and extended exercise actually lowers your immunity. That's why endurance athletes are often quite susceptible to cold and flu after a major endurance race.

Another key factor in immunity is stress. Stress has been shown to lower immunity and make us more susceptible to colds and flu. This is clearly important as we head toward the holidays - which should be fun, but let's face it, are often stressful.

So try to take a few minutes each day to relax - whatever way works for you. Take a quiet bath after the kids have gone to bed, sit quietly in your car for 5 minutes before heading in to work, turn off your phone and computer for just 10 minutes (probably the world will not actually end if you do).

Or go for a walk. That way, you'll relax and get a little moderate exercise.

Julie

Thankful

julie@life-cise.com (julie) — Fri, 27 Nov 2009 03:16:00 +0000

I've just returned home from Thanksgiving dinner with friends. I'm full of good food and wine, enjoyed good company, and am ready to toddle off to bed. But first, I want to add my thoughts of gratitude to the many that have already been expressed today.

I am grateful for family and friends who have supported me through dark times and celebrated with me in joyous times. I am grateful for sacrifices made by many which have benefited me. I am grateful for food, beautiful woods to walk in, and the ability to enjoy both of those things. I am grateful for bacon (OK, those of you who know me realize that I really mean this - life is just better with bacon!). I am grateful for 8 years NED (no evidence of disease)!!! And I am grateful for all of the people I have met through this blog and through Life-Cise - you have all touched my heart, thank you.

In short, I am thankful for life. I am simply grateful.Julie

My Opinion, For Whatever That's Worth

julie@life-cise.com (julie) — Sun, 22 Nov 2009 14:48:00 +0000

I'm going to weigh in on the great mammogram debate - at least it should be the great mammogram debate! OK, I've been weighing in: on FaceBook, on Twitter, in endless conversations all week.

For any of you in the U.S. who might have missed it (??!!?), the U.S. Preventive Services Task Force announced new mammogram recommendations last week, published in Annals of Internal Medicine. They recommend that screening should begin at age 50, rather than 40, and be done every two years. They also suggest that doctors should stop teaching their patients how to do Breast Self Exams.

To be clear, they are talking about routine mammograms, not diagnostic mammograms. If you or your doctor notices an irregularity, or if you have a strong family history of cancer, your doctor could choose to send you for screening if you are younger than 50.

And, these recommendations are not policy changes. Health and Human Services Secretary Kathleen Sebelius was quick to point out that no policy has changed. This is simply the panel's opinion based on their analysis of numerous US and international studies. This is, however, a panel who's recommendations are often looked to by the insurance industry.

There has been growing concern over false positive or inconclusive mammogram results that can lead to anxiety and unnecessary follow-up procedures. Related to this is worry about potential over-treatment of non-invasive cancers that might never become a serious health threat. Many non-invasive, or in situ cancers would never progress to invasive cancer. So in recent years, there has been much discussion of whether we are over-treating women with DCIS (ductal carcinoma in situ), putting them through difficult surgeries and treatments for a disease that would never threaten their lives.

The panel did find there is benefit to screening women age 40-49. The panel found that 1-2 breast cancer deaths would be averted annually per 1000 women screened if screening begins at age 40, compared with 50.

According to the Breast Cancer Surveillance Consortium, which is funded by the National Cancer Institute, last year there were approximately 135,000 mammograms given for women under age 50. (This is very approximate, the BCSC only provided a bar graph which I found a little hard to read.) So, if I'm figuring the math and understanding the statistics correctly, 135 to 270 young women's lives were saved.

The panel's opinion is that 135-270 women (actual women, not just statistics - your sister, your daughter, YOU) is insignificant compared to the cost in unnecessary procedures and anxiety.

I am the 1 life saved per 1000 screened. If these recommendations were in place in 2001, I would certainly be dead. My cancer was found during a routine self exam. The initial diagnosis was DCIS, but surgery revealed that I actually had two moderate, aggressive invasive cancers. Overnight, I went from stage 0 to stage 3 breast cancer. I would never have made it to age 50 for my first mammogram, as recommended by this task force.

In the New York City area, private insurance payments for mammograms are currently around $180. So, for my group of 1000 women screened, that is a cost of less than $180,000 in 2001, the year I was diagnosed. (for ease of argument, lets use $180,000 - I'm tired to looking up statistics and don't want to track down what mammos cost in 2001) But because $180,000 was spent on mammos., my breast cancer death was averted. If I live another 50 years from that year (reasonable, that would put me at 87), I estimate that between taxes paid and money spent on everything from food to charitable contributions, I could easily contribute over $2,000,000 to this country's economy.

That's just my monetary contribution (and very approximate). I also like to think that my life is intrinsically worthwhile - I could be wrong about this. I play music, but there are lots of good violists around; I could easily be replaced. I founded Life-Cise because I felt I had something to offer that could really help others who face a cancer diagnosis and treatment. Generally, I try to be a good person; help people when I can. But how valuable any of this is is debatable.

So the question is, is my contribution to the world worth the cost in dollars and stress caused by unnecessary procedures? Selfishly, I happen to think that my contribution is worth the cost of some mammograms. I happen to believe that the number of women saved by mammograms is not insignificant.

As much as I disagree with the conclusions of the USPS Task Force, I actually believe it is reasonable to raise the questions, however. Asking the questions is not "rationing" of health care. In reality, rationing happens all the time. Choices of what treatment is appropriate and available to us are made by out doctors, their hospitals, INSURANCE COMPANIES, and even our own finances. Costs of care and issues of the length or quality of life are really tough issues for all of us to sort out. They're tough issues, but they need to be discussed. We should all enter this dialogue with our doctors, our families, our friends, and our communities.

Mammograms are not without flaws. They do sometimes detect abnormalities that are harmless, but this leads to further tests. And being called back in for follow-up or biopsies does cause understandable anxiety!

Because younger women's breast tissue is denser, mammograms are less effective for them. Because of this, younger women tend to have more suspicious readings, which lead to more procedures.

Mammograms are an imperfect tool. I just don't believe that the proper response it to take away the only real tool we have because it's not perfect. I wish instead, that a discussion of the problems with mammograms would lead to a real call to action. Mammogram is a flawed tool - GIVE US A BETTER TOOL FOR DETECTION! If women are being over-treated for disease that would never become life-threatening - GIVE US BETTER TOOLS FOR DETECTION! If you think this is all too stressful for women to bear - GIVE US A BETTER TOOL!

Julie

My Back Hurts - That Would Be Serratus Posterior

julie@life-cise.com (julie) — Thu, 12 Nov 2009 20:02:00 +0000

OK, I was out hauling in firewood this morning. I reached over and, boom, my back seized up. It wasn't even a big piece of wood, just a little thing - so annoying! I came in laid down on the floor and took some nice deep breaths.

My SCM (sternocleidomastoideus) has been super tight lately - that's the muscle at the top of the neck that turns your head. And all of a sudden, I felt like a band had tightened around the bottom of my ribs - that would be serratus posterior inferior.

(Look, I'm a fitness professional. I'm not going to just say "my back hurts." I've studied anatomy. If I don't know which muscle it is, you can bet I'm going to get out my anatomy coloring book and look it up. I want to know which muscle, how it interacts with other muscles, and where it attaches. But then, I am something of a fitness geek.)

Now, the usual reaction to back pain is to take a pill and go to bed. Not for me. I decided to go for a run. I'm a pretty slow runner anyway, but today I was in serious turtle-mode! I ambled along, slow and awkward (and probably a little crooked). My ego cringed a little when I ran past the road crew like that. Not that any of those fat old guys care, but we're talking about ego.

I ran about 5 miles, and I feel much better. I can breathe more easily. I don't feel like my back is going to shatter into a hundred pieces if I pick up a glass. It's still a little tight, but manageable. And I'm mobile.

I wrote about the idea of exercising for back pain last March, after a back moment on a ski trip. My strong belief is that for most back pain, a little exercise should be your first step, not the bath or bed. It can help loosen up those stiff muscles that are in spasm.

This is totally unscientific; it's just my experience. But I do have experience. Many of you don't know that before I was diagnosed with breast cancer, I had a serious injury. I was run down by a taxi while crossing the street. (I know, I had some serious bad luck, health-wise, for a minute.)

I had a cervical spine injury resulting in lots of pain and physical limits. I learned that the best thing I could do was keep moving. It might not be easy or feel great, but if I did nothing I only got worse. If I just rested, the muscles simply tightened up and I would be less mobile and in more pain.

And I don't like pain!

What I learned from that accident served me well when I was going through cancer treatments. I knew that if I could just keep moving I'd feel a little better. - And from that was born Life-Cise and this blog.

So next time you have a little back pain, instead of just climbing in bed, try a walk or a swim - or even a run.

Julie

More On Getting Started - For Breast Cancer Survivors

julie@life-cise.com (julie) — Wed, 11 Nov 2009 02:08:00 +0000

To follow along with my recent theme of getting started with an exercise program, I want to give a few extra tips for breast cancer survivors.

The very first thing is to think about your bra. After breast cancer surgery it is so important to have a good, comfortable, and supportive bra for exercising. You've got incisions and scar tissue; you need good support. This really makes a difference - if you don't have one, spend the money and get one!

A lot of women like to wear two sports bras, especially if they're starting to run. I never did that because I didn't run back then (I know, how weird is it that with all the sports I do, I only started running a couple of years ago?). But I know several women who swear by it.

Second, take measurements of your arm before you start exercising. That way, you have a record, and can easily see if you're having any early signs of lymphedema.

And finally, whatever it is you like to do to get moving, do it! Numerous studies have shown a strong association between exercise and a lowered risk of recurrence - as much as 50% in the Nurses' Study.

So, if you used to exercise but fell away from it after surgery or during treatment, get back to it! If you've never been very active, now is a perfect time to start!

Julie

So You Started, Now What?

julie@life-cise.com (julie) — Wed, 04 Nov 2009 16:38:00 +0000

Alright, you got started! In spite of feeling exhausted from cancer treatments, being weakened by some other illness or injury, simply too overwhelmed by your life to exercise, or being really out of shape because you haven't gotten off the couch for three months, you took the advice and decided to start exercising. You found activities you enjoy, and you've figured out a good, appropriate level for you. Bravo!

So, what's next?

Figuring out how to progress can be tricky. I'm hoping you're enjoying yourself and feeling enthused. But a fairly common mistake comes from enthusiasm. Sometimes people make the mistake of ramping up their workout too much, too quickly. People find that what felt hard the first day starts feeling easier after a few more days. They're tempted to increase their workout right away. - I'm really enjoying this. I feel good; I'm sleeping better; I have a little more energy; yea! What I thought would be tough turns out to be fun. So if I feel good with this, I bet I'll feel great if I do twice as much!

The problem is, if you increase too much too quickly, you're risking injury because your muscles may not be strong enough.

Our workout may begin to feel easy after just a few days mainly because our bodies are learning to do the exercise better and more efficiently, not because we've really built up the muscle. Our bodies and our brains are adapting to the exercise. So if we increase too quickly, we may not have actually built up the muscles yet to handle the extra work.

It's a good idea to stick with your workout for a week or two before increasing. That gives your muscles a chance to really catch up. And by doing that, you will reduce your risk of injury because you won't be over-stressing muscles before they're ready.

And when you are ready to begin increasing your workout, do it gradually and once again, give your muscles a chance to adjust to the new level.

You can increase the duration, intensity, or frequency of your workout. But only increase one element at a time! If you started out with just a short amount of time, try increasing the duration first. Try increasing the time by 10% - if you walked slowly for 20 minutes, walk slowly for 22 minutes. After you adjust to that, try keeping the time the same, but increase the intensity - stick with 22 minutes, but walk a little faster. And after that, maybe add another day of exercise into your week - if you start by walking 3 days per week, increase it to 4.

This holds true for weight training, too.

The important thing is to increase only one element at a time, and do it incrementally. Don't suddenly double the amount of time and the intensity at the same time.

This is especially important when you're just starting out. If you've been inactive, you're body will take some time to adjust to the new stimulus.

So enjoy what you're doing; just be prudent about how you build from here. And again, bravo to you for getting started!

Julie

More Tips from Life-Cise on Getting Started

julie@life-cise.com (julie) — Thu, 29 Oct 2009 17:39:00 +0000

I had a terrific time talking with Irina Wardas, the NaturalCounselor.com. If you missed the show, you can hear the archived show at BlogTalkRadio.com/NaturalCounselor.

To follow up on something we talked about on the show: How to get started?

We all know we should exercise, right? Whether we've had cancer or not, we should; but a whole lot of us don't.

One of the barriers to getting started is how. If people are out of shape and have not been exercising for whatever reason (cancer, other illness, injury, or just haven't been active), it can be difficult to figure out how to get started. Many of the exercise recommendations or workout shows/DVDs can seem far out of reach.

Recommendations from the American Heart Association, the American College of Sports Medicine, and the US Dept. of Health & Human Services are to get at least 2.5 hours of moderate exercise per week. That breaks down to 30 mins. most days per week. It's important to remember, though, that those 30 minutes do not have to be done all at once. It is still effective to break it up into shorter segments: for instance, three 10 minute segments.

Two things are key: starting at an appropriate level, and doing something you enjoy.

If you are severely weakened, you may not be able to manage 30 minutes. Strive to do as much as you can - a little bit is better than none! This is simply your starting point. You can build up slowly from there. As my friend Mike from Asphalt Green says, if the most you can do is to get out of bed in the morning, fine. Get out of bed, now climb back into bed. Get up again - you've just doubled your exercise for the day!

It's about finding the appropriate level for you, not your neighbor or some fitness model on TV. You should feel like you are working, but not exhausting yourself. You should get your heart rate up some, be breathing a little harder, but not be gasping for air. You should be able to speak in short sentences. If you can recite all the lyrics to your favorite song, you can probably push yourself a little harder. If you can't even utter one word, ease up some.

And do something you enjoy! If you think that exercise means walking on the treadmill at the gym, but you hate walking on the treadmill, you are not very likely to continue with it. Do you like dancing? Gardening? Riding a bike? Walking with your best friend at lunch time & catching up on the latest gossip? Whatever it is, if it gets you moving, do it! You are more likely to continue if you do something that's fun.

So get started. Turn off the computer and go do something active that you enjoy. If you can only do a few minutes, OK. Do what you can. If you can do a lot vigorously, great. Whatever you can manage - do it & have fun!

I'm turning off my computer now and going out for a hike - bye.

Julie

Exercise & Breast Cancer on Blog Talk Radio

julie@life-cise.com (julie) — Wed, 28 Oct 2009 15:41:00 +0000

Join me tomorrow, thurs. Oct. 29, at 12:30pm EST, as I talk with Irina Wardas on Blog Talk Radio. Irina counsels women on holistic health and nutrition at www.NaturalCounselor.com. To round out Breast Cancer Awareness Month, we'll be talking about the importance of exercise for breast cancer. Exercise has been shown to be associated with reduced risk for developing breast cancer, as well as a lowered risk of recurrence for someone who's already had breast cancer. I'm looking forward to talking with Irina; I hope you'll join us (Feel & Look Fabulous with Irina, 10-29, 12:30pm EST)

Julie

Teaching An Old Dog New Tricks

julie@life-cise.com (julie) — Sat, 17 Oct 2009 23:54:00 +0000

I am so going to get in trouble for that title! - this is another post about my mom.

Some of you may remember my mom; I mention her pretty often. She's my star client. I made her do pushups, so I show her off whenever I can.

When I first did her fitness assessment, mom was not able to push herself up off the floor once in the pushup test. Aside from the pushup test, she was in good shape. I asked her what would happen if she fell sometime when dad wasn't around. Sure, she could probably roll to her side and manage to get up, but she understood my point.

She began in earnest to work on her upper body strength, especially pushups. She began doing wall pushups, moving her feet further from the wall as she gained strength. As her strength increased, she did pushups against the kitchen counter, and then moved on to modified pushups on the floor. I thought she would be satisfied with that, but she was on a roll, she was determined. Finally, she started doing full pushups. At first, she could only do 1 or 2. But she kept working on it until she could do 10 full pushups (in great form, I might add).

Now, this didn't happen overnight, or even over a couple of months. This was a slowly progressive exercise plan. It took her about a year and a half to go from just a few wall pushups to 10 full pushups.

Mom's new idea is that she wants to start running, maybe even run a race (I'm thinking the Komen Race for the Cure would be good). We worked out a plan. She's beginning with adding short running segments into her walk, and more strengthening exercises. As she gets comfortable and builds strength, she'll gradually lengthen the running segments.

Mom is 72. She wasn't some super athlete. She's just realized that she feels better when she exercises, and if she slacks off for too many days she feels worse. And, it seems, she like having a goal.

What's key about mom's progress is that she starts at an appropriate level, and makes gradual progress. She knows it's not going to happen quickly, and she is diligent.

So in response to people, decades younger, who ask if they can really expect to make fitness gains at their age, I say "Hey man, check out my mom!"

Julie

Don't Just Buy The Shoes With The Pink Ribbons, Get Your Mammogram!

julie@life-cise.com (julie) — Wed, 14 Oct 2009 23:15:00 +0000

Although sometimes it can seem like the month of October is just about having the chance to buy absolutely anything in Pepto Bismol pink, it’s supposed to be about awareness of a terrible disease. The American Cancer Society estimates that 2009 will see nearly 200,000 new cases of breast cancer in the U.S. And sadly, they estimate there will be over 40,000 deaths from the disease this year.

Thanks to dedicated researchers, we know much more about breast cancer than we did even a few years ago, so more women are surviving. Breast cancer is no longer seen as one disease. Each cancer has it’s own genetic makeup, and we’re learning how to target the specifics of each woman’s cancer. Twenty years ago, we basically had one cocktail of drugs. Now we have many more choices.

And more women are living longer in part due to earlier detection. More breast cancers are being found in stage 0 or 1, rather than at a late stage when treatment options are limited.

And how are they being detected earlier? – Mammograms! Ladies, get your mammograms. Here’s a sobering thought: according to a large Massachusetts study, 75% of breast cancer deaths occur in women who don’t get regular mammograms.

So, ladies, I repeat: get your mammograms!

Occasionally, a friend or colleague will complain to me about getting her mammo. It’s uncomfortable, stressful, there’s no time to schedule it, if they find something it just means more tests & it’s probably nothing anyway…. blah, blah, blah. I am always aghast at these comments. Do these women really think they’ll get a sympathetic ear from me?

I am alive because of a mammogram. And because I had a doctor who insisted, even though I was just in my 30s with no family history or risk factors, that I go. My cancer was very aggressive and had already spread to most of my lymph nodes. If I had waited a year, or even six months, I would be dead now.

Mammograms are important!

Sure, it’s sometimes hard to schedule them into our busy lives. Doll, we’re all busy – get over it. True, they are not the most comfortable procedure ever invented. And yes, they can be stressful. But I assure you, a mammogram is much less uncomfortable than a mastectomy or chemo. And while it can be stressful, I guarantee you it is not nearly as stressful as finding out you have a cancer that has already spread!

I repeat: mammograms are important; they save lives! No, mammograms do not prevent cancer; they only detect it. But if it’s detected early, it is much more treatable.

Sorry if I sound a bit testy about this, but it matters. I get crazy at the idea of just one woman dying because she discovered her cancer too late for effective treatment, simply because she couldn't be bothered to get her mammo.

So quit your whining and go!

Julie

For Breast Cancer Awareness Month, Get Thee To The Gym!

julie@life-cise.com (julie) — Mon, 05 Oct 2009 16:14:00 +0000

Here we are in October, the month of Breast Cancer Awareness. You’ll be seeing Public Service Announcements about getting mammograms, pitches for money to support research (please offer as much support as you can - those of us who have had breast cancer appreciate it!), and the ubiquitous pink ribbon on any number of products.

I, however, plan to spend a lot of time during Breast Cancer Awareness Month at the gym, or running, or hiking. Why? Because, when it comes to breast cancer, exercise matters.

For women who have not had breast cancer, solid scientific evidence shows that exercising is associated with a reduced risk of developing breast cancer. Over many years, numerous studies have shown a strong reduction in breast cancer risk in women who exercise regularly; some studies have shown as much as a 30-40% reduction in risk. In one such study, Dr. Friendenreich and colleagues, of the Alberta Health Servies-Alberta Cancer Board in Calgary, Canada, followed 1,231 women for 8.3 years. The women who exercised at least 4 hours per week had a 44% lower risk of breast cancer death.

Of course, we all know exceptions to any statistics; I’m a perfect example. I was young, very healthy, ate well, exercised, with no history of cancer in my family. And I got breast cancer in my 30s. Yes, there are exceptions, but the fact remains that exercise is one thing you can do to reduce your risk of breast cancer.

But what about women (and men - breast cancer is largely a woman's disease, but about 2% of cases are men) who have already had breast cancer? For those currently in treatment, exercise can be a powerful tool in managing the side effects of treatment. There is also evidence that exercise can reduce the risk of recurrence. Studies have shown that moderate exercise can reduce the risk of breast cancer recurrence by as much as 50%.

Fifty percent! That is a huge number. I happen to enjoy exercise. But even if I hated it, with numbers like that, you can bet I’d be lacing up my gym shoes!

And there’s more good news about exercise for breast cancer survivors. A recent study shows significant benefits from weight lifting for breast cancer survivors with lymphedema. Lymphedema is a swelling of the arm and hand that can result from removal or damage of the lymph nodes during surgery and treatment for breast cancer. It can be a debilitating condition, and precautions should be taken to minimize the risk of developing it.

In 2001, when I was diagnosed, the standard recommendations were to not lift anything heavier than 5 pounds, carry a heavy purse or groceries on the affected side, or do repetitive movements like scrubbing or painting. I couldn't figure out how, if I followed all those recommendations, I could actually live my life. So I set out to prove them wrong - just like a lot of women over the years, who have shown that with the right preparation, we can do most anything.

In August, the New England Journal of Medicine published a new study from researchers at the University of Pennsylvania School of Medicine. This study found that, counter to the common advice, a gradually progressive weight training program may be the best thing women can do for lymphedema. Those in the weight training program had fewer arm and hand problems, and fewer lymphedema flare-ups.

This is great news for everyone at risk of lymhedema from cancer – for those of us who enjoy some high-intensity activities like rock climbing, windsurfing, or tennis; as well as those who just want to be strong enough to hold their child or cook a roast.

So this year for Breast Cancer Awareness Month, after you’ve washed your hair with your pink ribbon shampoo, eaten your pink ribbon yogurt, placed the pink ribbon book mark in your book, do something else. If you have not had breast cancer, congratulations! Try to keep it that way - go to the gym. If you’ve been diagnosed with breast cancer, go for a walk (or swim, or dance, or whatever you enjoy). And if you have someone you care about who’s being treated for breast cancer, do something that will help both of you. Call her up and take her out for a walk.

Julie

(read more about exercise & the reduction of risk of recurrence in my June post; and the lymphedema study in my August posts.)

True Confessions

julie@life-cise.com (julie) — Mon, 28 Sep 2009 22:26:00 +0000

OK, it's time to come clean - I haven't been exercising. This is bad - I'm a personal trainer. I'm not supposed to admit I haven't been exercising.

As many of you know, I was on vacation out in MI. While there I was swimming twice a day and windsurfing every day there was wind. I got back a few weeks ago to a furiously busy schedule. I went from vacay. mode to long, all-day rehearsals, writing deadlines, clients, and assorted other things. It was over a week before I even had time to completely unpack my car. I had no time to work out. And then I had to do laundry & clean my house. And then I got rear-ended so my back hurt (hint: even if the light turns green, if the cars in front of you are not moving, you don't get to go yet!). And then I had a headache. And then I didn't feel like it. And then I thought, I'll just do it tomorrow. And then. Then. Then. Then....

OMG! I sound just like everyone else! Those are not reasons for not exercising, they're just excuses. They are no different than all the excuses people use all the time - the excuses for which, without even thinking, I can come up with multiple solutions. OMG!

So today I took my own advice. You've seen it posted here, on Facebook, on Twitter, or heard it from me in person. Start by making one healthier choice today. You don't have to be perfect. You don't have to change everything right now. Just start with one better choice.

It's good advice. I think I'll follow it.

So, maybe I don't have time to go to the gym for an hour or run 5 miles. I can run for two. I can do some pushups at home. I can eat some fresh vegs. from my garden instead of pasta with cream sauce (or popcorn with tons of butter).

This afternoon I went for a run before it started raining. It was just 2 miles, but it was a run. I'm getting back on track, getting back to the process. Fitness is not a destination. You don't get in shape once and then you're done. It's a process - an ongoing process. And I'm happy to be back in it.

Julie

Save the Boobs - PSA for Breast Cancer Awareness

julie@life-cise.com (julie) — Fri, 25 Sep 2009 23:06:00 +0000

This is a new Public Service Announcement for breast cancer awareness that has got people talking.

When I first saw it, I thought it was some bad, puerile beer commercial. I wondered if it made too light of an obviously serious issue. Breast cancer awareness is about saving lives; it's not about saving boobs for men to ogle. But although I thought I should be offended, I was secretly a little amused by it's irreverence.

The spot is clearly aimed at a younger viewers who often don't give much thought to breast cancer. As too many of us know however, it is not just our mothers' or our aunties' disease. So in the end, I decided that any PSA that gets younger women to pay attention to breast cancer is cool with me. Super-cool, in fact.

But I'm curious what others think of it....

Julie

Hidden Dangers of Soy

julie@life-cise.com (julie) — Tue, 22 Sep 2009 15:13:00 +0000

I want to take a minute to introduce you to my friend, Dianne Gregg. Dianne interviewed me back in July for her radio show, Health Watch Radio. I had a great time talking with her during and after the interview. The show ran live in July, but is archived. You can hear it at www.blogtalkradio.com/Health-Watch-Radio.

Dianne is also author of the book "The Hidden Dangers of Soy", available from Amazon.com.
Given the prevalence of soy in our food system and the occasional hyperbole of the benefits of soy, this is an interesting read. Dianne wrote this book after discovering and dealing with her own severe soy allergy. Soy can be found in many of our foods, often not listed in the labeling. If you suspect you may have a soy sensitivity, or would simply like more information, please check out Dianne's book.

Julie

Chemotherapy - Poison With A Plan

julie@life-cise.com (julie) — Fri, 18 Sep 2009 18:50:00 +0000

I'm going to take a brief break from writing about fitness issues to vent. As reported in the NY Post and Huffington Post, Suzanne Somers has said that Patrick Swayze was poisoned by chemotherapy. She says the chemo destroyed his body and instead he should have tried to build up his body holistically.

This type of blanket statement greatly angers me. There are very, very many of us who are alive and healthy because of chemotherapy! It is one of the great tools we have to fight cancer. Yes, it's scary. Yes, it is poison, but it's poison with a plan.

I believe there is much good to be gained from holistic practices, but I also believe in using every tool available when fighting a mighty foe!

The problem with those kinds of blanket statements (and I heard a lot of them while I was in the middle of treatment), is that each cancer, like each individual, is different. There is no statement that can be absolutely true for every cancer. There are too many variables: type of cancer, characteristics of the particular cancer, health of the patient, age of the patient, etc.

Statements like that are dangerous. They ignore a mountain of solid science.

And they spread fear and take away hope. Chemotherapy is scary. I don't know anyone who's had it who hasn't been afraid - we don't need more help in being scared! But we choose to do it because it offers us the chance for life!

Those statements also ignore that there is much that we can do to manage the side effects of treatment. We do have some control. There are better and better drugs to help minimize the side effects. There is good support available through the American Cancer Society and many other groups. And through my work at Life-Cise, I encourage people to stay fit and active throughout treatments. I work with people in any stage of treatment and beyond, but especially encourage people to keep exercising during chemotherapy and radiation.

We all make our own choices. And when we're facing cancer, all of our choices suck! But we gather all the information and seriously make our choices about our treatments and our lives. It is not easy; it is not comfortable. It is difficult and scary. I think that is what unites us as survivors. In spite of our diverse lives and diseases, we share those moments of heartbreaking choice.

And no one has the right to question our well-considered, serious choices for our lives.

That bears repeating: No one has the right to question our considered, serious choices for our own lives.

Julie

Get Strong, But Understand the Lymphedema Risk

julie@life-cise.com (julie) — Tue, 01 Sep 2009 16:23:00 +0000

Over the weekend, I had lunch with my friend Mel, author of the Cancer Warrior blog (TheCancerWarrior.blogspot.com). We both talked about some of our sports and interests (she plays hockey & I'm busy windsurfing since I'm out in Michigan on vacation). Mel commented that with all of my high-intensity activities, I'm very lucky to have not developed lymphedema. So, since I've been writing about lymphedema in my last couple of posts, I thought I'd continue.

Lymphedema is a very real concern for anyone who's lymph system has been compromised by illness, surgery, or treatment. It is a life-long risk, and there is no cure. Noticed early, it can be managed. But it can become a life-altering, disabling condition.

It is not to be taken lightly!

I acknowledge the risk and have always taken it seriously. But I refuse to have my life controlled by the fear.

From the beginning I decided to take control as much as I could. I educated myself about lymphedema. I read and I talked with my doctors. I sought out lymphedema specialists to talk with. And with all of the information I gathered, I came up with a plan of action.

Once I had regained good range of motion, I began strengthening my weakened muscles. Following the advice of people who knew more than me, I began with very light weights. Actually, I started with no weights, doing slow exercises using only the weight of my arms. As I gained strength, I added weight a little at a time.

I also monitored my arm for early signs of swelling. I periodically measured my arm in several places.

I made slow, incremental progress. Over the course of many months I built up enough strength to begin thinking about taking up some of my upper body-intensive activities. I got back to windsurfing and eventually rock climbing.

After a couple of brief bouts of minor swelling (which were managed with some self-massage, some exercises to stimulate the lymph system, and keeping my arm elevated), I got fitted for a compression sleeve and glove (mine is from Jobst). I found I didn't need to wear them all the time, only as a precaution with certain activities.

I've heard women complain about how they look or feel. I don't understand the reluctance to wear a compression garment if it allows you to do things you enjoy. Personally, I am less concerned with making a fashion statement than with what I can do. And a well-fitted garment is not prohibitively uncomfortable. I would much rather wear it occasionally and still be able to do the activities I love.

And, of course, this risk of lymphedema is ongoing. I never forget about it. If I have taken some time off and gotten a little out of shape (yes, it happens), I go back to lighter weights again. I start off easy and build slowly.

So, yes I've been lucky. I'm strong and have not been debilitated by lymphedema. But I've also been aware, cautious, and prepared.

Julie

How To Get Strong - Weight Lifting & Lymphedema

julie@life-cise.com (julie) — Fri, 28 Aug 2009 20:14:00 +0000

As a followup to my last post, I want to give a few tips for starting a weight training program for breast cancer survivors.

The most important thing is to begin with light weights. Even if you did weight training before breast cancer, you need to begin with easy weights to see how your body reacts now that your lymph system is compromised. Our bodies can compensate, but they need a chance to adjust to the change without being overloaded.

So begin with light weights. You may want to begin with slow, no-weight exercises. No-weight exercises, using just the weight of your arm, can be effective at building strength if done properly. The key is to do the exercises in a slow, controlled manner. For example, if you're doing a straight arm raise, raise your arm to shoulder height, hold for a couple of seconds, and lower. The raising and lowering should take at least a few seconds. It's especially important to lower your arm slowly, since about 70% of the work our bodies do in an exercise is in the lowering.

As you gain strength, you can increase the number of repetitions or number of sets, or the amount of weight. But don't do both at once. And as you increase the weight, do it gradually. At Life-Cise, I often recommend using water bottles for weights. Depending on the size, they weigh about a pound or two, and you can vary the weight by pouring out (or drinking) some of the water.

It's also a good idea to measure your arm at several places. Keep a record of the measurements and monitor yourself for any swelling. If you do have some swelling, back off the weight a little and talk to your doctor or lymphedema specialist.

And always remember, the risk of lymphedema is ongoing. Just because you haven't had a problem doesn't mean you can't develop one in the future. However, that risk is not a reason to do nothing. It's quite possible to gain the strength to do some pretty high-intensity activities. And, as I noted in my last post, now it seems that lifting weight may be the best thing you can do.

Julie

Get Strong! - Weight Lifting and Lymphedema

julie@life-cise.com (julie) — Tue, 25 Aug 2009 21:33:00 +0000

Good news! Getting strong may be the best thing women can do for lymphedema.

When I had my surgery for breast cancer in 2001, the standard recommendations were still to not lift anything heavier than 5 pounds, carry a heavy purse or groceries on the affected side, or do repetitive movements like scrubbing or painting. However, I found that therapists who specialized in lymphedema were cautiously less restrictive. They did warn against overexertion, but advocated a gradual progression of exercise. Based on anecdotal evidence, they said exercise might not hurt, and indeed might help with lymphedema. Often sighted were the dragon boat racers who were strong women doing a very repetitive sport, who seemed to have no higher rate of lymphedema than other breast cancer survivors.

This was good news for me since I had every intention of returning to climbing and windsurfing. And aside from climbing, I couldn’t see how to live a normal life with those precautions. How would I cook, carry groceries, haul my viola around, or play with my nieces and nephew?

Earlier this month, the New England Journal of Medicine published a new study that suggests that much of the advice we’ve been given over the years about lymphedema is too restrictive. Dr. Kathryn Schmitz, of the University of Pennsylvania School of Medicine, and colleagues studied 141 breast cancer patients who had lymphedema. Half followed the standard restrictions, and half took part in a progressive weight lifting program. The weight lifters had significantly fewer flare-ups than the women who restricted their activity.

In an accompanying editorial, the New England Journal suggests that the “policy of avoidance” should be replaced with advice on rehabilitation.

With my clients at Life-Cise, I always advise starting slowly and progressing gradually. It is really no different than rehab after an injury. You begin with very light weights; even just the weight of your arm may be enough to begin. Slowly increase the stress in a progressive manner, and keep monitoring the arm for swelling or pain.

For years, some of us have been showing what’s possible, that it may not be necessary to disrupt our lives so dramatically, that we can be active and strong. Now we have evidence to back us up.

This is great news for everyone at risk of lymphedema from cancer. You don’t have to want to climb or row or hammer. You may just want to be able to hold you child or cook a roast.

Julie

Body Image After Breast Cancer

julie@life-cise.com (julie) — Thu, 20 Aug 2009 19:19:00 +0000

My first article for GalTime has just been posted. I've written about body image after breast cancer, a subject I found surprisingly hard to write about. I say surprising because, as many of you know, I easily speak and write about my personal experiences when promoting fitness for cancer survivors. But this was an area I had not really addressed publicly. Anyhow, I hope you'll check it out (click here to read my article).

Aside from my article, I hope you'll visit GalTime often; it's well worth reading. And I don't say that just because I've got an article there - they've got a lot of terrific women writing a lot of great articles! Please, take a look.

Julie

The Number 2 Reason for Exercise

julie@life-cise.com (julie) — Sat, 08 Aug 2009 15:25:00 +0000

Poop. Yes, I'm going to write about poop, a subject most people don't give too much thought to.

When I started climbing I thought a lot about it. Mountaineering distills life to it's most basic elements: food, water, the need for shelter, and elimination. In the mountains, it's important to think about poop and safety: how and where to do it so we don't destroy the environment, compromise the health of ourselves or others, and protect ourselves (as in, how not to fall in a crevasse and die!).

But, except for the occasional bout of irregularity, most healthy people don't think much about it.

For people fighting cancer or many other serious diseases, regularity can be a constant concern. It's a big issue after any surgery; you will never be released from the hospital until you can go to the bathroom. Many chemotherapy and other drugs cause constipation. Depending on the cancer, radiation can disrupt regularity. And if cancer spreads to other organs, elimination can become a constant problem.

Diet is a key factor in regularity. It's important to eat a well-balanced diet with plenty of fiber.

And drink water! Sometimes, the importance of water is missing in discussions of diet and regularity. Your body simply cannot move waste through it's system without adequate water. Drink water!

But exercise is also important in maintaining regularity. That's one of the reasons it's so important to start walking after surgery. For people in various stages of treatment, exercise offers many benefits. It can improve energy level, relieve pain, improve mood, for example. But it's also useful in maintaining regularity. A simple walk can stimulate your body and encourage all your body systems, including digestion, to function smoothly. The American Cancer Society, in CA a Cancer Journal for Clinicians, says exercise can help relieve constipation, even for people living with advanced cancer.

With all of the other side effects of cancer treatment, constipation may seem like something relatively minor. But most people going through treatment find it a pretty important issue. It's just impossible to feel good if you can't go to the bathroom. And it's an ongoing issue throughout cancer treatment.

So, this topic may be TMI (too much information) for a lot of folks, but people in cancer treatment know just how important it is.

Julie

Thoughts on Surgery

julie@life-cise.com (julie) — Fri, 31 Jul 2009 23:23:00 +0000

This post is for my good friend Andrew. Andrew just dodged a couple of HUGE bullets. He went in for surgery last week for pancreatic cancer. It was found early while checking for a congenital heart problem. Amazingly, it turned out to be the 1-2% chance that it wasn't cancer. That's the great news. Unfortunately, he went into anaphylactic shock after surgery and spent a week in a coma. He's OK and finally back home, resting, to the great relief of family and friends.

So I've been thinking about surgery these last few days. It is incredible what doctors can do; surgery can save our lives. But it is tough on us, even when everything goes perfectly smoothly.

And coming home from the hospital is hard. We are frail and so dependent on others. At first I struggled just to get out of bed or to go to the bathroom. I'm a very independent person, so it was painful to not be able to care for myself. I remember my anger and humiliation at having to have my mother help me to bathe. (Mom, I know you will read this. Please know that I do appreciate that you were there and able to help me. I will always be grateful, but it was difficult for me, as a grown woman, to have my mother bathe me.) My partner, Ron, told me I didn't really stink that much so I should wait until I was stronger. But I wanted to bathe, so Ron and my mother obliged. I got clean, but felt completely frustrated and exhausted.

It's not just the physical hardship, though. Although we're happy to be back home, it can be a strangely unsettling experience. In the hospital we receive so much attention. I realize this sounds totally narcissistic, but it's easy to get used to all the attention from nurses, doctors, family and friends. Then suddenly we're home, struggling to fend for ourselves, and we are reminded that life has gone on without us. Bills still need to be paid; telemarketers still call; our husbands/wives still snore; our neighbor's dog still wakes us up with barking.

And if our surgery was cancer-related (or some other life-threatening accident or disease), we confront our own mortality - but that's a topic for another day, maybe best over a glass of scotch.

Whenever I have the chance, I stress to people the importance of exercise before surgery. I think of it as training for surgery. First, exercise is a great stress reliever. Also, whatever you do in the weeks before surgery will help your body in recovery after surgery. Healthy heart and lungs will help speed your recovery, giving you more energy. And strong muscles, especially core and lower body, mean better stability and mobility after surgery. That means fewer falls and greater independence.

After surgery, walk. Get up and walk, even when it's tough and you're tired. Walk, and keep walking. Walking gets your heart and lungs working, helping to clear the anesthesia and other drugs from your body. Walking also helps stimulate your appetite and regulate your bowels, always important after surgery.

Later, after you doctors tell you it's OK, you have to begin stretching to regain full range of motion and work to regain strength.

But first, walk. Walk, walk, walk.

Julie

Some Friends in the Social Media Cancer Community

julie@life-cise.com (julie) — Sat, 25 Jul 2009 15:49:00 +0000

Over the past several months I've had the opportunity to meet and, in some cases, make friends with some wonderful people trying to make a difference in the cancer community. OK, I say "meet", but many of these folks I've only met online.

Although I was initially reluctant, I have become a huge fan of social media. Yes, I drank the coolaid. I am now fairly addicted to Facebook, LinkedIn, and Twitter. I was afraid it would be a complete waste of my time, filled with the inane minutia of daily life. But I've largely found a group of interesting, supportive folks, sharing information and inspiration.

Today I'd like to share a few of these people with you. And I'm doing it here because a lot of these people don't really fit into the Life-Cise Resources page, but I still want to highlight them.

First, a couple of terrific women with books on cancer:

I met Gail Konop Baker this spring at the Women's Health & Fitness Expo in Kingston, NY.

I so enjoyed meeting & talking with Gail. Please check out her book, "Cancer is a Bitch (or I'd rathe

r be having a midlife crisis)", available at Amazon.com.

I recently met Cindy Papale online. We connected on LinkedIn and now follow each other on Twitter. On Twitter Cindy often sends out tweets of inspiration (@cindypapale). Her website is www.theemptycuprunnethover.com (I think she gets the prize for the longest domain name), and her book has the same name & is available on her site.

In past posts I've told you about Lynn Lane's Voices of Survivors, and Jonny Imerman and Imerman Angels, but they both bear repeating. Lynn is a dear, dear man who's rewriting some of the ideas of survivorship. I am the 52nd video on Voices of Survivors, and am honored to be able to share my voice. Please visit and hear & read the many voices of cancer, www.voicesofsurvivors.com. Voices is also on Twitter (@survivor). And please see what great work Jonny is doing at www.imermanangels.org (and follow on twitter, @imermanangels).

A few other tweets to follow (and I know this is only a few, I'll give you more later):

*Bertalan Mesko, from Hungary (@Berci), has a medical site filled with cancer resources, www.webicina.com/cancer

*YogaBear, providing yoga to cancer patients- @yogabear

*MyHopespace, offer patients, survivors, & caregivers an easy way to communicate-@MyHopeSpace

*Athletes for a Cure, advocate for cancer patients- @athletes4acure

*Team Heather, brother spreading breast cancer info in the name of his sister who lost her battle in 2002- @teamheather

*Army of Women, Susan Love & a new opportunity in breast cancer research- @armyofwomen

*David Pittman - @DP_Turtle, charity runner fighting cancer through running

*FollowHeidi, survivor building awareness for breast cancer research

OK - enough. But this list is nowhere near complete; these are just a few of the people out there doing good work, trying to make a difference in their own way. Give them a follow - they're worth it. And let me know (@juliegoodale) if you have other favs.

Julie

Dieting - Yes or No?

julie@life-cise.com (julie) — Thu, 16 Jul 2009 17:58:00 +0000

Three weeks at Saratoga, playing opera, eating lots of great food and drinking with friends has left me several pounds heavier than I'd like. This is the perfect example of the key to maintaining or losing weight. It's a simple equation: calories in vs. calories out. If you expend more calories than you take in, you lose weight. If you eat more calories than you burn, you will gain weight. There is no magic in this; it's all about calories in and calories out.

So even though I was running/swimming/biking/hiking most days, I gained weight because I was taking in more calories than I was burning with all that activity. (I mentioned there was lots of great food, didn't I?)

So what to do about it? Go on a diet?

I've never been a fan of diets. But if I don't diet, how will I lose the pounds? And I want to lose the excess pounds because I know I'll feel better, my clothes will fit better, it's better for my overall health, and EXCESS WEIGHT IS CLEARLY TIED TO BREAST CANCER RISK!

My problem with diets is that they are temporary. I follow a diet for a while and maybe lose a few pounds, but it's usually not something I can sustain. I need a healthy, sustainable way of eating. I need a healthy lifestyle that allows me to balance calories in and calories out.

In today's New York Times, Mandy Katz writes about dieting in "Tossing Out the Diet and Embracing the Fat". Certainly, overweight people would be better off at a lower weight, according to Walter Willett, chairman of the nutrition department at Harvard School of Public Health. However, Katz writes, "What remains undisputed is that no clinical trial has found a diet that keeps weight off long-term for a majority." She quotes Glenn Gaesser, professor of exercise physiology at Arizona State University, "If they really worked, we'd be running out of dieters."

Rather than dieting, I believe thinking about eating healthy foods in moderation, along with exercise is the answer. I don't get too hung up on a particular number (I'm not even sure what my weight is - I don't own a scale). I just pay attention to how I feel: do I feel good at this weight? does this weight make my life easier or harder? do I feel energized or sluggish at this weight?

I've decided that I'd like to lose a few pounds, so what now? I'll continue exercising, maybe even increase my workouts a little. And I'll think about my food intake. I won't go on a diet, but I'll think about making healthier choices (less ice cream, fewer fried or fatty foods, less alcohol, more water - you get the idea). I'm no saint when it comes to food, but I'll try to make more "better" choices than less.

And I will try to be more mindful about food: eat when I'm hungry, don't eat because I'm bored or just thirsty. I find it's very important to learn to be aware of just what my body is asking for. Mandy Katz also addresses this in another article about eating instinctively. The idea is that true hunger and taste cues can lead us to balanced, healthy eating.

To me, "diet" is a one-time fix. I am interested in a long-term, sustainable lifestyle. I am interested in overall health, not a number. I am interested in feeling good.

I know my weight won't change in a few days or a week - it didn't increase in a few days. But I know that with a little more mindfulness and time, I will lose a few pounds, feel better, be healthier.

Julie

(to read Mandy's articles, click here. they're well worth reading! and thanks to Karen for the Lake George Opera Festival pictures.)