In the refrigerator section at my local grocery store, right next to the dairy, I can now pick up almond milk, soy milk, or coconut milk. I can choose between sweetened and unsweetened and chocolate, vanilla, and plain. And if I care to look in the aisles, I can also find rice, hazelnut, oat, and hemp milks. What a change from 20 years ago, when I would have had to trek to a natural foods store for even just a few of these options! And what a testament to America’s changing dietary habits.

Nutrition facts: Cow’s milk vs. plant milk

Like cow’s milk, you can rely on most plant milks to provide key everyday nutrients, particularly calcium, vitamin D, and vitamin B12. Calcium, as you probably know, is essential to good overall health, particularly for building and maintaining strong bones. And the body needs vitamin D to absorb calcium. Vitamin B12 plays a critical role in the functioning of the brain and nervous system, and in the formation of blood. A cup of cow’s milk has almost a third of the daily calcium recommended for adults aged 19-50 and a sixth of the recommended daily intake for vitamins D and B12. Most plant milks are fortified so that they contain at least as much of these three nutrients, as well as some others like vitamin A. Be aware, though, that a few plant milks do not provide significant amounts of these nutrients.

A good rule of thumb is to always check the nutritional facts box, because amount of calories, proteins, sugars, and fats can also be highly variable.

• Calories: Cow’s milk has 86 (nonfat) to 150 (whole) calories per cup, while plain plant milks range from 35 to 130 calories per cup.
• Proteins: Soy milk has almost as much protein as the 8 grams in a cup of cow’s milk, but other plant milks have significantly less, including some almond, rice, and coconut milks that have just 1 gram.
• Sugars: Each cup of cow’s milk has 12 grams of naturally occurring sugars, while the sugar content of plant milk can be as small as 0 grams in unsweetened varieties. On the other end of the range, flavored plant milks, particularly chocolate, often have added sugars that boost the sugar content above 20 grams per cup.
• Fats: When it comes to fat, all milks except for nonfat cow’s milk contain some. The fat content of soy, rice, and almond milks is usually close to that of lowfat cow’s milk, about 3 grams per cup, while coconut and hemp milks typically have more, about 5 to 6 grams, but not as much as the 8 grams in whole cow’s milk.

Here’s a quick overview of the main types of plant milks.

Soy milk

One of the first widely available alternatives to dairy, soy milk is currently the most popular type of plant-based milk. Options abound in the refrigerator case and the grocery aisle. Soy milk is generally valued for its high protein content and thick, creamy consistency, but it can also be bitter or chalky, particularly when unsweetened.

In terms of breast cancer risk, the jury is still out on soy consumption. Soy contains isoflavones, which can act like estrogen in the body. But it also contains proteins that can help maintain normal cell growth and activity. Studies have been inconclusive on whether soy increases risk of the breast cancer recurrence in survivors. Until the issue becomes clearer, many doctors recommend that women who take hormonal therapy medicines or who were diagnosed with estrogen-receptor-positive breast cancer avoid highly concentrated soy supplements (such as those found in powders and capsules) because of their high isoflavone concentrations. In general, though, it is fine to consume moderate amounts of soy foods, such as soy milk, edamame (soy beans), and tofu (1/2 to 1 1/2 cups), as part of a balanced diet.

Almond milk

The popularity of almond milk is growing fast, and it is not hard to see why. It has a light flavor and nice creamy consistency and is both low in calories and high in nutrients, particularly antioxidant vitamin E. While most almond milks on the market have just 1 gram of protein per cup, some are supplemented to contain up to 5 grams. Anyone drinking this should be aware that if you are allergic to almonds, you will also be allergic to almond milk.

Coconut milk

Coconut milk has been available for a long time, but it is new to the refrigerator case. It has a light but not overpowering coconut flavor and a consistency like low-fat cow’s milk. There is saturated fat in coconut milk, but some of it is made up of medium-chain fatty acids, which research suggests may increase the metabolism and benefit immune function.

Hemp milk

Hemp milk may be the least familiar dairy alternative. It comes from Cannabis sativa L, the same plant harvested for marijuana, but it is made from the seeds, which don’t contain any THC (delta-9-tetrahydrocannabinol), the psychoactive component of marijuana. Nevertheless, hemp cannot be farmed in the United States, so the hemp in American-sold hemp milk is usually farmed in Canada. One of hemp milk’s big selling points is that it’s naturally rich in omega-3 and omega-6 essential fatty acids.

Rice milk, oat milk, and hazelnut milk

Rice milk has a thin consistency and pleasant sweet overtones that many people enjoy. Oat and hazelnut milks are both smooth and lightly nutty in flavor. All are good options and available at many grocery stores.

Which one is right for me?

By experimenting, you can discover which plant milks you like and have fun exploring how they make your food and drinks more interesting. I’ve found that I like the nice light taste and natural sweetness of unsweetened rice milk. On the other hand, I find hemp milk a bit dull and swampy. Soy milk has slightly chalky quality and a nutty flavor that I’m still getting used to. And while I can’t taste the almond flavor in almond milk, I still like it. You many prefer different milks for different purposes. Some people like almond milk straight, soy milk with their cereal, and rice milk in green smoothies. I have a colleague who loves coconut milk in her coffee every morning.

Besides taste, special health concerns may guide your selection, too. If you’re a vegan, it’s probably best to pick a plant-based milk with high levels of vitamin B12. If osteoporosis is a concern, choose a plant milk that gives you the most calcium. If you’re trying to lose weight, the unsweetened varieties provide lots of flavor for very few calories.

I’ve found that a lot of people are interested in trying dairy alternatives but most don’t have very much experience with them. How about hosting a tasting with friends to learn together? Pick up a selection of different plant milks and see how they compare. If you figure out which one is best for dunking cookies, or any other useful tips or information, please let us know!

The medicines can get in the water supply in many ways. Old medicine is often flushed down toilets (for years we were told to do this; now we know it’s not a good idea). A second source is our own bodies: People who take medicines end up excreting (peeing or pooping out) extra medicine or medicine byproducts that are still biologically active. Two common examples are birth control pill hormones and postmenopausal hormone replacement therapy. And medicines we apply to our skin get washed off when we bathe – down the drain and into the water supply.

Like people, animals that are given medicines excrete the extra (hormones given to beef and dairy cattle and antibiotics given to animals preventively, even if they’re not sick). And we all know what goes around comes around.

We’re not exactly sure how very low levels of these medicines may affect us, but there’s reason to be seriously concerned about the possible health effects if we continue to be exposed to them over time. After all, most medicines are designed to have a positive change on how our bodies work. But, getting exposed to these medicines through drinking water is not what the doctor ordered. In 2009, nearly 4 billion prescriptions were filled in the United States. And about 3,999,999,999 of them are someone else’s besides yours.

It turns out most drinking water treatment methods don’t remove pharmaceuticals. Their primary goal is to remove any infectious waste.

It’s up to all of us to keep medicines out of the water supply. The best way is to find a “take-back” program in your area. These programs are run by local law enforcement agencies and allow people to drop off all unused medicines at a local collection point, usually a police or fire station. The medicines are then burned by a licensed medical waste incinerator. Call your local health department and ask about programs in your area.

The U.S. Drug Enforcement Administration announces national take-back days on its website. Still, many people don’t have access to these programs because they live too far away.

The SMARxT Disposal Partnership, a collaboration between the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America, has developed steps you can take to dispose of old or unused medicines safely in household trash:

• Pour the medicine into a sealable plastic bag.
• If the medicine is solid (pill, capsule, etc.), add water to dissolve it.
• Add kitty litter, saw dust, coffee grounds, table salt, charcoal, nontoxic powdered spice (turmeric or mustard, for example), or any other materials that mix with the medicine and make it less appealing to animals and children to eat.
• Seal the plastic bag and put it in the trash.
• If the medicine comes in blister packs, wrap the packages in multiple layers of duct tape and then put in the trash.
• Remove and destroy ALL personal information from the medicine container before you recycle or throw it away.

If you’re concerned about pharmaceuticals in your water, you may want to pass your drinking water through a pitcher with a filter. Both Brita and Proctor & Gamble (maker of PUR filters) say their filter pitchers remove both E. coli and Cryptosporidium (harmful bacteria), as well as more than 96% of pharmaceutical contaminants. These companies also claim that their plastic pitchers are made without bisphenol A (BPA), a chemical that has been linked to certain cancers.

You also can use an activated charcoal filter under the sink or to filter refrigerator water lines. I have a filter under my kitchen sink since most of my drinking water comes from there. I prefer to store my water in a glass pitcher or jar to keep it cold and only use the plastic filter pitcher to pass the water through once before transferring it into my glass water bottle. It’s also important to change the filter at the recommended times.

There’s only one planet and we all need to do what we can to keep it and ourselves healthy.

Have you ever participated in a medicine take-back program in your area? Has anyone found a filter-pitcher made of glass instead of plastic? Post a comment and let us know!

When the dust finally settles at the end of all the treatment, you may find yourself — like many of us do — in the middle of limbo-land. We’re trying to get back to the swing of things and move on with the rest of our lives — but we need to find our way to a new normal. We need to figure out what we can do in our everyday lives to reduce the risk of ever seeing that cancer again. To look at our lives and say, “What was going on in my life before my diagnosis that may have played a role in putting me at risk? Was I a couch potato? Was my life full of stress and strain? Was I overweight, doing the whole yo-yo diet thing? Was I drinking too much alcohol? Was I eating all the wrong things…none of the right things? I need to know what was I doing that I need to change, because I don’t ever want this to happen again.” While there likely isn’t one thing that you did to cause the cancer, there are things you can do to live your healthiest life moving forward.

This critical part of the journey is the focus behind Nina Monteé-Karp’s Breast Cancer: The Path of Wellness & Healing — a 2-disc DVD series that weaves cutting-edge medical advice from leading doctors together with intimate first-person accounts about the entire breast cancer experience. Nina, an award-winning director and friend of Breastcancer.org, has been a selfless and tireless champion for women, men, and their families confronted with breast cancer. According to Nina, “My first goal in making this DVD was to raise awareness and bring hope. I heard from my girlfriends over and over again that once your doctor tells you that you have breast cancer, you can’t hear another thing. That’s a powerful sentence — ‘You have breast cancer.’ Your life changes.”

When Nina set out to make the DVD, she found everyday women, physicians, and celebrities affected by breast cancer to share their stories in a truly inspiring way. I was honored to participate along with these incredible people. Experts and diagnosed women share personal stories as well as information on risk, accurate biopsy reading, treatment options, diet, exercise, stress reduction, spiritual growth, talking to children about breast cancer, and much more.

According to Nina, “It was really obvious to me that we needed to have an educational DVD — not just another documentary — but something that educates women about every aspect of breast cancer from A to Z. Real, everyday women mixed with celebrities in a way that is positive and hopeful. Here, women can share a special sisterhood with those who have done really well — like Christina Applegate, who was 34 and went on to have a baby, or Sheryl Crow, who is looking fantastic and rocking it. A woman who is diagnosed can sit down with her family, and in a few hours can really get the whole big picture of what is ahead on her journey.”

My book, Living Well Beyond Breast Cancer, touches on all these issues too, and I’m proud of the word “well” for its double meaning. People don’t just want to live beyond breast cancer – they want to live well beyond breast cancer – far, far past this challenge in their lives. While the book provides answers to many of the questions women have, Nina’s DVD opens it up to a new level. Seeing and hearing a variety of women and specialists speaking frankly about their experiences, insights, and inspirations really brings it home: We’re all in this together.

Seeing the opportunity to give women a broader perspective on their treatment options, Nina brought together a mix of leading doctors and wellness experts. This unique blend of insight helps give women an understanding of how complementary medicine can work together with conventional medicine. “We feature the top doctors in every area of the breast cancer world. So women who may not have the chance to go and see these doctors can still benefit from their advice,” says Nina.

One of the standout moments of The Path of Wellness and Healing is Nina’s interview with Dr. Soram Khalsa, a Los Angeles physician and expert in integrative medicine. I was intrigued and inspired by what Dr. Soram had to say. Later, I had the fortunate opportunity to meet him, where I arranged for my own evaluation.

Dr. Soram compares cancer to weeds, a type of growth that crowds out the good crops and plants. Cancer, he says, is the result of unhealthy soil that’s been compromised by stress, robbed of nutrients such as good food and vitamin D, contaminated by chemicals like pesticides, plastic residues, and hormones. Plus it’s further strained by negative lifestyle habits such as smoking, excess alcohol, and inactivity. All of these forces, together or in sequence, can combine to damage our breast cells and yield unhealthy overgrowth of cells such as cancer.

Passionate about these issues myself — the focus of our Think Pink, Live Green initiative — I wanted to know more about how Dr. Soram uses holistic healing to complement his traditional internal medicine practice.

During the evaluation, he explored multiple areas of my life: quality of sleep, stress factors, my food intake, my weight, and how much I was exercising. His questions tried to get to the very root causes that may have contributed to the development of cancer in each individual — kind of like a nice FBI agent figuring out a crime.

Our medical practices are so entirely different. My practice of breast radiation oncology is part of the front-lines, direct battle against cancer cells that promises to reduce the risk of recurrence but has some potential side effects to go with it. To a person undergoing this type of treatment, it feels like something they have to do — but they really don’t want it. Our focus: fighting the cancer.

Dr. Soram works to improve overall strength and well being, to make you feel better than you ever have in the past — and less vulnerable to any future cancer event. His focus: nurturance and improving vitality.

So, you can understand why it feels better and more comforting to see a Dr. Soram rather than a doctor like me. And the different orientations of our practices are what make them complementary.

If you choose to visit a doctor like Dr. Soram, treatment might begin with a number of tests. The doctor may want to test your hormone and vitamin D levels. You might also be tested for certain chemicals in the environment. Once you and your doctor recognize the factors you may be dealing with — and to what degree — a treatment plan can be designed to complement your current therapy.

Whether you’ve just been diagnosed or you’ve completed treatment, I encourage you to explore your own next step. The Path of Wellness and Healing DVD set is a great place to start.

An additional reason to check it out: With every DVD purchase, a percentage of sales go to Breastcancer.org to help us continue in our efforts to bring the most up-to-date medical content to everyone affected by breast cancer. Visit The Path of Wellness and Healing website to order a copy.

Here’s how you can reduce your exposure:

Avoid bottles with a 7 recycling symbol on them. BPA is in all major brands of 3- and 5-gallon jugs for water coolers. BPA also may be in refillable water bottles and other rigid polycarbonate plastic bottles. Not every bottle with a recycling symbol 7 contains BPA, but you don’t know unless the label specifically says it doesn’t. If BPA is in the plastic, it can leach out into the liquid in the container. The older and more scratched up the bottle is, the more BPA leaches over the years. Hot beverages boost the leaching even more. Never put hot liquids into plastic bottles and don’t leave plastic bottles in the sun. Replace scratched plastic bottles and clean all plastic gently.

Avoid heating or cooking in plastics — even if they say “microwavable.” Researchers found BPA leaching from all “microwave safe” products they tested. Unfortunately, this included plastics that said “BPA-free” with recycling numbers other than 7, including frozen food trays, soup containers, and plastic baby food packages. “Microwave safe” DOES NOT mean that the plastic components won’t leach. It only means the container itself can withstand the microwave without melting. Your safest option? Don’t heat any plastic container or wrap. Even better, don’t buy these items. Only use glass and ceramic containers that are made for use in the microwave. A paper plate or bowl is another option. Cover with a cloth napkin, paper towel, glass or ceramic lid or plate.

Eat canned foods in moderation and look for BPA-free cans. BPA is used in the linings of canned food and drinks to keep the metallic taste away from the food and to protect against rusting and corrosion of the can. Studies show that food from cans do contain varying amounts of BPA. Food may account for most of kids’ BPA exposure (except for bottle-fed babies, who may be exposed from polycarbonate bottles). A few companies are starting to use BPA-free cans. Eden Foods has long used BPA-free cans for its beans and is starting to use them for other products. Several canned fish companies use BPA-free cans, including Vital Choice, Wild Planet, and Henry & Lisa’s. There are many companies that supposedly use BPA-free cans, but don’t say so on the label. Contact the company to find out. Alternatively, try to buy your food fresh, dried, in bags, or glass containers.

Handle sales receipts less frequently. BPA is in the coating of many sales receipts, especially those that have to be signed. This may be a bigger source of BPA exposure than many of the food sources. Still, it’s hard to avoid receipts. If possible, don’t take a receipt for things that you can’t return (gasoline, for example) or when you’re buying things that you’re sure you won’t have to return. If it makes sense for you, you may want to pay cash or write a check for your purchases rather than using a credit card so you don’t have to sign the receipt. Wash your hands after handling receipts.

Be aware that resin-based dental sealants and composite fillings release BPA. BPA is released in the hours immediately after these dental procedures, but the amount absorbed is unclear.

Be wary of “shown-to-be-safe” messages. Though bottled water delivery companies, producers of plastic food containers, and other groups put messages on their websites saying BPA is safe, this message is at odds with the reconsideration of its safety going on in the United States and around the world. Plus, the safety of bottled water is mostly unregulated. In general, tap water is much more carefully regulated. Right now most bottled water comes in a #1 plastic bottle, which is believed to be safer than the #7 bottle. But a safer bet and one that’s better for the environment is to drink tap water from a glass cup and use a metal water bottle to carry your water around.

Microwave reviews

It’s hard to resist the buttery flavor and aroma that comes from a bag of freshly popped corn. But it’s not just butter that’s tempting your taste buds. It’s an aroma-enhancing chemical called diacetyl that’s used in many food products, including microwave popcorn, to add or increase butter flavoring. Today, there is growing concern that diacetyl may have some link to serious health issues. Experts believe that when heated, diacetyl produces a toxic gas, and that long-term exposure to these fumes may eventually lead to breathing problems and possibly lung disease. While this concern applies mainly to workers who make the snack, there is also some question as to the extent of risk we face at home.

Along with diacetyl, microwave popcorn may expose us to other toxic chemicals. The grease- and water-resistant coating used in the paper packaging contains chemicals called perfluoroalkyl acids (PFAAs). For me, this is of particular concern, since PFAAs are known to be hormone disrupters and are under investigation by the Breast Cancer and Environment Research Centers for their possible role in early puberty and breast cancer risk. PFAAs are commonly used in non-stick cookware, but microwave bags provide a much higher exposure. This is because the high heat from microwaving may be more likely to cause the chemicals to be released into the popcorn and air. Some research estimates show that more than 20% of our exposure to PFAAs occurs from microwave popcorn bags.

Behind the scenes

It’s often hard to know where popcorn comes from and to what chemicals it may have been exposed. For those of us concerned about pesticides, we often rely on the Environmental Working Group (EWG) for guidance as to which types of fruits and vegetables are more or less likely to be contaminated with pesticides. But when it comes to popcorn, there’s no easy answer. The EWG’s “Clean 15” lists corn as having low levels of exposure, but it’s talking about sweet corn — a completely different crop than popcorn. So unless your brand of popcorn is USDA certified organic, you can’t be sure of your pesticide exposure risk.

Another mystery is whether or not our popcorn has been genetically modified. This has become a hot topic recently, since the health effects of genetic modification are unknown. While the U.S. Popcorn Board claims that no crops have been genetically altered, published research shows evidence otherwise.

A bust at the box office

For us popcorn lovers, a trip to the movie theater is incomplete without a bucket of crunchy salty goodness playing a leading role. Unfortunately, we may be left sitting in the dark about its nutritional content. According to an independent analysis of movie theater popcorn, a small bucket without buttery topping contained 34 grams of saturated fat and 550 milligrams of sodium (salt) with 670 calories. A medium/large bucket had 60 grams of saturated fat, 980 milligrams of sodium, and 1,200 calories. The American Heart Association recommends that we take in less than 1,500 milligrams of sodium each day. So even just a small bucket of popcorn puts us at almost half of our daily allowance. Much of the fat and calories in popcorn is the result of the large amount of cooking oils used. Plus, the cooking oils used are often unhealthy, containing trans fats.

Write your own script

The good news is, you don’t have to give up popcorn altogether — just make a few edits:

Consider your options. Microwave may be the most popular choice, but it isn’t your only option at home:

• Try popping corn the old-fashioned way, on your stovetop. Drizzle a little oil in an iron or stainless steel pan, add kernels, cover, and shake until popped.

• Use an air popper for a healthy choice. Just add kernels, and a steady flow of hot air raises the temperature and gently pops the corn.

• If you just can’t ditch the microwave, you can use a microwave-safe glass or ceramic bowl (not plastic) with a loose-fitting lid to let the steam out and keep the popcorn in. You can also try using a plain brown paper lunch bag. Just put in the kernels and fold the top. This way you can quickly prepare your popcorn and avoid the health risks of commercial bagged corn.

Go organic. Choose organic popping corn to avoid pesticide residue or kernels that have been genetically modified.

Get creative. Avoid or limit added ingredients such as butter and salt. Get creative…try some other toppings like garlic powder, hot sauce, or grated parmesan. Wanna know my favorite? I melt a bar of dark chocolate with almonds and then fold it into a bowl of air-popped popcorn. I stick it in the fridge to cool off so it doesn’t make a total mess when I wolf it down. It’s THE BEST — and you don’t need a lot of chocolate to make it great. It’s perfect while watching movies at home, and I also bring it out to the movie theater (my local theater hasn’t thrown me out yet for this). If you bring it out, be sure to bring napkins because it is messy.

Make it dinner and a movie. Eat a healthy, filling meal before going to the movies. If you’re feeling satisfied, you can avoid giving in to temptation.

Send us your vote for best popcorn topping or healthy suggestions for preparing popcorn at home.

And of course, we all know that being diagnosed and treated for breast cancer is a stressful and scary experience. You may feel that your body is out of your control and be completely tapped out, both physically and emotionally. And we also know that feeling overwhelmed and stressed out 24 hours a day can lead to depression, which can make you less likely to go to treatment or stay on track with your medicine.

So, even without a proven link to breast cancer risk, it’s still very important to manage the stress in your life.

There’s no one treatment that eases stress for everyone. I find great joy in Zumba, which gives me a great workout and relaxes both my mind and body. Other people find relief through massage or journaling.

Here are some techniques to try if you are feeling stressed:

Exercise regularly. Exercise increases the release of endorphins, chemicals that make you feel good. Find a mix of activities that appeals to you—for example, walking with a friend, doing the stairs at work, and taking a yoga class. Shoot for 3-4 hours a week, and work your way up to 5-7 hours if possible.

Get enough sleep. Being well rested helps reduce your stress levels and improves your ability to heal the wear and tear of everyday living and solve the challenges in your life. If you’re having a hard time getting a good night’s rest, check out my column Sleep Well: Turn In, Tune Out, and Unplug.

Avoid caffeine and nicotine. Both can increase stress levels and interfere with sleep. (Of course, there are other reasons besides stress to avoid nicotine.)

Consider joining a support group. Being surrounded by people who are in the same situation as you are can give you new ideas on how to handle difficult issues and ease your stress. The Breastcancer.org Discussion Boards offer a way to connect with thousands of passionate, caring people who can listen and offer help.

Don’t be afraid to try something new. Many complementary and holistic medicine techniques have been shown to ease anxiety and stress, including:

• aromatherapy
• guided imagery
• hypnosis
• journaling
• massage
• meditation
• music therapy
• progressive muscle relaxation
• prayer
• tai chi
• yoga

Learn about these therapies in the Types of Complementary Techniques section of Breastcancer.org.

Work on ways to feel more positive about your life. Accept yourself for who you are and spend your time with positive people who care about you. Expose yourself to productive, life-enhancing experiences. Take that cooking class you read about. Volunteer at your local animal shelter. Answer your local school’s call for tutors. On the other hand, if you’re feeling over-extended and pulled in too many directions, remember to take time for yourself. Learn to say “no” if there’s too much on your plate, and take time to let your batteries recharge.

Anyone who feels that their stress has lead to depression or anxiety that is seriously affecting your quality of life should talk to a psychologist or doctor. Talk therapy can help you learn to manage your stress and feelings without letting them overwhelm you, and there are medications such as antidepressants and anti-anxiety medications that make a huge difference.

What are some stress-relievers that work for you?

With me, no health topic can be off-limits. Especially when it comes to maintaining personal hygiene, feeling well, and being confident about our bodies during and after breast cancer. I’m tackling these delicate issues within Think Pink, Live Green, because the personal care products we use can be absorbed into our bodies and potentially affect how breast cells grow, function, and behave. So get ready, it’s time to talk vaginas!

Rather than make this a monologue — which would be rather dull, since I have only one vagina and it’s not particularly fascinating these days — I thought it would be better to kick up this how-to-take-care-of-your-vagina discussion as a Vagina Dialogue and make it a group conversation.

To start, any discussion about the vagina has to include the vulva, which frames and cushions the entrance to the vagina. Regardless of how happy your vagina may be, if your vulva is upset with itching or burning — you’re not going to be happy. Besides regular maintenance, you may have experienced extra changes during and after breast cancer treatment, which can significantly change your crotch conditions. Here are just two examples:

• Chemotherapy: chemotherapy can act like a strong antibiotic, making you more likely to get a yeast infection
• Anti-estrogen therapy: anti-estrogen therapy can make your vagina more delicate and less wet

When it comes to regular care of your vagina, the good news is, there’s not much to do. You may have heard it called a “self-cleaning oven.” And while that expression may seem a bit inappropriate, it’s true that the vagina is able to clean itself naturally. It makes mucous to keep the right balance of acid and base to protect against infection from unhealthy germs and foster a healthy mix of micro-organisms (healthy germs) that normally live “down there.” So if it’s that easy, why are so many women using personal cleansing products like douches, sprays, and powders? Of course it’s normal to want to be clean, fresh, and smell nice for ourselves and our partners, but are we going about it in the healthiest way?

Douching is a “don’t.”

A lot of women I know think douching is a good way to keep things clean and tidy down there.

Douching, which comes from the French word for “wash,” literally means to wash out the vagina. Douches often come as a prepackaged mix of fluids you can buy at drug and grocery stores. They come in a bottle and can be squirted into the vagina through a tube or nozzle. Douches may be described in simple terms such as “vinegar and water,” yet there are often other additives that may be unhealthy (such as preservatives and fragrances).

There are many different reasons why women douche — and most are based on misinformation. Women I’ve talked to say they do it routinely to either rinse away blood after their monthly period, to clean up before or after sex, or to get rid of an odor. And you might take this cleanup effort to whole different level if it’s a night that you expect to receive oral sex. A gynecologist colleague of mine regularly tells me about women who come to her office with swollen, red and painful vulvas and vaginas after using harsh douches, scrubbing their vulvas, and then spraying on a fragrance. Others douche because they think it can treat an infection, protect them against sexually transmitted diseases, or prevent an unwanted pregnancy. Unfortunately, these reasons couldn’t be farther from the truth. Douching does nothing to protect you, and in fact, it may cause real health issues.

Douching changes the natural acidic balance of your vagina. That balance is what keeps it healthy. Changes to this environment can leave you susceptible to harmful bacterial and infection. If you already have an infection, douching may make it worse by pushing the bacteria further up the vagina. Some research has linked ongoing douching to possible health conditions that can create problems with fertility, pregnancy, and even cervical cancer risk.

Another big concern of mine is the chemical ingredients used in douches and other personal cleansing products. Many of these products contain ingredients that can act as hormone disruptors. Hormone disruptors can affect how estrogen and other hormones act in the body, throwing off the body’s hormonal balance. Because long-term extra estrogen exposure may make hormone-receptor-positive breast cancer develop and grow, I suggest women limit their exposure to these chemicals whenever they can.

Is something fishy going on?

It’s normal for even healthy, clean vaginas to have a mild smell that varies from one woman to another. It’s just a natural part of being a woman. On the other hand, a strong, foul odor usually means something is wrong. It may be the sign of an infection. If you have greenish or yellowish discharge with itching or a fishy odor, don’t try to treat it on your own or cover it up with feminine powders or sprays. The same is true for cottage-cheese like thick white discharge on your underpants, in the little folds inside your vulva, and inside the vagina. Go see your doctor. While it can be embarrassing, doctors see funky stuff all the time. And, the only way to get rid of symptoms of an infection is with a prescription medication that treats the specific type of problem that you have rather than covering it up. Also, sweat alone, separate from vagina smells, can contribute to any odor that you detect. Everyone sweats and you’re most likely to sweat inside of deep skin folds, within belly rolls and between your crotch, belly, and thighs. Lots of bushy public hair can increase sweating, by causing heat and friction. The hair wicks the sweat out to the surface.

Rinse, wash, repeat

To help keep your vaginal area clean and healthy, follow these steps each time you bathe:

Step 1:

In the shower or bath, thoroughly rinse the vaginal area with warm water. Be sure to open up and rinse out all the skin folds, inside the lips of the vulva (labia) and around the hood of the clitoris.

Step 2:

Carefully wipe the inner labia and vulva area clean using a small amount of mild, diluted unscented soap. Unscented Dove is mild; however, Ivory, Irish Spring, and Dial tend to be too strong. Be sure to rinse again thoroughly. Any soap that is left on the vulva can cause irritation. A soft wash cloth can help make this job easier — but don’t scrub or put too much pressure on your delicate parts. This is a gentle but important job. My gynecologist friend says that many women with itching or soreness don’t know how to take care of all the nooks and crannies of the vulva and vagina. Either they don’t do enough (like getting into all the folds) or they over-scrub.

Step 3:

After your shower, pat the vagina and vulva area dry with a fresh towel. Re-using towels isn’t a good idea, since they can harbor bacteria. I keep a stack of soft washcloths in my bathroom — I buy them cheap by the pack and launder them at the same time as my underwear.

Some other tips to consider:

• Be gentle. Avoid abrasive washcloths or scrubbing, which can irritate sensitive tissues.
• Avoid harsh cleaning products. Strong soap can dry out the mucous membrane of the vulva and cause irritation. Soaps and washes also affect the natural pH of your vagina, and can disrupt its healthy balance. If you do use soap, be sure to find one that is mild, fragrance-free, and without other harmful chemical ingredients. Also, avoid cleansers or pre-wet wipes that contain these ingredients as well as alcohol. The skin around the vaginal area is extremely sensitive and delicate mucous membranes can allow harmful chemicals to be more easily absorbed. I always check the Environmental Working Group’s Skin Deep Cosmetics Database to make sure the products I use are rated low for hazardous ingredients.
• Use pure powder: If you feel damp or sweaty in the folds of your pelvic area surrounding your crotch, then kitchen corn starch can help. You can sift it to remove the lumps and put into a jar that you keep in the bathroom. Apply with your hand, a washcloth, or a retired blush brush that you can wash after each use. Don’t use talc powder because it’s not safe to breathe in the dust.
• Trim tall hedges. If you have a lot of bushy pubic hair and you think it may be making you sweat more than you’d like, consider a little hair cut. You can trim a little off by using blunt-tipped scissors VERY CAREFULLY. This can help to reduce sweat and lingering odor.
• Wear cotton. Underwear made from cotton and other natural fibers is more breathable and can help you feel fresher.
• Check ingredients. Whenever you can, avoid personal cleaning products made with synthetic ingredients. Some contain parabens and other chemicals that act as weak estrogens in the   body — potentially turning on the growth of hormone-receptor-positive breast cancers.

Potty talk: Minding your business

Keep in mind that the vagina and vulva have two very close neighbors. In front of the vagina is the urethra, the urine drainage pipe. And of course the anus leading to the rectum is in the backyard. What comes out of these holes can irritate the vulva and vagina, especially if these structures are already upset for one reason or another. Here are a few tips:

1)     Wipe right: After going to the bathroom make sure that you wipe properly. Wipe from front to back until the toilet paper shows no residue.

2)     Wet your wipe: Use water to wet your toilet paper before using it to help clean with less friction. Avoid use of the pre-packaged diaper wipes that can contain alcohol or other strong ingredients.

3)     Change your pad: Many of us dribblers have to wear a panty liner every day to deal with this issue. Having a damp pad with urine can irritate your delicate parts. Use the thinnest pad that works and make sure to change your pad a few times a day.

Stay tuned for the next Vagina Dialogue, in which where we’ll discuss lubricants and feminine moisturizers. In the meantime, post a comment and join the conversation!

Parabens. Parabens go by many names — methylparaben, propylparaben, butylparaben, ethylparaben, isobutylparaben, isopropylparaben — but no matter the type, they’re widely used as preservatives in moisturizers and other personal care products. Parabens can be absorbed through the skin and can act like a very weak estrogen in the body. Extra amounts of substances that look like, act like, or smell like estrogen to an estrogen receptor may turn on extra breast cell growth. This overstimulation could potentially affect the growth of hormone-receptor-positive breast cancers.

Phthalates. Phthalates are common fragrance components of many moisturizers and can work as hormone disruptors. While they don’t seem to act exactly like estrogen, they can disrupt the balance of other hormones that interact with estrogen, including testosterone.

Retinyl palmitate. Moisturizers may also affect the risk of other types of cancers. Made from vitamin A, retinyl palmitate is a common moisturizing ingredient that may increase the risk of skin cancer in sunlight. According to the Environmental Working Group (EWG), when retinyl palmitate is exposed to ultraviolet light it produces toxic free radicals that can damage DNA and cause gene mutations, a precursor to cancer. The U.S. Food and Drug Administration (FDA) says that when retinyl palmitate is applied to the skin in the presence of sunlight, it may speed the development of skin tumors and lesions. Despite this data, retinyl palmitate is an ingredient in more than 400 moisturizers.

Petrolatum. Made from petroleum, petrolatum is in more than 300 moisturizers reviewed by the EWG. While petrolatum has been given a low chemical hazard rating, the Breast Cancer Fund’s State of the Evidence report says that petrolatum often contains chemicals that may be linked to a higher risk of breast cancer.

To reduce your exposure to these potentially harmful ingredients:

• Visit the EWG’s Skin Deep website to search for moisturizers. Products are given a hazard score by EWG based on the ingredients’ links to cancer, allergies, and other issues.

• Learn more about which chemicals and contaminants to avoid at the Campaign for Safe Cosmetics website. Information is based on science that links specific ingredients to health issues and then lists the products that contain those ingredients.

Keep in mind that occasional use of these products is unlikely to cause any harm. But with regular use of a product that contains even trace amounts of unhealthy chemicals, your exposure may be significant. Low levels of chemicals can still have a biological effect, and a build-up of chemicals over time may negatively affect your breast health. And we can’t wait until a scientific study comes out to prove or disprove this. There are no such studies underway. So, until we have more science to back up our recommendations, we’re going to lean on the Precautionary Principle, which basically means, “it’s better to be safe than sorry.” For all of us, this means trying to make the healthiest choices on a daily basis. That’s the mission of my Think Pink, Live Green column.

Let me know what’s of greatest interest to you and your friends!

Update: On March 15, 2012, the U.S. Food and Drug Administration (FDA) issued a warning about skin lighteners, anti-aging creams, and other skin creams that may contain extremely high levels of mercury. Products that list “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury” as ingredients should be thrown away.

Specific skin cream brand names mentioned in the FDA’s warning include: Diana, Fasco, and Stillman’s. All these products are imported, but the agency emphasized that the warning applies to all skin creams.

What goes on you can go in you. Your skin is able absorb many of the things that you put on it. Just think of today’s new medicines that can deliver a full dose of a medicine through a small patch you place on your skin. So it is important to use healthy products on your skin.

Moisturizers are made up of many chemicals, some of which may be cause for concern. The chemicals may be the active ingredient, a fragrance to make it smell good, or a preservative added to help extend the shelf life of the product. There’s also the potential risk of contaminants — chemicals that come along with added ingredients and other chemicals that are formed when the additives react with each other.

Unless you’re a chemist, it’s hard to keep up with all the potentially harmful ingredients. As I’ve mentioned before, I’ve come to rely on the Environmental Working Group’s Skin Deep Cosmetics Database. The database provides hazard ratings for more than 3,000 common moisturizers, as well as other types of products. Hazard ratings range from the lowest, 0, to the highest, 10. The ratings are based on each product’s ingredients; the higher the rating, the higher the risk of potentially harmful ingredients. Moisturizing products with higher hazard ratings often contain ingredients such as:

• Fragrance. On labels, fragrance can mean any one — or a combination of many — unknown chemicals. Plus, many fragrances belong to a group of chemicals called phthalates, which can mess up the balance of hormones (called hormone disrupters). Fragrance mixes, which can be dozens of chemicals, have been associated with allergies, skin reactions, breathing problems, and even effects on fertility. There is concern about the effect of some fragrances on the health of our breast cells.

• Sunscreen. Many moisturizers contain sunscreen to block the damaging effects of ultraviolet (UV) light. Chemical UV screens used in hundreds of moisturizers are considered hormone disruptors. Hormone disruptors can affect how estrogen and other hormones act in the body, by blocking them or mimicking them, which throws off the body’s hormonal balance. Because excess estrogen over a long time can make hormone-receptor-positive breast cancer develop and grow, many women choose to limit their exposure to chemicals that can act like estrogen.

• Estrogen. While no product in the database lists estrogen as an ingredient, there are facial moisturizers that contain “placental extract or placental protein.” These ingredients come from the placenta, the organ that supports the developing baby during pregnancy. It produces progesterone, estrogen, and other hormones. Again, because estrogen can make hormone-receptor-positive breast cancer develop and grow, many women choose to limit their exposure to anything made with estrogen-like compounds.

So how to moisturize with minimal risk?

Use just a small amount of the product. Many women use moisturizers morning and night, doubling their daily exposure to the chemical ingredients. You might want to use moisturizers only once a day and reduce the number of products you use. So instead of face, hand, and body lotion, maybe you can use one or two for everything.

Choose low-risk moisturizers. If you have dry skin like me, and especially if you live in a desert climate or have your heat on for a good part of the year, it’s unlikely that you’ll completely give up your moisturizer. So the key is to find one that offers the least amount of risk. There are more than 400 facial moisturizers/anti-aging products in the Skin Deep database with a “0” rating. A recent and well-researched book, No More Dirty Looks by O’Connor & Spunt, also offers recommendations on “clean” products based on the authors’ research and personal experience with each recommended brand of moisturizers, anti-agers, and serums. Other great resources include the Campaign for Safe Cosmetics and the book Not Just a Pretty Face: The Ugly Side of the Beauty Industry by Stacy Malkan, co-founder of the Campaign for Safe Cosmetics.

Keep it simple. Substituting a safe homemade or single-ingredient product for a synthetic product is another way to go. Studies show that plant-based products can hydrate skin cells and reduce inflammation, as well as protect against skin damage and signs of aging. What they can’t protect you from are the harmful UV rays of the sun. But rather than slathering on a chemical sunscreen, try wearing a wide-brimmed hat, lightweight sun-protective clothing (like a long-sleeved shirt and long pants), and avoid the sun during peak hours. Also be sure to take a daily supplement of vitamin D, since avoiding or blocking the sun can lead to vitamin D deficiency. When I can’t avoid sun exposure, I wear a mineral sunscreen. (Read more on safe sun protection.)

To keep dry skin supple, try using vegetable oils such as cocoa butter or coconut oil. Green tea extract and grape seed oil offer anti-aging properties, while cucumber is cooling and soothing to irritated skin. My favorite is a jar of food-grade organic coconut oil that’s good enough to eat (it’s sold on the cooking oil shelf). When I bring it home to my house, the cooler environment turns it into a waxy consistency. But as soon as you put it on, it melts right into your skin. Ahhh…works great as a moisturizer and is very inexpensive. But I use it at the end of the day, after work, once I take off my work clothes and put on my sweats. The oils as well as many other commercial moisturizers can ruin your good clothes.

Be your own active ingredient: Don’t forget about the importance of exercise and healthy eating. Exercise increases blood flow to your skin both during and after a workout, bringing important nutrients to the surface. It also helps rid the skin of old cells, giving your skin a healthy glow.

Stay tuned to learn more about taking care of your skin in “Moisturizers: Hope or Harm in Jar, Part 2” where I’ll talk about other ingredients that may be cause for concern. In the meantime, let us know about your skin-care routine. Post a comment and share some personal advice.

Update: On March 15, 2012, the U.S. Food and Drug Administration (FDA) issued a warning about skin lighteners, anti-aging creams, and other skin creams that may contain extremely high levels of mercury. Products that list “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury” as ingredients should be thrown away.

Specific skin cream brand names mentioned in the FDA’s warning include: Diana, Fasco, and Stillman’s. All these products are imported, but the agency emphasized that the warning applies to all skin creams.

• I’m too tired.
• I’m too old.
• My knees hurt.
• I don’t have time.
• I don’t have the right clothes.
• It’s too cold/wet/hot/humid outside.
• I don’t know how.
• It’s boring
• I don’t like it.
• I’m not coordinated enough.
• I don’t like sweating.
• I’m hungry, gotta go home and make dinner.
• The fridge is empty, gotta go grocery shopping.

These are just a start… I’ve got plenty more to rattle off.

All of these excuses were real obstacles but still pretty flimsy. And they were surprisingly easy to overcome once I found Zumba — the only exercise plan that I’m able to stick with. It’s fun and social, convenient and not fancy (everyone comes in their old sweats), and it’s reasonably priced. I no longer allow myself to slip in an excuse. I just go. Now I look forward to Zumba class three times a week. When I’m done I’m glowing and sweaty and feel like a million bucks. The reality is, after a breast cancer diagnosis, exercise is mandatory; it’s no longer optional.

Research has shown that exercise can help:

• keep your body fat at a healthy percentage
• keep your weight at a healthy level
• lower your risk of many diseases, including breast cancer
• reduce the risk of breast cancer coming back if you’ve been diagnosed
• keep your bones strong and ward off osteoporosis
• improve your mood
• improve sleep quality

So how do you get started if you’re a lifelong couch potato who doesn’t know the difference between a barbell and the Liberty Bell? The key is to start slowly. Try walking for 15 minutes every day and then gradually up the amount of time you walk as well as how fast you walk. If you walk with a friend you can socialize and exercise. The best!

If you want to step it up a notch but aren’t sure how, you may want to visit a gym or make an appointment with a personal trainer to learn about different types of exercise. Does your town have a recreation league? That’s a great way to learn how to play soccer, softball, basketball, or learn how to swing dance or salsa. Some people like to exercise in their homes with videos on demand or DVDs. Other people prefer gardening or fixing up their homes. A bike ride or walk with the dog in the evening can be a relaxing way to wind down after a long day.

If you’ve had lymph node removal surgery, talk to your doctor about your risk of developing lymphedema and what activities could raise your risk. For information on exercising if you are at risk of developing lymphedema, check out the Breastcancer.org blog columns by Cathy Bryan, a certified cancer and exercise trainer.

There are so many options, there’s got to be something for you. Don’t be afraid to try any type of exercise that sounds interesting. I went through aerobics, running, elliptical machines, Pilates, yoga, walking, and biking before I found Zumba.

The bottom line is that you need to move every day. So get out there and do it!

I’m excited to share with you that Breastcancer.org will be launching our new exercise section in early 2012! So let’s talk — what’s your favorite type of exercise, and what’s the motivation that keeps you moving?