Cancer Survivors Confront Weight Gain Together

Friends & cancer survivors Karen
Cherelstein (left) and Diane McClyment
often exercise together

Karen Cherelstein had a normal mammogram in October 2006, but a self-examination in January 2007 revealed a lump. A visit to her OB-GYN and a biopsy confirmed her fears: she had Stage 1 cancer with a small tumor just before her 50^th birthday. “When my internist asked for a special appointment, I knew the news wouldn’t be good,” Ms. Cherelstein says. “As more results came through, I learned that my cancer was aggressive.” She spent several months undergoing chemotherapy and radiation under the guidance of Gary Cohen, MD, then-Medical Director of the Sandra & Malcolm Berman Cancer Institute at GBMC, and has been cancer-free for eight years.

“By October 2007, I was working full-time again and my hair was growing back,” Ms. Cherelstein says, “but I was beginning to have weight issues.” At 5 feet 1 inch tall, she says that any additional weight is obvious on her body. Not realizing it might be related to her cancer, she struggled with managing her weight for years and, by October 2014, she had reached a number on the scale that she could not believe.

While Ms. Cherelstein fought to achieve a healthy weight, her friend Diane McClyment was going through similar life and body changes. Ms. McClyment was called back after a mammogram in October 2013 and a biopsy revealed she had breast cancer. Her physicians at a local hospital recommended radical treatments, which had her on edge. Ms. Cherelstein suggested a second opinion with Dr. Cohen. “The minute I met him, I knew he was the right doctor for me,” Ms. McClyment says. “He handled everything, even contacted a physician I had 25 years ago in New York to discuss my previous lymphoma treatment.”

With Dr. Cohen overseeing her care, Lauren Schnaper, MD, performing her surgery and Geoffrey Neuner, MD, administering radiation therapy, Ms. McClyment felt she was in great hands. She had a lumpectomy and was treated with a “one and done” radiation treatment, both of which were successful. “My only complaint was the weight gain. Like Karen, I was grateful to be alive, but had a difficult time shedding excess pounds.”

At a September 2014 follow-up appointment, Dr. Cohen could tell Ms. McClyment felt negatively about her appearance. “Studies have shown that excess body weight may be linked to certain cancers, including breast cancer,” says Dr. Cohen. “Excess weight and obesity may lead to worse outcomes despite cancer treatments, and weight gain following a breast cancer diagnosis may significantly increase the risk of recurrence and cancer-related deaths.” Dr. Cohen referred Ms. McClyment to a clinical trial entitled “A Randomized Study Evaluating the Effect of a Remote-Based Weight Loss Program on Biomarkers in Women with Early Stage Breast Cancer” being offered through the Johns Hopkins Clinical Research Network (JHCRN). The JHCRN is a collaborative effort between GBMC, the Johns Hopkins Institute for Clinical and Translational Research and several other regional medical centers. It is designed to accelerate the transfer of new diagnostic, treatment and disease prevention advances from research to direct patient care. Ms. McClyment was excited about the weight control study and immediately enrolled.

“The trial is a yearlong weight loss program designed to specifically meet the unique needs of women who have completed their acute therapy for early breast cancer,” says Vered Stearns, MD, Co-Director of the Johns Hopkins Breast and Ovarian Cancer Program and a lead physician on the JHCRN research team. Study participants are randomized into two groups, self-directed weight loss or active remote intervention (Practice-based Opportunities for Weight Reduction, or POWER-remote), and each group follows a strict plan of exercise, diet tracking and health assessments. The goal of the study is to gauge the effectiveness of weight loss intervention techniques and assess the effects of weight loss on biomarkers associated with breast cancer, inflammation and obesity. This information will be used to help implement further clinical intervention techniques in breast cancer patients.

“While it is too early to determine overall benefits, we have seen an increase in awareness and attention to diet and physical activity in all participants, and several women have experienced a reduction in their weight,” says Dr. Stearns.

Ms. McClyment was placed in the active intervention POWER-remote group and has lost 37 pounds and four inches from her waist, is down four sizes and is pleased with the reasonable goals and accountability aspects of the program. Ms. Cherelstein, who could not directly take part in the study because of the time elapsed since her treatment, completed the program on her own by sharing Ms. McClyment’s study plan. Both women are thrilled with the marked improvement in their individual bodies, minds and overall health. “We started checking in with each other almost every day as the pounds started rolling off,” Ms. Cherelstein says. “It was a process, but we’ve both excelled. We talk about shopping for new clothes instead of how fat we feel! We’re grateful for the care we received and are optimistic that the odds of cancer recurrence have been decreased for both of us.”

For more information about oncology services at GBMC, visit www.gbmc.org/cancer. To learn more about the various clinical trials available at GBMC, visit www.gbmc.org/clinicaltrials or call 443-849-GBMC (4262).

Baby Spinach with Golden Raisins and Pine Nuts

Ingredients

4 tablespoons pine nuts
2 bags (10 oz each) leaf spinach, rinsed
⅔ cup golden seedless raisins
⅛ teaspoon ground nutmeg
⅛ teaspoon salt

Directions

In a medium nonstick pan over high heat, cook and stir the pine nuts until they begin to brown lightly and smell toasted, but not burnt. Set the pine nuts aside in another dish.

Return the pan to the burner over medium-high heat. Add ¼ cup water. As it begins to boil, add a small handful of spinach. Cook and stir just until it begins to wilt. Then push it to the side of the pan, and add another ¼ cup water and handful of spinach. Continue until all the spinach has been cooked, adding the raisins with the last handful of spinach.

Sprinkle with nutmeg and salt. Cook and stir until all the spinach is wilted and the raisins are warm.

Remove from heat. Press out excess water with a spoon or spatula. Place 1 cup of the spinach and raisins mixture in a serving bowl. Top with pine nuts.

Nutrition Information

Servings: 4
Calories: 76
Fat: 3 g
Sodium: 130 mg
Fiber: 3 g
Protein: 3 g
Carbohydrates: 13 g
Potassium: 510 mg

Recipe acquired from the U.S. Department of Health and Human Services, NIH, National Heart, Lung and Blood Institute. Keep the beat™ recipes

Safeguard Your Heart

You would know if you were experiencing high blood pressure, right? Wrong. High blood pressure, also called HBP or hypertension, is actually a largely symptomless condition. If the force of your blood flow is too high, and the heart is being forced to pump harder than it should, the tissue that makes up the walls of the arteries is stretched beyond its healthy limit, causing damage. The strain on the body can lead to a stroke, heart attack or chronic kidney disease.

High cholesterol can be another burden on your heart. When excess cholesterol, which is a waxy substance, starts to form between layers of artery walls, it is more difficult for your heart to circulate blood. The plaque-like build up can break open and cause clots, which may block an artery to the brain, causing a stroke, or one to the heart, causing a heart attack.

Luckily, controlling and preventing high blood pressure and high cholesterol involves easy-to-make lifestyle modifications that are beneficial for your heart and overall health:

• Eat nutrient-rich foods. Load up on fruits and veggies! Look for breads and cereals that are 100% whole-grain and high in fiber (at least four grams per serving). Select skinless poultry, lean meats, and fish that contains omega 3 fatty acids, such as salmon, trout and herring.
• Limit sodium, saturated and trans fats, and added sugars. Avoid sprinkling your meals with extra salt. Seek out good fats from avocado, eggs, seeds and nuts. Read nutrition labels to identify added hidden sugars with names like dextrose, sucrose and fructose.
• Be active. Not only does physical activity help control your blood pressure, it helps manage your weight, which will strengthen your heart. Try to aim for moderate physical activity, such as brisk walking, for 30 minutes a day at least five times a week.
• Do not smoke. Each cigarette you smoke temporarily increases your blood pressure for many minutes, even after you finish. Smoking has numerous negative effects on your cardiovascular and overall health. Research smoking cessation support groups, classes and hotlines for help.

Your primary care physician can help you learn how to better manage your blood pressure and cholesterol, ensuring a healthy heart. If you do not have a primary care physician, visit www.mygbmcdoctor.com to find one who is right for you.

Walk a Mile to Support SAFE and Domestic Violence Programs

On April 16, GBMC will host Walk a Mile in Her Shoes: The International Men's March to Stop Rape, Sexual Assault, & Gender Violence, with proceeds benefitting GBMC's SAFE and Domestic Violence programs.

The Sexual Assault Forensic Examination (SAFE) program provides cost-free services to sexual assault victims ages 13 and above. In a confidential, non-judgmental atmosphere, Forensic Nurse Examiners conduct complete medical-forensic evaluations, including collection of forensic evidence, documentation of findings, emergency contraception and antibiotic treatment to prevent sexually transmitted infections. The SAFE program and its complement, the Domestic Violence program, are located in a secure, private suite away from the hustle and bustle of the Emergency Department. They provide quality personal care 24 hours a day, seven days a week, 365 days a year. "It is important for people to know that we are always here for them," says SAFE Clinical Program Manager Laura Clary, RN, FNE-A/P, SANE-A, CFN, CPEN. "Our doors never close and we always have a SAFE nurse and Victim Advocate ready to respond when a patient arrives."

In addition to receiving the necessary medical treatments they require, patients of the SAFE program can expect crisis counseling, as well as new clothes and toiletries before leaving, if needed. The personal touch SAFE offers is vital. "Sometimes when patients come to us, they are so down, depressed, blaming themselves," Clary says. "They need someone to listen and to believe them. SAFE nurses care for the patient and do not place judgment; they give patients back the control that was so violently taken from them."

Similarly, Colleen Moore, Domestic Violence Program Coordinator at GBMC, also emphasizes the importance of empowering victims who come to the program. Her staff aims to promote a survivor's sense of personal agency in a non-directive way, which involves listening and responding, but not forcing someone to take steps they aren't ready for. The danger of violence can increase when someone attempts to leave an abusive relationship. "Many survivors are faced with significant barriers to leaving: finances, housing and concern for children are prominent obstacles," Moore says. "Some are trapped in a cycle of violence that rotates through a 'honeymoon phase' when they hope things will change."

People who visit SAFE and the Domestic Violence program can meet with an advocate who will assist them with a tailored safety plan and danger assessment. Patients can take advantage of referrals for counseling, shelter and legal resources, but most importantly, they can expect to be treated with compassion and respect. "It is a great feeling when a patient hugs you and says 'Thanks for listening, for being here when I needed you,' " Clary says. "We actually had a patient say in court, 'I truly feel like my SAFE nurse saved my life.'"

You can support the SAFE and Domestic Violence programs by attending and/or participating in Walk a Mile in Her Shoes, whether male or female, heels or not! In addition to the one-mile walk on GBMC's beautiful Towson campus, there will be a post-walk party with food and prizes. Visit www.gbmc.org/walkamile to register and for more information.

Maple Mustard Glazed Salmon

Ingredients

1¼ pounds salmon fillet
Pinch of salt and pepper

For the marinade:
¼ cup all-natural maple syrup
1 tablespoon lemon juice
2 tablespoons light soy sauce
1 teaspoon Dijon mustard
½ teaspoon ginger (optional)

Garnish:
2 tablespoons thinly-sliced scallions

Directions

Mix all marinade ingredients together in a small bowl. Pat salmon dry with a paper towel and season with salt and pepper. Place salmon skin-side down in a shallow dish. Drizzle most of the marinade over the fish, reserving about two tablespoons. Cover and refrigerate for about 30 minutes.

Heat oven to 400 degrees fahrenheit. Remove fish from the marinade and place in a glass baking dish. Bake for 15-20 minutes, basting occasionally with extra marinade. Cook until the fish flakes easily with a fork.

Garnish with scallions.

Nutrition Information

Servings: 4
Calories: 249
Fat: 5g
Saturated fat: 1g
Cholesterol: 74 mg
Sodium: 396 mg
Fiber: 1g
Protein: 29g
Carbohydrates: 20g
Potassium: 627 mg

Five Tips for Easier Breathing

Imagine feeling like you just ran up ten flights of stairs after simply walking to the kitchen for a glass of water. Think of the last time you had a serious cold and woke up throughout the night, coughing and unable to stop. People who suffer from respiratory illnesses, such as asthma and chronic obstructive pulmonary disease (COPD), regularly experience these unsettling symptoms.

Caused by airway obstruction and irritation, inflammation of air passages or other damage to lung tissues, chronic respiratory diseases make breathing an ever-present concern. As a result, people who have such illnesses often need treatment in an Emergency Room. They might avoid exercise to prevent feeling out of breath, which can then lead to weight gain, weakness and high blood pressure. Additionally, those who suffer from respiratory problems may become depressed or anxious, worried about when their symptoms will strike next.

Fortunately, there are some actions people can take to manage or improve their respiratory health.

• Quit smoking and avoid being around secondhand smoke. Quitting has immediate health benefits, even if you or a loved one has smoked for many years.
• Visit your primary care physician regularly. The care team can assess your needs and help you to identify things that trigger your symptoms. They can also refer you to a specialist if needed.
• Get a flu shot every year, unless otherwise instructed by your physician. Respiratory illnesses may make people more susceptible to viral infections like the flu. The infection can then become more serious or cause the respiratory illness to worsen.
• Get a pneumococcal vaccine at least once in your lifetime. People with respiratory problems are more likely to develop pneumonia from an infection, which can result in other health complications.
• Practice good hand hygiene. Washing your hands frequently with soap and warm water helps to prevent you from catching viral infections.

If you or a loved one is struggling with symptoms like shortness of breath, persistent cough, wheezing or a tight feeling in the chest, consider seeing a primary care physician. GBMC has primary care practices located throughout the Baltimore area. Learn more at www.mygbmcdoctor.com.

Nutritionist Q&A

This is the time of year when many people focus on getting healthy after an indulgent holiday season. In recognition of that and National Healthy Weight Week, which takes place January 18-22, GBMC asked one of its own dietitians, Katie Perry, RDN, to share insights and suggestions for effective weight management.


GBMC: How can reaching a healthy weight improve overall health?

Katie: There is a definite correlation between diet and mood. Many patients have told me that they feel better overall when they make dietary changes such as eliminating processed foods. Processed foods contain a great deal of fat, sugar and salt, which can be very addicting and often make you feel sluggish. Adopting healthier eating habits can help with weight loss or weight maintenance. Being happy with the way your body looks can also enhance your mood and confidence.

GBMC: How can people avoid overeating?

Katie: I encourage my patients to practice “mindful eating,” which is the act of being present in the moment during mealtime and really listening to your body. In order to practice mindful eating, one must remove all distractions including television, cell phones, computers, work, driving, etc. These distractions prevent one’s full attention from being directed towards internal cues of fullness. All senses are used in the act of mindful eating: sight, smell, taste, mouth feel (texture), and even the sound of food cooking.

GBMC: What foods do you recommend for weight loss?

Katie: The first thing I suggest is to choose snacks that are high in fiber and protein, such as Greek yogurt, string cheese, fruits, vegetables and almonds. These foods are high in fiber and protein and help you to feel fuller longer.

GBMC: What foods should be avoided for weight loss?

Katie: The worst things to eat are “empty calorie” foods, which are high in calories but do not provide much nutrition. They are often processed, high-fat, sugary foods including: cookies, cake, chips, crackers, donuts, ice cream, fried foods, etc.

GBMC: What are your tips for maintaining a healthy weight?

Katie: For maintaining weight, it’s all about balance.

• Do not skip meals. Consuming three or four meals per day helps maintain a healthy, steady metabolism.
• Stay hydrated. Be sure to drink plenty of water throughout the day. The sensation of thirst can often be mistaken for hunger. Dehydration can also cause drowsiness.
• Be active. Changes in weight are based on the “calories in vs. calories out” principle. Weight gain occurs when “calories in” exceeds “calories out.” Making exercise a part of your daily routine can help with weight maintenance.
• Get plenty of sleep. Sleep plays a roll in hormonal balance, which can affect the storage of fat, energy levels and hunger.

GBMC: What habits should people can incorporate into their lives to lose weight?

Katie:

• Practice portion control by measuring out your food based on serving size recommendations found on food labels. Using smaller plates and bowls can also help keep portion sizes small.
• Avoid beverages that contain sugar. Liquid calories can be very sneaky and do not provide any nutritional value.
• Increase physical activity. A combination of cardio and weight training can help burn fat and build lean muscle. Lean muscle is more metabolically active than fat and continues burning calories long after working out. It is recommended to be active for 30 minutes or more each day, at least 5 days per week.
• Eat only when you are hungry and stop eating once you feel full. If you notice that you are eating for reasons other than hunger, find a distraction or a different outlet. Eating slowly can help prevent overeating. It takes your mind 15-20 minutes to realize you are full; keep this in mind before going for seconds!