Wellness Library

Wellness Library articles contain step-by-step guides to diseases and conditions, ranging from how a baby develops and grows, to memory care for Alzheimer's patients. Resources include information on disease and condition management, prevention and self-care, when to consult a physician, what to ask the physician and educational quizzes to test knowledge and track symptom progression.

What is HealthDay’s Wellness Library?

HealthDay's Wellness Library is a collection of more than 1,500 original encyclopedic health and medical articles. The reference-style library features informative articles, special reports, first-person essays, quizzes and much more. Arranged into 42 topic centers ranging from Alzheimer's to Women's Health, the Wellness Library offers "what you need to know" content on a wide variety of topics.

The stories contain step-by-step guides on diseases and conditions, ranging from how a baby develops and grows, to memory care for Alzheimer's patients. Resources include information on disease and condition management, prevention and self-care, when to consult a physician, what to ask the physician and educational quizzes to test knowledge and track symptom progression.

Why Do Leading Medical Media and Hospitals Use the Wellness Library?

While large research hospitals may have ample resources to create their own health and wellness libraries, regional hospitals and health facilities such as Citrus Valley Health Partners, Community Foundation of Northwest Indiana and Northern Hospital of Surry County know they need to provide basic patient education as part of their service. They turn to HealthDay's Wellness Library as a turn-key solution for a fraction of the cost of making it themselves. HealthDay even takes care of reviewing and updating the content annually to ensure it stays up to date.

This deep and focused body of easy-to-understand and informative content is an excellent reference tool for engaging clients. Because of the highly granular nature of the content, clients find exactly what they are interested in reading, thus reducing bounce rates. The Wellness Library is also an excellent range of content from an SEO client acquisition standpoint.

Clients whose business model depends upon client behavioral change, such as wellness platforms, leverage this content to educate and inspire clients.

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Because of the encyclopedic nature of the Wellness Library, delivery could not be easier. The content can be delivered as an XML file, via API, or through HealthDay's EZ-Post JavaScript widget, which is simply plugged into your page.

  • Encyclopedic Content
  • 1,500 Pieces of Original Health/Medical Content
  • 42 Topic Centers of Information
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Brushing 2

Wellness Library

You know you need to brush your teeth and floss every day. But do you know how to get the most out of it? Even if you think you mastered brushing and flossing in grade school, you may still have a few things to learn.

What kind of toothbrush should I buy?

America is a world leader in toothbrush technology. Walk through the oral hygiene aisle of a grocery store, and you'll discover many innovations: toothbrushes angled like dental tools, handles that bend and twist and change colors, bristles that are "specially shaped to reach between teeth"... the list goes on. And don't overlook those electric toothbrushes, some of which are powerful enough to take that knot out of your back after you're done with your teeth.

So many choices, so little consequence. When it comes to brushing, the brush itself is much less important than the person holding it, says Cynthia Sherwood, DDS, a family dentist in Independence, Kansas, and a spokeswoman for the Academy of General Dentistry. If you know how to brush your teeth properly, you won't need a fancy toothbrush to keep your teeth healthy, she says. Sherwood does recommend electric toothbrushes to many of her patients with gum disease, however. The extra vibration seems to help massage the gums and speed healing.

Whether you decide to go for straight or angled, manual or electric, fancy or plain, you should follow a few basic guidelines. The Academy of General Dentistry recommends choosing a toothbrush with a small head (about an inch long and a half-inch wide) and a long handle. Ideally, the brush should have soft, rounded bristles (choose one labeled "Soft"). Hard bristles won't get your teeth any cleaner, but they can wear down your teeth and damage your gums.

How often should I change my toothbrush?

Bent, frayed, or flattened bristles can't clean teeth very well, but they can be a haven for bacteria. Change your toothbrush every three to four months, or sooner if the bristles are no longer straight.

What kind of toothpaste?

As with toothbrushes, the type of paste you use isn't nearly as important as how well you use it. "I tell my patients that they can use any paste they want, as long as it contains fluoride, " Sherwood says.

How should I brush?

First of all, don't rush yourself. Unless you've had a mishap or extraction along the way, you have 32 teeth to clean. This is not a 10-second job. Place your toothbrush at a 45-degree angle along the gumline. Using a circular motion, gently rub your brush back and forth across every surface of your teeth -- the tops, the backs, the sides, the front. Don't forget to brush along the gumline and behind your back teeth.


Interview with Cynthia Sherwood, DDS, a family dentist in Independence, Kansas, and a spokeswoman for the Academy of General Dentistry

Academy of General Dentistry. How do I choose and use a toothbrush?

Academy of General Dentistry. What is the best technique for brushing?

Academy of General Dentistry. Flosses and waterpicks.

Oral Health Information. American Dental Hygienists Association www.adha.org/oralhealth/brushing.htm

Quiz: How Much Do You Know About Breast Cancer?

Wellness Library

Breast cancer is the most common cancer in women in the United States (other than skin cancer). And while it takes over 40,000 lives in the U.S. each year, it isn't the deadliest cancer. (Lung cancer is). But when it comes to inspiring fear, breast cancer is in a class by itself. As is often the case with diseases, much of the fear springs from misunderstanding. How much do you know about breast cancer? Take this short quiz to find out.

1. Family history is a strong predictor of breast cancer. If close relatives have the disease, I'm at grave risk of getting it. True or false?



2. Which of the following may slightly increase your risk of breast cancer?

a. Taking birth control pills.

b. Having large or lumpy breasts

c. Breast implants

d. None of the above

3. Women who inherit faulty versions of the breast-cancer genes BRCA1 and BRCA2 are more likely to develop the disease. True or false?



4. Most lumps in the breast are harmless. True or false?



5. Mammograms are nearly foolproof. If the radiologist sees something suspicious, you almost certainly have cancer. True or false?



Your Results

1. Family history is a strong predictor of breast cancer. If close relatives have the disease, I'm at grave risk of getting it. True or false?

The correct answer is: False.

A family history of breast cancer can double your risk of developing the disease. That means that if you would have had a 1.5 percent chance of developing the disease in the next five years, with your family history factored in, you now have a 3 percent chance. In fact, the disease spares about three out of four women with a strong family history (such as an affected mother and sister). On the other hand, 70 to 80 percent of women who develop breast cancer have no family history.

2. Which of the following may slightly increase your risk of breast cancer?

The correct answer is: a. Taking birth control pills.

According to the American Cancer Society, taking birth control pills slightly increases a woman's risk of developing breast cancer, though that risk level returns to normal after a woman has been off the pill for ten years. (If you're at high risk for the disease, you should talk to your doctor before taking any hormone treatments.) The size and shape of your breast won't put you at risk, and neither will implants. And if you've read the rumors on the Internet, you'll be relieved to hear that antiperspirants and underwire bras can't cause cancer.

3. Women who inherit faulty versions of the breast-cancer genes BRCA1 and BRCA2 are more likely to develop the disease. True or false?

The correct answer is: True.

Up to 80 percent of women with one of these faulty genes will develop breast cancer in their lifetimes, according to the American Cancer Society. If a genetic test shows you're at risk, you'll need to be especially vigilant. Regular mammograms and breast self exams could save your life. Your doctor may also prescribe the drug tamoxifen to reduce your risk of breast cancer.

4. Most lumps in the breast are harmless. True or false?

The correct answer is: True.

If you find a lump during a self-exam, tell your doctor right away. However, you shouldn't assume the worst. Breast tissue goes through many natural changes, and 80 percent of lumps turn out to be nothing serious.

5. Mammograms are nearly foolproof. If the radiologist sees something suspicious, you almost certainly have cancer. True or false?

The correct answer is: False.

Mammograms are valuable tools, but they often give false alarms, more frequently in younger women. At the same time, they can miss cancers in their early stages. Mammograms generally miss 15 percent of malignant tumors. For this reason, you shouldn't rely on mammograms alone.

The American Cancer Society recommends that women between 40 and 44 be given the option to have yearly mammograms; women between 45-54 get mammograms every year; and women 54 and older either continue yearly or switch to every other year. Women between 20 and 39 should have their breasts examined by a doctor every three years.


Genetic Testing for Breast Cancer: What are the Advantages and Disadvantages? National Cancer Institute/CancerNet

National Institutes of Health Consensus Development Conference Statement, Breast Cancer Screening for Women Ages 40-49

What are the Risk Factors for Breast Cancer?, American Cancer Society.

Kumle M, et al. Use of Oral Contraceptives and Breast Cancer Risk. Cancer Epidemiology Biomarkers &Prevention.

American Cancer Society. Breast Cancer Facts and Figures

American Academy of Family Physicians. Genetic Testnig for Breast Cancer Risk: What Does It Mean to Me?

American Cancer Society. Overview: Breast Cancer, What Causes Breast Cancer?

Breast Self-Exam

Wellness Library

Why do I need to examine my breasts?

The short answer is that you may not have to. After decades of encouraging women to do self breast exams, the American Cancer Society (ACS) no longer recommends them. According to the ACS, research has not shown a clear benefit from either regular self exams or those done by a practitioner. For women who get regular mammograms, self exams have been shown to be of little worth. These days, physicians are counseling women to keep doing them only if they feel more secure with a self-exam.

But for women at higher than average risk, "health care providers may still offer clinical breast exams, along with providing counseling about risk and early detection," the cancer society writes. "And some women might still be more comfortable doing regular self-exams as a way to keep track of how their breasts look and feel. But it's important to understand that there is very little evidence that doing these exams routinely is helpful for women at average risk of breast cancer."

If you find that self exams work for you, here are some answers to questions many women ask. It's best to begin around age 20, so you can learn early on what your normal breast tissue feels like.

When is the best time to do the exam?

Examine your breasts at the same time each month. The best time is usually a few days after your period, when your breasts are least likely to be tender or swollen. If you no longer menstruate, pick a day that you can remember easily, like the first of the month.

How do I examine my breasts?

Some women hesitate to do a self-exam because they don't know what they're looking for. Generally, malignant lumps are firm, discrete and immobile. However, many malignant tumors do not fit this description, so any change you feel should be evaluated by a physician. It's important to remember that the old saying, "if it hurts, it's not cancer" is not true. Also remember that if your mammogram is normal and you find a lump, you should still be seen by a doctor because not all lumps show up on mammograms.

One breast surgeon in the San Francisco Bay Area says her patients have lots of reasons for avoiding self-exams: they don't know how, their breasts are too lumpy, they don't have time, or they're too scared of finding something. Physicians say that women should do whatever kind of exam they're comfortable with, as long as they get to know what their breasts feel like normally. In that spirit, here are a few guidelines:

1. Stand in front of a mirror with your arms at your sides. Look for any changes in the size, shape, or skin of your breasts, including dimples or scaly patches. Check for discharge. Any bloody discharge should be evaluated by a doctor right away.

2. Clasp your hands behind your head and again look for changes in the size, shape, and contours of your breasts. Then check again with your hands on your hips, bending slightly toward the mirror with your elbows and shoulders pressed forward.

3. Do this next part lying on your back in bed, where you have better access to the undersides of your breasts. Lying down also spreads the breast evenly and thinly, making any abnormalities in the tissue easier to feel.

With your left hand behind your head, use the fingertips of the three middle fingers of your right hand to feel for lumps under the skin of your left breast. Use small, overlapping, circular motions and start just below your left collarbone, pressing your fingers on a small area the size of a quarter. Using various amounts of pressure, feel both on the surface and deep in the breast tissue for lumps that differ from the overall consistency of the breast in any way. Continue to check the breast following one of the patterns shown in the diagram. Make sure you cover everything from the collarbone to the bottom of the breast, and out to and including the armpit. Move around the breast in an up and down pattern (experts say this is the most complete and effective way to examine the entire breast). Switch hands and examine the right breast in the same way.

What should I do if I find a lump or change in my breast?

It's normal for breasts to have some lumps, or for one to be slightly larger or lower than the other. Ideally you'll want to get to know every idiosyncratic lump and bump in your breasts, so you can recognize anything unusual. Suspicious lumps may be particularly hard to distinguish if your breasts contain fibroids or cysts, usually harmless masses that occur more frequently as you age. Searching for irregularities can be scary and frustrating, especially since doctors strongly recommend that you have anything suspicious checked out.

Make an appointment with your doctor if you do come across something that seems atypical. If what you've noticed is indeed suspect, he or she will probably advise that you have a biopsy. This involves taking a small sample of tissue from the mass for closer analysis. But even so, it won't be time to worry; 80 percent of breast lumps that are biopsied turn out to be harmless.

The American Cancer Society recommends that women have an annual mammogram starting at age 45 -- although women at high risk of breast cancer may want to start sooner. In addition to an annual mammography, women at high risk for breast cancer may also want to get magnetic resonance imaging. Women who are high risk include those with a BRCA1 or BRCA2 gene mutation or a first-degree relative with such a mutation, women who have had radiation chest therapy between the ages of 10 and 30, or women with a genetic disease such as Cowden syndrome or Li-Fraumeni syndrome.


Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society

American Cancer Society Recommendations for the Early Detection of Breast Cancer, April 22, 2021

Breast Cancer Treatment Overview

Wellness Library

Responsible breast cancer specialists advise their new patients to weigh their options carefully before rushing into treatment. If you have breast cancer, you're likely to need a combination of therapies. These will depend on the type and size of the tumor, your age, and the degree to which the cancer has spread. Take your time as you think over each option, and consider taking your partner, a friend, or a relative to your doctor's appointments to help you ask questions and remember the answers.

When is surgery recommended?

The first line of defense against most breast cancer is surgery. If your cancer is small and confined to one portion of the breast, the surgeon may take out only the lump and possibly a little bit of surrounding tissue. This is called a lumpectomy. If the cancer was detected early, chances are good you'll have a lumpectomy, possibly with removal of some underarm lymph nodes followed by radiation to kill any undetected cancer cells remaining in the area. (If a sentinel node biopsy found no cancer in the sentinel nodes, you may not need lymph node surgery.)

There is also a radiation option for women with early-stage breast cancers. Instead of the usual six-week course of radiation following a lumpectomy, the new treatment, called brachytherapy, takes about five days. In this therapy, radioactive "seeds" are temporarily inserted into the area where the tumor was removed. This technique allows the radiation to be more precisely focused than radiation from an external beam. Brachytherapy has been used to treat other cancers, like prostate cancer, but it's a new option for breast cancer patients. Initial studies on its effectiveness have been promising, but long-term results are not yet available to determine how this radiation treatment compares with traditional, external beam radiation.

If the cancer is more widespread, your surgeon may recommend a mastectomy -- removal of the whole breast. Radical mastectomies, which involved the sometimes disfiguring removal of the breast and the muscles of the chest wall, are rare today. A modified radical mastectomy -- removal of the visible breast, all breast tissue, and the lymph nodes in the armpit -- is the most commonly performed mastectomy. You may decide to have your breast reconstructed after this surgery. If you choose reconstruction, this can be done either at the same time as your mastectomy or at a later time. A newer procedure known as skin-sparing mastectomy may be an option for women with smaller tumors. Most of the skin over the breast is left intact in this procedure.

Will I need chemotherapy?

Women who've been through a breast cancer diagnosis and surgery are naturally apprehensive about the possibility of chemotherapy. The side effects of hair loss and nausea spring to mind for most, although new techniques have mitigated some of the side effects. It's important to note that chemotherapy isn't necessary for all women with breast cancer. However, if your doctor thinks there's a chance the cancer has migrated to other parts of your body, he or she is likely to recommend chemotherapy, hormone therapy, or both. Generally, chemotherapy works best in pre-menopausal women, and hormone therapy is more effective for women who are past menopause.

Chemotherapy uses drugs that kill all fast-growing cells -- cancerous ones, but also the cells that produce hair and those that spring to action in the immune system. It may be used prior to surgery as a way to shrink a large tumor or may be prescribed after surgery, if the tumor was invasive, to kill any remaining cancer cells. One of the most widely used drugs in chemotherapy is Cytoxan. Another is Taxol, now produced synthetically but originally derived from the bark of yew trees. Once used only to treat advanced breast and ovarian cancer, Taxol is now approved for treatment of early breast cancer. Other widely used chemotherapy drugs are Adriamycin, Methotrexate, and 5-Fluorouracil.

Is there an option to watch and wait?

Some doctors believe you should start treatment no matter what type of breast cancer you have, but others now think that in the case of DCIS, a non-invasive breast cancer confined to the milk ducts, women should have the option of watchful waiting -- that is, having mammograms alternating with MRIs twice a year to see if there is any change.

Targeted therapy

A drug named Herceptin, known as a monoclonal antibody, inhibits tumor growth by binding to the breast cancer cell at a site important to the regulation of cell growth. For this treatment to be effective, a woman's cancer cells must have an over-abundance of a protein called HER2/neu on the cell surface, which is the case in about 1 in 5 breast cancer patients. These cancers tend to spread more aggressively, and Herceptin can help slow the growth and may bolster the immune system to attack the cancer more effectively. The drug is given intravenously usually once a week or as a larger dose every three weeks.

Herceptin may produce serious side effects in some women, including damage to the heart muscle, breathing problems, and severe allergic reactions. In fact, the federal Food and Drug Administration (FDA) issued a formal warning for Herceptin in 2005 because it was linked to serious heart problems in about four percent of women who participated in a major government study. However, in most cases these complications are temporary and improve once treatment is stopped.

Hormone therapy

Tamoxifen, the most commonly used hormone-related drug, interferes with estrogen's effect on tumor cells and inhibits tumor growth. While the National Cancer Institute stresses that the benefits of tamoxifen greatly outweigh the risks, the drug does increase a woman's risk of developing two types of uterine cancer -- endometrial cancer and uterine sarcoma. Toremifene is similar to tamoxifen, but is used primarily in post-menopausal women with advanced cancers.

For post-menopausal women with estrogen and/or progesterone receptor-positive tumors, aromatese inhibitors including letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin) are now usually used at some point during treatment, either after tamoxifen treatment or instead of it. Studies are still under way to determine the optimal length of treatment and whether one of these drugs is better than the others. In a study of 9,300 women over five years, researchers found that anastrozole reduced the recurrence of tumors by 70 percent, compared to tamoxifen's 50 percent. It also had a lower associated risk of strokes, blood clots and uterine cancers than tamoxifen. Women on anastrozole did have a higher risk of osteoporosis, but researchers said drugs can be prescribed to reduce that risk.

Another study of over 5,000 women published in the New England Journal of Medicine found that letrozole reduced a woman's risk of subsequent breast tumors by 40 percent. The women in the study all had estrogen-sensitive breast cancer and had gone through a five-year regimen of tamoxifen. Half were given a dummy pill and half were given letrozole. Because the letrozole group experienced such positive benefits from the drug, the study was stopped early so that the other women in the study would be able to receive the treatment as well. The known side effects of letrozole are increased risk of osteoporosis, pain in the joints and bones, hot flashes, night sweats, and allergic reactions, but most people seem to experience only minor problems.

Still another drug that appears to work after tamoxifen is no longer effective is Fulvestrant (Faslodex). It damages the estrogen receptor and is approved for treatment of post-menopausal women with advanced breast cancer that no longer responds to tamoxifen or toremifene and women with HER2-negative breast cancer that has spread.

In addition, a group of drugs called LHRH agonists suppress the ovaries when offered to pre- and perimenopausal women with breast cancer. The aim is to protect fertility during chemotherapy by preserving the ovaries. Medicines in this class are goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar).

With all of these treatments, and more being developed all the time, it may seem daunting to figure out what's best. By reviewing your medical history, your doctor can help you weigh the benefits of a treatment against any side effects that might be of concern to you, and decide on the appropriate treatment.

What other treatments are in the pipeline?

Some promising research includes:

  • A vaccine to stimulate the immune system to attack breast cancer cells is now in clinical trials.
  • Compounds that can cause a tumor to destroy its own cells and others that cut off a tumor's blood supply by inhibiting the growth of nearby blood vessels.
  • A treatment called PARP that helps fight cancer caused by BCRA mutations
  • More targeted therapies that spare healthy cells while zeroing in on cancer cells
  • Oncoplasty, which combines breast cancer surgery with reconstruction of the breast in the same operation

What does alternative medicine have to offer?

No alternative remedies have been proven to cure cancer, and it's wise to check with your physician before turning to complementary therapies. However, certain unconventional treatments may help you feel better and recover faster. In many cases, acupuncture has proven to ease cancer-related nausea and pain. Some people report that smoking marijuana reduces chemotherapy-induced nausea and vomiting; the drug may be appropriate for some patients not helped by anti-nausea drugs, according to the Institute of Medicine under the National Academy of Sciences. Marijuana for medical purposes is available in some states. Guided imagery and meditation can help you relax and tolerate pain better. And research has shown that women in weekly support groups generally have a better quality of life than those who receive standard treatments alone.

There's no evidence that following a macrobiotic diet or any other food regimen will cure you of cancer; it may even keep you from getting the nutrition you need. But a varied diet that's low in saturated fat and loaded with fruits, vegetables, grains, and legumes can't hurt. You might also try drinking green tea; one preliminary study showed that breast cancer patients who drank four cups a day cut their chances of a recurrence in half. Though, after reviewing scientific data, the FDA concluded that it was highly unlikely that green tea reduced the risk of breast cancer.

Beware of herbal remedies that claim to cure cancer. Anything potent enough to affect tumor cells is likely to have serious side effects and should be taken only under a doctor's supervision.

A study reported in the Journal of the American Medical Association found that something as simple as taking a walk a few times a week may improve your chances of surviving breast cancer. Women in the study who walked from 3 to 5 hours per week at about 3 miles per hour were half as likely to die from the disease than women who didn't exercise. And you don't even have to work up much of a sweat -- the study didn't find any evidence that increasing the intensity of the exercise resulted in a significantly greater benefit.

Further Resources

For recent news about breast cancer:

American Cancer Society, http://www.cancer.org


Breast Cancer Vaccine. Johns Hopkins Medicine.

What's New in Breast Cancer Research and Treatment. National Cancer Institute.

O'Conner, Siobhan. Why Doctors Are Re-Thinking Breast Cancer Treatment. TIME Health, September 30, 2015.

McVea, KL, Minier WC. Low-income women with early-state breast cancer: physician and patient decision making styles. Psychonocology (2):137-46.

Breast Cancer: The Complete Guide by Yashar Hirshaut, M.D., and Peter Pressman, M.D., Bantam Books.

National Cancer Institute: Treatment Option Overview.

American Cancer Society. Breast Cancer: Treatment

Tamoxifen: Questions and answers. National Cancer Institute.

Herceptin: Questions and answers. National Cancer Institute.

Goss PE, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med .

Bryant J and Wolmark N. Letrozole after tamoxifen for breast cancer -- what is the price of success? N Engl J Med 349;19.

Holmes MD, et al. Physical activity and survival after breast cancer diagnosis;293:2441.

Preserving ovarian function after breast cancer treatment. Fertility and Sterility; 91: 694-697.

LHRH Agonists. Living Beyond Breast Cancer.

Breastcancer.org. FDA Tells Doctors About Potential Heart Problems with Herceptin.

Breastcancer.org. Herceptin Plus Chemotherapy After Surgery improves Survival of Women with Early-Stage HER-2-Positive Breast Cancer.

Imaginis. First Clinical Trial for Advanced Breast Cancer Vaccine Underway at UNC.

Food and Drug Administration. FDA Issues Information for Consumers About Claims for Green Tea and Certain Cancers. June 2005.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer.

American Cancer Society. Radiation Therapy.

American Cancer Society. Surgery for Breast Cancer.

American Cancer Society. Chemotherapy.

American Cancer Society. Hormone Therapy.

American Cancer Society. Targeted Therapy.

Mammograms: What You Need to Know

Wellness Library

Can a mammogram save my life?

Mammograms -- X-ray pictures of the breasts -- are a valuable but imperfect tool for detecting breast cancer. The death rate from breast cancer has dropped dramatically in the last 20 or 30 years, but most of that progress is due to better treatments, not mammograms. While a mammogram can definitely uncover hidden cancers, recent research suggests that the X-rays don't save as many lives as once thought.

A study in the New England Journal of Medicine that followed over 40,000 Norwegian women suggested that aggressive use of mammograms could, at most, reduce the death rate from breast cancer by 2 percent -- a benefit so small that it's hard to measure. If true, over 10,000 women would have to be regularly screened to save a single life.

Not all experts agree that the benefits of mammograms are so meager, however, and even the harshest critics believe that screening helps some women. At its best, mammography can find aggressive tumors while they're still treatable. Mammograms can also detect slow-growing tumors that could have safely been ignored.

How often should I have a mammogram?

The American Cancer Society recommends yearly screening for all women over 45 and screening every two years after age 55 (with women at higher risk starting at 40 or when their doctor recommends it).

In the end, women and their doctors should decide together about the timing and frequency of mammograms.

What happens during a mammogram?

The procedure itself is very simple. You'll undress from the waist up and put on a gown that opens in the front. The technologist will position your breast on a plastic tray and then lower a second tray that will compress your breast. (This can be a little uncomfortable, but it shouldn't hurt.) You'll raise your arm over your head and hold your breath for a few seconds as she takes two X-rays of each breast, one shot from above and another from the side.

How accurate are mammograms?

One of the downsides of mammograms is that they often uncover suspicious spots or masses that are actually harmless. Doctors call this a false positive. In other words, try not to panic if the radiologist finds something out of the ordinary. Depending on the experience of the person reading the X-rays, somewhere between 4 and 8 percent of mammograms are false positives. In addition to sending women on an emotional roller coaster, false positives can lead to further unnecessary exams and procedures. To confirm if a suspicious spot is really cancer, a doctor may order a biopsy, procedure that involves removing a small tissue sample that is then examined under a microscope. Most biopsies turn out to be negative, which is a huge relief. Alternatively, your doctor may recommend an ultrasound exam to get another look. If the ultrasound looks normal, your doctor may want to take a wait and see approach. If the spot hasn't changed by your next mammogram, it's not worth worrying about.

Another problem with mammograms is that they sometimes miss actual tumors. Up to 20 percent of tumors are overlooked. It can be especially hard to see tumors in women with dense breast tissue, which includes a lot of women who have not yet started menopause or are on hormone replacement therapy.

Where should I get my mammograms done?

Your doctor can refer you to a breast-screening clinic or you can find one in your area by calling the National Cancer Institute at 800-422-6237 or the American Cancer Society at 800-227-2345. Try to find a facility where the radiologist is reading at least 20 mammograms a week. The federal Centers for Disease Control and Prevention (CDC) offers free or low-cost screening and post-screening diagnostic services to women who can't afford them. For information on getting a free mammogram in your state, call the CDC at 888-842-6355.


Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society

Kalager M et al. Effect of screening mammography on breast cancer mortality in Norway. New England Journal of Medicine 1203-1210, 2010

Mayo Clinic. Mammogram guidelines.

American Cancer Society. False-positive mammogram results vary among radiologists.

National Cancer Institute. Mammograms.

Depression and Cancer

Wellness Library

How does depression affect cancer patients?

For cancer patients, depression means much more than just a dark mood. The illness, which strikes about up to 25 percent of all cancer patients (compared with about 7 percent of the general public), can sap a person's immune system, weakening the body's ability to cope with disease. Patients fighting both depression and cancer feel distressed, tend to have trouble with everyday tasks, and often can't follow medical advice. Indeed, doctors believe that depression, if left untreated, can shorten a cancer patient's life. A study by the California Department of Health and Human Services found that cancer patients without strong social ties were three more times likely to die earlier than their socially active counterparts.

Can treating depression help?

Yes, according to researchers. When a person suffers from cancer and depression, treatment for the mind can give the rest of the body a huge boost. A study of women with advanced breast cancer, conducted at Stanford University, found that those who attended weekly support groups lived an average of 18 months longer than those who didn't. Although more recent research has not found such an effect on survival rates, it has shown that support groups improve quality of life for patients.

A later study at UCLA of patients with malignant melanoma found an equally remarkable trend. Patients who participated in group therapy were three times more likely to be alive five to six years later than those who didn't receive therapy.

Antidepressants may also play an important role in the fight against cancer. An Israeli study found that antidepressants increased the levels of natural killer-cells -- soldiers of the immune system that destroy cancer cells and other intruders -- in a group of cancer patients.

The bottom line is that treating depression in cancer patients not only eases symptoms of pain, nausea, and fatigue, it may help them live longer and enjoy a better quality of life.

Can depression actually increase the risk of cancer?

Since depression can hamper natural killer-cells (lymphocytes that kill cancer cells and microbes) and other natural defenses the body deploys, scientists have long wondered whether the mental condition made people more vulnerable to cancer. Early studies had mixed results; research in the late 1990s involving 4,825 people ages 71 and over provided the first strong evidence that long-term depression could actually increase the risk of cancer. After taking into account factors such as age, sex, race, disabilities, alcohol use, and smoking, researchers from the National Institute of Aging found that subjects who had been chronically depressed for at least six years had an 88 percent greater risk of developing cancer within the following four years. The researchers cautioned that further studies would be needed to prove any cause and effect.

Further Resources

National Institute of Mental Health 6001 Executive Blvd. Room 8184, MSC 9663 Bethesda, MD 20892-9663 Phone: (866) 615-6464 http://www.nimh.nih.gov

International Foundation for Research and Education on Depression PO Box 17598 Baltimore, MD 21297-1598 Phone: (410) 268-0040 http://www.ifred.org


National Institute of Mental Health. The Numbers Count: Mental Disorders in America.

Brandt, M. Support groups don't extend survival of metastatic breast cancer patients, Stanford study finds.

Pennix, Brend W et al. Chronically Depressed Mood and Cancer Risk in Older Persons. Journal of the National Cancer Institute, Vol 90, No. 24.

Co-occurrence of Depression with Cancer: Awareness and Treatment Can Improve Overall Health and Reduce Suffering. National Institute of Mental Health.

National Institute of Mental Health. Depression and Cancer.

National Institute of Mental Health. Depression.

Image credit: Shutterstock

Week 01 to Week 04 of Pregnancy

Wellness Library

Your pregnancy may not even have been confirmed yet, but while you wait to find out, a miracle is occurring inside your body.

One single sperm out of millions of competitors has joined together with an egg. Under normal circumstances, fertilization occurs in one of the Fallopian tubes, then the fertilized egg begins to make its way to the uterus.

By about the fifth day after conception, the embryo finally reaches the uterus, where it implants itself in the endometrium, or uterine lining. If implantation occurs, then you are pregnant. (Implantation is something of a miracle itself: 60 percent are not successful.)

Although you won't get the news for some time, the gender of your child is already established. Half of the newly fertilized egg's genetic material comes from the father's sperm, half from the mother's egg, but gender is determined at conception by the sperm. The mother's egg always carries an X chromosome, while the father's sperm can carry an X or an Y. If the sperm carries an X, than the child will be female; if it carries a Y (to make the combination XY) the baby will be male.

Getting nourishment

Between four to six days after conception, the fertilized egg will develop into a blastocyst and burrow into the uterine lining, attaching itself firmly. In this early stage, the embryo develops a yolk sac, which provides its first nutrients. But as the tiny being grows, it will turn to its host (you) for sustenance. Tiny villi, or fingers of tissue on the outside of the fertilized egg, multiply in these early weeks. They go on to make connections with the capillaries in the endometrium, which supply nutrients and remove wastes. Over time this mass of cells will become the placenta, which will nourish and protect your baby throughout your pregnancy.

During the process of implantation the tiny embryo is actively secreting the pregnancy hormone known as human chorionic gonadotropin (hCG), which will keep you from menstruating and expelling the embryo from your uterus. In a blood test, hCG will show up as soon as six to eight days after you ovulate, indicating that you are pregnant. (One caution: Don't decide whether you're pregnant based on how you feel. The signs of early pregnancy resemble premenstrual symptoms, and include breast swelling and tenderness, bloating, nausea, and fatigue.)

The first weeks

During these early weeks, the embryo continues to grow as cells multiply and take on specific functions in a process known as differentiation. These specialized cells will eventually form your baby's organs and body parts. This stage of development is crucial, so if you know you are pregnant (or even suspect that you could be), it's important to avoid alcohol, street drugs, and tobacco. (Avoid these substances throughout your entire pregnancy, but the first 12 weeks --during which the basic formation of organs and body parts is nearly complete -- are especially crucial.) Also, don't take any prescription or over-the-counter drugs without checking with your doctor to ensure they're safe to use during pregnancy.

By four weeks, the embryo is made up of three distinct layers. The inner layer will gradually develop into the lungs, liver and digestive system; a middle layer will be the baby's bones, muscles, kidneys, heart, and sex organs; and an outer layer will eventually form the skin, hair, eyes, and nervous system.

What you may feel

By the end of the second week after fertilization, you may also begin to experience the first signs of morning sickness. About 70 percent of all pregnant women have some traces of morning sickness, but the severity of the condition can vary from mild nausea to daily bouts of violent vomiting. For some women, symptoms are not confined to the morning, either: many complain of a rocky stomach at the end of the day. Experts believe that morning sickness is caused by the increase in hormones coursing through the system of a pregnant woman.

You may also feel more fatigue than usual: Many women feel extremely tired during their first trimester of pregnancy. Experts attribute this fatigue to the additional work your body has to do, now that it is making a baby. Your blood flow has increased to accomplish the job of feeding your baby. As a result of the increased blood flow, your heart has to pump harder and your cardiac volume will increase by as much as 50 percent.

If your test shows that you're pregnant, congratulations! This is an exciting and joyous time, but it can be overwhelming as well. Don't be surprised if you are feeling a range of emotions, including apprehension and confusion. It will help to learn all you can about pregnancy and the steps you need to take care of yourself -- and your unborn child.


March of Dimes. Placenta Previa. http://www.marchofdimes.com/pnhec/188_1132.asp

Howard Hughes Medical Institute. Developmental Biology. http://www.hhmi.org/cgi-bin/askascientist/

Holy Name Hospital. Health Manual: Pregnancy and Childbirth. The First Trimester (0-12 Weeks). http://www.holyname.org/health_information_resourc...

Colorado State University. Thyroid Hormones: Pregnancy and Fetal Development. http://arbl.cvmbs.colostate.edu/hbooks/pathphys/en...

Merck Manual. Normal Pregnancy, Labor and Delivery. http://www.merck.com/mrkshared/mmanual/section18/c...

Labor: Six Signs You'll Soon Be There. https://consumer.healthday.com/encyclopedia/pregna...

Morning Sickness. Nemours Kids Health. https://kidshealth.org/en/parents/hyperemesis-grav...

The Hazards of Herbal Cigarettes

Wellness Library

What do corn silk, banana skins, and weeds have in common? People desperate for a smoke have used them all in improvised cigarettes.

If something can be rolled up and smoked, you can bet somebody, somewhere, has rolled it up and smoked it. Most of these experiments don't get very far, but a few non-tobacco substances have managed to catch on. In fact, "alternative" cigarettes have become a booming business. Some contain mixtures of herbs; some combine tobacco with cloves, dried tendu leaves (a plant from India and Southeast Asia), and other unusual ingredients.

Alternative cigarettes -- sold at many convenience stores and over the Internet -- are easy to find and easy to buy, even for kids who aren't old enough to buy tobacco. They often look exotic and come in appealing flavors such as cherry or vanilla. But their biggest selling point is that they're supposed to be a healthy alternative to "real" cigarettes. As one online merchant of natural tobacco and clove cigarettes put it, "Gotta smoke? Smoke smart!"

But despite this marketing ploy, alternative cigarettes are NOT safe. In fact, some are considerably more dangerous than normal cigarettes. As the director of the Federal Trade Commission's Bureau of Consumer Affairs once stated, "There's no such thing as a safe smoke."

"Simply being free of additives -- or in the case of herbal cigarettes, free of nicotine -- doesn't make them safer," says Matthew Gold, a staff attorney for the FTC. "Any kind of cigarette you smoke has tar and carbon monoxide, which have very real health hazards associated with them." Gold won a case against Alternative Cigarettes, Inc. that forced the company to display health warnings on its products.

Among the most popular types of alternative cigarettes are bidi, herbal, and clove cigarettes, all of which are especially popular with young people. Here's a close-up look at their risks:


Usually imported from India and Southeast Asia, bidis are small, hand-rolled cigarettes made with dark tobacco wrapped tightly in a dried tendu leaf. They look somewhat like marijuana joints and are available in just about every artificial flavor imaginable, including root beer, mango, chocolate, and cherry. Bidis are usually much less expensive than regular cigarettes; a bundle of 20 may cost just $2.00. Why so cheap? According to the U.S. Customs Service, some manufacturers rely on child slave laborers to roll the cigarettes.

Exotic look, candy-like flavors, low cost -- it's not hard to guess whom bidis are really trying to attract. "We call them training wheels for young smokers," says John Banzhaf, founder and former executive director of Action on Smoking and Health (ASH).

Unfortunately, these pleasant-tasting "herbal" cigarettes are more dangerous than tobacco cigarettes. For one thing, smokers inhale about 2 to 3 times more tar and nicotine than they would if they smoked regular cigarettes, according to an issue of Public Health. And since tendu leaves don't burn as easily as paper, bidi smokers have to inhale deeply and often just to keep the things lit. As a result, toxins and cancer-causing compounds found in the smoke may end up deep in their lungs.

Jennifer Williams, the American Lung Association's former director of tobacco control for the central California coast, says that high schoolers are often shocked to learn how bidis are made. "When we go into schools and talk, we let the kids know that many bidis are produced with illegal child labor," says Williams. "In fact, kids their own age are often indentured servants, spending the entire day rolling hundreds of these cigarettes for little or no money. This has a big effect on the kids. They're upset that kids are abused in order to produce this product."

Four leading bidi cigarette brands were banned by the U.S. in 2014, joining manyother bidi manufacturers that had to remove their products as a result of an earlier ban on flavored cigarettes. However, some are still sold online and over the phone. In one state-run sting operation, children as young as 9 successfully purchased bidis over the telephone using a toll-free number provided by a Web site.

Herbal cigarettes

Herbal cigarettes are tobacco-free and nicotine-free, but they are far from risk-free. "Many people assume that anything herbal or natural isn't dangerous, and that's not true," Banzhaf says.

Herbal Gold cigarettes are a prime example. They look exactly like regular cigarettes and come in different flavors including menthol, cherry, and vanilla. Because they don't contain tobacco, they can be sold legally to smokers of any age. Herbal Gold cigarettes contain a blend of herbs including marshmallow (the plant, not the hot chocolate topping), passion flower, jasmine, and ginseng. These herbs are staples of health-food stores, and they're generally safe -- until they're set on fire.

According to a report by the Federal Trade Commission (FTC), Herbal Gold and other herbal cigarettes produce many of the same toxins found in tobacco smoke, including tar and carbon monoxide. In April 2000, the commission ordered the makers of Herbal Gold (as well as another herbal cigarette manufacturer) to add the following warning to all packages: "Herbal cigarettes are dangerous to your health. They produce tar and carbon monoxide." Another FTC complaint against Alternative Cigarettes and Santa Fe Natural Tobacco Company -- the makers of "Natural American Spirit" cigarettes -- ended with the manufacturers agreeing to discontinue advertising claims that their cigarettes were safer because they contained no additives.

Clove cigarettes (kreteks)

Also known as kreteks, these cigarettes contain about 60 percent tobacco and 40 percent ground cloves. (Some baby boomers may remember buying them in exotic packages with a picture of a volcano on the front.) Far from being healthier to smoke, kreteks deliver twice as much nicotine, tar, and carbon monoxide as regular cigarettes, according to the American Lung Association.

In addition, switching tobacco for cloves isn't necessarily a good trade. Cloves may be perfectly fine in a cup of cider or a Christmas ham, but they produce dangerous chemicals when they burn, Banzhaf says. Inhaled clove oil may also raise the risk of pneumonia, bronchitis, and other lung infections. In a few susceptible individuals, clove cigarettes have even caused coma and life-threatening lung injury, including pulmonary edema, a condition in which the lungs fill up with fluid.

Kreteks were banned in the U.S. under The Family Smoking Prevention and Tobacco Control Act of 2009, and the CDC no longer collects data about their use. However, they are still available by mail order, something that concerns antismoking advocates.


John Banzhaf, interview

FDA Commits to Evidence-Based Actions Aim At Saving Lives and Preventing Future Generations of Smokers, 2021. https://www.fda.gov/news-events/press-announcement...

Bidis and Kreteks. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_s...

Is Any Type of Tobacco Product Safe? American Cancer Society. https://www.cancer.org/cancer/cancer-causes/tobacc...

Federal Trade Commission. FTC accepts settlements of charges that "Alternative" cigarette ads are deceptive. https://www.ftc.gov/news-events/press-releases/200...

Ask an Expert: E-Cigarettes and Other Alternative Smokes. Providence Health and Services. Oregon and Southwest Washington. https://oregon.providence.org/forms-and-informatio...

Committee on Oversight and Government Reform, 110th Congress. Davis and Waxman Reintroduce Legislation to Regulate Tobacco Products. March 17, 2005. https://www.everycrsreport.com/files/20070430_RL32...

Committee on Energy and Commerce, US House of Representatives. Energy and Commerce Committee Approves Landmark Tobacco Bill. April 2, 2008. http://energycommerce.house.gov/Press_110/110nr266...

Labor: Six Signs You'll Soon Be There

Wellness Library

Just as every pregnancy is different, every delivery is unique. Some women get no clues that labor is around the corner, and then -- wham! -- here it comes. Others have telltale signs for weeks, maybe even a false start or two, before the real thing begins.

The simple truth is, there's no way to predict exactly when you'll go into labor. In fact, no one even knows for sure what triggers the big event, although hormones are thought to play a part. Still, there are at least six concrete clues that your baby is preparing to make his or her grand entrance into the world.

1. Lightening: You can breathe easy again.

"Lightening" is the technical term for the point when your baby drops lower in your belly and settles deep in your pelvis. For first-time moms, lightening can occur a few weeks before your baby's birth; for second-timers it may take place only a few hours before labor begins. You may feel the baby drop, or you might notice that there is now space between your breasts and abdomen.

The good news here is that you may get some relief from the shortness of breath you've been experiencing, since this shift takes pressure off your diaphragm. The bad news is that it puts more pressure on your bladder, so you may be visiting the bathroom more than you ever thought possible. Some mothers feel more pressure on their pubic bones or can even see in the mirror that their belly has lowered after lightening; others may be unaware of any difference.

2. Effacement: Your cervix ripens.

Your cervix -- the lower, narrow end of the uterus that protrudes into the vagina -- softens as it's preparing for labor. This process, known as "ripening" or effacement, usually begins during the last month of your pregnancy. By the time the big day rolls around, your cervix will have stretched from around 1 inch in width to paper thinness. Your doctor or midwife may start checking for gradual effacement during your last two months of pregnancy with internal exams during your prenatal visits. Effacement is measured in percentages: Zero percent means no effacement; 100 percent means you're fully effaced.

3. Dilation: Your cervix opens.

As your baby's birthday approaches, your cervix begins to dilate, or open up. Dilation is checked during a pelvic exam and measured in centimeters (cm), from 0 cm (no dilation) to 10 cm (fully dilated). Typically, if you're 4 cm dilated, you're in the active stage of labor; if you're fully dilated, you're ready to start pushing. Your health practitioner will probably check for dilation and fill you in on your progress during your prenatal visits in the later stages of your pregnancy.

4. Bloody Show: Your mucus plug dislodges.

It's not as gross as it sounds, nor as bloody. Although it's termed the "bloody show," this telltale sign of impending labor occurs when the thick plug of mucus that seals off your cervix and prevents bacteria from entering the uterus during pregnancy gives way. Despite its name, the "mucus plug" doesn't resemble a cork (there will be no popping sound!). It's more like thick or stringy discharge that you may pass in a clump into the toilet or your underwear. The discharge can appear as pink, brownish, or slightly bloody in color. The bloody show usually debuts either a few days before your labor starts or at the very beginning of labor, although many women go into labor before it appears.

5. Rupture of membranes: Your water breaks.

Not everyone will have the dramatic "Oh my God, my water just broke!" scene from a Hollywood movie. The fact is, when the sac of amniotic fluid that surrounds and protects your baby during pregnancy breaks, it's more likely to leak from your vagina in a gentle trickle than it is to break the floodgates. The so-called "rupturing of the membranes" can happen at the very start of labor or during the first stage of labor. Usually the doctor, midwife, or nurse will break your water before you become completely dilated, if it hasn't broken by then. This allows them to learn if you have any problems that would impede the baby's safe delivery. Contractions usually become much more intense after your water breaks, and the labor goes faster.

Your physician or midwife should evaluate you and your baby as soon as possible after your water breaks. That's because the baby is at risk of developing an infection in the uterus once the protective fluid is gone. Doctors also advise that women not have sex after their water breaks to avoid introducing any bacteria into the uterus. Your practitioner will want you to have your baby within a day or two after your water breaks.

If you are close to your due date, your water breaks, and you don't go into labor on your own within a relatively short period of time, you will need to have labor induced. If your labor doesn't begin within a specific time period, your physician may want to bring on (induce) labor. How long your health practitioner is comfortable waiting before inducing will depend on your individual situation.

Be sure to tell your health care team if your "water" isn't clear. If your amniotic fluid is greenish in color or smells bad, it could signal either an infection or meconium (essentially baby feces), either of which could cause problems for your baby. Also, if you're leaking liquid but aren't sure whether it's amniotic fluid or urine (some pregnant women leak urine at the tail end of their pregnancies), you should have it checked by your health practitioner so you know what you're dealing with.

6. Consistent contractions: When your labor really gets going.

Contractions are strong, rhythmic, regular cramps that feel like a bad backache or extreme menstrual pain. These little doozies, if they're the real thing, are the most reliable of all the signs and officially mark the onset of labor.

A contraction occurs when your uterus tightens and then relaxes. Real contractions usually start in the back of your body and move toward the front. These movements open the cervix and help push the baby into the birth canal. True contractions come closer and closer together in a predictable pattern and last around 30 to 70 seconds each. They get steadily stronger and keep coming, regardless of what you do.

You and your health practitioner should come up with a game plan ahead of time about when you should call and what you should do if you suspect you're in labor. Most practitioners will probably tell you to call when you have contractions that last for around one minute and occur every five minutes for about an hour, but this could vary greatly depending on your health history and past pregnancy record. Women who have given birth before may have a quicker labor the second or third time around, so it's important not to wait too long to call if you think things might go quickly. Be sure to discuss this with your doctor or midwife. To time the frequency of contractions, start at the beginning of one and count until the beginning of the next one.

You should definitely call your practitioner if:

  • You are less than 37 weeks pregnant and are showing any signs of pre-term labor.
  • Your water breaks or you think you're leaking amniotic fluid.
  • You have vaginal bleeding, fever, or severe or constant pain.
  • Your baby stops moving or begins to move less.

When in doubt, call your practitioner. Even if you're not sure if your signs add up to the beginning of labor, it doesn't hurt to check in. Your doctor or midwife can give you concrete advice and help you determine if this is the moment you've been waiting for. Congratulations!


American Pregnancy Association. Signs of Labor, 2021. https://americanpregnancy.org/healthy-pregnancy/la...

Mayo Clinic. Signs of Labor: Know what to expect. May 14, 2019. https://www.mayoclinic.org/healthy-lifestyle/labor...

Whitsett, J.A. et al. Hydrophobic Surfactant Proteins in Lung Function and Disease. New England Journal of Medicine. Volume 347:2141-2148. https://www.nejm.org/

How Do I Know I'm in Labor? FamilyDoctor.org, a publication of the American Academy of Family Physicians. https://familydoctor.org/know-im-labor/

American Pregnancy Association. Stages of Childbirth: Stage I. http://www.americanpregnancy.org/labornbirth/first...

American Pregnancy Association. Stages of Childbirth: Stage II. http://www.americanpregnancy.org/labornbirth/secon...

Merck Manual. Management of Normal Labor. http://www.merck.com/mmpe/sec18/ch260/ch260d.html

Hey, Cancer, Take a Hike!

Wellness Library

"Take a walk. Earn big money, up to 1.7 cents per step!" If I saw an ad making that claim, I certainly would find it hard to believe. But in the last few years I have learned that in the fight against breast cancer, small steps can indeed lead to substantial cash.

More than 20,000 people know the power of walking and understand that the meager per-step earnings add up to a healthy sum that helps treat women afflicted with breast cancer. Two thousand steps per mile, $34 per mile, 60 miles.

I did the math. I took the walk.

My buddy Pat joined me on a walk to save her life and the lives of thousands of others. The trek we were on, The Avon Breast Cancer 3-Day Walk, included 21,000 walkers on a three-day, 60-mile course that ended in San Francisco's Golden Gate Park. Similar walks took place in eight other cities around the country. Each participant raised a minimum of $1,800 in sponsorships, and the net proceeds were used to support nonprofit breast health programs and breast cancer research.

This trek is just one of several nationwide walks in the fight against breast cancer. Others include the Susan B. Komen Foundation 3-Day Walk and the American Cancer Society's Making Strides Against Breast Cancer walk, which has raised $400 million for breast cancer research since 1993. Indeed, annual walks and marathons raise hundreds of millions of dollars to fight a host of major diseases and conditions, from the American Heart Association's Heart Walk to walks to support research on diabetes, Alzheimer's, leukemia, asthma and lung disease, kidney disease, cystic fibrosis, Down syndrome and many others.

Sponsorships and the adrenaline rush

Pat and I slowly drag our bone-tired bodies up an ungodly incline that stretches on and up, seemingly forever. We and 3,000 other walkers cover the first 34 miles chatting, laughing, and singing old television-show theme songs. After that, the group falls quiet, except for the sound of heavy breathing and soft footfalls, as we conserve our energy for "Hell Hill."

As we climb, so does the mercury. Cheering residents treat us to a spray from their garden hoses. We briefly admire white picket fences adorned with pink ribbons, the worldwide symbol for breast cancer survivors. I duck off the sidewalk and turn back to face the snaking line of walkers following me. As I go through the motions of retying shoes, sipping water, applying sunscreen, stretching hamstrings, and adjusting sunglasses, I appear to be the role model for other walkers. Actually, these preparations are stall tactics to catch my breath and steel my nerves for the final ascent. Was it worth six months of training for this?

Any doubts are erased with a sideways glance at Pat, a breast-cancer survivor who has been through a much more grueling journey.

Pat and I eventually do conquer the hill, traipse another five miles, and arrive at our homes away from home for the night: blue, plastic, two-person tents at cold, foggy, Skyline College in San Bruno, California. Outside our tents the wind howls. Inside, condensation from the rain drips down the sides, but we're warm and snug in our bags. My tent mate Jane grumbles about the snap-crackle-pop of my insulated space blanket that keeps me toasty, but keeps her awake all night. She nicknames me her "Rice Krispies Roomie." We joke that Everest is our base camp, but also remind ourselves that spending even the most miserable, noisy, soggy night in a cramped tent is not nearly as difficult as enduring surgery, chemotherapy, and radiation.

During a lunch date five months earlier, I convinced Jane to join me on this journey. We were excited about training together and agreed to share a tent during the walk. "I want to do something meaningful as a statement about this disease and its impact on women, their families and friends," Jane had said. Between us, we have five children ages 12 through 15. We fantasized that this would be a three-day weekend away from laundry, cooking, cleaning, homework, and Mom's Taxi Service. We thought walking 60 miles and camping at Skyline would be far easier than our regular hectic lives. Little did we know.

In mid-March, four months before the big event, I thought I was going to have to drop out. In mile eight of a training walk, a sharp abdominal pain interrupted my stride. I wrote it off as a muscle cramp, and finished the remaining two miles. I couldn't believe it was serious enough to prevent me from walking.

Thirty-six painful hours later, research from the Internet led me to self-diagnose appendicitis, and I drove myself to the emergency room. The doctor on call disagreed with me and declared it a hernia, which required a surgical consultation the next morning. Within two days I was in surgery to remove an appendix and repair a hernia. We were both right -- and I had two incisions to use as excuses, if I wanted to quit. But, one day later, I was doing laps around the surgical floor, IVs in tow. Soon after that, I was shuffling around the block.

At my one-week checkup, I thrust my fund-raising letter at the surgeon: "You do understand I will walk 60 miles, four months from now?" I declared with certainty. He agreed to sponsor me, which was just the vote of confidence I needed. With each sponsorship check came the adrenaline rush: "Hey, I really am making a difference." I looked at every check as if perhaps this was the one paying the salary of the overworked researcher who discovers the cure at midnight in her basement laboratory. No contribution was insignificant; no pledge too small. I told everyone, "I will love you the same whether it's a $500 check or a crumpled $5 bill."

Honoring our mothers

Why does a collective of strangers come together to do something this extreme? We walk to honor mothers, sisters, aunts, daughters, cousins, friends, and strangers. We just want to "do good." And the survivors walk because they can. Pat walked to prove to herself that she was strong again. "Once you've had cancer you feel like your body has betrayed you," she says. "You don't trust it. After all, I felt great and yet I had Stage Two breast cancer with positive nodes."

Pat's 21-year-old daughter, Anne, was one of the youngest walkers training for the trek.

"I want to do something with my mother, in honor of her strength and courage," says Anne. "Last year the walk was a personal feat for my mom. I wanted her to have that wonderful experience for her own personal healing, but I want to walk with her every step of the way this year, as I will walk with her for the rest of our lives."

For the event, Anne showed her support by working as a driver -- one of many crew members and volunteers contributing to the event's success. The crew's sole purpose is to have fun while ensuring that walkers are fed, watered, and loved.

Costumes are part of the fun: Pajama-clad crew members load gear onto trucks. The pit-stop team dances in grass hula skirts while doling out Gatorade and snacks. Cowboys and drag queens patrol in sweep vans, rescuing injured or staggering walkers. The kitchen staff rises at 4:00 am to prepare huge pots of oatmeal. Safety and security folks keep campsites and walking routes safe. And the route-marking crew posts signs so walkers can navigate their way. At the end of each weary day, volunteer medical students, chiropractors and massage therapists carefully work the kinks out of walkers' backs and feet.

The most distinguished volunteer to date is Kris, the "Butterfly Guy," who rides along on his bicycle, dressed in purple-sequined spandex, full-size wings, helmet antennae, and sparkly nail polish. Kris crewed all seven walks this year from California to New York, perched on the very same bicycle that carried him through five AIDS Rides that summer. His job, along with the crew member known as "The Caboose," was to keep an eye on the very last of the walkers.

How did a butterfly wind up on the crew?

"I wanted to share the incredible spirit that I had experienced when doing the AIDS Rides," says Kris, who lives in New York. His butterfly persona is symbolic of rebirth -- an appropriate symbol for those who view the walk as a journey of metamorphosis. Kris' fulfillment, he explains, comes from "knowing that we are making it possible for so many amazing people to accomplish the incredible."

"Everything hurts except my eyelashes"

Despite the crew's boundless enthusiasm and energy-reviving antics, by day three we walkers are desperate for something to distract us from the next 20 steps, and the next 20 after that. Someone reworks the lyrics to a Sound of Music standard, and we belt out our new theme song as it passes up and down the ranks:

Climb every mountain

Stretch every hour

Pee at every pit stop

Until you reach the shower.

Pop all your blisters

Ice both your knees

Spray us with your misters

And your hoses, please.

Thank the crew for dinner

We slept on the ground

Everest was our base camp

Fog and cold abound.

We raised lots of money

It was hard for sure

But we'll keep on walking

Until we find a cure.

We sing this refrain until our throats are sore, while street-side crowds applaud our resolve. The last verse always brings forth a tear or two, but then we laugh and cheer and start over again.

We are plodding slowly but surely toward Golden Gate Park, and Jane says she desperately needs a little party music right about now, anything but "that song" again. Amazingly, we turn the corner to the sound of Loggins & Messina's Best of Friends blaring from my sister Sharon's car, festooned with pink balloons dancing in the wind. Sharon is swept up in a flurry of hugs and shrieks of delight. The woman who started off as my personal cheerleader -- merely writing a check for the event -- decided she wanted "to join the journey, not as a walker but as a volunteer" for subsequent events. She has become the official cheerleader for the entire group, showing up in her black convertible at just the right moment with music blaring and horn honking. I'm proud she is here as part of this family.

As we near our final destination a fellow walker sums up our collective attitude at that very moment: "I'm feeling great; everything hurts except my eyelashes."

Heads nod silently in agreement. We're all thinking it, but we're too tired to comment. Many are visibly in pain, and the pace is noticeably slower than our start just 60 hours and 60 miles earlier. Every walker has blisters somewhere; knee braces and Ace bandages have become fashion statements. But we bring home more from this experience than just blisters, shin splints, and aching muscles. We have come together with a shared commitment to be part of something bigger than any one of us. Anne describes it as "three days of the world as it should be."

For Pat, it's all about renewed confidence and self-esteem: "I set a goal, achieved my goal, and proved to myself that I could challenge my body physically and survive again. A special community is formed during the three days and I hope I have been able to take the spirit of the event to heart and live my life differently."

The walk is not an experience that ends when the walking stops; it is a critical juncture in our lives. Jane says there's life before The Walk, and life after The Walk. "The lessons I learned," she says "continue to enrich my spirit daily."

I have to agree. This journey provides a pivotal point for each of us. Mine comes at the end: greeted by a giant outburst of love and admiration, I imagine the entire crowd to be cheering only for me. I bask in the spotlight for just a few seconds, then gladly relinquish it to the survivor who's staggering in just steps behind me. Despite agony and exhaustion I stand on my feet for another hour to cheer subsequent arrivals. I'm not the only one doing so. We may walk in one at a time, but we all finish together. Before we assemble for our victory march into the Closing Ceremonies, Jane turns to me and says, "Now I see why you walked for a second year."

Surrounded by such a miraculous celebration of faith and courage, I am helpless to resist as my feet carry me to the "3-Peat Tent" to register for the next walk.

Drug Therapy for Breast Cancer

Wellness Library

How are drugs used to fight breast cancer?

Doctors use certain medications to help prevent breast cancer or, in combination with other therapies, to fight it and treat it. The kinds of drugs you'll take depend on what stage your cancer has reached, whether it responds to hormones like estrogen, whether you're resistant to any medications or treatments, and how well you tolerate the ones prescribed. Chemotherapy is the traditional standard, but several newer drug treatments may also be helpful.

What's chemotherapy?

Chemotherapy is a treatment that uses drugs to combat cancer by killing all fast-growing cells, not only cancer cells but also those in your hair follicles and immune system. A combination of more than one drug is usually more effective than any single one. Your overall health is also important in determining what type of chemotherapy is best for you. The medications may be taken in pill form or through an IV (a tube inserted into a vein). An IV treatment, which lasts about two hours, often includes anti-nausea medications along with the chemo drugs. The treatment is painless, and you can usually relax in a reclining chair and read or chat while receiving it.

A typical course of chemotherapy might involve treatments every two to three weeks (to allow time for recovery in between) for three to six months, depending on the stage of your cancer and the other treatments you're receiving. Advanced breast cancer treatment may last longer. Chemo may also be used before surgery. This is called neoadjuvant chemotherapy and is used to shrink a large tumor that otherwise cannot be removed completely by surgery. It's also used to shrink large tumors so they can be removed by lumpectomy rather than mastectomy.

What are the side effects?

Chemotherapy is well-known for causing nausea and vomiting. Some cancer patients even start to experience anticipatory nausea before their chemo appointments. But these side effects can be treated, and sometimes they can be prevented entirely. Today's anti-nausea medications are more sophisticated and effective than those used even a few years ago: They can sometimes make you feel better and boost your appetite. Let your doctor know if you continue to feel nauseated; there are new drugs that can help control this even in highly sensitive patients. Discuss other things you can do to get relief as well, such as eating frequent, small, non-spicy meals, learning and practicing self-hypnosis, and having a few crackers every time you wake from sleep.

The most serious side effect of chemotherapy is suppression of your immune system, which can greatly increase the risk of serious infection. Chemo lowers your levels of red and white blood cells and platelets, an effect that's likely to make you tired and lower your immunity. It's very important to wash your hands carefully and often and, if possible, avoid being around sick people while you're undergoing chemo. You may be given drugs called colony-stimulating factors, which can improve your white blood-cell count and thus give you more energy. The exhaustion and nausea are at their worst shortly after you have a treatment, but within a day or so the nausea will often subside; it's the ever-present fatigue that many women find most debilitating.

Taking daily walks, getting lots of rest and frequent naps, and avoiding stress and unnecessary chores can help you cope. "There are many things that can be done to counter cancer-related fatigue, starting with a search for treatable physical factors, like low thyroid or blood count, and learning to recognize and respect one's limits," writes Dr. Wendy S. Harpman, the author of After Cancer: A Guide to Your New Life. "Many patients try to keep life as normal as possible, and in the process, they overdo it."

Other common side effects of chemotherapy are hair loss, sores in the mouth, changes in the skin, and menstrual irregularities. Whether you have these problems may depend on which drugs you're given or the dosage and length of treatment.

Some of the most common chemo drugs often used in combination are Cytoxan (cyclophosphamide), epirubicin (Ellence), methotrexate (Rheumatrex), 5-fluorouracil (Adrucil), doxorubicin (Adriamycin), paclitaxel (Taxol), docetaxel (Taxotere), and trastuzumab (Herceptin). All patients receiving Adriamycin-based therapy should have a special heart evaluation called a MUGA scan before starting therapy to assess for underlying heart disease. High doses of Adriamycin can cause heart damage, so the dosage must be carefully monitored by your doctor. All regimens containing Herceptin also require heart monitoring when you begin (to get a baseline) and at months 3, 6, and 9.

Generally, Adriamycin-based regimens cause temporary hair loss, which can occur not only on your head, but on other parts of your body. Other regimens can cause hair loss, too, but not always. Many women cut their hair short or buy a wig before starting chemo to help them cope with losing their hair.

Other serious side effects are possible but rare. For example, some women experience premature menopause or, more rarely, develop acute myeloid leukemia. Chemotherapy may infrequently lead to kidney or bladder problems, too. Some drugs can cause peripheral neuropathy, a nerve-related condition that may make your hands or feet feel tingly, weak, or numb. Consult with your oncologist if you develop any of these symptoms.

What can hormone therapy do?

The female hormone estrogen promotes the growth of about two-thirds of all breast cancers. Hormone therapy can help treat these cancers by lodging in the receptors of the harmful cells so that the estrogen can't get to the cells and feed the tumor.

One of these drugs, tamoxifen (Nolvadex), has been used for the treatment of known breast cancers and the prevention of new breast cancers in high-risk women. In terms of treatment, tamoxifen can improve a woman's ten-year survival by 5 to 11 percent. For prevention, tamoxifen decreases the risk of developing breast cancer in the same breast or the other breast by 50 percent.

Its rare but serious side effects include uterine cancer, blood clots, and cataracts. If you take tamoxifen, the American Cancer Society recommends that you get a yearly pelvic exam to screen for uterine cancer. In many women, the drug also causes such menopause-like symptoms as hot flashes, weight gain, and mood swings. Tamoxifen shouldn't be taken in conjunction with hormone replacement therapy.

Toremifene (Fareston) is similar to tamoxifen, but it is used primarily in post-menopausal women with advanced cancer who are estrogen-receptor positive.

LHRH agonists

A group of drugs called LHRH agonists suppress the ovaries when offered to pre- and perimenopausal women with breast cancer. The aim is to protect fertility during chemotherapy by preserving the ovaries. Medicines in this class include goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar).


Another class of drugs, called bisphosphonates, is used to treat osteoporosis but is also used to treat breast cancer because this drug group strengthens bones, including bones to which cancer has metastasized.

Aromatase inhibitors

Aromatase inhibitors are another form of hormone therapy that stop estrogen production in post-menopausal women (they are not effective at stopping the ovaries from making estrogen in pre-menopausal women). Letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin) are the three aromatase inhibitors approved for treatment of breast cancer. These drugs have been compared to tamoxifen in several studies, and they appear to be more effective than tamoxifen when they are used alone or following tamoxifen treatment. They also tend to have fewer serious side effects. They do not appear to increase the risk of uterine cancer and only very rarely cause blood clots. Some side effects are increased risk of osteoporosis, pain in the joints and bones, hot flashes, and night sweats.

If these medications don't work, progestins or androgens may be used, but they may cause undesirable side effects such as fluid retention or excessive body hair.

What other drug treatments are there?

Targeted therapies

Some drug treatments fight cancer with substances that act as "guided missiles," seeking out and destroying cancer cells. These are molecules known as monoclonal antibodies, which are synthesized proteins that can carry chemo medications or radiation directly to cancer cells in order to destroy them. Researchers are also experimenting with ways to arm these molecular "destroyers" with toxins or radioactive particles that are released directly into the cancer cells when the missile hits home. Unlike regular chemotherapy, this therapy targets only harmful cells, and so promises to be much less toxic and debilitating to patients.

In some forms of aggressive breast cancer, cancerous cells go out of control and produce too much of a protein called HER2/neu, which is thought to give the signal for cells to multiply. Monoclonal antibodies are designed to latch onto the surface of those cells and make it impossible for the cells to keep reproducing. Tastuzumab (Herceptin) and lapatinib (Tykerb) are drugs that have been used for years for the treatment of HER2-positive advanced breast cancer. A newer drug, Enhertu (fam-trastuzumab), is being used to treat HER2-positive breast cancer that has been unresponsive to other drugs.

Government studies found that women who took Herceptin along with chemotherapy were only half as likely to see a recurrence of their cancer than women who received chemotherapy alone. "These are truly life-saving results in a major disease," Dr. JoAnne Zujewski, a leading researcher for the National Cancer Institute, said in a statement released by the National Institutes of Health at the time.

About 5 percent of people who take Herceptin have suffered serious heart problems, especially when it was combined with other cancer medications; that's why people using it for breast cancer treatment require heart monitoring (above). It also produces some flu-like symptoms and breathing problems in some women, and a few women may experience severe allergic reactions.

What else may be available soon?

Some promising research includes:

  • A vaccine to stimulate the immune system to attack breast cancer cells is now in clinical trials.
  • Compounds that can cause a tumor to destroy its own cells and others that cut off a tumor's blood supply by inhibiting the growth of nearby blood vessels.
  • More targeted therapies that spare healthy cells while zeroing in on cancer cells
  • More tumor-starving drugs, which cut off the blood supply to the tumor, are currently in development. Recently scientists have found a new way to starve tumors to death. This is by blocking their "fuel supply routes." They are currently testing one such treatment in clinical trials.
  • Clinical trials are examining non-hormonal drugs for breast cancer reduction. These include drugs for diabetes like metformin, drugs used to treat blood or bone marrow disorders, such as ruxolitinib, and bexarotene, a drug that treats a specific type of T-cell lymphoma.

What can alternative medicine offer?

No alternative remedies have been proven to cure cancer, but some, such as acupuncture, may help you feel better and recover faster from the side effects of conventional drugs. Some people report that smoking marijuana eases the nausea and vomiting resulting from chemotherapy. The Institute of Medicine under the National Academy of Sciences reported that the drug may be appropriate for patients not helped by anti-nausea medications. It's best to check the laws in your state. In some areas marijuana is available for medical purposes.

The National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring a number of clinical trials to study alternative adjunct treatments for cancer. .


Breast Cancer Vaccine. Johns Hopkins Medicine.

What's New in Breast Cancer Research and Treatment. National Cancer Institute.

Study unveils new way to starve tumors to death: Blocking cancer cells' metabolism may make treatments more effective, less toxic. Science Daily

O'Conner, Siobhan. Why Doctors Are Re-Thinking Breast Cancer Treatment. TIME Health

Breast Cancer Treatment Regimens. Clinical Guidelines.

Jacobson JS, Workman SB, Kronenberg F. Research on complementary/alternative medicine for patients with breast cancer: a review of the biomedical literature. J Clin Oncol ;18(3):668-83.

Lissoni P, Fugamalli E, Malugani F, Ardizzoia A, Secondino S, Tancini G, Gardani GS.Chemotherapy and angiogenesis in advanced cancer: vascular endothelial growth factor (VEGF) decline as predictor of disease control during taxol therapy in metastatic breast cancer. Int J Biol Markers;15(4):308-11.

Osztie E, Varallyay P, Doolittle ND, Lacy C, Jones G, Nickolson HS, Neuwelt EA. Combined intraarterial carboplatin, intraarterial etoposide phosphate, and iv cytoxan chemotherapy for progressive optic-hypothalamic gliomas in young children. AJNR Am J Neuroradiol ;22(5):818-23. Spicer D, Pike M, Lobo R, Paganini-Hill A, Richardson J, Dworsky R, Weaver F. Gonadotropin hormone releasing hormone agonists [GnRHA] and prevention of familial breast cancer. Prog Clin Biol Res. 1990;339:193-9.

Tagliaferri M, Cohen I, Tripathy D. Complementary and alternative medicine in early-stage breast cancer. Semin Oncol;28(1):121-34.

Case problem: presenting conventional and complementary approaches for relieving nausea in a breast cancer patient undergoing chemotherapy. J Am Diet Assoc;100(2):257-9.

Herceptin: Questions and answers. National Cancer Institute.

Goss PE, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med.

Bryant J and Wolmark N. Letrozole after tamoxifen for breast cancer -- what is the price of success? N Engl J Med 349;19. 3.

Herceptin Combined With Chemotherapy Improves Disease-Free Survival for Patients with Early-Stage Breast Cancer. National Institutes of Health News.

National Cancer Institute. Adjuvant bisphosphonates for breast cancer.

American Cancer Society. Hormone Therapy.

American Cancer Society. What's new in breast cancer research and treatment?

American Cancer Society. Breast Cancer Chemotherapy.

Journal of the American Medical Association. Granulocyte Colony-Stimulating Factor.

Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER1-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010; 375:377-384.

National Cancer Institute. FDA Advisory Committee Recommends against Bevacizumab for Metastatic Breast Cancer. NCI Cancer Bulletin. Vol 7, No. 15.


Wellness Library

CPR -- cardiopulmonary resuscitation -- is a potentially life-saving procedure that can restart a person's heartbeat and breathing. CPR is often used to revive victims of electric shock, near-drowning, and heart attack. According to the National Institutes of Health, quick CPR can triple a victim's chances for survival. The best way to learn the technique is to take a certified training class. (See http://www.americanheart.org to find a class near you.) The following tips offer a quick introduction to CPR, but they can't take the place of training.

When to use CPR

Before performing CPR, check to see if the victim is responsive. Ask him if he's okay and touch him on the shoulder. If he responds or is breathing, CPR isn't necessary. If he doesn't respond, you need to get emergency help right away. Call 911 or have someone call for you. If you're alone, you may have to leave the victim for a few moments to call for emergency help. CPR is intended to keep a victim alive until medical help arrives.

Note: If you are alone, there are times when it is more important to start CPR immediately than to take the time to call 911 first.

  • If reviving an unresponsive infant or young child, perform CPR for two minutes before stopping to call 911. According to the University of Washington School of Medicine, an immediate attempt to correct airway blockage a common cause of cardiac arrest in infants -- should take precedence over calling 911.
  • If an unresponsive adult has been a victim of near-drowning, trauma, or drug overdose, the American Heart Association says it is more important to start CPR immediately than to delay while you call 911.

Special precautions during the COVID-19 pandemic

The American Red Cross cautions everyone to take these special precautions during the pandemic:

"While CPR with breaths has been shown to be beneficial when compared to compression-only CPR, during the COVID-19 outbreak, it is currently recommended that no rescue breaths be performed for adult cardiac arrest patientswith confirmed or suspected COVID-19, due to the risk of disease transmission.

"We recommend that adult victims of sudden cardiac arrest receive continuous compression-only CPR from their CPR/first aid care provider until emergency personnel arrive.

"Cardiac arrests that occur after a breathing problem (which is often the case in infants and young children), drowning and drug overdoses may benefit from standard CPR that includes compressions and rescue breaths. Note: It is recognized that in some of the cases, the victim may also have COVID-19. However, if a lay responder is unable or unwilling to provide rescue breathing with CPR, compression-only CPR should be initiated.

"We recommend placing a face mask or face covering over the mouth and nose of the victim. If only 1 mask is available and it is simple face mask or face covering, we recommend placing it on the victim."

Performing CPR

More than a decade ago, the American Heart Association announced a new lifesaving option for bystanders who witness an adult collapse due to cardiac arrest. After calling 911, people who are not trained in conventional CPR or aren't confident in their ability to give chest compressions and mouth-to-mouth breaths should use a simple technique called Hands-Only CPR. "This involves providing high-quality chest compressions by pushing hard and fast in the middle of the victim's chest, without stopping until emergency medical services responders arrive," the AMA committee explained. To learn more about Hands-Only CPR, go to http://www.americanheart.org/handsonlycpr.

The committee found that Hands-Only CPR was on par with conventional CPR when used for an adult who has suddenly collapsed due to cardiac arrest. It also should not be used for an unwitnessed cardiac arrest. In the case of near-drowning in infants and children or drug overdose, conventional CPR with chest compression and breaths would benefit the patient most.

Although Hands-Only CPR can save lives, conventional CPR is still an important skill to learn. The American Heart Association has standardized the following CPR instructions for all ages except newborns.

  • Carefully roll the victim over onto his back if he isn't positioned that way already. If the victim does not appear to be breathing normally, begin CPR.
  • Tilt his head back, pinch his nose closed and cover his mouth completely with your mouth.
  • Give him two, full breaths, each lasting about one second. The victim's chest should rise.
  • If it doesn't rise, check to see if something is blocking his airway. If you see something, try to remove it with your fingers. Try again to get air into his lungs.
  • If this attempt fails, but you see that a solid object is blocking the airway, perform the Heimlich maneuver by giving the victim a quick upward thrust on his upper abdomen until the blockage is expelled. (However, do not use the Heimlich maneuver to expel water, as its is quickly absorbed into the body: If the water is causing someone to choke, you need to remove it by suction. In fact, the American Heart Association warns against routine use of the Heimlich maneuver for drowning victims, calling it unnecessary and potentially dangerous.)
  • If the victim is still not breathing regularly, coughing, or moving, begin chest compressions immediately.
  • Place the heel of one hand right in the center of the breastbone (between the nipples). Put the heel of your other hand on top of the first and press straight down about one and a half to two inches into the chest. (For small children, you may need to only use one hand or two fingers.)
  • Give the victim 30 compressions without any pauses. The compressions should be at a rate of about 100 per minute, or faster than one per second. The key, according to the American Heart Association, is to "push hard and push fast."
  • After 30 compressions, tilt the victim's head back, pinch his nose, and give him two more deep breaths.
  • Repeat the cycle of breaths and compression until help arrives or until the victim shows signs of recovery such as moving, breathing, or coughing.

CPR on an infant

When performing CPR on an infant, tilt the baby's head back to open the airway, cover both the nose and mouth with your mouth, and give two gentle breaths. Each breath should be one second long. Then position your third and fourth fingers in the center of the baby's chest, about half an inch below the nipples. Give 30 quick, gentle compressions, pressing down about one third to one half the depth of the chest. The compression rate should be the same as for adults -- about 100 per minute, or faster than one per second. Repeat a cycle of two breaths and 30 compressions for about two minutes before calling 911. Continue the cycle of breathing and compressions until the baby starts breathing or help arrives.

Keep in mind:

  • Don't perform chest compressions if a person is breathing, coughing, or moving. His heart is already beating, and chest compressions could actually stop it.
  • Don't waste time looking for a pulse. Leave this to the professionals.
  • If a victim vomits, turn him on his side and clear out the vomit with your fingers.
  • It's possible to crack a rib during chest compressions, especially if the victim is elderly.
  • It is important, regardless of the risk of rib fractures, to perform compressions with enough force to get the heart going. In true emergencies that require CPR, a cracked rib is usually a small price to pay for a chance at survival.

Protecting yourself from bodily fluids during CPR

The American Red Cross recommends the use of protective breathing barriers during CPR to protect the rescuer from bodily fluids such as blood, vomit, and saliva. Called "pocket masks," these barriers are either reusable or disposable, and have one-way valves that allow air into the victim but prevent the rescuer from having contact with the victim's fluids. The chances of disease transmission during direct mouth-to-mouth rescue are very low, but if you're worried about bloodborne viruses such as HIV or Hepatitis C, keep a pocket mask at the ready in your first aid kit. Contact your local Red Cross chapter for purchasing information.

Further Resources

You can find illustrated guides on performing CPR on the University of Washington School of Medicine's Web site: http://depts.washington.edu/learncpr/


University of Washington School of Medicine. Learn CPR: You can do it!

First Aid/CPR/AED CAre During the COVID-19. American Red Cross.

National Institutes of Health. Medical Encyclopedia: CPR --Adult.

Harvard Medical School Family Health Guide. CPR on a child 8 years or older or on an adult.

Cardiopulmonary Resuscitation (CPR) American Heart Association. P.1http://www.americanheart.org/presenter.jhtml?ident...

Cardiopulmonary Resuscitation (CPR). Mayo Clinic. http://www.mayoclinic.com/invoke.cfm?id=FA00061

Emergency Cardiovascular Care (ECC) Revisions for the Lay Rescuer. American Red Cross. http://www.redcross.org/services/hss/resources/ecc...

Interview with Mickey Eisenberg, MD, emergency medicine specialist, University of Washington Medical Center.

American Heart Association. Hands-Only CPR Simplifies Saving Lives For Bystanders. http://americanheart.mediaroom.com/index.php?s=43&...

Image: Shutterstock

Animal Bites

Wellness Library

What should I do if my child is bitten by an animal?

Treatment depends on how bad the wound is. If it's clearly minor -- nothing more than a superficial scratch -- carefully wash the area with soap and water. Apply an antibiotic ointment twice a day. Cover the wound with an adhesive bandage if it's in an area that's likely to get dirty; otherwise, leave it exposed to the air.

If the injury is possibly serious -- if the skin is broken and bleeding -- apply a gauze pad or clean cloth to the wound and press with your fingers. Once the bleeding has stopped, cover the area with a bandage and call your doctor. If you think the wound might require stitches, take your child to the nearest emergency room. Animal bites to the face or neck are especially dangerous, since they may open up major blood vessels. If pressure doesn't stop the bleeding in a couple of minutes, call 911 for emergency medical care.

Should I worry about rabies?

Most dogs and cats in the United States are vaccinated for rabies, so they won't carry the virus that causes the disease. But if you have any doubts about the animal that has bitten your child, try to capture it. (Be careful to avoid physical contact.) If you can find the owners, ask if they can document whether the animal has been vaccinated for rabies. Animal control authorities can also check the animal for signs of rabies. Wild animals like raccoons, skunks, and bats can carry rabies. If a wild animal has bitten your child, call your doctor immediately.

What about other infections?

The most common problem following an animal bite is simple infection. The saliva of dogs and cats has been found to harbor a wide variety of bacteria, so if your child is bitten, it's important to wash the area thoroughly and apply an antibiotic ointment. If the wound is serious enough, your child's doctor may prescribe antibiotics. For any wound, even a minor one, your child may need a tetanus shot or booster.

If the wound is superficial and you treat it at home, be sure to keep an eye on it over the next few days. If it begins to look infected (red or swollen) or your child starts to run a fever or feel sick, call the doctor right away. Also see your child's doctor promptly if the bite doesn't heal within ten days.

What can I do to prevent animal bites?

Teach your children not to approach cats or dogs they don't know -- unless you tell them it's safe. Although some dog breeds can be especially dangerous -- pit bull terriers, German shepherds, Huskies, and Rottweillers, for instance -- any dog may bite if provoked. Teach your children not to go near a dog that's eating and not to touch a dog that's sleeping. Children younger than four should never be left unsupervised with pets.

Further Resources

National Institute of Child Health & Human Development


Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Perseus Books Publishing, L.L.C.

American Academy of Family Physicians. Prevention and Treatment of Dog Bites. http://www.aafp.org/afp/20010415/1567.html

eMedicine Emergency Medicine. Dog Bites.

Image credit: Shutterstock


Wellness Library

Shock can occur after any kind of trauma: a severe allergic reaction, poisoning, heat stroke, burns, or any other severe stress on the body. But the phenomenon can also ensue from severe dehydration, excessive vomiting, or extreme diarrhea. Some types of infections and certain heart or kidney problems that reduce blood flow can cause shock as well. What happens when the body goes into shock is that blood -- and the oxygen it carries -- can't get to vital organs, and the organs begin to fail. Treating shock early can save lives; left untreated, it can be life-threatening. It's essential to recognize the signs of shock and treat it quickly.

What are the signs of shock?

Signs and symptoms of shock include one or more of the following:

  • Cool, pale, clammy skin
  • Unusually high or low temperature
  • Rapid and weak heartbeat
  • Unusually fast or slow breathing
  • Abnormally low blood pressure
  • Confusion or anxiety
  • Faintness, weakness, dizziness, or loss of consciousness
  • Dull look to the eyes
  • Dilated (enlarged) pupils
  • Intense thirst
  • Reduced urine flow

What to do

Although it's important to act quickly, you must remain calm and focused. Because shock can accompany many different kinds of emergency situations, be alert for all signs of injury, including broken bones and bleeding.

  • First, call 911.
  • Check the person's airway, breathing, and circulation. If needed, begin CPR.
  • If the person is conscious, have the person lie down and elevate the legs about 12 inches. This helps increase blood flow to the head. Caution: Unless there's immediate danger in keeping the person where they are, do not move the victim if you suspect a neck or back injury. Doing so could worsen a spinal cord injury.
  • Try to keep the person from moving unnecessarily. This is especially important if you suspect an injury to the spine.
  • Treat the wounds, injuries, or illnesses such as broken bones or bleeding that can produce a condition of shock.
  • It's important to control the person's temperature while you wait for help. If the person is cold, keep him warm and comfortable by wrapping a blanket or a towel around him. If his temperature is elevated, wet a towel and put it on his forehead. Do not give the person anything to drink, however. Someone in shock may vomit anything taken orally, which could result in choking. If the person does need fluid, medical workers can attach an intravenous line.
  • If the victim vomits, turn the person gently to one side and make sure that fluid can drain from the mouth. This prevents choking.
  • Loosen tight clothing.
  • While you wait for help, continue to monitor the person's condition. If breathing slows or stops, administer cardiopulmonary resuscitation (CPR).


MayoClinic.com. Shock: First Aid.

National Institute of General Medical Sciences. Trauma and Shock Fact Sheet.

American Medical Association. Handbook of First Aid and Emergency Care.

American College of Emergency Physicians. First Aid Manual.

The American Red Cross First Aid and Safety Handbook.