All posts in Women’s Health

Caring for Aging Parents

Caring for Aging Parents

With the rising costs of living, it is becoming more and more common for families to be multi-generational and house family members of all ages under one roof. More often than not, this means that elders move in with their adult children, who may have their own young families.  This is an option that families decide on between themselves, for a variety of reasons, and sometimes it is more financially feasible than living in an elders’ community or a home. In addition to the psychological and communication factors that come into play with such a decision, there are also practical accommodations that need to be considered– which are often overlooked when the aging family member appears able-bodied, but can cause serious trouble if not addressed. 

Psychological and Communication Factors 

If a new family member joins your existing family, this will necessarily change the family dynamic. All members of the welcoming family need to discuss the options available to them and decide whether adding an aging parent to their household is something they are comfortable doing. Of course, aging parents need to have a say in this: many people are not comfortable with the idea of being a dependant, or with the need to adjust to someone else’s schedule. It is a difficult transition for both parties, and it needs to be treated carefully. Keep in mind that in addition to the behavioral adjustments and changes, there will also be a need for practical changes in the home itself. 

Practical Changes 

There is a reason why many restaurants and facilities ensure they are ADA compliant, and similar adjustments need to be made in a home where an elderly person resides. The simplest examples of this would be to ensure there is a step-free entry, ideally one that can accommodate a wheelchair and/or walker. Of course, that also means there is a bedroom and full bathroom on the ground floor–possibly enforced with safety amendments like a handrail, non-slip mats, a shower chair, and raised toilet seat. 

Practical adjustments don’t necessarily mean that your house will end up looking like a hospital–this popularized, and terrifying, idea only comes around when we talk about in-home hospice, for serious cases. However, basic adjustments do mean that your home will look different, and will probably not have any throw rugs: they are the number one tripping hazard for elderly people, along with pets who are not contained. 

Diet and Healthcare 

Another common change usually involves keeping tabs on the elderly person’s healthcare, and making adjustments to the usual diet to accommodate their needs. This can range from keeping track of medications, and securing them so that only the person who needs them has access to them, to scheduling doctor appointments, ensuring transportation, interpreting medical results, and advocating for the person you are caring for. 

 

https://www.fda.gov/consumers/womens-health-topics/caring-others-resources-help-you 

https://www.aarp.org/caregiving/home-care/info-2018/living-with-aging-parents.html?intcmp=AE-CAR-CAH-EOA1

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Birth Plan

If you are an expectant mother, and relatively close to delivery, you may have already started working on your birth plan. Or, you may be gathering information and becoming informed even while you are planning your pregnancy! Regardless of your timeline, it’s always a good time to consider your birth plan. Perhaps you have already heard that no delivery will go according to plan, and you need to have different options. While this is true, the suggested rule of thumb is to be well informed and flexible, as you may have to make last minute decisions and consider emergency changes; the goal is for the baby and the delivering mother to be safe and healthy. 

There are sample birth plans available in a variety of websites, but no plan is as good as the one you create yourself, personalize with your own tone and preferences, and one that addresses your medical team directly. Consider your birth plan a direct request to your OBGYN and the nurses that meet you at the labor and delivery ward. It should be easy to read, 1-2 pages long, formatted with bullet-points, personal statements and politely phrased requests; this shows you are well informed, educated, and engaged in your delivery process and take a serious interest in the delivery of your baby. If your birth plan decisions are based on medical conditions or previous delivery experiences, don’t hesitate to include a short description of those as well– it helps your medical team to know why your wishes are there. 

Check-off lists and pre-written birth plans almost never address the most important decisions during delivery: pain management and c-sections. In an ideal world, you would have completed a child-preparation program before creating your birth plan. While this may not always be possible, you can consider a book or video course. However, what will really help is for you to tour your birthing facility and learn of the options offered for birthing position, pain management, and newborn care. This is abundantly helpful especially if you require specific props for your birthing positions. If, for example, you request a birthing stool or bar, you need to ensure not only that your birthing facility has those available for you, but also that you are personally educated on how to use them. 

Keep in mind that you need to have a contingency plan in place, in case your initial wishes need to be adapted for your safety and the health of your baby. Though very few women opt for a C-section, you always need to be prepared for one. Note in your plan if you wish to receive medications that affect your consciousness, if you want to receive Pitocin for labor augmentation, and whether or not you want to receive an epidural. In case you decline an epidural, you should explain in your birth plan how you have prepared for this decision and what your pain-management plan is. 

The scary parts of your birth plan are the most important, almost like two sides of the same coin. Remember that you can, and should, write personal choices and wishes in your birth plan as well: who do you want present during labor, if you wish to place limitations on visitors, any allergies you may have, the contact information of your delivery team (partner, family or friends, doula, OBGYN, etc.), your wishes for newborn care and immediate postpartum care and preferences. Personalize your birth plan and go over it with your doctor, and those responsible for caring and supporting you, well in advance of your due date.

 

https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/birth-plan/ 

https://childrensmd.org/uncategorized/writing-a-birth-plan-10-essential-tips-from-a-pediatrician-and-mom-of-5/

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Weight Gain during Pregnancy


If you are expecting, or are thinking of becoming pregnant, it is possible that you are also worried about your body weight. Many expecting mothers have faced this worry before, as pregnancy significantly alters your body and is expected (and should) increase your body weight. At the same time, you want to make sure that you experience a healthy pregnancy and don’t put yourself or your baby in danger. First of all, you should remember your baby weighs around 7-8 pounds– that’s a big chunk of pregnancy weight! Additionally, your placenta, a larger uterus, and amniotic fluid add about 2 pounds each. You will also experience an increased blood volume of 3-4 pounds, and increased fluid volume of 2-3 pounds, as well as larger breasts which add 1-3 pounds. It is important to remember that your fat stores, which are much needed for a healthy pregnancy and delivery, will add 6-8 pounds. 

Though these amounts may differ from person to person, the general weight added to a mother’s body by the end of pregnancy is about 30 pounds. Most expectant mothers gain 1-5 pounds in the first trimester and 1-2 pounds per week in the second and third trimester. According to the American Pregnancy Association, a pregnant woman of relatively normal weight who gets less than half an hour of exercise every week should have a calorie intake of 1,800 in the first trimester, 2,200 in the second trimester, and 2,400 in the third trimester. It is suggested that you limit processed foods, sugars, and extra fats when you are thinking about your diet while pregnant. 

The first idea that pops into mind when thinking about a healthy diet during pregnancy is supplements and vitamins. Though these are definitely important, and prenatal vitamins ensure you don’t miss out on key nutrients, you do need to decide on the specifics by consulting with your doctor or healthcare provider. It is ideal to start taking a daily prenatal vitamin at least three months before conception. Discuss your options with your doctor before deciding, as supplements need to be tailored to add on to your current diet, any special diet, health conditions, and you need to know about possible supplements that do not have a good track record and may harm your pregnancy. 

Other than supplements, the principle of any healthy diet applies to pregnancy as well– make sure you consume plenty of fruits, vegetables, whole grains, healthy fats, and lean protein. Here are the nutrients that deserve special attention during your pregnancy: 

  • Folate and Folic Acid: this helps decrease the risk of premature birth or low birth weight. It is also a B vitamin that helps the healthy development of the brain and spinal cord. 
  • Calcium: you may already know calcium is necessary for healthy bones and teeth, and both you and your baby need it. Did you know that calcium also helps the circulatory, muscular, and nervous systems?
  • Vitamin D: this can work together with calcium to ensure healthy bones and teeth. Vitamin D is most commonly found in fatty fish, fortified milk, and orange juice. 
  • Protein: you want to keep on intaking protein throughout your pregnancy as it supports your baby’s overall growth and development. You need at least 71 grams a day. 
  • Iron: remember that during pregnancy you need double the amount of iron that non-pregnant persons need. The body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to the body’s tissues. If you don’t get enough iron during your pregnancy, you may be at risk of developing anemia. 

 

https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/pregnancy-weight-gain/ 

https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082 



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Vaginal Odor Concerns

Let’s get one thing out of the way: all vaginas produce some odor, and this odor varies through your menstrual cycle and through life’s activities. For example, you are more likely to experience a stronger smelling vaginal discharge if you are mid-cycle, after intercourse, or after a workout. However, if there is an unfamiliar, strong, and unpleasant odor that persists for several days that is cause for concern and should be checked out ASAP. If it is accompanied by other symptoms like grayish vaginal discharge, itching and burning, then it may be a sign of a health issue as well. 

The most common reason for a concerning vaginal odor is an imbalance in your vaginal pH; if your vaginal flora is imbalanced that may produce an unfamiliar smell. Some of those odors can be short term, and not a cause for concern. For example, if you are menstruating you may notice a coppery smell–that’s because period blood contains iron. A slight ammonia odor may be a sign that you are dehydrated or there is urine residue on your genitals. A smell similar to body odor can be a sign that you are stressed and your sweat glands are working overtime. 

Temporary changes in your vaginal odor are normal, and they are not always a cause for concern. If bad odor persists, however, you may want to look into one or more of the following possible causes: bacterial vaginosis, which is an infection caused by an imbalance in your vaginal pH; trichomoniasis–a sexually transmitted infection caused by a parasite; changes in your vaginal odor due to pregnancy; postpartum vaginal odor. Some rare causes for vaginal odor can also be rectovaginal fistula–an extremely rare condition where the opening between our rectum and vagina allows feces to leak into your vagina; vaginal cancer or cervical cancer. 

Treatments 

Before you jump into panic mode, and especially if you have just noticed an unpleasant odor down there, you can try the following simple methods to eliminate symptoms (considering they are non threatening):

  1. Sometimes we just need a really good shower, or more regular showers: if you are working out more, have intercourse more often, or are even way more stressed than usual, that may change your odor. 
  2. Do not wash inside your vagina: you definitely want to use appropriate products to wash the outside areas of your vagina, but do not use water, soap, or a washcloth inside your body. 
  3. Check for product changes: did you recently change your vaginal wash? You may have a sensitivity to a new ingredient, or a new detergent. Even underwear fabrics and tight clothes can cause irritation and a different smell. 
  4. Stay hydrated and eat a balanced diet: strong foods like onion, garlic, asparagus and oily fast foods can cause your body to produce not-so-pleasant odors. 

https://my.clevelandclinic.org/health/symptoms/17905-vaginal-odor

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Surrogate Mothers

You have probably heard of couples using surrogate mothers to conceive, or carry a pregnancy to term. The term is often associated with a couple’s fertility challenges, and difficult as those may be, it doesn’t stop being a wonderful way for a couple to have a baby– the parents who initiate the process are called the “intended parents,” and the individual carrying the fetus is the “surrogate mother.” Some of the reasons parents-to-be consider surrogacy may be: 

  • Trouble conceiving through IVF, which may be related to infertility of unknown origin
  • Medical issues that affect the uterus, or even a previous hysterectomy 
  • Conditions that make the pregnancy too high-risk, such as health concerns or advanced maternal age 
  • Queer couples 

If you didn’t know it, there are two types of surrogacy: traditional one and gestational surrogacy. 

Traditional Surrogacy: this is the least commonly used method of surrogacy as it comes with more legal and emotional complexities. In traditional surrogacy, the surrogate is both the egg donor and the surrogate mother. She uses her own eggs, and therefore has a genetic relationship to the baby. During this method, the surrogate is impregnated using intrauterine insemination. The doctor uses sperm provided by the intended father, transfers it into the uterus of the surrogate, and natural fertilization of the egg takes place from then on. As medical science advances, this type of surrogacy becomes increasingly less common. 

Gestational Surrogacy: this is the most commonly used type of surrogacy, and there is no genetic relationship between the surrogate mother and the fetus. Instead, an embryo is inserted into the surrogate’s uterus and she carries the pregnancy to term for the intended parents. To get to that point, the intended parents provide sperm and eggs–or use either/or from a donor–fertilize them and then have them inserted into the surrogate mother’s uterus using in vitro fertilization. In this type of surrogacy, the surrogate may be also called gestational carrier. 

Why this choice?

As mentioned above, there are several health reasons why intended parents may choose to find a surrogate mother. However, the decision does not have to rely on those health reasons, and it is always deeply personal and a private decision. The most common reason people choose surrogacy over adoption is that they want to have a biological connection to their child; even though familial bonds are not necessary to build a strong, happy, and healthy family, many parents do want a biological connection to their offspring. 

Surrogacy offers a safe and transparent pregnancy as the intended parents are there every step of the way. The most common concern with adoption is that the future parents do not know the medical history of the birth mother, or the father. This can raise serious concerns about their future baby’s medical history, and many parents feel uneasy not knowing whether their adoptive infant may have potentially been exposed to malnourishment or toxins in-utero. 

If you are considering a surrogate option for your family, consult with your family doctor first, and keep in mind you may also need to review your state’s laws around surrogacy agreements. 

 

https://www.surrogateparenting.com/blog/what-is-a-surrogate-mother/ 

https://www.fertilitypreservation.org/blog/when-to-consider-surrogacy-and-how-to-choose-the-right-one 



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Eating Disorders and Pregnancy

The two most common types of eating disorders are anorexia nervosa and bulimia nervosa, yet there are other types out there that are not as common. Unfortunately, research on eating disorders and pregnancy is quite limited– there are estimations that eating disorders affect 5-8% of women during pregnancy, but this may not be completely credible as results can be skewed due to women’s reluctance to recognize eating disorders. Anorexia and bulimia often become noticeable in adolescence, and it’s possible that they linger during a woman’s reproductive years. Consequently, they can of course affect not only a woman’s reproductive health but also the health of her baby. 

Fertility is the first affected area of women who suffer from an eating disorder: most women with anorexia do not have menstrual cycles, and approximately half of the women who have bulimia do not experience regular menstrual cycles. Absence of menstruation or irregular periods can limit the chances of conceiving, or even make it a lot more difficult for a couple to conceive. If you know you have an eating disorder and are seeking to get pregnant, it will be much healthier for you and your future baby if you try to treat your eating disorder first and establish some healthy eating habits. It is also important to share your history with medical professionals and ask for your weighing to be treated with more care. 

Though there is quite a long list of complications associated with eating disorders during pregnancy, rest assured that proper planning and prenatal care– as well as a commitment to building healthy eating habits and helping your body remain healthy– can minimize a lot of those complications, lessen the risks associated with them, and enhance your chances for a healthy pregnancy. Some of those complications can be premature labor and low birth weight, as well as delayed fetal growth and respiratory problems. You may also be at a higher risk for emergency cesarean birth and other complications during labor. Gestational diabetes, preeclampsia, and even miscarriage are also possible complications. Women with eating disorders are also at a higher risk for postpartum depression, and depression during pregnancy, and are more likely to have problems with breastfeeding. Women with bulimia are at a higher risk for hypertension, and substances such as laxatives and other medications may be harmful to the development of the baby and can lead to fetal abnormalities as well. 

Eating disorders unfortunately cannot be treated with medications that are pregnancy-safe. Treatment includes, first and foremost, the mother’s determination to have a healthy pregnancy and–difficult and shameful as it may be–disclosing to health professionals that you are struggling with an eating disorder. That way, your doctor will be able to tailor your prenatal visits accordingly, and know the risk factors associated with your pregnancy. The obstetrician’s care can be complemented by a registered dietitian/nutritionist and a therapist for well rounded care and medical treatment. 

 

https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/eating-disorders-and-pregnancy/ 

https://www.verywellmind.com/pregnancy-and-eating-disorders-4179037 



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Gestational Diabetes

You may be familiar with Diabetes Type 1 and Type 2, but did you know there is also a bonus one, called Gestational Diabetes Mellitus– or Gestational Diabetes for short? Gestational Diabetes is diabetes that’s diagnosed for the first time during the gestation period, aka pregnancy. Contrary to Type 1 diabetes, GDM is not caused by a lack of insulin. Instead, it is caused by hormones produced during pregnancy that make insulin ineffective. This is also known as insulin resistance, whereby the mother’s body does not use insulin as it should. Like other types of diabetes, GDM affects how cells use sugar. About 3-8% of pregnant people in the US are diagnosed with gestational diabetes; its symptoms disappear after delivery, and the great news is that you can help control gestational diabetes! 

Symptoms: gestational diabetes does not have any symptoms on its own, except increased thirst and frequent urination (which could be pregnancy related regardless). If you are risk for Type 1 diabetes because one of your parents or siblings has it, or at risk for Type 2 diabetes because you are prediabetic, over 45 y/o, may be overweight, don’t exercise often, or have previously had gestational diabetes, your doctor may deem you are at high risk for GDM and suggest you be tested. 

Risks: GDM is not like Type 1 Diabetes which can cause birth defects–in fact, GDM arrives too late in a pregnancy to cause any birth defects. Insulin resistance starts showing up around Week 24. Therefore, and thankfully, the complications are manageable and preventable. Generally, gestational diabetes may cause macrosomia and hypoglycemia, which are the two major health issues associated with it. Macrosomia refers to an excessively large fetus and hypoglycemia refers to low blood sugar in the baby immediately after delivery. 

Treatment: there are available treatments for gestational diabetes, and many depend on your age, overall health, and medical history. However, the most common ways to manage GDM are to regularly check your blood sugar so it stays on healthy levels, creating a healthy eating plan with your doctor and following it, being active, and monitoring your baby. 

As is the case with any pregnancy complication, it is understandable that it may cause you stress. While there is no certain way to prevent stress, do know that gestational diabetes is very manageable and has very low health risks for your baby. In fact, your own stress may cause more complications during pregnancy than gestational diabetes. You can better gauge your risk for GDM by checking your family history and having a general health assessment with your doctor early on in, or even before, your pregnancy. It is advisable to attend all your prenatal appointments, voice your concerns with your doctor, and maintain a healthy lifestyle to address the possible risks of gestational diabetes. 

 

https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 

https://www.cdc.gov/diabetes/basics/gestational.html 

https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes 



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Osteoporosis

You may have heard the occasional old person complain about their bones hurting when the
weather turns, or struggle to eliminate chronic back and joint pain. Though there can be many
reasons for this, one of the most common is the silent disease of osteoporosis: it causes bones to
weaken and turn brittle and fragile. As such, the risk of broken bones or fractures is significantly
increased.

Unfortunately, if you’re not regularly tested for osteoporosis you may not even be able
to tell you have this disease until a seemingly minor accident leaves you with a broken bone…

How to Diagnose
The later stages of osteoporosis come with several symptoms, such as back pain, stooped
posture, minor fractures, and loss of height. You can, however, be proactive about osteoporosis
before you suffer those symptoms or a broken bone (seemingly out of nowhere!). The easiest
way to keep tabs on osteoporosis is a bone density test. Imagine osteoporosis turning your strong
bones into sponge-like structures. Bone density tests help compare your bone density to the
average bone density of a healthy, young, US-based woman. They are officially called Bone
Mineral Density (BMD) tests, and resemble an X-ray but with less radiation exposure. The BMD
results, along with other health factors taken into consideration, estimate your risk of having a
bone fracture in the next decade.

Getting Tested
As osteoporosis may creep up on you, it is recommended to get tested if you are a woman of
menopausal age with osteoporosis risk factors, or a woman over the age of 65. If you are under
65 but have a family history of osteoporosis and are postmenopausal, you should also get tested.
Breaking a bone after age 50 is also a good indicator you should get tested for osteoporosis.
If you have already been diagnosed with osteoporosis, and are even taking medications for it,
you may want to repeat BMD tests every couple of years. If you are switching osteoporosis
medications, it is likely that your medical professional will recommend you get tested.

Preventing Osteoporosis
There are several risk factors for osteoporosis, including age, sex, race and family history.
Women are at a greater risk for osteoporosis, as are all people as they get older. If you are white
or of Asian descent, you may also be at a higher risk. Some factors that can be controlled are low
sex hormones, excessive thyroid hormone, and other overactive parathyroid or adrenal glands.
Low calcium intake puts you at a greater risk of developing osteoporosis, as it contributes to
decreased bone density. Eating disorders or being severely underweight do the same, as they can
weaken bones in both men and women. Gastrointestinal surgery can also have a negative impact
on your bone density, as this type of surgery limits the available surface area of your body to
absorb nutrients, including calcium.

https://www.everydayhealth.com/osteoporosis/guide/symptoms/
https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968

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Breast Cancer Treatments

Thinking about breast cancer treatments is undoubtedly not the most enjoyable activity
one can engage in, but knowing your options can be a revealing and empowering experience. If
you have been diagnosed with breast cancer, it is very likely you will have one or more of these
experts in your treatment team: a breast surgeon or surgical oncologist, who is a doctor
specializing in surgery to topically treat breast cancer; a radiation oncologist, who specializes in
using radiation against breast cancer–also a topical treatment.

Some other experts, who focus more on systemic treatments, are a medical oncologist–a doctor who uses chemotherapy,
hormone treatment, immunotherapy, and other medicines to battle cancer and a plastic surgeon
who–as you may know–is there to reconstruct or repair parts of the body.

Local, or topical, treatments treat the tumor without affecting the rest of the body; surgery
and radiation are local treatments. Depending on the type of breast cancer, its stage, and your
overall health, you may need other types of treatment as well (before or after surgery, or both):
those are called systemic treatments because they reach cells almost anywhere in the body.
Systemic treatments can be given by mouth, put into the bloodstream, or injected in a muscle.

2022 has been a great year for breast cancer treatment, as the FDA approved a new drug
to treat HER2-Low Breast Cancer: trastuzumab deruxtecan (T-DXd). The approval came
through on August 5, 2022 and this therapy is meant to help patients who suffer from HER-2-
Low Breast Cancer that has spread to other parts of the body and cannot be surgically removed.
The clinical trial results for T-DXd were presented by medical oncologist Shanu Modi to this
year’s American Society of Clinical Oncology meeting. The clinical trial was led by Memorial
Sloan Kettering Cancer Center, and according to Dr. Modi, its results redefine how many
patients with metastatic cancer will be treated.

Targeted therapy works by identifying and attacking certain types of cancer cells, but it
doesn’t kill normal cells so its side effects are fewer than other treatments. However, until now
HER2 treatment has not been successful in treating cancer that is HER2-low. During the trial,
patients were given Enhertu (or T-DXd) which targets the protein HER2. The patients who
received Enhertu did noticeably better than the patients who received standard chemotherapy!
The new targeted drug held the cancer of the receivers in check nearly twice as long, and also
increased the survival rate by 35%.

This is wonderful news for breast cancer patients, and a great advancement in breast
cancer research and treatments! To consider if this is the right treatment for you, ask your
medical professional, and seek as much information as possible before you make a decision.

 

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Breast Cancer Awareness Month

October is best known as the month dedicated to spooky costumes and candy, but it is
also the month dedicated to Breast Cancer Awareness. Apart from skin cancers, breast cancer is
the most common one among American women. Facts show us that 1 in 8 women in the US will
receive a diagnosis of breast cancer in her lifetime, but the really good news is that 65% of cases
are diagnosed at a localized state–meaning that the cancer has not spread past the breast–for
which the five-year survival rate is 99%.

It is also encouraging to hear that there are over 3.8
million breast cancer survivors in the United States alone. The positive facts about breast cancer
assure us that science is working hard to enhance the survival rate for women who are diagnosed
with breast cancer, and is also making great strides to provide successful preventative
techniques.

During the month of October, there are continued efforts to fundraise money for
dedicated breast-cancer research, to support survivors, and to spread awareness and information
to younger women. If you are in Buffalo, NY you may want to consider participating in the
annual Making Strides of Buffalo walk, which is dedicated to making an impact and saving lives,
organized by Roswell Park Comprehensive Cancer Center. This year, the event takes place on
October 22nd, and you can easily sign up for the event on the American Cancer Society’s
website. The event does not have a registration fee, so it is accessible to a greater number of
people.

If you cannot attend the event in person, you can also make a donation, and keep
fundraising going by looking into the Matching Gifts programs: many employers will match
their employees’ charitable donations, or even volunteer hours, thus doubling the impact
individuals make on Breast Cancer Awareness! You can find out directly from your employer if
they are registered for a matching gifts program, or you can use the tool provided by Double the
Donation.

Another great way to support research and other initiatives toward Breast Cancer
Awareness is to create your own fundraising events; many tech-savvy folks set up their own
fundraising pages, or they simply ask their loved ones to collect donations towards this cause in
lieu of birthday, wedding, or anniversary gifts. If you have an online presence, you can easily
bring people together through Facebook or Instagram Live, and even Zoom, to provide support,
share knowledge, and build a community.

Breast Cancer Awareness Month


https://www.bcrf.org/breast-cancer-awareness-month-ideas-fundraising/

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