Coping with Side Effects Related to Uterine Cancer Treatments

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Unknown
Hello and welcome to today's webinar Coping with Side Effects Related to Uterine Cancer Treatments. I'm Kitty Silverman, the uterine cancer program director at SHARE. And I'm Corby Arthur SHARE’s uterine cancer patient support coordinator and a uterine cancer patient myself. Before the presentation begins, I'd like to tell you a little bit about SHARE. We're a national nonprofit that supports, educates and empowers anyone diagnosed with breast or gynecologic cancers and provides outreach to the general public about signs and symptoms.

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Unknown
For more information about upcoming webinars, support groups, podcasts and our helplines, please visit our website at sharecancersupport.org

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Unknown
Now I'd like to hand it over to Jessica Walchonski.

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Unknown
The screen is yours, Jessica.

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Unknown
I think so much. My name is Jessica Walchonski, and I am a physician assistant at UCLA in the Gynecologic Oncology department. And I'm really excited to be participating in this webinar today. Thanks for everyone for joining and of course, thanks to the whole chair team for putting on these webinars. And also just for everything that you do for patients and all of your support.

00:01:19:00 - 00:01:42:19
Unknown
So I'm going to share my screen so we can get started. Okay. So today, of course, I'm going to talk about how to cope with side effects related to uterine cancer treatments. So let's get started. So I wanted to start off by talking about some stats in uterine cancer. So it is the most common gynecologic cancer in the United States.

00:01:42:21 - 00:02:13:03
Unknown
And the sixth most common female cancer worldwide is a very prevalent cancer. We have many patients. We have many survivors. With this diagnosis this year, it is estimated there will be almost 68,000 new diagnoses of uterine cancer. So most cases are diagnosed between the ages of 45 and 74. And the reason that all of this is so important and really talking about treatment management and all of these interventions with symptoms is because there is a growing number of cancer survivors.

00:02:13:03 - 00:02:44:18
Unknown
We have better treatment options. People are living longer, people are doing very well. And so what we really need good interventions to help manage these symptoms so we can just get you guys feeling a lot better. So what is our off by doing a quick summary on different treatment options in uterine cancer? So most patients will undergo surgery, so we almost always will do a removal of the uterus, which we call a hysterectomy, and we oftentimes will also remove your ovaries and fallopian tubes.

00:02:44:18 - 00:03:05:02
Unknown
So that's an issue for me and a small project. Me. Sometimes we will also remove nearby lymph nodes. So a lot of pelvic lymph nodes and this is called a lymphatic academy or a sentinel lymph node dissection after surgery, sometimes before a surgery, just depending on the person, depending on the exact diagnosis, a lot of patients will undergo chemo therapy.

00:03:05:04 - 00:03:27:02
Unknown
There are numerous different chemotherapy agents that we can use. And important to note too, that uterine cancer chemotherapy is very different from other chemotherapies used in other cancer treatments. So I know sometimes we get patients who are on support groups or they have friends and, you know, maybe they live colon cancer, maybe they have a lung cancer. We don't always use the same chemotherapy agents.

00:03:27:06 - 00:03:46:22
Unknown
So it is important to kind of always keep that in the back of your mind. There are many, many agents out there. Radiation therapy is also very common in uterine cancer. So we'll kind of briefly touch on this a little bit too later. But the two types that we normally give our external beam radiation and then also brachytherapy, some patients will receive hormonal therapy.

00:03:46:22 - 00:04:08:20
Unknown
So this could be either an anti estrogen medication or a progesterone medication. Then there's things like immunotherapy. So immunotherapies would be things like pembrolizumab to Starling, Mab. These are medications that really rev up your immune system to hopefully fight off any cancer cells. This is not an all inclusive list, but these are just kind of the most common treatments that we see for uterine cancer.

00:04:08:20 - 00:04:27:00
Unknown
And these are kind of what we're going to touch on today. So I also want to kind of briefly go over the female reproductive system here. I think that's very helpful in talking about side effects and kind of managing side effects. So you can see here on the left hand side in the picture of the pelvis that I have.

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Unknown
So the uterus, of course, is the pear shaped organ right in the middle of our pelvis. The bladder sits right on top of it. And that is usually what is removed with uterine cancer treatment and many other gynecologic cancers. So when we remove the uterus, oftentimes a cervix comes with it. The cervix is going to be the opening of the uterus.

00:04:46:17 - 00:05:12:00
Unknown
There are special cases where the cervix might stay in place, but usually the cervix will come out with the uterus. When we remove the cervix, we suture the very top or the very back of the vagina, and that is what we call the vaginal cuts. CFF So this is really important because a lot of times you'll hear your team talking about, you know, your marginal cost in this and not and sometimes people don't have any idea what their oncologists are talking about or what their team is talking about.

00:05:12:00 - 00:05:29:06
Unknown
So we remove the cervix, it forms of vaginal cost and of course the vagina is the opening. And then you can see the ovaries and fallopian tubes which tend to also come out with these uterine cancer treatments, but not always. And then radiation therapy. Just kind of briefly wanted to touch on the two ways that we do it.

00:05:29:06 - 00:05:51:04
Unknown
Like I said. So one is brachytherapy, which you can kind of see on the left hand side there, brachytherapy is where radiation oncologist will use applicators and inserted into your uterus to really kind of deliver targeted radiation to the area. The other type of radiation is external beam, which is that bottom right picture, which is almost more like an X-ray.

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Unknown
So imagine it. You know, it is a targeted area, but a little bit more widespread than brachytherapy would be. So some patients will get one or the other, some will get both. It just depends, again, on your pathology and your specific diagnosis. So now that we kind of did that brief summary, I really want to get into the side effects management the overall here.

00:06:13:04 - 00:06:37:20
Unknown
So really important and I'm going to say this over and over again today, please, please talk to your team. We are here to help. We can only help with symptoms if we know about them. So when you come in for your visits, you know, whether it's every three weeks, every three months, you know, however often you're coming in, we tend to ask patients and women about the most common side effects, or we make assumptions as to what side effects we think you're going to be experiencing or feeling.

00:06:38:00 - 00:07:00:12
Unknown
But we're not always right. And so really, if you have symptoms that are bothering you, if you have symptoms that seem weird or a little bit off, please bring it up to us so we can help. I get a lot of patients who come in and they'll say, you know, I'm a little embarrassed. Like I feel we're bringing this up or I sent you this message and I didn't know how you would respond.

00:07:00:14 - 00:07:19:04
Unknown
Judgment Free zone. So we are here to help with any symptoms, whether it's emotional health, physical health, sexual health. This is what we're here for. And I always tell patients it's not complaining, it's just reporting. So please, you're never a bother. But this is how we can help. You really, really feel a lot better and manage your symptoms.

00:07:19:06 - 00:07:41:04
Unknown
So let's get into it. I'm going to start with fatigue. Fatigue is so common. Definitely with uterine cancer treatments. It's common in life and it's also a really, really hard symptom for us to treat. It's really hard to kind of monitor. It's hard to figure out what exactly is causing it. And that's because there are so many potential contributing factors.

00:07:41:06 - 00:08:00:15
Unknown
So we know that fatigue, of course, can be a side effect of cancer. It can be a side effect of your treatment, but it can also be, you know, if you're a little bit anemic, maybe your red blood cells are a little bit low, maybe your hemoglobin is a little bit low from treatment or from diet or whatever it may be that can make us feel really fatigued, any emotional distress.

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Unknown
So if you're feeling anxiety or worry or panic that can contribute to fatigue, maybe you're not sleeping well. So of course, if you're not sleeping well at night, maybe it's from insomnia, maybe it's pain from surgery again. Maybe there's a worry piece to it. Of course, we're going to feel more tired in the daytime. Too Low appetite or poor diet, maybe.

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Unknown
You're currently on treatment and you really have no no appetite. Or maybe you're really nauseous and you're not eating as well, so that can contribute. Deconditioning is also a really, really big one. So when we have surgery, you know, right after surgery, your team tells you to rest and take it easy and you're recovering, which is very important.

00:08:42:22 - 00:09:02:09
Unknown
But during that time, we sometimes will lose some muscle mass and we become a little deconditioning. That's going to happen during treatment, too. So imagine if you're having, you know, daily radiation treatments or infusions that are frequent. You have all these doctors appointments and that can actually be exhausting and that can also lead us to become a little bit conditioned.

00:09:02:11 - 00:09:23:19
Unknown
And then I added here to, of course, life in general. So I think that when we have cancer diagnoses, we focus so much on like the treatment and the labs and all the medical things. But what about just life? What about friend relationships and family relationships and work and financial issues? And so all of these things can contribute to fatigue.

00:09:23:21 - 00:09:46:14
Unknown
And so really important to talk to our team so they can figure out which one of these factors, if not all of them, are contributing, because treatment really does depend on the cause. And fatigue is really important because it really can last months, but sometimes years after a diagnosis or after a treatment. And so it's something that your team really should be frequently checking in with.

00:09:46:16 - 00:10:10:01
Unknown
So that way we can just get you feeling better and a little bit more energized. So talking about some management options for fatigue. So one really big one and you'll hear me talk about this a lot today is activity enhancement. So this is exercise. So we know that exercise has been shown to combat fatigue and really help. So we really want to focus on doing regular exercise.

00:10:10:07 - 00:10:39:16
Unknown
So this way we can improve our strength, our energy, our fitness. So the American Cancer Society recommends at least 150 minutes of exercise per week. So you should incorporate strength training and also cardio exercise or aerobic exercise. And this really improves our overall mobility, our physical function. But studies have shown that even cancer just in moderate walking has been shown to help with so many side effects related to treatment.

00:10:39:18 - 00:10:56:24
Unknown
And so I'm not sitting here telling you, you know, to go from 0 to 100, you don't have to go out and run three miles today. You don't have to go to the gym and start, you know, doing CrossFit. I really want you to find something that you enjoy so you can get creative with it, you know, even if you're gardening.

00:10:56:24 - 00:11:17:23
Unknown
I mean, that might be something you could do, like a gentle yoga workout, You could do bar workouts are really great. So kind of finding something that you think is fun. And so that way it doesn't feel so much like a chore. Again, we're usually so busy with doctors appointments and treatment appointments and all these things, so we don't want to add another torture to your list.

00:11:17:23 - 00:11:39:21
Unknown
We want you to really enjoy what you're doing. Your team can also consider a referral to physical therapy. I love physical therapy. I think they're really great to get on board early on. They can focus on a whole body deconditioning, but they can also kind of target specific muscle groups too. And so they have a lot of really great recommendations, although never too late to start.

00:11:39:23 - 00:12:11:20
Unknown
So we know that exercise really can contribute a lot to overall longevity and help us, you know, decrease cardiovascular risks and metabolic syndrome risk and heart disease and all of these things that are so important. And so, again, I'm not telling you to go out and do anything crazy when it comes to exercise, but gradually getting into it, working with your team, maybe to come up with with some appropriate and reasonable activity goals for yourself, I think is a really good place to start turning kind of more so to psychosocial interventions.

00:12:11:20 - 00:12:32:17
Unknown
So a little bit different from the exercise, things like cognitive behavioral therapy. So with a therapist is really, really great support groups. We love our support groups. We think that they're so important and just a really great way to hear other people's thoughts and opinions and maybe hear some things that you wouldn't have thought of otherwise. Journaling is great.

00:12:32:17 - 00:13:00:12
Unknown
Different art and music therapies, relaxation techniques are really important. So mindfulness and cognitive behavioral therapy are actually the two like really scientifically proven options to help with fatigue management when looking at psychosocial interventions. So if you can pick two things from this category to help with your fatigue, therapy is going to be really important. And then mindfulness and really learning how to relax your body.

00:13:00:14 - 00:13:25:15
Unknown
I also want to point out that mindfulness meditation, a lot of people think that that means, you know, you're sitting here in your body, you have zero thoughts and that's not what it is. But mindfulness and meditation means is that you're sitting there listening to your thoughts, listening to how your body feels in a no judgment way. So even if you're stressed and even if you're anxious and if your brain is thinking about a million different things, that's okay.

00:13:25:18 - 00:13:47:04
Unknown
But recognizing how you're feeling. So then you can go back to, you know, your therapist or your support group or your journaling and kind of talk through these feelings and these emotions that you're feeling. Again, listen to your body and what it needs. Maybe you started a really great exercise program, but then you're just really tired and your muscles are sore and you're you're even more fatigued than before.

00:13:47:07 - 00:14:16:04
Unknown
And so maybe take a break that day, rest when you need it. That's also very important. Prioritizing tasks. I think this is also really key. So I think really important when we're so busy, when we are having low energy, important to really do your high energy tasks when you have the most energy. So if you wake up at 8 a.m., you're like prime energy at 9 a.m. That's when you should be doing all of those kind of heavier tasks and then spending your energy on activities that make you happy.

00:14:16:06 - 00:14:39:13
Unknown
I think this is so important. I think that a lot of times women before cancer diagnoses tend to be caregivers and, you know, they're spread very thin and they're taking care of everyone and trying to do a million things at once. And that can sometimes change when we have cancer treatment or a cancer diagnosis. And now it's okay to focus a little bit more on yourself and what you need.

00:14:39:17 - 00:15:02:04
Unknown
And it's okay to say no to things and it's okay to really do things that you think are important to you, and that will also actually help with fatigue management as well. So now moving on to sleep hygiene. So again, if you're not sleeping well at night, we're bound to be really fatigued the next day. So really big things avoiding screen time.

00:15:02:06 - 00:15:40:01
Unknown
I really recommend at least 3 hours before bed, but I think one hour is a good place to start. If you are going to be on screens before bed using blue light blocking glasses are really great, really developing a wine down bedtime routine. Our bodies are actually creatures of routine, and so when you have a set wine down schedule, you know, every night I'm going to brush my teeth at this time, wash my face with the same shower, go to bed at the same time, your body will actually start recognizing these things as a bedtime routine, and it should actually increase your fatigue at night using the restroom before bed.

00:15:40:01 - 00:16:01:20
Unknown
You don't want to be waking up, of course, multiple times throughout the night urinating. Sometimes we can't help it, but limiting liquids as much as we can before bed. Keeping your bedroom cool. Very important for both sleep hygiene. It can help with hot flashes too, which we'll get into later. Avoiding spicy foods, alcohol. We really don't want to be drinking alcohol before bed.

00:16:01:22 - 00:16:24:06
Unknown
I think the latest that you really should be drinking alcohol is probably 6 p.m., maybe earlier. So people sometimes confuse drowsiness from alcohol as being very tired and ready for bed when actually it's not it's not restful sleep when you're drinking alcohol. So trying to limit alcohol intake, really, we should try to avoid eating also a few hours before bed as well.

00:16:24:08 - 00:16:46:18
Unknown
Meditation, gentle yoga, all great things to calm the body down. Then there are supplements that you can do to help sleep. So magnesium, calcium, melatonin, they're all great options. Then there are a few herbs that you could try as well too. There's also like sleepy time teas and camomile. So those are great options to try. Also, dietary modifications I think are so important.

00:16:46:22 - 00:17:06:19
Unknown
So really focusing on nourishing your body. If you're not getting good protein intake, nutrient intake, you're going to be fatigued and we know that and that's in the whole population. So I also wanted to mention here because I think it's a great way to kind of sneak it in. But sugar does not make your cancer grow and it also doesn't make it go away.

00:17:06:21 - 00:17:36:16
Unknown
The problem with sugar intake is that being overweight and carrying excess weight does increase many different health risks. And so while yes, sugar doesn't necessarily, you know, impact your cancer and your cancer care, it does impact many other things. So really kind of focusing on protein, iron, well-rounded foods, anti-inflammatory diet, so kind of avoiding things like dairy, avoiding things like gluten, things like that can also help us feel better.

00:17:36:18 - 00:17:58:16
Unknown
Supplements are really great if you're deficient, but actually our bodies absorb all of these vitamins and stuff more so if it comes from food as opposed to oral pills and things like that. So definitely talk to your team. If you're wanting to start a supplement or if you think that maybe you need a supplement, So do some other things that I wanted to mention for managing fatigue.

00:17:58:22 - 00:18:22:19
Unknown
So Ginseng Daily actually has been shown to help their small studies, but it has been shown to help kind of combat cancer related and treatment related fatigue. So that could be something you could consider. Starting acupuncture, I think is great for so many different reasons. So you could talk to an acupuncturist. There are some medications or psycho stimulants that really can increase our energy as well too.

00:18:22:20 - 00:18:41:08
Unknown
So talking to your team, if that maybe is an option for you, referral to palliative care. I love this one and I really want to touch on this one for a moment. A lot of people hear palliative care and they think that that means hospice and they think that that means end of life care with 100%. Palliative care does do those things.

00:18:41:10 - 00:19:11:07
Unknown
But they're also the other thing that they do is really, really manage symptoms related to cancer and symptoms related to treatment. And so I actually love getting palliative care on board, really from the time of diagnosis. They can come on board obviously at any time, but I like getting them on sooner rather than later because they've all these other kind of tips and tricks up their sleeve and they can really help manage physical symptoms of treatments and cancer diagnoses, but also kind of emotional and more of the mental health as well.

00:19:11:07 - 00:19:31:04
Unknown
So they're really, really great to kind of help combat all of these symptoms. And then obviously, a referral to a nutritionist or dietician can help. Maybe you need, you know, some more ideas for what foods to eat, what foods to avoid, so they can really kind of be helpful as well to really I think cancer care, the big thing is a multidisciplinary approach.

00:19:31:06 - 00:20:00:11
Unknown
So that is where we kind of use many different experts in many different fields to really kind of give you the best treatment and also get you feeling as best as we possibly can and help manage all of these symptoms. So now moving on to emotional distress, very common in a lot of our patients, of course. And so a lot of times, you will hear things like anxiety, depression, distress, fear of recurrence, really hard time moving forward sometimes.

00:20:00:13 - 00:20:18:10
Unknown
And hyper vigilance. So I'm sure a lot of people say, you know, especially when you're finishing treatment, maybe you're maybe you're on surveillance mode now where you're not on a treatment, You know, maybe you're just being monitored every three months, every six months. And I'm sure a lot of people can relate that you feel a symptom and you just hyperfocus on it.

00:20:18:14 - 00:20:41:21
Unknown
And, you know, we can have bell abnormalities for so many reasons and bloating for so many reasons. And, you know, a little bit of discomfort for so many reasons. But being hyper vigilant with all of this, we hear all the time and then really body image and self-esteem. If you had surgery, maybe you had radiation, you know, maybe you are now menopausal and you weren't before.

00:20:42:00 - 00:21:04:17
Unknown
And so maybe things look different, things feel different. And so it can take time kind of adjusting to that as well. It really is almost your new body. You know, I've heard a lot of women say even if things physically look fine on the outside people, sometimes it does emotionally affect them saying, well, I don't have a uterus anymore, I don't have ovaries anymore.

00:21:04:19 - 00:21:23:08
Unknown
And it sometimes makes me feel less of a woman. And then you get other women and they're like, yes, take it all out. Now, I don't have to worry. But there are many different feelings and emotions surrounding surgery and things like that. So also, just like I keep saying, talk to your team so we can talk you through it.

00:21:23:10 - 00:21:44:20
Unknown
And just being patient with yourself during this time. Maybe really hard to get back into dating or relationships and intimacy again, that goes with, you know, the anxiety, the fear, recurrence, all of that, but also kind of the body image as well. And then returning to work and financial hardship. I think this is one that a lot of us gain.

00:21:44:21 - 00:22:05:15
Unknown
Oncologists don't really focus on enough to be honest and we don't think about as much. But medical bills are expensive and a lot of times people are off of work for long periods of time while they're on treatment and then you finish treatment and maybe you're back to work. And now it's so different because now you have these side effects you're dealing with, you know, do coworkers know?

00:22:05:15 - 00:22:26:09
Unknown
Do they not know? You know, maybe you still have all these frequent doctor's appointments. So this is a big one, too, that if you are struggling with, please also talk to your team. All of this emotional distress really can persist for many years following diagnosis there, there's been studies that show that it really can last up to ten years, and that's a significant period of time.

00:22:26:11 - 00:22:51:08
Unknown
Family members, of course, can be impacted, family members, caregivers, friends, your whole support system can also be impacted by this. So just knowing about resources for yourself, but then also knowing about resources that are available for other people in your life who may be affected. So things that we can do for emotional distress. So of course, addressing any contributing factors, emotional distress is another one.

00:22:51:08 - 00:23:13:01
Unknown
There's so many things that could be kind of causing it. And so pain, of course, if you're having significant pain that can lead to a little bit of depression, maybe a little bit of anxiety. So treating that sleep, your medical comorbidities and maybe you maybe your treat may give you neuropathy, but maybe you also have a history of diabetes and you have neuropathy from that and now you're really struggling.

00:23:13:03 - 00:23:31:18
Unknown
And that can really affect our emotional health and our mental health. So just kind of treating all of these factors, acupuncture again, which can be great. Maintaining a steady blood sugar is also really important. So if your blood sugar is dropping, it actually can cause you to become very irritable, which can then also lead to distress and anxiety.

00:23:31:23 - 00:24:02:00
Unknown
It's kind of like a vicious cycle, all of these things. So eating small, frequent meals throughout the day is important, and incorporating healthy fats, protein, omega threes are really important, and then just getting your body moving again. So yoga, exercising, meditation, socialization is also really important for emotional health and mental health health therapy. So again, talking to a social worker or talking to a psychologist, a psychiatrist are all really great options.

00:24:02:05 - 00:24:19:02
Unknown
And then if you are really struggling, there are many medications out there that you can discuss with your team, many medications to help with depression and also anxiety. So now switching gears, I know this is a lot of information, so I'm kind of moving quickly, but I just want to cover a lot of things here. But moving to hot flashes.

00:24:19:08 - 00:24:41:12
Unknown
So I'm sure a lot of us know what hot flashes are, kind of these sensations of heat all of a sudden intense sweating flushing. We usually also will get anxiety and heart palpitations that come along with it. Hot flashes are experienced by so many women. Over 75% of women. And then I just want to briefly mentioned natural menopause versus surgical menopause.

00:24:41:14 - 00:25:07:02
Unknown
So natural menopause occurs. The average age of menopause in this country is about 51, 52. So that's where our ovaries stop producing and stop making so much estrogen. Our estrogen levels drop, we start having periods and that is a natural menopause. Surgical menopause means you are still having normal periods. You know, you are younger then an average age of menopause.

00:25:07:02 - 00:25:31:15
Unknown
And then we went and we removed your ovaries and now we put you in surgical menopause. So very, very similar, if not exactly the same symptoms, if it's not from menopause or a surgical menopause. Other risk factors that can contribute to hot flashes, smoking, obesity, and then certain races are at an increased risk, too. So really decreasing any smoking, I mean, smoking is detrimental to your health for so many reasons.

00:25:31:15 - 00:26:05:18
Unknown
So I encourage anybody who's smoking to try to stop or decrease your smoking habits. But then obesity. So again, exercising is going to be really helpful with hot flashes to lifestyle changes. So again, keeping your room very cool. We really want to avoid things that are going to rev up the immune system. And so avoiding caffeine, alcohol, spicy foods, so things also like anxiety and things that really kind of get us, you know, bothered or or upset, things like that are actually going to be classified as a lot worse.

00:26:05:22 - 00:26:23:24
Unknown
And so kind of staying calm, avoiding things that are going to cause an increase in our nervous system, weight loss, like I mentioned, some natural remedies that we can try that are really great so aromatherapy can work. So things like lavender, sandalwood, you can get oils to put, you know, behind your ear and you can put it on your wrists.

00:26:23:24 - 00:26:48:18
Unknown
You could get spray bottle also kind of spritz on your pillow before bed or diffuser many, many ways that you could do aromatherapy, acupuncture, yoga is really great. Again, because it calms down the nervous system, mindfulness meditation, black cohosh, that is an over-the-counter supplement that actually has similar effects to estrogen. So it has been shown to improve hot flashes as well.

00:26:48:18 - 00:27:08:20
Unknown
But important to talk to your team and just make sure that black cohosh is safe for you with your history. There are many prescription medications that we can give for hot flashes, also hormone replacement therapy. So that would be things like estrogen. So a systemic estrogen like a pill or a patch, there's also vaginal estrogen, which is not systemic.

00:27:08:20 - 00:27:43:01
Unknown
Vaginal estrogen works just on the vaginal tissue, vaginal estrogen, which we'll talk about later, too, is not going to help with hot flashes. Systemic estrogen can help with hot flashes, but systemic hormone therapy is not safe for everyone. So really important to talk to your team and see if it's an option for you. There are other medications, so antidepressants actually have been shown to help with hot flashes, too, so that things like paroxetine, venlafaxine gabapentin, was actually originally created as an seizure medication.

00:27:43:05 - 00:28:04:10
Unknown
But we use gabapentin all the time in the Gan oncology world. And so it's great for pain, it's really great for hot flashes. The nice thing too, about Gabapentin is that there's a wide range of dosing, so we can really work on finding the right dose for you to help with hot flashes but also limiting side effects. Diosa is a new medication on the market.

00:28:04:10 - 00:28:25:17
Unknown
It is prescription. It was just newly FDA approved Non-hormonal. It's a daily pill. So that's also another option to talk to your team about to see if that's an option for you. So now switching gears to neuropathy, So neuropathy, of course, is that burning numbness, tingling, It's usually going to be in your hands and fingers and your feet and toes.

00:28:25:19 - 00:29:01:09
Unknown
So really the incidence of neuropathy depends on what treatment you have. How long were you on the treatment? So it's very different for everyone. Neuropathy does tend to gradually improve over time, so really being patient is going to help, but some of it can kind of linger and be permanent. So while we're on a treatment, we really try to ask about neuropathy frequently because if it's getting really significant and we might want to decrease your dose, we might want to delay your treatment a little bit because some of it can be permanent things though, that can help with neuropathy.

00:29:01:11 - 00:29:26:22
Unknown
So he or cryotherapy, cryotherapy like ice gloves and ice socks can be really good while we're actually on treatment. But after treatment, if you're still struggling with struggling with neuropathy, using heat or ice therapy can also actually feel really, really good and stimulate some of the blood flow back into the area. Exercise again has been shown to help with neuropathy, physical therapy, acupuncture.

00:29:27:01 - 00:29:47:00
Unknown
So I normally say we have our east west medicine at UCLA that does acupuncture and massage and acupressure, and only to all my patients bring in a list, like literally write down a list of every single symptom that you're feeling. Bring it into the acupuncturists office and see what they can help with, because they actually can help with a lot more things that people even know about.

00:29:47:02 - 00:30:15:06
Unknown
So just recommend doing that. If you go in to see someone massaging the area can help. So massaging your hands, massaging your feet, maybe you have a partner who can massage your feet. There are different supplements. So things like these are over-the-counter, but things like alcohol, lipoic acid, glutamine, vitamin B6, those can all help prevent neuropathy while you're on treatment, but can also be used after you're finished with treatment to kind of help resolve some of those symptoms.

00:30:15:08 - 00:30:38:11
Unknown
It is important to note that with vitamin B, if your levels so vitamin B helps with the neuropathy. However, if your vitamin B levels are too high, it can actually make neuropathy worse. So if you have been taking vitamin B for a while and you're still having significant neuropathy, doesn't hurt to ask, you know, primary care or your oncology team, you know, just ask someone to check a quick vitamin B level and see if you're really high.

00:30:38:16 - 00:31:03:13
Unknown
It might help to actually remove the vitamin B from your daily regimen. There are also prescription medications, so Duloxetine is a great medication. Gabapentin, again, can help a lot with neuropathic and help with hot flashes and then medications like Pregabalin and Amitriptyline. They're just other medications that you can talk to your team about it. These other kind of more natural, holistic things are not working.

00:31:03:15 - 00:31:30:12
Unknown
So now switching gears to urinary symptoms, so a lot of times these will come with radiation treatment. And so what we see often with radiation is what we call radiation cystitis. So we know that when we radiate to when we give radiation to the pelvis, it can irritate. Remember, the bladder sits right on top of the uterus so the radiation can also hit the bladder and cause a lot of inflammation and even some scarring of the bladder lining.

00:31:30:14 - 00:31:57:17
Unknown
So radiation works by kind of interrupting cancer cells, DNA. And so they can't replicate, they can't multiply. The problem, though, is that the radiation also will hit some normal cells. And so that is when we start developing symptoms. So it decreases blood flow to the area. And then some of these normal cells can be affected. So with the radiation cystitis, a lot of symptoms that people will experience can be discomfort with urination.

00:31:57:17 - 00:32:16:17
Unknown
It can be urgency. So, you know, as soon as you get the feeling that you've to urinate, you have to run to the restroom frequency, sometimes blood in the urine. So a lot of people will actually think that they have a urinary tract infection. We'll check the urine, you know, we'll do the work up and it's negative. It really is just kind of what we call this radiation cystitis.

00:32:16:19 - 00:32:38:13
Unknown
Some women will also experience urinary incontinence, many potential causes, of course, for incontinence. So it can be part of radiation, it can be part of surgery. If you had vaginal deliveries, it can be related to that. As we lose estrogen, too. It can be related to that. So just important that one really depends on the cause. And the treatments are different depending on the cause.

00:32:38:15 - 00:33:01:12
Unknown
But your team can help you kind of maneuver around that. But some recommendations for these symptoms. So and Z, so things like ibuprofen and things like that actually can help a lot, especially if you're having a lot of discomfort with urination. Cranberry juice is great. AZO is a works great for kind of all of the symptoms that go with UTIs.

00:33:01:12 - 00:33:28:13
Unknown
I'm sure people have been on them when they've had urinary tract infections in the past. It works a lot with symptom management. So that's a really great option. Increasing hydration is really good for a lot of reasons, but it should help a little bit with these radiation changes, kind of flushing everything out. Bladder irrigation is occasionally an option, so people who are noticing a lot of blood in their urine, sometimes a team can go in and kind of just irrigate and wash out the bladder.

00:33:28:17 - 00:33:49:12
Unknown
And this just removes any kind of old blood clots or if there is any abnormal tissue or scarring, you can kind of remove that at the same time as well. And then prescription medications. So there are anti spasmodic medications that can also really help with the urgency and the frequency that we see. So a lot of really good options.

00:33:49:12 - 00:34:13:13
Unknown
But just talk to your team to see about what might be the best option for you. Moving on to GI symptoms. So very, very common constipation, diarrhea. I hear these things, of course, all the time. So regardless if you're having constipation or diarrhea, really important to stay hydrated. So if you're having constipation, hydration will kind of help soften the stool and help it move through your bowels a little bit more easily.

00:34:13:15 - 00:34:38:12
Unknown
And then, of course, if you're having diarrhea, we can actually become dehydrated very quickly. So really important either either symptom that you might be experiencing to just be really increasing your water intake, increasing activity walking that helps, especially for constipation. It can help get things moving as well. If you're having a lot of constipation, prune juice, hot water with lemon coffee, there's teas out there.

00:34:38:12 - 00:35:01:10
Unknown
So like smooth move and things like that can help with bowels if you're having a lot of diarrhea. Important to stick to a bland diet. So we use a lot of times what's called the brat diet. So it's bananas, rice, applesauce and toast. I mean, that tends to be really, really bland in the bowels. Can tolerate it. Well, just kind of while things get back on track, there are a lot of over-the-counter medications that can help.

00:35:01:12 - 00:35:22:23
Unknown
So we have so many kind of tips and tricks. Our sleeves, depending on what you've tried and what is and isn't working. So, again, talk to your team. Send us great. Miralax is great if you're having a lot of constipation and Doc, you say diarrhea, things like Imodium, we can sometimes prescribe less modal. So a lot of different things to try.

00:35:23:00 - 00:35:45:00
Unknown
There are prescription medications if you need them, if you get to that point and sometimes we will refer to GI if we think that maybe it's not necessarily from treatment or maybe we're still having a really hard managing it. Sometimes we'll get GI on board as well too to kind of help a little bit more. So sexual health, I love this little photo that I got from.

00:35:45:00 - 00:36:11:12
Unknown
It's called Meet Rosie dot com and we'll talk about it. But this is a really great picture that just describes how many different things contribute to sexual health and sexual wellness. So we're not really going to go into all of these today. But just important to remember that if you are struggling with sexual health, it's probably multifactorial and we probably really have to kind of dive in deep and see exactly which one of these puzzle pieces are contributing.

00:36:11:14 - 00:36:34:06
Unknown
So I wanted to start with dyspareunia. When we talk about sexual health, so dyspareunia is going to be pain with intercourse and there's a couple different causes. So you can see here I have in this picture what a healthy vagina on the left looks like. So you can see that basil tissue is very thick. It's pink. We see a lot of ruga, which are kind of these ridges in the vaginal walls, very elastic.

00:36:34:11 - 00:36:57:22
Unknown
And so this is what a healthy vagina looks like, not menopausal. But then you see on the right hand side what atrophy looks like, An atrophy is going to be this thinning of the vaginal tissue. The tissue becomes whiter in appearance. There's less blood flow to the area. We can have kind of easily bleeding areas. So areas that can spot a little bit more easily.

00:36:58:01 - 00:37:16:14
Unknown
And we do lose a lot of elasticity. This can shorten the vaginal canal a little bit and of course can cause some discomfort. And so when we have a lot of atrophy, what happens is that we feel a lot of burning, itching, dryness. And this may be during intercourse, but this also might just be on a day to day.

00:37:16:18 - 00:37:37:04
Unknown
So sometimes it can be described as like an overall awareness of your vagina. So, you know, you're just like out of the grocery store and you're like, feels kind of weird down there. Like, I'm just noticing it. And that might mean that you have atrophy and there are things that we can help. So recommendations I love vaginal moisturizers, so I always compare about, you know, moisturizers kind of to our face.

00:37:37:04 - 00:37:57:02
Unknown
So I'm sure all of us moisturize our face probably at least once or twice a day. We've been doing it since we were young. We never think, though, about moisturizing our vagina, and it's so important. So I recommend getting at least starting with a nonhormonal over-the-counter moisturizer and I'll list a few at the end. But there's a million out there.

00:37:57:04 - 00:38:26:16
Unknown
The finding about the whole moisturizer using it three times a week at bedtime and then if there's any left in the morning, you know, just wipe it away. But this will really add moisture back into the basil tissue and those vaginal walls and moisturizers that are different than lubricants. So they work differently. So lubricants I want you to use during intercourse or during, you know, intimate moment is, you know, intimacy is not just penetrative intercourse, but using a lubricant during intimacy is really important.

00:38:26:18 - 00:38:50:02
Unknown
So lubricants will kind of make things smoother, whereas moisturizers are really meant to be kept in the vagina. So the vagina walls can really absorb that into the tissue. There are a lot of CBD infused lubricants, which a lot of women do like. CBD infused lubricants are great. During intercourse, they help increase blood flow to the area, improve relaxation.

00:38:50:07 - 00:39:06:20
Unknown
And so I did list one here. Foria tends to be one that I've heard a lot of women really liking. And so that might be a good option for some women. Vaginal estrogen cream, we know, helps. Environmental dryness, we know helps with atrophy. But again, talk to your team to see if it's an option for you or not.

00:39:06:23 - 00:39:39:14
Unknown
And then increasing hydration. So if you're dehydrated, that actually can contribute to atrophy as well, too. So again, increasing water intake will be super important. So then looking at other causes of dyspareunia, so vaginal stenosis can also cause discomfort. And so that's going to be a shortening or narrowing of your vaginal canal. This can happen from radiation and this can happen if you've had multiple excision procedures or multiple vaginal or cervical procedures that lead to scar tissue.

00:39:39:16 - 00:40:05:22
Unknown
And so a couple really great things that we can do for stenosis. So that modulators are really important. Vasodilators help to keep the vaginal walls open and help decrease scar tissue or treat scar tissue. And so I know a lot of radiation offices will kind of give you these like medical grade looking dilator is and they're plastic and they're not comfortable and you don't have to use those.

00:40:05:22 - 00:40:26:23
Unknown
You can really get fun with it. There are silicone dilator is on Amazon that I love so they come in all different colors and sizes. You also could use a vibrator too, like no one says that you have to use the dilator. Is it radiation oncology gives you. So try to get a little bit fun with it. You could use a CBD lubricant on the dilator.

00:40:26:23 - 00:40:45:22
Unknown
You can use the moisturizer on the dilator and using the dilator either in bed or in the shower. Those are two great places to use them, but really important to kind of keep the vaginal walls open and limit that scar tissue. There's also something called the owner. It was I actually have one here to show you if we have time at the end.

00:40:45:22 - 00:41:08:05
Unknown
But I also included a picture here, so, nuts are these little silicone rings that you can put on a male partner. So that way you have control over depth of penetration. And so a lot of people might have discomfort or pain, the deep penetration or back where that vaginal cuff or cervix is, that's a very common area to have some discomfort.

00:41:08:07 - 00:41:28:00
Unknown
And so the onus is really great because you are in control and it makes it a lot more enjoyable. And I've heard the male partners also like it and are fine with it. So definitely something to try with your partner. And then pelvic floor physical therapy. I love pets who focus on pelvic floor. They will always say we're more than just key goals.

00:41:28:04 - 00:41:48:08
Unknown
And so talk to your team about maybe putting in a referral to them. What they normally do is a by manual or an exam with their hands on your first visit and they really kind of target all of the pelvic floor muscles and see which muscles might be a little bit weaker. And then they'll give you exercises to do at home to kind of strengthen these different muscles.

00:41:48:12 - 00:42:10:05
Unknown
And that can help with a lot of things, but it can help with, you know, urinary incontinence. It can help with this dyspareunia or discomfort. It can help with that gentle start spasms, muscular spasms. So that sort of honestly, I think every woman in the world should should undergo. But definitely talk to your team to see if it might help with some symptoms that you're experiencing.

00:42:10:07 - 00:42:34:15
Unknown
Lastly, with sexual health and dyspareunia, is the social and emotional peace. So like we kind of briefly mentioned before, maybe after treatment, maybe after surgery, you're not connecting with your body in the same way. Maybe you're not connecting with your partner in the same way, you know, things that maybe felt good before feel different now or maybe now they hurt or maybe other things are more sensitive, but in a good way.

00:42:34:17 - 00:42:55:19
Unknown
And so really important to kind of work through this. Some people don't mind, right? Like some people don't have a sexual relationship and that's okay. Some people do want to have a sexual relationship and it really affects their quality of life or their relationships if they're not having it. So if it is something that's bothering you again, talk to your team to see what they recommend.

00:42:55:23 - 00:43:19:24
Unknown
I love, though, sex therapists, cognitive behavioral therapy. So you talking to a therapist yourself or even going to couples therapy, your partner? I think that all of these are really great options. You know, your oncology team, you know, the NPS, all of us really can help. But these people who are experts who are trained in it, so I think are also really good additions to the team.

00:43:20:01 - 00:43:39:20
Unknown
A lot of women will be on antidepressants or anxiety medications, which is great because it can help a lot with mood. But some of these medications can also decrease our libido. So talk to your team. If you're not having libido, where you want it to be and see if maybe it could be secondary to one of your medications and being patient with yourself.

00:43:39:20 - 00:43:57:24
Unknown
So things are going to get better with time and right when you're finished with treatment or right when you're finished with surgery, you know, pain tends to be a little bit more. Symptoms tend to be a little bit more than they do tend to get better with time. So being patient, be open with your partner are finding new ways to be intimate.

00:43:58:01 - 00:44:21:17
Unknown
Rosie app and OMG Yes are two really great resources that I recommend. Everyone check out Rosie app. They have a website, but it's also an app that was developed by doctors and psychologists and they talk a lot about sexual health pain, intimacy and kind of maneuvering around all of these different pieces that come along with sexual health. And then OMG dot com is a really great website.

00:44:21:17 - 00:44:43:10
Unknown
It was very, very well done by women who talk about their stories and kind of give you ideas for other things that maybe you could try. If you are trying to be intimate with the apartment with a partner but don't really know where to start. So that's really great. It gives you options for physically things to do, but also just kind of how to talk to partners and how to kind of transition through this time.

00:44:43:12 - 00:45:08:06
Unknown
So those are two really great resources. Quickly, I want to talk about joint pain. So many different causes. We know that treatment, especially those hormonal treatments, can cause joint pain, but it also could be arthritis, it could be injury, it could be over use. So important if you're having knee joint pain, talk to your team different things that we can do for joint pain.

00:45:08:06 - 00:45:33:15
Unknown
So there are over-the-counter medications, of course, ibuprofen, acetaminophen, they can be great in the short term. Omega three foods are really great with decreasing inflammation. They also increase lubrication to joints, so they can be really important to add into your diet too. What I've listed a few examples limiting alcohol, again, limiting those inflammatory foods decrease any smoking exercise.

00:45:33:15 - 00:45:56:13
Unknown
Exercise so important, it's really good for your joints. And then also it's important to strengthen the muscles around these joints and that can better help joints and then decrease any pain. Yoga's great. Acupuncture again is great. And then there are things over-the-counter like Voltaren gel and capsaicin cream. They work really well, especially if you just have, you know, a couple joints here and there that maybe you're bothering you.

00:45:56:18 - 00:46:18:21
Unknown
But again, important to talk to your team. Maybe it's not related to your treatment. Maybe it is just arthritis or maybe it is an injury and you need a different treatment. So just make sure that it's getting looked into if you're having joint pain. So additional resources, if anybody wants to screenshot this, I know this PowerPoint will also be up online, but these are just also a lot of great options that I kind of listed.

00:46:18:23 - 00:46:42:05
Unknown
Can't make a dream. I actually just recently found out about they started out for ovarian cancer patients, but they've now expanded to all different types of patients. And it actually is a camp where you do a lot of like outdoor activities, but there's workshops and there's presentations and it's just a really, really well thought out weekend. And I think it's totally free too, for survivors, for cancer patients.

00:46:42:05 - 00:47:02:17
Unknown
And so something to look into. Donation for women's cancer has so many great resources for all different cancer types. They have brochures and they have symptom management and survivorship tips and you know, how to maneuver around all of these times and how to talk to your team. So feel free to check out the FWC website. Rosie, we talked about O-M-G.

00:47:02:17 - 00:47:35:19
Unknown
Yes, we talked about Foria Wellness. Is that CBD lubricant that I mentioned, although there's many out there, you could use any of them moisturizers. So these are going to be the ones that I recommend three times or so a week at bedtime. So I've listed a few there. They're all non-hormonal. You can get them over the counter. Headspace app is a really great app that helps with mindfulness and meditation and just working on that because it can be really hard, you know, if you've never really meditated before or even if you have, it can be really challenging to get into it.

00:47:35:21 - 00:48:00:08
Unknown
I know that from personal experience, but headspace is great and it really kind of can help get you started. And Xian is a national comprehensive cancer network. That's where providers and a lot of I'm sure your your provider teams go for guidelines and recommendations. There's trials. We get a lot of information from there. They also have really great sections for patients when it comes to symptom management.

00:48:00:08 - 00:48:20:01
Unknown
And again, how to talk to your team, how to talk to people in your life, to your support system. So also something great to check out. Cancer Dog Club has so many resources. I did actually include this eating hens, which is great. It's this whole PDF where they talk about different things to eat and avoid before, during and after cancer treatment.

00:48:20:03 - 00:48:35:12
Unknown
But their website has so many great options. So great to check out there too. And of course you already know about Share I'm sure has so many resources. I didn't feel like I had to mention that because you're all here. But share obviously has so many things to do. And so my last final takeaway is so really important.

00:48:35:12 - 00:48:57:21
Unknown
Please, please advocate for yourself and talk to your providers. We really can only help if we know how you're feeling. Again, we're just assuming symptoms that you might be feeling, but there's so many other symptoms that you could that you could be experiencing. And we want to help. We want to improve your quality of life. And we really want to get you feeling well after going through these cancer treatments.

00:48:58:02 - 00:49:19:14
Unknown
So definitely to us, the second one is exercise. I'm pretty sure every single symptom that I mentioned today, exercise was in there somewhere. You know, it improves all of these different treatment side effects. It is linked to overall longevity and life and really extending our life. And remember, it's never too late to start, start small. You can gradually work your way up.

00:49:19:16 - 00:49:38:05
Unknown
And then lastly, let's spread the word. So I encourage all of you today who are here, take one thing, at least one thing that you learn from this presentation and go tell a friend or tell a family member or tell a coworker, and this is how we're really going to see change. We need to spread awareness. We need more options.

00:49:38:05 - 00:50:00:20
Unknown
We need better interventions and better management for symptoms. And so the best way that we can kind of spread this knowledge is if every person just goes and tells at least one person. And so let's just work on making a change, let's work on getting the word out, and that is all that I have. So I went a little bit over time, I'm sorry, but now I'm happy to take any questions about anything.

00:50:00:22 - 00:50:24:11
Unknown
Thank you so much, Jessica. That was really terrific and so comprehensive that most of the questions we had were definitely covered. So we'll just pick a handful from both the pre submitted questions and the live ones today. And you can still add in a question in the Q&A section at the bottom of your screen. And we'll just get to as many as we can.

00:50:24:13 - 00:50:56:24
Unknown
So I did have one live question that that related to your topic about the sexual issues. Somebody wrote string has major warning for uterine cancer should it be prescribed with kesari for vaginal dryness. So it's a good question. So that is a form of original estrogen and that is very, very specific to the patient, to your history and exactly what kind of uterine cancer you had.

00:50:57:01 - 00:51:30:13
Unknown
So if you are somebody who does not have a history of cancer and you're using estrogen and you have a uterus, you likely also need progesterone. So we need both of those hormones together, because when we use estrogen, there is an increased risk of endometrial cancer, of uterine cancer. However, if you are a patient that has a history of uterine cancer or endometrial cancer, that is not estrogen preparations do actually tend to be safe in more women than we think.

00:51:30:15 - 00:51:58:23
Unknown
And so important to talk to your team. But if you already had had your uterus removed, if it's safe with your history and other co-morbidities, you could probably be on a, you know, estrogen. But you have to talk to your team because it really depends on on, you know, That's great. Thank you. And I think it's wonderful how you covered so much because there you do have a lot of solutions and, you know, just really impressing upon people how important it is to talk to your team.

00:51:59:00 - 00:52:37:06
Unknown
Somebody asked about radiation induced back Titus rectal inflammation. What would be best treatment for that? Yeah, and that one that one can be another tough one. Just like radiation. Cystitis can sometimes be bit tough. And so really getting a good bowel regimen will be important. And so if you're having a lot of abnormal, like really hard stool or really frequent stool, that make it worse, we can do sometimes different prescription medications also to kind of help decrease some of the inflammation and things like that.

00:52:37:12 - 00:52:54:11
Unknown
But I think the best start that you can do at home is really just managing your bowels, increasing your water intake and then talking to your team to say, Hey, is there a prescription medication that might help a little bit? There are many different like tips and tricks that we do have up our sleeve. Like we can combine.

00:52:54:17 - 00:53:14:01
Unknown
I'm not necessarily saying that this is for radiation practice, but for so many of these things that come with radiation, like we can combine some medications that like compounding pharmacies, like there are many different things that we can try if we're not managing it. But I think for you personally to do at home would be increase hydration and try to get really good management of your bowels.

00:53:14:03 - 00:53:42:18
Unknown
Thank you. I know you talked about sippin chemo induced peripheral neuropathy. Are there any newer treatments for that? There is not. And so this is another thing and I and I could talk about this forever is that in women's health, we need so much more research. Right. Like so much more needs to be done in GYN cancers and really just all of OB-GYN and women's health as a whole.

00:53:42:22 - 00:54:02:03
Unknown
There's not new medications, but the medications that we do have tend to work pretty well. You know, I know a lot of people like for Gabapentin, for example, they're like, I don't want to be on a seizure medication. Like, that's it's not for neuropathy, but we can use all of these medications for off label uses. We use these medications often.

00:54:02:03 - 00:54:27:22
Unknown
So whether it's Gabapentin, whether it's, you know, one of the one of the like antidepressants, things like that, like we use these off label all the time. We know that they're safe. But I also would encourage acupuncture. If you haven't tried that before, there's not great research on acupuncture, working but from what I hear personally and I deal with obviously so many women, we do actually see results with acupuncture.

00:54:27:22 - 00:55:00:09
Unknown
So not everyone, but some women do see an improvement with that. Thank you. And actually, this is a related question that that came in. Somebody who's tried a lot of treatments that haven't worked for their CPM and but they also live in a rural area. So there's challenges to that. Are there some specific places they should potentially look at online if they're not getting, you know, what they need from?

00:55:00:09 - 00:55:19:10
Unknown
Yeah, it's a really good question. And I think it's you know, it is a challenge sometimes. I'm fortunate to be at UCLA where it's a big academic center and we have all these resources, I think looking at those websites that I listed earlier. So Foundation for Women's Cancer is great and you can share I'm sure you guys have a lot of resources too.

00:55:19:10 - 00:55:49:13
Unknown
But what I find is helpful a lot in community centers or rural areas is you could do a lot of video visits probably with with these other experts. And so like I mentioned, palliative care. So a lot of times when we have neuropathy and we have symptoms that, you know, we tried all the things and we saw no improvement that is 100% where I'm like, if you haven't already met with with palliative care, we should now because they really can kind of help with these complex symptoms, but also neurologists.

00:55:49:13 - 00:56:11:18
Unknown
So a lot of us think about neurologist being the brain and being like, you know, headaches and memory issues and things like that, which they are. But there are many neurologists who also will specialize actually in neuropathy. And so if you're in a rural area, it might be difficult for you to actually physically go in to see, you know, a part of your doctor or a neurologist, but probably just starting even with a video visit and see if they have any other recommendations for you.

00:56:11:22 - 00:56:40:19
Unknown
I think that might be a good place to start. Thank you very much. Now, I'd like to turn over the last three for 5 minutes and we go over quite a bit over time. I'm sorry. It's my fault. No, no, you guys, your talk was fantastic, and Corbett will do a few more questions. Thank you. Hi. So one question that often comes up in support group is how do you detox from post chemo?

00:56:40:21 - 00:57:08:22
Unknown
Yeah, it's a really good question. I also get asked that a lot. I think there's not many things that you can personally do at home to necessarily detox. So the best thing that we can do to kind of remove the toxins from our body and stuff will be staying hydrated, flushing everything out. So whether it's chemo, whether it's radiation, but really increasing your hydration and water to kind of flush it all out.

00:57:08:24 - 00:57:29:06
Unknown
Exercising, too. I know that. I keep talking about that, but I don't think there's great research on this. But I genuinely believe that exercising when you're sweating, you are also releasing toxins, and that's helpful for so many different things. So not necessarily like a detox per say, but I think really just kind of doing your best to live an overall healthy lifestyle.

00:57:29:06 - 00:57:49:20
Unknown
So doing those dietary modifications, exercising and just talking to your team about managing all of these symptoms. But really just being as healthy as you can I think is the best the best thing that we can do right after treatment and our whole lives, but especially right after treatment. Okay. Thank you. And can you give us some your experience on coal caps?

00:57:50:00 - 00:58:12:18
Unknown
I know they're not 100% effective, but is it worth to save 50% of our hair? Good question. I can't personally say if it's worth it or not. I think, you know, studies the companies will tell you that it works. The research will say we don't know. What I personally seen is probably what's most common is that people will lose.

00:58:12:18 - 00:58:31:09
Unknown
They'll have a lot of hair thinning. They don't lose all of their hair. That's what I see personally. However, I've seen many people using cold caps and they lose all of their hair. I've also seen people use cold caps and they don't lose any hair. And it looks like they never even went through treatment. And so that's the really tough thing about cold caps.

00:58:31:09 - 00:58:53:06
Unknown
For me. It's really hard to make a recommendation, especially because they are so expensive. But I have seen a lot of movement happening right now of people really working and pushing with insurance companies to actually start getting them covered or at least partially covered. So I think that that will be really important. The other thing to note about cold caps, too, is that it can be really uncomfortable.

00:58:53:06 - 00:59:13:16
Unknown
So you wear this ice helmet for your whole entire treatment. It's like brain freeze. So I think it's really kind of personalized in a personalized decision. But I it's hard to make a decision kind of or a recommendation one way or the other, because I've just seen such varied results. Okay, we're working on insurance coverage, so hopefully stay tuned.

00:59:13:18 - 00:59:45:06
Unknown
Okay. Thank you so. All right. Now I'm trying. I'm trying to find something that you didn't answer so that. this this is one. Can you talk a little bit about blood clots related to treatment? Yes. So that could be a big question. And so sometimes radiation, we can notice blood and that can be kind of old blood clots.

00:59:45:08 - 01:00:08:16
Unknown
So that is one way that we can have blood clots. If you're on the go, hormonal therapy, like let's say you still have a uterus and you're on a hormonal therapy right now treating your cancer, you can also see blood clots that way, too. So it's tough. But I think the big thing would be to really make sure you're having a good pelvic exam so your provider can see exactly where it's coming from.

01:00:08:16 - 01:00:26:03
Unknown
So is it your bladder? Is it urinary in nature? Is it coming from your uterus or is it vaginally? So, you know, if you have a history of uterine cancer and you have your uterus removed, if you start having blood clots again, 100%, we need to know about that. But clots and bleeding can also just be from scar tissue.

01:00:26:07 - 01:00:43:08
Unknown
So some people have scar tissue kind of piled up. Of course, we kind of talked about that. And then let's say you have intercourse or let's say, you know, you just have it's extra hot out, extra dryness, whatever, and you might notice bleeding with that, which is fine. It might just be from the scar tissue. We can put a little solution on it to treat it.

01:00:43:10 - 01:01:09:10
Unknown
But I think if you are noticing any bleeding, just talk to your team so they can see exactly where it's coming from and then manage appropriately. Okay Well, I have I guess the time is coming to the end. Thank you so much, Jessica, for your thoughtful and very thorough answers to these many questions. We'll have a recording of this program available on our website.

01:01:09:10 - 01:01:39:13
Unknown
And 1 to 2 weeks. Also, please make sure to check Cher's website for upcoming educational programs and events and support groups. You can join the conversation also on our online uterine cancer forum, Health Unlocked. And don't forget to follow us on social media. And please take a moment to complete the survey at the end of the webinar. The survey will pop up in your browser when the webinar ends, and the link will also be sent in a follow up email.

01:01:39:13 - 01:01:57:09
Unknown
And all surveys are anonymous. So this concludes today's webinar. Thank you again, Jessica, for this terrific presentation and I hope that everyone has a great afternoon and weekend. They care so much for having me. Thank you for coming. Thank you.