Spring is the season for delicious, ripe rhubarb.

Spring is a season of hope, rebirth, and rhubarb. That’s right—along with daffodils and chirping birds, the season brings this red vegetable that can be used in countless recipes.

About Rhubarb

Rhubarb is officially a vegetable, although it’s often treated like a fruit. It has a strong, tart taste, which is why it is often cooked with sugar for use in recipes. In fact, its use in pies and sweet desserts has earned it the nickname “pie plant.”

Rhubarb stalks resemble celery stalks, but they range in color from crimson red to light pink to light green. The leaves of rhubarb can be toxic, but they are normally removed before the stalks are sold.

Rhubarb grows best in cool climates. Stalks typically start appearing in markets in April and depending on the region, you may be able to find it as late as September. For optimal taste and freshness, look for long, firm, fleshy stalks.

Rhubarb is an excellent source of vitamin C, potassium, and fiber.

A Little Rhubarb Trivia

Rhubarb inspires strong feelings—most people either love it or hate it. Even those who don’t love the idea of strawberry rhubarb pie in the spring might be interested to know that this tart, pucker-inducing vegetable has uses beyond the kitchen. The vegetable contains oxalic acid, which makes it tart and also makes it useful for scouring cooking pots. Furthermore, it can be used as a garden spray to deter aphids and has even been found to neutralize CFCs, the culprits associated with the decline of the ozone layer.

Preparing Rhubarb

Rhubarb is typically cooked or stewed with sugar and then used in a variety of desserts; however, it can also be pickled or used in savory dishes. Rhubarb can also be dehydrated and infused with fruit juice—in fact, it is often infused with strawberry juice to mimic the flavor of strawberry rhubarb pie.

Get creative with rhubarb—you can make rhubarb sauce, rhubarb jelly, rhubarb wine, rhubarb pudding, rhubarb pancakes, pickled rhubarb, rhubarb crumble, and of course rhubarb pie. Some people even make rhubarb daiquiris or margaritas. Your imagination is the limit. Below are a few recipes to stir your creative juices. Bon appetite!

Rhubarb Sauce:

2 pounds of rhubarb (cut into 1-inch pieces)
1 cup sugar
¼ cup honey
½ cup water

Combine all ingredients in a heavy saucepan and bring to a boil. Reduce the heat and simmer, covered, for 20 minutes or until the rhubarb is tender. Transfer to a serving bowl and chill. Serve over grilled meat or fish. It’s especially delicious over pork tenderloin.

Roasted Rhubarb Salad:

2 cups rhubarb (chopped into ½-inch pieces)
2 Tablespoons of sugar
Mixed greens
Walnuts
Goat cheese
Balsamic vinaigrette of your choice

Toss rhubarb with sugar and let stand for about 10 minutes. Spread the rhubarb evenly on a baking sheet and bake at 450 degrees for about 5 minutes, or until soft. Remove from oven and allow to cool. Toss with salad ingredients and drizzle with balsamic vinaigrette.

By Laurie Wertich

You don’t need an expensive gym membership or fancy equipment to get in shape. All you need to do is lace up your shoes, put one foot in front of the other, and head out the door. The bonus: while you walk your way to fitness, you’ll be enjoying fresh air and an improved mental outlook.

Walking is one of the simplest, most natural forms of exercise there is—and the best part is that you already know how to do it! Walking is a gentle, low-impact way to move your body, increase your heart rate, gain cardiovascular benefits, and ease your way into a higher level of fitness.

Walking toward Fitness

Once you’ve initiated a walking program, you can set a fitness goal. You may be walking for overall health benefits or you may have a more specific goal of losing weight or building cardiovascular fitness. Your personal goal will help determine how long and how often you need to walk. In general:

A daily 30-minute walk at “talking pace” will help you maintain general health.

Walking at a fast pace for 20 to 30 minutes three to four times a week will help build cardiovascular fitness.

Walking at a brisk pace for 45 to 60 minutes five or more days per week will promote weight loss.

Once you are comfortable with your walking program, you can vary the length and the intensity (with speed or terrain) of your walks to meet your fitness goals.

Form and Function

Although walking is simple, there are a few points to consider.

Posture. Stand tall with your shoulders back. Tighten your abdominal muscles and buttocks and fall into a natural stride.

Stride. Avoid overstriding. Take small, quick steps and allow the foot to roll through the gait pattern (rather than slapping against the ground).

Arms. Allow your arms to swing alongside your body. Avoid letting the elbows swing out to the sides like chicken wings.

Tools of the Trade

You really don’t need anything to begin walking, but some people find a few accessories helpful.

Water bottle. It’s important to stay hydrated before, during, and after your walk. Consider investing in a water bottle holster or a handheld water bottle that straps to your palm.

Pedometer. A pedometer will measure your steps and the distance you have walked. It can be a motivating tool to help you build distance.

Heart rate monitor. A heart rate monitor will help measure the intensity of the exercise. Not everyone needs a heart rate monitor, but if you are trying to build cardiovascular fitness, it can provide valuable feedback. Individuals who are recovering from health problems may benefit from the use of a heart rate monitor to prevent overdoing it.

Maintaining Momentum

Like any fitness program, walking provides benefits only if you actually do it. To stay motivated, try the following simple tips.

Make it a habit. Schedule your walk for the same time each day. Write it on your calendar and commit to it, rain or shine.

Make it social. Many women find a friend or group with whom to walk. In addition to helping you keep the commitment, this provides an opportunity for social connection with the added bonus of fitness.

Make it fun. Have the kids accompany you on bikes. Bring the dog. Listen to music. Try anything that will add a dose of fun to your walk.

Incorporate variety. Vary your route to prevent boredom and plateaus. Treat yourself to changes in scenery and terrain to keep your walks interesting.

Have a destination or goal. Use your walk as an opportunity to run an errand or to meet a friend for coffee. You’ll be reducing your carbon footprint while increasing your fitness factor.

Sign up for an event. Signing up for a fundraising walk not only will motivate you to train but will inspire you and provide an opportunity for community engagement.

Measure your progress. Consider maintaining a log of your walks. You could keep track of distance covered, time spent walking, or weight loss. Find a system that works for you.

All great journeys begin with a single step, so lace up your shoes and take the first step toward fitness. Have fun!

The benefits of walking are many:

a Improved cardiovascular fitness

a Improved mood

a Weight loss

a Reduced blood pressure

a Reduced risk of heart disease, diabetes, and stroke

Getting Started

Starting a walking program is simple. All you really need is motivation and comfortable shoes. If you have had health problems or are new to exercising, you may want to consult your doctor before beginning a walking program.

Once you are ready to start, it’s as simple as taking a stroll around the neighborhood. Begin slowly and build. If you are starting from years spent on the couch, aim for 10 minutes. If you already have a strong exercise regimen, you’ll be able to walk for longer periods of time.

Stretching can help keep you fit and flexible.

By Laurie Wertich

When most people think of fitness, they think of cardiovascular and strength exercise; but if you want to get and stay fit, don’t forget to stretch! Stretching and flexibility exercises are an important component of any fitness regimen. So, go ahead—stretch yourself.

Stretching

Stretching refers to a practice of elongating a muscle or muscle group to its full length. Though we may not realize it, stretching is actually a natural, instinctive behavior. Upon waking, most of us will instinctively reach our arms overhead and stretch from fingers to toes. Our body naturally craves a stretch after long periods of sitting or inactivity. This natural instinct is your body’s way of telling you that stretching is good.

Benefits of Stretching

Stretching offers numerous health and fitness benefits:

• Relaxation. Put simply, stretching feels good. It’s an excellent way to cool down and relax after an invigorating workout. Furthermore, research has shown that stretching can lower blood pressure and improve artery function. It’s a natural stress reliever.
• Increased flexibility. Flexibility refers to the degree to which an individual muscle will lengthen. As we age, our muscles grow shorter and tighter and we become less flexible. As a result, we become more susceptible to injuries. Stretching is an effective way to maintain and increase flexibility. A regular stretching routine will keep you flexible—and hopefully injury-free.
• Improved circulation. Stretching increases the blood flow to the muscles, which helps not only nourish the muscles but also eliminate waste byproducts from muscle tissue.
• Elimination of pain. Many of us experience muscle tightness in our quadriceps, hamstrings, and hip flexors. What we may not realize is that this muscle tightness is a common cause of low back pain. Short, tight muscles result in impaired movement patterns and compensation, which leads to low back pain. A regular stretching routine can help solve this common problem.

Don’t underestimate the value of stretching. It can keep you fit and healthy for years!

Stretching Tips

To gain the benefits of stretching, it’s important to stretch properly:

Warm up. Never stretch a cold muscle; it can result in injury. Warm up with some cardiovascular activity prior to stretching. This will help make your muscles more pliable and conducive to stretching.

Breathe. Sometimes we’re inclined to hold our breath when stretching, but this is counterproductive because it results in tightness and resistance. Instead, breathe into a stretch. Breathe slowly and deeply. As you exhale, you may feel yourself naturally sinking a little deeper into the stretch.

Be gentle. Never force a stretch. Gently ease your way into a stretch and let your body dictate how far you can go. Flexibility will naturally increase over time; forcing a stretch will only result in injury, not increased flexibility.

Be consistent. The best way to build flexibility is with a consistent stretching routine. Aim for three to five days per week. If you commit to a stretching program, you will see results.

A star student at the University of California, Berkeley, Jill—as she was known to friends and family—was also a competitive athlete, serving as coxswain of the university’s varsity eight-crew boat, and a student leader within the school’s Greek system. Her passion and commitment to each of her endeavors—and to her friends and family—defined her. It was a similar passion and dedication that would mark her battle with lung cancer.

Jill was a nonsmoker with no family history of the disease when she was diagnosed with Stage IV lung cancer at age 21. As she faced treatment, Jill confronted the grim statistics and the stigma associated with the disease: a 15.5 percent survival rate, which has not improved in more than 40 years; a lack of funding and awareness when compared with other major cancer types; and a widespread perception that lung cancer is a disease of smokers and the elderly.

In the face of these discouraging facts, Jill was determined to effect positive change. Still pushing through the coursework required for graduation and her commitment to the crew team—not to mention a rigorous treatment schedule that included chemotherapy and radiation—Jill embraced another challenging role: cancer advocate. Hired as director of communications and awareness for the Bonnie J. Addario Lung Cancer Foundation (BJALCF), Jill worked tirelessly to launch Jog for Jill, a 5K walk/run on the UC Berkeley campus that raised more than $46,000 for research and awareness funding, and to reach out to media outlets and pharmaceutical companies about the dire need for increased attention to lung cancer.

Jill’s college roommate and close friend, K.C. Oakley, remembers the way Jill’s grace and fortitude were evident through this difficult time, as she fought her own battle and took on the larger role of advocacy. “Jill’s conditions were tougher than one could ever expect or imagine,” K.C. says, “and, as her roommate, I saw her struggle to get out of bed every day. I knew she was always tired from chemotherapy and radiation, but even with her deteriorating body her love for life and the people around her helped her break through with endless smiles.”

Sadly, Jill’s journey ended far too quickly. She passed away on June 24, 2010, a year after her initial diagnosis. Now, inspired by her legacy of courage, action, and passion, a committed group comprising many of Jill’s closest friends and other young adults affected by the lung cancer diagnosis of a loved one has come together to ensure that Jill’s advocacy efforts and brilliant spirit will continue to make a difference. Jill’s Legacy, a subsidiary of BJALCF, was created in December 2010 to honor Jill’s courage and to raise funds and awareness for lung cancer among young people.

“Jill left us with a clear message: to beat lung cancer,” says Darby Anderson, one of Jill’s closest friends, who now serves on the board of Jill’s Legacy. The foundation’s mission, Darby says, is simple: “to be the driving force in significantly increasing the stagnant 15.5 percent survival rate of the world’s number one cancer killer.”

To that end Jill’s Legacy is working to fund a series of Jog for Jill events on college campuses across the country, to promote research related to early-detection methods and promising treatments, and to change the widely held perception that lung cancer is a disease of smokers and the elderly. “Anyone can get lung cancer, and it is our job to raise awareness about this fact so that fundraising efforts can be applied to research that will later help save lives,” K.C. says.

In addition to raising much-needed awareness and funds, Jill’s Legacy will focus on making a difference for patients facing a diagnosis today. Equally important as the research and advocacy efforts, says board member Kristina Renda, “is our goal to be a source of support to people who are battling lung cancer right now. We want to help in any way we possibly can to make the lives of people with lung cancer that much easier.”

Lung cancer survivor Taylor Bell—who, like Jill, was an otherwise healthy, athletic nonsmoker when she was diagnosed at 21 and now serves on the Jill’s Legacy board—knows well the many challenges the organization will face as well as the critical need for change. “When you advocate for lung cancer, it can sometimes get discouraging because it feels like you are screaming at the top of your lungs (or lung), and no one is listening,” she says. But backing down, Taylor knows—as Jill did—is not an option. Having been given the opportunity to continue the fight, Taylor is determined to carry on through Jill’s Legacy: “Jill would never want us to give up. Lung cancer took her from us way too soon, but she never gave up the fight, and neither will we.”

When added to pain relievers, caffeine can bring significant relief.

Caffeine is a powerful stimulant that affects the central nervous system and can help you stay alert. Many of us are slaves to the caffeine habit, maintaining a steady stream of coffee, tea, soda, or chocolate in an effort to push past fatigue. But caffeine may do more than keep fatigue at bay—it can also play a role in pain relief. In fact, it is an added ingredient to many over-the-counter and prescription pain medications. But, can caffeine really make a difference when it comes to pain?

The Evidence for Caffeine

Researchers have long studied the effects of caffeine and not surprisingly, the results vary. So a group of researchers recently reviewed 19 studies that included more than 7,200 patients who took pain relievers such as acetaminophen and ibuprofen. Each study compared the effects of a single dose of a pain reliever compared to the same dose plus added caffeine. The combined results from all of the studies indicated that the patients randomized to receive pain medicine with caffeine experienced more pain relief. In fact,

five to ten percent more of the people who took pain medicine with caffeine reported a high level of pain relief compared to those who took pain medications without caffeine.

Another study found that caffeine had pain-relieving effects when healthy college students were asked to perform a grip task that involved holding a heavy metal weight. Participants who chewed a piece of caffeinated gum prior to the task reported less pain than those who chewed placebo gum.

Why Caffeine?

Scientists aren’t sure why caffeine works to help relieve pain—but they have some theories. The stimulant may help with the delivery mechanism of pain medications. For example, it could help the medication enter the bloodstream more quickly or, in contrast, it might slow the body’s ability to clear the medication from the bloodstream. Either way, it appears to help the body absorb pain medications more quickly.

Scientists also speculate that caffeine may provide a mood-boosting effect that helps ease pain. Regardless of the mechanism by which it works, the data does indicate that caffeine does indeed make pain medications more effective and help ease pain.

Drink Up?

So what does this mean for you? If you experience pain, should you start slurping coffee or soda all day long? Not necessarily. The old adage still rings true—everything in moderation. Too much caffeine can cause stomach pain, acid reflux, mood swings, sleep disturbances, and a range of other problems. Most experts agree that about 300 milligrams of caffeine per day is a safe amount—that’s the equivalent of three 8-ounce cups of coffee. In comparison, most pain medications contain about 30-100 milligrams.

The bottom line—if you have a headache, a little caffeine might help and probably won’t hurt. As with anything, it’s always best to check with your doctor first and use common sense and moderation.

References:

If you are a cancer survivor, there’s a good chance that you’ve been discharged from treatment without a referral for cancer rehabilitation. It is also likely that you’ve been told to accept a “new normal.” While accepting a “new normal” may sound like reasonable advice, it often undermines survivors’ efforts to heal and recover as well as possible.

Imagine someone who had a stroke being advised to accept a “new normal” without the benefit of rehabilitation medicine. That would not be very good medical practice, yet it’s exactly what many cancer survivors are told.

So, before you decide to accept a “new normal,” consider whether you are functioning as well as possible. Ask yourself whether cancer rehab services might help. If you aren’t sure, keep reading.

What is cancer rehabilitation?

Cancer rehab is very similar to other forms of rehab after a serious illness or injury. Services should include consultations with appropriate board-certified or licensed clinicians in rehabilitation medicine, including physiatrists (doctors who specialize in rehabilitation medicine), rehabilitation nurses, and physical, occupational, and speech therapists.

Will my insurance cover cancer rehabilitation services?

Yes, medical insurance, including Medicare, usually covers rehabilitation medicine consultations and services so long as they are provided by rehabilitation healthcare professionals (as listed above). As with all insurance issues, check with your carrier about deductibles and co-pays.

Which problems can be addressed through rehabilitation?

Rehab professionals can help with a wide variety of treatment-related conditions and their symptoms. Here are examples of those that can occur in breast cancer survivors:

• Pain
• Weakness
• Fatigue
• Scar tissue adhesions
• Shoulder problems
• Balance and gait problems
• Memory and concentration issues
• Lymphedema
• Post-mastectomy pain syndrome
• Radiation fibrosis syndrome
• Brachial plexopathy
• Chemotherapy-induced peripheral neuropathy
• Difficulty with daily activities  such as dressing, chores, and shopping
• Difficulty returning to work
• Difficulty returning to recreational or community activities

One way to think about the role of a rehab clinician is to consider our motto: Focus on function. Focusing on function is the primary goal in all rehabilitation medicine interventions, so one of the first questions we are taught to ask our patients is, “What were you able to do before you were diagnosed with cancer that you aren’t able to do now?” Of course, there is no guarantee that you will be able to function in the same way you did prior to your diagnosis, but it’s important to consider your precancer functional status and compare that with your current functional status. Then your clinician needs to evaluate what interventions might be helpful in improving your daily function.

What types of cancer rehab interventions can help?

Because cancer survivors encounter many different problems—depending on their health status before the diagnosis, the type of cancer, and the treatment choices—there are many solutions to consider. Some are very sophisticated and require procedures that are usually performed only by highly skilled physiatrists with a subspecialty interest in cancer rehabilitation. For example, botulinum toxin injections are sometimes used to treat radiation fibrosis syndrome or post-mastectomy pain syndrome. Physiatrists may also administer other interventions such as trigger point injections to decrease muscle spasm and pain. Some patients benefit from oral or topical prescription medications to help treat pain or address fatigue issues.

Physical therapists who are specifically trained in cancer rehabilitation work with survivors to address pain, fatigue, and musculoskeletal problems as well as to recommend the right exercise program. Occupational therapists focus on upper-body problems and frequently recommend specialized equipment for home or work that helps survivors function better. Speech/language pathologists address swallowing and speech problems.

Can cancer rehabilitation help with “chemo brain”?

Cognitive rehab interventions can certainly help people with “chemo brain,” the medical term for which is mild cognitive impairment. Problems with memory, concentration, and other cognitive issues are best addressed by clinicians who have expertise in cancer rehabilitation. Consultations with occupational and speech therapists who are experts in cancer rehabilitation and neurocognitive rehabilitation can be extremely helpful in improving survivors’ ability to function at home and work.

How do I find cancer rehab experts?

Talk with your healthcare providers about what is available in your community. You should expect a high level of services and healthcare professionals trained in rehabilitation medicine. If you have medical insurance, this care should be covered; with the exception of deductibles, co-pays, and some other insurance restrictions, rehabilitation medicine treatment is typically covered.

Cancer rehabilitation is becoming an increasingly important part of the survivorship care continuum. Some hospitals and cancer centers are now offering excellent cancer rehab services in a well-coordinated effort between the oncology and rehabilitation medicine departments. A growing number of hospitals and cancer centers are Survivorship Training and Rehabilitation (STAR) certified. This is a best-practice model that offers multidisciplinary cancer rehab care that is generally covered by medical insurance. STAR Programs and STAR Clinical Groups are staffed by rehabilitation healthcare professionals who have undergone extensive training in cancer rehabilitation.

Rhode Island is the first state in the country to make cancer rehabilitation geographically available to all of its survivors. In October 2011 the state announced that 20 facilities would become STAR certified so that survivors will have access to high-quality cancer rehab services. For more information about finding a STAR-certified institution near you, visit www.oncrehab.com.

What is the future of cancer rehabilitation?

The future of cancer rehabilitation is very bright! More and more hospitals and cancer centers are investing in excellent survivorship care and implementing new or improved cancer rehab services. If cancer rehabilitation hasn’t come to your town yet, talk to your healthcare providers about how valuable it would be to offer these services to survivors. The goal in rehabilitation medicine is always to help people function at the highest possible level, no matter what their diagnosis or current state of health—and helping people achieve the best possible level of health is everyone’s goal in medicine.

Julie Silver, MD, is an assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. She is the founder of Oncology Rehab Partners (www.oncrehab.com) and the creator of STAR (Survivorship Training and Rehabilitation) certifications, which enable hospitals and cancer centers to deliver a best-practice model of cancer rehabilitation services. Dr. Silver encourages patients with serious illness or injury to be proactive in facilitating their own recoveries, and she offers healing strategies in her new book, You Can Heal Yourself (St. Martin’s, 2012). She also believes it is critical for patients to work with an experienced and knowledgeable healthcare team that can offer evidence-based rehab medicine treatments typically covered by medical insurance.

Young adults face unique emotional challenges in the wake of a cancer diagnosis. Now treatment centers are increasingly offering special resources and tools to help these patients cope with cancer.

First, which patients qualify as young adults for the purposes of your program at Dana-Farber/Brigham and Women’s Cancer Center?

There have been a variety of age ranges proposed in defining the young adult population. Although we have not established specific age-range parameters, the program we have developed is used by patients mostly in the 18- to 34-years-old range. The cancer experience can both delay and accelerate adult development, so we understand that patients up to age 40 may benefit from what we offer. Currently, our program is based in adult (18 and older) medical oncology.

What are the unique psychosocial challenges that these patients face?

The biggest challenge for young adult patients is coping with the often-contradictory emotional challenges of a cancer diagnosis while also trying to move forward with normal young adult tasks. While the normative emotional demands of young adulthood include planning for the future, exploring independence and interdependence, forming intimate relationships, and family planning, the emotional demands of cancer often include isolation from peers and coping with vulnerability, dependence, and uncertainty. Body image struggles, as well as threats to fertility and sexual functioning, are also particularly difficult challenges for young adults with cancer. Cancer can change what young adults imagined their life would be like. These unwelcome changes can be both distressing and, for many, opportunities for enhanced adaptation and personal growth.

What should families and loved ones of young adults know about how they might be most effective in helping a young adult patient cope with cancer?

There is no right way to deal with cancer as a young adult. What is most important for families and friends is to communicate and ask. Be prepared that the same question may be answered differently from one day to another. Sometimes young adults need assistance or suggestions about what they feel or might need, but be advised that it’s never a good idea to tell a young adult what it is he or she needs; instead work with that individual to find a solution.

What are young adults looking for when they seek out resources through your program?

Mostly, patients are looking for emotional support for coping with the cancer experience. This support takes many forms: for some it is help from a professional counselor; for others it is information about what is normal for them to feel; and for some it is meeting a peer who is going through the same experience.

What resources do you offer young adults to help them cope with these issues?

Knowing that each young adult is unique, we have tried to offer a variety of support experiences. We offer professional individual, group, family, and couples counseling for patients. In addition, we offer many educational programs to help strengthen existing emotional coping skills and promote the development of new skills. Furthermore, we offer opportunities for peer support, which includes meeting face to face with other patients as well as meeting other patients on our web-based social-networking site.

What role do social media and online resources play for young adults, and how have you integrated these tools into the young adult program?

Young adult culture includes high utilization of Internet and social-networking resources. A young adult program must provide some way to meet patients in this cultural setting. We have developed an innovative website that is aimed at creating a community for the young adult patients at Dana-Farber Cancer Institute (DFCI). The community offers individuals the opportunity to have a personal profile, share information about themselves, and connect with other patients who are being treated at DFCI. It offers a way for our program to advertise face-to-face groups and workshops. The site also has a self-help component where patients can learn about common emotional reactions to the cancer experience. Community members can use self-help modules to aid them in strengthening their skills in problem solving, communication, emotional coping, and maintaining a value-based identity despite delays in goals during cancer treatment. The website also has the capacity for video chats and sharing personal stories and creative expression. Patients have expressed that the site is a welcome addition to their comprehensive care at DFCI.

Karen Fasciano, PsyD, is a clinical psychologist and the director of Young Adult Mental Health at the Dana-Farber/Brigham and Women’s Cancer Center. She has been working as a psychologist in oncology settings for more than 17 years. She is also an instructor at Harvard Medical School.

Test seeks to predict prognosis and guide treatment decisions.

Ductal carcinoma in situ (DCIS) of the breast is a commonly diagnosed, very early stage of breast cancer. As research on DCIS has increased, it has become apparent that the underlying biology of DCIS can vary substantially among patients. Researchers in the field of genomics are working on characterizing this variability, with the goal of providing more-personalized treatment.

First, a little background: DCIS refers to abnormal cells in the lining of a breast duct. It is classified as Stage 0 breast cancer—the earliest possible stage. The condition usually does not produce any symptoms (such as a breast lump), and it was an uncommon diagnosis prior to the introduction of screening mammography. Diagnoses increased greatly once mammography became widespread, and DCIS now accounts for up to one-quarter of all breast cancer diagnoses in the United States.1

Examples of genomic tests are the Oncotype DX breast and colon cancer tests. The tests evaluate the activity of several genes in a sample of tumor tissue to assess the likelihood of cancer recurrence. Information about recurrence risk obtained using the Oncotype DX genomics test can be used to individualize treatment decisions.

The Oncotype DX breast cancer test was originally developed for use in certain groups of women with early-stage, invasive breast cancer, but it’s now possible to also use the test to generate a DCIS recurrence score—an indicator of the likelihood that DCIS will recur after treatment with lumpectomy alone.

Results from a study of the DCIS score were recently presented at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium.3 The study involved 327 women with DCIS who had participated in an earlier clinical trial of DCIS treatment. The women had been treated with lumpectomy but had not received radiation therapy.

Three-quarters of the patients had a low risk of recurrence based on the DCIS score. For these women the likelihood of any kind of local recurrence (either DCIS or invasive breast cancer) was 12 percent, and likelihood of a recurrence that involved invasive breast cancer was 5 percent. By comparison, among women with a high risk of recurrence based on the DCIS score, the likelihood of any kind of local recurrence was 27 percent, and the likelihood of a recurrence that involved invasive breast cancer was 19 percent.

These results suggest that the Oncotype DX DCIS score provides information about the risk of recurrence after breast-conserving surgery for DCIS. This information could help guide decisions about the need for postoperative radiation therapy following treatment with lumpectomy. Research in genomics is expanding at a rapid rate and will have a profound effect on many aspects of disease prevention, diagnosis, and treatment. Diseases such as cancer are remarkably complex; genomics provides researchers and physicians with tools to explore and address these complexities and help individualize treatment decisions.

References

1. Kerlikowske K. Epidemiology of ductal carcinoma in situ. Journal of the National Cancer Institute Monographs. 2010;41:139-41.

2. Goodwin A, Parker S, Ghersi D, Wilcken N. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database of Systematic Reviews. 2009;4:CD000563.

3. Solin LJ, Gray R, Baehner FL et al. A quantitative multigene RT-PCR assay for predicting recurrence risk after surgical excision alone without irradiation for ductal carcinoma in situ (DCIS): a prospective validation study of the DCIS Score from ECOG E5194. Paper presented at: 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium. December 6-10, 2011; San Antonio, TX. Abstract S4-6.

No one becomes a money master by accident. It takes a lot of trial and error, dedication, and discipline to become master of your financial domain. Whether your goal is to reduce debt or increase savings, there are a number of simple strategies that can help you improve your financial situation. Creativity, smart planning, and consistency are keys to financial health—but sometimes, more drastic steps can pay off in dividends.

If you’re ready to take charge of your finances and make big changes, consider taking one of these money challenges to motivate you in the right direction.

1. The Spending Freeze: Spending freezes aren’t just reserved for corporations (or governments) in crisis—they can be an effective strategy for anyone who needs to adhere to a budget and save some cash. Can you go 30 days without spending? Try implementing a 30-day spending freeze and see how much extra money you have left in the bank at the end of the month. Here’s how it works:

• Establish ground rules at the beginning of the month. You likely have non-negotiable expenses each month, so the spending freeze won’t apply to those. This is for anything above and beyond the basics.
• Create a grocery list and menu for the month and set aside the cash you will need for groceries.
• Determine what your non-negotiable expenses are at the beginning of the month (gas, train fare, etc.) and budget those in.
• Hide your checkbook and credit cards and set out to enjoy a month free from spending.

A spending freeze separates the wants from the needs. For 30 days, can you refrain from lattes, movies, snacks, clothes, or anything else that catches your eye? By the end of the month you’ll not only have more money in the bank, you’ll gain an awareness of your “spending leaks”—all of those places where you spend money, but don’t really need to. Who knows—you may even decide to sign on for 30 more days of freedom.

2. The Grocery Challenge: Could you eat home-cooked meals for 30 days? Do so and you may just end the month healthier and wealthier. Here’s the challenge:

• Create a menu and corresponding grocery list for the month.
• Determine your grocery budget for the month. How much do you really spend on groceries? Can you reduce it by 10 percent?
• Withdraw your grocery budget in cash from the bank and divide it among four envelopes.
• Each week, take one envelope to the grocery store. Limit your purchases to what you can buy with the cash in the envelope.
• Enjoy a month of meals at home. Get creative! Resist the temptation to resort to takeout or a restaurant.

The crux of this challenge is to cook with what you have on hand rather than running to the grocery store for missing—or extra—ingredients. You’d be surprised at how much those impulse grocery purchases cost you—both in dollars and calories. The most fun part of the grocery challenge—tallying up how much extra money you have saved at the end of the month.

3. The Mortgage Challenge: Want to pay down your mortgage faster so you can own your home outright sooner? It’s not as far-fetched as it sounds. Here’s how:

• Do the math. Take a look at your budget and determine how much extra you can afford to direct toward your mortgage each month.
• Consider increasing your income. If you can’t spare any extra, can you find ways to increase your income each month with the goal of directing the extra money toward your mortgage? Get creative—take on odd jobs, sell extra belongings that are collecting dust, or ask for a raise.
• Set the goal and hold yourself to it. If you have decided to direct $500 extra to your mortgage each month, create an automatic payment so you won’t be tempted to spend the money elsewhere.

The mortgage challenge is a big one because it requires you to make big and permanent adjustments to your spending habits and goals—but the payoff is huge. If you pay off your home five years early, you’re five years closer to financial freedom and retirement. This is one challenge that requires you to dig deep and prioritize.

4. The Monthly-Bill Challenge: Recurring expenses can add up quickly and they’re usually not on our radar. Slash your monthly bills for extra savings that last all year long. Here’s the challenge:

• Make a list of all of your monthly expenses.
• Shop for lower rates anywhere you can—insurance, cable, Internet, cell phone, etc.
• Make sacrifices. Where can you trim features or downgrade? Do you really need an unlimited text messaging or data plan? Do you need 500 TV channels? Reduce the extras for added savings.
• Give up. Can you one thing up entirely? For example, if you gave up television, you would save both money and time—and you might find that you spent that time on healthier endeavors, such as exercise.
• Compromise. How much is your commute costing you? Would taking the bus or riding your bike one day a week offer significant savings? What about two days a week?

The monthly bill challenge inevitably leads to lasting change—for your behavior and your wallet. It forces you to streamline your spending. The bonus—your savings accumulates over time.

Which challenge will you take? Join us on Facebook to share your experience. What better way to stay motivated than to join like-minded money masters in the journey?

If you’re worried about bone loss, there are several preventive strategies you can take to maintain bone density, such as avoiding alcohol and tobacco, participating in weight-bearing exercise, and getting plenty of vitamin D and calcium. But there are two other, lesser-known, strategies that might be important, too: managing stress and getting plenty of sleep.

What do stress and sleep have to do with bone health? Chronic stress and sleep deprivation can lead to elevated cortisol levels, which have been associated with bone loss.

Architecture of Bones

We tend to think of bones as hard and durable, but in fact, they are comprised of living tissue that grows and changes throughout our lives. Bone formation is sort of like a never-ending remodel project taking place within the body. Old bone is constantly being removed and new bone formed. This process is regulated by two cell types: osteoblasts, which aid in depositing new bone tissue, and osteoclasts, which break down old bone tissue. Disruption to either of these cell types results in changes in bone density.

In childhood, adolescence, and early adulthood, new bone formation outpaces the removal of old bone. As we age, however, that process reverses—as a result of aging, as well as a variety of other lifestyle factors.

The Cortisol Connection

Cortisol is one of the body’s stress hormones. It is secreted by the adrenal glands and is supposed to regulate the body’s stress response. During the fight-or-flight response, the body releases a surge of adrenaline, followed by a surge of cortisol. The cortisol serves to replenish energy—energy that was theoretically “spent” during the adrenaline surge. When it comes to acute stress and fight-or-flight situations, cortisol is helpful; however, with long-term, chronic stress, cortisol levels in the body can remain elevated for long periods of time and this can have negative effects on your health.

Elevated cortisol levels interfere with osteoblast formation and dramatically decreases bone building—resulting in reduced bone density. Put simply—more bone tissue is broken down than deposited. As a result, patients with chronically elevated cortisol levels may be at an increased risk for osteoporosis.

Stress, Sleep, and Bones

As long as your body remains in a state of chronic stress—with elevated cortisol levels—bone formation is disrupted. Without the opportunity for adequate rest and repair, the body simply cannot keep up with the bone-building process.

Bone loss is a silent condition—it has no symptoms and occurs slowly over many years. But, this silent condition has serious repercussions, namely fractures. If you want to take care of your bones—and your health—start by reducing your stress and making healthy sleep a priority.

If you want to reduce cortisol levels and improve bone health, here are a few simple lifestyle changes that go a long way:

• Get approximately eight hours of sleep per night.
• Prevent chronic stress by setting healthy boundaries, employing time management techniques, and maintaining a work-life balance.
• Engage in stress management techniques, such as deep breathing, meditation, and guided imagery.
• Optimize vitamin D levels
• Participate in regular exercise. Cardiovascular exercise will help you to manage stress and maintain heart health; weight-bearing exercise helps build healthy bones.

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