In today's episode, host, Laura Carfang speaks with breast cancer survivor Briana Rickertsen. Briana was diagnosed with invasive ductal carcinoma in July 2020 at age 35. She underwent chemotherapy, surgery, radiation, and additional treatments due to a HER2 positive tumor. Briana discovered she has a BRCA2 mutation, leading to further preventive measures, including ovary removal.
Pre-Diagnosis, Briana was an active person, engaging in activities like yoga, cycling, hiking, and running. During Treatment Briana used the Peloton app daily for mental health and physical activity, adapting her routine based on her energy levels and treatment schedule. Post-Treatment, Briana emphasizes the importance of movement in managing fatigue and overall well-being, advocating for small, consistent efforts.
Timestamps:
[00:03:23] Breast cancer diagnosis in 30s.
[00:09:44] Bone health and treatment decisions.
[00:11:45] Discussing fertility options during treatment.
[00:14:17] Genetic testing and surprises.
[00:19:01] Coping through daily exercise.
[00:23:41] Exercise in cancer treatment.
[00:25:18] The power of walking during treatment.
[00:29:15] Exercise dosing in cancer treatment.
[00:34:24] Strength training for beginners.
[00:38:06] Lymphedema and strength training.
[00:41:13] Weightlifting and health journey.
[00:45:03] Finding joy in exercise.
[00:45:53] Reframing approach to daily activities.
In today's episode, host, Laura Carfang speaks with breast cancer survivor Briana Rickertsen. Briana was diagnosed with invasive ductal carcinoma in July 2020 at age 35. She underwent chemotherapy, surgery, radiation, and additional treatments due to a HER2 positive tumor. Briana discovered she has a BRCA2 mutation, leading to further preventive measures, including ovary removal.
Pre-Diagnosis, Briana was an active person, engaging in activities like yoga, cycling, hiking, and running. During Treatment Briana used the Peloton app daily for mental health and physical activity, adapting her routine based on her energy levels and treatment schedule. Post-Treatment, Briana emphasizes the importance of movement in managing fatigue and overall well-being, advocating for small, consistent efforts.
Timestamps:
[00:03:23] Breast cancer diagnosis in 30s.
[00:09:44] Bone health and treatment decisions.
[00:11:45] Discussing fertility options during treatment.
[00:14:17] Genetic testing and surprises.
[00:19:01] Coping through daily exercise.
[00:23:41] Exercise in cancer treatment.
[00:25:18] The power of walking during treatment.
[00:29:15] Exercise dosing in cancer treatment.
[00:34:24] Strength training for beginners.
[00:38:06] Lymphedema and strength training.
[00:41:13] Weightlifting and health journey.
[00:45:03] Finding joy in exercise.
[00:45:53] Reframing approach to daily activities.
Brianna Rickertsen: Thanks so much for having me. It's been great to get to know you a little bit more as we've been chatting leading up to this too.
Laura Carfang: So why don't you give yourself like a brief introduction, let our listeners know maybe like the age at which you were diagnosed, the type of breast cancer that you had, and then any treatments and where you are today.
Brianna Rickertsen: Yeah, so I was diagnosed July 1 2020. And that was you know kind of right in that beginning part of the pandemic. I was 35. And, you know, originally, my cancer was. I can't even remember what stage I was at this point, I think 2A, but it was invasive ductal carcinoma, very hormone sensitive, HER2 negative, went through the hard hitting chemo, our good friend, the red devil, you know, taxol, the whole works for about five months. I had surgeries for, you know, having a mastectomy, having axillary dissection, I also have a BRCA2 mutation. And so my ovaries have also been kicked out of here. But during my mastectomy, they actually found surprise part of one of my small tumors had HER2 positive. So that was a big surprise. So that also kicked me into more treatment. So I spent about a year and a half at the infusion center. But I was also able to get extra treatment. So I ended up getting it done via Fezgo, so Herceptin and Progetta, but they were able to do it as an injection versus an infusion, which kind of at least helped mentally, being able to do that. And then I had radiation. As I tell people, I'm like, pretty much anything you can think of, almost everything, not everything, for treatment-wise, I feel like I've done it, done it all. And so, yes, had radiation, and then had, let's see, where did I go after that? I've had my final surgery and my final treatment then January 2022. So we're just over two years out from that. Was that reconstruction surgery that you had? It was, yep. So that was the final surgery I had was the kind of final reconstruction and piece of that. I started on an aromatase inhibitor in 2021. That would have been right after radiation. Then the latest and greatest is that my latest DEXA scan last year showed significant bone deterioration. I'm now on infusions for the bone part of it. I'm back in the infusion center with my favorite nurses. That's kind of the current treatment I'm on. But at this point, I'm just about four years out of diagnosis. And so right now, it's a lot of the managing of the ongoing effects from that. There was this one time I'll never forget. I was in the waiting room at the infusion center with my mom. And there was somebody who I still thought was young at the time. She was in, I think, her mid-40s. But she just stared at us and said, wait, you're here for treatment because of course I had like my head wrap on. She couldn't believe that I was there for treatment, kind of not my mom. And then she warned me about estrogen. She was sitting there and she's like, you need to know about estrogen. And I was like, I can't even think about that right now. I just need to get through my chemo treatments before. And then now, you know, four years later, I'm like, oh, I understand. I understand why, why you were warning me about estrogen and the lack of estrogen.
Laura Carfang: Yes. I feel like it's something that we don't talk a lot about. And like, I think when I, even sitting with my oncologist too, they're like, okay, you're hormonal positive. We're going to decrease your estrogen levels. It'll stop and hopefully delay any like progression or recurrence. But then you don't realize like how much your body actually needs estrogen and all of the side effects that happen when you don't have estrogen circulating through your body. So we can definitely talk about that too. And so just a couple of clarifying questions. So when you had reconstruction, did you opt for implants or did you do one of the flap surgeries, just out of curiosity?
Brianna Rickertsen: Yeah, so I really only had one option, according to my surgeon, and that was just implants. So no flap surgery for me. It was a tough decision, but I did decide to try reconstruction. Probably two weeks into my tissue expanders being in, I did really contemplate if I should have gone flat. But I also kind of, for me, I decided I wanted to try. and definitely helped remind me though that there is no one way to do any of this and there are so many options for that.
Laura Carfang: And then you were mentioning, you know, the effects that the aromatase inhibitors can have on you, especially around, you know, osteoporosis, osteopenia. And so I think understanding bone health is really important. So for those who are listening, it's always helpful to get like one of just like a baseline DEXA scan, right? To kind of see what your normal is and then monitoring that every so often, whether it's one year or every two years to kind of check on your bone health. So I too started off on an aromatase inhibitor. In fact, there's three different types of drugs in that class. And they all have the same but similar side effects, right? We all respond to them differently. And so I feel like I was the trifecta. I kept trying one until I found one that worked and ultimately ending up on letrozole. And then very similarly to what they prescribed, were you on Zometa now for the infusion?
Brianna Rickertsen: I am, yes.
Laura Carfang: Okay. So yes, that's the same thing I was onto to kind of help strengthen the bones. And now I've been on the aromatase inhibitor for about five years, and now they're putting me onto tamoxifen for the remaining two to five years as well. Again, kind of weighing the pros and cons, bone health, There's also side effects of tamoxifen. There's also predisposition to endometrial cancers and stomach lining, like all sorts of things. I mean, you just can't win. However, just trying to make the best decisions with the information we have at the time. So I feel you.
Brianna Rickertsen: Yeah, absolutely. Yeah. I remember during one of my chemo teach sessions, I had an amazing pharmacist. When he was going over the side effects of some of the chemos and then other treatments, and the side effect was cancer, I'm like, you've got to be kidding me, Joe. Oh, my side effect for cancer treatment is more cancer. I was like, wow, what is going on?
Laura Carfang: Oh, I know. And so you also had sounded like when you were giving your timeline of treatment that you had chemotherapy first, then surgery, and then more treatment after that, based on what you've found with her two positive. Okay. Yeah. Very similar. We're like very, very similar paths here as well. um, you know, with having the, what they call the neoadjuvant chemotherapy, which, you know, I, I think it's really interesting because when they have, when you get surgery after having neoadjuvant chemotherapy, they could really see if you've had a complete response or not to the drugs. And that really helps actually inform kind of the next steps and whether they're discovering the HER2, um, trait on your tumor cells Or in my case, I actually did not have a complete response to the treatment. So I was also given more chemotherapy after surgery as well. And so it was just like this long, like, yeah, 18 months, a year and a half of just like doctor's appointments, infusions, fatigue, dealing with the trauma of a breast cancer diagnosis, just trying to get through it all. So I appreciate you sharing all of those details.
Brianna Rickertsen: Absolutely. Yeah. Like I said, I'm an open book. Um, I guess the one part of my treatment I didn't mention, um, I did also go through a flash fertility round. Um, it was not successful, so I actually couldn't finish. Um, I needed to, it did not work, but we tried it, but that was another part that we threw in there.
Laura Carfang: And was that something that was discussed like with your doctor before starting treatment?
Brianna Rickertsen: I will say, um, my health system is the university of Colorado health system. And I feel honestly really fortunate because they have so many things set up for this. So, they had me connect with people in all different areas, including oncofertility pretty much right off the bat, which is great. And when you mentioned the DEXA scans, for example, you know, some things that I've gotten feedback on from others is that, you know, maybe their teams for various reasons may not recommend a baseline. For me, everyone is different and every, you know, I do trust that your doctors know your situation and everyone may be different, but it's also worth like, I love knowledge and having the questions to ask, because for me, that was something that's just been part of it. They baseline me
Laura Carfang: you know, one of the things that we actually have on our website, um, under our resources page are like questions to ask your doctors and they are sourced questions from our community members of like the things I wish I had known or asked, because if you haven't gone through cancer before, which we have not, like, how are we supposed to know what to ask? We don't know what we don't know. And so we put together a list of questions to ask your oncologist questions, ask your surgeon and questions to ask your radiologist oncologist. And then we took those questions and ran them by our medical advisory board, just to make sure, like, are there things that we're forgetting? Or as a doctor, like, what are things that we should be asking that we aren't? And so those have been, like, very successful and highly downloaded.
Brianna Rickertsen: Yeah, I can imagine. That's such a great resource and tool to have. And it is, you know, I think, you know, I will not say the proverb correctly at all, but there's that where it's like, to a hammer, everything's a nail in that realm. And that happens a lot during treatment. You have a team. I'm lucky that our team really works together, has multidisciplinary clinics, and they all talk. But that being said, your radiation oncologist is focused on radiation. Your medical oncologist is focused on your other treatment plans. Everyone has their own focus that is the priority for them, because that's what their expertise is in. Yeah, to get that tied all together and to understand for yourself as well. I love having those questions.
Laura Carfang: So you mentioned also that you did some genetic testing to find out that you were BRCA2 positive. Tell me a little bit about genetic testing. And then if in fact that how that has like kind of played out with any siblings that you might have or your family or parents or things like that, because, you know, genetic testing is one of those things where it's like personal to you, but it also affects everyone around you because their genes, right?
Brianna Rickertsen: Oh, yeah, it's it's interesting. And it we definitely went on a little bit of a journey, you know, once again, with being diagnosed young and then having the approach that UC Health does, I was introduced to a genetic counselor within those first weeks. So that was part of the plan, part of the discussion. I had a fantastic genetic counselor who talked with me on questions, really walked me through it. It was kind of for me a no brainer to get tested, getting diagnosed with, you know, pretty aggressive cancer. at 35, and we were a little surprised. I did have one of my aunts, who I'm very close with. She's my mom's sister, and she had had breast cancer a little bit older than I was when I got diagnosed, but it was really secondary cancer from treatments when she was younger, when she was a young teenager area. there was never concern throughout my life. Like I'd bring it up, but it was kind of like, no, that was that. So then when this came up, it was like, okay, well actually now we're going to look to see what that was. So we got tested and I got tested, I should say, and the genetic counselor, everyone was pretty darn certain based on history that it was going to come from my mom's side. It was a total surprise. We didn't find out. My mom ended up getting tested and it was not her. So we knew then that it kind of came from my dad's side and was kind of buried a bit because he has all brothers. So does my dad. Yeah. Also buried. Okay. Yeah. So buried underneath there. Um, but that being said, when we were kind of in that middle ground, like I've given all like, you know, my family really talked with my like aunts and uncles cousins as well, where it's like, here's what you need to know about me, but it's such a personal decision. So I will share my report. I will share all my information with any family member that wants it, but I also am not going to push anyone. Right or follow up with any it's really like I am here I'm open, but you do what you want to do, because there are absolutely people who would prefer not to know. I'm exactly about, you know, it's kind of like their let it kind of come in its course. I am an information person I want all the information I can I want all the data I have. That's how I make my decisions. You know, it's definitely been, I've had, I have had, you know, cousins on both sides get tested. I have had, you know, family that's decided that, you know, they do want to know more about it as well.
Laura Carfang: So I know we started off talking a little bit about, you know, the healthy lifestyle and exercise and movement that we're both involved in. Were you, tell me a little bit about like your exercise routine, maybe before your diagnosis and then during and now post, if you will.
Brianna Rickertsen: So, um, I, I'm like a, a relatively healthy person. Um, I'm married to somebody who has done triathlons for a living for a long time. So to him, like he's like in another world, I'm like a normal active person. That's how I say it. Um, but it, you know, movement has always been, you know, really important. Um, you know, whether it's, you know, yoga. Cycling, you know, hiking, running. um, you know, really have enjoyed everything. It's definitely a part of our, our lifestyle and what we do. Um, you know, I have a slightly dark sense of humor. Um, there's lots of jokes around this when I got diagnosed though, but I was, I started to laugh cause I'd go to doctor's appointments and they check everything out and they're like, Oh yeah, you're so healthy except for the cancer. So it kind of became like a tagline, like healthy except for the cancer. Um, because that kind of came up often and it, so, you know, it also shows you that you can do every, you know, You can do the right things and it is what it is. Um, so. You know, kind of the, the pandemic timeframe itself. Um, when the pandemic started in March, 2020, I hopped on the Peloton bandwagon. I Peloton offered free app access for like two months. I hopped on my husband, set my bike up on a trainer and I was riding with friends. Cause you know, really couldn't see people in person. So I would join friends before work, or after, during, like we'd kind of take, you know, I was able to, that was like a great way to connect. Yes. And then, you know, kind of moving into May, mental health wise, I was using the app every day starting in May of 2020, which is also when I started to notice something was off. But using the Peloton app kind of helped me just mentally do something for myself every day, whether it was a meditation, a walk, a run, bike ride, something in that realm. So When I got diagnosed, I decided that I wanted to keep that going. It was an important thing for me to take back a little bit of control when there was so much that was outside of my control. So I kind of decided, I'm going to keep this going. I'm going to use the app every day. And I would ask my doctors, any surgery, any treatment, anything I had, I was like, what exercise can I do? When can I do it? Can I walk? Can I cycle? Like, what can I do? So it was kind of like, I kind of communicated with my team and throughout communicating with my team, I also found out that a lot of my providers were familiar with either the app or they had the bike, they had something. So we could actually communicate sometimes and talk about, Oh, Hey, here is a ride. You know, yes, you can do low impact rides. Just don't spike your heart rate or, you know, no, you're totally good to go with. It was a way that we could actually communicate about types of movement.
Laura Carfang: How did you manage like the fatigue or any of the other side effects going through treatment?
Brianna Rickertsen: Yeah. So I definitely think movement played a huge part on, you know, being the day that you have the most energy is your day that you're actually getting your chemo. Right.
Laura Carfang: All the steroids, I was like cleaning the house, doing everything.
Brianna Rickertsen: It's like between the cycle of it and the steroids, one of the things I did is I had a treatment day group ride. So every morning before chemo, I would do, I picked a ride, I sent it out to a group of friends, family, and we, people would do it either at the time with me or they do it before or after, but it was great because every chemo I had people riding with me before I went in, which is also mentally extremely helpful because you kind of get to gear yourself up. You're like, I've got to go back in. There's a lot of this just kind of grit of an enduring during that time. So that was really great to have that to look forward to. So that would always be kind of the most probably intense ride I would do during treatment was kind of that day of chemo when I was feeling the best. And maybe the next couple of days as the steroids were in, I could do a little bit more. And then as you move into the chemo cycles, the ebbs and flows, I would move more towards walking. I really enjoyed, for example, in the Peloton app, they have these outdoor audio walks and runs. They're all based on the rate of perceived exertion, which during treatment, that's huge because somebody tells you to go a certain speed. You might not necessarily need to go that certain speed, but feeling what that feels for you Um, was great.
Laura Carfang: And so, you know, I would more similar to like, you know, 70% effort or 35% effort, like what that percentage is for you.
Brianna Rickertsen: Yeah. Like they, they guided on a RP scale of one to 10. And so they'll say, you know, like you had a three right now. So then whatever your three is for that day, it varies my phone. Yeah. I walked slower during chemo than I have ever. my phone actually recalibrated my steps. So it told me I was like walking a mile. And then when I actually started walking my regular route and speed, it was like eight tenths of a mile. So I thought I was going further than I was all through chemo. But I'm not taking that away from me. I was still happy with it. It was funny because it was I was slower.
Laura Carfang: Yeah, I was going through chemo for the first part during winter in Boston. And I just remember like my boyfriend at the time has been now you know, we would get bundled up, we would take walks, he was really supportive of like, let's get outside, let's get some fresh air. But there were days where I'm like, it took longer to like, literally get bundled up. And like, walk a block, feel exhausted, and just be like, I just don't have it in me, we got to turn back around. And it was like this, like 35 minute, like ordeal of just like, getting ready to go out and then feeling exhausted. And then there were other days where I was like, doing my five mile loop, no problem. And, you know, just having that, you know, opportunity to do more on the days that you feel well, and then having grace with yourself, just understanding like there's going to be days where you're tired and you have to honor how your body's responding.
Brianna Rickertsen: Yeah, absolutely. It's so much about listening to what it needs and knowing that like, it's okay to rest. It's encouraged to rest. Um, and also sometimes challenging yourself just a little bit because it is counterintuitive that, you know, One of the best ways to combat fatigue is movement, but too much movement will create fatigue. So that is a weird place to be and finding that kind of that sweet spot, it's not second nature always. So it's a little bit of like, try it, you know, try five minutes. Does five minutes make you feel better or worse? And then, you know, kind of it kind of gauge like if you know to be able to, you know, continue and yeah take advantage of those days where you're feeling a little better to do a little more. I think it's a great rule of thumb.
Laura Carfang: And I'm noticing also so many oncologists now are engaging in various clinical trials and studies to understand the amount of energy, sorry, the amount of exercise to help those who've been diagnosed with breast cancer or cancer in general to really take a look at what type of movement classes, what type of cardio, what type of strength training, especially for bone health in us women. it's really great to kind of see these trials happening so that way we can get actual concrete evidence-based research on knowing then what we can be doing. And so this kind of leads me into your project. I wanted to ask you, I know that your Instagram handle, the nifty150 is kind of how you were able to connect with us at survivingbreastcancer.org. So tell me a little bit about how and when you started this. Was this something you started before your diagnosis or afterwards or during?
Brianna Rickertsen: Yeah, it was started afterwards. I mean, it was very important for me to movement throughout. And as I kind of neared, I think it was when I probably a year in, I was finishing radiation and I was really feeling like I would like to connect with, ideally I wanted other people to have the ability to have access to the Peloton app, for example. Part of the reason I'm so fond of the Peloton app is because of the walking content. I really haven't found walking content that remotely matches that. And I just feel like walking is this very underrated tool that can be used for movement during treatment in particular. And so having kind of guided walks is honestly one of the main reasons that I really like that app. And the ability to also work out with people no matter where they're located. But walking is honestly like the key thing. So I kind of started about a year into treatment, reaching out to Peloton directly to try to see if I could get anything, you know, hey, are you, could you have an, I asked, you know, if they could have an oncologist on their advisory board, because they do have some various advisory boards with some medical professionals that work primarily in the cardio space or the OBGYN space. So I'd kind of started asking, you know, here are some ideas, because honestly, I was still a little close to diagnosis that it was a lot to, I was like, I'm just going to try to see if someone else can Yeah, would like to do this. And after a year of kind of getting some like hey that's a good idea but we're going to send it here hey thanks for reaching out or just no response at all. I just couldn't quite let go of the idea I was like there's just there's something. want to kind of test it out, want to see if I can at least help support others. And so in 2023, I kicked off the Nifty 150 project, which really has a couple goals. You know, one of the main goals is honestly just providing more awareness and ideally accessibility to be able to first off know that movement and exercise is not only encouraged, it's now absolutely recommended and part of the studies that have been going on. absolutely recommend it, which we can talk a little bit more about. Also provide some insight into how you can use Peloton, and I mean honestly, I never, I work in small business lending, I love small businesses, never in a million years did I think that I would be spending time trying to like promote a corporation for free. But here I am. But it's just because I feel so strongly about the content it has that I just, you know, want people to be able, I really want Peloton app access to be provided at diagnosis and at survivorship for at least like a year, just to be able to have that option.
Laura Carfang: And you used it, like you're the testament, right? Like this worked for you and it really helped you. So why wouldn't you want to share that message widely?
Brianna Rickertsen: It is. And I'm very aware that what works for one person doesn't work for everyone. Totally aware of that. I have also talked and been in touch with so many people that it has worked for as well. And it's a tool. And it's not the end all be all. And if you have something else that works for you that's not Peloton, fantastic. If this reminds you, if you see a post and you're like, oh, I do want to go for a walk today. you have your audio book to walk to, fantastic. Like I try, you know, all of that. It's all great and encouraged. And so one of the pieces I do with the Nifty 150 is I do recommend 150 minutes of workouts a week on the Peloton app. So that way, and I link it so people could easily access and just click on some links, add it to their Peloton app stack and have 150 minutes should that's what they want to do. But really the goal too is just to have a little bit more of that like reminder and encouragement and ultimately visibility as well within Peloton and other groups to hopefully be able to recognize this is a really big opportunity to be able to help reach cancer survivors, you know, at diagnosis and again at survivorship, your needs just vary throughout the time. And I get, you know, on one hand, it seems like such a simple concept, like there are like hundreds, hundreds of studies that support exercise and movement during and after treatment. And, you know, for me, I mean, in the simplest way, it, it frustrates me that like, there's so much money spent on drugs. And exercise is such a component that can help with not only side effects, but it can actually help your response to the drugs. Like there are It's just like the benefits are numerous for it. And the cost in theory should be minimal to what's spent on the other parts of our treatment. But it is so hard to get all of these things to tie together and to work and to implement.
Laura Carfang: Amazing. I don't know if you follow Dr. Neil Iyengar. He's out. Yes, I sure do. Oh, you got, okay. Yeah. He is a dear friend as well for surviving breastcancer.org. And we work with him running some of his clinical trials, you know, some of his scientist friends for some of the drugs that he's working on, but he's actually doing a study recently too on trying to find out what that right dose of exercise is. Yes. So as we talk a lot about, you know, what is that right dose of chemotherapy? Is it always the maximum? Like if you're 250 pounds and, you know, I'm 140, like, do I need the same amount as you do, et cetera. And so he presented not too long ago at an infinite strength conference I was attending in Connecticut talking about the, the, the dosing, I guess, of exercise. Right. And so is it one 50, is it, you know, what are the different dimensions, um, specifically whether you're living with metastatic disease or your early stage and kind of what those goals are. So that's the study I am following quite closely, but I'm sure you have other examples too. Yeah.
Brianna Rickertsen: I've listened to him talk about that. And it's so fascinating. I mean, to be able to like agree, you know, no, Hey, this is what we, want to see. We know exercise is there, but then taking it down into these levels of the types of movement, the intensity, the number of minutes, like there are so many pieces. And once again, these are all studies and they are so great, but everyone also is different. So, you know, just because if you would work out 148 minutes and not 150, it's okay. There are definitely, and there's various studies, you know, some of them are smaller, And some of them are larger. Some of them are meta-analysis, looking at multiple studies. There's so many different things out there. And you can also usually find a study to support what you want. But there are absolutely studies that are showing things, for example, on chemo response. That's another one that's funded by BCRF that they've been looking at combining both exercise and nutrition. But that study showed that able to impact positively the response to chemo. That's crazy to me. I mean, not crazy because I mean, I would believe that would happen, but to be able to show that and to be able to show exercise and this dietary component together can really help you have a better response to chemo.
Laura Carfang: Like, yeah, let's do it. And I'm not a scientist by any means, but you know, I do feel like sometimes cancer gives us that like deep dive into like biology one-on-one and understanding like metabolic health and all of the like gears that are turning in your body at the molecular level is quite phenomenal. And then how that can kind of strengthen the, um, the chemotherapy that we're receiving.
Brianna Rickertsen: Absolutely. Which also brings me back to my monetary component. Chemo's freaking expensive. Like let's have like a $10 app option that can be covered by insurance that can then go alongside of your chemo. Chemo's like, you know, 10, 20, 30 plus grand per time. $10 like I just I'm like I don't know but that's my idealistic like simplistic view of like oh my goodness let's do this please. Some of the other studies that I know and I actually will be sharing some of the 2024 studies on the NFTY 150. I actually just did kind of some put some of the highlights together for some of the studies that have come out this year but there are some ones like that show walking, for example, and looking at the different intensity of walking. So when you don't, like, for example, and this study was done for breast cancer, breast cancer in particular, but it was shown that if you walk at a low intensity level, That can still help your fatigue, it may need to be a little bit longer overall throughout the week, but low intensity can still get you those you know benefits for fatigue versus, you know, moderate or vigorous for example like, you know, so looking at that being able to really show, um, you know, looking The exercise snacks may have heard of that I feel like that came highlighted this year a bit as well but for people who maybe aren't aren't active or able to be as active, you know, doing five minutes, two minutes of the sort of like bursts of activity have really large impacts, if that's the main thing that you're doing, for example. You know, of course, bone health is huge. And, you know, kind of tied to the cancer, you know, population that we're in, but kind of on the side of it adjacent with our menopausal friends and myself. And I'm 39, menopause at, you know, 36, I think. But I've been learning so much about the menopause piece and trying to understand those studies there. It's tougher in that space a bit when you're looking at menopause and then also cancer survivors with menopause, like there is, you know, you kind of have to take a little bit of it both. And I'm no, I'm not a doctor. But I think, you know, there's maybe more that can be done in that space. But really looking at that part of it and the strength that's recommended, it's actually recommended that you do strength three times a week, which seems so daunting if you do not do strength regularly. And that's, you know, one of my goals And I know from my, my small space but hopefully you know impactful is like just to help people just even get started with like five minutes of strength, one time a week, because you know it's just it's starting it's starting in these increments, it's finding things you enjoy to keep you going. Because if you start with something and it's not your thing. it, it's going to be harder to stick, but when you can really, like I've now it's taken me four years, but I have now love strength and prioritize strength, but I had to start low. I had to start slow. I had to find the types of classes that, you know, I was comfortable with. Um, and now I love it, you know, like now I'm like, I used, I would never have done a 45 minute strength class in the past. That'd be so daunting to me. And now they're one of my favorites to do.
Laura Carfang: And do you do those through the Peloton app?
Brianna Rickertsen: I do.
Laura Carfang: You do. Okay. Awesome. So I also fell into the COVID Peloton trend. I got the Peloton and I got a golden retriever. I got a puppy because I was like, you know, it's, it's COVID. This is my rainy day fund and we're spending it. So I love, and I agree that like, it's just been nice to have something that you can do it in the comfort of your own home and that they have different timelines. Right. So like, if I only have five minutes to do something, you can sort by duration and choose something that's shorter or longer, depending on how much time you have. So when you're talking about strength, just to clarify, like strength training, is that still part of the one 50, like one 50 could be cardio or strength training or does it, is it separate?
Brianna Rickertsen: So how I approach it and keep in mind like i'm not it's not like the scientific exact way, but when I look at 150 I do include strength classes within the hundred 50 minutes part of the reason for that is the recommendation. for survivors during treatment, after treatment, is 150 minutes plus of moderate activity or 75 minutes plus of vigorous activity. So when I'm recommending 150 minutes a week in the classes, it's kind of a mix of classes. So there's going to be some maybe HIT classes, runs, walks. You can all, if it's a run, you can always walk it. If it's a walk, you can run it. There's no rules. But, you know, within that 150 minutes that I'm recommending, I do make a general assumption that some of it is actually done at a vigorous activity. And because it is important to try to start to get, you know, start to move towards two times of strength a week, I always include at least two strength classes within that 150.
Laura Carfang: So. That's great. Thank you for that explanation. And did you mention also during your treatment that you had auxiliary node dissection?
Brianna Rickertsen: I sure did.
Laura Carfang: You sure did. So can you talk to me a little bit about how that plays into some of the strength training? Because again, because you're more I'm talking with you, I realized that we're more like cancer twins, too. I also had surgery and have developed lymphedema as something that, you know, I feel like we were either managing to prevent or you get and you continue to manage. So either way, you're managing potential lymphedema. And so I know that's something that I've been like wearing specific compression sleeves, seeing a lymphatic therapist for lymphatic massage, draining, etc. And I want to also kind of demystify the idea of like, oh, I, I'm scared to lift weights or I'm scared to do something because it might trigger or flare up my lymphedema. Whereas there are very safe and effective ways of still being able to incorporate that. So have you noticed, like, how has that impacted your life?
Brianna Rickertsen: Yeah. So I'm looking around because I'm actually trying to see if I can reach my lymphedema sleep. It's sitting on the Peloton, but I can't reach it. It's like right to my left. So Lymphedema scared the crap out of me when I first learned about it. But all the examples that were given were like, you can't wash 100 dishes at church. And I was like, what a interesting example. Now, I did use it to my advantage when I didn't want to weed initially, like weed the garden. I was like, oh, I'm sorry, lymphedema. I can't weed. That's a repetitive motion. Nope, can't do that. So I tried to get away from that for a while. But I had, you know, great physical therapist, focused in lymphedema. She fitted me for a sleeve, went through physical therapy multiple times throughout treatment because of these various surgeries, radiation, and other pieces. And so, you know, we really, you know, paid attention to it. Now, technically, she diagnosed me with stage zero. and I have like a machine that does like kind of that lymphatic, it looks like an elephant trunk. Yes. Yes. So I do have one of those machines. I don't use it as much as I should, but it's at my house. And what I do do is find the best ways to use my sleeve. So I do use my sleeve for more intense workouts, for lifting. I personally use it for long haul flights, but it is all based on my conversations with my situation and, you know, my physical therapist there. And when it comes to weightlifting, there are definitely studies that are out there that show it is safe. It is safe to do. And it's really Now, anyone who listens to this, talk to your physical therapist, talk to your doctor, do not listen to me, but you can listen to the questions I have. When you progress slow and you're working on that way, that you can definitely work up and there should be no limits to what you do as you're working up. Now, when you take a break or you have another surgery or anything happens, you do need to back off and start again. you know you might not need to go down to the beginning, but there are rules of thumb, and there are many people may be familiar with Helen Beely, she's a physical therapist based out of Australia that shared a lot about strength training over the last four years or so. Helen has taken a break from social media for the time being, but she has so many good resources and I share those as well on some of the lymphedema in particular because she is a physical therapist that is aware in these areas. But I find it really interesting to be able to kind of know, you know, the general rules, you kind of start low, progress. And then when you do take a break, you do have to come back a little bit, progress again. And that's been, you know, I kind of thought maybe I'll never do a pushup again, which I honestly didn't mind because I do not like pushups. And those are still really tough for me to do. But weightlifting, it's like, you know, I am at the point where I am buying new dumbbells every two or three months right now, which is really exciting to be able to, you know, and I'm not, you know, people say like that you should lift heavy, heavy means different things to different people, you build up my heavy is different than other people's heavy right now, but it is heavier than I've ever lifted.
Laura Carfang: very interestingly, and people who listen to my podcast may know this about me already, but I used to be an avid yogi before my diagnosis. And I was also a strict vegan before my diagnosis. So as you were saying, like, you know, kind of that, oh, you're super healthy, except for the cancer. I was like, you know, people are like, Oh, like you should eat more mushrooms or more cow. I was like, I was a freaking vegan and I still got cancer. So it doesn't actually matter, you know? And, and since then I follow more of a pescatarian diet now. Um, but I also used to do yoga all the time. And after my diagnosis, yoga became incredibly, incredibly triggering for me. I couldn't do the Chaturanga pushups anymore. I was so stiff in my upper body. I like lost, like it was. It was very angering for me, especially in some of these yoga classes where everyone's wearing like cute little like Lululemon bralettes and everything. And I'm like going through breast surgery, not looking cute. So it was very hard for me. But I'm very excited to share that I just started going back to yoga last week. Congratulations, thank you and Megan who you were conversing with earlier on our team is did her yoga teacher training so she's also very proud of me as well, but it's one of those things where it's like it's okay to find different activities. After a diagnosis right and so during this time, like I picked up tennis, just to like try a new activity I was never a tennis player but like, why not take a private lesson here and there or play with some friends just hitting the ball back and forth and getting into swimming because I know that even though it's a repetitive motion that resistance of the water really helped. kind of move and pump the lymphedema and lymphatic fluid in your arms as well. So trying to find like other activities, so it's not like all or nothing. But then I'm also very excited to kind of get back into yoga and remind myself how much I loved and enjoyed and appreciated that type of practice.
Brianna Rickertsen: And it's harder to do than you think sometimes, but like you don't have to follow the rules. Like you don't have to, if somebody tells you to do a chaturanga, you do not have to do a chaturanga. Now, if you want to and you're not able to, that can be really frustrating and I understand that. But it's also okay if somebody tells you to do a motion. Like, it's okay to not do it. It's okay to do things body weight. You know, it is one thing I, you know, I will mention about the app that I have enjoyed too, is for strength For example, you can search by, you can see the class breakdown so it'll tell you what is being done. So if you look at the class and you see there's a whole bunch of push-ups and that's not what you can do, don't do that class. You can see other classes and you can tell the movements and the plan and that can also help maybe set you up to prepare for, oh I can do those motions.
Laura Carfang: Great. I really enjoyed this conversation, kind of just chatting about exercise in general and overlaying that with a cancer diagnosis. So I appreciate your personal experience, your knowledge, the research and studies that you're sharing through your Instagram account. Um, so people can find you at the nifty one 50 on Instagram. Is that the best place to like connect with you on?
Brianna Rickertsen: That's the best place.
Laura Carfang: Any final thoughts or nuggets that we haven't talked about yet that you want to share with our listeners? Or what's next in your world of exercise and survivorship?
Brianna Rickertsen: Honestly, just enjoying that movement and hopefully helping to be an encouragement to others. And I think we touched on this, but I think maybe one of the final thoughts I'll leave is just that I say it, but I really do mean it. There are no rules. You know, it's, you have these studies and it's great support for what we do, but also like there's, you don't have to follow a box. It's really finding what is enjoyment for you, what you can do, like what you can do today may not be what you're able to do in a month. That's okay for the person next to you. It's just, there are so many right ways to do something. And it's just finding what is the best for you. And ideally the best you can not comparing yourself to anyone else.
Laura Carfang: I'm so glad you said that because I feel like that's giving us and all of our listeners like permission to like not follow the rules, to modify, to find something that works for us. And sometimes we just need to hear someone say, it's okay to break the rules. It's okay to be like, don't compare yourself to the person next to you, et cetera. So thank you for sharing that. what is it that we can do to find joy in our world? So finding those nuggets of joy, those moments, you know, I find it very hard. I am like a workaholic. I work all the time, but like, I have these like, quote, unquote, like mini vacations. I'm like, maybe just 20 minutes where I'm on vacation mentally, because, you know, I just need these times. And then lastly is, you know, it's not that I have to work out, but that I get to work out, that I get to move my body, that I get to go outside in nature, that I get to walk around the block. Um, and so kind of reframing how we approach these, these activities. Yeah, I love it. I think that's great. Amazing. Well, thank you so much for taking the time to share your story, be a guest on breast cancer conversations, and I hope we can continue the conversation. I'd love to have you back and keep us posted on all of the studies that you're following.
Brianna Rickertsen: Absolutely. So great to talk with you today and I love everything that you're doing and how you're supporting so many survivors out there.
Laura Carfang: Thank you. Thank you so much. And thank you everyone for listening to our show. I would like to acknowledge that all of the information on our podcast are from personal experiences and are not a substitute for professional medical advice. You should always contact your medical care team. If you're looking for specific topics or would like to be a guest on our show, please feel free to reach out to me. My email is Laura at surviving breastcancer.org until next time, keep on thriving.