21: Surviving, Thriving, and Living Your Breast Life with Tessa Guevara

Hello and welcome to the Kenya breasts podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools, and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breast I need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being. You know what I say? Breast health is health. So no matter who you are, a breast cancer survivor, newly diagnosed in treatment, living with metastatic disease, or you're simply seeking to improve your breast health, this podcast is for you. Join us on this transformative path towards better breast health and a thriving life. And now, let's get to today's episode. Hello, and welcome back to the Keeping abreast podcast with Dr. Jen. I'm your host, Dr. Jen Simmons, and today I am bringing you a story of surviving, of thriving, of a woman who is living her best life despite her diagnosis, and is here today to share her experience with you, share her wisdom with you, and allow you to have some insight into how this disease affects people and what you can do to harness your power around this diagnosis. So I'm going to welcome Tess Guevara. Tessa, I'm so delighted to have you here today. I know that you are a breast cancer survivor, but you're also a nutritionist, a certified health coach, and you are a nurse anesthetist. So you encompass and embody the medical field both in the conventional way as a nurse anesthetist, and then as a nutritionist and a certified health coach, you kind of see the other side of it and you see the layers and the nuances. So I'm so delighted to have you here today to share your experience and to share your wisdom, because people need to hear it.

Yeah. Thank you so much for having me. You're getting me on a very good. A very good morning. Like, I am really kind of. You know, I had an experience at the doctor's office just a while ago drawing blood, and. And I just had a moment, and I think if you are a breast cancer survivor, you just know what that means. You just have your moments, like you go through your day like everything is okay, and then something happens and it really triggers. So I have no doubt, because there is no accidents in life or very few, um, that that is the reason why that happened. So I could Come and, like, fully share today and just be as transparent and authentic as possible. So on any day, I would be happy to spend time with you, but today is really extra special, so I'm super, super, super excited to be here.

Well, I'm super happy to have you. So can you start off by just sharing with us your breast cancer story?

Yeah. Yeah. So I think that my husband kind of put it. Kind of put it simply, whenever I had to, like, literally come home and tell him the news in that, he just looked at me and started crying and said, you know, I've never seen him cry, but he. He started crying and said, I don't understand. Like, you are the healthiest breast cancer person I know. Like, up into that point, up into the point of my diagnosis, I think I was the pretty average, you know, American woman in that. You know, the average American woman from the generation that was promised that we could do everything. Like, we could have it all. We can have a. We can have a career, and we can be a mom and we can run a home. Like, we were promised all that. Right? And so I was, like, truly fulfilling that promise that was given to me. And do you.

Do you believe that?

Do I believe that? Now? I. I'm. I'm questioning it, honestly, because I really think that, you know, there is a way to have it all, but you just have to be very mindful about the way that you are going about getting it. And I think that was where I just completely derailed the train for me and put my body in. In. In harm's way unknowingly. And I see so many women that are following that same path, you know, because we have to. We have to do all of the things to. To keep up, and that really sort of deprives and starves our body from the things that it really needs to make hormones. Like, I just feel like, you know, at that point in my life, I was really attacking my body's ability to make hormones. Therefore, I was not making any. Therefore, I was investing in hormone therapy. And once I got on that train, you literally can't get off because you're replacing hormones that your body is designed to make, but you can't because you're too busy trying to, you know.

Yeah, I want to get there. I want to get there. Before I do, I just want to share with you the words that I was given in residency, because I think they're so appropriate now. So, you know, as a surgical resident, I'm, like, so geared up to take on the world, right? And I feel so empowered and, like, I can do it all. And there aren't a lot of female surgeons, so I was the only female surgeon in my class. And of our staff of, like, 45 attending surgeons, three of them or two of them were women. And so we meet as a department every week. And in the very beginning of the year, one of the female surgeons came up to me. Her name is Diana Dixon Whitmore. We used to call her DW and she came up to me and she asked me if she could take me out to dinner. And, you know, of course, like, she was accomplished and married and children and a successful career and admired. And so, of course, I jumped on the opportunity and we had a lovely dinner. And at the end of the dinner, she left me with this. Jen, I see all the excitement in you. I see all the potential in you. I want to share these words with you because I know that you have been raised to think that you can have it all, and you can, but you can't have it all at once. And I was so fortunate to have those words of wisdom, though I didn't appreciate or believe them then. I was so fortunate to have those words of wisdom so early in my career that I was able to take that to heart and I was able to look back on it during times of challenge and remember. Oh. Oh, yeah. This is where the balance comes in. Like, you can be a wife and you can be a mother and you can be a surgeon, you can be an athlete, but you're never going to do all of those things well at once.

Mm. Yeah. That is power.

Yeah. So it's part of that balance. I'm sorry, my dog is crying. Now that I would love for you to share where your balance fell off, because you started by saying that you were the healthiest woman with breast cancer.

Yeah.

So, so often this happens where I'm seeing a new patient and they say to me, I'm healthy, except I have breast cancer. And I think that that happens so often with so much disconnect that people do not see the difference, and they don't see the connection that if you have breast cancer, you probably aren't healthy. But. But what we see on the outside and what's happening on the inside are often different things.

Yeah, Yeah, I totally agree with that, and I understand it because I think that, you know, I did look really great on the outside. Being on the inside, that wasn't happening. And, you know, where the disconnect happened was, you know, I really feel like I got caught up in the business busyness of life. And even though I knew about self care, even though I, you know, had all of the new, I ate really well. But I really think the disconnect for me was I did not have any work life balance. I did not take the time to invest in self care and understand, like, the true value of self care and what it brings to a female body. Like that to me was a complete and utter disconnect. Like, I did not get that piece. Like, I understand it now and, and I do feel like, you know, in some aspects, our generation has also been groomed to detach from our bodies. And so I realized that I was detached because, you know, we're always told like, oh, it's just in your head, oh, well, this is what it's like to be a woman. If you're, you know, not sleeping or your periods are heavy or whatever, you know, and there's not a pill for it, then it's just all in your head. Right. And so there was that detachment piece and that work life balance piece that I was not honoring that I really feel like was, you know, the huge disconnect for me not to say that if I did self care, I wouldn't have gotten breast cancer. But I, I, I, I believe that that is so important for women. That's an investment in your body that you can easily be making.

Yeah, but you, you mentioned that you had clues before this because you mentioned that your hormones shut down and started on hormone replacement. So talk to us about the signals that your body was giving us. What did that look like for you?

So there was a lot of, like, not sleeping through the night. That was like one of the first signs. Energy levels, you know, how energy levels drop over the course of the day. I was waking up not feeling rested. You know, what's really interesting is that I've always had this, you know, like, drive to be intimate with my husband. Like, that didn't go away. I mean, that's, it's, it's not there now as a survivor, and that's for other, you know, hormonal reasons. But, you know, at the time, you know, I was always, I've always been the man and in our relationship and needing and wanting and, and all of that. But, you know, you're talking about libido. Yes, libido was always there on point, so. But it was more the, even with.

Even with your, your perceived hormone disruption, that the libido part didn't change for you.

It did not change for me.

Yeah, you're really lucky.

Yeah.

Because with most women that's not the case.

Yeah. Yeah. Like I've, that's never been an issue at that, at that particular time. And you know, I mean, once you give a woman testosterone, like it only, like, you know, I was like a teenager, like it was just crazy. Yeah. You know, anyway, so, so it was really sort of the energy and sleep and just the overall feel good. That hormone replacement was kind of like my, my, my juice to get me to having it all and doing it all at once. Like you're saying, like, I'm literally gonna have it all. And then there, there was always this fear in the background of, you know, menopause and making that transition and how difficult it was going to be thought that, you know, I was doing my body what it, I was giving my body what it needed. And you know, in, in hindsight, I feel like we are, you know, given everything that we need to survive in terms of hormones, it's, it's more of the lifestyle piece that we're not, that we're not used to and we're not honoring in our lives that is causing that depletion that so many women experience.

Well, also, we are living so far out of our system design because we are modern beings. We're living on a very old gene code and we only really know two states. So we know sympathetic state or fight and flight. And we know parasympathetic, which is rest and repair. And we are built to spend the vast majority of our time in that parasympathetic rest and repair state. And only for short periods of time are we designed to be in that sympathetic state. So we are designed to come out of the cave in the morning and encounter the saber toothed tiger, at which point we can either run away and escape or get eaten. But we are not meant to run away and escape for three hours or three days or three weeks or three months or three years. And yet our current reality is filled with saber toothed tigers.

Yep.

And we unfortunately spend the vast majority of our time and in sympathetic tone in that chronic sympathetic state. And as a result, we don't have the opportunity or the ability to heal.

Yes. Totally agree.

Yeah.

Yeah.

And so, you know, when you talk about work life balance, you're really talking about sympathetic versus parasympathetic, that balance and that you were in sympathetic mode, that driven mode, which is great for getting ahead, but not, but not meant to be sustained. Right, right. Like we can do it for three days when we need to cross an ocean, but we can't do it for three months and three years.

Yes.

And that is what we are all asking of ourselves. We're all asking ourselves to cross the ocean constantly.

Yes. And it's so, you know, it's so. Crazy is not the word. I'm trying to think of the word to describe it, but, you know, I see so many women on that trajectory, and it's hard to get them off because they're too focused on, oh, I've got all of the things to do. Right. And it's like, oh, you know, you just take a time out. I know, into parasympathetic instead of being in sympathetic all the time and, and.

Making a list and deciding how many of those things really matter. Because when it comes down to it, like, so many of the things that we allow to hijack us and occupy our time and. And attention are. Are things that are not important.

Yes, 100%.

Yeah.

We put a lot of pressure on ourselves.

We do. We do. We absolutely do. And it's funny because I think that there is a huge difference between men and women in that regard, in that I. I allow the busyness of life to dictate my time, and my husband does not. Yeah, my husband. My husband is very good with the. Yeah, that doesn't matter.

Yes, mine is the same. And. And it's always interesting to me how they can turn things off. And, you know, it's like, work is done for the day, shut the laptop and, you know, shut the computer down and don't think about it, you know, Whereas, like, I have a tendency to ruminate over things that happened in my workday. And you'll never get that from a man. And I'm. I'm. That's absolutely true.

I mean, I'm just thinking about, like, we have a holiday dinner coming up, and, you know, for me, it's very stressful because I have the table to set and I have to pull out all the china and I have to get all the serving pieces and I have to make sure the tablecloth is washed and the napkins and the this and the that, and then I have to cook all the food and. And he's like, I got it. What do you mean? And so I was having this discussion with my friend Amy, and my friend Amy said, why don't you let him have it? And just like, see what happens. And, you know, you'll eat off of paper plates and paper napkins. And it is what it is. Like, let him have it. I can't. I can't do it.

I can't do it.

I would love to say that I could, but I can't.

I can't. And that's okay because you have the expectation of how you want the dinner to go. Right.

But, you know, to him, he sees what's important. The important part is that we're all together.

Yeah.

The family is together, that we spend time together. Meanwhile, I'm going to waste all of my time in the kitchen and not be a part of things. So I know he's right. And yet I can't. I guess it can't.

Yeah. Yeah. Do you think that that is, like. Because I try to rationalize it in my mind. Do you think that that is truly a function of oxytocin and, you know, the way that hormone sort of drives us to take care of others and things? Or is that something else? You know, because I'm, I'm, I'm trying to.

It's an excellent question. It's an excellent question. I haven't thought about it. I mean, what women perceive as love and connection and acceptance is definitely different than men. And I know the reason that we, that we want to fill the world with beauty is because it is in that arena that we feel loved. Like, when we create something beautiful and people appreciate it, we. We feel the love. So I, I, I think that that's where it's coming from, But I'm not 100% sure. But I do know that. That the small stuff that I sweat all the time doesn't even occur to him.

Yeah.

And I, I do believe that sweating all that small stuff has consequences.

Yeah.

And is definite. Definitely contributes to the diagnosis. And, you know, people talk about perfectionism all the time and how that is a huge contributor to stress, to that sympathetic state, to, to diagnoses, to chronic disease. And that's definitely a part of the picture.

Yeah, yeah, yeah. I totally agree. And you know what's so interesting, and I was having this thought this morning because I have to, like, be strategic about what happened, you know, because I'm making a transition from, you know, being a W2 CRNA to a 1099 CRNA. So there's much more stress in that transition than I actually anticipated. And so, you know, just in terms of, you know, what things need to get done and moved around and this and that. And I noticed this morning that I was like, hold on. I am getting caught up in the story of this, whatever it is kind of like, you know, having to transition whenever, from, you know, cancer patient to survivor. You have to sort of make, Make A transition mentally and understanding that, oh, I'm, you know, I'm smart, I am capable. You know, I'm not going to let the story affect how I am showing up, because if I do, then I won't be showing up as my best self. And this is just something that needs to be figured out and stop getting caught up in the story of it all and just execute, you know. So, you know, I'm kind of like relating that to, you know, the process of getting ready for your dinner, you know, because you have, you know, the things that you want to. To. To do, but you don't want to get caught up in the story of it all. And, you know, that's another thing. You know, I could go all day is where I see women kind of like, derailing. But, yeah, I think we get so caught up in our story sometimes that we lose our own power and that. That we have control of the situation and we're giving it away to the story that we're telling in our head. So, anyway, that's so true.

That's so true. So I want to back up because you started to talk about hormone replacement. So I want to. I want to hear that story and what was happening with you and what that looked like, what the workup was and how you decided to go on hormone replacement, what you went on, how old were you, and then how did that lead to your breast cancer diagnosis?

Oh, this is great. So, you know, I was overhearing a conversation. Another mom. It was at, you know, the school book fair when my kids were younger, and she was talking about a functional medicine provider that she had found, you know, over in, you know, a city next to where I live. And I was like, oh, I'm really interested in that because, you know, at the time, I wasn't interested in it in terms of, you know, all the other things. You know, I was feeling tired, I wasn't sleeping well, you know, feeling like there was hormonal transition of perimenopause, scared to go into menopause without, you know, some guidance. And in that area to help me transition, you know, I was like, I don't have time to have hot flashes and whatnot. So, you know, went simple blood work. Oh, you have, you know, low testosterone. We're not going to touch estrogen. So I did pellets for. For, you know, testosterone pellets solely for, you know, that was in after my daughter was born. And I was 38 at the time. Yeah, I was 38. And so that's kind of when I started and it was just testosterone up until the point of diagnosis.

Just out of curiosity, what did we're not going to touch estrogen mean.

That she, at the time, she was like, you don't need estrogen because you're not transitioning into, you know, menopause. So.

But your testosterone levels were low. But do you didn't have any problems with libido? Your problems were mostly with energy.

Yes. And yeah, so, you know, it was testosterone pellets. Sleeping good, energy level was good. What was interesting was that, you know, I never needed less, it was always more. Right. And I definitely knew, you know, when my three months was up and I needed another pellet. You talk about turning into a crazy person. Like, that was me. And you know, along with, you know, following, you know, what my testosterone levels, of course there was cortisol that we were monitoring other things like homocysteine. And then we started monitoring my ability for my own body to make growth hormone. And that was starting to decline. And that was declining over, you know, several years that we were watching it. And then whenever it came out that, you know, you can start injecting yourself with growth hormone, that was the next thing. And so then I started using that. And you.

So how old were you at this point?

I was 46, 47.

So you'd been on testosterone for a while at this point.

Mirena IUD after is was born and growth hormones. Sorry, I didn't mean to interrupt.

No, no, no.

Yeah, yeah.

So the Mirena has a little bit of progesterone in it. Well, your progesterone levels. Okay.

Oh, no, thank you for reminding me. No, progesterone levels were in the tank. I was using, you know, a sustained release progesterone at nighttime. Okay.

Along with. At the. At the time that you were taking, you had the thyroid, the testosterone pellets placed.

Yeah. And what's really interesting, Jen, is that whenever I got pregnant with izzy, I was 38. So. So actually I started, you know, all the testosterone after she was born. So yeah, so I would have been 38, but. So I conceived her whenever I was 37. And you know what's been really beautiful about any sort of health related problem that I have is that I'm connected to healthcare. I mean, it was. It paid off in dividends whenever I was d. Diagnosed with cancer. I mean, I couldn't have had a better experience. But whenever I got pregnant with Izzy, I just knew something was wrong. Like I was like, something is not right. And I was in the OR with My OB gyn. And I was like, look, I know I'm early. Something's not right. So he. He had me in there. Drew. Drew a progesterone level. My progesterone level at that time was, you know, tanking. And so he put me on oral progesterone. And still to this day, I wonder what would have happened to her if I would have never been that intuitive with what was going on, you know, but that's. But that's a whole nother thing. That's a. Another sideline conversation, and I'm getting off topic here, but yes. So it was progesterone that I started with. The testosterone was on that for, you know, you know, 10 years and. Or up until diagnosis. And then I started the growth hormone around 46, 47.

And what was the goal of the growth hormone? What was happening for you?

It was to help with. Help with sleep, you know, because I would have problems with sleep on and off. Like, even though the testosterone, I, you know, started primarily using it for energy and sleep, you know, I would still kind of go through these spurts whenever I would.

It's. It's funny, though, because you're being given something for energy and then struggling with sleep. Right. And it's kind of. It's kind of counterintuitive that, like, maybe we back off the energy thing so that we don't cause sleep disruption. You know, Logic.

Yeah, yeah.

Hindsight is 20 20.

Hindsight. Hindsight is 20 20. And I can remember having. I can remember watching her, this doctor in her office, and she said, you know, whenever we were deciding, you know, because I always had a chance to say, yes, no, whatever, but I can remember her saying, you know, the only problem with starting with the growth hormone was that you, you know, you could grow a tumor, but you don't have any history. So we're, you know.

But was that really true? Do you really have no history?

Who knows? You know, my mom, she died in a car accident around the same age that I was diagnosed. And she had found something that she. In one of her breasts that she was going to go get investigated that very week that she was, you know, that she was killed. So I don't really know if there was a history or not. And honestly, I didn't even think about that until, you know, I was putting the pieces together after my own diagnosis. And I was like, oh, there might have been something there. I just wasn't aware. Just didn't think of it in the time.

Yeah, it's funny because we. We Started to talk about how history repeats itself and how maybe this is, you're living out your mother's experience or diagnosis because she didn't get the opportunity to do that. But when, when you were diagnosed, what was the response in terms of what did your doctor say about this hormone?

It was very ominous because at the time, I, I can remember asking and the, you know, there hasn't been a study, so nothing to point to. And so there was a lot of, like, inconclusiveness around it. And there was like. Well, you know, I do see a lot of patients that, you know, are investing in hormone replacement in the form of pellets. But, you know, it was more of like that storyline. You know, there's nothing that, no study that they can point to.

Yeah.

Says direct relationship.

To be honest. I mean, I don't, I don't blame the hormone. Although, you know, we can argue that if you're using synthetic hormone, that, that is inflammatory. And there's no question about the fact that breast cancer is an environmental disease. And so much of our environment are things that we create. And, you know, the earth that we're living on now, this is not our grandmother's earth. It's not even our mother's earth. We're living on a far more toxic earth. Some of those toxins are really obvious, and some of those toxins are invisible. Like difficult jobs, difficult relationships, abuse, trauma, you know, things that we don't necessarily think about as concrete causes of cancer that actually contribute hugely to the development of cancer.

Yes.

And so, you know, your body, in needing this hormone replacement, was already telling you that it didn't have what it needed to thrive. Right. And so I could see blaming the hormone, but to me, the much bigger issue is why did you need that hormone? I mean, you were 38 years old, for God's sakes. Like, this should not be a time when your ovaries shut down and don't provide you what need.

Yes, exactly. And, you know, that was the, the, the, the connection that I wasn't making. And, you know, that, that in hindsight, you know, now I see it so differently. And you know, I, I, I, I have the feeling that, you know, we weren't created imperfectly. Because, because if I believe that I didn't have what I needed, that's proof that, that we were made imperfectly and we weren't, you know, like, we were, we were built and by design have everything that we need to survive and thrive. It's just a matter of, like you said, that environmental piece we are missing. You know, we're analyzing too many things. We're doing too many things.

You know, we're perfect beings living in a very imperfect environment.

Yes, yes, yes. You know, and. And so I had that feeling, as, you know, I can remember in. In hindsight as a survivor. And then I also have it, as I also have this piece in my brain that, you know, now that I've gone through every aromatase inhibitor and now I'm on tamoxifen, you know, I feel like. I feel like.

And that's because you had, er. Positive.

Yeah, yeah.

And what, what else did you do for treatment? So people know.

So I, you know, I. The, the HER2, I had to do. I had to do chemo, six rounds of, you know, of.

Did you have the Adriamycin, Cytoxan? Did you have Cytoxan, Taxatir, Taxoline?

I had Taxotere and Carboplatin. And then I had Herceptin and Progetta for those six. And then I continued it for a year. And then after that I took a. It's. I believe it's the Progetta in pill form for the year after that. And that's. That's for the HER2. I had to do, you know, six rounds of the Zometa. So I've completed that. And then I had to go on an. An AI for recurrence. And I haven't done really well with the AIs. And. And then I got switched over for joint pain. Like, I was having tons and tons and tons of joint pain.

Did you go into menopause with the chemotherapy?

I'm.

Were you already menopausal? And, you know, puzzle.

They, you know, they. The. The oncologist was like, okay, we're going to do lab work. We did, you know, one round of lab work. They looked at my fsh. LH said, you're in menopause. Congratulations. Just kidding. Yeah. And an aromatase inhibitor. So be excited about that. And, you know, to be honest, I wasn't. And I'm still not to this day because I feel like. And this goes back to the detachment that I was mentioning earlier. Like, I feel like women have been under attack for a very long time and, you know, with this, like, grooming to. To detach, you know, and always playing on women's emotions to get, you know, whatever political gain out there, that's another soapbox I can get on. But, you know, here in. Now, there's been this attack on estrogen, and I'm still being attacked. And Estrogen is what makes us women. And they are attacking the very hormone that is responsible for making me female. And I'm not even mentioning attacking my bone health, my brain health, and my cardiovascular health, but, you know, I feel like I'm under attack. And so every time I have to open that bottle and take the pill, that pill, I just get angry because I feel like, you know, the whole world is on this attack of, of women. And, you know, I just do not believe, you know, along with believing that our creator made us with everything that we needed to, to transition, thrive, hell, we, our bodies, our hormones fluctuate on a monthly basis. Like, we really think that our body is not being made to, you know, experience hormonal decline. I mean, that was dumb on my part, but you know, on, on, on the flip side of that, you know, I don't believe that God gave us estrogen as a dangerous compound that needs to be battled.

Of course not. I mean, if you believe that estrogen causes breast cancer, then by definition you believe that God put us here to get breast cancer. Yes. Which is a ridiculous concept, a ridiculous notion and is not supported in any of the literature.

No.

In fact, you know, when we look at the incidence of breast cancer, what does it do with age? It increases with age.

Yes.

Happens to estrogen. After women go through menopause, it goes down. Gone. It's gone. You can barely measure it. The average age of menopause in this country is 52.

Yeah.

So we, we are talking about the vast majority of breast cancers happening in an estrogen deprived state.

Yes.

So if estrogen is the problem, what is the problem? Rear its head when estrogen is gone.

Yeah.

Doesn't make any sense.

Doesn't make any sense.

And yet people so want to hang on to that explanation because it's easy.

Right. And it keeps you like, medically managed. Right. There's a pill for that.

So there's a pill for that. That is that, that is the major driver. There's a pill for that.

Yes, yes, yes.

So you finished your chemo and you finished and you said that you took a number of aromatase inhibitors and then now you're on tamoxifen. Is that because you didn't tolerate the aromatase inhibitors?

Correct. Yes.

Or do you want to share your experience?

I. Yes. Like I, I had terrible joint pain. And the other thing that I did not like was, well, there's a, there's a few things. There's the joint pain. That was, that was terrible. You talk about getting out of bed and feeling like, you're 90 years old. Like, that's exactly how I felt. I could barely move. I love, love, love the thought of having the ability to, you know, work out, to feel good. I mean, that is just. That's just part of my being. Like, I really love that feeling. And so getting up and, you know, even my husband would watch me, and he'd be like, are you okay? And I was like, no. It just. It just. It just takes me a minute to, like, get going. And, you know, once I get going, it would be okay. You know, I started having elbow pain. And, you know, whenever you work in anesthesia, you have to use. I mean, this is your. This is your Open the airway or right here. Yeah. And so, you know, that was. That was whenever that started to happen, you know, I was like, okay, I can't. I mean, this is, you know, interfering with livelihood. So they. They switched me to another one. And, you know, along with the joint pain, I kind of, like, mowed through all of them. You know, along with the joint pain, there's the whole dry vagina that's just. I mean. I mean, just unbearable. And I'm not talking about using it for, you know, my own pleasure. I'm just talking about just walking around with dry vagina is not a fun thing. I don't recommend it.

Yeah, no. Vaginal atrophy is horrible.

Yes.

Horrible.

Yes.

And women really suffer.

Yes. And, you know, I didn't realize that, you know, how much of my own sort of mental well being as a woman was tied to my vagina. Like, never thought about my vagina until that time. But then, you know, then you put your foot up in the stirrups, and you hear your, you know, gynecologist say, oh, there's a lot of atrophy down here. And, you know, I just wanted to reach up and slap her and be like, do you think this is how I want to be? Like, you know, say something that is a little different than that. I know.

I think it's really important for people to know that the American Menopausal Society has put out a position statement that intravaginal estrogen is safe for everyone, including people who have a history of breast cancer, and that women, especially women who have been treated for breast cancer, should universally be put on intravaginal estrogen in order to prevent these exact symptoms, in order to prevent the vaginal atrophy and also to protect the health of the bladder.

Yeah. Yep. Because I started having UTIs.

Yes. So this is what everyone who has a history of breast cancer should be talking to their doctor about.

Yes.

And everyone who has a history of breast cancer should be on intravaginal estrogen.

Absolutely. Absolutely. 100%.

Yeah.

You know, the last thing that I did not like or appreciate was, you know, the 20 pound weight gain right off the bat. And, you know, like, I'm a nutritionist. I know what to eat, you know, and I think I just got caught up in the throes of being insulin resistant without even knowing it. So whenever you're insulin resistant, you can gain weight eating really good food. I mean, it's not the food.

True. It doesn't matter. Right. Because when you're insulin resistant, like, all you're gonna do is store. That's all you're gonna do is store.

And that's what I did. Drinking a beautiful green protein shake every morning. 20 pounds, just like that. Permanent, not moving. Like it's been a struggle. And don't appreciate that again. Yeah, yeah.

It's brutal. It's brutal. So you started to talk about the transition in your job from being a W9 employee to. To being a 1099. And I want to talk about the transition from being a breast cancer patient to being a survivor, because that's a really difficult time. And I say it's the quiet after the storm. It is going from constant noise and let's be honest, I mean, it's noisy, right? There's a lot of opinions. There's a lot of stuff going on. There's a lot of busy stuff. There's a lot of treatment, There are a lot of appointments. And you go from that to, you're good, see ya. And it's scary.

Yes, it's very scary.

And it's lonely.

It is, it is.

So how did you make that transition and how's it going?

So I, you know, that's a really great question because I feel like when you're in the throes of a cancer diagnosis, you know, there, there was a point that I really had to come to terms with my own spirituality. And there's. It was such a powerful, powerful moment. I have a problem calling you Jen, because I'm used to calling doctors like Dr. Simmons. I'm just calling you Jen.

You can call me Dr. Jen.

That's fine. So. So there was such a point in, you know, early on in my diagnosis because, you know, whenever you have that diagnosis, it's important to really get your mind right because, you know, there's so much going on around you. And so I was waking up in the middle of the night this was, like, probably three weeks into my diagnosis, and, you know, I was. I was waking up with doubt. And so I had a really good friend at work that I was confiding in and trying to get my spirituality work. Spirituality. Right. So I could really become that warrior that I felt like I needed to be. And so at the time, I. I was working on an OB CRNA team, and we worked 24 hour shifts, so I was coming off a 24 hour shift. I was going to do a couple of hours of C sections after that shift, and I had scheduled an appointment at the cancer center to get my lab draw done. It was after one of my. It was after my first chemo treatment, and you have to go and get lab work done to make sure that your. Your counts are good and you don't need a blood transfusion and, you know.

Or your white cells aren't. Yeah.

Because we.

We won't. We generally won't treat you if your.

White cells are too low. Yeah. So. So I. They. They wound up letting me go earlier than I was supposed to from work. So I called the cancer center because I was like, I don't want to go home and then come back this afternoon, you know, So I was like, I, you know, I want to call and move my appointment up so I can just do it on the way home and just go and be home. Right. So I. Before I left work, I sat down with my friend that I trusted, and I was like, look, I'm a believer, and I believe in God, and I believe that God is in control, but I'm having doubts. So I'm feeling like this is not making me a good believer because I am doubting and, you know, doubting my faith and. And it's really making me feel bad. And he said, you know, all you need to do, Tessa, is live in the present moment. Don't worry about the past. Don't worry about the future. Just, you are supposed to be here and now. And I was like, okay, so good. So go to the cancer center reminding you I wasn't supposed to be there at that time. Go and get my lab draw. Go and sit upstairs in the atrium where all the other cancer patients are waiting outside the chemo room to go in and get their treatment. I was just there because they have to come out and clear you so you can, you know, go about your way and. And bless you and you can go into the world. So I'm sitting there, and mind you, it's after a 24 hour shift. I pick A spot where there's no one around. I can lean my head back and just wait because I know it's going to be probably 45 minutes. So I lean my head back, eyes closed, and this guy comes and sits down next to me, and he is talking, and I am looking around kind of like, what's this guy doing? There's other seats. They're open. Like, can you go and sit in your personal space that I'm eyes closed, don't want to talk, you know, whatever.

Yeah.

So finally I was like, read the room. Yeah. I was like, okay, I'm gonna listen to what this guy has to say. And he turns to me and he says, do you know who. Who cures cancer? And I was like, oh, you know, this should be good. I'm gonna say, who? So I said, who? And he's like, God does. And I was like, holy moly. I just got an angel sitting down next to me, and he just delivered a message to me about how doctors are here on this earth doing his work. And you don't have to worry about this. You don't have to worry about a thing. He's got this. His name was Charlie. He was from Israel. I will never forget. I'm trying to find a Hebrew. Hebrew tattoo artist to tattoo his name on my body. Because at that point I was changed. I knew that. That a message was sent from a higher power. I didn't have anything to worry about. All I had to do was show up and show up in a way that would, you know, please, you know, the. The.

To.

To please God and. And. And spread his message. Right. It's so.

It's so interesting that you say that, because the truth is that if you go in with the frame of mind that this is going to cure you, then it's going to cure you. And if you go in with a frame of mind that. With doubt, with, you know, I'm not saying that you shouldn't fear what happens in treatment, of course, like, it's scary and you feel out of control, but what you believe will happen, will.

Yes.

And. And that. That ignitement of your faith, that awakening, I'm sure you feel it today.

Yeah, Still. Yeah, still.

It lights your fire.

Yeah. Like, all I have to do is show up. I don't have to have control of the situation at all. All my job is to show do is to show up and be present. So, you know, that sort of helped me that, you know, that was kind of the jumping off point to becoming, you know, a cancer patient, to A survivor. All I have to do is. Is. Is like, truly show up in a moment. It does feel different because you're like, you know, there's. You've got the warrior mentality when you're. When you're. When you're in the fight, and then you're like. And then after the fight is done, then the processing has to start, and then you start like, holy crap, what just happened to me? And then having to. You know, what's really interesting, and one of the most powerful thoughts that I've had in making that transition is being very cognizant of who I was before and not repeating those same patterns because I'm different now. You know, the experience makes me different. And so there's. There's this rush that you want to get back to just being normal, but your normal is different, you know, and I'm not a fan of like.

Well, and it's. It's your normal that got you there.

Yeah. Yeah. And so you become. You become a new. And I love that you can sort of pick and choose the things that. That. That you're going to put, you know, time into and, you know, let the other things go. I think that, you know, I. I'm. I'm still trying to do this and. And, you know, one of my. One of my crutches, the way that I. The way that I numb, because all of us numb in very different ways. And numbing can be things like watching Netflix, you know, so you can avoid certain emotions or being on social media or eating ice cream or, you know, binge eating or whatever. You know, we're. We're always trying to buffer, you know, so my buffer is work. Like, I can, like, dive off into a work bender like nobody's business, because that keeps me from feeling. And so, you know, I have to be really, really careful and in feeling the emotions and that's kind of, you know, comes up in different ways. Like this morning when I was. Whenever I was at my primary care and we were getting labs drawn and I have to use the left arm only, and it hurts. Like, this is the first time that it really hurt whenever I was getting my lab drawn and I just lost it. I was like, I have, you know. You know, so for as much work that I've done, I still feel like, as a survivor, I process it in those moments whenever they present themselves, and I let myself sort of feel those emotions fully because I think it's so important with, you know, still, even four years later, I'm still transitioning and that's okay, you know, And I'm allowed to have those moments.

Yeah.

Yeah.

So the recognition that you have changed your life, that you've, you've set your priorities differently and you have developed a respect, respect for what your body needs. Right. And it's that, it's that intuition that so often we don't dial into until we have to dial into it. Right. And our diagnoses end up dictating our relationship with ourselves. Yes. Because if you're not going to respect the relationship with yourself, the relationship with your body, the relationship with your mind and spiritual spirit, then you're going to lose that relationship and lose that connection and lose your health 100%. Yeah. So I would love you to leave people with some advice for people just getting on this journey, for just getting a diagnosis, for setting out on their treatment journey. What, what can you say to them? What advice can you give them that can help make their, their journey easier?

I think, you know, it's important to get really present with your body and present in your world as it is now and be very in. Tuned to, you know, where you are and what you might be there for and be open to kind of like my Charlie experience, because I think that every cancer person has probably a person diagnosed, diagnosed with cancer, has something, you know, has a similar story out there. But if you're not open to it, then you're going to miss it. And, you know, just be open to, you know, those kinds of experience. Be opened to the experience of people coming from everywhere and wanting to love on you. Just be open to those instances because you need that to be able to put yourself and your body and your mind and your spirit in the right position to go through the battle. And, you know, and when, you know, kind of like you said, you know, cancer is an environmental disease. And so everything about your whole landscape, including what goes through your mind, including, you know, where you are in the world and where your life is taking you. Just be open to experiencing all of it. You know, even experiencing those emotions whenever you just lose it, you don't have to have an excuse for losing it. You know, those emotions were made to be felt as well, and it's okay to feel them, it's okay to let them out, and it's okay to just open up your world to allowing all of the things to come in. Because I've never felt more loved, I've never felt more seen than when I was going through my diagnosis. Like, I got to really show the world who I was and, you know, I invite you, you know, even in the midst of, you know, terrible, terrible news and, you know, terrible prognoses, like if that is not a wake up call for you to show up to your life like you want to show up, I don't know what is. And so rather than looking at it as the end, looking, look at it as a beginning. That's what I would say.

I love that. And a beginning to a new chapter. Right. And I think giving yourself permission to ask why. Ask what needs to be changed. Ask what you know, how you got here and how you're going to pave a different path forward. Because we know that without change, we can't expect change. And even for women who are seemingly healthy, right, I'm healthy, but I have breast cancer. There is some message there for you. And I don't, I actually don't go to the battle kind of imagery because I think that we're, we're fighting enough. And so I, I choose to come at it with a love and acceptance and, and knowing that, you know, cancer isn't a foreign invader. Cancer is a part of you. And it's the part of you that's saying that this isn't working. And if we can, instead of seeing it as a punishment or another, another thing to fight, if we can instead frame it as an opportunity, we can often come out the other side better for it. With better health, more aligned to our values we were talking about in the beginning, it's so easy to power through. It's so easy to be so goal oriented and to allow your priorities to be hijacked by the accomplishment. And when it's only when you're given these opportunities to slow down and say, is this really important? What, what is really important to me? You. What do I want to be remembered for? Because you have to start living your life, building that story that you want to be remembered for. For.

Yes, 100%.

And, and for many people, this is the opportunity to do that, to be in alignment, to remind yourself of what, of what your purpose is and what's important to you and double down on that.

Yes, 100%.

So I loved spending time with you here today. I really appreciate you sharing your story and your experience. Experience. And I just hope that women can use it to empower them, to ask questions, to realign their lives and to capture the health that they want.

Yes, me too. Thanks for having me.

Thank you so much for being here. It's Dr. Jen. Bye for now. Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Jen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoy enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Rjensimmons and remember, my Jen has two ends, so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.