? Because you have had breast cancer, you probably cannot take estrogens. Currently there are clinical trials underway to determine the safety of HRT (hormone

replacement therapy) for women who have had breast cancer. You may want to talk with your doctor about this in the future. There are other strategies for dealing with menopausal symptoms. Find a gynecologist who is experienced with women who have had breast cancer.

? Some women find that hot flashes are helped by eating soy products or drinking soy milk or taking vitamin E (800 units a day). Look carefully at any holistic menopause treatments: many contain natural or plant estrogens. Before taking them, be sure to consult your physician.

? A few prescription medicines you can safely take may help. Ask your doctor about the clonidine patch (otherwise known as a blood pressure medicine), bellemene s, or about a low dose of Effexor.

? Remember the handheld fans which your mother or grandmother used. They are still available (look in Asian markets), and they still work.

? Hot flashes tend to be worse at times of stress—another good reason to try to reduce the stress in your life.

? Dress in layers. Try V-neck shirts or blouses with a cardigan-style sweater or jacket over them for warmth. The outer layers can then be removed when the flash strikes. Scoop-neck or jewel-neck tops make an excellent choice for a first layer, too. You will probably want to avoid turtlenecks at this time.

? If you have hot flashes at night, keep an extra pillow near you. When you awaken in a sweat, switch to the fresh, cool pillow. It helps. Also, keep fresh drinking water next to your bed along with a few mints or suckers.

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The most important thing is your health, now and in the future. You need to do what is best for you and what has the best chance of ensuring your long and healthy life. Remember that there is no single right choice of treatment. It is important that you receive appropriate chemotherapy, but there are likely to be several treatment regimens that are equally right for you.

Many women are more frightened by the prospect of chemotherapy than they were of surgery. It can be difficult to forget images you have seen in the movies or read in books of cancer patients being desperately ill from the chemotherapy treatments. Fortunately, times have changed and real progress has been made with controlling the nausea and vomiting you may be dreading. There are new and powerful drugs, such as Kytril and Zofran, which eliminate or greatly reduce these side effects. Over time, there will be additional new drugs discovered and recommended as well.

You may also be fearful of having such powerful drugs injected into your system. It can be hard to think of chemotherapy as lifesaving rather than as toxic poisons. Talk with your doctor about your concerns, and remember that a drug strong enough to kill cancer is going to be strong enough to have some other side effects. All of this is temporary. You are trying to save your life.

Talk with other women who have undergone chemotherapy about their experiences. What you hear from them will be somewhat different from what you hear from your doctors. Most women will tell you that their fantasies about chemotherapy were much worse than the reality. No one would suggest that receiving chemotherapy is pleasant, but it is completely manageable. Use all the information to help you make the best decision for yourself.

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Several types of reconstruction may be available to you. Following a mastectomy, reconstruction can be done either immediately (at the time of the mastectomy) or at a later date (many months or even years after). (There is usually no need for reconstruction after surgery less than mastectomy.) In either case, further procedures may be necessary in the months that follow—for example, placement of a nipple/ areolar complex, reduction of the other side to match the reconstructed one, and so forth.

Reconstruction has become more common, but remember that you do have another option: mastectomy alone. In some hospitals immediate reconstruction is the standard of care, and women are told in the same breath that “you need to have a mastectomy, but you can have reconstruction at the same time.” For many women, this may indeed be the best option, as they never have to deal with the total absence of a breast and do not have to make a decision to return in the future for more surgery. However, for others, this may be a mistake. You will find it hard to think clearly about these choices, some of which involve major surgery with long recoveries, while you are still trying to absorb the initial diagnosis of breast cancer. Remember that you can opt to take care of the cancer now, with a mastectomy, and then revisit the question of reconstruction next year or even five years from now.

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Very young children will not understand the facts and details about what is happening; they will, however, know that something is very wrong. In reaction they may be more clingy and irritable, or conversely, they may be too well behaved and anxious to please. What they need most is reassurance that someone (ideally someone whom they already know and trust) will always be there to care for them and reassurance that they are not responsible or to blame for what has happened. The normal magical thinking of young children may lead them to believe that their anger or words have caused your illness; tell them directly that this is not so.

You must also distinguish between your cancer treatment and the more ordinary illnesses ttiat may happen to them. We have heard stories of young ch iidren panicked about taking an antibiotic because “momrviy’s medicine” made her hair fall out! Many mothers worry* that their young children will be especially upset if they lose their hair because it is harder to explain the process to them. Our experience has been that preschool children accept their mother’s baldness as one more interesting and new thing about the world. One woman said that her three-year-old daughter wanted her to come to nursery school as her show-and-tell exhibit!

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Here are some things to remember as you choose your medical team:

? First and foremost, you are looking for the best doctors in your area with whom you feel comfortable.

? Most likely your medical insurance plan will place some limits on your choices. Your doctors will need to be on their list of approved providers/specialists.

? Geography matters. Although it is certainly worth traveling a reasonable distance for better care, remember that you will be spending a fair amount of time with doctors and treatments in the site you select. Since one overall goal is to make your life easier, not harder, whenever possible, you might want to consider geographic location very carefully.

? Trust your gut. Remembering that it is hard to like the messenger of bad tidings, pay attention to your reaction to the doctors with whom you are speaking. Do they treat you respectfully? Do they spend enough time to answer your questions? Do they talk to you and not to your spouse or partner? Do they tell you how to reach them or their coverage at any time, and do they suggest the best way to ask them questions at times other than during office visits?

? Ask to tour the treatment area. It will nor be as scary as you imagine, and different practices are set up in different ways. Would you be more comfortable in a large and airy space, where you can see other patients and the nurses at all times, or would you prefer a small and private room away from others?

? Ask who administers the chemotherapy and whether you can be introduced. Most often chemotherapy is given by skilled and experienced oncology nurses; some oncologists, however, do it themselves. One way is not better than the other; they are just different systems.

? Ask about available support services. Is there an oncology social worker on site? Can you and your family meet with her or him? Are there support groups? Peer support programs? Educational materials? Resources for your family—your partner, husband, children?

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