URL: http://bcresourcedirectory.org/posttreat.htm


                     <h>You have to accept whatever comes,
                        And the only important thing
            Is that you meet it with courage--Eleanor Roosevelt

   <p>Once you have completed your treatments for breast cancer (including
   surgeries, chemotherapy, radiation therapy, etc.), you will naturally
   want to "get on with your life." Although each of us goes through the
   experience of being diagnosed with and treated for breast cancer
   differently, there may be some common issues that you will need to
   deal with either immediately or long after our treatment is over.
   Having an awareness of the possibilities puts you in a better position
   to know how to deal with them or where to turn for help if one arrives
   in your life.

   <p>In this section, as in the previous one, we have chosen to address
   some of the more common "post-treatment" issues which many breast
   cancer survivors may be concerned with. Along with the resources we
   list at the end of this section, you should talk with your doctor
   about any health situation that gives you concern.
   
                        <h>HORMONE REPLACEMENT THERAPY

   <h>I have breast cancer and had been taking hormone replacement therapy.
   Should I continue to take it?

   <p>Your doctor should advise you about whether to continue HRT (hormone
   replacement therapy) at the time you are diagnosed with breast cancer.
   Generally, hormone replacement therapy is not recommended for women
   who have been diagnosed with breast cancer.

   <h>Why would hormone therapy be given to women with breast cancer?

   <p>Researchers have found a way to use hormones as therapy against breast
   cancer. This is different than HRT (hormone replacement therapy),
   which is given to imcrease levels of hormones (such as estrogen and
   progesterone) that are decreased in the body due to menopause.

   <p>One hormone therapy drug for breast cancer is Tamoxifen.  By blocking
   estrogen, Tamoxifen can block the growth of cancer cells. If your
   tumor is estrogen receptor positive (called "ER positive") this may be
   a good treatment for your breast cancer.  (Estrogen receptors are
   found in the nucleus or center of the tumor cell. The ER allows cells
   to use estrogen to grow).   Tamoxifen can be used alone, with
   chemotherapy, or following chemotherapy. Tamoxifen is also being used
   to prevent breast cancers from developing. You may want to ask your
   doctor about this.

                                 <h>LYMPHEDEMA
   lymphedema therapists in North Carolina

   <h>What is lymphedema?

   <p>Lymphedema is the collection of lymph fluid that can occur in your arm
   and hand after your lymph nodes have been removed or damaged from your
   underarm area (axilla) during breast cancer surgery.

   <h>What is lymph fluid?

   <p>Lymph fluid is a colorless fluid containing the white blood cells that
   fight infection and disease. Lymph fluid travels through channels of
   the lymph system throughout your body much like blood travels through
   arteries and veins.

   <h>What are lymph nodes?

   <p>Lymph nodes are small, pea-sized organs located along the lymph
   channels. They are grouped in clusters. Their job is to trap foreign
   bodies such as bacteria or cancer cells to keep them from spreading
   throughout the body. The nodes are clustered in areas throughout your
   body such as underams (axilla), groin, neck, chest and abdomen. The
   ones in your chest and underarm are the ones that collect the lymph
   fluid from your breast. This is why they are often removed at the time
   of surgery.

   <h>What causes the arm to swell after surgery?

   <p>Not every woman's arm swells after surgery. It swells because the
   number of pathways for the lymph to drain from the arm are reduced by
   the removal of or damage to the lymph tissue during surgery or
   radiation therapy. Fewer channels to drain the fluid can result in
   collection of fluid in the arm (or swelling). The extent of lymph
   tissue removed or damaged relates to how much swelling you may
   experience. Swelling may occur weeks, months or even years after
   treatment.

   <h>Are there any safety precautions I should be aware of?

   <p>Yes. Because the lymph channels and nodes have been removed (or
   decreased) on the side of your surgery, you must take extra caution to
   protect your hand and arm from injury, cuts, scrapes and insect bites.
   You may have less protection against infection in that arm. Some
   people wear a medical alert bracelet with this information on it. It
   is important to remind healthcare workers to avoid drawing blood and
   measuring your blood pressure on that arm. It is also recommended that
   you wear gloves while doing housework, gardening and other activities
   that may put your arm or hand at risk for injury. In addition, it is
   possible for lymphedema to occur years after you have finished your
   treatment; therefore, taking care and being aware are your two best
   keys to avoiding or managing lymphedema.

   <h>What about using antiperspirant or deodorant under my arm?

   <p>You should not use deodorants or antiperspirants while you are healing
   from surgery on the armpit on the side of your surgery. Once you are
   healed, you may use either antiperspirants or deodorants. Some doctors
   may recommend use of deodorants only. You should talk about this with
   your healthcare team.

   <h>What can I do about the swelling? Is it permanent?

   <p>You should talk with your doctor about this. Sometimes, elevation of
   the arm for brief periods throughout the day is adequate to promote
   fluid drainage. Other methods to reduce swelling include arm exercises
   and gentle massage that specifically promote lymph drainage. Your
   doctor should refer you to a practitioner who specializes in
   lymphedema treatment if you have a persistent problem with this. More
   severe cases may require use of pressure sleeves to compress the arm.
   Lymphedema can be a permanent condition in some cases.

   <h>How do I choose a lymphedema therapist?

   <p>Lymphedema therapists have a range of training options. The programs
   they attend vary in length. When you are choosing a therapist, you
   might want to consider how much training he or she has.

   <p>The programs include: LeDuc (6 days of training), Lerner (14 days),
   Casley-Smith(14 days), Academy of Lymphatic Studies (ALS; 14 days),
   Klose-Norton (15 days), Foldi (20 days), and Vodder (20 days; some
   programs teach Vodder "techniques", but only therapists who
   have completed the entire program are Vodder credentialed). Recently,
   the Lymphology Association of North America (LANA) began certifying
   lymphedema therapists who also passed a comprehensive national exam.
   If you have questions about the trainings, call the National
   Lymphedema Network at 800.541.3259 or see http://www.lymphnet.org.

   <p>Also, see the listing of lymphedema therapists in North Carolina in
   this directory.

   <h>Some questions to ask the lymphedema treatment center

   <p>Does it provide combined decongestive therapy (CDT)? (This includes
   skin care, manual lymphatic drainage (MLD), bandaging and exercises.)

   <p>What training/experience do its therapists have in CDT?

   <p>Is there a physician with training in lymphedema available for
   consultation?

   <p>Does the center provide patient education in exercises, skin care,
   self-massage and self-bandaging?

   <p>Will the initial therapy be done daily, and for how many days?
   (Generally, therapy is given at least five days in a row for early
   stage, and up to four weeks if the lymphedema is more advanced.)

   <h>What is Manual Lymph Drainage?

   <p>Manual Lymph Drainage is a massage technique used to improve the flow
   of lymph using light, rhythmic strokes.  This therapy may be effective
   for the lymphedema that sometimes follows breast surgery.


                                 <h>MENOPAUSE
                      (Natural & Chemotherapy-Induced)

   <h>What is menopause?

   <p>Menopause is the absence of menstrual periods due to reduced function
   of the ovaries. This can occur naturally with aging, or from damage to
   the ovaries. This naturally occurs in women beginning in their 40s and
   50s.

   <h>Will chemotherapy cause me to experience menopause?

   <p>Before menopause, your ovaries produce estrogen. Estrogen is
   responsible for your monthly menstrual cycle and reproduction. Some
   chemotherapy drugs interrupt (temporarily or permanently) ovarian
   function, which can result in early (or chemotherapy-induced)
   menopause. This type of menopause can be permanent and has the same
   effect on your body as naturally-occurring menopause.

   <h>What are some of the typical side effects of menopause?

   <p>Hot flashes, night sweats, vaginal dryness, and irregularity or
   absence of monthly menstrual periods are the most common effects of
   menopause. Menopause is also associated with bone loss due to reduced
   calcium stores in the bone.

   After chemotherapy treatment, some women resume their menstrual cycle.
   If you do not, you should seek advice about calcium replacement and
   exercise to promote bone health.

   <h>What can I do to manage side effects of menopause, such as hot flashes
   and vaginal dryness?

   <p>You should discuss menopause management strategies with your doctor or
   nurse. For hot flashes, there are medications available; also, many
   people are beginning to explore the use of alternative therapies, such
   as soy products or herbs. You should check with your doctor before
   proceeding with this approach. You must always be cautious about the
   possibility of drug interactions when taking supplements or herbals in
   addition to medications.

   <p>Other considerations include choosing loose-fitting, comfortable
   clothing and regulating the temperature control to suit your
   preference.

   <p>Vaginal dryness can be addressed through the use of lubricants prior
   to sexual activity. There are many products available without
   prescription to remedy this problem. Persistent vaginal itching should
   be investigated to rule out the possibility of infection (see also the
   section below on Sexuality).
   
                                <h>OSTEOPOROSIS
                      (Natural & Chemotherapy-Induced)

   <h>What is osteoporosis? 

   <p>Osteoporosis or "porous bones" is a condition of decreased bone mass.
   Bone is living tissue that continuously undergoes breakdown and
   rebuilding (at a cellular level) as a normal body process. Peak bone
   mass is usually reached by age 38. After that, bone begins to lose
   mass as part of the aging process. As bone mass is lost, bones become
   brittle. Men generally lose 20-30% of their bone mass over their
   lifetime, and women generally lose 45-50% of their bone mass.
   Decreased bone mass can lead to an increased risk of bone breakage and
   disability.

   <h>Why is this important to me now, and what are the risk factors?

   <p>As a person receiving cancer treatment, you are at increased risk for
   osteoporosis. Risk factors for osteoporosis include:

   <l>Early hormone deficiency (menopause)

   <l>Chronic malnutrition
   
   <l>Smoking

   <l>Alcohol consumption
  
   <l>Limited weight-bearing exercise

   <l>Family history

   <l>Ethnicity--more prevalent in Caucasian (white) and Asian women

   <l>Small body frame

   <p>Chemotherapy can interfere with your normal production of hormones due
   to its effect on ovarian function. Reduction or failure of ovarian
   function automatically places you at increased risk for osteoporosis.
   It is important that you discuss prevention and treatment strategies
   with your doctor or nurse.

   <h>Would I know if I had osteoporosis? Can I be tested for it?

   <p>Early changes in bone density are usually painless. Most people don't
   know they have osteoporosis until they break a bone. That is why it is
   important to know the risk factors and to learn what you can do to
   prevent bone deterioration.

   <p>Testing can be done for osteoporosis. First, you should have a
   thorough health history and physical exam to determine your risk
   factors for osteoporosis. Then, your doctor will discuss or recommend
   your having a bone mineral density test if you are considered to be at
   high risk. It is a safe, painless and non-invasive test. This
   establishes your baseline bone density and provides useful information
   in determining the best course of action for you.

   <p>In North Carolina, bone mineral density (BMD) tests are available in
   some pharmacies. The cost of measuring the BMD in the heel is
   generally around $30, and this correlates well with the trabicular
   (spine) bone. This test reveals very little about the cortical (hip)
   bones, so you will not get the whole picture. However, the test will
   give you a reasonable assessment and baseline information that you can
   take to your doctor to see if further testing is needed. The test
   takes about five minutes or less and is pain free. You can have this
   test done without a referral from your doctor.

   <h>Can I help prevent osteoporosis from happening to me?

   <p>Yes. There are a number of prevention strategies that are recommended
   to reduce your risk for osteoporosis:

   <l>Eating a well-balanced, nutritious diet

   <l>Including Vitamin D and calcium in your diet

   <l>Avoiding animal protein, salt and caffeine

   <l>Quitting smoking and avoiding excessive alcohol intake

   <l>Taking medications that reduce the natural bone breakdown process

   <l>Increasing your weight-bearing exercise, such as walking or lifting
   weights.

   <p>Again, your healthcare team should advise you in regard to these
   strategies, but you should not hesitate to initiate this discussion
   with them.
   
                                 <h>SEXUALITY

   <p>Every woman's image of their body and sexuality is unique. No two
   people have exactly the same response or feelings when they learn they
   have breast cancer. If a mastectomy is performed, this can be
   overwhelming and emotionally difficult for some women. For others, it
   is a relief to have the cancer removed. Treatment for cancer, such as
   chemotherapy, can cause physical changes that may interfere with a
   woman's sexuality.

   <p>In addition, breasts are a part of many womens' sexual identity.
   Breasts are symbolic of nurturing, sustaining new life and intimacy.
   The loss of a breast can be threatening to body image and sense of
   self.

   <h>If I have a mastectomy, will I be disfigured?

   <p>Mastectomies today are done to preserve muscle, so there is much less
   disfigurement than there used to be.  It is very important that you
   discuss this topic fully with your surgeons. If you are interested in
   reconstruction, you may want to consider options regarding breast
   reconstruction at the time of your initial surgery. If so, you should
   be referred to a plastic surgeon for a full discussion of your
   options. In some situations, reconstruction is not advised at the time
   of your initial surgery, but can be done at a later date after all of
   your cancer treatment has been completed. Reconstruction can also be
   chosen years down the road.

   <h>What if I choose not to have reconstruction?

   <p>If you wish to use one, external breast prosthetics (breast forms) are
   available to help minimize the visual alteration of losing a breast.
   There are many different options available to you. You might want to
   consider this, too, when deciding about surgery and potential
   reconstruction options.  (Also see the section on Reconstruction in
   After the Diagnosis in this directory).

   <h>Will my sex life be different after breast cancer?

   <p>Chemotherapy for breast cancer can sometime cause a woman to go into
   premature, or early, menopause. This can be difficult for a woman
   physically, emotionally and sexually. The symptoms of early menopause
   are sometime more severe than those that occur with natural menopause.
   These symptoms can include hot flashes, vaginal dryness, and low
   sexual desire, as well as depression, anxiety and increased
   irritability. Other menopausal issues include increased risk of heart
   disease and osteoporosis.

   <h>Are there solutions to the sexual problems I might face?

   <p>The good news is that there are solutions for these problems. Hot
   flashes can be treated with specific drugs prescribed by a doctor.
   Some women also have found Vitamin E or soy products to be helpful.

   <p>Vaginal dryness can be improved by the liberal use of a lubricant such
   as Lubrin, K-Y Jelly, Ortho Personal Lubricant, Surgilube, Today
   Personal Lubricant or Astroglide. Replens, a vaginal moisturizer, can
   be used three times a week. Recent studies have found that both
   Estrace, a estrogen cream used vaginally, or Estring, a vaginal ring
   with slow release of estrogen, restore the vaginal tissues without
   increasing estrogen in the rest of the body.  Ask your doctor about
   these options.

   <p>Persistent, low sexual desire is sometimes treated with androgens. You
   can have your hormone levels checked and discuss this option with a
   doctor. Other ways of increasing desire are reading erotic literature
   or watching erotic videos. Almost all women who were orgasmic before
   cancer treatment can be so again although sometimes it takes
   relearning and practice.

   <p>If needed, doctors can also prescribe therapies that address other
   menopausal issues (depression, anxiety, irritability, increased risk
   of heart disease and osteoporosis). Several new, improved therapies
   are now available.

   <p>See the publications and organizations in Resources below for more
   help with managing menopausal symptoms.

   <h>How will my spouse or lover feel about me after surgery?

   <p>It is very important that you discuss this with your partner. Open,
   honest communication about your feelings and theirs is very beneficial
   to your overall sense of well being and the intimacy you experience
   before and after treatment. Your healthcare team may include a social
   worker or psychologist who can specifically help you to address your
   feelings and fears regarding sexuality and intimacy. Your acceptance
   of your body changes will affect how others react to you.  It is
   important for you to be open about your feelings to yourself and to
   your spouse, lover or partner.

   <p>Always remember that who you are has nothing to do with your breasts
   (although perhaps they may have played a part in your self-esteem or
   sexual identity prior to your surgery).  You are special no matter
   what the size of shape of your body, and you deserve to be in an open,
   honest and loving relationship with someone who cares about you--and
   accepts you--because of who you are in your heart, mind and soul.

   <h>I'm single and not in a relationship.   How and when do I tell someone
   new in my life about my breast cancer and surgery?

   <p>This is not a question with any easy answers, but there are some
   things you can consider when you find yourself in a new relationship:

   <l>First, have you reached your own personal level of acceptance of your
   body and your experience with breast cancer?

   <l>Have you accepted the possible changes to your body which might later
   be issues in a relationship, such as early menopause and inability to
   bear children, or possibility of recurrence?

   <l>Are you comfortable enough with yourself and your experience to share
   it with someone else?

   <l>Decide whether this new person is one who would be caring and
   sensitive to your needs. Are you comfortable enough to open yourself
   up and share it with this person? If not, then perhaps either the
   timing is not right or the person is not the one for you.

   <l>Only you can decide whether you are ready to enter into a new
   relationship with someone. And you alone are the only person who can
   know whether you feel comfortable and "safe enough" in a new
   relationship to share your feelings, your experience and your body.


                                 <h>RESOURCES

                               <h>Organizations

   <h>American Cancer Society, Inc. (ACS)
   <p>800-227-2345 or 800-282-4914
   http://www.cancer.org
   Publishes "Sexuality and Cancer", an excellent, free resource to
   address the sexual needs of women with a cancer diagnosis or in
   premature menopause. Call to order or see the web site.   ACS provides
   information and services for all forms of cancer; diagnosis,
   treatment, and many other topics. Programs offered by ACS include:
   CanSurmount, I Can Cope (coping support), Reach to Recovery
   (rehabilitation after surgery and support), and Resources Information
   and Guidance. Free educational materials available on a wide variety
   of topics relating to cancer.

   <h>American Menopause Foundation
   <p>212-714-2398
   menopause@americanmenopause.org
   http://americanmenopause.org
   Provides support and assistance on issues concerning menopause. The
   AMF has support groups across the country. Call or write to order
   articles on menopause-related issues such as anxiety, coping,
   sexuality, hormone replacement therapy, phytoestrogens, bone health,
   premature ovarian failure, etc.

   <h>The Breast Cancer Fund
   <p>415-543-2979 or 800-487-0492
   info@breastcancerfund.org
   http://www.breastcancerfund.org
   Has information on breast cancer and treatments. Web site has good
   resource links to books, organizations, and breast cancer awareness
   events.

   <h>Cancer Care, Inc.
   <p>212-221-3300 or 800-813-4673
   info@cancercare.org
   http://www.cancercare.org
   All services free. Provides emotional support, information, and
   practical help. Staffed by trained oncology social workers. One to one
   counseling, support groups, information, educational programs, and
   referrals for services available. Publishes A Helping Hand, a free
   resource guide for people with cancer. Call (800) 813-HOPE or order
   through Web site. Web site has comprehensive resource information.

   <h>The Hormone Foundation
   <p>1-800-HORMONE (1-800-467-6663)
   http://www.hormone.org
   Publishes "Menopause: What Every Woman Should Know", an excellent,
   free resource about menopause helpful for women who have had breast
   cancer. Call 1-800-HORMONE to order or see the web site to download
   free.

   <h>Lilly Center for Women's Health
   <p>888-WMN-HLTH
   http://www.lillywomenshealth.com
   Provides information about breast cancer, menopause, and other women's
   health issues.
   <h>Living Beyond Breast Cancer
   <p>610-645-4567 or 888-753-5222
   lbbc@earthlink.net
   http://www.lbbc.org
   Addresses post-treatment needs of women with breast cancer through
   educational programs, newsletter, call in help-line for survivors and
   family members. Toll-free survivor's helpline 888-753-LBBC available
   Tuesdays 11am-3pm. Many conference tapes, workshop tapes, and
   videotapes about survivor issues also available.

   <h>National Alliance of Breast Cancer Organizations (NABCO)
   <p>212-889-0606 or 888-806-2226
   NABCOinfo@aol.com
   http://www.nabco.org
   This network of organizations is an information and education resource
   on breast cancer. Publishes a yearly, comprehensive Breast Cancer
   Resources booklet which includes many aspects of breast cancer
   diagnosis, treatment and issues. Call to order one, or view the
   resource list online at their excellent Web site.

   <h>National Lymphedema Network, Inc.
   <p>510-208-3200 or 800-541-3259
   http://www.lymphnet.org
   Education and guidance for lymphedema patients, healthcare
   professionals, and the general public. Referrals to treatment centers,
   health care professionals and support groups. Resource materials, a
   toll-free recorded information line, pen pals/net pals peer support,
   lymphedema alert bracelets, and newsletter also available. Extensive
   guide on how to avoid lymphedema.

   <h>National Osteoporosis Foundation (NOF)
   <p>202-223-2226
   http://www.nof.org
   Offers education, information, support and advocacy. Publishes several
   informational booklets (including a Spanish language one) and an
   osteoporosis exercise video. Has an electronic support group called
   "Linking Up" which offers peer support for men and women ages 20-50;
   call or email supgroup@nof.org to sign up. Web site has much
   information and an online "Find a Doctor" service; bone health
   newsletters offered by email.

   <h>National Women's Health Network
   <p>202-628-7814
   http://www.womenshealthnetwork.org
   A national, nonprofit advocacy and public interest organization
   devoted solely to women's health issues. Call the clearinghouse Tues.
   and Thurs. 9-5:30 to request information on a range of topics,
   including breast alternative therapies for menopause; osteoporosis;
   tamoxifen, and others. Can also see Web site for fact sheets on
   different topics.

   <h>National Women's Health Resource Center
   <p>877-986-9472
   info@healthywomen.org
   http://www.healthywomen.org
   Offers comprehensive information on women's health topics.

   <h>North American Menopause Society
   <p>440-442-7550 or 800-774-5342
   info@menopause.org
   http://www.menopause.org
   Promotes understanding of menopause. Has much information and
   publications about menopause and menopause-related issues. Has lists
   of menopause clinicians, discussions groups, and a reading list. Much
   of their information is available for download on their Web site.

   <h>Osteoporosis and Related Bone Diseases-- National Resource Center
   (ORBD-NRC)
   <p>202-223-0344 or 800-624-BONE (2663)
   TDD: 202-223-0344
   orbdnrc@nof.org
   http://www.osteo.org
   Clearinghouse for information about osteoporosis, Paget's disease and
   related disorders.   Includes a sign-up for an osteoporosis listserv
   (online discussion group).

   <h>Osteoporosis Coalition in North Carolina
   Older Adult Health Program
   <p>Post Office Box 29605, Raleigh, NC 27620
   Provides information about osteoporosis programs in North Carolina.

   <h>Resolve: National Infertility Association
   <p>617-623-0744
   resolveinc@aol.com
   http://www.resolve.org
   Provides support and information about infertility. Has information
   about infertility, how to select an infertility specialist, and other
   topics. Offers a Helpline to order publications, give information and
   direct you to resources in your area.

   <h>Sexuality Information & Education Council
   Resource Center and Reference Library
   <p>212-819-9770
   Provides information and suggestions about how to manage problems
   related to sexuality after breast cancer.
   
                               <h>Books and More

   <p>After Cancer: A Guide to Your New Life, by Wendy Schlessel Harpham, MD
   (HarperCollins, Inc., 1995). A warm, informative overview written by a
   physician and cancer survivor. She discusses sexuality in the chapter
   "Where did my Libido Go?" and offers practical advice.

   <p>Coping With Lymphedema: A Practical Guide to Understanding, Treating
   and Living with Lymphedema, by Joan Swirsky, RN, and Diane Sacket
   Nannery (Avery Publishing Group, 1998). A practical guide to
   understanding, treating and living with lymphedema caused by treatment
   for breast cancer. Can be ordered by calling 800-548-5757, Ext. 123.

   <p>Dr. Susan Love's Hormone Book: Making Informed Choices About Menopause
   by Susan M. Love, MD, with Karen Lindsey (Random House, 1997). Offers
   comprehensive information on menopause and coping with symptoms, and
   addresses concerns about breast cancer. Also includes a listing of
   resources.

   <p>Living in the Post-Mastectomy Body: Learning to Live in and Love Your
   Body Again by Becky Zuckweiler, MS, RN, CS (Hartley & Marks, 1998). As
   a nurse, psychotherapist and breast cancer survivor (who had a double
   mastectomy), Zuckweiler guides women through all aspects of recovery,
   focusing on regaining confidence in your body and developing a
   comfortable self-image and intimate relationships.

   <p>Lymphedema, by Jeanne Petrek, MD, Peter I. Pressman, MD, Robert A.
   Smith, PhD (1998). Results from a workshop on breast cancer
   treatment-related lymphedema and lymphedema resource guide. A bit
   technical and scientific; useful for health professionals. Order
   online at American Cancer Society's web site at
   http://www.cancer.org/bookstore/lym_pub.html or call toll-free
   888-227-5552.

   <p>Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing,
   by Jeannie Burt and Gwen White, PT (Hunter House, 2000). Provides
   clear information on what lymphedema is and why it occurs. Describes
   treatment procedures to suit a range of needs and emphasizes that
   lymphedema can be treated successfully. Covers preventing lymphedema,
   reducing lymphedema through professional therapy and self-massage and
   more.

   <p>Managing Menopause (magazine) Includes helpful information on dealing
   and living with symptoms of menopause and other interesting articles
   regarding women's health. Published biannually (free in OB-GYN
   offices) by American College of Obstetricians and Gynecologists.
   Contact 202-484-3321. See also http://www.acog.org

   <p>Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner (#
   4657), by American Cancer Society. (FREE) A brochure available from
   the ACS. Call 800-ACS-2345 or see their web site at
   http://www.cancer.org

   <p>Sexuality and Fertility After Cancer by Leslie R. Schover, Ph.D. (John
   Wiley and Sons, 1997). Addresses how treatment may interfere
   emotionally and physically with male and female sexual function and
   fertility. Offers help for survivors and their partners learn to enjoy
   sex again and make informed choices about having children. (Schover
   also wrote the influential 1988 book, Sexuality and Cancer: For the
   Woman Who Has Cancer and Her Partner.) On American Cancer Society's
   booklist.

   <p>Strong Women, Strong Bones: Everything You Need to Know to Prevent,
   Treat and Beat Osteoporosis, by Miriam Nelson, Ph.D., with Sara
   Wernick, PhD. (Putnam Publishing Group, 2000). This book teaches women
   how to recognize, prevent and treat osteoporosis through exercise
   (strength training, weight-bearing aerobic exercise, stretching and
   balance) and nutrition. Tufts University nutrition researcher, Miriam
   Nelson, and award-winning health writer, Sarah Wernick team up on
   their third "Strong Women" book to bring you the latest science about
   osteoporosis.

   <p>What Every Woman Facing Breast Cancer Should Know About Lymphedema:
   Hand and Arm Care Following Surgery or Radiation Therapy for Breast
   Cancer, by American Cancer Society (ACS). (FREE) A brochure available
   from the American Cancer Society. Call 800-ACS-2345 or see
   http://www.cancer.org

   <p>Without Estrogen: Natural Remedies for Menopause and Beyond by Dee Ito
   & Barbara Herbert (Crown Publishing, 1995). Offers options for
   managing the symptoms of menopause for women who cannot or choose not
   to rely on hormone replacement therapy.

                                 <h>Web Sites
   
                                 <h>Lymphedema

   <p>Bosom Buddies: Breast Cancer and Lymphedema Support Group
   http://www.go-icons.com/bosombuddies.htm
   Web site has info about lymphedema, case histories, compression pumps
   and more.

   <p>Circle of Hope Lymphedema Foundation
   http://lymphedemacircleofhope.org
   A non-profit organization to promote education, awareness, research,
   assistance, and support to lymphedema patients and their doctors.
   Website has info about lymphedema, including travel, psychological
   aspects, insurance and other issues. Also "Ask A Therapist" online.

   <p>National Lymphedema Network
   http://www.lymphnet.org
   Information about lymphedema, finding support groups, finding/choosing
   a therapist, lymphedema alert bracelets, news, a resource guide, and
   educational materials.
   
                    <h>Sexuality, Premature Menopause, HRT

   <p>Breast Cancer and Sexuality: Surviving and Thriving
   http://www.cancercare.org/campaigns/breast1.htm
   Information on the ways breast cancer can affect sexuality and how to
   cope with difficulties in sexuality and intimacy.

   <p>Menopause From Breast Cancer, from INFO Breast Cancer
   http://www.infobreastcancer.cyberus.ca/meno.htm
   Has info about menopause secondary to breast cancer, how to help with
   hot flashes, and a resource list.

   <p>Oncolink's Page About Cancer and Sexuality
   http://www.oncolink.upenn.edu/psychosocial/sexuality
   Has several resources and information about about sexuality and
   cancer, including a link to sexuality after breast cancer.

   <p>Power Surge: A warm and caring community for women in menopause
   http://power-surge.com
   Information and frequently-asked questions about menopause,
   interactive chats, medical consultants, message board, Ask the
   Experts, resources, bookstore and more.

   <p>Questions and Answers About Hormone Replacement Therapy, from the
   National Cancer Institute
   http://rex.nci.nih.gov/massmedia/pressreleases/hormone_qa.html
   Questions and answers about menopause, HRT, types of HRT, risks and
   benefits, alternatives, etc.

   <p>Sexuality from the American Cancer Society
   http://www.cancer.org
   The site has a comprehensive sexuality section for women who have
   cancer and their partners. Click to the left on "Living With Cancer,"
   then choose "Coping with Cancer." Choose Sexuality & Cancer from the
   list of topics.

   <p>Sexuality from the National Cancer Institute
   http://cancernet.nci.nih.gov/coping/emotional_concerns.shtml
   Discusses sexual problems after cancer (psychological and physical
   factors) and treatment.

                           <h>Online Support Groups
    <p>(note:  ACOR.org, the source of most of these groups, is called the
    Association for Online Resources.  They have over 100 public online
    support groups which provide information and community to patients,
     caregivers, or anyone looking for answers about cancer or related
                                conditions).

   <p>CANCER-FERTILITY
   http://www.acor.org
   On the web site, click on Mailing Lists to the left, then page down to
   "CANCER-FERTILITY" to sign up.  This group is for people concerned
   with fertility issues after cancer.

   <p>CANCER-SEXUALITY
   http://www.acor.org
   On the web site, click on Mailing Lists to the left, and page down to
   "CANCER-SEXUALITY" to sign up.  The group is concerned with sexuality
   after a cancer diagnosis.

   <p>LYMPHEDEMA
   http://www.acor.org
   On the web site, click on Mailing Lists, then page down to
   "LYMPHEDEMA" to sign up.  The group is for people concerned with
   lymphedema.

   <p>OSTEO-P
   http://www.acor.org
   On the web site, click on Mailing Lists on the left, then page down to
   "OSTEO-P" to sign up.  This group is concerned with osteoporosis.
