• Adequate nutrition, but control excessive calories; especially fat intake.
  • Limit fats to 20% of caloric intake and decrease saturated fats to 7%.
• At least 5-9 fruits and vegetables and 6 grain foods daily.
• Restrict or eliminate alcoholic beverages.
• Vitamin and mineral supplementation, in particular:
  • B12, folic acid, thiamin, riboflavin, iron and zinc.
• Phytoestrogens?
  • With women who have ER positive tumors, exogenous estrogenic substances should be eliminated. Tomaxifen is trying to block the ER receptor, and there's no reason to provide agents that compete for the receptor.
  • Her question is certainly legitimate.
• Medications containing estrogens, such as oral contraceptives and estrogen replacement for osteoporosis may need to be curtailed.
• Maintain good hydration, particularly while on Cytoxin.
  • Cytoxin is especially toxic to the bladder mucosa;keeping the urine dilute.
• Herbal and botanical supplements should not be used. Echinacea especially, in combination with methotrexate, can cause serious liver damage.
• Encourage exercise, swimming and brisk walking are particularly helpful.
• She should continue doing routine breast self exams.
• Family counseling. Mrs. O'Dea has 2 sisters and a daughter.
• Be prepared to address psychiatric issues early. Depression is not uncommon.
  • Numerous support groups exist and participation has a major positive effect.

Mother to be is our next case.