In my sixteen years of working with cancer patients, I would say this is the number one “overlooked” issue amongst cancer patients. More often than not, they will not even be told about lymphedema. Following lymph node dissection and/or radiation, the lymphatic pathways do not operate with the same efficacy that they did previously. Therefore, we no longer know what the individuals exercise threshold is. It is critical to START and PROGRESS SLOWLY. This allows for a gradual increase in frequency, intensity, and duration of the exercise program. If at any point there is swelling, the patient should be advised to stop exercising and see their doctor immediately to determine if, in fact, they do have the onset of lymphedema. They should come back with a medical clearance form and the exercise instructor should take a step back with the frequency, intensity, and duration to the point prior to the onset of swelling.

Putting all of these pieces together is very much like solving a mathematical equation. If you are missing any of the information, you will never solve the problem. A typical exercise session should begin with cardiovascular exercise. This too should be gradually increased at a rate that the client is comfortable with and their body responds favorably to. They should stay well-hydrated, they should not wear tight-fitting or restrictive clothing on their upper body, and they should not overheat (all of these factors can increase the risk of lymphedema). Following the warm-up they should be instructed to do a series of lymph drainage exercise to open up the lymphatic pathways and prepare the body for exercise. I reference these exercises in CETI’s Cancer Exercise Specialist Handbook and Breast Cancer Recovery with the BOSU® Balance Trainer Book.


Following the warm-up and lymph drainage exercises, the exercise specialist should determine what the areas of “need” are for the client. Remember to begin with stretching and range of motion exercises until they have close to “normal” range of motion. At that point the goal becomes strength training and choosing exercises that will strengthen the weaker muscles and stretch the tight and shortened muscles. Weight/resistance should also be very gradually increased and attention paid to any potential swelling of the extremity. Typically I chose exercises that will stretch the chest (chest fly, corner or door stretch, assisted stretching) and will strengthen the back (low/high rows, reverse flies, lat pulldown). They often [present with winged scapula following a node dissection. If this is the case, I will incorporate exercises that will strengthen the serratus anterior. If they have undergone an abdominal TRAM procedure, core work will be of the greatest importance in preventing, or minimizing, low back pain.

Because every muscle in the body works synergistically, an imbalance in the shoulder can lead to a multitude of imbalances from the hips to the knees to the ankles etc… Choose your exercises carefully. Put emphasis on the areas of need. This is not and can never be a cookie-cutter workout. No two breast cancer patients are the same. Not only are you taking into consideration their surgery, reconstruction, and treatment, you have to also factor in the remainder of their health history and any additional orthopedic concerns. I urge anyone who wants to work with cancer patients to undergo specialized training. It is very complex and the untrained professional can end up doing more harm than good.

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A promising clinical study shows that the turkey tail mushroom (Trametes versicolor) improves the immune systems of breast cancer patients. The multiyear study, funded by the National Institutes of Health (NIH), tracked whether or not turkey tails could positively affect the immune system of patients rebound after they ended their radiation therapy.

Immunity — as measured by the number of lymphocyte cells and natural killer cell activity — usually declines dramatically after radiotherapy. Natural killer (NK) cells protect us from tumors and viruses. Researchers at the University of Minnesota Medical School and Bastyr University Research Institute hypothesized that breast cancer patients’ health can be improved after radiation treatment if NK cell counts increased quickly to attack remaining cancerous cells.
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Seize Control, Avoid Toxins

When I went through cancer treatment, and even now eight years later, one of the hardest things for me was the lack of control I had. Other people were making decisions for me about what was best for my body. One of the reasons I chose to become a holistic health coach was because I wanted to control those things that I could control to be able to minimize my risk of recurrence. At the same time, I wanted to be mindful and aware of not becoming stressed out or anxious about the information that I gathered and the choices I was making.

Understanding toxins in our environment is difficult. The science is not clear and we often do not know what is actually toxic or the source of the toxin.  One of the reasons that I am so passionate about education regarding how to avoid the toxins in our environment is that often we don’t know that we are encountering them.  It’s easy to choose to walk away from the back of an idling truck because of all of the exhaust pouring out, but it is harder to know what lurks in our products, our foods, and our furniture.

Unless we live completely off of the grid (and even then), we are all exposed to toxins.  Trying to avoid all of them would be the cause of much stress, which in itself is a major toxic load on our body.  Instead, I try to live my life with a philosophy of moderation and listening to self.  How much we really do know if we listen to our bodies and our intuitions?

I marvel at the wonder of our bodies. They somehow know enough to tell us when there is a problem.  In addition, often they try to eradicate the toxins by getting rid of them. I believe that many of us have gotten out of touch with listening to our bodies about toxins. This is made more complicated by the fact that chemicals in our foods and products are designed to make us enjoy them or want more, covering up the underlying chemical or toxin flavor, taste or odor.   On top of that, those of us who go through chemotherapy know that while the chemotherapy is a toxin designed to heal us, it wreaks havoc with our senses making it hard to be in touch with what is best for our bodies.

It is possible to make small, incremental changes to decrease the toxic load on our systems.  Here are five quick and easy tips for removing toxins from your home:

  • Remove all artificial fragrances.  Check your dish soap, laundry detergent, other cleaning products, and personal care products.  Anything that has a chemicalized smell or anything that says it contains “fragrance” is a likely suspect.  Because a company can claim that its fragrances are trade secrets, they are not required to provide the ingredients that comprise the fragrance.  Better yet, shop non-toxic by using a tool such as the EWG’s SkinDeep datbase and cleaning products database to make informed choices or make your own.  I have never been a big fan of perfume, but it took awhile to grasp the fact that the lemon scent in my furniture polish was chemical and not an indicator of cleanliness.
  • Pay attention to the label.  If a label says that it is banned in California, consider that perhaps it is not the wisest choice.  If it includes a skull and crossbones and the number for a poison center, again, there might be a better choice.
  • Minimize the amount of processed foods that you consume.   I only partially jokingly say, don’t buy foods with ingredients that you can’t pronounce, other than Quinoa.  It’s not quite that simple, but it’s not a bad yardstick.  Check out the EWGs Foodscores database.  There is a great deal of discussion and controversy over ingredients in processed foods, chemicals in the packaging itself and whether or not these contain carcinogens. There are a number of ingredients allowed in this country that are banned elsewhere.  For the most part, they don’t add value for you, so why consume them?
  • Dust, vacuum and clean.   My least favorite thing about living a non-toxic life is how important it is to eliminate indoor air pollutants.   Getting rid of dust and other debris in your house is a great way to do this.  De-cluttering your house can help as well.  After my reconstruction surgery, I got my surgeon to tell my husband that I couldn’t vacuum for a REALLY long time, unfortunately, my husband didn’t buy it.  Houseplants can help cleanse indoor air, they don’t replace cleaning, but are a great addition.
  • Get outside in nature.  Not only is it a good way to get away from toxins (most of the time); it is also good for your mind, body, and spirit.  When you are going through cancer treatment and are feeling beyond tired, it is hard to exercise, but even a few minutes of  fresh air can be good for your health and your mental state.  Even if you can’t go outside, try sitting by an open window, if you can.
  • Be Happy. Don’t get too stressed about all of this.  Make wise choices. Accept that we live in the real world and that you will come into contact with toxins.  Do what you can to minimize these toxins, but stress is also a toxin, so take steps to reduce your stress.  HeartMath™ is a great tool.  Many cancer centers or non profits offer access to counseling, classes, and other programs that can be incredibly beneficial for cancer patients, caregivers and survivors.

Do any of these resonate for you? I would love to learn about what you choose to do or other steps that you take to reduce the toxins in your life.

By Wendy Kuhn

Holistic Health Coach and HeartMath Coach

Posted in Daily Matters, Emotional Health, Toxins | Tagged , | Leave a comment

The most common issues that plague post-mastectomy patients are upper-crossed syndrome and range of motion limitations in the affected shoulder. Upper cross syndrome is the combination of protracted (rounded) shoulders, forward head, cervical lordosis, winged-scapula, and thoracic kyphosis. As a result of these postural deviations, mastectomy, lymph node dissection, and/or radiation, the chest muscles may become tight, shortened and spastic. This not only exacerbates the postural deviations, but may limit the ability of the patient to move their arm/shoulder through flexion, extension, abduction, and external rotation. While this is a general statement, the majority of patients will present with these symptoms. This is compounded even more if the woman undergoes reconstructive surgery. Not only with it further exacerbate upper-crossed syndrome, it will create a muscle imbalance in the area of surgery, if either the rectus abdominis or latissimus muscle are used for reconstruction.
The most important factor in the safety and efficacy of the exercise program is the initial assessment. At the very least this should include a comprehensive postural assessment as well as shoulder range of motion measurements taken with a goniometer. The well-trained fitness professional will be able to deduce, from the results, which muscles need to be stretched and which need to be strengthened. By selecting the wrong combinations of exercises, the results may not only be undesirable, they may in fact be detrimental. For example, if a client presents with moderate to severe upper-crossed syndrome, performing any kind of “pushing” exercise that would involve the chest muscles (chest press), could make the syndrome even more pronounced by causing the pectoral muscles to tighten and contract. Instead, the goal need to be on stretching the chest wall and strengthening the opposing muscles in the back; particularly the scapular stabilizers.
Prior to adding a load (resistance) of any kind, the patient should have close to full range of motion through the particular plane of motion. Without correcting the range of motion first, the patient will reinforce the negative movement pattern by performing strength training exercises throughout a limited pattern of movement. Therefore, initially the focus should be on range of motion exercises. These may include very basic exercises that the patient can do on their own; front wall walks, side wall walks, pendulum swings, and corner stretch, or active isolated stretching that can be executed with the assistance of a professional. The combination of both will increase the speed of improvement in most cases.
Once close to full range of motion is achieved, the emphasis can be on strength training. Not only will this help to correct the postural and range of motion deviations, it will help increase bone density and lean muscle mass. Many women will either be of menopausal age, or thrown into menopause from their cancer treatment. With estrogen no longer being produced, the risk of osteoporosis increases. To make things even more complicated, the long-term side-effects of chemotherapy include osteoporosis, diabetes, and damage to the heart and lungs; all of which can be avoided or improved through proper exercise recommendations.

The last part of the equation is the risk of lymphedema of the affected arm/shoulder. Lymphedema is the swelling of the extremity following the removal of, or radiation to the lymph nodes on that side. Even if someone has undergone a sentinel node biopsy, and only had one node removed, they can still get lymphedema. Lymphedema is progressive if untreated and can be very painful and disfiguring. It can happen at ANY time after surgery; one hour or fifty years. The risk doesn’t increase or decrease with time, however a higher percentage of body fat, infection, age, and poor nutrition can all increase the risk once someone is at risk.

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Ginger Green Smoothie Refresher is simple, cleansing, quick, easy and filled with super nutrients.

Rich in super antioxidant cancer fighting cell protection with a hint of ginger that adds spiciness as well as support for digestion and  enhanced inflammation control.  Ginger root is also powerful for enhancing normal control of nausea.

Vegan, Vegetarian, Gluten Free

2 servings


  • ½ cup filtered or spring water
  • 1 large organic cucumber, peeled and cut into ½ inch rounds (approx. 10-12 ounces)
  • 2 large organic apples, with skin, seeds removed, cut
  • into quarters (approx. 12 ounces)  preferably tart and green
  • 2 organic celery stalks (approx. 3 ounces) cut into quarters, leaves removed
  • 2 cups organic kale leaves and/or spinach leaves, spines removed from the kale (approx. 2-3 ounces)
  • 1 inch square slice of fresh ginger root with peel (approx. ½ ounce)


  1. Place in a blender and blend until smooth

Enjoy immediately!!


  • add 4 ice cubes
  • add ¼ cup fresh mint leaves
  • add ¼ cup fresh parsley leaves
  • add 2-4 fresh basil leaves (try Purple Thai Basil for a more subtle flavor)
  • add ½ peeled and seeded lemon or lime
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