Prioritizing Mental Health and Exercise During and After Cancer Treatment with Dr. Simran Malhotra
The importance of focusing on mental and physical health during and after cancer treatment.
Focusing on your mental health and getting back into exercise after cancer treatment, can be a tough process to navigate.
This week, we took some time to chat with Simran Malhotra, M.D., DipABLM, about her personal experience with prioritizing health and wellness after a cancer diagnosis.
Dr. Malhotra works as a palliative care physician, and also had a preventative mastectomy and hysterectomy herself.
As both a physician and patient, Dr. Malhotra provides important insights on how to navigate your life before, during, and after cancer treatment.
Please also be sure to check out Part 2 of this discussion, where Dr. Malhotra provides tips on how to enhance your nutrition and diet when undergoing cancer treatment.
Brilliantly: In your experience, what are some common misconceptions people have about working out/staying active after a cancer diagnosis and/or preventative treatment (e.g. preventative mastectomy, hysterectomy, etc)?
Simran: I think the most common misconceptions about working out are that people who have had cancer or major surgery, believe they are too weak to work out. They think working out could slow down the healing process. This is simply not true!
In fact, regular physical activity can actually help improve strength, energy levels, and boost your mood and immune system. It can also help reduce fatigue, nausea and other side effects of cancer treatment or major surgery.
Most people underestimate the power of movement as medicine. There is an abundance of research showing the benefits of physical activity in primary risk reduction. Research also shows movement can help prevent secondary recurrence of several different cancers, especially breast cancer.
Another common misconception is that people need to wait until they are fully recovered before moving their body. This is also not true!
It’s usually safe to start slowly and gradually increase intensity and duration as you feel stronger. It’s important to keep in mind that everyone’s body and situation is different, therefore, you should always consult with your health care team first. But overall, there is no reason to avoid working out after a cancer diagnosis or major surgery. In fact, it can be an important part of your recovery!
Brilliantly: What are some of your favorite workouts to do?
Simran: Since I was cleared for exercise 8 weeks after my surgeries, I got on my peloton and haven't gotten off ever since (yup I'm addicted!). I have 3- and 5-year-old kids so they are often around, and I try to find ways to involve them. They have a kid's bike that they ride while I'm on my peloton or we do a family yoga or strength class together on the peloton app.
Often, we think of workouts as intense exercise classes or fitness routines, but for me working out is simply movement. I enjoy gentle yoga, stretching and nightly dance parties with my kids!
Brilliantly: What specific things do you think have helped you show up as the strongest version of yourself (both mentally and physically), after your preventative mastectomy and hysterectomy? What’s the biggest thing your experience has taught you about life and overcoming challenges?
Simran: I think the three realizations that were most powerful for me were:
1. Lifestyle is medicine.
I only really started to prioritize myself about a month or two before my surgeries. I was a full-time working physician married to a physician. We had 2 kids in 19 months without any family nearby, so self-care was often at the bottom of my to do list—similar to many moms.
As a patient myself and as a palliative care physician, I had seen significant strife and suffering. I have come to realize that despite many of the modern medical advances, incorporating positive lifestyle habits is still the best and most powerful investment you will make in your life. And I only realized that after becoming a patient myself.
Before surgery, I got a strength coach and started making small sustainable changes to my lifestyle. This included moving my body, going to bed earlier, surrounding myself with like-minded people, and practicing more consistent meditation.
2. Mindset is medicine.
What I realized after COVID and working with people at the end of life, is that there is incredible power in recognizing there are certain things you can control, and certain things you cannot control. I realized you can rise above any situation. At the end of the day, no one can take away your ability to choose what to focus on, the meaning you give to things, and what you will do next.
Taking actions consistently on these small but powerful therapeutic lifestyle habits, allowed me to stand guard at the entrance of my mind. This was no doubt one of the hardest phases of my life, but I realized if I could learn to control my mind, anything would be possible.
3. Gratitude is medicine.
I can say 2020 was probably one of the most difficult years of my life. I was caring for the sickest COVID patients as a palliative care doctor, and was becoming a patient myself as I was undergoing my preventative mastectomy and total hysterectomy.
In times of tragedy, it’s incredibly difficult to find what we are grateful for. But, that doesn’t mean it’s impossible. Recognizing this was a key breakthrough for me.
I kept a journal and wrote down 3 things I was grateful for every day. This consisted of the simple things like being able to breathe easy, being in the same room as my family while recovering from surgery, and simply waking up to live another day.
Brilliantly: South Asian women are commonly underrepresented in the breast cancer space, sometimes making the mental health impacts of a cancer diagnosis even harder. Do you believe being part of an underrepresented group impacted your experience when going through your preventative mastectomy and hysterectomy? What do you wish to tell other South Asian women in a similar position?
Simran: I was lucky because my husband and parents supported every decision I made. From choosing to have a preventative mastectomy and hysterectomy on the same day, to choosing not to have reconstruction and live flat.
But there were definitely times being South Asian left me feeling very isolated on this journey. Other than my mom, I didn’t know anyone like me who had this gene. And on top of that, I went on to pursue specialty training in hospice and palliative care—a field that most of my family members still do not understand. This is due to the cultural taboos surrounding death and dying—just like a lot of them do not fully grasp what it means to have a BRCA 1 mutation.
When I first found out about my mutation, I had paralyzing fear, anxiety, and panic attacks. This was because of my family history and being a palliative care physician who was caring for young women like me at the end of life, often from cancer.
South Asians, and other minorities, only represent a small number of hereditary breast and reproductive cancers. This is an underestimation of prevalence due to lack of screening, stigma of cancer, cultural and religious taboos, body image expectations, lack of experience and support, incomplete family medical records due to immigration history, and not enough priority placed on women’s health.
My advice to all South Asian women, with or without genetic mutations is:
Ask the uncomfortable questions!
You should feel empowered to ask questions about your family history (maternal and paternal).
Know your risk factors for cancer & what you can do to decrease your risk.
Learn about your options for genetic testing, screening, treatment, surgery, etc.
Advocate for your LIFE, no one else will!
If you’re a South Asian woman who is considering a preventative mastectomy and hysterectomy or recently were diagnosed with cancer, know that you’re not alone! There are many other women like you out there who have gone through or are going through the same thing.
And now as a young mother of two, daughter of 2-time breast cancer survivor, palliative care physician, wellness coach, and BRCA 1 previvor, I feel more empowered than ever before to be an advocate and voice for young women, especially women of color.
Since my surgeries, I have had several young South Asian women reach out to me on social media platforms sharing their isolation, fear and lack of family support. I was beyond elated to be able to support these women, even if just to let them know they are not alone!
Brilliantly: What helped you most when it came to improving your mental wellness after your preventative mastectomy and hysterectomy?
Simran: For each of us, this is a deeply personal journey that affects our bodies, emotions, and minds, much of which doctors do not prepare us for. I was blessed with the gift of being able to make proactive decisions when it came to my genetic mutation and risk of cancer. This means I was able to do my own research, talk to women who walked this path before me, and just process all the difficult decisions that were ahead of me. All of these factors were huge when it came to my mental health.
One of the most powerful things I did before my surgeries was take the time to grieve the loss of my breasts, ovaries, and uterus. I wrote a letter to my breasts, ovaries & uterus before surgery, ending it by saying, “Thank you, I will carry on your legacy with the two beautiful miracles you created for our family”. This was really cathartic, and I allowed myself to feel every emotion before surgery, including the loss of a big part of me.
I also was lucky enough to do a boudoir photoshoot (something I thought I'd NEVER do!) and I had my breasts painted by Fallon Smalberg of Titty_pix. After surgery, it has been empowering to look back on these tributes to my body.
I would encourage women to pay close attention to what inspires them and brings them joy to cultivate more of that in their life after surgery, especially during the recovery phase. Before surgery, I created a healing vision board that I put in front of my bed. On it, I put my favorite quotes, pictures, and self-love notes.
Simply looking at it gave me a boost of love, confidence and positive energy. Other things I did that helped me mentally and emotionally were EFT (emotional freedom technique) meditation, gratitude journaling, and surrounding myself with people that really lifted me during the difficult phase after my surgeries.
Please be sure to also check out Part 2 of this discussion, where Dr. Malhotra breaks down diet and nutrition tips for cancer patients.
Simran Malhotra is an M.D., 𝘋𝘪𝘱𝘈𝘉𝘓𝘔, and Certified Health and Wellness Coach (CHWC). She specializes in empowering women who are at high risk of cancer, by shifting their lifestyle and mindset.
She is a proud mother of two beautiful children, and is committed to helping raise awareness of the power of lifestyle medicine.
As both a palliative care physician and breast cancer previvor, Dr. Malhotra is committed to improving the quality of life for those suffering from chronic illnesses. She is a BRCA 1 mutation carrier, and opted to have a preventative mastectomy and hysterectomy, amidst the COVID-19 pandemic.
Navigating her own health and treating her patients during the toughest of pandemic conditions, has motivated her to empower, educate, and represent those going through similar experiences.