I don’t feel pretty, and that’s okay

Ugly witch – disguise – I kinda want one for Halloween!

So I’m 5 months out from my mastectomy, waiting for reconstruction of my left breast, and I feel fugly. Not just ugly, but the kind of grotesque that can only come from looking in the mirror and STILL being shocked to see one nipple hanging significantly higher than the other. When I’m clothed it’s slightly better. I can shove my fake boob into my bra and sort of look balanced.

I say “sort of” because the damned insert moves around and is slightly bigger than my intact right boob, so I have to stuff the other freakin’ side with inserts from sports bras, which also move around, and I swear I can tell that I’m lopsided when I look at recent photos.

My family assures me that no one else notices, and maybe they’re right, but I notice, and it makes me self-conscious. It sucks. I also feel old. I’m coming up on my 48th birthday, which technically means I’m still middle-aged. But between the breast cancer diagnosis three years ago, two surgeries, radiation, and three years in medically-induced menopause plus estrogen suppression, I swear I’ve aged ten years.

Am I grateful to be alive? You bet! Do I feel lucky that my prognosis is great? Of course! Is every day a gift? Abso-fucking-lutely! But there are days when cancer and all that comes with it crashes down on me and I get sad, tired, and pissed off about what the big C has done to me.

I’m not alone. If you’re out there feeling the same way, you aren’t alone. We are strong. We are survivors. But we are also human and we will have bad days. And that’s okay. We can’t avoid them, and we have to endure them, but we don’t have to get sucked into the pit of despair. Here are some coping strategies I’ve found helpful. Maybe they’ll help you.

Put on some cute clothes

Happy plus size women shopping – I grabbed this one from Deposit Photos for the description alone!

Fall is here, and that means it’s time to pull out those fuzzy sweaters, leggings, boots, and cute scarves. I’m self conscious about my neck and my cleavage, so scarves have REALLY helped. I’m not going out as much thanks to Covid, but I’ve made it a point, at least once a week, to put on real clothes (instead of the athleisure wear I’ve been rocking since work-from-home became a thing). I choose colors that make me feel bright and shiny, and select from outfits that I’ve been complimented on before. It helps! Those are the days when I can focus more on what I like about my body and face rather than what I don’t like. Have fun, wear what makes YOU feel beautiful, and don’t worry about the folks who say women of a certain age/weight/body type shouldn’t wear certain clothing. The only thing a woman should NEVER wear is the weight of other people’s expectations.

Have Fun with Makeup

My amazing teen and me with makeup!

I’ve always been pretty basic when it comes to makeup. Foundation, blush, concealer on the blemishes, and boom – done! Fortunately, I have a teen who is super creative, into cosplay, and LOVES makeup. Thanks to her, I’ve upped my makeup game and it has helped me feel pretty. A lovely sales associate at Sephora taught me how to contour, another fantastic salesperson at Ulta recommended primer and an eyeshadow pallet that I LOVE – dramatic eyes really work in the era of masks – and my teen routinely helps me out with the eye makeup game. The old barn does look better with some fresh paint!

Simple Self Care

Anything from drugstore face masks to bathbombs to nice-smelling lotion can be cheap ways to pamper yourself when you’re feeling like a wart on the ass end of a troll. Have a soak, wash your hair (especially if it’s been daaaaaaaaays), brush your teeth, put on some perfume, and treat yourself like the absolute fucking QUEEN you are. You are worth it.

Take a Freakin’ Selfie and Send it To Your Friends

I stole this one from “Everything is Awful and I’m Not Okay,” which I totally recommend you print out and post to your bedroom door. Take a selfie, send it to your friends and/or put it on social media – Facebook, Instagram, Snapchat, hell, make a TikTok video. Speaking of TikTok, get on there and find yourself some support from Your Fairy Godmother @starr_mcqeen_, Your Non Binary Uncle @thaddeusshafer, and the aggressively supportive @angryreactions. They don’t think you are pretty, precious, loved, and worthy, and awesome, they KNOW it and they’ll tell you. Your friends and social contacts will tell you you’re pretty, and you’ll believe them and feel better.

Send ME a selfie and I’ll tell you how pretty you are!

Got any other tips? Let me know. I can use all the help I can get, and I’ll share the love!

Screw the Woo Woo: Apple Cider Vinegar

This is an oldie that keeps cropping up in the sphere of (completely unvetted) wellness tips – apple cider vinegar. I’m a bit puzzled by the claims that this is a “natural remedy.” Apples are natural. Cider is processed, as is vinegar, through a fermentation process involving bacteria and yeast that occurs on an industrial scale. It’s not magic. It’s chemistry.

Anyway, a Google search revealed top hits chock a block FULL of Woo Woo claims that are fantastical in nature and, you guessed it, not scientifically vetted. The “apple cider vinegar process” is only at the top because I searched for it first, I suspect. But the rest – “apple cider vinegar gummies” (gross!), “apple cider vinegar benefits” (makes foods taste yummo, but that’s it), “apple cider vinegar pills” (WTF?), “apple cider vinegar weight loss” (maybe if all you eat are salads with apple cider vinaigrette dressing – but that’s a sad way to live), and “apple cider vinegar diet” (that doesn’t even make sense) – it’s all a bunch of doo doo!

“My grandfather’s work was doo doo!” Young Frankenstein. Photo source.

But, since I’m a debunker of woo woo scams, I’m doing the research. A PubMed (database of peer-reviewed published biomedical research) search using “apple cider vinegar” yielded 94 results. Aside from a few articles on the antimicrobial and anti-fungal properties of ACV (not surprising, considering that ACV contains 5-6% acetic acid) and studies in rodent models (cardiovascular health, obesity, and something about boosting immunity in carp and – those were weird) that may or may not translate to humans, most of the articles covered the dangers of using ACV as a “natural remedy.”

Photo credit here.

For example, tooth erosion and esophageal injury was documented in at least two studies [Case Reports Ned Tijdschr Tandheelkd. 2012 Dec;119(12):589-91. doi: 10.5177/ntvt.2012.12.12192 “Unhealthy weight loss. Erosion by apple cider vinegar”; J Am Diet Assoc. 2005 Jul;105(7):1141-4. doi: 10.1016/j.jada.2005.04.003. “Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products.”]. Seriously, do NOT use this to treat heartburn or GERD. It’s a fucking ACID and adding ACID to a condition caused by escape of stomach ACID is completely ridiculous. Don’t drink it. Cook with it, but don’t drink it.

Not only does ACV have no benefit for atopic dermatitis [(skin irritation) Pediatr Dermatol 2019 Sep;36(5):634-639. doi: 10.1111/pde.13888. Epub 2019 Jul 22. Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity], topical skin treatments with ACV can cause chemical burns [J Am Acad Dermatol. 2012 Oct;67(4):e143-4. doi: 10.1016/j.jaad.2011.11.934. “Chemical burn from topical apple cider vinegar.”]! Don’t put it on your skin. Please.

One study reported a lack of antiglycemic (lowering of blood sugar) by vinegar, including ACV, in humans [Nutr Res. 2009 Dec;29(12):846-9. doi: 10.1016/j.nutres.2009.10.021. “Vinegar lacks antiglycemic action on enteral carbohydrate absorption in human subjects.”]. So no, it won’t help people with diabetes.

Apple cider vinegar and a paper funnel inserted into a cup are used as an at home fruit fly trap. Photo credit here.

Fun rando fact – apparently ACV attracts several species of fruit flies, so if you want to collect some wild ones as pest control or for DIY experiments at home, try it! I’m not citing these. Look it up yourself. There are a surprising number of studies documenting this.

Bottom line – there are no validated health benefits in humans for this “natural remedy,” but there are plenty of bad things that can happen if you drink a lot of cider vinegar, put it on your skin, or take pills (and presumably gummies).

And ACV does NOT cure or treat cancer. Only two references came up in a PubMed search for “apple cider vinegar cancer,” and neither reported any benefits for treatment of warts or moles, let alone skin cancer.

BUT…ACV can make tasty salad dressings and delicious sauces. One of my favorites for fall is apple glazed baked chicken. Here’s the recipe:

Ingredients:

1 whole broiler chicken, apple jelly, apple cider vinegar, apple pie spice, apples (tart or sweet)

Recipe

Preheat oven to 325 degrees. Season the chicken with olive oil, salt, and pepper. Bake chicken for 1 1/2-2 hours. While chicken is baking, slice apples and prepare glaze. To prepare glaze, heat 1/2 jar of apple jelly with an equal volume of apple cider vinegar and 1-2 teaspoons of apple pie spice. Boil until volume is reduced by 1/2. Remove chicken from oven, drain chicken stock (can be used to prepare some DELICIOUS rice), cover with glaze, and place apple slices around chicken in the baking dish. Cook another 1/2 hour or until chicken is done. Serve with rice or potatoes, green beans, and enjoy!

Screw The Woo Woo: Essential Oils Won’t Cure Your Cancer

Essential oils. They’re EVERYWHERE! Articles and posts touting their alleged benefits are all over social media, some news media, and the Internet. A Google search I performed today yielded 1.7 billion results. 1.7 BILLION! Yup, there’s a LOT of buzz about the wonders and medicinal benefits of essential oils.

And almost all of it 100% certified Grade A Bullshit.

This post is dedicated to debunking one of my least favorite bullshit woo woo scams (second only to homeopathy). And I will do so with the power of science and snark, because that’s just who I am as a person.

So what are essential oils? They are oils purified from plants and carry the aroma of the source from which they are extracted. Their name comes from the fact that they are thought to contain the essence of their source, and they smell pretty good thanks to terpenoids, aromatic organic compounds produced by plants that often function as chemical protection against herbivores, insects, and microbes. They also serve as attractants for pollinators, seed dispersers, and in mediating plant–plant and plant–microbe communication. Humans enjoy them because they smell and in some cases taste really good. Sadly, allergies prevent me from enjoying the florals, but I enjoy herbals and fruit oils in a wide array of products – cosmetics, soaps, perfumes, lotions, bath products, and many food items. They’re just nice.

Fresh herbs and oils, wooden table background – we smell good and taste nice!

But do they have any medicinal value? What about medicinal value when it comes to cancer? Part of the issue with answering this question involves the (lack of) regulation when it comes to production and testing. The concentration of active chemicals in extracts can vary widely from plant to plant, which parts are processed (different concentrations in leaves, flowers, stems, and roots), which season the plants are harvested, which strains are sourced, etc. Without consistent batches subjected to quality control to assure consistent concentrations of active chemical components (like terpenoids), and without rigorous, scientific studies, we can only rely on anecdotal evidence and (often misleading) claims from suppliers. Some efforts are being made by the WHO for quality and safety evaluation of herbal products, including chemical fingerprint analysis*. Much like vitamins and supplements, which are not subject to the same rigorous FDA standards for safety and efficacy (how well it works) as drugs, essential oils fall under the category of “safe for their intended use,” which does not involve use as medical treatments. They’re considered safe until proven otherwise, a MUCH lower standard than FDA approved drugs.

More importantly, they are (by fairly low standards) rated for safety, but not for EFFICACY. That would require clinical trials and rigorous testing.

Should we be researching them? Sure! Some pre-clinical studies involving cultured cells (cells grow in a petri dish under laboratory conditions) and animal (primarily mouse) models have been published. A systematic review of the literature from 2014 to 2019 identified 79 studies that fit inclusion criteria – including studies investigating essential oils with anti-microbial and immunomodulatory (affects the host immune response) properties, nutrition studies, studies with controls and proper statistical analyses. Of those studies, many documented the anti-microbial (bacteria fighting) and anti-fungal (fungus fighting) properties, antioxidant properties that may help slow food spoilage, and anti-inflammatory properties in laboratory and agriculture models. And, in some preclinical studies, high doses of essential oils can kill cancer cells in culture in a laboratory setting. Does that mean they’ll do the same thing in humans? Not necessarily. See my post on turmeric.

Just for perspective, it’s pretty easy to kill cancer cells in culture in a laboratory setting. I once killed a dish by accidentally leaving the cells in phosphate buffered saline instead of growth media. Yes, salt water can kill cancer cells in culture. So can many drugs, but the majority of compounds with anti-cancer activity in cultured cancer cells and mouse models are not effective in human clinical trials. So, the jury is out on whether or not the active ingredients essential oils can help treat cancer. And inhaling the pleasing aromas produced by essential oils may effect mood, but it doesn’t do anything to thwart cancer growth, survival, or invasion.

These observations definitely warrant more laboratory investigation, but as of this post, there is no evidence that essential oils fights cancer when inhaled or ingested or delivered in any other way into the human body. Advertisements by scammers like the ones listed below are lies:

These are some of the top hits under a Google search for “treating cancer with essential oils.” As is my standard policy, I will not share links for woo woo. The misinformation and outright lies are not only infuriating, they can prove deadly for patients who skip standard therapies in favor of alternative “therapies.” The stats are heartbreaking. In a Yale School of Medicine study (link to original publication here*), “patients who used alternative medicine in place of standard evidence-based medicine had a death rate 2.5 times higher than patients who received standard evidenced-based therapies.”

Women with non-metastatic breast cancer who opted for alternative “medicine” were ~ 6 times more likely to die within 5 1/2 years compared to women who received standard of care therapy. This is a small study – 281 patients – and captures data from patients who disclosed their decision to follow alternatives versus standard of care. It doesn’t include patients who do not disclose or discuss this with their health care providers, so the numbers could actually be higher.

For more information on aromatherapy – separating fact from fiction – click here. Check out this article, too. Bottom line: much like cannabis, essential oils may offer relief from the side effects of standard of care treatments, but they cannot cure cancer nor should they be used as a substitute for standard of care. Complimentary alternative medicine is fine, as it compliments proven therapies, but not on their own.

*Access to this article is limited by a paywall. If you want to read it for yourself, hit me up and I’ll send the PDF.

Science Break! Cancer 101: How Normal Cells Become Transformed Into Cancer

Cancer has been with us since we became human, and probably before, since cancer isn’t common to our species. In a fundamental way, cancer is us. Cancer was once healthy tissue, starting out as a cell in your body fulfilling its function to keep the collective whole, you, functioning. This cell toed the line, divided when it was supposed to, stopped dividing when it was supposed to, differentiated and specialized to perform its function, and if it had remained normal, it might have died when told to do so after that function was fulfilled. Those are three of the hallmarks of cancer: uncontrolled cell division (cells making more cells), failure to respond to the normal programs that put the brakes on cell division, and failure to undergo programmed cell death (die when the time is right).

The process by which a normal cell becomes cancerous is called malignant transformation or carcinogenesis. This video provides an excellent overview of the process.

To understand how cancer forms, we need a basic framework for understanding cellular function and its regulation at the molecular level. Don’t get bogged down in the terms. Cellular function refers to how the cell does its programmed job, how it grows and divides, and how it dies, the same basic life cycle that the human host experiences. Regulation at the molecular level means the plan the cell follows, the blueprint for its growth, function, and death. It starts with DNA, the double helix genetic blueprint in all cells that contains the instructions for the cell’s functions and life plan.

Illustration of the Central Dogma of Molecular Biology – Nuclear DNA is transcribed to an intermediate, called RNA, which is then used as a template for translation into amino acid chains that form proteins. Illustration credit: Shutterstock.

So what does DNA actually do, or perhaps the better question, how does the information encoded in DNA actually instruct the cell what to do? This gets into something call the Central Dogma of Molecular Biology. That’s a fancy title for the way in which the instructions encoded in DNA are used to manufacture proteins, the work horses of cells. Now, when most people think about proteins, they envision a juicy piece of meat or powerful muscles, and the components used to build muscle fibers are proteins. But proteins are much more than that. They are the essential building blocks of cells, which in turn build tissues, organs, and all parts of the body. They can be structural, like the fibers that form the cell’s cytoskeleton and histone proteins that wrap around DNA strands and protect them. They can be functional, forming enzymes that do everything from metabolize nutrients, breaking them down into usable building blocks for building biomass and generating energy for the cell. They also play a critical role in transmitting information within cells and between cells, integrating communication between different parts of the body.

Proteins are made up of chains of amino acids, and the order in which they are put together is determined by the sequence of the portion of DNA that encodes that protein. That sequence is called a gene. But as a matter of practicality, since DNA is housed in a subcellular organelle called the nucleus and therefore inaccessible to the protein production machinery in the cytoplasm, and because the cell needs to protect the integrity of its DNA, proteins are not built using pieces of actual DNA. The portion of the DNA, the gene, that encodes instructions for making a specific protein, is first transcribed into an intermediate molecule, call messenger RNA. Transcriptional machinery within the nucleus unwinds and separates the DNA strands, using one strand to copy the information necessary to build a protein. The messenger RNA molecule is then transported out of the nucleus and used by the protein synthesis machinery to translate the information encoded by the mRNA to protein. That’s the Central Dogma: DNA transcribed to RNA, and RNA translated to protein.

The abnormal growth that is cancer is controlled by abnormal proteins that were once (supposed to be) normal proteins. Most of the proteins that drive cancer are proteins that regulate cellular division and cellular survival, and they fall into two basic categories: oncoproteins and tumor suppressors. Oncoproteins are hyperactive proteins that start out as normal proteins, encoded by normal genes, proto-oncogenes. They become oncogenes due to alterations in DNA: mutations that change the DNA sequence, which in turn changes the amino acid encoded and the function of the protein; DNA repair mistakes that cause multiple copies of genes (amplification) to produce too much of a protein that drives growth and survival; changes in DNA that make the gene more accessible, which in turn causes the cell to make more copies of the encoded protein. DNA damage that causes breaks, which can eliminate genes that normally keep cell growth controlled, can silence tumor suppressors.

Types of DNA damage – if damage is not repaired or is improperly repaired, alterations in DNA (e.g. mutations, deletions, amplifications) that encodes growth and/or survival genes can lead to malignant transformation of a normal cell into a cancer cell. Link to photo source.

What’s worse is that the longer the cancer grows unchecked, the more mutations and DNA changes it collects. Those alterations and mutations that give the cell an advantage (more growth, better survival, the ability to break away from the tumor mass and spread) make the cancer more aggressive and difficult to treat.

Cancer Formation and Abnormal Growth – Illustration credit: Deposit Photos.

In my next post, I’ll cover the process of malignant transformation of breast cells, which leads to breast cancer.

Science Break! Intro to Cancer

Cancer, from the Latin word for “crab,” and from the Greek word for crab, karkinos or carcinos, used by Hippocrates to describe tumors, has plagued humanity since antiquity, and probably before recorded history. The name make sense, since the swollen blood vessels that surround, infiltrate, and feed the tumor mass, reminded Hippocrates of the claws of a crab.

From Brantley et al. (2002) Oncogene 10;21(46):7011-26. PMID: 12370823

As you can see from the picture on the left, this is an understandable comparison. The tumor in the picture is of an invasive mouse breast cancer. It is large, chock-a-block full of blood vessels, and looks like a disorganized blob. Not very pretty, and definitely deadly. Those blood vessels feed the tumor at the expense of the host (i.e. the patient’s body) and can help tumor cells that break off from the primary mass to travel through the bloodstream and colonize other organs in a process called metastasis.

By National Cancer Institute,
Public Domain,
https://commons.wikimedia.org/
w/index.php?curid=1972023

But what is cancer? Where does it come from? Why is it so difficult to treat? Let’s start with the first question. According to Google, cancer is defined as “a disease caused by an uncontrolled division of abnormal cells in a part of the body.” Uncontrolled growth is a hallmark of cancer. Where does it come from? Cancer comes from the transformation of a normal cell, which works in harmony to fulfill its assigned function in the body, into a cell that abandons its normal function and growth constraints to divide (make copies of itself), displacing and destroying normal cells and tissue, hijacking resources (e.g. oxygen and nutrients delivered by blood vessels), and if untreated or undetected, spreading to other parts of the body and destroying normal cells in tissues outside of the site of origin. Why is it so difficult to treat? It’s complicated, but it relates to at least three inherent properties of cancer: (1) cancer comes from normal cells, which makes it difficult for the immune system to recognize it as a threat; (2) cancer cells are genetically unstable and prone to collecting mutations in DNA, the genetic blueprint that controls all cellular functions – see Figure on the left; and (3) because there are many genes that control normal cell growth, survival, and other processes exploited by cancer, each cancer is unique – cancer isn’t a single disease, even within the same tissue. There are at least 5 distinct types of breast cancer (and subtypes within those types), and each is as unique as the patient in which they grow. More on that in a future post.

Unlike infectious diseases caused by viruses and bacteria, pathogens that the immune system can recognize and defend against, cancer cells are seen by the immune system as “self” in many cases (more on anti-tumor immunity and immune checkpoint inhibitors on the market in a future post). Even worse, when immune cells do enter tumors, the tumors can adapt and send signals to immune cells instructing them to protect rather than destroy the tumor. The same genetic instability that enables mutations and changes that allow cancer cells to grow uncontrollably also allow cancer cells to adapt to attacks from the immune system and therapies including chemotherapy, molecularly targeted therapies (like estrogen and HER2 blockers in breast cancer). The rapidly growing tumor mass also tricks the surrounding tissue into sending new blood vessels to infiltrate and feed the tumor, allowing tumor cells to grow, survive, and invade to metastasize.

So, in a nutshell – normal cells + mutation(s) leading to uncontrolled growth + more mutations leading to transformation into malignant cells + more mutations + a blood supply + tricking the immune system = cancer. It’s more complicated than that, but this is a good starting point for understanding cancer.

Want more information? I’ll be posting a LOT more on this topic. In the meantime, here are some really amazing resources on the subject: The Emperor of All Maladies: A Biography of Cancer (Book by Siddhartha Mukherjee and PBS documentary); SciShow’s excellent video on YouTube; Cancer Research UK’s video overview. is also an excellent resource.