Transcript
WEBVTT
00:00:00.140 --> 00:00:01.262
I saw this funny thing.
00:00:01.262 --> 00:00:02.766
Oh my gosh, what was it?
00:00:02.766 --> 00:00:14.632
It was like talking about how I can't remember what it was, but it was equivalent to like the length of a some sort of a whale or something, and I wish I could remember the joke.
00:00:14.632 --> 00:00:24.358
But it was like saying, like such and such is the same distance as like the length of a whale, or three whales, and they're like you know how come the US just can't use like regular, so bad at telling jokes.
00:00:24.358 --> 00:00:25.280
But it was funny.
00:00:25.280 --> 00:00:28.289
I swear I'll take your word for it.
00:00:29.332 --> 00:00:30.554
I swear we can take this out.
00:00:30.554 --> 00:00:45.121
I'm Dr Tina Kaser and, as Lea likes to say, I'm the science one, and I'm Dr Lea Sherman and I'm the Cancer Insider, and we're two naturopathic doctors who practice integrative cancer care, but we're not your doctors.
00:00:45.121 --> 00:00:49.530
This is for education, entertainment and informational purposes only.
00:00:49.530 --> 00:00:54.091
Do not apply any of this information without first speaking to your doctor.
00:00:54.091 --> 00:01:00.085
The views and opinions expressed on this podcast by the hosts and their guests are solely their own.
00:01:00.085 --> 00:01:01.948
Welcome to the cancer pod.
00:01:01.948 --> 00:01:22.034
Hello Tina, hello Lea, so formal this morning.
00:01:22.454 --> 00:01:23.376
I know, I know.
00:01:23.376 --> 00:01:25.037
Well, you know it's a new year.
00:01:25.037 --> 00:01:26.462
I guess it will be.
00:01:26.462 --> 00:01:28.228
We're releasing this in the new year.
00:01:28.911 --> 00:01:31.037
Yes, Welcome to 2024.
00:01:31.037 --> 00:01:32.180
Happy New Year everybody.
00:01:34.567 --> 00:01:42.759
So today we're going to be talking about something that I've actually received several requests from people if we could discuss it, and we're kind of making it more broad.
00:01:42.759 --> 00:01:57.784
I've gotten a few messages from people wanting us to discuss the joint pain related to aromatase inhibitor use, and that's not the only cancer treatment that can cause joint pain, and so that's going to be.
00:01:57.784 --> 00:02:11.320
Our subject today is just joint pain related to cancer treatment, and we're probably focused a little bit more on the aromatase inhibitors because it is so common and I would even say that some of the things we talk about today will be generic, just for joint pain in general.
00:02:11.622 --> 00:02:13.389
So oh, yeah, like arthritis?
00:02:13.389 --> 00:02:15.879
Oh, definitely, yeah, so I don't think it's going to be.
00:02:15.879 --> 00:02:25.448
I mean, we're going to put it in the context of cancer treatments and it'll also help people understand what's going on with generalized joint pain as well.
00:02:25.448 --> 00:02:27.812
So talk about general.
00:02:27.812 --> 00:02:31.931
I've had requests from specifically family members saying why don't you talk about joint pain?
00:02:32.960 --> 00:02:33.943
And they don't have cancer.
00:02:33.943 --> 00:02:35.187
They haven't been.
00:02:35.207 --> 00:02:35.689
They're just like.
00:02:35.689 --> 00:02:39.300
I really like the show that you're doing?
00:02:39.341 --> 00:02:42.207
Tina, Can you talk about joint pain?
00:02:42.207 --> 00:02:43.972
Can you help me out?
00:02:46.418 --> 00:02:48.825
Yeah, and you know it's so universal.
00:02:48.825 --> 00:02:52.000
I mean, if you live long enough, generally you're going to have some discomfort in joints.
00:02:52.741 --> 00:02:55.088
So I didn't receive an aromatase inhibitor.
00:02:55.088 --> 00:03:17.633
I received a chemotherapy which can kind of cause that achy joint pain, and I also was on tamoxifen and what I noticed was it seemed like areas that maybe I had probably a risk of getting arthritis, like one day down the road I probably was going to have arthritis in my lower back or my hips.
00:03:17.633 --> 00:03:19.941
I found those were the areas that really hurt.
00:03:19.941 --> 00:03:33.912
So definitely there is a correlation and I found that also when I got my first COVID vaccination and I got achy and all that kind of flu-like symptoms.
00:03:33.912 --> 00:03:45.504
But the joint pain was really more noticeable in those the hips and the lower back where I probably am at risk of having arthritis anyways, and I think I do now.
00:03:46.206 --> 00:03:55.318
So yeah, and you know that that speaks to just generalized inflammation, because we all manifest an inflammatory reaction differently.
00:03:55.318 --> 00:04:17.173
Some people get sinusitis and their sinus passages will fill up with mucus, and some people will have joint pain, and so whenever anything in the background whether it's a vaccine, chemotherapy or an ongoing drug like these aromatase inhibitors that are used whatever increases that background inflammatory state, will manifest in where your vulnerabilities already lie.
00:04:17.173 --> 00:04:28.064
So I think that's a I don't know from a clinical perspective, from my perspective, when I'm talking to a patient, I mean that's important information for me, going forward for preventative purposes and to address any pain that's happening right now.
00:04:28.064 --> 00:04:45.812
So I suppose that's what makes it a generalized topic, right, because joint pain happens and preventing it and getting yourself as resilient as possible as you head into treatment, as you come out of treatment we'll talk about what can be done and, yeah, we have talked about inflammation a lot like.
00:04:45.833 --> 00:04:49.023
That's pretty much like a common thread and a lot of the things we talk about.
00:04:51.086 --> 00:04:57.168
Yes, because in some systemic inflammatory effect is inevitable if you're getting chemotherapy or radiation.
00:04:57.629 --> 00:05:09.204
Okay, so let's talk about risk factors for just joint pain in general with treatment, and then also there are some that are specific for aromatase inhibitor pain.
00:05:09.504 --> 00:05:13.569
Yeah, and you know we've keep saying aromatase inhibitor as if people listening know what we're talking about.
00:05:13.569 --> 00:05:17.208
Well, the people who are on it will know, but I think we should explain to everyone else what it means.
00:05:17.208 --> 00:05:20.581
And aromatase inhibitor is exactly what it sounds like.
00:05:20.581 --> 00:05:28.490
It inhibits an enzyme called aromatase and that aromatase is responsible for the production of estrogen in the body.
00:05:28.490 --> 00:05:40.110
So when people are on this drug, it essentially brings the estrogen levels very close to zero nil, so there's no estrogen being produced in the body when people are on that drug, which that alone tells us something.
00:05:40.110 --> 00:05:46.694
Right, because these aromatase inhibitors pretty much always give some level of joint pain.
00:05:46.694 --> 00:05:47.197
Not always.
00:05:47.197 --> 00:05:54.644
I've had a few patients take them and have no side effects at all, including no joint pain, but I would say the majority of people who start the drug have joint pain.
00:05:55.165 --> 00:06:01.103
And examples of aromatase inhibitors are things like anastrasol, letrasol.
00:06:01.245 --> 00:06:04.089
Yep, anastrasol, letrasol, X-mestane.
00:06:04.089 --> 00:06:06.560
They're steroidal and nonsteroidal forms.
00:06:07.021 --> 00:06:19.721
And I have found studies that show that tamoxifen also can cause joint pain, even though there are some providers out there who will say that it does not, but there are studies that talk about it.
00:06:19.882 --> 00:06:21.086
So there you go.
00:06:21.086 --> 00:06:22.930
That's not too surprising.
00:06:22.930 --> 00:06:24.154
Tamoxifen.
00:06:24.154 --> 00:06:36.733
Unlike those aromatase inhibitors, tamoxifen is a estrogen receptor modulator, and so you always have to keep in mind that tamoxifen is often given when there is a lot of estrogen circulating already.
00:06:36.733 --> 00:06:51.245
So it's often given not always, but often given to pre-menopausal women who have plenty of estrogen circulating, and estrogen acts a lot like a lubricant on the joints, and so the loss of estrogen creates more friction within the joints.
00:06:51.245 --> 00:06:58.430
And so if you go on tamoxifen after being, say, you're 35 years old and you have plenty of estrogen circulating, you go on tamoxifen.
00:06:58.430 --> 00:07:12.605
It's actually kind of like less estrogen in the joint spaces than you had, because estrogen itself, and estradiol especially, is so estrogenic and tamoxifen is considered a weak estrogen or a neutral estrogen on the joints.
00:07:13.026 --> 00:07:22.199
There is a greater risk, though, of having the joint pain in patients who've received aromatase inhibitors and tamoxifen, if they've also received chemotherapy.
00:07:22.199 --> 00:07:23.603
So that's one of the risk factors.
00:07:23.603 --> 00:07:34.612
So for patients who have received radiation and tamoxifen or surgery and tamoxifen, they may have not really that risk than if you have received chemotherapy.
00:07:34.612 --> 00:07:54.213
So in general, you have a greater risk factor of joint pain with cancer treatment, if you are diabetic, if you have a history of alcohol abuse, a history of arthritis or a history of neuromuscular disease like myocenic ravis or muscular dystrophy or something.
00:07:54.213 --> 00:07:56.622
It could either be genetic or auto immune.
00:07:56.622 --> 00:07:59.934
I mean, there are a variety of neuromuscular disease, but anyways.
00:08:00.154 --> 00:08:07.233
So having a preexisting condition that would favor one having joint pain will put you at greater risk of having joint pain.
00:08:07.233 --> 00:08:08.341
That makes a lot of sense.
00:08:08.341 --> 00:08:37.587
And then the risk factors for aromatase inhibitor pain in general is younger age, having had received chemotherapy with, in particular, those taxings, which is pachylo taxol and taxiteer, and then the use of granulocyte colony stimulating factors like nupigin and nulasta, prior history of joint pain Laughing because it's like, oh, you're going to get joint pain if you have a history of joint pain.
00:08:37.587 --> 00:08:44.043
So a prior history of arthralgias, which is joint pain, arthritis or even fibromyalgia, which I see a lot.
00:08:46.285 --> 00:08:47.990
Yeah, that all seems to make sense.
00:08:47.990 --> 00:08:52.359
None of that's too surprising, I don't think yeah, yeah, well to us.
00:08:52.926 --> 00:09:02.676
But I mean, for somebody thinking like, oh, I'm diabetic, is that why I'm getting the joint pain, you know, it's not really what comes, I think, front of mind for a lot of people.
00:09:03.066 --> 00:09:07.596
Yeah, and I think of those taxing drugs as well, and true funny chemotherapy.
00:09:07.596 --> 00:09:12.200
There's collateral damage, right, and there's some damage to systems, whether it's your nerves, your joints.
00:09:12.200 --> 00:09:37.524
And when you have diabetes, healing is slower, you know, especially, I should say, if you have uncontrolled diabetes, because if your glucose levels are controlled well, your hemoglobin a1c or glyco hemoglobin, that's the same thing that gives you an idea of the last three months where your glucose has been, then If that's fairly well controlled, then it shouldn't be as much of a factor.
00:09:37.524 --> 00:09:44.347
I think it's when your glucose goes high, which often happens during these treatments, because they give a steroid and so Glucose shoots up.
00:09:44.347 --> 00:09:49.739
It's harder for people with established diabetes to, you know, get that glucose under control post treatment even.
00:09:50.826 --> 00:09:52.874
It's pretty important that you mention it to your doctor.
00:09:52.874 --> 00:09:59.899
There are some things that you want to rule out osteoarthritis, rheumatoid arthritis or even, you know, bone disease.
00:09:59.899 --> 00:10:10.696
So you know, mentioning it, talking about what aggravates it, what makes it feel better of anything, can really help guide what you know your treatment can be mm-hmm.
00:10:11.547 --> 00:10:14.272
Yeah, and brings up something that is a.
00:10:14.272 --> 00:10:19.884
It's a tough topic and that is new joint pain, especially low back pain and hip pain.
00:10:19.884 --> 00:10:24.236
I don't care if it's 510 or 20 years after a diagnosis of any cancer.
00:10:24.236 --> 00:10:27.205
It needs to be at least taken seriously.
00:10:27.205 --> 00:10:40.311
And if you do things for joint pain whether that is you know what do you call it Advil and it doesn't work if it doesn't respond to treatments for garden variety arthritis, then make sure you get it worked up.
00:10:40.311 --> 00:10:46.933
I mean, the worst case scenario is that there is a recurrence of the cancer and that needs to be found sooner than later.
00:10:46.933 --> 00:10:51.399
It's kind of an ugly reality that I know everyone who has had a diagnosis lives with.
00:10:51.399 --> 00:11:02.865
But I just want to put that out there Because I know in my practice there's been a delay of diagnosis, money times when Cancer has metastasized to the bone because it was dismissed.
00:11:02.865 --> 00:11:09.979
Yeah, it was just written off because cancer happened, you know, 10 years ago, 15 years ago, and so nobody was looking for it anymore.
00:11:10.826 --> 00:11:21.671
So that's one of the things that my oncologist did work me up for, because I was having this sort of I guess it was just more like an increase in back pain, lower back pain, just and and hip pain.
00:11:21.671 --> 00:11:37.710
It was really really bad and it was several years after I'd completed treatment and I got an x-ray and then I ended up getting an MRI and it was just your run of the mill kind of arthritis, joint pain and I what we'll talk more about.
00:11:37.710 --> 00:11:39.256
You know treatments and whatnot.
00:11:39.256 --> 00:11:42.427
But yeah, I was referred to physical therapy but that was scary.
00:11:42.427 --> 00:11:53.264
I mean, it was truly scary when it's interrupting your sleep and everything else I've had patients see a physical therapist for like a year or two before it was found.
00:11:53.947 --> 00:11:54.246
I know one.
00:11:54.246 --> 00:12:00.557
We're really thought to work it up and and sometimes you as a, the patient there is a fear of recurrence.
00:12:00.557 --> 00:12:09.705
That is normal, right, that is completely understandable, and sometimes I think, because that happens so often, it's almost like crying wolf to your own consciousness.
00:12:09.705 --> 00:12:11.871
You're like no, I couldn't possibly be so.
00:12:11.871 --> 00:12:14.702
You kind of, even yourself, ten years down the road, might be like I shouldn't.
00:12:14.702 --> 00:12:16.470
If nobody else Is worried about it, I'm not gonna worry about it.
00:12:16.470 --> 00:12:18.947
So I'm not talking people into just checking it out, but I think it's.
00:12:18.947 --> 00:12:26.455
It's important because these days we have so many treatments that Bone metastasis is something that's very treatable now that it didn't used to be.
00:12:26.455 --> 00:12:30.336
You know, when I started 20 plus years ago, it was less treatable.
00:12:30.857 --> 00:12:31.099
All right.
00:12:31.099 --> 00:12:41.015
So let's take a break and when we come back We'll talk about what is typically recommended Conventionally for joint pain, as well as what we would recommend as naturopathic doctors.
00:12:41.015 --> 00:12:42.379
All right let's do that.
00:12:49.147 --> 00:13:00.745
So, lea, yes, tina, what's top of mind conventionally, because I think you are more attuned to what's happening on a regular basis in the Conventional world, coming from the hospital Environment.
00:13:01.006 --> 00:13:11.333
I mean, it depends on what the treatment is as to what they're going to recommend, but it can be anything from ibuprofen, tylenol, sometimes alternating the two.
00:13:11.333 --> 00:13:21.725
I've seen tramadol recommended those cox, two inhibitors like celibrex that's another one that is.
00:13:22.105 --> 00:13:45.758
Mm-hmm often recommended and that doesn't really have as much of a effect on the, the GI system, the way that, like ibuprofen can I have seen prednisone used, I have used, or I you know, with my patients, especially with the, the taxing related pain, gabapentin can be used as well.
00:13:45.758 --> 00:13:49.566
And then you know there are other recommendations that I don't know.
00:13:49.566 --> 00:13:56.419
You know what the evidence is behind it, but I've also had people who were referred to massage.
00:13:56.419 --> 00:13:59.528
I mean it starts to get more into like more than naturopathic type things.
00:13:59.528 --> 00:14:01.192
Like you know, get a massage.
00:14:01.192 --> 00:14:05.650
My oncologist actually recommended that I take Boswellia, which I thought was really cute.
00:14:09.006 --> 00:14:09.629
That's awesome.
00:14:10.980 --> 00:14:12.985
Referrals to physical therapy, that kind of thing.
00:14:12.985 --> 00:14:18.014
And then it starts to you know, there's like that, like meld between like words, like the integrative.
00:14:18.679 --> 00:14:26.129
Yeah, it's interesting that your oncologist brought up Boswellia, which is a plant, because oftentimes I have found oncology.
00:14:26.129 --> 00:14:39.399
You know, when they're conventionally trained they're okay with the body work, mind body medicine, they might even be okay with acupuncture, but they stop, just shy of any supplements or plants because that's not their realm.
00:14:39.399 --> 00:14:44.231
So they're okay with things that they know are nonchemical or non-pharmaceutical.
00:14:44.821 --> 00:14:55.650
So my oncologist is at a cancer center where there are naturopathic physicians employed there, and so I'm assuming that she learned about Boswellia.
00:14:55.650 --> 00:15:07.172
I think she used it herself, even though she's not a cancer survivor, but she was using it herself for her own joint pain, and I'm sure she heard other patients were using it, and so that's probably where the recommendation came from.
00:15:08.100 --> 00:15:13.288
That is so funny because I have found most conventional doctors who are open to our medicine.
00:15:13.288 --> 00:15:18.640
They'll use their own experience and make a recommendation based on that Right.
00:15:18.640 --> 00:15:19.602
So they used something.
00:15:19.602 --> 00:15:20.105
It worked.
00:15:20.105 --> 00:15:22.611
They're like, oh, you should try this because it worked for them.
00:15:22.611 --> 00:15:25.419
Which is fascinating because it just shows you that there is a way to do it.
00:15:25.419 --> 00:15:28.606
It shows you that there is another level of evidence they will listen to.
00:15:28.606 --> 00:15:30.672
It's their own personal evidence.
00:15:30.831 --> 00:15:31.032
Yeah.
00:15:31.032 --> 00:15:38.259
So what's funny is, my initial reaction was well, I need to check and see if that's going to interact with my tomoxifen.
00:15:38.259 --> 00:15:41.760
That's funny, yeah, okay.
00:15:41.760 --> 00:15:46.379
So let's keep going with this whole integrative naturopathic approach to joint pain.
00:15:46.721 --> 00:15:46.941
All right.
00:15:46.941 --> 00:15:59.173
Well, you mentioned Boswellia, so I'm just going to riff off of that and just talk about some other plants that are useful Turmeric, turmeric root or curcumin, if you're taking in a supplement, is strongly anti-inflammatory and can help with joint pain.
00:15:59.173 --> 00:16:00.802
And then ginger comes to mind.
00:16:00.802 --> 00:16:02.306
Ginger is high on the list.
00:16:02.306 --> 00:16:04.669
If you take enough of it, it can be helpful.
00:16:04.669 --> 00:16:09.585
It's an anti-inflammatory In plants, whether it's Boswellia, turmeric, ginger plants.
00:16:09.585 --> 00:16:14.953
For those of us who recommend plants for people, they never have one effect.
00:16:14.953 --> 00:16:28.251
So if you're looking for an anti-inflammatory for your joints and you line up those three different plants and you say, okay, which one should I take, or should I take more than one, you look at other things that are going on and other things those plants do.
00:16:28.251 --> 00:16:33.292
So ginger is really helpful for the GI tract, really helpful to promote digestion.
00:16:33.292 --> 00:16:34.201
It's very warming.
00:16:34.201 --> 00:16:38.932
It's a very warming plant, so it supports the fires of digestion, as we say.
00:16:39.480 --> 00:16:41.326
Yeah, it can stimulate appetite.
00:16:41.326 --> 00:16:46.206
It can help if you have that feeling where the food's just kind of sitting there.
00:16:46.206 --> 00:16:50.974
You know that happens a lot with treatments where your food just doesn't seem to be moving along.
00:16:50.974 --> 00:16:52.822
Yeah, ginger helps it to move along.
00:16:52.822 --> 00:16:57.192
Yeah, it's kind of a nice addition, as long as it doesn't interact with anything.
00:16:57.580 --> 00:17:02.152
We'll have a whole episode on ginger coming up in the near future, so we'll go into details.
00:17:02.152 --> 00:17:06.757
Turmeric is something I might think of if I want someone to have digestive support.
00:17:06.757 --> 00:17:13.413
Further down the line, like this is someone who could use more bile acid production and they're not absorbing their fats so well.
00:17:13.413 --> 00:17:22.420
Bazwellia I might think of for someone who is also having brain fog and issues with executive function, which is high level processing in the brain.
00:17:22.420 --> 00:17:26.023
So translation chemo brain Could be.
00:17:26.023 --> 00:17:27.271
Yeah, it could be chemo brain.
00:17:27.271 --> 00:17:28.400
It could be plain old aging.
00:17:29.442 --> 00:17:38.420
We have a whole episode about turmeric and we have a whole episode about cognitive issues as well, so go back through our catalog if you have not listened to those yet.
00:17:39.001 --> 00:17:39.241
Yeah.
00:17:39.241 --> 00:17:42.049
So we've talked about these things in depth, so I want to put those things out there.
00:17:42.049 --> 00:17:50.400
But before you take any plants and everybody should be doing this you have to have to have to have a foundation of an anti-inflammatory diet.
00:17:50.400 --> 00:17:55.400
Because think of it this way Inflammation is like an accelerator pedal.
00:17:55.400 --> 00:17:57.846
There's an inflammatory process in the body.
00:17:57.846 --> 00:17:58.990
What pushes the accelerator?
00:17:58.990 --> 00:18:00.982
Chemotherapy pushes the accelerator.
00:18:00.982 --> 00:18:05.972
These aromatics inhibitors push the accelerator, meaning it creates inflammation in your body.
00:18:05.972 --> 00:18:15.051
So what puts the brakes on those plants I just mentioned can put the brakes on An anti-inflammatory diet is basically taking your foot off the accelerator.
00:18:15.961 --> 00:18:21.113
So I say this because there's no use putting your foot on the accelerator and the brake at the same time.
00:18:21.113 --> 00:18:23.305
This is not logical.
00:18:23.305 --> 00:18:26.112
What you want to do is take your foot off the accelerator first.
00:18:26.112 --> 00:18:32.113
You can't stop the treatment, you can't just put your drugs aside and cross your fingers.
00:18:32.113 --> 00:18:46.400
So your diet is generally, if you're not paying any attention, you're just eating a standard American diet, or whatever we want to call it these days, a Western diet, which is high in meat, high in processed foods, high in sugar, high in animal fats.
00:18:46.400 --> 00:18:48.420
That diet is very inflammatory.
00:18:48.420 --> 00:18:56.233
And so removing inflammatory foods and eating an anti-inflammatory diet and there's a lot of ways of going about that.
00:18:56.233 --> 00:18:59.970
We've talked about some, but we probably should do a special episode just on that topic.
00:18:59.970 --> 00:19:11.231
If you can remove inflammatory foods, you take your foot off the accelerator a little bit so that everything else you do, that all works better because you're not adding to the inflammatory state of the body.
00:19:11.231 --> 00:19:14.106
So I would put anti-inflammatory diet is like a must do.
00:19:14.106 --> 00:19:16.532
Nothing else will work if you don't do that.
00:19:17.797 --> 00:19:33.390
And it is difficult for some as they go through treatment, because with taste changes, with nausea I mean sometimes the only foods that taste good to them or that they can tolerate are foods that might not be considered part of an anti-inflammatory diet.
00:19:33.390 --> 00:19:44.000
So that's where you can find someone to work with, whether it is an oncology trained, registered dietitian or somebody who has experience working.
00:19:44.000 --> 00:19:47.736
You know a naturopathic doctor who has experience working with cancer patients.
00:19:47.736 --> 00:19:50.622
You know that's really vital.
00:19:51.042 --> 00:19:56.808
Yeah, and if you can't do that, because I just think of how many people are just out there and they just don't have access to that.
00:19:56.808 --> 00:20:07.704
Rebecca Katz K-A-T-Z does a nice job online of giving away a lot of information on how to deal with taste changes throughout treatment, how to cook for someone who is going through treatment.
00:20:07.704 --> 00:20:19.921
So if you're a loved one and you want to make some meals and bring them over, how to make healthy meals so you're not undermining their inflammatory state unwittingly with your casserole nothing wrong with a good casserole.
00:20:19.921 --> 00:20:23.343
You just have to make sure that you, you know, put some ingredients in that aren't inflammatory.
00:20:23.343 --> 00:20:24.990
She also wrote a couple cookbooks.
00:20:24.990 --> 00:20:26.596
One is called One Bite at a Time.
00:20:26.596 --> 00:20:31.517
That's her older cookbook, and then the newer edition is called the Cancer Fighting Kitchen.
00:20:31.517 --> 00:20:33.843
I would recommend both of those.
00:20:34.263 --> 00:20:36.008
And that's like for a newer edition.
00:20:36.008 --> 00:20:57.493
I mean, that was around 10 years ago when I was, when I was going through treatment, but again and this is, I think, from my experience working in the Midwest, where people's food preferences in general may not be vegetables and you know a variety of fruits, it's just not their experience.
00:20:57.493 --> 00:21:13.449
And so to be just given a resource and say, oh here, you know, start cooking with this, you know, or have someone cook this for you, that's not always an option, and so that's why, if you can find a dietitian who can really work more specifically, I don't know.
00:21:13.449 --> 00:21:17.809
I just keep thinking of like, when I ask you people you know, like, do you eat vegetables?
00:21:17.809 --> 00:21:19.696
And you know it's green beans and corn.
00:21:20.117 --> 00:21:28.080
Yeah, yeah, If you did one thing the person you're cooking for is like, all I want is, you know, meatloaf and mashed potatoes and that's it.
00:21:28.080 --> 00:21:28.942
Add to it.
00:21:28.942 --> 00:21:32.540
You know, I think berries are kind of an entry, Absolutely yeah.
00:21:32.540 --> 00:21:38.640
So adding some kind of berries can can actually negate some of the inflammatory effect of the animal fats.
00:21:38.640 --> 00:21:44.481
So there's been studies showing that when colorful berries are added, doesn't matter if it's blueberries, blackberries.
00:21:44.481 --> 00:21:51.196
You don't have to get exotic, you don't have to go to South America and get a side berries or Costco you don't have to go to Costco and get this.
00:21:51.218 --> 00:21:55.046
I saw you berries, but I'm saying well, yeah, go to you.
00:21:55.046 --> 00:21:55.527
Know what I'm saying?
00:21:55.527 --> 00:22:00.232
I would say eight out of 10 people have no access to a dietitian who is well versed in this.
00:22:00.232 --> 00:22:01.718
Eight out of 10 I would put in America.
00:22:01.718 --> 00:22:08.844
I think the folks that you and I talked to who are RDS and are dialed in to nutrition as we know it, are not the majority.
00:22:08.844 --> 00:22:10.227
I think that's in the minority.
00:22:10.247 --> 00:22:11.596
No, no, but that's a whole.
00:22:11.596 --> 00:22:12.298
Yeah, that's a whole.
00:22:12.318 --> 00:22:17.301
another episode, okay, but oh, speaking of back episodes, they can listen to the Sammy Peterson episode.
00:22:17.301 --> 00:22:18.224
Oh, there you go.
00:22:18.224 --> 00:22:22.499
She is an RDS that is dialed in oncology trained.
00:22:22.598 --> 00:22:40.450
Yeah, so, and again, I know we have mentioned this in the past, but taking turmeric, you know, or curcumin as a capsule, taking a lot of herbs or supplements, just check with your provider if it's safe to take while you're in treatment.
00:22:40.951 --> 00:22:44.022
While you're in treatment, yeah, yeah, especially the pharmacist.
00:22:44.022 --> 00:22:45.006
I would ask the pharmacist.
00:22:45.006 --> 00:22:51.343
If you have access to a pharmacist, ask someone, yeah, after treatment.
00:22:51.343 --> 00:22:57.086
It's tough because I will tell you my issue with this, and the reason I'm hesitating a little bit, is because that's going to be don't do anything.
00:22:57.086 --> 00:23:08.851
In general, I think in community clinics, if there's no one trained in integrative oncology and there's no pharmacist dedicated to it, they're just going to say don't do anything.
00:23:08.851 --> 00:23:14.401
And that may or may not be true, but I'm just saying that's going to be the default because, of course, if they don't know about it, they're going to say don't do it.
00:23:14.642 --> 00:23:24.174
So one of the number one things that I do recommend, if it is joint pain related to treatment, is well, I ask the patient well, what makes it better?
00:23:24.174 --> 00:23:25.961
Does movement make it better or worse?
00:23:25.961 --> 00:23:28.672
And nine out of 10 times, movement makes it better.
00:23:28.672 --> 00:23:53.568
And so having someone referred to physical therapy and recommending exercise so important with joint pain, whether it's arthritis pain, whether it's aromatase inhibitor pain I have found that and this is also through personal experience, but I've found that, just because of fatigue and other factors from going through treatment, you get weaker.
00:23:53.568 --> 00:23:57.304
If you have weaker glutes, that can lead to lower back pain.
00:23:57.304 --> 00:24:03.201
So if you're sitting a lot, if you're laying down, if you're propped up in bed and you're not quite sitting up or laying down, you know.
00:24:03.201 --> 00:24:13.141
So there are physical things like if you strengthen your muscles that support your lower back, then that can reduce the pain as well.
00:24:13.355 --> 00:24:23.869
Yeah, there was a study on aromatase inhibitor induced joint pain and they showed that while joint pain didn't improve, it didn't become worse.
00:24:23.869 --> 00:24:29.243
And so you're basically going to tread water for some of these, at least as far as the studies show.
00:24:29.243 --> 00:24:37.512
The people who didn't exercise the control group, their joint pain got worse and worse and worse and worse over the course of 12 months of that study.
00:24:37.512 --> 00:24:49.265
So even if you think, oh gosh, I still have my joint pain, it's not getting any better, it's also if it's not getting any worse, that is some level of success when you're on a drug that continually causes joint pain.
