Barb Swegarden felt a pop in her back while exercising at a fitness club. She suspected a pulled muscle. Then pleurisy was implicated as the cause of her pain.
But the chronic pain persisted, unalleviated by removal of her gallbladder. Finally, at the Mayo Clinic, doctors found the cause: cancer in her spine. It turned out the cancer had spread from her breast, where the tumor began, then lodged in her spine.
"They called it a rogue cell," Swegarden said. Then she faced a gauntlet of treatments: radiation to her spine, a breast lumpectomy, chemotherapy.
More than eight years later, Swegarden is thriving. Her doctors categorized her breast cancer as stage IV, the most advanced stage, but she believes herself to be cancer-free today. At least that's how she feels.
Swegarden has participated in a cancer survivorship program at Sanford Health's Roger Maris Cancer Center, which has a focus on holistic healthy living practices, including diet, physical activity and meditation.
Even before her cancer diagnosis, Swegarden had drastically altered her diet, breaking with processed foods and embracing whole foods. Her diet is low on carbohydrates, with lots of protein and healthy fats.
"You can eat very, very well," she said.
Although happy with her diet, Swegarden admits the transition was difficult. She still craves soda, and allows herself the occasional cookie, but otherwise shuns processed foods.
She's learned to love roasted vegetables, many harvested from her backyard garden in north Fargo.
"You have to make it interesting or it can be extremely boring," Swegarden said of her whole foods diet.
Dr. Shelby Terstriep, an oncologist, directs the cancer survivorship program at Roger Maris Cancer Center, where Swegarden has been one of her patients in the program.
"People can take some control of themselves," she said, explaining the idea behind the survivorship program. "Cancer survivors are at increased risks of another cancer."
Eating a healthy diet is one of the factors Terstriep encourages with her patients. She considers a healthy diet to be "additive, not curative," and said researchers have had great difficulty in pinpointing what kind of diet can prevent cancer or its recurrence.
"Studying the diet is extremely complicated," she said. "It's hard to tease out components because there's so many of them. It's extremely difficult to study."
Also, cancer is complex, with great diversity among tumors. "Cancer is 60 to 80 diseases," she said. "It's not one disease."
Nevertheless, Terstriep has boiled down the often contradictory advice about diet and cancer prevention into a few simple tips: Eat whole foods, control carbohydrates, get some exercise, reduce stress, never smoke.
"All those factors play together," she said. "It all makes a difference."
As diet watchers know, nutritional advice changes over time. For decades, for instance, people were told to adopt a low-fat diet. That advice has now been discredited, and critics blame it for pushing people to eat more carbohydrates, including sugar, which have fueled the obesity epidemic.
Obesity, by the way, is a risk for multiple cancers, as well as other diseases, including diabetes and hypertension.
Some have embraced a high-fat, low-carb diet that induces ketosis, a condition in which the body burns fat, as a way to prevent or recover from cancer. But the evidence, so far, is inconclusive, Terstriep said.
Others extol the benefits of fasting, which some advocates claim boosts the immune system, which would be a big help in combating cancer. But, once again, the studies are mixed.
"The research is inconclusive," Terstriep said. "We're watching the data really closely."
One clear takeaway from the research is that advice to eat lots of meals throughout the day, a practice some call "grazing," might not be legitimate, she said. Eating only three meals a day might help the body's metabolism and might have some hormonal benefits, research suggests.
Not all the cancer survivorship patients embrace the diet and lifestyle changes Terstriep's team encourages.
"We've had very poor accrual," she said. "People want to hear about it, but they don't want to do it."
Some patients complain that, in addition to treatments and the stresses of battling cancer, it's too much to worry about sticking to a healthy diet. "By the time patients are done with treatment, they're done," Terstriep said.
But Swegarden is happy about the changes she's made, which now are woven into the fabric of her daily routines. Now, when she and her husband eat any processed food, such as in a social setting, they feel the difference.
Besides the diet and lifestyle changes, she credits the breast cancer drug Heparin, with keeping her healthy. She recently had her 81st infusion of the drug.
"It really is quite miraculous," she said of keeping her cancer at bay. "I feel great. I really can do anything I want to do except run, and I never liked to run anyway."