Cancer log 167: Weight

TW — this one’s all about intentional weight loss and cancer prevention. Please do skip if it’s likely to be triggering.

So, I went in for my latest Herceptin infusion (9 left!) last week, and also a follow-up with my oncologist. We talked about my tentative plan to do the fat-grafting reconstruction procedure, where they suck out a bit of fat from my lower belly and insert it into my breast, and then repeat that procedure a few times over the course of a year or so, to hopefully reshape it to more closely match my other breast.

They inject the fat in a thin layer, and hope it meshes with the existing blood vessels; it needs blood flow to survive. Some of it usually dies in the process and is discarded by the body, and the skin stretches slowly to accommodate it. They do the procedure again three months later, and then again, three months after that, and each time, the breast becomes a little fuller, so by the end, it should be close to ‘normal’ appearance. They can’t do it all at once, because then they get a big ball of fat, and everything in the center dies for lack of a blood supply and is just wasted. So it’s a layering process.

I’m almost certainly going to do the procedure, because even though I’m very tired of procedures, I also find the way my breast looks right now pretty upsetting. I could live with it, but I don’t think I want to.

Of course, any time you go in for plastic surgery that’s meant to have a cosmetic effect, they advise you to gain / lose any weight you mean to beforehand. Otherwise, they could give you a nice aesthetic result, and then you might lose (or gain) weight, and change the result in a way you’re unhappy with. This is particularly tricky if you’re someone who has a hard time maintaining a stable weight, but I generally don’t have trouble with that. The times when my weight has gone noticeably up or down as an adult, there have usually been very clear situational reasons why that’s happened — I tend to be pretty stable otherwise.

So with that in mind, I asked my oncologist for more information about the effects of being overweight on cancer recurrence. If I was remembering right, my particular cancer, which is hormonally triple-positive, is more likely to recur if I have more fat, because the fat cells put out more of the relevant hormones (that make the cancer cells grow). She confirmed this, and said this was actually one of her areas of research (metabolic syndrome, I think she said), and I said that given that, I thought I’d like to try to lose a little more weight before doing the surgery. And she asked if I wanted to talk hard numbers, and I said yes.

(Let me pause here to note that I really love my oncologist, and part of what I love about her is that she has never pushed me to lose weight. She’s very calm and factual, and offers what information she has on the subject, if I want to hear it. I just appreciate the way she handles it, and frankly, how she’s handled everything all along. It must be such a hard job, being an oncologist — if it were my job, I’d want to do it pretty much exactly the way she does. Dr. Robinson, Loyola Hospital. Highest recommendations.)

So the numbers say that I’m in what doctors consider the overweight range right now — I used to be in the obese range, but a combination of diet and exercise brought me down from that some years ago. To get to the top of normal range, I’d need to lose 15 pounds. I told her that I’d actually love to lose 25 pounds, and her response was essentially, “Well, you might be going through a lot of effort for not much reward.” So in terms of cancer prevention, she thinks getting to the top of the normal range is sufficient to make a worthwhile difference in recurrence rates. That was good to know.

So the upshot of all of this is that the semester is ending, I should have more time for concentrating on eating healthy and exercising, and I’m going to try to take the next 3-4 months to try to lose 15 pounds. Usually a combination of counting calories / carbs is effective for me — it just makes me a little cranky, as I end up going to bed a little hungry. Are three months of tedious counting and mild crankiness worth it for a notably reduced cancer recurrence risk? I think so, especially when you factor in the aesthetic and general fitness benefits too. I had gestational diabetes with Anand; I’d like to avoid developing the real thing.

If it doesn’t happen, or if I only make it to 5 pounds lost instead of 15, I’m not going to beat myself up over it either. But it does seem worth trying, at least. So if I’m over at your house and say no to dessert, be patient with me; it’s just for a few months. And if you’re local and looking for an exercise buddy, ping me. smile emoticon

(No diet or exercise tips on this post, please; I actually am pretty good at this for my body, and know what works for me. It’s just a matter of actually doing it.)

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