Serving in the U.S. Army in South Korea in 1984, a fellow soldier convinced me to give tattooing a try in an effort to supplement my meager income. At the time I think it was $500 per month. What a great plan… I had always been fascinated with the art form as a kid. I was a combat medic and had access to a medical facility and sterilized equipment, and I was familiar with universal precautions and prevention of cross-contamination. Most importantly, by the nature of the military, there was an endless supply of willing candidates eager to let me practice and learn the craft on their skin. The ensuing result was the birth of my tattooing career.

The following 17 years I spent traveling the world plying my craft and discovering everything I possibly could about this legendary, and at the time, little-known art form. Since then, the newfound main stream acceptability of tattooing has begun to open other doors for me and many other tattoo professionals.

In 2001 I was contacted by a local plastic surgeon who asked me if I would be interested in tattooing a few of his patients who’d had breast reconstruction. “Yes… nipples,” he declared. “What a novel idea,” I thought. Tattooing realistic images was my specialty, and this should be fairly easy. Little did I know that it would not be easy, and I wasn’t prepared for the powerful impression it was about to have on me — and more importantly, the overwhelmingly positive psychological impact it would have on the women I would tattoo. Using the fundamental skills learned from years of traditional tattooing, the metamorphosis into “medical cosmetic tattooing” or “3D nipple/areola tattooing” became obvious and seamless.

“3D nipple/areola tattooing,” as it’s been coined, has redefined a procedure that for so long has been somewhat overlooked in the reconstructive healing process of those affected by breast cancer. In the past, most often, the only option for so many was to have a patch of pigments implanted into the skin by hospital or office staff. While in some instances the results may have been good, many were not. Thus, the obvious transition of this practice was towards tattoo professionals — those who’ve spent their entire careers perfecting the craft: trained cosmetic tattooers (who apply permanent makeup) and traditional tattoo artists. Using the foundational skills of tattooing coupled with precisely mixed pigments, shadows, and highlights, a very realistic result can be achieved. This 3D approach to the procedure offers each client numerous possibilities in obtaining the best end result and appearance, even for those who’ve already had nipple tattooing done.

A little more than a year ago, my younger sister was diagnosed with stage IIA breast cancer. Her battle has reinvigorated my desire to help as many people as I can with what has become my newfound career path. While tattooing “MOM” hearts and dragons was fun and a great job, this new dynamic in my vocation has become my obsession. The future for me will be to connect with as many people as I can either through tattooing, consulting, or teaching what I’m learning so that those affected by breast cancer can be — as Lillie Shockney, R.N. and director of the Johns Hopkins Breast Center, put it — “whole again.”

I feel like I have the best possible job as a service provider for breast cancer warriors. I’m on the back side of the battle… the finishing touch… the last step. I truly get to put the “cherries on the cupcakes”!

I look forward to hearing your questions and thoughts.

If you are an endorphin junkie like I am, you’ll find that keeping up with an exercise program during chemotherapy, if you are physically able to, is a good way to maintain mental health during a stressful time. Whether you are a runner, a cyclist, a walker, or any other type of athlete, continuing those activities is key to staying fit and mentally healthy.

Without a doubt, going through chemotherapy interferes with your regular exercise program. Between traveling to and from oncologist appointments, sitting through an intravenous drip, and then overcoming the related fatigue and nausea, it will be hard to find time to exercise. Fatigue and nausea alone will hamper any sincere athletic goals.

But chemotherapy does not mean you have to give up on running or other aerobic activity, or that you need to ditch your exercise goals. Quite frankly, running during treatment was my nirvana for maintaining health. As soon as the nausea wore off and my energy came back, I was out there on the trails, pounding out the miles. My pace surely slowed down, and it took longer to get warmed up, but my endurance was still there.

The feeling of being strong and healthy is reassurance that cancer is just a footnote to your otherwise active and healthy life. Aerobic exercise strengthens the heart, minimizes weight gain, and supports blood flow to the extremities that may be at risk of numbness and stiffness during chemotherapy.

There are certain rules of thumb that you need to think about before continuing an exercise program during chemotherapy.

1.  Don’t exercise without telling the oncologist. You need to get his or her okay on your exercise plans. Certain chemotherapy drugs are known to stress the heart muscle or cause bone damage.  There may be times in your chemotherapy cycle when you are at greatest risk of illness and infection due to a decrease in white blood cells. Your oncologist will be able to tell you when, in your treatment cycle, you can exercise.

2.  If you’ve had lymph nodes removed, don’t exercise without first consulting your surgeon and possibly a physical therapist specializing in treating lymphedema — swelling that can develop when lymph nodes have been removed. The swelling can be temporary or permanent. Overworking the affected arm too quickly can pose a risk for developing lymphedema. A physical therapist trained in lymphedema diagnosis and treatment can give you a baseline evaluation and go over your plan with you. You can also read the National Lymphedema Network’s Position Statement on Exercise (PDF) to learn about their recommended precautions.

3.  Stay hydrated. A lack of hydration could make you feel dizzy or nauseous and cause the heart to work harder. Staying hydrated during times of intense exercise could stave off these feelings.

4.  Avoid running or exercising immediately after receiving chemotherapy unless your oncologist gives you the go-ahead. While those chemicals, anti-nausea medications, and steroids are flowing through your bloodstream, you may not have the ability to recognize physical signs of distress.

5.  Check your pulse often and keep it within your usual limits.

6.  If you go out to exercise (running, bike riding), bring a cell phone in case you can’t make it back home.

7.  Lower your expectations and don’t be too hard on yourself. This is not the time to try to run a 7-minute mile if you are used to running 10-minute miles. If you are used to running 20 or 30 miles per week, don’t beat yourself up if you need to take off a few days to recover from treatments. Some days you may need to skip it if you still feel like you’re dragging or overtired.

While you have very little control over the drugs that are prescribed, or the dosage given of a certain drug, you do have some control over your physical fitness. Sarah W. from White Plains, New York told me that she continued training for mountain bike races during chemotherapy and rarely felt fatigued. Exercise is definitely an energy booster and a natural way to minimize some of the side effects of treatments.

The period of time following breast cancer treatment is one of significant transition. Women are coming to the end of an extremely challenging time and often want to integrate positive self-care, such as healthy diet, exercise, and meditation. Acupuncture is an outstanding choice for healing during this time since it works on the level of the body, mind, and spirit. Many acupuncturists can make recommendations about these changes and also provide exceptional emotional support.

Choosing the right acupuncturist is key to your experience. Each practitioner has his or her own style and a good fit is essential. If you have a friend who can recommend a practitioner they see, that is a starting place. I would also recommend looking at acupuncturists’ websites and seeing what their specialties are. Each acupuncturist is unique, and it’s advisable to call several to see who has a schedule and location compatible with yours. Acupuncture is an intimate modality, and it’s important to make sure that you like your practitioner! I would also ask them about their experience working with cancer patients. You will probably learn a lot. It’s important that your practitioner be a licensed acupuncturist (L.Ac.) and be certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). You could also inquire about any continuing education they’ve had in oncology. Don’t feel shy asking questions about their approach to treatment. Update: Women who have had surgery and other treatments for breast cancer are at risk for lymphedema, and it is important to make sure that your acupuncturist knows not to insert needles in the chest, arm, or back in the areas where lymph nodes have been removed. Current research does not show that acupuncture can prevent or treat existing lymphedema. If you start receiving acupuncture and don’t feel comfortable with your practitioner, don’t hesitate to find someone else who will better complement your recovery support team!

In my clinic, I find people to be particularly responsive to acupuncture when dealing with cancer. From the anxiety of waiting for a diagnosis, through surgical or chemical treatment, to establishing a new normal afterwards, acupuncture has much to offer. Acupuncture is widely believed to support the body’s ability to heal. Acupuncture can help clear the effects of surgeries with protocols for healing scar tissue and assisting range of motion. Update: While it is customary to avoid needling the quadrant of the body that has had lymph node removal, if a client is comfortable with it, I offer gentle acupressure can be used on the area to keep energy flowing throughout the body. Another technique that I find to be very helpful for certain clients is “cupping.” This involves the very light placement of glass or silicone cups on the body for the purpose of pain relief, detoxification, and for some clients, lymphatic drainage assistance in areas of the body that have not undergone lymph node removal. In my clinic, I never use heat or extreme suction on the cups. I commonly use this painless technique in conjunction with acupuncture after medical treatment to detoxify from medications and release tight tissue and muscle. Not every patient is a candidate for all treatments, and it is essential that treatment is tailored to your specific needs. What is most important is that your acupuncturist respects your concerns and cares about your comfort and safety.

The time following diagnosis and treatment is often a very emotional period deserving a great deal of compassion and support. Mood changes are common, including anxiety and depression — sometimes resulting in insomnia. These emotional issues respond very well to acupuncture treatments and the therapeutic relationship. At a spirit level, I see women who have experienced loss and trauma, but also possess an emerging sense of connection and a realization of support and strength. In addition, there is the gradual process of seeing oneself as being strong and resilient after having been sick or in pain.

During my treatments, I typically combine some of the researched Sloan–Kettering protocols for symptom relief (such as hot flashes, joint pain, or fatigue) with acupuncture points selected for my patients’ individual constitution. Depending on the situation, I might use a combination of needles, a TDP infrared lamp (to help circulation and release tight tissue), liniments, foot massage, aromatherapy, or whatever else seems most beneficial that day. Some people require fewer needles than others, not everyone enjoys essential oils, and not everyone responds the same way to sessions. Frequency of treatments varies between patients and stage of treatment.

From a practitioner’s perspective, the work I do with patients who are dealing with cancer is some of the most rewarding. I experience this as inspirational work, a chance to accompany women who have already faced many fears and pain. My role as an acupuncturist affords me the opportunity to help my patients rebuild, and to identify the virtues they possess that support them during this journey. The intimacy of our acupuncture sessions and the time spent is particularly helpful and nurturing. In addition to being a powerful complementary medicine, acupuncture provides patients with a unique opportunity to be known and cared for.

Have you been treated with acupuncture? What were your experiences? I welcome your comments and questions.

The results were amazing — 70% of you exercise regularly and 23% exercise sometimes. So a whopping 93% of people who filled out the survey do exercise, which is tremendous! You’re reaping the benefits of working out, which include lowering your risk of cancer coming back (more than 60% of respondents were diagnosed within the last two years or more recently) or of being diagnosed in the first place, as well as fewer and less severe treatment side effects and increased mobility and energy.

Since it’s fairly easy to do and can be done almost anywhere, it’s no surprise that walking was the most popular type of exercise. More than 80% of people who filled out the survey walk, but it’s clear from the results that a lot of you are doing several types of exercise, which is what most trainers and physical therapists recommend. Great job! Here’s what you told us you’re doing:

• weight lifting: 35%
• cycling: 29%
• yoga: 28%
• running: 23%
• elliptical machine/stair stepper: 22%
• swimming: 19%
• dancing: 15%
• hiking/rock climbing: 14%
• aerobics class: 11%

Smaller numbers of other people are skiing, skating, rowing, playing golf and tennis, and doing Pilates.

The American Cancer Society recommends that women who’ve been diagnosed with breast cancer exercise about 4 hours per week; it seems that quite a few of our survey respondents are superstars when it comes to exercise: Nearly a quarter of you exercise more than 5 hours a week and another quarter exercise 4 hours or more each week. Another 20% exercise between 3 and 3.5 hours per week — that’s some awesome sweat equity you’re building in your body.

It’s also pretty clear that our visitors know that they need heavy breathing now and then. Nearly 70% of you exercise at a moderate level most of the time — impressive for a group of people moving through the treatment and recovery process.

If you didn’t fill out our survey and don’t exercise, I bet these testimonials will rev up your resolve. You can feel the glow coming through these women’s words:

“I’m at the halfway mark on my chemo now, just finished 3 x FEC and will start weekly x 9 of Taxol this Tuesday. I’m running though chemo, much slower pace and shorter distance. My heart rate on my long run is the same when I did my tempo run before chemo, but doesn’t bother me at all! As long as I can get out there and run I’m happy.”

“I have lymphedema, but I love my yoga classes and wouldn’t give them up for the world! That said, I always wear my compression sleeve and gauntlet and I do avoid poses like downward dog. I can do plank just fine for some reason. After dealing with lymphedema for so long, I’ve just kind of learned what poses will leave my arm with that dreaded ‘heavy’ feeling, and I avoid those, but I do all others with enthusiasm.”

“I just passed the half way mark on radiation therapy today and went for a 4-mile JOG — I emphasize jog because my husband can actually walk beside at the same rate. In any case, it just feels good to still be getting out there and sweating no matter how far or how fast.”

“While on chemo and radiation, I was walking every day. It really helped with fatigue. Even if you have to crawl out the door, you get your b*** out there. It will be well worth it in the end. During radiation I also did my arm exercises every day. I just hated the tightening feeling if I didn’t do my upper body workout.”

“A couple of months ago I decided to take up running again, something I hadn’t done in 10 years. I’m doing that ‘couch to 5K program’ and finish it next week. So while it’s not a lot, running about 5K 3x a week has really changed the quality of my life. I felt so sluggish all the time I didn’t think I was ever going to be able to exercise again! Chemo-induced menopause and a new belly I never used to have sure didn’t help.”

Thanks again to everyone who completed our exercise survey! Your input helps us be the best we can be!

My post-cancer self is sort of like that — she finds less appeal in acquiring stuff and is much more eager to spend time in nature, getting exercise and some psychological balance. I like this change — I wish I had made it without having to go through surgery, chemo, radiation, and fearing for my life. I’ve learned that contentment is not for sale at the mall or on the Internet, but discontent surely is. And it is all ramped up during the holidays.

In most cases, the holidays can’t stand up to their own hype. We, in general, expect too much of the season — family togetherness, a beautiful snowy landscape, peace, joy, exquisite decorations, and fancy cookies. Our own living, breathing Hallmark card — a pretty tall order under the best of circumstances. But when you’re dealing with breast cancer, the season of forced glee can be a heavy burden.

The sadness of what a diagnosis means, the fear for our future, worry about our kids, anxiety about what treatment will do to our bodies, terror about whether or not we can beat this disease, anger that we got sick in the first place — it can be a pretty potent stew of emotions on any given day. And we’re often simply sick and tired and not physically up to our usual, let alone somebody else’s expectation of holiday-level wonderful.

My first post-diagnosis Christmas came when my hair was a thin layer of fuzz and my energy was stuck at slug level. I was still at the point where I resented every woman I saw who did not have breast cancer, so I was a little raw physically and emotionally. The only thing I really wanted that year was normalcy, which I tried to achieve by making myself at least look somewhat like the old me. I was tired of wearing wigs, so I opted for a snazzy silk scarf for a family celebration at our home. Hair equaled ordinary to me, so I wanted to show off my new stubby growth. But, for the life of me, I cannot tie a scarf like a grown-up, so that little number kept falling down my forehead or slipping lopsidedly over one ear and then another. I looked like a drunken pirate. I considered ducking into my bedroom and throwing on a wig. But, ultimately I decided that this is the way I looked at this point in my life, and my family loved me despite that fact. Or, maybe even because of it.

This should be a season of love, a time for you to rebuild your health, which may be the only gift your family and friends want. Some thoughts on making the season more enjoyable for you:

Manage Expectations. What do you need from the holidays this year? Rest? Peace and quiet? Or lots of company? Talk this over with friends and family and determine what you can and can’t do — and realize it’s OK for this year to be different. I found that decorating the house perked me up, but I still left quite a few ornaments in the basement because I simply ran out of energy. Nobody noticed.

Avoid Holiday Pitfalls. Caffeine and alcohol can take us even farther into the doldrums. Both are plentiful during the holidays and both are harmful for our physical recovery. I generally follow a diet heavy on complex carbs — grains, vegetable, and fruits — supported with cheese, yogurt, fish, and shellfish. I use the Mediterranean diet as a model, but reduce the amount of wine it suggests because of the link between breast cancer and alcohol.

Keep Active. Walk, do yoga, swim, dance — anything that keeps your body active can help calm your mind. If you feel sadness descending, or you are getting anxious, get up and do whatever you can handle: walk to the mailbox, put on a yoga DVD, or hang up the Christmas wreath. Any activity will do. A friend of mine started taking piano lessons during treatment, bought herself an inexpensive keyboard, and hit the ivories when she started feeling low. She now plays pretty darn well.

Enjoy Nature. Spending time outdoors can increase your energy and reduce your anxiety. I actually enjoy bundling up in a warm coat, hat, scarf, mittens, and boots and going out into the wintry air. Too much hot inside air can be stifling. Fresh air is invigorating for body and mind.

Honor Your Emotions. I was sad and angry that first year, grieving my former life. Pretending otherwise would have been denying my own reality. Bottled emotions, like liquor, get stronger with age. And denying them just gives them more power over you. Your body, mind, and spirit have been through a huge change, especially if you have already started treatment, and that can turn your emotions inside out. Check Breastcancer.org’s overview of treatment side effects, which includes anxiety, depression, and fatigue.

Talk it Out. If the holidays are making you especially low, find a wise friend, counselor, minister, or anybody you can trust and sit down and talk about how you feel. Sometimes simply expressing yourself is the first step toward feeling better.

Know the Difference Between Sadness and Depression. Sadness is not a sign of weakness. It is a sign you are human. Yet, if you are so sad you don’t feel like doing anything or seeing anybody, and if it’s not getting any better, you might be depressed. Depression requires professional help. But before you take any additional medications, check with your oncologist to make sure those drugs will not interfere with your treatment, especially if you are on tamoxifen.

Laugh. Watch funny movies, hang around friends who make you laugh, do anything that can tickle your funny bone. Even try laughing yoga. The act of laughing itself can reduce stress. I come from a funny family in oh so many ways, but mainly we just enjoy laughing. I know that helped my recovery greatly. And if you’re going to look like a drunken pirate in your Christmas pictures, you sure should be able to chuckle about it.

Breastcancer.org can help you with these questions and more. Our core content and Ask-the-Expert Conference transcripts offer a wealth of information — here are some links to help you get through the holidays.

How much alcohol is too much?

New research recently came out showing that 3 drinks a week can raise risk of developing breast cancer by 15%. While this new guideline is disappointing for many women, it can be especially hard to follow during the parties and long meals (and stresses) of the holidays.

Learn more about the study and suggestions for how to cut down on the amount you drink. 

What should or should you not eat?

Our experts have answered readers’ questions on the best way to enjoy all the foods of the season. Find out what they recommend and how they treat themselves.

“How bad is sugar when you’ve had breast cancer? And how you can avoid it through the holidays?”

Read the answer.

“What’s a seemingly indulgent but nutritionally sound buffet menu for a cocktail party? What would YOU serve at such an event?”

Read the answer.

“I’m Catholic and we’re doing our traditional Seven Fishes dinner this year for Christmas. With all the mercury issues, is there a safe way to do this or should we alter it somehow?”

Read the answer.

Scheduling treatment during the holidays

Whether you’re traveling during the holidays or hosting, breast cancer treatments such as daily radiation appointments or the ups and downs of your chemotherapy cycles, can throw a wrench in your plans. Our Fitting Treatment into Your Schedule page has information and tips on talking to your doctors about adjusting your treatment schedule.

Managing side effects

Side effects from breast cancer treatment are common, but there are ways to manage them — which can be especially important at a busy, food-centered time of year. Find out how to manage everything from changes in your appetite, nausea, and diarrhea to fatigue and mood swings in Treatment Side Effects.

Anyone who has had lymph nodes removed during surgery is at risk of developing lymphedema and/or serious infections in the affected body part. Lymphedema is the swelling of the soft tissues caused by the build-up of lymph fluid. Physical activities such as shoveling snow or carrying heavy shopping bags could potentially trigger lymphedema; cuts or burns in the kitchen and dry and cracked winter skin could lead to infection. Learn about how to avoid and manage lymphedema, and read the account of a skin infection from one of our bloggers so you know what the signs are.

Our experts have answered these questions about side effects and more:

“I am constantly getting hot flashes from the tamoxifen!! I don’t want to embarrass myself at a party. Are there foods I should steer clear of so my hot flashes won’t get triggered?”

Read the answer.

“Chemo has altered my taste buds. Have you heard from others about what kinds of foods taste better to them when this happens? Or is it individual to the person?”

Read the answer.

“Chemo has been giving me diarrhea. Are there any foods I should avoid at parties to prevent an episode of diarrhea?”

Read the answer.

Stress Relievers

Complementary medicine techniques such as journaling, meditation, yoga, and aromatherapy can be used to ease side effects and improve quality of life — they can also help you relax and relieve stress! Check out our list of which therapies work for which symptom in the  Complementary & Holistic Medicine section to learn how to integrate these techniques into your routine.

The Breastcancer.org Discussion Boards is a good place to talk with others in a similar situation.

Dr. Marisa Weiss recently shared her ideas for ways to unwind (since she no longer drinks her evening glass of wine). Did she cover your favorite stress-reliever?

We wish you a joyful season, no matter what or how you celebrate. If you have tips for managing the holidays during breast cancer treatment and beyond, please share them in the comments!

To briefly recap Chapter 1 and Chapter 2 , this summer (our first living full-time on the farm) found me loving living here and farming full-time, but thinking, thinking, thinking about everything that needed to be done, and running, running, running trying to do it all. Somewhere in there I first stopped sleeping through the night (which is highly irregular for me) and then I even began having mild night sweats.

While at my primary care physician’s office for a check-up, which I have every 6 months ‘rain or shine’  because I have so many post-cancer long-term medical concerns (some little, some big) that are generically called ‘late effects’ from cancer therapies, she asked if I had been having any ‘night sweats.’ Well, gosh, I don’t ever remember her asking me that before, ever! Even though I had thought my night sweats were odd but so mild that I might be able to ‘get away’ with not mentioning them at this appointment (NO, no, no – big mistake!! – don’t hold back, don’t do that, ever! – YES, always mention any new symptom that is out of the ordinary for you!). After a thorough Q&A session, she and I together decided to ‘watch and wait’ since these night sweats were mild (i.e., not soaking my pajamas or sheets), of recent onset (only about 2 weeks, not months and months) and except for the other new development of difficulty sleeping through the night, I was actually feeling well. I left her office with a clear charge that I should call her if anything changed.

Wham-bam!! Change did not take long at all to happen.

That night after first falling asleep and then waking up an hour or so later, wide awake with my mind racing as I have recently become accustomed to happening, I got up to walk through the house. Before I took 10 steps (I was still in our bedroom), for some reason I rubbed one of my arms, hmm maybe I do that all the time anyhow, never noticing anything out of the ordinary. However, this time, I about shot through the ceiling with pain in my upper right arm. When I came back down and cleared my senses, I rubbed my arm again, yes, it was screaming in pain when I touched it, and this time I could feel a lump, a rather large lump actually, perhaps the size of a small egg.

Wow, where did that come from all of a sudden and what could that possibly be???? Somehow I got back to sleep, after all, the morning would bring a very busy day. My husband and I had to finish cleaning more garlic for our last farmers’ market of the week that afternoon. I had to help get our stand set up at the market (leaving my husband to staff the table by himself) before I left to go pick up our daughter-in-law at the airport and then help her get ready for a weekend retreat with some friends before making dinner after we all got back home to the farm. Whew!

My wildest hope was that this odd pain and lump would just disappear over the day – I know that was optimistic, but I was WAY too busy to pay much attention to it anyhow. However, I became aware that I was ‘fading’ all day long, even if I could somehow compensate in a way that my arm did not hurt and maybe, maybe, maybe, hopefully I didn’t have a fever.

By the time I got to bed, I just fell into bed in my clothes, too tired to put on my pajamas and also too tired to find the thermometer. No this pain did not go away today – sigh…….not that I really expected it to do so. Yes, my arm still hurt like crazy when I touched that odd lump. However, this time when I woke up in the middle of the night I had a ‘flash’ of what could be happening and knew there would be no more wishful thinking, no more delay no matter how busy the following day was already scheduled to be. The ‘distress signal’ would go up at 8 AM when my doctor’s office began taking calls, even before my daughter-in-law would have left with her friends.

In a nutshell, women who have had breast cancer surgery that has removed many lymph nodes from the armpit (called a full lymph node dissection) on the same side of the body as the cancer was found in the breast are at very high risk of developing both lymphedema and infections in that arm. My first breast surgeon sat me down in 1984 to warn me about the dangers of these infections, grabbing my left hand and telling me that he could “win the cancer war and still lose me in a side skirmish to an infection.”

He proceeded to tell me with tears in his eyes that such an occurrence happened to someone he knew who had insisted on pruning her roses after her breast cancer surgery and lymph node dissection without using good protective gloves, was poked by a thorn, developed an infection in her hand that quickly spread up her arm then into her bloodstream because she did not have a full functioning lymphatic system in that arm to help fight and contain it, and then she quickly died, pure and simple. (Wham-bam, I added that thought myself just now.)

Those words and those tears made a strong and lasting impression on me. I remember every detail of that conversation like it was yesterday. I have been fortunate to never have any hint of lymphedema develop in either arm after each breast cancer surgery, even with all the air traveling I have done over the past 15+ years. In addition, I have been meticulous about reducing risk for an infection by trying diligently to not injure my hands or arms since then. I try to always remember to wear good garden gloves when working outside and also in the barn, making the trek into the house to wash any hint of an abrasion or cut thoroughly. I wear long-sleeve shirts to avoid scratches and insect bites even on most of those hot hot summer days, and I also often use awful bug spray to reduce the risk of insect and spider bites when working in the fields.

I am meticulous in the kitchen with knives and other sharp utensils and only rarely use that mandoline for grating hard cheese, which I swear has a scheming mind of its own and tries to scrape my fingers! I bought myself a better rolling suitcase that was not so hard on my arms to pull, and I really really do try to remember to not be ‘helpful’ by lifting heavy objects (including my roller bag into the overhead bin on the airplane). Hmmmm, maybe I am not remembering enough here, as I can now hear several conversations in my memory with our garlic helper this past July about just how heavy those tubs of garlic were as they were carried from the field back to the barn (“yes, yes, I can help you, I can do this,” says Diana).

I was on the phone at exactly 8 AM and my doctor had personally called me back by 8:04. I was in her office by 9:30, in the light of her office it was obvious my arm was red and swollen with the large lump no longer clearly visible, and I had a fever. She told me that I very likely had an infection within the skin of my arm called cellulitis, often caused by an insect or spider bite (we were now into that horrific mosquito outbreak that happened in SE Michigan this past summer), and that it was far enough advanced and I was at such high risk for the infection quickly developing further that I needed to head to the emergency room for intravenous antibiotics as soon as possible. She said I could go home to get my husband, but I was to tell him that he was not to let me get frustrated and walk out like I did last March (long story that I probably didn’t blog about!), with a ‘look’ that said ‘I mean it.’

Yikes! I worked so many years in the intensive care units that I knew all about the ‘worse case scenarios’ of systemic infections, plus I had the warning from my first surgeon burned into my DNA so I fully understood what my doctor was saying, what she was not saying, and what I would be doing for the next day, at least.

To try to shorten this up a bit, the upshot was that I spent 24 hours in the emergency room as my infection did not respond to the first 4 doses of Plan A of IV antibiotic and was clearly spreading. On to Plan B, which is a stronger antibiotic. Intermittent with all of this were multiple ultrasounds of that painful lump in my arm to try to assess just what that lump was (a blood clot?, abscess?, swollen lymph node?, tumor?). If that second antibiotic did not work, then it would on to Plan C, which was the least desirable because there would be no oral form of that antibiotic to ultimately switch over to.

As soon as it was apparent that we were on to Plan B, antibiotic #2, I was promptly admitted to the hospital versus continuing with the ER protocol for cellulitis. Thankfully, with the second dose of the second antibiotic, the redness began to recede (my arm was marked at regular intervals with magic markers, using various colors and patterns and initials to follow the course of the infection) and most interestingly, I slept off and on that second night without any night sweats. At the end of the 3rd day, I was able to be sent home on the oral equivalent of this antibiotic (clindamycin) with the infection clearly receding.

It is still unclear what the trigger was for this infection. There was no obvious sign of injury or insect bite. Several doctors said the two weeks of night sweats that I had prior to this infection becoming clinically evident would not be typical of cellulitis, that this type of infection usually manifests very quickly. (However, the graduate student currently living with us for a few months recently said, with fondness , that ‘everything in this house is atypical!’). Since these night sweats have not recurred at all since the resolution of my infection, in spite of several medical opinions to the contrary, I will believe there was a connection, that my body was slowly fighting an infection secondary to some unperceived injury and ultimately was overwhelmed without a fully present and functioning lymphatic system.

1) If you have had lymph nodes removed (and this can be done with other cancer surgeries, too, in addition to breast cancer), know that you are vulnerable and at high risk of developing lymphedema and infections that can quickly spread to become serious and even deadly.

2) Know the precautions you should adopt into your lifestyle (even burn into your own DNA) to prevent lymphedema. If you already have lymphedema, find help to best treat it and control the symptoms. Know that any sign of an infection in an affected limb could be serious and call your doctor promptly.

3) Be vigilant! I told several people treating me while in the ER and hospital that in spite of what my admitting card said, my middle name was actually was ‘Vigilant.’ I was paying attention to myself and to them, and I would ask questions, add more information, and even correct them if I thought that was appropriate to optimize my care while shooting for the best possible outcome here.

4) If you are a newly diagnosed breast cancer patient, read, read, read about options for surgery including lymph node surgery (single node sampling versus the full lymph node dissection techniques). Be very cautious about opting for full lymph node dissection since a recent large study has showed no survival advantage with this invasive technique that clearly has multiple known side effects that can compromise both health and quality of life (I wrote about this previously on my blog).

5) This is so obvious that I almost did not think to mention it. If you do not have a primary care doctor, or do not have one that you trust as a ‘partner’ for your medical care, please find one as soon as possible. My doctor called the ER ahead of my arrival, told them everything they needed to know to be ready to swing into immediate action, told them all precautions needed for me, and basically had them ready for me. Besides her telling me that I ‘could not leave the ER,’ all of her meticulous attention to medical detail plus caring about keeping me a ’survivor’ may have saved my life.

I have already had one farmer friend tell me she now knows she needs to be paying more attention to the lymphedema in her arm that has resulted from her breast cancer surgery (yes, yes, yes! to all of you reading who are cancer survivors out there in the blogosphere with lymph nodes removed, no matter what type of cancer surgery you have had).

I have had one of the smartest dietitians (RD) I know tell me she had no idea about the risks involved from breast cancer surgery in which the lymph nodes are removed.  (To all RDs – are those of you out there also in the blogosphere paying attention? Are you telling your breast cancer survivors to use extra caution when using knives or other sharp implements in the kitchen? Are you reminding them to use extra care not to burn themselves when cooking or washing dishes or handling hot dishes, pots, or pans?)

Well, it would be glib to sign off with a simple ‘all’s well that ends well.’

Wow…Yes, this was a ‘wham-bam’ experience and could have ended much differently. I guess The Universe got my attention with the ultimate message to ’slow down.’ Hello! I hear you, I get it, I will listen, I will let this message burn into my DNA like my first surgeon’s message to be vigilant about the care of my hands and arms. Cancer survivorship is ‘tricky business,’ it is not ‘back to normal,’ and it is definitely not clear-cut medicine. In fact, I think it would be fair to say that all cancer survivors likely fall outside the box into an ‘atypical’ category as both a patient and with life.

This post was borrowed with permission from Diana’s blog, DianaDyer.com. Read the full post.

I never thought that getting diagnosed with breast cancer would be on that list of life-changing events, but it is.

Walking into the doctor’s office to get the results of the biopsy of my left breast on December 15, 2010 changed me. I remember my life prior to that date as a carefree and healthy 45 years. Of course, that’s not true. I am a worrier by nature and was often filled with angst about some or other issue in my life. But even in my mid-40s, I felt immortal. I swam too far out in rivers and lakes, went running alone in mountains near my house where bears are often spotted, and traveled to countries where I barely spoke the language.

When I hurried to the oncologist’s office for results last December, despite the palpable lump in my breast and the knowledge that I had the BRCA2 gene, I still had a certain level of optimism and assumption of longevity. I walked out of that office with the frightening reality of a cancer diagnosis.

A cancer diagnosis is a stark reminder of your own mortality.

For me, the fear of the disease was the incentive to take control of it. Fear is one of the most productive motivators. Doing something periodically that causes your heart to race makes you stronger in the end. For instance, years ago as a new swimmer, I signed up for a swim across the Hudson River. As I stood with the other swimmers, clutching my goggles, I began to shiver and my knees were shaking. I emerged from the other side of the river, a mile and a half away, feeling proud and a little stronger.

So that is how I decided to deal with cancer. Researching my options obsessively and choosing aggressive treatments, for me, was my way of confronting the fear. There are certain things that you can’t control relating to the lump in your breast. But there are many decisions that are up to you.

In the months to come, I will share with you how I was able to guide the steering wheel on difficult decisions relating to my breast cancer treatments. I plan to discuss topics relating to exercise and how to maintain physical health during chemotherapy and radiation, from my own perspective and experience.

My story is just one of many. Everyone diagnosed with the disease has a mounting list of decisions to wrestle with: mastectomy versus lumpectomy; both breasts or one; work through treatments or take a leave of absence; tell everyone about cancer or keep it a secret; wig or scarf. I look forward to sharing my journey with you, the Breastcancer.org readers.

I still remember a time in college when I was hanging out with some housemates in my bathrobe, weeping over some romantic crisis or other. (There were lots.) In the midst of my lamentations, one of my friends, a guy, said, “Not to interrupt or anything, but damn, Gina, you are stacked!” Oddly enough, that made me feel better.

And then my breasts, the one part of my body I’d always been at peace with, decided to declare war on me. Or at least the right one did. In 2004, I was diagnosed with invasive ductal carcinoma, stage IIB, with lymph node involvement, and went through the dark merry-go-round of treatments: neoadjuvant chemotherapy (AC-T), a lumpectomy and excision of nine lymph nodes, and 33 rounds of radiation, followed a bit later by a year of Herceptin.

After all of that, my battered chest didn’t look so cute or perky. I still had both breasts, true, but Cancer Boob was noticeably smaller than the other, and there were those scars around the nipple and in my armpit. My hair eventually grew back, of course, but looking in the mirror naked was not something I looked forward to—despite how often my husband told me how sexy I was.

But how I looked in the mirror wasn’t something I had time to think about much at that point. At 38, I was much more focused on something else: having children. Despite the fact that the American Society for Clinical Oncology advises its members to discuss cancer’s impact on fertility with all of their patients of reproductive age, surveys show many oncologists still don’t. I was lucky—mine did offer my husband and me the option to freeze embryos before treatment. After much angst, we eventually elected not to—I just couldn’t handle more medications, more surgery, more injections, more tests.

So after the Cancer Year came the Adoption Year. We figured that I would not be able to get pregnant at 38, after aggressive chemo, so we intensely researched adoption and then in February 2006, brought home our beautiful newborn daughter Annika, entrusted to us by her wonderful birthmom Kim, who’s still a big part of our lives.

A year and a half later, we discovered I could still get pregnant. And when I was about six months along with my son, Adrian, who’s now three, I suddenly took a sharp look at my body again. That’s because one morning, when I looked in the mirror, I realized that my left breast wasn’t just a little bit bigger than Cancer Boob—it was a whole lot bigger. Like, Three Mile Island bigger. After letting out a giant shriek, I ran to the computer, did some research, and found out that irradiated breasts tend not to lactate. If I was going to breastfeed—and I wanted to—Lefty would stay rather massively larger than Righty for as long as I did.

But something strange happened.

I didn’t care.

Once I got over the initial shock, I didn’t really mind that I had a cantaloupe on one side of my chest and a tennis ball on the other. First of all, damn, I was pregnant! I had pretty much given up on the prospect, but my fierce little ovaries had said a big “In your face!” to cancer. The body that had endured eight rounds of systemic poison and a whole lot of radiation was now sheltering a growing baby.

And then, once my son was born (via a very unwanted but very necessary C-section, which added yet another scar to my body) and placed on my chest to nurse—which he did immediately and avidly—the fact that I could nourish my child from my own body, and instantly turn his tears to contented sighs, pretty much completely erased any concerns about how I might look in a swimsuit.

I never bothered to stick cutlets in my bra. I’ve even been known to go out to schmancy events wearing a plunging neckline that makes it necessary to occasionally retuck one boob, but not the other. Do people look? Maybe. I don’t care. If they ask—and sometimes they do—I’ll tell them, without a single blush.

When Adrian was about four months old, we were in the checkout line at Target. The cashier asked me, “Do you breastfeed?” After blinking in surprise that she’d ask such a personal question, I responded “Yes.” She said, “I thought so. You’re a little … engorged on that side.” I burst out laughing.

Today, I have three kids—our youngest, Katia, was born six weeks after I turned 43. My body looks like—well, it looks like the body of a 43-year-old woman who’s had a lumpectomy, a lymph node dissection, several biopsies, a C-section, and a VBAC, and nursed babies for going on four years now.

And I love it. I look in the mirror and I love it. I see the left breast that nourished two children, and the right breast that I’ve forgiven for letting its cells mutate. I see the chest that three kids lay their heads on while we read bedtime stories. I see the arms that have gotten stronger not in the gym that I rarely get to, but from carrying them. I see the stretch marks bearing witness to where two of them made renovations to the temporary home they lived in while inside me. I see the wrinkles (more and more of them every day) that show how often they all make me laugh. (And yes, the gray hairs that demonstrate how often they stress me out.)

I see a body that has triumphed. I see a body that has declared victory over cancer. I see an incredibly lucky woman who loves her life and loves the body she lives it in.

I owe that gift to my children and to the good fortune I’ve had in being able to have them. Having children after cancer really did give me the ability to love my body again. It also gave me the ability to reconcile myself to my cancer in the first place.

I’m not one of those people who says “Cancer is a gift.” If cancer’s a gift, where can I return it and exchange it for a nice pair of Manolos? But thanks to my kids, I recognize that, had I not had cancer, I would not have the life I have today. I might have had kids sooner—but they would be different kids, and I can’t imagine life without these three amazing little people. I spend endless hours loving and taking care of them, and in return, they have transformed me. To paraphrase Wicked, I think I have been changed for the better—and I know I have been changed for good.

Although I’m smitten with the earthy-sweet flavor of beets, I must admit that I love them, first and foremost, for their ability to naturally impart foods with a vibrant, Schiaparelli-pink hue. It’s hard not to smile when faced with a plate of flaming pink rice! Although this easy risotto tastes rich and comforting – perfect for a chilly fall night – it’s deceptively low in fat [less than 5 grams per serving].

Confession: Being a connoisseur of groan-inducing puns, it took everything I had to not title this post “Beet Breast Cancer.”

Pink Ribbon Risotto

• 1 small red beet
• 3 cups vegetable broth
• 1 T  olive oil
• 1 clove garlic, crushed
• 1 small red onion, chopped
• 1 cup arborio rice [Important: use Arborio. Other varieties won't work for risotto]
• 1/4 cup dry white wine [Optional]
• Salt and fresh ground black pepper, to taste

Serves 4

Heat oven to 425 degrees. Wrap beet in foil, place on a cookie sheet, and bake for 30-45 minutes, or until soft. Remove foil, peel and chop finely. Set aside. Be careful: beet juice will stain countertops and clothing.  [Time- and energy-saving tip: I bake several beets at once, and use the rest to make borscht or to slice for salads]

Warm stock over medium in a medium saucepan.

Heat oil in a large pot over medium. Add garlic and onion and saute until soft, about 5 minutes. Add the rice and stir to coat with the oil. Cook about 1 minute, then add the wine, if using, or a ladle of warm stock. Stir. Turn heat to medium low.

Once most of the stock is absorbed, add the beets and another ladle of stock. Stir and cook until the stock is almost absorbed. Continue in this manner, adding stock, a ladle at a time, stirring occasionally and cooking until stock is absorbed, until the rice reaches your desired consistency –about 30-40 minutes.

Adjust seasonings and serve warm.

This post was borrowed with permission from Dynise’s blog, urban vegan.