238: Raising Awareness on Cancer Survivorship with Dr. Amy Herman Comander and Dr. Simran Malhotra

[00:00:00] Dr. Amy Comander: I'm seeing my patients, they've been through months of chemo, radiation, they're maybe now taking Tamoxifen, and I'm like, see you in six months. And to a patient that's who's been through so much, so many intensive medical visits to say, I don't need to come back for six months. It's very disconcerting and as the oncologist, well you don't really have to come here. And I feel like survivorship care, there's such an opportunity, we can do such a better job. 

[00:00:28] Dr. Simran Malhotra: Take a journal and just whatever thought is coming. It's almost like a brain dump before you go to bed, and then taking some deep cleansing breaths after that can really help calm the mind down so that you can start to fall asleep.

[00:00:43] Maya Acosta: You have more power over your health and what you've been told. This is the Healthy Lifestyle Solutions podcast. I'm Maya Acosta and I'm passionate about finding healthy lifestyle solutions to support optimal human health. If you're willing to go with me together, we can discover how simple lifestyle choices can help improve our quality of life and increase longevity in a big way.

[00:01:07] Maya Acosta: Let's get started. So, friends, we continue to talk about Breast Cancer Awareness in the month of October. Now, this episode that you are going to listen to today is with Dr. Amy Comander and Dr. Simran Malhotra, and I aired it in June. They came on the show to talk about cancer survivorship, and I thought, you know, maybe a lot of you didn't listen to that episode.

[00:01:35] Maya Acosta: I have a lot of new listeners, a lot of new subscribers. I thought it'd be great to re-air it again so that you can become familiar with what support looks like once a breast cancer survivor is in remission. And so Dr. Amy Comander, who is both doctors, Dr. Amy Comander, and Dr. Simran are both boarded in lifestyle medicine.

[00:01:57] Maya Acosta: They're both part of the Women's Health Interest Group for the American College of Lifestyle Medicine, and Dr. Comander, basically, she's an oncologist who also partnered with Dr. Michelle Tollefson, who happens to also be a breast cancer survivor and Dr. Beth Frates to create a program that offers support for the patient after all of her treatments.

[00:02:21] Maya Acosta: And I'm just gonna kind of explain that real quickly. In this episode, we talk about from the time of screening, what does that look like when a patient is screened? When she's diagnosed, and then when she goes to her treatments, and many times she'll have a team of specialists. All sorts of doctors that are going to work with her during the treatments to fight this cancer.

[00:02:44] Maya Acosta: If the patient goes into remission and she's sent home to live the rest of her life, a lot of times she is left feeling overwhelmed without any support like she had during her treatments. So Dr. Comander, like I said, along with Dr. Beth Frates and Dr. Michelle Tollefson, they launched PAVING the Path to Wellness.

[00:03:05] Maya Acosta: This is a lifestyle medicine-based program for breast cancer survivors that continues to offer that support that a lot of our patients need. And then Dr. Simran Malhotra, who you just recently heard her beautiful story of being diagnosed with BRCA1, the gene mutation. She talks about how she also supports women who are at high risk.

[00:03:29] Maya Acosta: So I thought it would be really nice to re-air this episode for a lot of you who are new to my podcast, you might be new listeners just started subscribing or didn't know that I aired this episode. Along with that in the show notes, I'm going to link an episode to Dr. Michelle Tollefson, where she shares her story of surviving breast cancer and how she also supports women in health. And so my friends, I hope that you enjoy this episode. Please share it with one remarkable woman who could really benefit from this. All the notes and the full bio to all of my guests can be found on the website healthy lifestyle solutions.org. And stay tuned. Next week, I'm bringing you Dr. Rizwan Bukhari who will speak about soy and whether we should stay away from it or not. Thank you again. During the month of June, we celebrate the nearly 17 million Americans who have bravely and successfully battled cancer to earn the designation survivor. Whether someone is still undergoing treatment or has long since won their battle against cancer, June is an opportunity to celebrate all cancer survivors.

[00:04:40] Maya Acosta: Nationally recognized as Cancer Survivor Month. June is an opportunity for all 16.9 million cancer survivors across the country to celebrate their milestones and to recognize those who have supported them along the way. It is also an opportunity for those who have not been affected by cancer to learn and understand the challenges that a company survivorship this year, whether a survivor or not.

[00:05:04] Maya Acosta: There are many opportunities to embrace National Cancer Survivor Month. Dr. Amy Herman Comander is a breast oncologist at the Massachusetts General Hospital Cancer Center. She's the director of the breast oncology and survivorship that at Mass General Cancer Center in Waltham in Newton. Wellesley Hospital and medical director of the Mass General Cancer Center in Welcome she is, She's on the board of Ellie Fund, which provides support to women with breast cancer in Massachusetts.

[00:05:37] Maya Acosta: She has a passion for improving the quality of life and outcome of cancer survivors through lifestyle interventions, including exercise, diet, and mind-body strategies. In collaboration with Dr. Beth Frates and Dr. Michelle Tollefson, she has launched, PAVING the Path to Wellness, a lifestyle medicine-based program for breast cancer survivors.

[00:06:00] Maya Acosta: Recently, Dr. Comander, Dr. Beth Frates, and Dr. Michelle Tollefson have published PAVING the Path to Wellness Workbook. Dr. Simran Malhotra is a triple board-certified physician in internal medicine, hospice, and palliative care in Lifestyle medicine. She's a member of the ACLM's Women's Health Member Interest Group, and serves as the co-chair of the Breast Cancer Subcommittee alongside Dr.

[00:06:26] Maya Acosta: Amy Comander. A BRAC1 previvor with a strong family history of breast and female reproductive cancers. She underwent a risk-reducing bilateral mastectomy and total hysterectomy in 2020 outside of her palliative care practice. She recently started Coach Simran MD, a platform she uses to empower, educate, and guide women.

[00:06:49] Maya Acosta: Particularly at a high risk for cancer with or without genetic mutations and a powerful impact that positive lifestyle changes can have on their quality of life and even longevity. Let's welcome both Dr. Amy Comander and Dr. Simran Malhotra. Let's start with defining what Cancer Survivor is. Um, uh, Dr. Comander, how do you feel about this term?

[00:07:13] Dr. Amy Comander: First of all, I just wanna thank you for inviting both of us to be guests on your podcast, um, to address this really important topic. We're really so honored to be here and bring awareness to Cancer Survivor Month. So you ask a really important question as we launch our discussion.

[00:07:31] Dr. Amy Comander: How does one define the term Cancer survivor? And actually, the National Cancer Institute has provided us with a definition and an individual is considered a cancer survivor from the time of diagnosis through the balance of his or her life. , every survivorship experience is unique and these individuals face different types of challenges along the way.

[00:07:58] Dr. Amy Comander: I do just wanna acknowledge that some individuals do find it difficult to use that term survivor. Um, for example, um, Thankfully, due to so many great advances we have in cancer treatment, many individuals who do have advanced cancer or who are living with cancer, thankfully, are living for many years. So they may not identify as much with the word survivor.

[00:08:26] Dr. Amy Comander: Maybe we refer, refer to them as living with cancer. Another term that's being used more commonly is Metvivor or Thriver. So I think all of these terms should be part of the discussion cuz some individuals don't completely identify with the term survivor. But regardless, I'm so grateful that the month of June is an opportunity to celebrate all of these individuals and the challenges they faced.

[00:08:51] Maya Acosta: Thank you for clarifying that because some people can, uh, feel offended with some, the use of some terms. But for us, the rest of us who perhaps have never have never gone through this, um, cancer diagnosis and treatment, it's important to understand how we can be sensitive to loved ones who perhaps have undergone this or are facing a cancer’s, uh, fear. Um, why is it important, Dr. Malhotra, to have the month of June as a time for us to acknowledge survivors?

[00:09:21] Dr. Simran Malhotra: I think that's a great question. Um, you know, I'm a palliative care physician, um, and a daughter of a two-time breast cancer survivors, so, I've seen cancer up close and personal, as has Amy. Um, and so I'm sure we can tell you tons of stories of what our patients go through when they're dealing with a cancer diagnosis and treatment.

[00:09:42] Dr. Simran Malhotra: Um, so I just think it's amazing that we even have a month to celebrate millions of people, not just in this country, but also you know, the people in the rest of the world that have gone through a cancer diagnosis, come on the other side, or like Amy said, are just chronically living with cancer. Um, and, and, and not only do I think we should give them recognition during this month, but I think we should recognize their caregivers, um, because cancer doesn't just affect a person, it affects.

[00:10:10] Dr. Simran Malhotra: The whole family and their whole tribe. Um, and it really takes a village. I'm sure Amy will also mention that, that it takes a whole village to really care for someone that's going through, um, a diagnosis of cancer. Um, like you said, I, I think it's a time to bring awareness to, um, what living with a diagnosis of cancer looks like.

[00:10:30] Dr. Simran Malhotra: Um, but when most people think about cancer, they think about chemo, they think about radiation, they think about. Uh, surgery, that's kind of like the face of cancer, but what a lot of people don't know about and don't witness and don't see is what you mentioned is what does survivorship look like? And it carries its own unique struggles and, and challenges.

[00:10:51] Dr. Simran Malhotra: And so I think this is a great month to, to talk about, um, some of those things. And, and one of the ways to do that in my personal way is really to lift up some of these Cancer survivors and to, to share their stories out into the world because stories are, you know, the way that we all connect and, um, what I've learned through my personal experience is, you know, when you share.

[00:11:17] Dr. Simran Malhotra: Words or a distinction or a piece of your story, you just don't know who's listening on the other side and you don't know how you might have just changed the trajectory of their life. You know, they might go talk to their doctor about something that's been bothering them. They might go get that screening mammogram or screening colonoscopy. Um, and without even knowing it, like here, you've changed someone's entire life. Um, so I think stories are just so empowering and this is the month, um, to, to really share those stories.

[00:11:46] Maya Acosta: That's a very good point I think of how brave, uh, the individuals are when they come on the podcast or when they, you know, speak in public or share their story.

[00:11:57] Maya Acosta: And in any platform really, it takes a lot of courage and vulnerability to be open and to say, This is where I am, this is what I've went through, Uh, which can sometimes feel like a rollercoaster ride. And I've wondered, I wonder. If each, either of you doctors could answer this. I've of often wonder if survivors live with a sense of, you know, maybe perhaps some anxiety or depression of feeling, you know, like, why did this happen to me? Some sort of emotion that continues to sort of affect them, and perhaps that is why support and acknowledgement is also important for them.

[00:12:35] Dr. Amy Comander: Yeah, I'm happy to address that first, and I welcome Simran thoughts as well, but, Um, first of all, Simran, I love everything you said and certainly agree a hundred percent that we should acknowledge the caregivers and the family and the support system for these individuals.

[00:12:50] Dr. Amy Comander: And they should be recognized as well since, um, they're all key to supporting individuals as they go through cancer treatment in survivorship. Um, in terms of your question, Maya, you're absolutely right. Um, unfortunately our patient population, you know, I'm a breast oncologist, but I also care for other individuals with other diagnoses of cancer and, um, various kinds of psychological distress are unfortunately very common after a cancer diagnosis, whether that's anxiety, depression, insomnia, um, fear of recurrence, which is way up there.

[00:13:24] Dr. Amy Comander: These are all issues that our patients, unfortunately commonly experienced. And so it's very important for us. As you know, I'm an oncologist. Um, you know, Dr. Maholtra is a palliative care physician, but also coaches many, um, cancer survivors. And just really thinking about how can we support them, provide that, um, key support, whether that's through mind body interventions, cognitive behavioral therapy, all kinds of intervention to help, um, individuals cope with the uncertainty and stress of a cancer diagnosis.

[00:13:56] Maya Acosta: Uh, Dr. Malhotra, I was just thinking, and I, forgive me if I mispronounce your last name. I did mention I in your bio that you were a previvor. Can you, uh, tell us a little bit about your own story, because I'm thinking that as you probably would fall into that category of survivor, or how different is it for someone like yourself who the issue immediately, um, as a, because it was that genetic component in your family history as opposed to someone who, um, went through the treatments, diagnosis, and then treatments. 

[00:14:29] Dr. Simran Malhotra:  Um, so I'll, I might have to come back another time to share like the full on story, but I'll give you the Reader's Digest version. Um, but essentially when I was 13, my mom was diagnosed with, uh, breast cancer. She was 33 at the time. Um, and that was like over 20 years ago. And since then we have uncovered several women. I'm South Asian, um, by background, and so a lot of talking about cancer and death and things like that are very taboo. Um, but over the years we've uncovered many women who have had either breast or ovarian cancer in her family.

[00:15:02] Dr. Simran Malhotra: Um, and so when I was pursuing my medical training, um, you know, I, I spoke with some of my colleagues and they really encouraged me to tell my mom to get genetic testing again, even though she had gotten it over 20 years ago at the time of her diagnosis and it was negative. Um, so. About seven or eight years ago, um, maybe a little bit more than that now, but she got genetic testing again.

[00:15:23] Dr. Simran Malhotra: Um, and this time was found to have, uh, the be say, one or BRCA1 genetic mutation. Um, and basically, you know, that's the Angelina Jolie mutation for people that don't know, but it radically increases your lifetime risk of, um, breast cancer by, I think over 80% as well as ovarian cancer by up to like 40 to 50%.

[00:15:45] Dr. Simran Malhotra: So, Essentially, um, fast forward to 2020. Um, after years of surveillance, having my kids back to back nursing, you know, kind of closing up that chapter as fast as I could. Um, at the recommendations of my oncologist, I, um, ended up pursuing a bilateral. A preventative bilateral double mastectomy. Um, I chose not to have reconstruction, so I had flat closure, um, along with a total hysterectomy, um, at the age of 32.

[00:16:16] Dr. Simran Malhotra: Um, so now I'm, I'm on hormone replacement. I'm, I'm, uh, almost, um, two years outta surgery. Um, and that, you know, previvorship is, is very similar, um, in some ways to sh survivorship. Um, there's a. Unique challenges that you just don't know what you're going to face, um, after surgery. And, um, you kind of hope for the best.

[00:16:40] Dr. Simran Malhotra: And, and so I'm going through some of those things now and, uh, so some of the things that you're talking about, this fear and this anxiety, um, comes up for me personally and it brings me back to the story and, um, trying to find meaning and purpose. Um, in, in my story and, and the way I've done that is how can I, thinking back to 25 year old me who had so many questions about like, what can I do to reduce my risk of cancer?

[00:17:10] Dr. Simran Malhotra: Um, you know, thinking back to that girl and thinking about how many women there are right now in that very moment, and I'm here eight years out on the other side of surgery, Found lifestyle medicine, found all these empowering tools to help me reduce my risk, and so. Anytime I have a hard day or a bad day, I come back to that.

[00:17:31] Dr. Simran Malhotra: Like, this is, this is the purpose, this is the meaning of my story and my hardships is to, you know, maybe lessen someone else's pain and help them on their journey. 

[00:17:41] Maya Acosta: Mm-hmm. , thank you. And yes, you'll have to come back to share that story. Um, thank you for sharing that and, and, and explaining what it all means to you, uh, and, and why you're using this platform as well to encourage other people.

[00:17:54] Maya Acosta: So in many ways, I guess June could be also a way to encourage people to screen and to test. Okay, let's talk about lifestyle medicine. Dr. Comander. Um, I often wonder too, I when, and you hear this like in the movies and other things you see in the media that people survive cancer and you think they live happily ever after, and then that's it.

[00:18:16] Maya Acosta: But that's not true. There are continued care that has to take place in order for that cancer survivor to continue to thrive in life. So can you tell us how they can use lifestyle medicine to optimize their overall health and wellbeing and, um, their future outcomes? 

[00:18:34] Dr. Amy Comander: Thank you for that important question. And certainly Simran and I both have a strong interest in this area. We ki we came to it through different ways, but. Definitely share this interest as you do as well. Um, just highlighting again that you noted in your intro that at present in the United States, there's close to 17 million cancer survivors, um, which is amazing.

[00:18:55] Dr. Amy Comander: And that number is just going up. In fact, by 2030, that number is expected to reach 22 million. So certainly caring for individuals who with a history of cancer, it's a team approach. Like I'm an oncologist, um, you know, Simran is a palliative care physician, but we need to collaborate with primary care physicians, nutritionists, physical therapists, um, you know, social workers, psychologists.

[00:19:21] Dr. Amy Comander: Um, I physiatrists, I can go on and on and on. I'm sorry if I'm leaving important specialties out. But it really is a team effort, a multidisciplinary approach is really needed. And one of the key aspects of. , um, care for individuals with the history of cancer is really thinking about prevention of chronic disease and health promotion.

[00:19:40] Dr. Amy Comander: That's sort of one of the number one areas that we must focus on for individuals who have been through cancer treatment. And acknowledging that many of these treatments can have effect on our heart and lungs and other parts of the body. Um, therefore, just a quick intro. How did I get into lifestyle medicine?

[00:20:00] Dr. Amy Comander: Honestly, I was a breast oncologist at the Mass General Cancer Center. One day I see a flyer about a lifestyle medicine conference being, um, hosted by Harvard Medical School. You know, in June actually. Um, and I was like, Oh, that looks interesting. I think I'll go to this conference. I was interested cuz it was a lot about diet and exercise, which is, you know, hobbies of mine.

[00:20:21] Dr. Amy Comander: And I went to the conference and I was like really blown away because a lot of this information I see Simran nodding her head like about. You know, the evidence behind exercise and how we should prescribe it to patients and the benefits of plant-based nutrition, et cetera. Um, I did not learn that in medical school or in residency or in my oncology fellowship or as an early attending.

[00:20:44] Dr. Amy Comander: So I was learning all this information at that conference and I'm like, Wow, this has so much power for my patients with breast cancer. I really need to learn more and, and that Dr. Freddie's there too. So that was helpful. So anyway, that's why I think all these tools from lifestyle medicine, the six pillars, which, you know, we can talk about really each of them have so much relevance to individuals with all types of cancer at any stage. And I think this has so much power and I'm really excited that I had the opportunity to meet you and Simran cuz we're all, we have this shared interest in how can we bring these tools to help, um, these individuals. And Simran, I'd love to hear your comments about this as well.

[00:21:25] Dr. Simran Malhotra: I absolutely agree. I mean, I, I think, um, to give your listeners Maya, the biggest, uh, bank for their buck, I would love to just dive right in. Um, And talk about some of these pillars. Sure. Um, because like, like Amy said, I mean, I only came to this because of my own health issues. I had never heard about lifestyle as medicine, um, before I, I was diagnosed with my genetic mutation and it has completely blown me out of the water. I, I, I wish I could have learned about it earlier. Um, but now I know about it and now, you know, look at everything that we're all doing. It's wonderful.

[00:22:04] Maya Acosta: Okay. Thank you for that. So let's talk about nutrition. How do you speak with cancer survivors after they've gone through all their treatments?

[00:22:13] Dr. Simran Malhotra: Yeah, I mean, I, I think to kind of echo what Amy said earlier, um, I've met personally and professionally met many people going through cancer in the early stages, in the later stages. And on the other side, inter survivorship and, excuse the pun. Literally, every person I've met is hungry to know what they can do to either reduce their risk if they're a survivor like me, but if they're a survivor, how can I reduce my risk of re recurrence? Um, and I think nutrition I, and food is like, Probably the most empowering way because it's something that we all do every single day, you know, multiple times a day.

[00:22:58] Dr. Simran Malhotra: Um, and so educating people on the cancer fighting properties of not, you know, any fancy supplements or anything, but just simply on like basic supermarket foods, like, you know, broccoli, um, and garlic. Um, it really gives them back they’re, the control that they're looking for. Um, and, and I think that's what it comes down to is you were talking about the fear and the anxiety.

[00:23:25] Dr. Simran Malhotra: A lot of these people want to be able to know that they're doing something actively to reduce their risk. Um, and so I think nutrition, Is, um, a major key in that, um, I think all the major cancer, uh, organizations, um, agree that focusing on a plant-forward diet is the best way to reduce your risk of not only primary prevention, but also recurrence of cancer.

[00:23:51] Dr. Simran Malhotra: So, For me, the way I break it down to people is I just tell them to eat the rainbow, right? So the more colors, the more colorful foods that you're eating, the more cancer-fighting nutrients you are taking in with every bite. Um, and so to break it down even further, what that means is more fruits and vegetables, more whole grains, legumes, beans, um, and really focusing.

[00:24:15] Dr. Simran Malhotra: You know, I like to think about it from an abundance standpoint, like focusing on all the hundreds of thousands of foods in the plant kingdom that you can incorporate more of, as opposed to focusing on all the things you have to limit or avoid. Um, but for the purposes of your audience, really, when it comes to cancer risk reduction, um, you know, that means reducing ultra process foods, packaged foods, fast foods, um, you know, red and processed meat. Those are really the, the types of foods that we recommend to at least try to limit. Um, and alcohol, of course, is its own, uh, topic, under this, um, Do you wanna add anything, Amy?

[00:24:56] Dr. Amy Comander:  I know we both have a shared interest in talking about nutrition, which I agree with everything you said. I mean, in my clinic visits every day, I feel like, you know, I'm talking about nutrition all day long and it's definitely an interest of mine, which I did not learn much about a medical school, but you know, certainly taken this on as my own interest to learn more.

[00:25:15] Dr. Amy Comander: And dive into the literature. And I just wanna give a shout out and I know SIM's gonna nod her head as well. Um, if your listeners are like, Where can I learn more? What are some great resources that are evidence based? Because let's be honest, there are constantly all kinds of headlines out there making all kinds of claims about.

[00:25:34] Dr. Amy Comander: Eat this to prevent breast cancer or don't eat this, or whatever. And it's really hard when you're a layperson reading, you know, the news and whatever's on the internet to make sense of it all. The American Institute of Cancer Research, AICR is their website, has lots of evidence-based tools. Really a lot of it's focused on nutrition.

[00:25:56] Dr. Amy Comander: Everything Simran just said, um, is very much, There's lots of articles and resources about that. Um, and actually information about physical activity too, which we'll get to, but I think that's a great resource. Um, Simran, I'm sure you could share many more, but that's just the first one that comes to mind.

[00:26:12] Maya Acosta: So I'll go ahead and add that link to the show notes. But I also wanted to add that you, the American College Lifestyle Medicine has a lot of great resources, and I don't know how available they are to other people. 

[00:26:23] Dr. Simran Malhotra: I mean, I, I think that the, my top three. Um, when I think about resources that I tell people about our AICR, ACLM and PCRM um, you get great recipes on AICR and PCRM'S website.

[00:26:36] Dr. Simran Malhotra: Um, and the handouts are available on ACLM's website, um, for anybody. So, um, they can definitely look into that. To, to address your, your last comment, Maya, about, um, particular foods for cancer. Um, when I'm asked that question, I usually tell people, you know, the best foods to fight cancer, the best whole plant foods to fight cancer are the ones that you're actually going to eat, Uh,

[00:27:01] Dr. Simran Malhotra: So the best, the best and first approach is to make a list of all the foods that you already love, whole plant-based foods that you already love, and find a way to incorporate more of those. But when we talk about like which, you know, foods in particular are worth mentioning when it comes to cancer, I think.

[00:27:22] Dr. Simran Malhotra: You know, the, the, the king and queen are the cruciferous vegetables. Um, especially when we talk about breast cancer. Um, they have a very potent, um, phytonutrient in, they're known as sulforaphane, um, which has some great properties. Um, the Allium family, you know, onion, garlic in particular, has great anti-cancer properties.

[00:27:45] Dr. Simran Malhotra: Um, uh, berries, uh, berries are, are very, very rich and antioxidants, as you mentioned. Um, antioxidants are really important to neutralize those free radicals, which can cause cell damage, which can then, you know, lead to cancer. Um, and then I'm Indian, so I would have to mention turmeric, you know, um, turmeric has a compound in there known as curcumin, um, which.

[00:28:10] Dr. Simran Malhotra: Has been shown in many studies, but also for many, many years, has been used, um, in Southeast Asian cooking and, um, is very, very great for, um, cancer risk reduction, I think. And, and then of course, soy, um, is another, uh, the only thing I'll mention about soy is that you really wanna focus on whole food soy.

[00:28:28] Dr. Simran Malhotra: So things like edamame, and Tempe, and. And, uh, and tofu, uh, with this whole fad of veganism and, and plant-based foods, right now, there's a lot of processed vegan junk food, which has processed soy in it. And so you really wanna try to avoid that sort of soy. .

[00:28:50] Maya Acosta: Yes. And I'm glad you also mentioned PCRM, because having access to those recipes makes it easier even for the other people that are supporting the cancer survivor, because I'm assuming that sometimes it can be a little difficult to do all of this at home.

[00:29:04] Dr. Amy Comander: I love that Simran is really emphasizing, eat the rainbow, eat the fruits and vegetables you like, you know, and she cited all the benefits of certain, you know, broccoli, et cetera. Another important point is eat food. Eat real food, supplements. You know, supplements. Don't cut it. Okay. And the AICR states this very clearly as well.

[00:29:25] Dr. Amy Comander: Supplements do not prevent cancer and supplements do not prevent cancer recurrence. So there's a lot of claims out there, you know. Drink this every day or take this every day. Um, but those really, to be honest, the evidence supports eating real food. And I see some nodding her head and I just wanna, I think that's a really important point to make, that that's the best way to get all these nutrients into your body.

[00:29:49] Dr. Simran Malhotra: If it sounds too good to be true, it probably is. . There's a lot of people trying to sell cures and magic pills. I agree with that. 

[00:29:58] Maya Acosta: That's a good point though, and I'm, I'm glad both of you have brought up the idea that, um, you know, we shouldn't necessarily rely or focus on supplements, but also that it, we can fall into the trap of, of consuming plant-based process foods, which can be just as bad because they, uh, preservatives and the additives that are found, they're not the healthiest and they're probably, um, Deficient when it comes to nutrients. Let's talk about, uh, the role of exercise, Dr. Comander, that's another important pillar of lifestyle medicine. How is exercise important for cancer survivors?

[00:30:33] Dr. Amy Comander: Thank you for asking that question. You know, that's what I love to talk about. Um, so yeah, so physical activity is another key pillar of lifestyle medicine.

[00:30:42] Dr. Amy Comander: And certainly physical activity is important for all of us, you know, all Americans, but in particular, um, very important for our cancer survivor population and exercise is safe for cancer survivors. I think that's an important thing to note If an individual's listening to this podcast and not sure. What he or she can do safely.

[00:31:05] Dr. Amy Comander: Um, that's where perhaps seeing a physical therapist or a physiatrist may be helpful in terms of developing a safe exercise plan. But the American College of Sports Medicine, since we're into listing resources, Has some great, um, resources, specifically focused on exercise and oncology, and has outlined some very clear guidelines for how much exercise cancer survivors should strive to do and what the benefits are, and just to try to make it easy.

[00:31:39] Dr. Amy Comander: Um, and simplistic, really the ultimate goal. Um, and I recognize people may need to take steps to get there, but the ultimate goal is really 150, 150 minutes of moderate aerobic activity each week. And what does moderate mean? That Simran and I could go for a walk outside right now for 30 minutes and have a fun conversation, and we're getting our heart rate up a little bit, but we're not winded and gasping for breath.

[00:32:08] Dr. Amy Comander: So, you know. That might be 30 minutes, five times a week, that may, and it may take someone time to work up to that, but that is the ultimate goal. And I should also say that it doesn't have to be 30 minutes altogether, like you put on the outfit and the shoes and go out for 30 minutes, sometimes broken up throughout the day, 10 minutes.

[00:32:29] Dr. Amy Comander: Three times a day, something like that. Um, it all adds up and is beneficial not only for, um, given the patient the individual's history of cancer, but also for prevention of many other chronic diseases. So, So that's the aerobic exercise. And then another key point is strength training. Um, really should be done twice a week.

[00:32:50] Dr. Amy Comander: And I think that's one people have a real hard time with. How do I start a strength training program? Do I go to a gym and get a trainer? And, you know, I think it's very daunting for many individuals. And we're fortunate that, you know, there's so many free types of, um, exercise videos now on the internet.

[00:33:09] Dr. Amy Comander: YouTube, there's so many great apps and resources out there. A lot of these things we can do at home. Um, you know, even if you don't have weights, you can pick up. Cans or water jugs or your kids' toys. There's so many different creative ways to exercise at home and to do strength training, and the internet has lots of great resources and this is so important for building our bones, improving muscle strength.

[00:33:34] Dr. Amy Comander: Improving muscle function in general cuz that can take a hit during cancer treatment. So the aerobic exercise and the strength training are the key parts. And of course flexibility and balance are important too, but I think it's all really important to help optimize health after cancer treatment. And Simran, I know you're nodding as well cuz I know this is an area you're very interested in too.

[00:33:55] Dr. Simran Malhotra: Yeah, I mean, I'll also just add on echo all of that. I'll, I'll say. For anyone listening who's living with cancer, um, from a palliative care perspective, when you talk about prognosis and overall outcomes, um, with chemo and, and treat aggressive treatments like that, you know, the stronger your body is, the better you're gonna tolerate all these treatments and the better your quality of life is gonna be throughout all of this.

[00:34:20] Dr. Simran Malhotra: So, you know, the latest studies, I believe, showed even as little as 10 minutes of movement a day. Uh, benefit your overall outcome. So, um, and, and just a quick shout out here, because Amy just ran another Boston marathon, which is just like amazing to me. , how she does it with, Yes. How she does it with all of everything, all her other hats.

[00:34:44] Dr. Simran Malhotra: But I think for our healthcare colleagues, what's important to know is. Research also shows that you know, doctors who practice what they preach, their patients are more likely to also do these helpful lifestyle behaviors. So Amy, you're awesome. .

[00:35:00] Dr. Amy Comander: Aw, thank you. But people, you don't need to run a marathon. Just getting, starting with baby steps, 10 minutes a day as you noted, um, is great. But thank you for the shout out. Thank you.

[00:35:10] Maya Acosta: That's wonderful. So I, I wanted to add that, um, or just really say that these recommendations, especially about exercise are so encouraging. Feel also, not only you're taking care of your physical health, but it, it feels like that component of self care that you're, you've come out of, um, a difficult time and then you continue to do this for yourself, um, to optimize your health.

[00:35:34] Maya Acosta: Dr. Simran, I mentioned earlier, you know, my, my question was on anxiety and stress, so we can talk about that. So a diagnosis of cancer certainly comes with it, many emotions, uh, like. Anxiety and stress and what are some ways that we can help address these concerns?

[00:35:52] Dr. Simran Malhotra: So I think this is, and Amy can probably add on to this, but I think this is a two part, two part answer. Um, so I think there's the fear and anxiety that comes with. You know, the diagnosis of cancer and then during treatment, um, you know, some, a person's life is basically turned upside down. Um, but I think what helps in this particular phase of the, the cancer journey is that they have a roadmap and it's very clear.

[00:36:22] Dr. Simran Malhotra: Um, they have very close follow up and appointments and blood work and imaging and, you know, if they're, if they're blessed, they have a. Good family support, um, system that's kind of carrying them through that, that journey. And for some people that may be months for others, they may be years. Um, but I, I think you know what's really important in this phase, um, and this is again where the palliative piece comes in, is naming the elephant in the room and naming the emotion, naming the fear, naming the anxiety, and asking.

[00:36:53] Dr. Simran Malhotra: Really solid questions of like, you know, what is important to you? What are you worried about? What are you hoping for? And it's gonna be different for every person depending on what season of life they're in. Right. Um, and so I think along with that, which is, you know, something that I do in my practice, along with that you have all the tools that, some of the tools we already talked about in lifestyle medicine.

[00:37:17] Dr. Simran Malhotra: I think regardless of whether you're talking. You know, the, the food you're eating, the way you're moving, the way you're optimizing your sleep, um, or the specific kind of tools for, um, improving your emotional mental fitness. All of them have been shown to improve mood and reduce. Um, anxiety and depression.

[00:37:38] Dr. Simran Malhotra: Um, so no matter which tool that, that calls out to them, I think those are all great ways to empower them to take control of those, um, of those symptoms. Um, but I, I think in particular, if you're talking about specific structured kind of stress reducing modalities like meditation, um, we, there's a, a, um, an article.

[00:38:01] Dr. Simran Malhotra: Um, a study that I like to cite that I share about young breast cancer survivors, you know, just eight weeks of a daily meditation practice for them, improved their quality of life scores, improved pain, improved fatigue, self image, um, sleep disturbances. Um, so again, it doesn't have to be a lot, even just a little bit.

[00:38:20] Dr. Simran Malhotra: And meditation for everyone can look different. As you mentioned, it could be going outside in nature for other people. It could be, you know, sitting inside and sitting in silence for 10 minutes and breathing. Um, or for other people it could be having a simple gratitude practice. Um, one of the things that really helps me on my journey is, you know, Tony Robbins says, The antidote to fear is gratitude, and you can't have both at the same time.

[00:38:44] Dr. Simran Malhotra: Um, so that I think can be very powerful. Um, I don't know, I'll mention the next part of survivorship, but if anyone wants to comment on that, since, you know, she sees this often. Yeah,

[00:38:56] Dr. Amy Comander: I love your answer. This is great. And you know, we're talking about another, a third pillar of lifestyle medicine, namely stress management, which is, again, so important for this population.

[00:39:07] Dr. Amy Comander: And I agree with everything you said, and I think for those listening, if you are a cancer survivor, who is, um, dealing with a lot of the stress, anxiety, fear of recurrence, um, many cancer centers do have programs specifically dedicated to helping individuals. With these concerns, I'm fortunate. At our cancer center, we have the Benson-Henry Institute for Mind Body Medicine.

[00:39:31] Dr. Amy Comander: It's a wonderful eight week program, which is really dedicated to cancer survivors to help manage fear for recurrence, anxiety, resilience, learn mindfulness and meditation techniques. A lot of the things Simran just mentioned, and certainly that type of program. Isn't everywhere, but a, a lot of cancer centers or you know, in community centers throughout the country might have these types of offerings for cancer survivors that I think it's really important to take advantage of these offerings.

[00:40:01] Dr. Amy Comander: Many of them are virtual now because as Simran noted, you really need to, individuals should like identify when they're experiencing these types of symptoms and what are some strategies to best address it. Um, so I. I agree with what you were, all your suggestions.

[00:40:15] Dr. Simran Malhotra: And I, and I think the other, the other thing as you're talking about survivorship is it's, it's not as clear a road as it is when you're given the diagnosis and while you're going through treatment.

[00:40:27] Dr. Simran Malhotra: Right. Um, I, I think, um, and I know this personally because of what I went through with my mom, um, but also because I'm in a lot of breast cancer support groups and I hear this very often from women. Like, you know, you're carried so carefully by your oncologist and your medical team and your family, and then you get to the other side, you ring the bell and it feels like everyone's gone from around you.

[00:40:51] Dr. Simran Malhotra: Um, because there's no more roadmap. It's like, Okay, I'll see you in three months, or I'll see you in six months. Like, This is, it's supposed to be really good news, but it sometimes leads to more isolation and more anxiety and more fear, um, kind of like Amy said. So of course, support groups are super important because like I said, if you know you're not alone and there's other women or other people rather going through what you're going through, that in and in and of itself can be, um, comforting.

[00:41:16] Dr. Simran Malhotra: But I think. Again, this is a palliative care physician in me. Sorry. But having conversation is so powerful, like sitting your family down, um, who says, Okay, you rang the bell. Everything's good. Let's go back to normal, regular scheduled programming. To have that conversation and say, I'm not that same person anymore, like this really changed me.

[00:41:38] Dr. Simran Malhotra: And it's also okay to know that it may take time to find your new normal. It may take time. To experiment with things and you know, a lot of the things that you used to do, you may not do them anymore. You may not need them in your life anymore. Um, and so I think to have the conversation with your family and friends to tell them what you need during this time is super important.

[00:42:00] Maya Acosta: Thank you for mentioning the importance of support groups, and that's a conversation that Dr. Comander, um, and I had when she came on previously and spoke about PAVING the Path to Wellness, so supporting women after they've gone through their treatments. What's the best way for my listeners or anyone who's listening, who is a survivor to have access to virtual support groups?

[00:42:25] Dr. Amy Comander: That's such a great question and thank you for giving a shout out to PAVING the Path to Wellness. And you know, Simran, you hit on exactly what led me to, um, to start this group along with Dr. Beth Frates and Michelle Tollefson. It was like, I'm seeing my patients, they've been through months of chemo radiation.

[00:42:45] Dr. Amy Comander: They're may be now taking, let's say, tamoxifen and. See you in six months and to a patient, you know, that's like, who's been through so much, so many in intensive medical visits to say, I don't need to come back for six months. Like, it's very disconcerting. And as the oncologist I'm like, well, you don't really have to come here, you know?

[00:43:07] Dr. Amy Comander: Um, and I feel like survivorship care. Such an opportunity, we can do such a better job. That's why we're doing this podcast as a way to bring awareness so we can all think about strategies to improve care, certainly for our breast cancer survivors, but for all 17 million of those cancer survivors who have all kinds of different diagnoses.

[00:43:29] Dr. Amy Comander: So ask a great question, Maya. How can we perhaps make these virtual offerings more available or, and how do patients find them? And It's a great question cuz you. There, our patients are very savvy and creative, and the internet has opened up a wealth of possibilities. So yeah, I know for my own patients, many of them are in Facebook groups specifically dedicated to their own type of breast cancer.

[00:43:56] Dr. Amy Comander: Um, that's just one example. Certainly there's communities on Twitter as well, and so many other platforms and many other support groups, which now many are meaning virtually. Maybe the pandemic. Forced that to happen. And maybe that is a good thing that's come out of this very challenging time we've lived through for the past two years, but certainly the paving program that I've been offering through the MGH Cancer Center, that was an in-person program for survivorship program for women with breast cancer and now it's virtual as well.

[00:44:28] Dr. Amy Comander: And I hope to be able to expand that further. So I think there are many offerings, but um, certainly for breast cancer there are many offerings, but you know, I have to be honest, I'm not sure if there are. American Cancer Society is a great resource. The YMCA Lives Strong programs, a great resource. Um, but for many other cancer diagnoses, you know, I'm not familiar with all the exact programs that might be out there for those individuals. Simran, I, I'm welcoming your comments as well. 

[00:44:55] Dr. Simran Malhotra: I'm thinking of one right now. It's, um, so for any women that, um, have like female cancers, um, you know, Bright Pink was a good one. I know they're in the middle of transitioning. I'm a part of the Breasties. I, they're wonderful for young women. Um, Because it's, it's mostly women in the ages of 20 to 40.

[00:45:17] Dr. Simran Malhotra: Um, Stupid cancer, I think that's what it's called. Um, is a , I hope I'm saying this right, is another one. Um, which, if I remember correctly, cause I went on there once, they have like tons of lists of different support groups. But I agree with Amy. Like nowadays, if you go on Facebook, you can literally find a specific group.

[00:45:39] Dr. Simran Malhotra: For your specific cancer, um, or on Instagram or any of these social media platforms. Um, and then I think, you know, just simply talk to your oncologists. A lot of the local cancer centers have groups, and now in the post pandemic world, I think they are starting to open up again. So, Um, there's so much support you just have to ask.

[00:46:02] Dr. Amy Comander: I just wanna say we're hitting on a fourth pillar of lifestyle medicine, the importance of social connection. So the support piece is so key as we've been discussing and, um, and support certainly from. You know, your neighbor, your friend, your partner, your family, but also the support from other individuals who get it, who really get what you just went through. So, um, Maya, we're glad you asked about this too.

[00:46:28] Maya Acosta: I've had a couple of individuals like that who come on and didn't have that guidance and support that. You know, they wish they had. And so they also work on the preventative end. So they go on and create groups in their communities where they help educate people about the power of nutrition.

[00:46:44] Maya Acosta: And I think that's so cool because now suddenly you have people that are on board to support you as well. Um, people that are, uh, like-minded and have the same values to prevent or reverse disease. Um, so I think that's great. And then also we have sleep Doctor Comander that we can talk about, which is difficult for all of us. Um, uh, but what do we know in terms of the role of sleep for cancer survivors?

[00:47:09] Dr. Amy Comander: Thank you for asking. We're making sure we hit all these colors of lifestyle medicine. So sleep is number five. And we do know from numerous studies that sleep disturbance or other sleep disorders such as insomnia, um, are unfortunately very prevalent in cancer survivors.

[00:47:27] Dr. Amy Comander: and you know, the rates can be between 40 and 70% and we really are in need of better resources to help this population address this concern. And obviously a major contributing factor is fear of our recurrence. You know, just anecdotally, um, since we like sharing stories, I mean, many of my patients will say, I wake up at three in the morning.

[00:47:49] Dr. Amy Comander: And I can't stop thinking about my cancer and whether it could come back. And, you know, it's really scary for people and, you know, how do we best counsel our patients to address that concern? And, um, I'm fortunate that one of my colleagues at the MGH Cancer Center, Dr. Daniel Hall, who's a psychologist, is doing a lot of research specifically on how to.

[00:48:11] Dr. Amy Comander: Manage insomnia and cancer survivors. And there's a lot of interest in cognitive behavioral therapy for insomnia, but he's adapting it for our cancer survivor population. So there's, that's one great example, um, of research that's being done to help. Address sleep disturbance. I know there are actually a number of apps out there, interestingly, that are helping individuals, um, improve their sleep habits.

[00:48:36] Dr. Amy Comander: But, you know, sleep hygiene is a piece of it and we can talk about what that means. Um, You know, but the cognitive behavioral therapy piece is really interesting too, and I've been fortunate to learn more about that. Um, Simran, I don't know if you wanna give your tips on sleep hygiene, you're probably better at it than me sleep is one of the things I'm working on too.

[00:48:58] Dr. Simran Malhotra: I think the thing with sleep right now in this, again, this pandemic world we're living in, like we're all in front of screens all day long. And so, you know, when it comes to sleep hygiene, and trust me, I. Also working on this myself, but like really being mindful about shutting down, you know, all your screens, your phone in particular, you know, at least an hour, if not 90 minutes before you're getting ready to wind down.

[00:49:26] Dr. Simran Malhotra: Um, and instead during that time, find something that really relaxes you. So whether it's mindfulness or, you know, music or reading or, or drinking a, a. Warm tea or taking a warm shower, whatever it is, finding a, another alternative to the blue screen that really we know I is going to, um, disrupt your sleep.

[00:49:47] Dr. Simran Malhotra: Um, the other thing I, I found, um, personally helpful, but also something that I've heard has helped a lot of. Um, of my patients who, you know, I, I deal with some of the sickest patients, um, in palliative care, but I usually tell people to keep like a journal at their bedside. A lot of times people can't sleep because they have racing thoughts and they just keep ruminating on the same what ifs and fears and anxieties, and so take a journal and just like whatever thought is coming. It's almost like a brain dump, you know, before you go to bed. And then taking some deep cleansing breaths after that can really help calm the mind down so that you can start to fall asleep.

[00:50:27] Maya Acosta: I was thinking Dr. Sim Simran as you were saying that, um, giving us those tips that, you know, the last couple of years going on three years of having this pandemic, probably a lot of individuals either were not tested or screened for cancer or didn't, or weren't able to have access to treatments. I happened to have met a couple who just before the pandemic hit, was able to fly to Columbia to do his treatments for pros, prostate cancer, and is surviving now and it's doing well. Um, so that's very interesting. Can we talk a little bit about some of the limitations and what the numbers may look like this year and also substance abuse and, um, how, why is it important for us to talk about this topic and the risk factors, um, that are still associated with cancer, 

[00:51:17] Dr. Amy Comander: Uhm, I’m happy to address that and I'll let you Simran address, um, avoidance of risky substances so we get all six pillars covered in this podcast today. Um, but my, I'm so glad you asked that question cuz that's an area that's of great importance to me.

[00:51:31] Dr. Amy Comander: And actually Simran and I, along with Nigel Brockton from the A I C R. Did a webinar last October for a C L M, specifically focused on lifestyle medicine and breast cancer, but also. Why screening is so important and what's happened during the pandemic, and you're absolutely right. During the pandemic, I'm certainly starting in March of 2020 until the end of May of 2020, all sort of non-essential medical testing was essentially, Canceled and discontinued per the CDC.

[00:52:05] Dr. Amy Comander: So mammograms, colonoscopies, you know, all of these routine, um, important screening tests were canceled. So we saw a significant drop off, of course, in screening, testing. And I would say just in my own practice now, we're still trying to catch up. I mean, I still see patients every day who will acknowledge, you know, Oh, I missed my mammogram in 2020.

[00:52:30] Dr. Amy Comander: Finally I got in and what if I had done it? You know, like we don't like the what ifs, but it is really hard to have those conversations with patients. So I guess to your listeners, you know, Cancer Survivor Month is really an opportunity to celebrate and honor individuals who've been through cancer treatment, but also a reminder to all of us.

[00:52:48] Dr. Amy Comander: Get that mammogram that is self-care. Taking care of yourself. Take that time off to get your mammogram. Nobody likes getting a colonoscopy, but schedule it anyway. You know, um, you know, your pap smear. Um, discuss with your doctor the role of PSA screening for prostate cancer. If you meet criteria, I can go on and on, but it's really an important wake up to, um, get back to all those important screening tests that may have been neglected over the past two.

[00:53:15] Dr. Simran Malhotra: And I'll, I'll just take a moment to throw in there. You know, if you, if you are a loved one of a cancer survivor, uh, June is a great month to really dive into your family history and figure out, like, you know, am I am, am I, I'm the daughter of a survivor or son of a survivor? Am I at higher risk? Is there a genetic component? Should we talk to a genetic counselor? Um, that's also another conversation I think that needs to have more awareness.

[00:53:42] Maya Acosta: So, in an ideal world, how can we make the tools for lifestyle medicine more available to cancer survivors?

[00:53:48] Dr. Simran Malhotra: The first step is we shared, um, several evidence based, um, sources today. So I think going there, exploring, they have beautiful, colorful websites. So going there, exploring the information, learning yourself, and like Amy said, you know, it's possible that you bring this information about a whole food plant-based diet. You know, whatever to your doctor. And they may not have ever heard about the evidence behind it, but I'll tell you one thing, doctors love science and they love to learn.

[00:54:19] Dr. Simran Malhotra: So if you bring them the evidence, most of them will look at it and you, you don't know, you may change the practice of your doctor. So, That's what I say, like, every story has the potential to change someone else's life, and it could even be your doctors. So, um, I think, you know, we all learn from each other.

[00:54:36] Dr. Simran Malhotra: And so, um, but those are, those are the first, um, stepping stones I would say to really get the information of lifestyle medicine out there. And I, and I know, you know, of course, there's, there's, um, institutions like ACLM who are. You know, when you talk about the medical system trying to fix it from the inside out, like they're, you know, involved with medical schools and health systems across the US and they're just doing a fantastic job. So I think we just address it from all angles.

[00:55:05] Maya Acosta: Thank you. And finally, I don't know if you wanted to add a comment to that, uh, Dr. Comander.

[00:55:11] Dr. Amy Comander: I just wanted to give a shout out to you, Maya, just the fact that you're, you have this amazing podcast that covers so many important aspects of lifestyle medicine to really reach such a broad audience. And I agree. I think. That is so important and thank you for doing what you do.

[00:55:27] Maya Acosta: Well, thank you. Thank you so much. It's encouraging. It's you, the guests that come on and share this with the listeners. And not long ago we had a survivor o colorectal cancer survivor, and you know, because of that she gave us tips on how we can test for that and screen for that.

[00:55:45] Maya Acosta: So it's just us hearing more about this, having the conversation and the exposure, uh, from the doctors, but also from the survivors that, um, these conversations are what convince the rest of us to take care of our health. Um, and so finally, um, do you have a final message for survivors and what is, what links would you like to share with my listeners for them to learn about your programs or your websites, social media, anything that you'd like to, uh, share with the listen.

[00:56:14] Dr. Simran Malhotra: My final message is that you all are just incredible. Um, and what I think Amy, Amy will speak for herself, but Amy and I both want you to know, is that there are so many tools available when it comes to your lifestyle to reduce your risk of a recurrence. And you don't have to live in fear. But there, there, there's so much you can do to take action and.

[00:56:36] Dr. Simran Malhotra: And you can find me at, uh, coachSimranmd.com or, um, my Instagram handle is @Dr.Simran.Maholtra. Um, and I don't expect you all to know how to spell that, so maybe you can just share it in your value

[00:56:50] Dr. Amy Comander: that, Thank you for that question. I'm gonna read you a quote that is very inspiring to me and I share with my patients, and I think this is, A great thing for, um, the cancer survivors who are listening to contemplate.

[00:57:06] Dr. Amy Comander: Um, I'm not sure if you've heard of Gabe Greenwald. Um, so I'm a runner. As we alluded to earlier, Gabe, um, was a really amazing professional distance runner who unfortunately at a very young age was diagnosed with a very rare type of cancer involving her liver. Um, but she adopted. Really amazing attitude, um, during her treatment and how she faced a lot of the struggles that we've discussed, and this is her quote, Cancer can stop you from doing a lot of things. I'm well aware of that, but I'm more interested in what cancer can't stop me from doing. Here's to finding out. So I love that sentiment and I think that's a great quote for us to conclude on, and I hope that provides inspiration to many who are listening. 

[00:57:56] Maya Acosta: Definitely. Thank you so much, Dr. Comander and Dr. Simran for taking the time to really encourage all our listeners to have this awareness and to support our survivors. So thank you again.

[00:58:09] Dr. Amy Comander: Thanks for having us. Thank you.

[00:58:12] Maya Acosta: You've been listening to the Healthy Lifestyle Solutions podcast with your host Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode.

[00:58:24] Maya Acosta: Feel free to leave us an honest review on Apple Podcast that helps us to spread our message. You can also hit on over to podinbox.com/hls to leave me a voicemail. Don't forget to subscribe and as always thank you for listening.