Dr. Amy Rothenberg on Healing After Treatment

[00:00:00] Amy Rothenberg: I think that for caregivers to do their best job advocating for their loved one, they, if at all possible, they need to understand what the loved one wants, and what the loved one is willing to do and go through and to, to really honor that. 

[00:00:16] Tina: I'm Dr. Tina Kaeser, and 

[00:00:17] Leah: I'm Dr. Leah Sherman, 

[00:00:19] Tina: and we're two naturopathic doctors who practice integrative cancer care, 

[00:00:22] Leah: but we're not your doctors.

[00:00:24] Tina: This is for education, entertainment, and informational purposes only. 

[00:00:29] Leah: Do not apply any of this information without first speaking to your doctor. The 

[00:00:33] Tina: views and opinions expressed on this podcast by the hosts and their guests are solely their own. Welcome to the Cancer Pod.

Leah. 

[00:00:48] Leah: I'm so bummed I missed you. This conversation with Amy Rothenberg. 

[00:00:53] Tina: I know I am too. 

[00:00:55] Leah: Yeah, but you did a great job and it was really good interview. I listened to it when I was editing it and it was a lot of really good information. 

[00:01:04] Tina: Yes. Well, I have to say. Amy Rothenberg is one of the easiest people to interview because she's one of our fellow naturopaths and she knows exactly who our audience is.

[00:01:16] Leah: Right, because she is a naturopathic doctor on the East Coast and she sees a wide variety of patients, but she does also see cancer patients. 

[00:01:24] Tina: Yes. And she's considered in our community one of our elders, even though she doesn't look or seem old enough. Well, she's not that 

[00:01:32] Leah: old. 

[00:01:33] Tina: I know, but we still, we still all in our community of naturopathic physicians, she has spoken at graduations and such.

[00:01:39] Leah: I mean, She's well respected in the naturopathic, community and she is now a three time cancer survivor, um, with three different cancers. And so, I mean, she talks about what she just most recently experienced, but for anyone who hasn't listened to past episodes of the Cancer Pod, she does talk about her story about her first two cancer diagnoses in a previous episode.

So we'll put a link to that in our show notes. 

[00:02:09] Tina: Yeah. Two cancers, two treatments, one year. 

[00:02:12] Leah: Yeah. 

[00:02:12] Tina: So it was a lot then. 

[00:02:14] Leah: Yeah. And that was 2014. So fast forward and she was diagnosed again with a different cancer. And think she has really good information, for people who are going through something similar, maybe not with the three diagnoses, but, um, yeah, I don't, I don't want to give too much away.

I want people to listen to this episode because. Yeah. I kind of got a little emotional too, listening to it. So like in a good way, like in a happy way. 

[00:02:42] Tina: Yeah. 

[00:02:42] Leah: It's really weird when you're talking to someone who's, you know, been through everything she's been through, but she's such a positive person. 

Yeah. So 

it was kind of, gave me the warm fuzzies. I like that. 

[00:02:53] Tina: No, I'm glad to hear that. I'm, I'm eager to listen to it myself. I haven't, I've only been there. 

[00:02:58] Leah: You just lived it. Yeah. 

[00:03:00] Tina: Oh, it'll be worth listening to Amy again, for sure. 

[00:03:04] Leah: Yeah, 

[00:03:05] Tina: if you do find this episode useful and you find it is helpful to you, please consider going over to buy me a coffee and give us a small donation to keep the Cancer Pod going and production costs and such and we promise to put it to good use and just improve this podcast as much as we possibly can and bring you more offerings.

[00:03:22] Leah: And if you have any ideas for For future shows, you can head over to our website and click on the little microphone off on the tab to the side and leave us a message. Let us know if we can play it on the air, because that would be kind of fun to hear a message from you. 

[00:03:38] Tina: Yeah. Yeah. We know that there's lots of people listening, so hit that button.

Let's hear from you. 

[00:03:43] Leah: So with that, here's Tina's conversation with Dr. Amy Rothenberg. 

[00:03:48] Tina: Hello, Amy. Hi there. Good to see you. Likewise. She is returning to us. She was in episode 41. And do you remember that at that time? I believe it was 2022 when your book came out. 

[00:04:01] Amy Rothenberg: Yeah. 

[00:04:02] Tina: Okay. You finished treatment now what?

And that was, I looked back at our episode notes and it explained how you were talking at that time about resilience after treatment because as a little Background for folks who didn't hear that episode, you had two separate cancers, two separate treatments, full treatments in the same year back in 2014, right?

[00:04:23] Amy Rothenberg: Yes. That's right. I had breast and ovarian cancer back to back in 2014. 

[00:04:29] Tina: Yeah. 

[00:04:29] Amy Rothenberg: So 

[00:04:30] Tina: that was all about what to do after that from a naturopathic medicine perspective because you've been a naturopathic physician for how long? 

[00:04:36] Amy Rothenberg: 38 years. 

[00:04:38] Tina: 38 years. 

[00:04:39] Amy Rothenberg: Sounds like old people. 

Yeah. But you are the perfect person to talk about this topic.

We're going to talk about resilience. We're going to talk about bone marrow transplantation, something you got a crash course in, um, the hard way. I did. 

I did. 

[00:04:57] Tina: So your diagnosis this year, well, I should say the treatment was this year. Um, 2024 was for leukemia. So just give us a little background on what happened around that.

[00:05:10] Amy Rothenberg: Yeah, I was feeling great. I was in my 10th year post treatment and my book had come out about a year before. And I had, I had really waited that many years to write that book. I didn't want to seem cavalier. Um, I wanted to be sure all the things that I was doing and that I had researched and for which there's pretty good evidence to be helpful for cancer survivors in terms of quality of life, energy level, mental clarity, um, um, Not having any physical body problems.

I just wanted to be sure that everything really worked and that I was, I could speak from a, from the inside, if you will. So I waited quite a while to, to write the book and I was very happy writing it and got a lot of wonderful feedback and wonderful people supporting me in the process, including you, Tina.

Thank you for that. And, um, the book did and continues to do very well. It's an Amazon bestseller. It won a Nautilus Book Award. I read it for Audible and it was, uh, a little less than a year after the book was published that I was diagnosed with an acute form of leukemia, which most of my providers felt was due to all the chemo I had had the 10 years before.

Now, when I say that kind of carefully, because I don't want people to hear all Oh, well, if you're going to get cancer from chemo, I'm not going to do chemo. I had a very unusual situation. Most people do not get diagnosed with two kinds of cancers in the same year. I had more chemo than most people will ever see in a lifetime.

Thank goodness. And so I was more at risk for that reason. And I have a genetic. predisposition to cancer. That's pretty strong. So put those two things together. I was, I was a little bit of a, um, wasn't so unusual, but it was shocking in that I felt fabulous. I was at the top of my game. I was enjoying my three grown kids and traveling and hiking and doing triathlons.

I really never felt better. But because of my history with the breast and ovarian cancer, I was followed, uh, at a world renowned teaching hospital in Boston, and, um, every three months I had lab work done, every six months I saw somebody. Once a year I had chest, abdomen, and pelvic CAT scans or MRIs, and so they followed me pretty carefully, and when they said, wow, you know, your blood work is something really not right there, I was like, oh, that's funny, I feel fabulous, uh, and then with the bone marrow biopsy, we, I was diagnosed with acute lymphoblastic leukemia, which is a very serious, you know, potentially dangerous kind of blood cancer.

And there are a few different kinds of treatment recommended for it. Uh, I seemed. in most people's opinions, and I did get a number of people's opinions, uh, like a candidate for a stem cell transplant, which I did have in January of 2024 this year, um, I'm about 9 months going on 10 months out from that, and I'm back to feeling 100%.

So I don't really know, uh, why I am so lucky and people say, well, how can you say you're lucky? But I'm lucky because I feel better than most people I know. Um, and I have great energy and my mind is clear. My heart is open. So, I have a lot of thoughts about why that's the case, which we can talk about some, but that's basically the, the story in a nutshell.

[00:08:30] Tina: Yeah. And for those who aren't familiar with stem cell transplants, this is an intense, really intense. So they basically wipe out. The bone marrow of the patient completely and give you the stem cells of another person or a family member or your own depending on the type of transplantation. But it's how long were you in the hospital for that?

[00:08:53] Amy Rothenberg: Well, the treatment for this kind of leukemia first, they need to knock out the leukemia. So I was in the hospital for about a week. Last summer, Uh, and after one, uh, round of chemo over the course of a week, the cancer was pretty much gone. They gave me a couple of days off and then I had another round, just kind of lock that in.

And then a lot of the current research on. This kind of cancer reflects that different kinds of immune therapies are also very effective for helping prevent any wayward cells from setting up shop somewhere else. So after I had two rounds of chemo each time in the hospital for about a week, um, I was outfitted with a wonderful PICC line, which I got for that chemo in my arm.

And I I had two months of Blintumamab, which is an immunotherapy that is basically training your body to go after any cancer cells that might be around. And the side effects of the immunotherapy are very much tumor load dependent. So the more tumor somebody has, the more side effects they might get from that kind of immunotherapy.

But because I had, Basically, the zero tumor load, I had no side effects. So I had this drug coming into my system 24 hours a day for 28 days, um, through the PIC line. And I, except that I had this annoying thing in my arm, I could not tell that I was on anything and I felt quite well. In fact, during that time, one of my kids got married and we had a wonderful celebration.

I had, I think I had three weeks off between those two rounds of immunotherapy. I had my pick line taken out so that I could dance at my daughter's wedding without worrying. and then I was basically going to gear up for the transplant. Now for the transplant, it takes about a week in the hospital before they give you the stem cells.

And if just if people don't know what stem cells are, stem cells are basically the cells with a lot of imagination and capacity and can grow sort of into anything. And these kind of stem cells can become white cells. red blood cells or platelets and the way that we find a match and I was particularly, unique in that I had 30 perfect matches, which is very unheard of.

Uh, I actually came up as a match for myself because I had done the cheek swab. About 10, before my original cancer, maybe like 12 years ago, there was a drive at our local, university and we knew somebody who was looking for a stem cell, donor. So I did the swab. 

[00:11:27] Tina: I'm just going to interject there.

The swab that you're talking about is how we all can put our own cell type into the bank for Be The Match. If you look up, BeTheMatch.Com. You can find out how you can become a donor for people who need transplants. So it's as easy as getting some saliva from or some cheek cells, really. 

[00:11:47] Amy Rothenberg: Yeah. It's a very low entry point.

It doesn't hurt. There's no side effects. I mean, it's also true that they prefer people stem cells that are younger. my doctor, when I first met, I said, you know, we really prefer somebody under 40. But if we can find somebody under 30, better yet. My donor was a very generous young woman who was 23 years old.

So I, I hope to meet, at that one year mark. So you go in the hospital and, they basically have to knock you down and knock your bone marrow out. And they lose between 10 and 15 percent of people in that process because you're very susceptible to infections. You're very susceptible to bleeding.

You're susceptible to all kinds of problems. Thank God. And with much, and very deep gratitude, I Didn't run into any of those problems. Now, is that because I was just lucky? Uh, I'm sure luck has something to do with it, but I also had a lot of support. Tina was helpful in this time as well. And my naturopathic physician, husband, and sort of research phenom, Dr.

Paul Herscu kind of at my side. And we did everything that we could to prepare me, for this transplant and to support me during the process of the chemotherapy. There's, for instance, I'll just give one example. There's one chemotherapeutic agent that I took that's very, very hard on the kidneys. So they give you another drug to help protect the kidneys.

And They're keeping you hydrated through your PICC line. and then I was also doing the gentle herbs that we know are very supportive to kidney and bladder function. things like that. And, and there were things like that all along the way. We had a whole closet full of homeopathic remedies, botanical medicine, nutritional supplements, food.

We brought all our own food to the hospital. I had a team of people cooking for me. I knew what I wanted to eat and what I needed to eat. to be as healthy as possible during this process and to counter the negative effects of the strong but needed medicines that I took. So 

[00:13:40] Tina: I'm going to, I'm going to interject again.

Let me ask you this one, if you had to summarize the food in a, in a general sense, what type of diet did you eat when you were in the hospital? And two, how did you get the staff at the bone marrow transplant unit, which is, you know, these are, these are specialty floors, usually in hospitals that have positive air pressure and all these, uh, Cautions around infection because people are so vulnerable on the floor, often they don't allow food or drink in and out.

So I guess my first practical question is, how did you overcome that? 

[00:14:13] Amy Rothenberg: You know, we were, everybody knew me. They knew the book I had written. My book was all over the hospital. I mean, a lot of people had read it and seen it a lot. There was a lot of, uh, mutual respect and deference. You know, if Dr. Rothberg wants to try that, that's fine, kind of comments, uh, a lot of looking the other way with food, as long as it was something that was on their accepted food list, they were fine.

So there's certain foods that people who are getting ready for a transplant and people that are immune compromised as I was because of what was, had been done to my bone marrow. you know, no sushi. No raw foods. That was very hard for me. A big fruit and salad lover. No raw foods, no foods off of a salad bar, you know, where other people, you know, that sneeze guard is only as good as it is.

It's not that good. Um, but I knew that, in some of the research that Tina had helped us with, it seemed that a diet that was restricted in methionine, which is one of our amino acids or building blocks of protein, was would be the best environment into which to put a transplant. So that kind of diet basically means a vegan plus fish.

So, uh, I'm not, I don't believe a vegan diet is, is the right diet for most people. I certainly myself, I'm not a vegan, but I did that for about three months leading up to the transplant and it was fine. I really leaned into quinoa that I sort of like I had quinoa before, but somehow that was my main, one of my main proteins, because I was also trying to eat a lot of protein to keep my blood counts that I had as high as I possibly could.

Um, and then I think for me, probably just personally, the hardest thing was staying hydrated. I'm not a person, it's probably my one health related skill, if you will, that I'm not very good at. I have almost no thirst. I never have. I'm a major athlete, workout, gym rat. I'm never thirsty. I have to really train myself to drink.

Um, and I had to remember not to lean into the idea that I had. I could ask for fluids, you know, coming into my arm, but that wasn't really the point. And I had to get better at drinking, which I, which I did. And I have. It is true what I've said to my patients for decades, you know, the more you drink the thirstier you'll become.

I believe that's true I am thirstier now than I've ever been Maybe it's from my donor. I don't know but I'm doing a better job at hydrating And you know, I maintained of course, there's no alcohol and I never drink anyway, no refined sugar, which is bad pretty much the way I live. I already don't eat gluten and not a lot of dairy.

So those are things I continue to do not to eat the foods that I know are somewhat irritating to my personal system. and if I were working with a patient in a similar situation, I would really ahead of time, want them to go through some food sensitivity testing, food allergy testing, really, if anything, whatever we can do to decrease the The overall inflammation in the body is probably a good idea in any day, and particularly for somebody going through something kind of tough.

Then there's also the things related to, well, we know that chemotherapy, many, many of the drugs used make people quite nauseous. Well, there are lots and lots of tools in a conventional medical setting for helping prevent or address nausea, but many of them have other effects on the body. For example, we know that Zofran, which is like a miracle anti nausea medication, is extremely constipating.

And so then, if a patient in the hospital setting gets constipated, well, don't worry, you know, we have stool softeners. And then, get on the stool softeners, and that, and that can very much, the next day, lead into having loose stools, or we can use Imodium. I wanted to kind of sidestep the whole prescribing cascade.

And because I knew of this from so many of my patients who have shared their stories with me, I right away said, well, I think I'd like to take half the dose. of the Zofran. We know that most side effects to most drugs are dose dependent. and a lot of the doctors are like, well, don't you want to avoid the nausea?

I was like, I do, but I really want to avoid getting super constipated, which is not that fun and not that pleasant and also not that good in terms of recirculating toxins in the system. Our bodies are beautifully designed to get rid of toxins and to metabolize and process. But when we're constipated, that's one area that we're not detoxing.

So I had a lot of conversations with my nurses there and other people I came in contact with. You know, in the, in the end, there were times at one point during this whole process, acute leukemia likes to hide out in the central nervous system. So that includes the spine and the brain. um, and the reason I learned this was I asked early on, I was like, well, Am I a candidate to use a cold cap?

Because I had lost my hair, you know, 10 years ago, a couple of times. And as many listening to this podcast, no, it's not that fun. Uh, especially when we're going into the winter and the doctor said, well, actually, you're not a good candidate for a cold cap because with leukemia, we really want to be sure that the chemo gets everywhere, including the head and the brain, as much as it does.

And so, I knew from that, that I was not going to be able to do. A cold cap that I would probably, uh, lose my hair again, which I did. This is my growing out from losing my hair. 

[00:19:31] Tina: Um, I'm going to interject again because I, you know, I like to like explain to folks how these things work and a cold cap is worn when people get chemotherapy to cause constriction of blood vessels.

around the scalp. if you constrict the blood vessels, you stop or at least impede the delivery of the chemotherapy to that tissue. And so we use ice chips for the mouth from mucositis, the same theory. So wherever we're putting cold when someone's getting chemo means vasoconstriction or blood vessel contraction.

That means, um, then we don't get as much drug to that area. So carry on. 

[00:20:01] Amy Rothenberg: So this is something we also use with people that are taking a chemotherapeutic agent that causes neuropathy. People do the cold boots, the cold gloves. It's not that pleasant. It's not that, um, it's not that sustainable. So like for me, I had some chemos that were going in 24 seven for three days.

You know, you can't do these kinds of approaches, but for somebody who's having the two hour infusion of a drug that's known to cause neuropathy. You know, yes, that's something to ask for. Insurance will cover it. You can find them online. It's, it's, uh, It's definitely something to consider. But for me, you know, in addition to not being able to do the cold cap, I actually had what is called intrathecal chemotherapy, which is when they put the chemotherapy directly into your spinal column.

Uh, if you think about having like a spinal tap, but instead of taking things out, they're putting things in. I think I had six rounds of intrathecal chemo and So a lot of the chemo given is a kind of chemo that when taken by mouth causes extreme nausea. But when it goes in through the spine, I wasn't sure that it would also give the nausea.

So they came right away to give me the Zofran. I was like, you know, I think I'm going to try one round of this format without any Zofran at all because I really don't think this is going to cause nausea. And it didn't. And so, Being able to advocate for oneself and, you know, when I couldn't having my husband advocate for me was so important.

And I think I sidestepped a lot of extra drugs, really extra drug therapy, which then enabled me to sidestep the drugs that are given to treat the side effects of the first drug, um, which is helpful, I think in the long run, helpful. And then, I mean, to answer your question from 10 minutes ago, how long I was in the hospital, for the transplant itself, you're in there for a week beforehand, getting ready with all of this, knocking you down, down, down, down, down, uh, and then you get your transplant.

And I have to say that the. Stem cells come in a little baggie that you could fit like a tuna fish sandwich. It's just a little bag and it goes in. At this point, I had the PICC line out. I had a few weeks off and I had a central line put in into my, right above my chest here. And it goes into the central line.

It took 20 minutes, start to finish. Um, and that was that. And then you have a day off of any drugs, and then they hit you with some more chemo to make sure that you're not taking anything in that might have any cancer cells in there. And then you start soon after that on some immune suppression so that you don't reject.

Um, you know, if somebody has a kidney transplant, they're taking drugs so that they don't reject the kidney. When you have a stem cell transplant, you take immune suppression so that the new cells do not attack you. Uh, mostly that's in the attack, the digestive system or the skin or in the eyes or the three big areas, which is called graft versus host disease.

 um, I had three weeks in the hospital. You're basically waiting for the stem cells to engraft. So that basically means, and they don't totally understand how this works. There are a lot of theories on the mechanism of action, but how those stem cells, uh, Get into the marrow and encourage, cajole, enable the marrow to start producing again, white blood cells, red blood cells, and platelets, and the order that that happens in the first thing that you see is a few, white cells, butit takes about three weeks.

So I was in the hospital for three weeks and I can tell you that, um, I did not feel well. Um, I felt like I often say I felt like a little centipede curled up on my side. I didn't do much. I certainly got deconditioned. I didn't eat much. I mean, you just, you don't feel very good. Um, and there were moments that were very, very hard.

I am not going to lie. And that I said things like, I don't think I could recommend this to anybody. This is not something I can really wholeheartedly recommend, but slowly, but surely, you know, the body has amazing ability to respond, uh, when given the right nourishment and, the right medicines and the right encouragement, and I think I came home at about.

Three and a half weeks. I could hardly walk from the couch to the bathroom. I was so deconditioned, but I'm also very strong willed And after a few days I said to my husband I cannot lay on my butt anymore and I started started out today I'm gonna try to walk a hundred steps and tomorrow I'm gonna walk 200 steps and you know soon enough I was like walking a mile on the road.

I mean, you know It took, it took a good month to be able to do that. And my doctors were always saying, slow down, slow down. There's no rush. I'm like, might not be a rush to you, but I can, I gotta get back to my life. I have a very big, beautiful, full life and I felt like I really needed to get back to it.

So, um, 

[00:24:41] Tina: it's interesting. And I know that, I know some people are listening to this and thinking these are naturopathic doctors and they're talking about all this chemo, like a amount of chemo that, like you just said, I really would have a hard time even recommending this to anyone. But I think. The context for this, especially with an acute leukemia, is before we had these treatments.

The fatality rate wasn't 20 percent or 50%, it was 100%. And so in certain cases, and this is what I advocate everyone do you want to know is, is the intent of my treatment to cure my disease process or as best we can, or is it to palliate or kind of, you know, Just to knock it backwards a little bit, in your scenario, obviously curative intent was the Yes.

[00:25:26] Amy Rothenberg: Yes. I mean, I was in the hospital with people. They don't really encourage too much chatting between patients, first of all, because of the germ thing. And people have Everybody has a different story, but I can't help myself sometimes, you know, uh, and there was a woman there. She was there when I was first there with my chemo.

When I went into remission right away and she had never left, they couldn't get her into remission. So she was a person who was, you know, it was such a sad story. She had a kind of, she had the same diagnosis as I had, but they couldn't get her into remission. So she didn't get into remission. She could never get a transplant.

That's not going to happen. And I do want to just say one thing about the transplant donor. People think, oh my God, it must be so painful to be a donor, but for stem cell donation is very different than bone marrow donation. Bone marrow where they have to go into your marrow, very painful, uh, done under anesthesia, you know, in, um, interventionist radiology would do that.

But for somebody who's, who's donating stem cells, it's the day before they go in and they get what's called a Neulasta shot. Some of you've heard of Neulasta, something you're given often the day of, the day after chemo to help keep up your white count. So it stimulates a little bit more white count production.

And then the next day they go in and it's as if they're giving blood. They sit down, They give blood right through the vein in the arm, and they take out the entire volume of the person's blood as they're putting it back in the other arm. And in the middle, you can think of this metaphorically, I'm sure there's a more technical term, it's like a sieve, and the sieve is catching the stem cells.

Those stem cells are then taken, they're processed a certain way, they're actually frozen, they're all frozen now. They used to do them immediate, but now that with COVID and then there were hiccups in the processes, they just freeze them now. And I asked my transplant doctor, how long could these stem cells last?

He said, uh, they think between 100 and 200 years. I was like, okay, okay, we're not going to worry about them going bad. so that for the person doing the donation, yes, it is a day of their life and it's very generous and I don't underestimate it at all, but it's not painful. There's no lasting side effects.

There's no side effects, really. it's just, it's just that process. 

[00:27:34] Tina: Yeah. And I encourage anyone who's young and healthy to, to get on the Be The Match program. I know I've been on it since 2000 and never gotten a call, which, you know, at this point I might be too old to be calling anyway. 

[00:27:44] Amy Rothenberg: Maybe. It was a couple of weeks ago.

It was, Be the match, uh, day, and I did a social media post about it, but in my looking at be the match website, they highlighted a fellow who was a perfect match for somebody a couple years ago, and then a couple years later, he was perfect match for somebody else. And how, and how much he loved doing it and he felt like, you know, it's so easy for me and here I'm giving a person another chance at life.

[00:28:10] Tina: Yeah. Yeah. I mean it's, it's like the, it's a major opportunity to, to kind of be a hero of sorts, which I think we all secretly want to 

[00:28:17] Amy Rothenberg: do. I know. I know. I feel, I feel kind of bad. I'm never going to be able to give anybody a kidney. Nobody's going to want anything of mine at this point, but I'd love to, a cornea, something, you know?

[00:28:26] Tina: So, so, okay. Okay. So. When it comes to, and this is, I want to, I want to make a universal, uh, recommendation of sorts, one thing that we emphasized for you, and this was true in the literature all the way back, I think the first inklings were 2014, people who went into a transplant with the most gut diversity possible.

fared the best, had the best results, complete remissions and grafting of the stem cells. Yes. Um, so from a practical perspective, how did you achieve that? Yeah. Thank 

[00:29:00] Amy Rothenberg: you for that. Thank you for that reminder. Um, well, first thing I did was I did a stool analysis because I was just kind of curious what was the level of my microbiome in terms of the commensal bacteria.

And it was quite good and it wasn't perfect, but it was good. And then we did some, some other readings around how The prebiotics, the non digestible starches that we ingest, are such a central part of having a robust and diverse microbiome and that one of the best sources of prebiotics is potato starch, which a lot of us have potato starch In the cupboard that we kind of never really use.

We have it there. I don't know why, but it turns out that even just a little bit, you know, half a teaspoon, a teaspoon of potato starch, which has almost no taste, you know, pennies on the dose, has a wonderful capacity to really lay down a good prebiotic, um, layer, if you will. for your probiotics and different bugs in your systems to work on to do their job.

So I just added that half a teaspoon of potato starch to each of my day's ingestion. Sometimes I would mix it in some water or juice. Sometimes I put it on some oatmeal. Sometimes I'd have it in rice and veggies. It just, it doesn't affect anything. I did that. And then I also continue to do ground flax seeds, which are a wonderful source of, Uh, high fiber and beautiful anti inflammatory oils.

 and then because I couldn't eat raw fruits and vegetables, I was just sure that I had high fiber grains, legumes in my diet each day. Cooked vegetables still have fiber. So, so that too. Um, I would say a lot of the, as many people experience, a lot of the chemo therapy changes your interest in food, your taste buds, things you just want certain things.

I had a thing like all I wanted for quite a while there was canned peaches. I'm like, I mean, it's not logical, but people just running to go buy some canned peaches because that they want to make you happy. And I appreciated that. Um, so yes, we worked on the microbiome. And then I actually, about six months after the transplant, I redid my stool analysis and it was.

Perfect. In terms of like the, the, I think it was 42 commensal bacteria, every single one in the normal range. I mean, I've never even seen a still analysis like that. So maybe it's the other drugs I'm on. I don't know. 

[00:31:16] Tina: Right? Right. so yeah, that one last comment on that, because I'm just remembering some of the research, it actually lowers the risk of the acute graft versus host disease, too.

There was a lot less of it when people took prebiotics and when they had better So, all around it's a good idea. I mean, I'm a fan of prebiotics. It's called Optimizing Gut Diversity for Everyone's Health. It's kind of like anti inflammatory. 

[00:31:35] Amy Rothenberg: Well, it's interesting because the guy who was in charge of my transplant, a medical doctor named Zachariah DeFilipp, MD, I had done a deep dive on him while I was choosing my providers.

Uh, and he had, he was on PubMed, had three or four articles on using, Fecal microbial transplant, which of course has a big ick factor, but is FDA approved for things Like C. Diff and things like that And he was using it in people in his patient population who had bad graft first host disease So that somehow when they had the transplant the transplant kind of attacked the patient's digestive system and gave them the equivalent of like severe ulcerative colitis and those people are treated You know, as if you would treat somebody with ulcerative colitis in a conventional medical setting with, you know, steroids and other drugs, and they failed, they, you know, they'd failed that treatment.

They'd failed this one. They, and they worked with fecal, microbial transplant to good effect. So I knew that he was particularly open to all of the work that I was doing with my diet, with my microbiome, with my fiber. He, he was, you know, he leaned in and was interested in. in that. 

[00:32:48] Tina: Yeah. It helps, right? It helps to have an open minded team.

Yes, it does. 

[00:32:52] Amy Rothenberg: Yes, it does. 

[00:32:53] Tina: Because I think that that's the psychology of that can be really wearing when you're somewhere where they don't really allow anything. I mean, when I was practicing in Eugene and have people go up to Portland for transplantations and I didn't have a lot of patients, but when I did, I didn't get to see them.

You know, basically the bone marrow transplant unit up there said, uh, yeah, you'll see your naturopath when you're all done in about six months. And so we did. things for diet as best we could, but that was all I could do. I didn't have any way to get them anything but maybe some probiotics once it was all done and said.

But even probiotics were a big no no inside the unit. 

[00:33:30] Amy Rothenberg: Yeah. I get it. So 

[00:33:32] Tina: what do you think? So here's, here's my question to, I guess, is Paul, your husband, great advocate. how would you say, how would you, how would you empower the caregiver to advocate? I guess part of me is like, I know you, Amy, and I know you're, you're strong and you are physically and mentally tough as far as self agency, you can advocate for yourself.

Um, I'm sure during treatment you lost some of the strength that you are known for. Um, but how can caregivers Do their best to meet the needs of the patient going through it and and not using Paul as an example let's do it in a general sense of someone who may be not a naturopathic physician Which Paul is someone who doesn't know much about this.

What can they do? That's like not gonna do harm and support They're loved. Yeah, 

[00:34:19] Amy Rothenberg: it's a beautiful question and it's a very important question. I, you know, in my book, I actually have a whole chapter on caregivers because I feel like caregivers are another form of survivors. I mean, for sure. First of all, the traumatized by this, the word cancer and just .

The early days of diagnosis and creating a treatment plan is very traumatic for the patient and also for the caregiver who's trying to put up a good front and be supportive and manage the finances or the kids or the home or work. Um, I think that for caregivers to do their best job advocating for their loved one.

They, if at all possible, they need to understand what the loved one wants, and what the loved one is willing to do and go through and to really honor that. Um, I think the second piece, which is not easy to hear, but I think is true, is that it is that just like getting on that airplane and they say, you know, put that oxygen mask on yourself before you put it on the kids, whatever.

The caregiver needs to continue to eat and sleep and go out for a walk and take some breaks. And. bring in other people to be supportive so they can go away for an overnight. You know, at a certain point in a lot of these kinds of treatments, and this is not just in the world of cancer, anybody that is living with a loved one that has a chronic ailment, you know, and is going to be doing a lot of the heavy lifting, uh, is going to need a break, and it's going to need some support, and it's going to need somebody else to do Some of the day to day.

And so just thinking about that and thinking about that early. I had the opportunity myself to caretake my sister who has since passed away in the last couple of years of her life. And as soon as I started, I was I realized, okay, this is I am not going to be able to do this by myself and created the team and the meal train and people can give some rides and, um, and whatnot.

And of course this is all playing out over the nature of the relationship, whoever you're with and everybody's different. And we have a lot of people now, sadly, where both people are going through something. I have one couple in my practice, he has prostate cancer, she has breast cancer and it's, and they're not that old and they're, you know, they have put together quite a good team of support.

But. Um, starting early, understanding, um, understanding really what some of the parameters are. If you want, Tina, I can send you, I wrote an article that takes this a little further than what's in my book recently on caregiving and I'll send it to you and you could pop that in as a resource for your listeners if you want.

[00:36:47] Tina: Oh, great. Is it, it's online? We can just send it to people with a link? I don't, 

[00:36:50] Amy Rothenberg: I, it was, it was published in a paper magazine, can we go still exist, um, but I think I have a, uh, like a PDF of it. 

[00:36:58] Tina: Okay. At worst, we'll put up as a guest blog post. 

[00:37:02] Amy Rothenberg: Okay. Okay. Sure. Because it just has some lists of like literally things to think about.

Yeah. 

[00:37:07] Tina: It's really important. I mean, it's kind of a whirlwind when people are going through this. And obviously people have never done it before. I mean, generally speaking, it's not something people are practiced in. So. wherever people are in their relationship in their life, it's going to be for the first time that they're either getting transplant or helping someone through one.

[00:37:24] Amy Rothenberg: Totally. I mean, some of the very basic things I would say, you know, this is really for everybody, but like, be sure you have your partner's password to the, get onto their computer and how to get into their bank account. I mean, just simple, basic things that, Just make a day so much easier. 

[00:37:39] Tina: Yeah, that's a really good point.

Like, because we all kind of fall into different tasks, especially if you've been with someone a very long time and making sure that you can take over tasks that are maintenance tasks for the house or the, yeah, that's a very practical piece of information. Yeah. 

[00:37:53] Amy Rothenberg: There's certain things my husband didn't do at all while I was sick and I came home and they, it was

still waiting for me for there, waiting there for me when I got better. And that, and that was fine, you know, and nothing too, nothing too, uh, bad for our credit rating, thinking about things like in our greenhouse and just things are like, he just never does those things. So that's my job and that's okay.

[00:38:14] Tina: Well, I know you putter around the house doing gardening and cooking and all that stuff in addition to your practice and you're practicing again, I hear. 

[00:38:21] Amy Rothenberg: I am. It's so lovely to be back in the saddle. And I think that the, you know, I'm 64. Many people have retired by now. And I don't think I'm going to be retiring anytime soon.

You know, I love my work. I love working with people that have cancer or going through treatment or afterward. But I also have just a family practice with little kids with earaches and, you know, teenagers with allergies and whatnot. I like the variety. But I do have a lot of street cred. So when I have a cancer patient, you know, like it's, there is a comfort level.

I think they have understanding that I've been through this and I, whatever, whatever they're going through, I've probably been through something similar, um, if not longer and worse. And so a lot of times I'm saying things like, don't worry, this is never going to happen to you. You know, this is not going to happen to you.

Don't use me as an example, but by the way, here are the things you can do to like help yourself feel better. improve your digestive system, get rid of the brain fog. Can we address the lymphedema? Can we do anything around this peripheral neuropathy? My digestion has never been the same. Yes. The answer in most every one of those situations, the answer is yes.

Is somebody going to get back to perfect and get back to how they were before? Probably they, they may, and they may not, but they can certainly improve upon where they are at this moment. Um, and for a lot of people, a cancer diagnosis and going through treatment is going to be a blip. In a line of a very long life and they're going to die from something else and I think they're, you can, you probably know this better than me, Tina, but I think there's a statistic around most women with breast cancer are going to actually die from heart disease, not from breast cancer, and not necessarily from heart disease related to the breast cancer.

There are. Some breast cancer treatments, we know that can be hard on the heart, but I mean, just in general, as heart disease remains the number one killer, women who have breast cancer in their 30s, 40s, 50s may die 20, 30, 40 years later, and it won't be from cancer. 

[00:40:18] Tina: Right. And you bring up a good point, and that is, um, one of the things that's kind of built into a naturopath is we're never satisfied until we get to that optimal health that we can achieve, right?

Like when you're not well. You start to say, why am I not well? Am I sleeping well? Am I eating well? Am I exercising? Am I, are my relationships healthy? We just kind of go down the list very naturally with our patients and ourselves. Um, I think people need to understand that being active in self care, is the way to be healthier, like don't allow the new normal to be acceptable if it's not acceptable to you.

[00:40:51] Amy Rothenberg: Right, right. I mean, I think, I would say that the number one complaint cancer survivors have in my practice is fatigue. And the unique thing about fatigue, and I would say this is probably also true for fatigue of chronic disease in general, um, is that rest and sleep do not help. So for, whereas most people, they're tired, they take a little nap, they feel rejuvenated, many cancer survivors, they, they don't, they don't, it doesn't help them.

And people always say to me, look, you seem to have so much energy, you know, like I don't, I don't get it. And I'm like, well, I work a lot on creating a schedule and a lifestyle that allows me to do all the things that I know help to bring my energy level up to what it was before. I don't feel I'm any less energetic than I was when I was 20 or 30.

I mean, I, I really don't. People say, well, you must have a little bit of brain fog. I'm like, maybe I wasn't that good before, but I don't think I have any brain fog or at least it's not severe. But I think the number one treatment for that really, there's many, many things to do, but the number one thing is exercise.

And I know not everybody loves to exercise, but, um, it does seem, Just all study after study after study do show that exercise helps with fatigue, which sounds contradictory, but not if you think about what exercise does with regard to improving circulation, getting rid of toxins, clearing the mind, raising our thresholds for feeling stress.

 and the list goes on. And then the number two thing would probably be eating an anti inflammatory diet, which, you know, it's just like two little words, but it, it's, it's quite. It has a quite a broad, spectrum of what that means. It basically means not eating, refined sugars, focusing on your vegetables, fruits, whole grains, lean proteins, uh, healthy fats and oils, nuts and seeds, and, and not a lot else.

And trying to get out and get away from the highly processed foods and besides dipping alcohol altogether. So that's, that's a diet that many of us have been eating forever. I've always eaten that diet my whole life, pretty much. and you can say, well, it didn't help you too much. You know, you could say that, you know, and truly, Many people look at me and like, Oh my God, she got cancer.

What am I, I have no hope, but I do have a genetic predisposition that, um, is a little hard to beat. So that's, that's my excuse. But I do think that the diet that I've eaten and my commitment to exercise, um, have enabled me to go through challenging treatments and not get all the terrible side effects and come out the other end feeling.

 Feeling quite well. 

[00:43:26] Tina: Yeah, that's a really good point that the healthier you are when something does happen, whether it is something like this, a chronic disease process that you get diagnosed with, you have to go through treatment, or it's a car accident for that matter. I mean the healthier you are when something happens, the better.

You should be getting through it. You're at an advantage to get through it. I will say that the BRCA mutation that you carry, um, you know, this is 2014 or so. You were in your fifties when you were diagnosed. Yes, 

[00:43:58] Amy Rothenberg: I was. 

[00:43:59] Tina: You know, so part of me goes, well, maybe all your good lifestyle kept you going for quite some time until it finally caught up to you.

What happens with age, the aging process creates more damage in our cells. And so that genetic, I know you know this, but I'm telling our audience that. is a DNA repair issue. so if there's more, uh, damage to the DNA as we age, it gets tougher to repair. And with that genetic mutation hampering your Your repair of DNA.

[00:44:28] Amy Rothenberg: Yeah. Yeah. I'm sure it's something like something like that. And I think you know that the there's a certain element of who gets what when that we can look at the Statistics and say there's more of a tendency and it's always going to be outliers and it's going to be like we have no idea Truly, we have no idea why this person got this at this time and, um, you know, increasingly we are all 

You know, we should never say all, but many doctors are pointing to the environment and the poor state of the environment, our food sources, water sources, the air, the soil, the microbiome of the soil being terribly depleted, etc., etc. These are all things that are contributing to chronic disease. So that's A hard nut to swallow.

On the other hand, we know, and there have been incredible studies that have come out in the last few years, that it's like 80 to 85 percent of the three biggies. So that's heart disease, diabetes and cancer are lifestyle preventable. So when, you know, I'm just gonna say that 1 more time, because it's kind of a fascinating statistic.

And if you, you may know these studies that I'm citing better than me, Tina, but it's something like 80, 85 percent of the three big killers, heart disease, cancer, and diabetes are lifestyle preventable. So in terms of public health, we have so much to do. So much to do. I was very happy last week. I was reading about how smoking rates.

I was reading about this in the context of why so many 7 Elevens are closing across the country. Part of the reason is that smoking incidence is actually going down and it's really going down. It's much lower than it's been ever since they've been tracking it. So, um, that's good. That's good. That's a lifestyle thing that we know really contributes stopping smoking.

wherever you are in a cancer journey, you know, is important and to prevent future cancers. But, um, So there's some things we can't control, but there's a lot that we can. 

[00:46:26] Tina: Yeah. Yeah. I mean, I feel like, you know, I think I've talked to you about this. I feel like when you do things that take care of yourself, um, self care, whether it's eating well, exercising, sleeping well, having great relationships, all those things, and stuff still happens.

Like that would be, that is your example. You've always done self care. in a naturopathic way, not just, just, you know, the RDAs or the, you know, the food pyramids, or whatever they're coming out with these days, this is like

It doesn't get any better. but it still happens. And I always think of it like when we get in our cars and you buckle up for safety you buckle up, you adjust your mirrors, you look in the back, your rear view mirror, you make sure everything's good and safe. You drive defensively, but it doesn't guarantee you won't get an accident or that some truck coming around the next corner doesn't hit your car.

It just helps you get through that. Um, but it doesn't prevent that. The event, 100%. There's no such thing as prevention. There's risk reduction, you know, so we talk a lot about risk reduction because yeah, prevention is almost an over promise today because I don't know if people understand that at some point you have to let go.

You know, you do everything you can and then you just let go. 

[00:47:31] Amy Rothenberg: Yeah. And try to have some fun. I mean, I think, you know, for me, One of the most incredible things during this whole process is that my, my daughter was expecting our first grandchild, her first child. So, you know, I have this enormous, you know, it's like you finish a long, hard race and you get this great like ice cream treat or something.

I finished this long, hard thing and I got this grandchild. So like really life is good and it's full of love and it's full of purposeful work and beautiful surroundings. And I, I can't say, uh, I, I can't underscore like how much gratitude I have for, for conventional medicine, for all the naturopathic approaches and for the gift of, you know, new life in our midst.

It's, it's so exhilarating. It's, it's just that, that is the word, it's exhilarating and it kind of informs a lot of our, our day to day and it's just been such a treat. 

[00:48:23] Tina: Yeah. And, and I urge everyone to be open minded. Whether you're a conventional doctor looking at naturopathic medicine and natural medicine, or you're a naturopathic doctor looking at conventional medicine, like the truth is often a mishmash of both of what's best for anyone's given care.

So it's important to check ourselves when we're being non receptive. So true. I mean, I had 

[00:48:45] Amy Rothenberg: naturopathic doctors have literally said to me, I can't believe you subjected yourself to that. And I'm like, well, you, you might be able to believe it, but I'm standing here talking to you because of it. So, uh, I find that even more off putting than the conventional medical doctors who sort of look askance at something I might recommend or bring in or study I want to share, uh, probably because I feel like we should be more open minded having been marginalized for so long as a profession.

But, I will say that, having cancer 10 years ago to now, even in that 10 years, I would say that the conventional medical providers that I worked with, and there were many. I had opinions, second opinions. I had oncologists, transplant people, all the incredible nursing staff, much more open than 10 years ago.

So I think we're making progress. I think there's, it's, it's incremental. But just in general, I, I felt less, uh, I feel like people often came in after the shift was over. Oh, I hear you're a naturopathic doctor. You know, I have a daughter with menstrual cramps or, you know, my husband's really struggling with gallstones.

I mean, people just wanted to pick my brain. I mean, I'm like laying there like that, trying to pick my brain a little bit about, uh, some naturopathic approach to, you know, problem du jour. Uh, I found that very interesting. 

[00:50:04] Tina: Yeah. Yeah, that's awesome. Yeah, because when I did my residency, and that's going back a long time now, 24 years ago, I can quote a medical oncologist who literally looked at me and said, the immune system has nothing to do with, with cancer.

Oh my God. I said, I looked at him like, Well, I guess there's nothing to talk about, right? Like I, in my mind it did, but now I think everybody's on board because there's immunotherapies that to honest to God just weren't around two decades ago. So 

[00:50:29] Amy Rothenberg: yeah, 

[00:50:30] Tina: I love it because I feel like the world and our culture is coming towards naturopathic medicine.

So it's a good place to 

[00:50:36] Amy Rothenberg: be. It's a, you know, it's a very, very big ship and it's turning slowly toward us. And I agree. It's a, it's a great place to be. 

I think I'd be impatient if I just graduated, but being 50 something and haven't seen the ship move slowly in the right direction, I, I am actually very much an optimistMe too.

Me too. 

[00:50:53] Tina: Well, I'm trying to think if there's anything else we should talk about. 

[00:50:58] Amy Rothenberg: The one thing I would say is if you fell off your wagon of doing your mammograms or having any kind of screenings done based on your age or your genetic history. Please get back on those schedules. We know that the earlier things are found, the easier they are to treat and they will cause much less issue.

And a lot of people are like, Oh, I don't want to look. I don't even care. I don't want to go. I don't want to, I don't want to. Remember something like colonoscopy it's both the diagnosis and the treatment. Not every polyp is going to become colon cancer, but pretty much. all colon cancer started out as a polyp.

So don't put these things off. Remember, put them in context, contextualize it in your whole big life. Take the day to do that thing and yeah, earlier diagnoses are always going to be, have better outcomes. 

[00:51:51] Tina: Yeah. And I'm watching the literature come across on, uh, looking at various biomarkers in the blood that are going to be a tip off for various cancers.

So hopefully next, I would say five to 10 years, they might come out with some good, reliable tools that just draw blood and tell us that we need to go get other things checked, get a CT scan, et cetera. Yeah. That's exciting. Yeah. Cause I agree. Finding things early means a cure is on the table for most cancers.

[00:52:19] Amy Rothenberg: Totally. 

[00:52:20] Tina: All right. 

[00:52:21] Amy Rothenberg: Thank you for the opportunity to talk about this and I hope I didn't scare anybody off. No, 

[00:52:27] Tina: you know, we have cancer in our title, so I'm hoping that people realize when they hit the play button. 

[00:52:35] Amy Rothenberg: Fair enough. Fair enough. 

[00:52:36] Tina: Yeah. Yeah. I was advised not to put it there, but you know, it's a reality, so that's what we're talking about.

[00:52:41] Amy Rothenberg: I love it. It's a fabulous podcast. Really. 

[00:52:43] Tina: Thank you so much, Amy, for joining us and uh, yeah, so we'll put Instructions for caregivers or your tips for caregivers on our website and any other links to anything you're doing. We'll put on your page We have a bio page for you since you've been a guest before So yeah, hopefully people check that out.

And of course, you're always welcome back to our show 

[00:53:02] Amy Rothenberg: Thank you so much. Good to be with you. 

[00:53:04] Tina: Thanks for your time. 

[00:53:04] Leah: Thanks for listening to The Cancer Pod. Remember to subscribe, review, and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The Cancer Pod is hosted by me, Dr.

Leah Sherman, and by Dr. Tina Kaczor. Music is by Kevin MacLeod. See you next time.