Lymphedema: diagnosis, treatment and self care

 As those of you who read by blog know, I am both a thyroid cancer and a breast cancer survivor. I try to write about subjects that can affect people who have/ have had one or both of these cancers. Lymphedema is a condition that can affect anyone who has had cancer. While there is no cure for lymphedema, there are several ways to manage lymphedema, thus achieving a better quality of life. When I was looking for articles on lymphedema, I came across a wonderful quote by a physician who works for MD Anderson. Dr. Jan S. Lewin is a professor in the head and neck surgery department and section chief of speech pathology and audiology. She said :" There's such a focus on cancer that patients don't see past the diagnosis and treatment to understand the outcomes they will face and the quality of life challenges that lie ahead. " I think that Dr. Lewin hit the nail on the head with this statement! 

Using myself as an example, for the hundredth or so time, after my diagnosis and treatments for my cancers, it was over ( except for routine checkups and blood work) as far as my doctors were concerned. I appreciate the amazing work they had done to get rid of the cancers, but what do I do now? How do I manage the aftercare and challenges that being a cancer survivor brings? How do I improve upon my quality of life? 

Lymphedema is a condition that affects many cancer patients after surgery, radiation and chemotherapy. Lymphedema is defined as the swelling of tissues caused by the accumulation of lymphatic fluid. A healthy lymphatic system will carry extra fluid to the blood vessels near the heart. Lymph nodes filter viruses, dying cells, foreign matter, and bacteria. This is part of a healthy immune system, when the lymphatic system is working properly. One estimate I saw states that there are between 500-600 lymph nodes in the body! The groin, arm pits and neck seem to have more lymph nodes than other places in the body, but lymph nodes are scattered throughout the entire body. 

Lymphedema usually happens 2 to 6 months after treatment, but it can also occur YEARS after treatment. Since there is no actual cure for lymphedema, it is prudent to get  a diagnosis as soon as lymphedema is  suspected and start on treatment and care. What are the symptoms of lymphedema? They include swelling ( both internal and external) near the surgical/treated place, a feeling of tightness in the area affected, restricted movement, recurring infections, and sometimes  thickening of the skin. 

When one thinks of lymphedema, one thinks of the arm ( as in breast cancer patients ) or leg being involved. It can occur anywhere in the body because of all of the lymph nodes that we have. If it does occur in the head or neck ( in a thyroid cancer patient for instance) it can involve the oral cavity, tongue, larynx, airway and throat. These places would be considered internal lymphedema sites. External lymphedema sites ( in head and neck cancers) can occur in the neck and face and can also occur in the lips, nose, eyelids and ears. One can have internal, external or both. 

The more lymph nodes a person has had removed, the greater the chance of that person having lymphedema. Diagnosis is often made by a patient's signs and symptoms, but can also be diagnosed by MRI scan, CT scan, ultrasound, and a test using a radioactive dye and scan. 

In my case, I noticed a change in my left arm. I had had three sentinel lymph  nodes removed during my bilateral mastectomies. It was several months before I noticed a difference ( size and swelling) between my left and right upper arm. I made an appointment with my family care physician, who referred me to a special physical therapist ( a CLT-LANA ). This is important! These physical therapists have hundreds of hours of training to learn how to treat lymphedema. They learn how to do the special massage to help move the excess fluid from the site. The massage is a light, circular massage- not deep tissue massage. Our lymph nodes are located close to the surface of the skin, so only light pressure is needed. CLTs also can do measurements to check any progress made, as well as measuring for compression garments. They can also teach patients how to do the massage at home. The CLT that I saw taught my husband how do to the massage for me. It really helps with the swelling. 

Treatment for lymphedema can also include light exercises to move the fluid, compression bandages, and sequential pneumatic compression- which is a pump system that moves the fluid. Having lymphedema also increases the risk of skin infection. This is called cellulitis, and can be caused by cuts, bug bites, and other injuries to the affected limb. Cellulitis requires the use of antibiotics quickly to prevent sepsis. Some signs of cellulitis include redness, rash and the skin may feel hot to the touch. If one thinks one may have cellulitis, a trip to the urgent care or ER is warranted. 

On the subject of compression garments, there are a few options. After a CLT-LANA measures the arm or leg for example, one can determine the size needed for a compression garment. There are prescription compression garments- some but not all -insurance companies will pay for them. They are tight and require a special "sack" to slide the garment onto the leg or arm. I tried these at first, and although some people like these and get good results, they just did not work well for me. There is another choice and it is called Active massage, by Solidea. In my opinion, the garments are more comfortable, while providing light to moderate compression with a wave type system. They are available for the arm, leg, abdomen, hand ,feet and perhaps other sites. This is my personal choice, but everyone is different of course. I think the company is working on getting insurance coverage,  but so far I have not gotten my insurance to pay for my garments. Since they are comfortable and easier to put on than the traditional prescription garments, they are a good fit for me and I do wear them almost every day. 

There are other ways to provide good self care if one has lymphedema. Wearing compression garments is one way, of course. Learning how to prevent injury ( so as not to get cellulitis),  moisturizing the skin, avoiding tight clothing- especially in the area affected, getting enough sleep, eating a good diet ( lots of veggies and fruit), reducing stress ( good luck with that one!) and including exercise, even a walk, daily are some ways to take good care of oneself. It is also helpful to get support from lymphedema groups if available to you. Talking to others with lymphedema can provide emotional support as well as finding out other ways to practice good self care. I follow a very good blog, " My Lymphedema Life" by Sue Callison, who is a breast cancer survivor herself. She provides some very good info on techniques to manage lymphedema. In the spirit of full disclosure, Sue recommends Solidea active wear garments, which I wear and prefer over the traditional prescription garments. As I stated above, everyone is different, and a traditional garment might be best for you. I do not receive any compensation for mentioning this site, but I do suggest that if one has lymphedema, it would be good to check Sue's blog out. 

So in summary, lymphedema is a chronic condition with no cure. There are new surgical techniques that may be helpful, but are not widely available. I did not include them in this blog, but if one is interested, one can check on the Mayo Clinic microsurgery website. The success rate for the surgery is 0 to 42%., according to their studies. I would like the "takeaway" from this blog to be that while lymphedema is not curable as yet, it can be managed so that there is improvement in a patient's quality of life. Lymphedema can occur anywhere lymph nodes or lymph glands are removed or damaged-  arms, legs, head, neck, etc. I think that everyone has to be their own  best patient advocate- especially concerning lymphedema. Know the signs and seek the appropriate help and treatment. 

A thyroid and breast cancer survivor's cautionary tale about having shingles...

 Back in June of 2022, I was awakened to some nasty symptoms. My scalp was burning- sort of like I had a sunburn, and there were the beginnings of red welts on my forehead, temple, and most disconcertingly,  around my left eye. Since I had been practicing pharmacy for over forty years and have talked with patients who had shingles, I had a pretty good idea of what was happening to me. One of the most important things that one can do if they suspect shingles, is to go see a doctor ASAP. The sooner one gets started on an anti-viral medication, the better the outcome. The doctor that I saw at Urgent Care also referred me to an ophthalmologist ( eye doctor) . That was because the shingles was so close to one of my eyes. Sure enough, the ophthalmologist confirmed that I did have shingles in my left eye. He upped my dose of the anti-viral that the doctor at Urgent care had prescribed, and added a steroid eye drop. I made several visits to the ophthalmologist that summer. And I took the anti -viral medication for about six weeks. The good news is that the shingles finally cleared up and I did not lose vision in that eye. 

Fast forward to September, 2023. Sadly enough, I have shingles again. I have them on the same places as before except that while they are close to my left eye again, they are not in my eye. This was confirmed yesterday by my ophthalmologist. You might be wondering, why did I not get my shingles vaccination after round one with shingles? I had read that one needs to wait until one has fully recovered from a shingles outbreak to get the vaccination. This could be anywhere from three to six months. Since it has been over a year from my first tango with shingles, I really have no excuse. Big mistake on my part, not getting the shingles vaccine before now. I am not an anti-vaxer person. I have received all of my covid vaccines as scheduled, but for some reason I just did not think that I would get shingles again. I was certainly wrong about that!

If a person has had cancer ( or two kinds, like me) or is currently in treatment for cancer, that person could be  immunocompromised. A big word that means the disease and treatment ( especially chemotherapy) has affected our white blood cells. It has been proven that a person needs a certain number of these white blood cells to successfully fight off any offenders, such as viruses, bacteria, fungi or parasites. While chemotherapy is busy killing off the cancer cells, some healthy white blood cells ( call it "friendly fire") get killed off also. Our bodies are trying to kill off the cancer cells, too, so that lowers our immunity to some of the other offenders listed above. 

The current shingles vaccine ( Shingrix) is a two shot deal. After I fully recover from shingles, I will get the first vaccine. Then, it is recommended in two to six months after the first shot, to get the second one. No vaccine provides 100% immunity from illness, but this newer vaccine provides anywhere from 68% to 97% effectiveness in the prevention of shingles. Trust me on this, YOU DO NOT WANT TO GET SHINGLES!!  

The CDC has recommended that adults 50 years and older get the two dose Shingrix vaccine. Adults 19 years of age and older who are immunocompromised due to disease and/or treatment are also encouraged to get the vaccine. The down side is, as it usually is, the cost of the vaccine. If one has medicare, the cost is covered at no charge. For adults too young for medicare, the cost is fairly expensive. A call to one's insurance company in this case would be necessary to find out how much this would cost. 

So why worry about getting shingles? Well, there is the pain- sometimes unbearable, depending on the site and how fast one gets treatment. The pain has been described as aching, burning, stabbing or shock-like. These symptoms can occur several days before the rash appears. When the rash does appear, it can progress to blisters that crust over. The rash usually lasts 7-10 days, and will heal in 2-4 weeks. Other possible symptoms of shingles include: fever, headache, light intolerance, and just a feeling of being unwell. I had all of those symptoms except for the fever. Shingles follow a nerve pathway, and can appear on the torso, arms, thighs, or head( including the eyes or nose) A serious consequence is that the pain can be LONG TERM and severe, and remain long after the rash clears. 

I am writing this blog with the hope that people, especially those who have had or currently have cancer, will talk to their physician about getting the shingles vaccine. I would not wish shingles on anyone! I hope that maybe this blog will encourage those people who have been putting off getting the vaccine ( unfortunately like I did) to get their shingles vaccine ASAP. 

How to store one's thyroid medication while on vacation- or how I did it, anyway.

 I am back! My husband and I were gone for a two month long trek across the country. We took our trusty little camper and a 90 pound German Shepherd dog along with us. We traveled almost 11,000 miles and while we had a few misadventures, it was an overall wonderful  vacation. We camped in mostly state and national parks. Most of the parks had electricity, but some did not. We have a little mini-fridge in our camper, which made keeping heat sensitive medication easier, but I had to take enough medication for two months. Levoxyl or any brand of levothyroxine is heat intolerant. That means it will lose potency and break down if stored in a heated or damp location. The somewhat " official" temperature that this medication needs to be stored at or under, is 77 degrees Fahrenheit, or 25 degrees Celsius( for those that use the metric system.)

So, I stored my stock supplies  of medications in our fridge, but I needed to take along my daily medication reminder pack with me in our truck. When we started our trip, it was cold most places that we were visiting/camping. In fact, there was lots of snow at Crater Lake, for example. My husband and I wore coats, sweaters, etc. during the first part of our trip. I felt fine taking my weekly medication container in my purse, as it was with me when we traveled and hiked. As we moved along the country, the weather warmed up and storage was a bit of an issue. I began to be concerned about the medication in my purse. Although we turned on the air conditioner when needed, the sun still heated up the car a bit. I had brought a small cooler for our lunches, so sometimes, depending on the temperatures, I put my daily reminder container in the cooler. 

Another concern was when I would take my medication. It is best if one takes their Levoxyl or other brand of levothyroxine at the same time each day. We stayed at a few campgrounds for two or three days at a time, but mostly we only spent one day. I did my best to take my medicine at the same time each day, but it was a challenge! We have a little bathroom in our camper, but it is damp in there so I could not put my daily reminder container in there. As stated above, the manufacturers recommend not storing medications in a bathroom. The dampness, and possible heat, could greatly affect the potency of thyroid medication. I could not leave it out on the counter because our dog, who is technically still a puppy ( a very large, long haired puppy who thinks everything is a toy) would have certainly chewed my container up along with my medication. Out of sight, out of mind as the saying goes. I can say that I missed only one dose of my Levoxyl, but as far as the time(s) that I took it were varied I am afraid. I did manage to always take it on an empty stomach, and wait the hour before eating. 

As it worked out, I had a doctor's appointment scheduled the week after I returned from our big trip. My T4 level was up a little (However  I am still in the suppressed range, which is what my endocrinologist wants, since I had both papillary and fairly aggressive  follicular thyroid cancer) My T3 was almost in the low range- just barely in the normal range. I have been very tired lately, and since T3 is our body's  "fuel" that may explain my fatigue. Hopefully, now that I am back home and have returned to a somewhat more normal schedule, my T3 will eventually go up a bit.

Proper storing one's thyroid hormone medication, either at home or on vacation, is very important. If our medication gets hot or damp, it will not work as well and that leaves us feeling badly. If a person is on a suppression dose, taking medication that is not potent could possibly  make that person more prone to a recurrence. So, in summary, how one stores thyroid hormone medication, and when and how it is taken is important to our health and well being. This is obviously more difficult if on vacation, especially a long one, but there are things we can do to insure a good outcome. So take that trip! Have fun but remember to store your thyroid medication correctly, and take it as close to the same time each day as possible. 

What is Phantom Breast Pain?

As I said a few years ago, I merged my thyroid cancer blog with my breast cancer blog to make sort of a " two-fer" blog. I devote most of my blogs to issues dealing with thyroid cancer, however. Mostly because I feel like there are fewer thyroid cancer blogs than breast cancer blogs. So I feel that there is a greater need for information about thyroid cancer. 

I have been experiencing some phantom breast pain for some time now. I did not know it was a "actual  thing" until recently. Any chest pain after breast cancer surgery/reconstruction should be immediately addressed with a patient's physician or surgeon, of course. When other possible causes have been ruled out, then perhaps the pain, itching, pressure, etc, can be attributed to phantom breast pain. I think that most people have heard about phantom limb pain or sensory perception in a missing limb, but as I said, I had never heard about phantom breast pain until recently. So what is it and how is it treated?

I have read that anywhere from 10% to 60% of women have phantom breast syndrome after mastectomy. Phantom breast syndrome means that a woman has the sensation of a breast ( or breasts in my case) being present after removal. This can be temporary, but up to 50 % of women have chronic breast pain after surgery for breast cancer. This pain could be a symptom of phantom breast syndrome or  nerve cell damage after surgery. 

Other phantom breast syndrome symptoms, besides pain, include the following:

* itching ( usually deep inside of the chest wall, and not relieved by itching)

*tingling

* pressure or a heavy feeling in the chest area

* a burning or stabbing sensation

* throbbing

* an electric shock type sensation

What can cause phantom breast pain or some or all of the symptoms mentioned above? The central nervous system ( the brain and spinal cord) may receive incorrect messages or signals from the damaged nerves caused by mastectomy. One study found that this syndrome may be more common in younger women and/or women who are more educated. The only reason that I can imagine that would explain why younger or more educated women may have more phantom breast pain, is that perhaps women in these groups see their doctors more often and possibly feel more comfortable discussing their symptoms to their physicians. 

Sadly, I did not have any after care, other than checkups from my surgeon and oncologist, after my breast cancer surgery and treatment. It was shocking and confusing to me to go from such structured treatments and surgery to being " on my own". What was I to do now? I have a very supportive family and group of friends, but no one understands what a breast cancer patient is feeling better than another breast cancer patient. I was not offered counseling or physical therapy of any kind after my medical treatment was completed. I felt, and still feel ( I fear that my phantom breast syndrome is chronic at this point) sensations of pain and intense itching that come and go, but have not completely resolved. The treatment options for chronic phantom breast syndrome (CPBS- my abbreviation, because I am tired of typing in the whole thing) are not any that I found suitable for me. This is not a one size fits all, so these options may work for others. They include:

* opioids in severe cases ( not ideal, as addiction is a real concern)

* anti-seizure drugs ( well known, and loved by some, include Neurontin( or gabapentin)

* antidepressants ( too many to list)

* Mexitil ( which is a medicine for abnormal hearth rhythms) not sure how this is supposed to work...

* the miscellaneous category, which include clonidine ( usually used for blood pressure) and others

There are also topical medications which have the advantage of fewer side effects; these include:

* topical lidocaine patches - please use caution here! These can affect the heart ( arrhythmias for example) and should only be used after talking to one's physician.

* Capsaicin patches( 8%)- these have FDA approval for treatment of chronic pain. As a reminder though, while they may be useful, patients should be mindful of the fact that this drug is derived from hot peppers and will bind to the skin making it difficult to wash off should the effect become too intense. 

* CBD oil- with or without the presence of THC. In some states, the topical preparation with THC is legal and in other states it is not. In my state of North Carolina, the CBD oil with THC is not legal. I am using a CBD salve without any THC. It does contain eucalyptus, lavender and beeswax and is all organic. Personally, this works fairly well for me. Of course, the action of massaging the salve into my skin may be helpful as well. 

Which brings up another important component of obtaining a better quality of life after breast cancer. Counseling- for the physical discomfort as well as for the emotional pain that breast cancer patients have to deal with. Counseling was never suggested to me. I just assumed that I needed to deal with the after effects of breast cancer on my own- in the best ways that I could. I feel very strongly that EVERY woman dealing with breast cancer should at least have the option of counseling. I have read that counseling after treatment/surgery for breast cancer may in fact increase the survival rate of some patients. 

Even though I feel that traditional medicine is the first line treatment for breast cancer, and other serious health disorders, complementary alternative therapies can be an important part of the treatment. These could include the following:

* acupuncture

*massage

*yoga

*qigong

*meditation

*music therapy

*art therapy

* pet therapy ( who does not love to pet a dog or cat? Studies have shown that petting a dog for just 15 minutes can lower blood pressure by 10% and can even lower cortisol ( which is a stress hormone) in the body. 

The above listed items are adjunct therapies- to be used along with but not in place of  traditional medical treatments. They are pleasant parts in our treatment plans to help breast cancer patients, perhaps those dealing with CPBS, obtain better quality of life and outcomes. 

Another important treatment, that may improve CPBS, as well as promote a better quality of life, is Physical therapy. This was not offered to me after my surgery for breast cancer. Some doctors feel that this is an important part of rehabilitation after breast cancer. I would have to agree with this. I would urge breast cancer patients, those with CPBS or not, to discuss a referral from their physician to a physical therapist who has experience helping breast cancer patients. 

The takeaway from this blog about Phantom breast pain is that little is known about the prevention or  treatment of this disorder. Even though I am late to the game, and have been dealing with CPBS for some time now, I am being my best own patient advocate and seeking out some effective ( or so I hope) treatment for the CPBS. I hope that by talking about this disorder, women who have been experiencing the symptoms of CPBS will seek out the appropriate help. Even better, I hope that newly diagnosed breast cancer patients will be able to recognize problems early and address their issues. 

Some reasons why thyroid cancer is NOT the " good cancer"

There are few statements that can light a fire under me as much as someone telling me that " Oh, you have  ( or had) thyroid cancer! That's the good cancer, right? Aren't you lucky? It is so easily treatable and the prognosis is great! " I had thyroid cancer in 2010, and have dealt with these comments for years. It was not too long before I put my Southern manners aside, and tried to educate others on thyroid cancer- specifically why it is not the " good cancer". 

First the obvious. the words "Cancer " and "good " usually do not belong in the same sentence! Who in the world thinks having ANY type of  cancer is a good thing? And I do not put too much faith in statistics, either. I have been told that 95% of thyroid nodules are benign. I guess that puts me in the unlucky 5%, then. 

Before discussing the types of thyroid cancer, it is important to note that the thyroid gland has two main types of cells. Follicular cells get iodine from our blood and make thyroid hormones that regulate metabolism. The other cells are called C-cells or parafollicular cells, and these make calcitonin which helps with how our bodies use calcium.

It matters what type of thyroid cancer one has insofar as diagnosis and treatment.  That is another eye opener for some people. There are at least five types of thyroid cancer ( Papillary, Follicular, Medullary, Hurthle, and Anaplastic). A person can have one or more of these types. I had both Papillary and Follicular thyroid cancer. Papillary cancer accounts for about 80% of diagnosed thyroid cancer. Follicular comes in at about 10%, while Hurthle accounts for around 3%, Medullary around 2-4% of thyroid cancer cases, and lastly, the rarest of all- Anaplastic thyroid cancer- accounts for about 2% of all cases. 

Papillary and Follicular are classified as differentiated thyroid cancer. Simply put, this means that the thyroid cancer cells retain important features of normal thyroid cells. ( before malignancy). These two types are the easiest to treat of the above five mentioned,  with Follicular being a little more challenging than Papillary. Papillary, Follicular and Hurthle thyroid cancer develop from thyroid follicular cells. Medullary thyroid cancer develops from the C-cells. Anaplastic thyroid cancer is called undifferentiated thyroid cancer. It is rare, difficult to treat, and the cancer cells do not look anything like normal thyroid gland cells. The scary thing to me is that sometimes Anaplastic thyroid cancer develops from existing papillary or follicular cancer. Maybe because this is such a rare cancer, but  there is not a lot of information about this type of thyroid cancer. I am hoping that more research will be conducted on this type. 

Treatment for differentiated thyroid cancer can include surgical removal of the thyroid gland- full or partial- possibly  along with treatment with the radioactive I-131. To simplify, these follicular  cells are involved with iodine uptake. So when one gets the I-131 after surgical removal of the thyroid gland, the only thyroid gland cells remaining will be the cancerous ones. The rogue ones, as I like to say. They gobble up the radioactive  iodine, after being deprived from the patient being on an iodine free diet, and the remaining cancer cells die. Medullary comes from the C-cells, so the I-131 is not an effective treatment for this type. Anaplastic is undifferentiated, so treatment is also challenging. 

Thyroid cancer is not a " one size fits all" kind of cancer- either in type or treatment options. After surgical removal of the cancerous thyroid, full or partial removal, thyroid supplement is necessary for the patient to feel " more normal". Herein lies the problem! Many factors influence the type of thyroid hormone that works best for the individual patient. This means many dosage adjustments as well as perhaps  types of thyroid hormone. Synthetic or naturally sourced? Does a patient need T3 supplement or not? We thyroid patients are used to rolling up our sleeves constantly for blood work, as well as enduring at least yearly ultrasounds and exams. Recurrence is always a possibility- albeit not an extremely common occurrence.

 Also, after having thyroid cancer, the American Cancer Society states that thyroid cancer patients have a slightly increased risk for having a SECOND PRIMARY cancer. These are not recurrences of the thyroid cancer, but are new, unrelated cancers. The types the ACS says that thyroid cancer patients are somewhat more at risk for are: Breast cancer ( in women), Prostate cancer, Kidney cancer and Adrenal cancer. The risk of adrenal cancer is higher in those who had medullary thyroid cancer. As a side note, I had breast cancer in 2015. I had stage 2B invasive lobular breast cancer. I had bilateral mastectomies and three months of chemotherapy. I am in remission now, thankfully. 

As I said at the first of this blog: there is no cancer that qualifies as the good cancer. There are certainly some that are more easily treatable and have a better survival rate. Personally, I am hoping for a time when all cancers can be survivable and easily treated. 

Self Care for thyroid cancer patients

 As thyroid cancer patients, we have all certainly been through a lot! Surgeries, radioactive treatments, biopsies- in fact we still go through a lot trying to maintain our health. Constant dosage adjustments with our thyroid medications so that we can feel somewhat " normal", blood work to monitor thyroglobulins ( a predictor of  possible thyroid cancer recurrence) , ultrasounds to check for thyroid cancer spread ( I call them goblins), and for me, at least, the search for a physician who will listen to how I am feeling and is willing to work with me cooperatively to maintain good health. And this is just a partial list, but certainly does help explain why thyroid cancer is NOT the good cancer!

I think that a balance of self care along with medical care is essential to good health. As we enter into a new year, it is a good idea to think about what things that we might do to improve our health and well being. The following is a list of some basic self care therapies, as well as an abbreviated explanation of how these therapies might work. While these therapies would work well for anyone,  I think that since the thyroid gland (  ours now gone missing!) controls so many of our bodily functions, self care is even more essential for those of us who have/have had thyroid cancer. 

1) Sleep. Adults are supposed to get 7 to 9 hours of good quality sleep per night. Some of the benefits of this are: better memory ( even more important as we age), better performance, lower weight gain risk( the postulated reason for this is that sleep deprivation is associated with an increase in the hormone that causes us to be hungry), reduced salt retention, reduced fatigue, better control of blood pressure by the body, and a stronger immune system. 

2) Strengthening our immune system is very important. Over 70% of our immunity is in our gut. Getting enough sleep allows our gut to get maximum nutrient absorption. Also, our gut houses the largest number of immune cells in the body. Limiting caffeine intake or large meals near bedtime allows our gut to rest and process the nutrients in the food that we eat. Which leads us to #3...

3) Eat a healthy diet! I think most people know what a healthy diet entails. But to summarize, more chicken and fish, less red meat, more fruits and vegetables, less sugar and caffeine, etc., As I mentioned above, I think the time of day that we eat is important, also. Eating an early supper lets our intestines rest, as well as having a positive effect on sleep. Win-win.

4) Exercise. Well, this is difficult to do sometimes. But exercise can reduce stress and anxiety as well as promote weight loss. Even if it is just a nice walk outside, it is very beneficial to schedule some exercise on a regular basis. Since fluctuations in thyroid medications can cause mood swings ( I know this personally!) exercise can become a non-medicated way of helping us feel better. 

5) Increase water consumption. This is so very important, folks. Adequate water intake can: help us maintain our electrolyte balance and good blood pressure, lubricate our joints, regulate our body temperature, help us keep our cells healthy,  help our brain function, aid our food digestion, improve blood oxygen circulation, help prevent kidney stones and urinary tract infections, keep our skin hydrated and may promote collagen production, and ( my personal favorite) help create saliva ! ( water is the main component of saliva) One way that is helpful to me is to use my water canteen and refill it as much as I can during the day. I carry it around the house with me and also put it on my bedside table at night. Also, I drink water with each meal. 

6) Learn to say no! Everyone deserves a little "me" time. Take a warm bath, read a book ( my personal favorite), go see a good movie, etc., Also good for one's mental health. 

7) Make friendships. I just saw a report on this and how long term friendships promote happiness. It does take time and work, but definitely worth the payoff. 

8) Go outside. Nature is the best healer. Take a walk, take deep breaths, On your walk outside you could also...

9) Take a pet with you. Studies have shown that dogs can cause humans to release oxytocin- the happiness and love hormone. So having a pet, especially a dog, is good for your health. 

10) Organize your home and work space ( as much as you can). I know that I feel much more relaxed and happy when my home is organized. Of course, small children and pets put some limits on this(!), but do what you can.

11) Cooking meals at home- even once a week- is not only good family time, but a thoughtful and healthy  meal at home is better than a" McMeal" any day. 

12) Practice deep breathing. This can help reduce stress, lower blood pressure, lessen PTSD symptoms, increase lung function- thereby enabling the lungs to clear out toxins and deliver oxygen into the blood stream more efficiently. There are videos out there that can help one learn deep breathing techniques. I have been working on this for a while now. When I had my knee revision surgery, I had been practicing deep breathing a few months before the surgery so that my body could clear out the anesthesia more effectively. And it worked for me. Deep breathing also helps to calm me during stressful situations. This sounds so simple, but it really works, if done properly and consistently. 

Of course, there are many more things one could do for good self care. What I have listed here are just a few that interest me. I hope that by practicing these or other positive techniques, we thyroid cancer patients ( and others) can live better, healthier, and happier lives.