Rip Esselstyn continues his special series for Breast Cancer Awareness Month with Dr. Amy Comander, a leading expert in breast oncology and lifestyle medicine at Massachusetts General Cancer Center. Together, they delve into how breast cancer survivors can reclaim their health and thrive after a diagnosis through lifestyle changes and holistic wellness practices.

Dr. Comander introduces her innovative 12-week program, "Paving the Path to Wellness," which supports breast cancer survivors in their recovery by focusing on the whole person-body, mind, and spirit- with the goal to empower individuals to live healthier lives with a sense of purpose.

The episode also highlights the growing concern of younger individuals being diagnosed with breast cancer and the importance of preventive lifestyle measures.

Dr. Comander emphasizes the powerful role of a whole food, plant-based diet in reducing cancer risk and improving overall health, providing practical tips for patients to incorporate more plant-based options into their meals.

Exercise, too, plays a critical role in recovery, and she discusses how it can reduce the risk of cancer recurrence. Dr. Comander also addresses the lack of confidence many healthcare providers have in guiding patients toward effective exercise routines, identifying an area for improvement in oncology care.

The conversation also explores the importance of sleep, stress management, and social support, with Dr. Comander sharing heartwarming stories of patients finding community and healing through her program.

This episode is a must-listen for anyone interested in the intersection of lifestyle medicine and cancer recovery, offering valuable insights and hope for breast cancer survivors.

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Rib Esselstyn: 00:00:00

I'm Rib Esselstyn and you're listening to the Plan Strong podcast.

Rib Esselstyn: 00:00:05

Today as we continue our series on breast Cancer Awareness Month, you're going to meet a special oncologist and lifestyle medicine physician who is paving the path to wellness for her patients.

Rib Esselstyn: 00:00:18

That's coming up right after these words from Plantstrong.

Rib Esselstyn: 00:01:27

Last week on the Plant Strong podcast, we had part one of our interview with the incredible Doctor Don Musalem from the Jacobi center for Breast Cancer at the Mayo Clinic in Jacksonville, Florida, where we discussed a couple of the recent studies on the benefits of whole food, plant based nutrition for the prevention and healing around breast cancer.

Rib Esselstyn: 00:01:53

We're going to have part two of that conversation in a few weeks, but today I want to introduce you to another lifestyle medicine rock star, Doctor Amy Commander.

Rib Esselstyn: 00:02:05

Doctor Amy Commander also specializes in the care of women in breast cancer.

Rib Esselstyn: 00:02:11

She is medical director and director of breast oncology and cancer survivorship at Mass General Cancer center in Waltham, Massachusetts.

Rib Esselstyn: 00:02:23

She's also board certified in lifestyle medicine and is an avid athlete and super busy doctor.

Rib Esselstyn: 00:02:31

She embraces these pillars herself every single day.

Rib Esselstyn: 00:02:35

It's the work that she's doing at Mass General Cancer center that really caught my attention.

Rib Esselstyn: 00:02:42

Doctor commander and her colleagues have developed a twelve week program called paving the path to wellness where they work with breast cancer patients on their healing journeys using the pillars of lifestyle medicine, including social connections that are so important movement why we all need to move sleep.

Rib Esselstyn: 00:03:03

So many of us are deprived with sleep and of course, you guessed it, a plant forward diet.

Rib Esselstyn: 00:03:10

Now, this twelve week program is specifically designed to enhance your body, your mind and your spirit both after and during breast cancer treatment, with the goal to help you achieve your optimal level of wellness.

Rib Esselstyn: 00:03:26

They cover numerous topics that are of importance for breast cancer survivors, including sexual health, physical therapy, behavioral health, integrative medicine, nutrition and culinary medicine.

Rib Esselstyn: 00:03:41

So often we hear stories of patients who are simply sent on their way after a diagnosis and treatment.

Rib Esselstyn: 00:03:48

With no real plan of action and no support system, they're left wondering what's next?

Rib Esselstyn: 00:03:56

How do I get back to my full self?

Rib Esselstyn: 00:03:58

How can I get back to normalcy and thrive?

Rib Esselstyn: 00:04:02

Well, doctor Commander and her team are digging in deep to change that paradigm.

Rib Esselstyn: 00:04:09

Please welcome Doctor Amy Comander.

Rib Esselstyn: 00:04:16

Doctor Amy Comander, welcome to the plan Strong podcast.

Rib Esselstyn: 00:04:21

It is so good to have you because this is breast cancer Awareness Month, or as you love to call it, action month.

Rib Esselstyn: 00:04:33

And who better to have than yourself?

Rib Esselstyn: 00:04:36

So welcome to the show.

Doctor Amy Commander: 00:04:37

Thank you so much.

Doctor Amy Commander: 00:04:38

It's an honor to be here.

Rib Esselstyn: 00:04:40

Yeah.

Rib Esselstyn: 00:04:41

So where are you this fine day?

Rib Esselstyn: 00:04:44

Where am I talking to you from?

Doctor Amy Commander: 00:04:46

I am in Newton, Massachusetts, which is right outside of Boston.

Doctor Amy Commander: 00:04:51

And it's a beautiful fall day.

Doctor Amy Commander: 00:04:53

It is October, as you noted.

Doctor Amy Commander: 00:04:55

So it's breast cancer awareness month, or breast cancer Action Month, as I like to call it.

Rib Esselstyn: 00:05:01

And how long have you been in Austin?

Rib Esselstyn: 00:05:03

I'm Boston.

Rib Esselstyn: 00:05:04

I'm in Austin.

Doctor Amy Commander: 00:05:07

Honestly, for a really long time.

Doctor Amy Commander: 00:05:10

I was at Harvard undergrad, and then I did leave Boston for medical school, but then I've been back ever since for all of my medical training and as an attending physician.

Doctor Amy Commander: 00:05:20

So it's been a while.

Rib Esselstyn: 00:05:21

Wow.

Rib Esselstyn: 00:05:23

So do you love Boston and all that it has to offer?

Doctor Amy Commander: 00:05:28

I honestly do love it, but I will acknowledge my husband is from Miami.

Doctor Amy Commander: 00:05:33

And I.

Doctor Amy Commander: 00:05:33

Even though he's been here longer than me, I feel like he is still adjusting to the winter.

Doctor Amy Commander: 00:05:39

So we're toughing it out, but it's always a struggle in the winter time.

Rib Esselstyn: 00:05:43

Now, did I see.

Rib Esselstyn: 00:05:44

Did you recently run the Boston marathon?

Doctor Amy Commander: 00:05:49

So, yes, I ran my 11th consecutive Boston marathon this past April.

Doctor Amy Commander: 00:05:54

I ran it well, I've been running for the past eleven years, and I always run to support charitable causes, so it's a passion of mine.

Doctor Amy Commander: 00:06:02

I would never miss it.

Rib Esselstyn: 00:06:03

Wow.

Rib Esselstyn: 00:06:04

Eleven straight years.

Rib Esselstyn: 00:06:05

And what'd you do during COVID Was it virtual or how did that happen?

Doctor Amy Commander: 00:06:09

Great question.

Doctor Amy Commander: 00:06:11

remember that day in March of: 2020

Doctor Amy Commander: 00:06:26

But it did.

Doctor Amy Commander: 00:06:27

You know, it was quite upsetting at that time to read that email.

Doctor Amy Commander: 00:06:30

They did defer the marathon till the fall, and it became a virtual Boston marathon, which meant you could run it anywhere you wanted during a certain timeframe.

Doctor Amy Commander: 00:06:39

So a friend of mine did run together on the course, so that was actually a memorable Boston marathon for us.

Rib Esselstyn: 00:06:47

Well, congratulations, eleven.

Rib Esselstyn: 00:06:50

That's pretty phenomenal.

Rib Esselstyn: 00:06:51

Quite the record.

Rib Esselstyn: 00:06:53

You're putting a lot of pressure on yourself.

Doctor Amy Commander: 00:06:56

Well, I run for.

Doctor Amy Commander: 00:06:57

You know, I've been running for the past few years to support the Le Fund, which is a great nonprofit organization here in Massachusetts that provides supportive care services to individuals with breast cancer.

Doctor Amy Commander: 00:07:07

So that's a passion of mine, too.

Doctor Amy Commander: 00:07:09

So that's my why.

Doctor Amy Commander: 00:07:11

That's what gets me out the door to train, especially in the winter.

Doctor Amy Commander: 00:07:14

So I really love doing it, and it's such an exciting day in our city, so you should come sometime.

Doctor Amy Commander: 00:07:19

It's on Patriots Day, which is always the third Monday of April.

Rib Esselstyn: 00:07:22

Yeah.

Rib Esselstyn: 00:07:23

Yeah.

Rib Esselstyn: 00:07:24

Don't you have to, don't you have to qualify for the Boston marathon?

Rib Esselstyn: 00:07:29

Or if you've done more than five, do you automatically qualify?

Doctor Amy Commander: 00:07:33

Great question.

Doctor Amy Commander: 00:07:35

You, you know, you do have to qualify for the Boston Marathon, and I am in awe of those individuals who do qualify because that is really tough.

Doctor Amy Commander: 00:07:44

But if you don't qualify, like me, you can run for charity.

Doctor Amy Commander: 00:07:48

So if you choose the fundraise and there are so, so many amazing causes that you could run Boston for that.

Doctor Amy Commander: 00:07:54

That is a great option for somebody who truly wants to run the marathon but isn't going to qualify anytime soon, which is me.

Rib Esselstyn: 00:08:01

Yeah.

Rib Esselstyn: 00:08:01

Well, so you mentioned the charity that you love running for is for breast cancer.

Rib Esselstyn: 00:08:06

So with that, I think it's a great transition.

Rib Esselstyn: 00:08:09

Let me tell the audience a little bit about yourself, and that is, you know, you're the medical director of mass General Cancer center.

Rib Esselstyn: 00:08:18

That's in Waltham.

Rib Esselstyn: 00:08:20

Is that pronounced correctly?

Rib Esselstyn: 00:08:21

Waltham, Waltham.

Doctor Amy Commander: 00:08:23

It's okay.

Rib Esselstyn: 00:08:24

Waltham, Waltham.

Rib Esselstyn: 00:08:27

There you go.

Rib Esselstyn: 00:08:27

Waltham, Massachusetts.

Rib Esselstyn: 00:08:29

You also serve as the director of breast oncology and cancer survivorship there.

Rib Esselstyn: 00:08:36

And Newton, Wellesley Hospital.

Rib Esselstyn: 00:08:40

You're also an instructor in medicine at Harvard Medical School.

Rib Esselstyn: 00:08:46

My question to you is, wow.

Rib Esselstyn: 00:08:48

I mean, have you always been, like, this really ambitious human being?

Doctor Amy Commander: 00:08:54

If you ask my friends, they would probably say, yeah, that's Amy.

Doctor Amy Commander: 00:08:58

But I love everything I do.

Doctor Amy Commander: 00:09:00

I also oversee our lifestyle medicine program at the cancer center, which is a lovely, amazing program with a wonderful team.

Doctor Amy Commander: 00:09:08

And it's a true passion of mine to bring those tools not just to our patients with breast cancer, but to all individuals with cancer diagnosis.

Doctor Amy Commander: 00:09:15

And I hope we continue to spread the word about the importance of this for cancer patients.

Rib Esselstyn: 00:09:19

Yeah.

Rib Esselstyn: 00:09:20

Yeah.

Rib Esselstyn: 00:09:21

So speaking of ambitious, you mentioned, did you say you went to Harvard undergraduate?

Doctor Amy Commander: 00:09:28

Yes.

Rib Esselstyn: 00:09:29

Okay.

Rib Esselstyn: 00:09:29

Harvard graduate undergraduate.

Rib Esselstyn: 00:09:32

Where did you go to high school?

Doctor Amy Commander: 00:09:35

Well, I actually grew up in Savannah, Georgia, so I grew up in the south.

Doctor Amy Commander: 00:09:40

My parents were actually New Yorkers who ended up in Georgia since my dad was in the army.

Doctor Amy Commander: 00:09:45

And so I grew up there.

Doctor Amy Commander: 00:09:46

And to be honest with you, by the time I was a senior, I was like, I just was ready to be somewhere else.

Doctor Amy Commander: 00:09:53

You know, I wanted to be in a big city, and I just fell in love with Boston.

Doctor Amy Commander: 00:09:57

And I'm so grateful that I did end up here.

Doctor Amy Commander: 00:10:00

And obviously, I'm still here.

Rib Esselstyn: 00:10:02

Yeah.

Rib Esselstyn: 00:10:02

So let us know.

Rib Esselstyn: 00:10:04

Where did you go to medical school and residency?

Doctor Amy Commander: 00:10:07

Right.

Doctor Amy Commander: 00:10:07

So I was fortunate to go to the Yale School of medicine in New Haven, which was also an incredible experience.

Rib Esselstyn: 00:10:13

And I'm very heard of that place.

Rib Esselstyn: 00:10:16

Yeah.

Doctor Amy Commander: 00:10:17

And then I ended up back in Boston for internship, residency, and fellowship, and then, of course, I've stayed ever since.

Doctor Amy Commander: 00:10:24

And my husband was here as well, and he's been here the whole time, actually, since college.

Doctor Amy Commander: 00:10:29

So we met in college, and so that's kind of why we're stuck here.

Doctor Amy Commander: 00:10:32

But we do love it.

Rib Esselstyn: 00:10:34

So you met your husband at Harvard?

Doctor Amy Commander: 00:10:37

Correct.

Rib Esselstyn: 00:10:37

And were you in the same class?

Rib Esselstyn: 00:10:39

Were you guys, did you bump into each other in the cafeteria, at a bar?

Doctor Amy Commander: 00:10:45

We were in the same class.

Doctor Amy Commander: 00:10:46

And my husband is also.

Doctor Amy Commander: 00:10:48

He's actually a physician scientist at mass Sioneer.

Doctor Amy Commander: 00:10:51

He does really cool work in research in gene therapy for individuals with inherited retinal disorders.

Doctor Amy Commander: 00:10:58

So he does very cutting edge, exciting work, and so it's really great for him to be at mass scientist.

Rib Esselstyn: 00:11:05

So is it fair to say that you're specialty is oncology, correct?

Doctor Amy Commander: 00:11:11

Yeah, breast oncology.

Rib Esselstyn: 00:11:12

Yeah.

Rib Esselstyn: 00:11:13

And so for people that aren't familiar with oncology, what exactly is oncology?

Doctor Amy Commander: 00:11:19

Yeah.

Doctor Amy Commander: 00:11:20

So oncology is really a fascinating field that's changed so much even since my medical training and really focused on the care of individuals with a cancer diagnosis.

Doctor Amy Commander: 00:11:32

And as I'm sure your listeners and you can attest, like, this field has changed so much just even in the past 20 years with all the exciting advances that we've witnessed.

Doctor Amy Commander: 00:11:42

So it's really an honor to be an oncologist, and my job is very tough, but I love what I do because of my patients.

Doctor Amy Commander: 00:11:50

I love my patients.

Doctor Amy Commander: 00:11:51

They inspire me every day, and I learn so much from them.

Doctor Amy Commander: 00:11:54

So it's really a passion of mine.

Rib Esselstyn: 00:11:56

Yeah, well, I want to talk about that in just a little bit.

Rib Esselstyn: 00:12:01

So you mentioned that you're also involved with lifestyle medicine, and that, it sounds like, has become a another huge passion of yours.

Rib Esselstyn: 00:12:11

When did lifestyle medicine poke its head up and when did you go, oh, that's.

Rib Esselstyn: 00:12:17

That looks interesting.

Rib Esselstyn: 00:12:18

I think I'll check that out.

Doctor Amy Commander: 00:12:20

Yeah.

Doctor Amy Commander: 00:12:21

Great question.

Doctor Amy Commander: 00:12:22

So it's funny.

Doctor Amy Commander: 00:12:23

So in my undergraduate days, I thought I'd be a neuroscientist, so I was really into studying psychology and neuroscience and integrating those tools, and somehow I thought I'd end up in psychiatry or neurology or something like that.

Doctor Amy Commander: 00:12:37

Obviously, I ended up in oncology.

Doctor Amy Commander: 00:12:39

That's a whole other story.

Doctor Amy Commander: 00:12:40

But when I was working at MGH, I remember one day I just saw a flyer for a lifestyle medicine conference that was being sponsored by the Institute of Lifestyle Medicine and Harvard Medical School, and I looked at the agenda.

Doctor Amy Commander: 00:12:53

There was talks about how to prescribe exercise to your patients, how to talk about the benefits of a plant based diet.

Doctor Amy Commander: 00:13:00

Like, these were the topics.

Doctor Amy Commander: 00:13:01

And I was like, wow, I'm personally so interested in these areas, but I really didn't have a lot of education or training in those specific areas in all of my medical training.

Doctor Amy Commander: 00:13:11

So that's how I ended up at that conference, and I was really blown away.

Doctor Amy Commander: 00:13:15

That was my first introduction to lifestyle medicine, and I was just sitting there thinking like, wow, I need to learn more.

Doctor Amy Commander: 00:13:21

I need to bring these tools to my patients with breast cancer who asked me this questions all day long in clinic and obviously to cancer survivors in general.

Doctor Amy Commander: 00:13:29

There's so much power from this field in terms of the evidence based information that we can use to help our patients.

Rib Esselstyn: 00:13:35

Yeah.

Rib Esselstyn: 00:13:35

What year was this that you went to?

Rib Esselstyn: 00:13:37

This.

Rib Esselstyn: 00:13:38

Can you remember?

Doctor Amy Commander: 00:13:39

ant to say it might have been: 2012

Rib Esselstyn: 00:13:44

So a good twelve years ago?

Rib Esselstyn: 00:13:47

Yeah, yeah, yeah.

Rib Esselstyn: 00:13:49

So that's pretty good.

Rib Esselstyn: 00:13:50

I mean, you've kind of been in the thick of it for over a decade.

Rib Esselstyn: 00:13:53

Good for you.

Rib Esselstyn: 00:13:54

You were one of the early pioneers.

Doctor Amy Commander: 00:13:56

Well, I mean, I think it took me some time to really get into it, to do the board certification, lifestyle medicine, et cetera.

Doctor Amy Commander: 00:14:02

But you're right, I did get exposed to it and interested and then, you know, found ways to learn more and, you know, certainly bring other colleagues into the fold, too, who are interested.

Doctor Amy Commander: 00:14:11

So that you're right, though, it has been a while.

Rib Esselstyn: 00:14:14

Yeah.

Rib Esselstyn: 00:14:17

Did you.

Rib Esselstyn: 00:14:18

I mean, so when you started learning more and more and more, did it just, were you like this intuitively, kind of makes sense, and it just kind of resonated with you because I'm just.

Rib Esselstyn: 00:14:29

I am frankly just amazed that more physicians somehow or another, haven't embraced this and that unfortunately, you are part of the minority instead of the majority.

Rib Esselstyn: 00:14:42

And I'm wondering if you have any thoughts around that.

Doctor Amy Commander: 00:14:45

You know, it's a really great question.

Doctor Amy Commander: 00:14:47

I think back to my days in medical school, school at Yale, which I was, you know, a great place to be in medical school.

Doctor Amy Commander: 00:14:53

We had really amazing lectures from world renowned professors.

Doctor Amy Commander: 00:14:57

But when I think back to education about nutrition, benefits of exercise, you know, I don't recall a lot of specific instruction on those topics.

Doctor Amy Commander: 00:15:07

And similarly an internship, residency, fellowship.

Doctor Amy Commander: 00:15:10

I mean, there's so much information that we need to learn and acquire, obviously, to become doctors and then later to be become an oncologist.

Doctor Amy Commander: 00:15:18

But these tools are absolutely important.

Doctor Amy Commander: 00:15:21

I fully agree with you.

Doctor Amy Commander: 00:15:22

There is such a need to integrate this information, certainly in medical school.

Doctor Amy Commander: 00:15:26

And I know that's changing, but we obviously need to do more.

Doctor Amy Commander: 00:15:29

And, you know, I'm working with a hemonk fellow right now at Cleveland Clinic, doctor Jasmine Hundell.

Doctor Amy Commander: 00:15:35

Give her a shout out.

Doctor Amy Commander: 00:15:36

And I know she's very passionate about this area.

Doctor Amy Commander: 00:15:37

So I think the future is bright that more doctors are learning about this and interested in bringing these tools to their patients.

Rib Esselstyn: 00:15:45

Well, I know on your Instagram post you recently posted, it was a study that came out, and it basically cited that almost 40 plus percent of these adult cancers are really due to lifestyle.

Rib Esselstyn: 00:16:06

And when I seed studies like that, when I see numbers like that, and I think that's really low, personally, but 40 or 50% of these major cancers are preventable through these modifiable risk factors, I'm like, wow.

Rib Esselstyn: 00:16:24

I mean, this should be headlines everywhere.

Doctor Amy Commander: 00:16:26

100% agree.

Doctor Amy Commander: 00:16:28

I mean, thankfully, we've seen major strides in reduction of use of tobacco.

Doctor Amy Commander: 00:16:34

Right.

Doctor Amy Commander: 00:16:34

Which is definitely led to a decrease in cancer and since immortality.

Doctor Amy Commander: 00:16:38

But, you know, excess body weight, as we know, is a major issue plaguing the United States and countries around the world.

Rib Esselstyn: 00:16:46

And let me ask you this about excess body weight.

Rib Esselstyn: 00:16:50

What is it about excess body weight that contributes to the acceleration of tumors and cancers?

Doctor Amy Commander: 00:16:59

That's such a great question.

Doctor Amy Commander: 00:17:00

And I feel like researchers are still trying to figure out exactly the mechanisms by which obesity or excess body weight increases risk of actually 13 different types of cancers.

Doctor Amy Commander: 00:17:10

And that was published in the New England journal in the early two thousands.

Doctor Amy Commander: 00:17:14

So this is not new information.

Doctor Amy Commander: 00:17:15

We've known this for quite some time.

Doctor Amy Commander: 00:17:17

Is it because of excessive inflammation in the body, oxidative stress, insulin resistance, changes in the gut, microbiome?

Doctor Amy Commander: 00:17:25

I mean, I think I'm listing all these things.

Doctor Amy Commander: 00:17:27

Cause I feel like we're still trying to understand these mechanisms so we can pinpoint this and address that issue in order to help reduce risk of cancer.

Doctor Amy Commander: 00:17:35

Because.

Doctor Amy Commander: 00:17:35

Yeah, as you know, cancer incidence, unfortunately, is increasing in individuals under age 50.

Doctor Amy Commander: 00:17:41

And we really need to figure out the reasons why and address that first.

Rib Esselstyn: 00:17:44

Yeah, and I cut you off with body weight.

Rib Esselstyn: 00:17:49

We were talking about how so much of the country is also overweight.

Rib Esselstyn: 00:17:52

And you mentioned how we've pretty much, I think, done a.

Rib Esselstyn: 00:17:57

A good job eradicating smoking.

Rib Esselstyn: 00:18:00

And I looked it up, and, you know, the definition of eradicating is getting less than 20% of the population to be doing something.

Rib Esselstyn: 00:18:08

So wouldn't it be great if we could have.

Rib Esselstyn: 00:18:10

We could eradicate the eating of animal products and animal byproducts.

Rib Esselstyn: 00:18:14

So it's less than 20% of this country that'd be, wow.

Rib Esselstyn: 00:18:19

And then the last thing, I think, where you are going was alcohol consumption, if I'm not mistaken.

Doctor Amy Commander: 00:18:25

Right, yeah, we know that.

Doctor Amy Commander: 00:18:26

In fact, that was a recent report that came out from the AACR just a few weeks ago, highlighting that alcohol is a carcinogen and a significant contributor to cancer risk in this country.

Doctor Amy Commander: 00:18:38

It's actually the third leading risk factor, modifiable risk factor, I should say, after tobacco use and excess body weight.

Doctor Amy Commander: 00:18:45

So it accounts for about 5% of cancer risk.

Doctor Amy Commander: 00:18:48

So, you know, I think.

Doctor Amy Commander: 00:18:49

And actually, what was also interesting in that study is over half of Americans did not know that alcohol use does increase risk for cancer.

Doctor Amy Commander: 00:18:58

So certainly it's a public health issue as well.

Doctor Amy Commander: 00:19:00

We need to get this message out.

Rib Esselstyn: 00:19:02

So how do you approach alcohol with your patients?

Doctor Amy Commander: 00:19:07

Right.

Doctor Amy Commander: 00:19:07

So certainly there's a lot of research in breast cancer that, you know, excessive alcohol use for my patients who have breast cancer is not recommended.

Doctor Amy Commander: 00:19:16

So, you know, based on many studies from the nurses health study and other studies, I don't tell my patients they have to completely eliminate alcohol.

Doctor Amy Commander: 00:19:24

But I like the AICR, American Institute of Cancer Research's motto, think before you drink.

Doctor Amy Commander: 00:19:31

So be mindful.

Doctor Amy Commander: 00:19:32

Why are you having a drink?

Doctor Amy Commander: 00:19:33

So if you're at a wedding and it's a big celebration and you want to have that glass of champagne, you can have that glass of champagne.

Doctor Amy Commander: 00:19:40

But in general, you know, people who drink mindlessly, I hate to say that, have that, two glasses of red wine each night, which a lot of people do, you know, I think that is an area that I really work with my patients to cut down on sort of the mindless drinking.

Doctor Amy Commander: 00:19:54

I'm not saying people are drinking in a mindless way, but, you know, sometimes there's just not a lot of thought because you don't think it's perhaps harmful to health.

Rib Esselstyn: 00:20:01

Yeah.

Rib Esselstyn: 00:20:02

Do you know who doctor Don Musalem is?

Doctor Amy Commander: 00:20:05

Yes, I'm a huge fan.

Doctor Amy Commander: 00:20:07

Love her.

Doctor Amy Commander: 00:20:08

Yes.

Rib Esselstyn: 00:20:08

Yeah.

Rib Esselstyn: 00:20:09

So just had her on last week, so you're gonna be on the heels of dawn.

Rib Esselstyn: 00:20:16

So you guys are like soul sisters.

Doctor Amy Commander: 00:20:19

Really love her very much, and I can't wait to see her at ACLM in a few weeks.

Rib Esselstyn: 00:20:23

Yeah.

Rib Esselstyn: 00:20:24

Oh, how exciting.

Rib Esselstyn: 00:20:28

But we talked a little bit about alcohol and I mentioned to her, and I'll just repeat it, that.

Rib Esselstyn: 00:20:33

Do you know who doctor Christy funk is?

Doctor Amy Commander: 00:20:35

Yes.

Rib Esselstyn: 00:20:36

Out in LA.

Rib Esselstyn: 00:20:37

Yeah.

Rib Esselstyn: 00:20:37

And so we also have her on this month as part of breast cancer, not awareness, but action month.

Rib Esselstyn: 00:20:47

Action month.

Rib Esselstyn: 00:20:49

And she mentioned to me that she's known about alcohol and she just said she's never really done anything about it, but she said finally she decided, I got to do something.

Rib Esselstyn: 00:21:00

And so she hasn't had a drink since January 1.

Doctor Amy Commander: 00:21:03

Oh, wow.

Doctor Amy Commander: 00:21:04

Yeah, I have a tip.

Doctor Amy Commander: 00:21:06

So, a wonderful oncology registered dietitian I work with, Carol Sullivan, has a tip to help people who have that craving for red wine.

Doctor Amy Commander: 00:21:15

Holding the wine glass and sipping it at night, she tells them to substitute with tart cherry juice, which actually does have benefits in terms of perhaps helping with sleep, helping with arthralgias that many of my patients experience secondary to their treatment.

Doctor Amy Commander: 00:21:31

And so I've actually had some patients tell me putting the tart cherry juice in the wine glass really helps them.

Doctor Amy Commander: 00:21:38

So that's one.

Doctor Amy Commander: 00:21:39

One pro tip I can share, thanks to Carol.

Rib Esselstyn: 00:21:42

That's a great pro tip.

Rib Esselstyn: 00:21:43

So anytime while we're talking, if you can think of a pro tip like that, that is gold.

Rib Esselstyn: 00:21:50

Okay, so let's talk about your signature program that you started is called paving the path to wellness.

Rib Esselstyn: 00:22:02

And it's a twelve week program, and you've also got this flywheel of twelve different things that you ask people to follow.

Rib Esselstyn: 00:22:09

And I think that it's fair to say that it really, it steps for not only breast cancer survivors and thrivers, but also people that maybe haven't, that are trying to prevent breast cancer.

Rib Esselstyn: 00:22:27

And it can allow everybody to kind of optimize their outcomes or their life going forward.

Doctor Amy Commander: 00:22:34

Yes.

Doctor Amy Commander: 00:22:34

I just want to say, getting back to that conference I attended back when I first started at Mass general, that's where I met Doctor Beth Fredes, who is currently the president of the American College of Lifestyle Medicine.

Doctor Amy Commander: 00:22:47

And we had coffee after the conference, because she's so generous with her time.

Doctor Amy Commander: 00:22:51

And I was like, I wanna start a program for my patients with breast cancer.

Doctor Amy Commander: 00:22:55

I'm gonna focus on diet, I'm gonna focus on exercise.

Doctor Amy Commander: 00:22:57

This was me.

Doctor Amy Commander: 00:22:58

Okay?

Doctor Amy Commander: 00:22:58

And she's like, Amy, you should think about a program that incorporates all the tools of lifestyle medicine.

Doctor Amy Commander: 00:23:06

Your patient would derive such great benefit.

Doctor Amy Commander: 00:23:08

And around that time, she had been offering a program called paving to stroke survivors at Spaulding Rehabilitation Hospital, which is a Harvard medical school affiliated rehab hospital here.

Doctor Amy Commander: 00:23:20

And that's actually how our collaboration began.

Doctor Amy Commander: 00:23:22

So, paving is really the inspiration of Doctor Fredes, I have to say.

Doctor Amy Commander: 00:23:27

And we began this collaboration to offer this to individuals with breast cancer.

Doctor Amy Commander: 00:23:31

So that's really where I took off with it.

Doctor Amy Commander: 00:23:33

And I continue to work closely with her and another wonderful colleague, who you may know, Doctor Michelle Tollefson.

Doctor Amy Commander: 00:23:39

And so I have really grown this program at Mass general.

Doctor Amy Commander: 00:23:43

And right now, we have, like, 65 people doing it.

Doctor Amy Commander: 00:23:47

It's really amazing.

Doctor Amy Commander: 00:23:48

Happy to tell you more about it.

Doctor Amy Commander: 00:23:50

And we hope to offer it to more because there's so much interest from this population.

Doctor Amy Commander: 00:23:56

There are 4 million breast cancer survivors in the US, and we need to help them.

Doctor Amy Commander: 00:24:01

And these tools have so much power, as, you know.

Rib Esselstyn: 00:24:04

Wow, I didn't know 4 million.

Rib Esselstyn: 00:24:06

So 4 million women that, yes.

Rib Esselstyn: 00:24:10

Living.

Rib Esselstyn: 00:24:10

Living and hopefully thriving.

Doctor Amy Commander: 00:24:13

That's the goal of our program.

Doctor Amy Commander: 00:24:15

We want to help people not only survive, but to thrive after their diagnosis of breast cancer.

Rib Esselstyn: 00:24:20

Yeah.

Rib Esselstyn: 00:24:20

And is this your fifth year of the program?

Doctor Amy Commander: 00:24:23

tarted it back in the fall of: 2019

Doctor Amy Commander: 00:24:33

It was in person.

Doctor Amy Commander: 00:24:34

n, you know, in the spring of: 2020

Doctor Amy Commander: 00:24:40

So we transitioned to a virtual format via Zoom.

Doctor Amy Commander: 00:24:43

And honestly, we've continued offering it that way.

Doctor Amy Commander: 00:24:46

There's pros and cons to in person versus virtual, but it's really enabled us to meet the needs of our patients who seek care at MGH or, like, all over Massachusetts.

Doctor Amy Commander: 00:24:56

So it's really been wonderful, and we have this amazing community that's really developed from people who have participated in this program.

Rib Esselstyn: 00:25:02

ou were going to launch it in: 2019

Rib Esselstyn: 00:25:15

And if so, how challenging was that?

Doctor Amy Commander: 00:25:19

Well, I will tell you, I had a dear patient, Arlie Langseth, who sadly has passed away.

Doctor Amy Commander: 00:25:26

But I will tell you, her passion was lifestyle medicine.

Doctor Amy Commander: 00:25:30

She did not know it at the time, but as a breast cancer patient, she sought out all the areas of lifestyle medicine to educate herself as she was going through her treatment.

Doctor Amy Commander: 00:25:38

Her dear husband donated to support the development of this program.

Doctor Amy Commander: 00:25:42

So I just went with it.

Doctor Amy Commander: 00:25:44

I may have told an administrator, I'm getting a hospital conference room and starting a program, and they were probably like, great.

Doctor Amy Commander: 00:25:50

But I just did it.

Doctor Amy Commander: 00:25:51

And I had funding and that support, bringing plant based food from the hospital cafeteria to the women who participated.

Doctor Amy Commander: 00:25:58

And really, that was the only cost we had.

Doctor Amy Commander: 00:26:01

And getting some workbooks for patients, but really, we just did it.

Rib Esselstyn: 00:26:05

Yeah.

Rib Esselstyn: 00:26:06

You know what?

Rib Esselstyn: 00:26:08

Kudos to you for, like, having.

Rib Esselstyn: 00:26:10

Having that attitude and that gumption.

Rib Esselstyn: 00:26:14

This is just a little side story.

Rib Esselstyn: 00:26:15

ember back in, must have been: 2001

Rib Esselstyn: 00:26:27

He likes to be busy.

Rib Esselstyn: 00:26:28

And so I tried to get him speaking engagements at different places that I knew, the fire station and the workout club and the library.

Rib Esselstyn: 00:26:41

And I even went to a couple hospitals, and two of the hospitals that I went to, they both said, this is too preventative oriented.

Rib Esselstyn: 00:26:49

And they said, no, thank you.

Rib Esselstyn: 00:26:51

So it's amazing how far we've come, right?

Doctor Amy Commander: 00:26:54

That is crazy.

Rib Esselstyn: 00:26:57

But.

Rib Esselstyn: 00:26:57

So let's talk about your program.

Rib Esselstyn: 00:27:01

ically have, do you call them: 1012

Doctor Amy Commander: 00:27:11

Yeah, so we do focus on the six key pillars of lifestyle medicine, which I'm happy, you know, exercise, plant based nutrition, sleep, stress management, social connection, and avoidance of use of risky substances.

Doctor Amy Commander: 00:27:26

So those are the six pillars of lifestyle medicine.

Doctor Amy Commander: 00:27:29

But when Doctor Fredes developed this program, she also wanted to incorporate other steps, such as how do we make goals?

Doctor Amy Commander: 00:27:37

Like what is the science of goal setting, which is really interesting.

Doctor Amy Commander: 00:27:41

How do we form new habits?

Doctor Amy Commander: 00:27:42

What is the, you know, why do we need to take breaks or timeouts?

Doctor Amy Commander: 00:27:46

What is purpose and how is that important sense of purpose after a cancer diagnosis?

Doctor Amy Commander: 00:27:50

That's a really big topic for our program.

Doctor Amy Commander: 00:27:52

So she incorporated a total of twelve different topics, as you noted.

Doctor Amy Commander: 00:27:57

And we meet weekly over twelve weeks and take a deep dive into each topic and also discuss the evidence that's relevant for breast cancer survivors.

Doctor Amy Commander: 00:28:06

And we make it very interactive and supportive.

Doctor Amy Commander: 00:28:10

And the patients honestly probably learn more from each other than from me and our other leaders.

Doctor Amy Commander: 00:28:15

But it's really been such a powerful program and it gives me such satisfaction to do it too.

Doctor Amy Commander: 00:28:20

I just absolutely love it.

Rib Esselstyn: 00:28:21

Well, I just can't even, I can't even imagine how fantastic it is to have this kind of a community, this kind of support where women, and I would imagine men, there might be a.

Doctor Amy Commander: 00:28:32

Maybe very few men get breast cancer too.

Doctor Amy Commander: 00:28:35

We actually have not had a male participant yet, but men would be welcome.

Doctor Amy Commander: 00:28:39

I want to say that.

Rib Esselstyn: 00:28:40

Okay, but these, where these women up to now have a place to just share something as that is just taking the earth out from underneath their feet and.

Rib Esselstyn: 00:28:55

Wow.

Rib Esselstyn: 00:28:55

So this is huge.

Rib Esselstyn: 00:28:57

I would, I would love to throw to you each one of the twelve and then just talk about it for a little bit, just so people can get a sense.

Rib Esselstyn: 00:29:05

So the first one is physical activity.

Rib Esselstyn: 00:29:09

And I guess my question to you is, after somebody has, well, let's set some ground rules here.

Rib Esselstyn: 00:29:17

Are we talking about people that have not had breast cancer or is this people that have had breast cancer and now they're trying to thrive and live after that.

Rib Esselstyn: 00:29:27

You want to do it that way.

Doctor Amy Commander: 00:29:29

As it currently is formed, is for individuals who've had a diagnosis of breast cancer.

Doctor Amy Commander: 00:29:36

But you're right, these tools are so important for risk reduction as well.

Doctor Amy Commander: 00:29:39

But that is the current population have had breast cancer.

Rib Esselstyn: 00:29:42

So physical activity, what is your position on physical activity after breast cancer?

Doctor Amy Commander: 00:29:48

Ooh, this is one of my favorites, but of course, I love all the topics.

Doctor Amy Commander: 00:29:52

So obviously, from talking to doctor Musalim and doctor Funk, you're going to learn all about the immense benefits of physical activity for breast cancer.

Doctor Amy Commander: 00:30:00

Cancer survivors.

Doctor Amy Commander: 00:30:01

There are so many studies that demonstrate that exercise itself can help reduce risk of recurrence from breast cancer and improve outcome from breast cancer.

Doctor Amy Commander: 00:30:11

So this is huge just from exercise.

Doctor Amy Commander: 00:30:13

So, in fact, exercise is now incorporated into the guidelines from my organization, the American Society of Clinical Oncology, and other major reputable organizations.

Doctor Amy Commander: 00:30:25

We need to be talking to our patients about exercise, but I will tell you that many in my field do not feel comfortable providing counseling and advice about an exercise regimen.

Doctor Amy Commander: 00:30:37

And there's really not enough programs out there to provide instruction to patients.

Doctor Amy Commander: 00:30:40

So this is another area of great opportunity that we need to work on, not just for the breast cancer patients, but for all cancer patients.

Rib Esselstyn: 00:30:48

I mean, yeah, I really think that physical activity is built into our DNA as human beings, and there's just so many incredible benefits that have been shown around movement.

Rib Esselstyn: 00:31:01

What about, I'm trying to think what, what is great that goes right after that, because I also notice in your.

Doctor Amy Commander: 00:31:10

We can go down it, so we can keep it simple.

Doctor Amy Commander: 00:31:12

Attitude.

Rib Esselstyn: 00:31:13

Okay, you know what, you know what?

Rib Esselstyn: 00:31:14

Let's do that.

Rib Esselstyn: 00:31:15

Let's do that because I have that in front of me, so, okay, so, yes, attitude, yay.

Doctor Amy Commander: 00:31:21

So that is a big one, right?

Doctor Amy Commander: 00:31:24

Especially for, unfortunately, our patient population who has just gone through cancer treatment.

Doctor Amy Commander: 00:31:29

Usually most of our folks have completed primary chemotherapy, radiation therapy.

Doctor Amy Commander: 00:31:32

Some of them are still in the midst of it, but they're taking their anti estrogen therapy or other targeted therapies.

Doctor Amy Commander: 00:31:38

So attitude's a big one.

Doctor Amy Commander: 00:31:39

So we talk about that a lot.

Doctor Amy Commander: 00:31:41

And what comes with attitude, like how you cope with your diagnosis, the concept of self compassion, the work done by doctor Kristin Neff and others.

Doctor Amy Commander: 00:31:50

And a major topic we discuss in our groups is how to handle fear of recurrence.

Doctor Amy Commander: 00:31:55

Because if you ask any breast cancer survivor that is always top of mind, is that back pain I'm having related to my breast cancer.

Doctor Amy Commander: 00:32:04

And we really tackle that and discuss strategies to help individuals manage that problem, because it is always on their mind, unfortunately, yeah.

Rib Esselstyn: 00:32:13

I mean, I think, you know, the longer I live, the more I'm convinced that attitude is everything so vitally important to everything we do in this lifetime.

Rib Esselstyn: 00:32:28

And again, as you said, we're going to be using paving steps.

Rib Esselstyn: 00:32:32

So the next thing is a.

Rib Esselstyn: 00:32:34

I'm sorry, is van, which is variety.

Rib Esselstyn: 00:32:37

What, what do you mean by variety?

Doctor Amy Commander: 00:32:39

And we just did this topic this past week, and this is a fun one.

Doctor Amy Commander: 00:32:42

I mean, some of our patients like this one the most, and you'll like it, too.

Doctor Amy Commander: 00:32:46

We just talk about variety with, you know, with regard to the other things like physical activity.

Doctor Amy Commander: 00:32:50

What are different types of exercises that you can try that might bring joy?

Doctor Amy Commander: 00:32:55

When we think about nutrition, you know, we say eat the rainbow.

Doctor Amy Commander: 00:32:58

What does that mean?

Doctor Amy Commander: 00:32:59

Maybe you try, you know, different fruits and vegetables that you've never tried before.

Doctor Amy Commander: 00:33:03

Or when we think about managing stress, what are different techniques that one could use to help address that?

Doctor Amy Commander: 00:33:09

So we just talk about thinking of creative ways to explore all of the different topics.

Doctor Amy Commander: 00:33:14

And we always have a great discussion with the women about that topic.

Rib Esselstyn: 00:33:18

Well, I've heard this quote that variety is the spice of life.

Doctor Amy Commander: 00:33:22

Yes, we use that.

Doctor Amy Commander: 00:33:23

That is what we launched the session with.

Doctor Amy Commander: 00:33:25

So that is a great quote for sure.

Rib Esselstyn: 00:33:28

Good.

Rib Esselstyn: 00:33:30

I is for investigations.

Rib Esselstyn: 00:33:33

I have no idea what that means.

Rib Esselstyn: 00:33:35

Investigations?

Rib Esselstyn: 00:33:35

What am I investigating?

Doctor Amy Commander: 00:33:37

So we encourage each participant to think of herself like she's the n of one in a scientific experiment.

Doctor Amy Commander: 00:33:44

So we all want to try new things.

Doctor Amy Commander: 00:33:46

So let's say, you know, an individual's like, oh, I really know.

Doctor Amy Commander: 00:33:50

Doctor commander told me I need to start a strength training program to help my bones and improve my muscle mass.

Doctor Amy Commander: 00:33:56

After, you know, my breast cancer treatment, I guess I will go to a gym and try a class two times a week to really work on strength training.

Doctor Amy Commander: 00:34:02

How do I feel?

Doctor Amy Commander: 00:34:03

So we encourage our participants to do little experiments on themselves and think of themselves, you know, have a hypothesis, gather the data, look at the results.

Doctor Amy Commander: 00:34:12

And so that's what we talk about when we focus on that topic.

Doctor Amy Commander: 00:34:14

And we have a lot of fun with that, too.

Rib Esselstyn: 00:34:16

Yeah, well, it's nice.

Rib Esselstyn: 00:34:18

It gives them something to focus on, right?

Doctor Amy Commander: 00:34:21

Definitely.

Rib Esselstyn: 00:34:22

N is nutrition.

Rib Esselstyn: 00:34:26

I have no idea where you're going with this one.

Doctor Amy Commander: 00:34:29

And I know I have to hold up the cookbook, right?

Doctor Amy Commander: 00:34:32

I have be a plant based woman warrior cookbook right here.

Doctor Amy Commander: 00:34:35

So we talk about different approaches for incorporating more plants into our diet.

Doctor Amy Commander: 00:34:40

You know, what are the recommendations from organizations like the American Cancer Society, American Institute of Cancer Research, American College of Lifestyle Medicine.

Doctor Amy Commander: 00:34:48

How can individuals you know, incorporate more of a whole food plant based diet into their routine.

Doctor Amy Commander: 00:34:53

And, you know, this is a challenge for many people who maybe never thought about that and haven't really tried to make dietary changes, but this is always a favorite topic.

Doctor Amy Commander: 00:35:02

In fact, we actually kind of do it over two sessions.

Doctor Amy Commander: 00:35:04

In fact, next week I'm hosting, I'm not the chef, but I'm hosting with a chef, a culinary medicine cooking class.

Doctor Amy Commander: 00:35:12

We'll do some cooking with our participants and provide education at the same time.

Doctor Amy Commander: 00:35:17

We try to make it fun and interactive.

Rib Esselstyn: 00:35:19

You just rattled off a bunch of organizations that are advocating for whole food plant based.

Rib Esselstyn: 00:35:26

Is there anyone that, you know, any of these organizations that are not leaning into plants?

Doctor Amy Commander: 00:35:33

I mean, all of these organizations.

Doctor Amy Commander: 00:35:35

American Cancer Society, of course, AICR, which I love, and of course ACLM very much recommend incorporating.

Doctor Amy Commander: 00:35:42

At least half of your plate should be fruits and veggies, and also trying different plant based proteins, limiting the ultra processed foods that unfortunately are such a huge component of our diet.

Doctor Amy Commander: 00:35:54

And we're learning more and more about how they're not good for our health.

Doctor Amy Commander: 00:35:57

So we really talk about that.

Doctor Amy Commander: 00:35:59

And I would say the major organizations now, thankfully, do recommend a focus more on a whole food plant based type of pattern.

Doctor Amy Commander: 00:36:06

I mean, you know, whether people eat chicken, meat or fish, you know, that gets into the details.

Doctor Amy Commander: 00:36:12

So some of them don't have, you know, specifically say patients should not consume that.

Doctor Amy Commander: 00:36:16

But certainly there is a focus on eating the rainbow.

Doctor Amy Commander: 00:36:19

Get lots of fruits and veggies into your diet, Evan.

Rib Esselstyn: 00:36:21

Yeah.

Rib Esselstyn: 00:36:22

So specifically around breast cancer, is there any particular foods that you recommend that women eat?

Rib Esselstyn: 00:36:34

For example, soy, whole soy or something like that?

Doctor Amy Commander: 00:36:38

Yeah.

Doctor Amy Commander: 00:36:38

So we, I think there's a lot of fear around soy and a lot of misconceptions.

Doctor Amy Commander: 00:36:42

I'm sure you've encountered this as well.

Doctor Amy Commander: 00:36:44

And, you know, the data would suggest that soy consumption, you know, from a whole food type of source, is safe for breast cancer survivors and in fact, maybe improving outcome.

Doctor Amy Commander: 00:36:54

So we do encourage consumption of soy, whether that's edamame, tofu, that type of thing.

Doctor Amy Commander: 00:36:59

And, you know, for example, on our cooking class next week, I think one of our recipes does involve tofu, which some people have never even tried to cook before.

Doctor Amy Commander: 00:37:07

So we discussed strategies for incorporating soy and other plant based proteins into the diet.

Doctor Amy Commander: 00:37:12

We talked a lot about alcohol and the need to limit it, as we discussed earlier, because, again, there's not a lot of education and awareness about that topic, which is a food, right?

Doctor Amy Commander: 00:37:21

Food or drink.

Rib Esselstyn: 00:37:23

So are all the breast cancer survivors and thrivers that are part of the paving steps.

Rib Esselstyn: 00:37:32

Twelve week program.

Rib Esselstyn: 00:37:34

Do they have to be a patient at one of your hospitals or is this for anybody?

Doctor Amy Commander: 00:37:39

Great question.

Doctor Amy Commander: 00:37:40

So the program we're currently talking about I offer at the Mass General Cancer center for our mass general patients, but in collaboration with Doctor Friedes and Doctor Tollefson and Val Tibnan and another wonderful colleague, we did start a nonprofit called Paving Wellness.

Doctor Amy Commander: 00:37:54

And our goal is to offer this program and for other populations through our nonprofits.

Doctor Amy Commander: 00:38:00

So that is a work in progress.

Doctor Amy Commander: 00:38:01

But we're excited to start doing that because I feel like there's so many individuals who would get derived benefit from this program and we need to spread the word.

Rib Esselstyn: 00:38:10

Yeah, I would imagine that for those that don't know what they're getting into, maybe with this twelve week program, they must come out of it just raving and going.

Rib Esselstyn: 00:38:25

This exceeded all my expectations.

Rib Esselstyn: 00:38:28

I can't believe what you've put together here.

Rib Esselstyn: 00:38:29

And I even noticed, Amy, that you guys have put together a paving steps guidebook for as well.

Rib Esselstyn: 00:38:38

I mean, so well organized.

Doctor Amy Commander: 00:38:40

Bravo workbook.

Doctor Amy Commander: 00:38:41

And by the way, any proceeds from that goes to our nonprofit.

Doctor Amy Commander: 00:38:45

But yes, the workbook is a great tool and we encourage our participants to use the workbook during the course of the program and we get great feedback about that.

Doctor Amy Commander: 00:38:55

So.

Doctor Amy Commander: 00:38:55

But you're so right.

Doctor Amy Commander: 00:38:56

I will say one of my patients told me this program provided me with a roadmap for hope after cancer, which is like, it was such a gift.

Doctor Amy Commander: 00:39:06

And, you know, just comments like that are just so wonderful and touching and really, you know, this is why we do this, right?

Doctor Amy Commander: 00:39:15

Because it really does make such a tremendous impact on our patients after they got something gone through, such a traumatic thing as a breast cancer diagnosis and all the treatment that that entails.

Rib Esselstyn: 00:39:23

Yeah, well, you mentioned that.

Rib Esselstyn: 00:39:25

So one of the goals is to have the proceeds go to fund the nonprofit.

Rib Esselstyn: 00:39:32

Bravo.

Rib Esselstyn: 00:39:34

The last letter in paving is g goals.

Rib Esselstyn: 00:39:38

So what do you, are these goals around people's recovery?

Rib Esselstyn: 00:39:42

What is it?

Doctor Amy Commander: 00:39:43

Yeah, we talk about setting smart goals.

Doctor Amy Commander: 00:39:45

So, you know, when our patients are like, oh, my gosh, exercise, like, how am I going to do that?

Doctor Amy Commander: 00:39:50

So we talk about how to, like, break it down into little action goals and we talk about, you know, what the recommendations are, you know, in terms of exercise for cancer survivors.

Doctor Amy Commander: 00:39:59

But, you know, we don't want someone to be like, okay, I have to go from zero to 150 minutes of moderate aerobic activity each week.

Doctor Amy Commander: 00:40:05

So we talk about how to set goals and the importance of accountability and the community.

Doctor Amy Commander: 00:40:11

And it's really powerful.

Doctor Amy Commander: 00:40:13

And I should tell you, there's five more steps.

Doctor Amy Commander: 00:40:15

S t e p s s.

Doctor Amy Commander: 00:40:17

I can go.

Rib Esselstyn: 00:40:18

I know, I know.

Rib Esselstyn: 00:40:19

I'm getting there.

Rib Esselstyn: 00:40:21

Yeah, yeah, we got.

Rib Esselstyn: 00:40:22

We're just getting started here.

Rib Esselstyn: 00:40:23

Okay, hang in there, everybody, because that was paving.

Rib Esselstyn: 00:40:28

Now we're going to steps.

Rib Esselstyn: 00:40:29

And the first thing is stress resiliency.

Rib Esselstyn: 00:40:33

You know, I think we all know what stress is, but stress resiliency, maybe.

Rib Esselstyn: 00:40:38

Well, what is that exactly?

Doctor Amy Commander: 00:40:40

Right.

Doctor Amy Commander: 00:40:40

Well, I think many would say that there's unfortunately not much out there that is more stressful than a diagnosis of cancer.

Doctor Amy Commander: 00:40:49

And so in that session, we really focus on what are some strategies that cancer survivors can use to help manage stress and become more resilient.

Doctor Amy Commander: 00:40:59

And so we talk about what the latest evidence with support, but we also talk about different strategies.

Doctor Amy Commander: 00:41:05

And again, the women always learn from each other.

Doctor Amy Commander: 00:41:07

Some are really interested in meditation, forest bathing.

Doctor Amy Commander: 00:41:11

Cooking is their stress tool.

Doctor Amy Commander: 00:41:13

Like, there's just so many interesting approaches people take to manage stress.

Doctor Amy Commander: 00:41:16

So that's always, you know, a really important topic that we focus on.

Rib Esselstyn: 00:41:20

Nice.

Rib Esselstyn: 00:41:21

I've been doing a lot of forest bathing lately.

Rib Esselstyn: 00:41:23

It's been very, very therapeutic.

Rib Esselstyn: 00:41:26

I need to do more of that, especially in Boston.

Rib Esselstyn: 00:41:30

So, time outs.

Rib Esselstyn: 00:41:32

T is for timeouts.

Rib Esselstyn: 00:41:34

Is this where you go sit in the corner by yourself?

Doctor Amy Commander: 00:41:37

Those of us with kids?

Doctor Amy Commander: 00:41:38

No, that's our definition of timeout.

Doctor Amy Commander: 00:41:40

And, hey, I guess it does apply, but really, the concept of taking time for yourself, the importance of taking breaks, you know, in this fast paced world, sometimes we rarely take time for ourselves just to kind of, like you said, go outside and walk or take a little hike, you know, in the middle of the day, just to kind of clear your brain, like.

Doctor Amy Commander: 00:41:58

And we talk, you know, there's science behind this.

Doctor Amy Commander: 00:42:00

This is, like, important that we do this, that we allow ourselves to take these breaks, especially for in front of screens, all day.

Doctor Amy Commander: 00:42:06

And so we do dedicate a session to that.

Doctor Amy Commander: 00:42:08

And our participants do love that.

Doctor Amy Commander: 00:42:11

And it's really special.

Rib Esselstyn: 00:42:13

Yeah.

Rib Esselstyn: 00:42:13

I don't think nearly enough of us take enough timeouts during the day, whether it's to meditate, whether it's to, frankly, do a 30 minutes workout or something, to just kind of reset.

Rib Esselstyn: 00:42:27

Right.

Rib Esselstyn: 00:42:27

You're just kind of your whole system.

Rib Esselstyn: 00:42:30

Speaking of e energy, what kind of energy are we talking about here?

Doctor Amy Commander: 00:42:35

I know.

Doctor Amy Commander: 00:42:36

So this is another really important one.

Doctor Amy Commander: 00:42:38

So they're all important.

Doctor Amy Commander: 00:42:40

So there is this entity called cancer related fatigue, which is really the most common symptom that often my patients will report to me in clinic, and that can be multifactorial due to specific medical reasons, perhaps anemia, thyroid dysfunction, or it could be side effects from drugs, or it can just be recovery from that intense cancer treatment.

Doctor Amy Commander: 00:43:01

And it just takes time for the body to bounce back.

Doctor Amy Commander: 00:43:03

So we really talk about strategies to manage energy.

Doctor Amy Commander: 00:43:06

And I work with an amazing social worker colleague, Kirsten Anderson, who, for example, talked about this concept of the spoon theory.

Doctor Amy Commander: 00:43:14

I'm not sure if you're familiar with it, but I love this metaphor.

Doctor Amy Commander: 00:43:18

We each wake up in the morning with a certain set of spoons.

Doctor Amy Commander: 00:43:22

Spoons.

Doctor Amy Commander: 00:43:23

That really is sort of a metaphor for how much energy we have.

Doctor Amy Commander: 00:43:25

And so she kind of talks with the participants about, if you have five spoons and you have like 15 things you were hoping to do today, maybe you need to cut it down to five and think about, prioritize, what are the most important thinking about ways to manage your energy.

Doctor Amy Commander: 00:43:39

And so that's another really important topic for this population.

Rib Esselstyn: 00:43:44

Yeah, yeah.

Rib Esselstyn: 00:43:45

I can't even imagine.

Rib Esselstyn: 00:43:48

Um hmm.

Rib Esselstyn: 00:43:50

Um.

Rib Esselstyn: 00:43:50

Okay.

Rib Esselstyn: 00:43:51

P purpose.

Doctor Amy Commander: 00:43:55

So that's a big one.

Doctor Amy Commander: 00:43:57

And you know, this is coming near the end of the twelve weeks, but we really have a discussion with the group about sense of purpose, why it's important for our well being and overall health.

Doctor Amy Commander: 00:44:09

And also, how does one sense of purpose perhaps change after a cancer diagnosis?

Doctor Amy Commander: 00:44:15

And I will tell you, this is always a very powerful discussion amongst our members, and some individuals actually don't know what their purpose is and they're trying to seek it out and figure out what they want to do now with their time.

Doctor Amy Commander: 00:44:28

And some have all of a sudden, like, almost like an epiphany of something they've always wanted to do and now they're going to do it.

Doctor Amy Commander: 00:44:36

So it is, it's a really interesting topic for this popular for all of us to ponder.

Doctor Amy Commander: 00:44:41

Right.

Doctor Amy Commander: 00:44:41

But in particular in this group, it's a always a really robust discussion.

Rib Esselstyn: 00:44:45

Well, regarding purpose and our time here on earth.

Rib Esselstyn: 00:44:50

And after a breast cancer diagnosis and then surgery and all the different procedures these days, on average, how long is the average person that's been diagnosed with breast cancer surviving?

Doctor Amy Commander: 00:45:10

Great question.

Doctor Amy Commander: 00:45:11

Thankfully, due to so many advances in treatment, our patients do really well.

Doctor Amy Commander: 00:45:17

I mean, the five year survival rate obviously depends on the stage, but it's very high now.

Doctor Amy Commander: 00:45:22

And even our patients with advanced breast cancer can live for years with that diagnosis.

Doctor Amy Commander: 00:45:28

So our patients thankfully live for many years and therefore they do have an opportunity to really concentrate the sense of purpose and what's important to them.

Rib Esselstyn: 00:45:39

So along those lines, are you a big fan of testing and testing often.

Rib Esselstyn: 00:45:45

What is your philosophy?

Doctor Amy Commander: 00:45:47

And that's a really interesting question.

Doctor Amy Commander: 00:45:49

In our field, there's now this new technology.

Doctor Amy Commander: 00:45:52

You can do a blood test on a patient and look for circulating tumor DNA in the blood.

Doctor Amy Commander: 00:45:58

And this is kind of something they've been using in the colon cancer space for quite some time.

Doctor Amy Commander: 00:46:02

But in the breast cancer world, these are new tests that are now being used, and some patients can order them actually on their own.

Doctor Amy Commander: 00:46:10

But learning how to best use this technology, I would say, is still an area of ongoing research, and I do not recommend this as a standard practice.

Doctor Amy Commander: 00:46:18

But I do have some patients who have chosen to do this.

Doctor Amy Commander: 00:46:21

When you say, why have you not recommended this?

Doctor Amy Commander: 00:46:23

Because we actually are still learning what to do with that data.

Doctor Amy Commander: 00:46:26

If a patient did have a positive test and has a scan that's negative.

Doctor Amy Commander: 00:46:30

So this is an area that we will need to sort out over the next few years.

Doctor Amy Commander: 00:46:33

But definitely, we certainly follow our patients closely in our clinic, and they are seen every six months in the first five years for close follow up.

Rib Esselstyn: 00:46:46

Let me ask you this.

Rib Esselstyn: 00:46:48

Outside of these lifestyle pillars that we've been talking about, is there anything else that you've seen that in the advancement of breast cancer or other cancers that has you going, wow, I can't believe how fast medicine is moving.

Doctor Amy Commander: 00:47:08

I mean, I will say every day in clinic when I have a patient who's on a trial, for example, October 1, just a few days ago, I saw my first patient early in the morning, and she's on a clinical trial setting a new anti estrogen medication in the adjuvant setting.

Doctor Amy Commander: 00:47:24

So she has early stage disease, and she's on this trial studying this new agent.

Doctor Amy Commander: 00:47:29

And I just said, it's October 1, this is breast cancer awareness month.

Doctor Amy Commander: 00:47:33

And I did tell her, you know, I love calling it breast cancer Action Month.

Doctor Amy Commander: 00:47:38

And I thanked her.

Doctor Amy Commander: 00:47:39

You are taking action by being on a clinical trial to help us determine if this medicine you're on will be the next endocrine therapy for future women just like you.

Doctor Amy Commander: 00:47:49

And she was like, thank you so much for pointing that out.

Doctor Amy Commander: 00:47:52

That really made my day.

Doctor Amy Commander: 00:47:53

So we've had so many advances in our drugs in just the past few years that sometimes when I'm in clinic, I really take a second to ponder that, and I'm like, wow, you know, we really are.

Doctor Amy Commander: 00:48:04

I mean, it's, it takes a team.

Doctor Amy Commander: 00:48:05

You know, we need the clinical researchers, the basic scientists, the oncologists.

Doctor Amy Commander: 00:48:10

You know, there's just such a collaboration to help bring these drugs to our patients.

Doctor Amy Commander: 00:48:13

And so I have seen really immense progress, even in the past few years.

Doctor Amy Commander: 00:48:17

So it's really exciting.

Doctor Amy Commander: 00:48:19

It's an exciting field to be in, but the lifestyle piece is absolutely key as well.

Rib Esselstyn: 00:48:23

Oh, yeah.

Rib Esselstyn: 00:48:25

S.

Rib Esselstyn: 00:48:26

We got two s's to tackle here.

Rib Esselstyn: 00:48:30

The first is sleep.

Rib Esselstyn: 00:48:32

I'm getting tired.

Doctor Amy Commander: 00:48:34

Yeah, sleep is, I mean, I hate to say this, insomnia, sleep disturbance, like really, really prevalent in cancer survivors and very unfortunate.

Doctor Amy Commander: 00:48:44

And sleep can be disruptive for so many reasons.

Doctor Amy Commander: 00:48:46

Hot flashes, pain, anxiety, or just hormonal changes that can make sleep difficult.

Doctor Amy Commander: 00:48:52

So I'm fortunate to work with a colleague, doctor Daniel hall, who's doing a lot of really interesting research on how to improve sleep in cancer survivors.

Doctor Amy Commander: 00:49:00

And so that's a topic that, you know, definitely helps a lot of people because we all need to work on our sleep and that, and me included, by the way.

Doctor Amy Commander: 00:49:08

So that's an important one.

Doctor Amy Commander: 00:49:11

And then the last one is actually one of my favorites.

Doctor Amy Commander: 00:49:15

And I underestimated the importance of the last topic until I actually ran my first paving program.

Doctor Amy Commander: 00:49:22

And that is social connection.

Doctor Amy Commander: 00:49:24

So I was always like, yeah, social connection, that's a great topic.

Doctor Amy Commander: 00:49:29

But our first paving program ended and I was like congratulating the participants for sticking it out with me for twelve weeks.

Doctor Amy Commander: 00:49:37

And I was also secretly congratulating myself like, you actually did it.

Doctor Amy Commander: 00:49:41

You led a group program for twelve weeks.

Doctor Amy Commander: 00:49:43

And I said, you all graduated, you can move on.

Doctor Amy Commander: 00:49:46

And they were like, doctor, commander, we are not done.

Doctor Amy Commander: 00:49:50

They had really bonded by studying all these topics together.

Doctor Amy Commander: 00:49:53

And they're like, we want to do it again.

Doctor Amy Commander: 00:49:56

And they actually did that.

Doctor Amy Commander: 00:49:57

They did it again on their own.

Doctor Amy Commander: 00:49:59

They stayed together and they are still like this.

Doctor Amy Commander: 00:50:03

They call themselves the originals and they meet on Zoom once or twice a month and continue to focus on the paving steps or whatever else they want to talk about.

Doctor Amy Commander: 00:50:11

But they continue to support each other after their cancer diagnosis, which is really beautiful.

Rib Esselstyn: 00:50:15

Yeah, no, we, we hold these retreats twice a year, typically for 80 people.

Rib Esselstyn: 00:50:23

And people, they come because they want to be around like minded people.

Rib Esselstyn: 00:50:28

They, they're just dying for the social connection because where they are, they just feel so alone.

Rib Esselstyn: 00:50:33

Right.

Rib Esselstyn: 00:50:34

So social connection.

Rib Esselstyn: 00:50:35

Can't underestimate it.

Rib Esselstyn: 00:50:37

Yeah.

Rib Esselstyn: 00:50:37

So those are, those are the twelve and you.

Rib Esselstyn: 00:50:39

And in the pinwheel that I'm looking at right now, I see you've kind of broken it up into four quadrants.

Rib Esselstyn: 00:50:45

Action, joyful heart, healthy body and peaceful mind, which is, which is nice.

Rib Esselstyn: 00:50:51

Really nice the way you've done that.

Doctor Amy Commander: 00:50:53

Yeah, I love.

Doctor Amy Commander: 00:50:54

Yeah.

Doctor Amy Commander: 00:50:54

Doctor Beth Brady's, that's her thing.

Doctor Amy Commander: 00:50:56

She wants to help people achieve healthy body, peaceful mind, and joyful heart, and then focus on the action steps needed to get there.

Doctor Amy Commander: 00:51:05

So I absolutely love that, too.

Rib Esselstyn: 00:51:07

So you have your paving steps now.

Rib Esselstyn: 00:51:09

Recently, you came out with your breast cancer action plan, right?

Rib Esselstyn: 00:51:16

And that was published by Harvard Medical School, and you were the medical editor for that.

Rib Esselstyn: 00:51:24

When did that come out, and what's that all about?

Doctor Amy Commander: 00:51:27

Yeah, it just came out, I want to say, a few months ago, and it was a wonderful collaboration and really just to help, you know, in this world of social media and TikTok and all the stuff that's out there, I feel like our patients are very savvy.

Doctor Amy Commander: 00:51:43

They do their research.

Doctor Amy Commander: 00:51:44

When I see a new patient, she's already read about everything that she thinks I'm going to tell her about.

Doctor Amy Commander: 00:51:49

So I think it's really great to provide, provide evidence based, reputable resources for our patients because we know there's a lot of misinformation out there.

Doctor Amy Commander: 00:51:57

So that was why I was really excited to collaborate and work on that action plan booklet because I feel like, you know, people will trust Harvard Medical School and hopefully me, to provide evidence based information that's cutting edge.

Doctor Amy Commander: 00:52:11

And we did incorporate information about the tools from lifestyle interventions, too, and how those are very important after a breast cancer diagnosis.

Rib Esselstyn: 00:52:19

Yeah.

Rib Esselstyn: 00:52:20

So hanging around Harvard.

Rib Esselstyn: 00:52:22

d Harvard now for what, about: 1520

Doctor Amy Commander: 00:52:27

I mean, since I came back for internship and residency.

Doctor Amy Commander: 00:52:30

I know it's hard to believe, but.

Rib Esselstyn: 00:52:33

So have you ever run into Walter Willett?

Doctor Amy Commander: 00:52:37

I know he's such a fan.

Doctor Amy Commander: 00:52:39

So, yes, I've been fortunate to hear him speak and certainly been over to the Harvard School of Public Health.

Doctor Amy Commander: 00:52:44

And by the way, they have an amazing cafeteria.

Doctor Amy Commander: 00:52:49

But yes, I know he's definitely renowned around here, for sure.

Rib Esselstyn: 00:52:53

Yeah.

Rib Esselstyn: 00:52:53

Yeah.

Rib Esselstyn: 00:52:54

And so is the cafeteria.

Rib Esselstyn: 00:52:56

Do they have some nice plant based offerings?

Doctor Amy Commander: 00:52:59

Yes.

Doctor Amy Commander: 00:52:59

I mean, I haven't been there in a while, but last time I was there, I was like, ooh, this is a good cafeteria to visit because I can't always say the same about the hospital cafeteria.

Rib Esselstyn: 00:53:08

Yeah, yeah.

Rib Esselstyn: 00:53:09

You mentioned hot flashes.

Rib Esselstyn: 00:53:12

I just like to touch upon menopause for a second.

Rib Esselstyn: 00:53:16

Have you found that kind of these lifestyle steps also help women with menopause?

Doctor Amy Commander: 00:53:27

Definitely.

Doctor Amy Commander: 00:53:28

I mean, we know there's evidence that certain lifestyle interventions, such as regular physical activity, incorporating some soy foods into your diet, following more of a plant predominant diet, definitely can help reduce hot flashes.

Doctor Amy Commander: 00:53:43

And so.

Doctor Amy Commander: 00:53:44

And, you know, my colleague, Doctor Michelle Tollefson, speaks about this a lot, too.

Doctor Amy Commander: 00:53:47

So I think it's really important to start with these lifestyle interventions for my patients.

Doctor Amy Commander: 00:53:52

Certainly, if they're trying these measures and it's really not working, we will consider various medications, you know, non hormonal medications to help them manage their hot flashes, because that is a pretty distressing symptom that many of our patients experience, often secondary to some of the treatments that we're recommending for them.

Doctor Amy Commander: 00:54:09

So, yeah, so we deal with hot flashes a lot in our population, unfortunately.

Rib Esselstyn: 00:54:15

Yeah.

Rib Esselstyn: 00:54:15

What, what's, what's the average age of your breast cancer patients?

Doctor Amy Commander: 00:54:22

Right.

Doctor Amy Commander: 00:54:22

st cancer in this country for: 2024

Doctor Amy Commander: 00:54:32

The average age is early sixties, I believe 62.

Doctor Amy Commander: 00:54:35

But I will tell you, I mean, maybe it's because I'm at mass general cancer center, where it's a referral center, we tend, I tend to see a younger population.

Doctor Amy Commander: 00:54:43

You know, I would say the average age of my practice, it's probably mid to late forties.

Doctor Amy Commander: 00:54:49

That's the average age that I see, but that's probably just because of where I work.

Rib Esselstyn: 00:54:54

And so would you say it's infrequent to see somebody with breast cancer in their thirties?

Doctor Amy Commander: 00:55:01

Well, that's another unfortunate finding from recent studies, including this American Cancer Society report that was recently released, that we are seeing an increased incidence of breast cancer, particularly in women under 50, and that risk can be about 1.4% per year increase over the past ten years.

Doctor Amy Commander: 00:55:22

And so there is an increased incidence, again, it was under age 50.

Doctor Amy Commander: 00:55:27

I don't know if they broke it down to women under 30, although we sometimes see that, too.

Doctor Amy Commander: 00:55:31

But I think this is a real wake up because certainly there's reports about increased incidence of early onset colon cancer and other types of cancer.

Doctor Amy Commander: 00:55:40

So we really need to focus on why is this happening, as we talked about in the beginning, and how can we address this and curtail this trend?

Rib Esselstyn: 00:55:48

What do you think is causing the increase?

Doctor Amy Commander: 00:55:50

Well, you know, I think we both are probably on the same page about our concerns about our sad standard american diet, which, I mean, I hate to say it, that's obviously, we're worried that that's one of the factors.

Doctor Amy Commander: 00:56:03

There are probably, it's probably multifactorial.

Doctor Amy Commander: 00:56:06

You know, there's so many other potential exposures that we have from when we're kids until we're adults that could affect that.

Doctor Amy Commander: 00:56:14

Not just the diet, environmental exposure, exposures, toxins, more data about pollution, you know, microplastics.

Doctor Amy Commander: 00:56:20

Again, I'm.

Doctor Amy Commander: 00:56:21

There's so many factors.

Doctor Amy Commander: 00:56:22

So often when I read articles about this, they're still like, we're still trying to figure it out.

Doctor Amy Commander: 00:56:26

But I think.

Doctor Amy Commander: 00:56:27

I think we'd all agree that one area that we can all work to address is our diet.

Doctor Amy Commander: 00:56:32

So I think that's something we should focus on.

Rib Esselstyn: 00:56:36

I swim every morning in, this morning in the locker room, one of my very, very good friends who actually turned on to whole food, plant based nutrition, he said that his daughter is freaked out by oatmeal because she says it.

Rib Esselstyn: 00:56:52

She's heard that it causes blood sugar spikes.

Rib Esselstyn: 00:56:56

And, you know, there's all this noise right now around blood glucose monitor, continuous glucose monitors and all this other stuff.

Rib Esselstyn: 00:57:04

Do you have any.

Rib Esselstyn: 00:57:06

Can you comment on this?

Rib Esselstyn: 00:57:07

And, and I'm sure you've had to address this with your patients.

Doctor Amy Commander: 00:57:11

Yeah, I mean, I think these, the use of these continuous blood glucose monitors, certainly for our patients with diabetes, there's evidence that that is beneficial.

Doctor Amy Commander: 00:57:20

But for an otherwise healthy young woman, like, yes, your glucose will go up after you eat carbs, but you know it's going to come back down after your body metabolizes it.

Doctor Amy Commander: 00:57:29

And we both know that oats are so healthy for our body in terms of the fiber, and we haven't even talked about fiber.

Doctor Amy Commander: 00:57:35

Fiber is so important in terms of helping create a healthy gut microbiome, which is so important not just for cancer risk, but for so many medical reasons.

Doctor Amy Commander: 00:57:45

So I think, I know this is just an example of there's so much out there on social media and TikTok that young people and people my age are getting their information from these sources.

Doctor Amy Commander: 00:57:56

And the medical community really needs to work hard to ensure that people are getting evidence based health information.

Rib Esselstyn: 00:58:02

Yeah.

Rib Esselstyn: 00:58:03

What's your opinion on mammograms?

Rib Esselstyn: 00:58:05

And if it's a thumbs up, when do you think women should start?

Doctor Amy Commander: 00:58:09

So it is a thumbs up for me.

Doctor Amy Commander: 00:58:12

And certainly recent guidelines that have been updated by the US Preventative Services Task Force do recommend that all women start mammograms at age 40.

Doctor Amy Commander: 00:58:23

Certainly, if an individual has a strong family history or potentially genetic risk, she would start screening earlier and potentially with breast MRI in addition to mammograms.

Doctor Amy Commander: 00:58:32

So I am a fan, and definitely since this is breast cancer Action Month, I would encourage people who are overdue for their mammogram to please schedule one, because we do know that over the course of the pandemic and after that, people have unfortunately gotten behind many types of cancer screenings.

Rib Esselstyn: 00:58:53

What are you finding is the biggest challenge in your line of work?

Doctor Amy Commander: 00:58:58

Oh, well, the biggest challenge for me is when a patient has a recurrence of her disease.

Doctor Amy Commander: 00:59:07

Even though I know my patients, you know, they go, they work so hard to go through their treatment and be so adherent to what we recommend and, you know, work so hard to improve their lifestyle.

Doctor Amy Commander: 00:59:21

And as their doctor, I work so hard to monitor them and keep close tabs.

Doctor Amy Commander: 00:59:24

But when a patient does recur, because that does happen, it's really, really hard.

Doctor Amy Commander: 00:59:29

So that part of the job is always hard, and that will never get easier.

Rib Esselstyn: 00:59:35

What would you say now, flip side of that, what's the most gratifying part of your.

Doctor Amy Commander: 00:59:41

Well, I'll just tell you a story again from my clinic the other day.

Doctor Amy Commander: 00:59:44

You know, I was seeing this lovely patient of mine who, by the way, does have advanced breast cancer that's estrogen sensitive.

Doctor Amy Commander: 00:59:50

And she's been living with it for a number of years, years, really doing well.

Doctor Amy Commander: 00:59:56

And she shared with me that she had two grandchildren born, honestly, within, like, two weeks of each other.

Doctor Amy Commander: 01:00:01

I think one came a little early and one came a little late, so they ended up being born right around the same time.

Doctor Amy Commander: 01:00:06

And now she's a grandmother, and it brings her so much joy.

Doctor Amy Commander: 01:00:09

And I'm so happy for my patients when they celebrate these two of milestones.

Doctor Amy Commander: 01:00:13

And in my mind, I do think, thank goodness for the current treatments we have that enabled this woman to become a grandmother at times, too, by the way.

Doctor Amy Commander: 01:00:22

And that's just really, I just love celebrating milestones with my patients like that.

Rib Esselstyn: 01:00:28

Yeah.

Rib Esselstyn: 01:00:33

So, Amy, it sounds to me like you have landed in the perfect place.

Rib Esselstyn: 01:00:41

Like you, it sounds like you're absolutely happy and you're just sharing your gifts with as many people as you can.

Rib Esselstyn: 01:00:52

And I want to say, and I read this quote, it was on your Instagram channel, and I think it's really applicable to you and all the fantastic work that you're doing.

Rib Esselstyn: 01:01:03

And this is from Pablo Picasso, and it's, the meaning of life is to find your gift.

Rib Esselstyn: 01:01:10

The purpose of life is to give it away.

Rib Esselstyn: 01:01:13

And how beautiful the work that you're doing is.

Rib Esselstyn: 01:01:17

So wonderful, so beautiful, so absolutely important.

Rib Esselstyn: 01:01:22

And I want to thank you, Amy, for coming and joining me on the Plantstrong podcast for breast cancer Action Month.

Rib Esselstyn: 01:01:32

Yay.

Rib Esselstyn: 01:01:33

Any last words that you'd like to.

Doctor Amy Commander: 01:01:35

Say, by the way, thank you so much.

Doctor Amy Commander: 01:01:37

I truly appreciate you inviting me as a guest.

Doctor Amy Commander: 01:01:40

And thank you for sharing that quote, which is a favorite of mine, and it exemplifies you, too, so you should use that quote.

Doctor Amy Commander: 01:01:48

Thank you for all the important work and education and outreach that you do to spread the important message about the benefits of lifestyle medicine, plant based diets.

Doctor Amy Commander: 01:01:57

I'm just so grateful as part.

Rib Esselstyn: 01:01:58

Well, yeah, well, thank you.

Rib Esselstyn: 01:02:01

My plan strong sister.

Rib Esselstyn: 01:02:02

So with that, will you give me a virtual plan strong?

Rib Esselstyn: 01:02:05

Fist bump on the way out?

Doctor Amy Commander: 01:02:07

Boom.

Rib Esselstyn: 01:02:10

Go get them, Amy.

Doctor Amy Commander: 01:02:11

Thank you.

Doctor Amy Commander: 01:02:13

You too.

Rib Esselstyn: 01:02:15

Thank you, doctor commander, for paving the path to wellness, not just for your patients, but for all of us who want to empower ourselves with the knowledge and information that could save our lives and the lives of our loved ones.

Rib Esselstyn: 01:02:31

For more information, go to pavingwellness.org and I'll be sure to link to that and other resources, including Amy's workbook in today's show notes as always, I want to thank you so much for listening to the Plant Strong podcast, and I would encourage you to share it with anyone who you think may benefit from the information.

Rib Esselstyn: 01:02:52

I appreciate you and your support.

Rib Esselstyn: 01:02:56

Until next time.

Rib Esselstyn: 01:02:58

Always, always keep it.

Rib Esselstyn: 01:03:00

Plan strong the Plan Strong podcast team includes Carrie Barrett, Lori Cordowicz, and Amy Mackey.

Rib Esselstyn: 01:03:10

If you like what you hear, do us a favor and share the show with your friends and love ones.

Rib Esselstyn: 01:03:16

You can always leave a five star rating and review on Apple Podcasts or Spotify.

Rib Esselstyn: 01:03:21

And while you're there, make sure to hit that follow button so that you never miss an episode.

Rib Esselstyn: 01:03:28

As always, this and every episode is dedicated to my parents, Doctor Caldwell B.

Rib Esselstyn: 01:03:34

Esselstyn Junior and Ann Kryle Esselstyn.

Rib Esselstyn: 01:03:38

Thanks so much for listening.