Next month will mark two years since my doctor found a lump in my breast during a routine exam. Given that I  had a clean mammogram and sonogram 9 months before, exercise vigorously nearly every day, am not overweight, eat tons of fruits and vegetables and have no family history of breast cancer, the revelation was stunning. Duh. When isn’t it?

I’ve since learned that my maternal grandfather’s prostate cancer (a form of hormonal cancer, like breast cancer) may have elevated my risk. Having particularly dense breast tissue, not having children and taking birth control pills also may have played a role. Other studies show that women with vitamin D and Folic acid deficiencies and women who drink more than 2-3 alcoholic drinks a week can also up their chances. But since it is estimated that one out of every 7 women will get breast cancer, pretty much just being a woman is a risk. Sorry to be such a downer. But there is good news, as I’m sure you’ve heard. There is a much higher success rate in detecting and treating the disease than ever before. And I know this is due in no small part to the magnificent (and I mean truly magnificent) Evelyn Lauder and her tireless and phenomenal work with the Breast Cancer Research Foundation. And how's this for making lemonade out of lemons: With so many women experiencing it, there is now a treasure-trove of info. to help us get through the ordeal with more dignity, comfort, and peace of mind than was previously imaginable.

So in honor of Breast Cancer Awareness Month, here are the tips, tricks and products that made breast cancer slightly less of a pain in the ass for me, plus one that didn’t.

Best Advice: Don’t surf the net after diagnosis

Boy, did my surgeon have my number (I guess I’m not all that unique). After we discussed my course of treatment and probable outcome, she strongly advised me to steer clear of the internet and most books written about breast cancer. The reason? Many sites and books paint the worst-case scenarios, which can provoke crippling fear and anxiety. Like I didn’t have enough already? She did give me a big binder of  of explanations, resources and tips compiled by California Pacific Medical Center, where I got my treatment. I chose not to look at it. And I have to say, that as crazy, neurotic and anxious as I am,  I experienced far less emotional turmoil than some of my more investigative friends. Granted, my diagnosis and proposed treatments were very straightforward—pretty much the norm for stage 1 breast cancer with a low risk of recurrence and negative tests for BRCA genes. My agreed plan of attack was a lumpectomy, sentinel lymph node biopsy, two months of five days a week radiation and a five-year course of Tamoxifen—standard operating procedure. If things had been more complicated and extreme, I would have definitely done more research and gotten second opinions.

Most Important Part of Recovery: Acupuncture

I’ve written before about how acupuncture gave me my life back in terms of helping me finally recover from the aftermath of radiation (extreme fatigue, lethargy, depression, pain and swelling (aka lymphedema) for over a year after I concluded treatment) and managing my side effects from Tamoxifen (extreme fatigue, lethargy, depression, leg and feet cramps, weight gain and insomnia, to name a few). Acupuncture helped with all these symptoms, even mitigating my advanced arthritis, and I think made me slightly less neurotic, though my husband might argue that point. 

Unfortunately, the Tamoxifen is so toxic to my system, I need to be stuck with needles every other week to maintain and hopefully advance acupuncture’s salubrious effects. And I simply loathe it. The other patients are on beds in other parts of the room thinking serene thoughts or blissfully snoring away. Meanwhile, I’m lying on the table hating their guts trying to soothe myself with the Allman Brothers Band on my IPOD so I don’t jump off the table and murder at least one of them. How Zen. But believe it or not, my one regret is that I didn’t start treatment sooner. A friend of mine who basically sailed through radiation did acupuncture concurrently. She might have had that outcome anyway—everyone responds differently to cancer and cancer treatments. And this is a great tidbit so I’ll repeat it, “Everyone responds differently to cancer and cancer treatments.” But given the myriad benefits acupuncture seems to impart, I can’t help but believe it might have made radiation a less grueling experience.

Most Flattering Sports Bra: Anita Maximum Control Momentum Wire-Free Sports Bra, $69 (barenecessities.com).

Typically, I’m a Champion Powersleek Sportsbra girl, $46 (champion.com). It’s a  heavy duty number that can withstand high-impact activity with an adjustable back and straps —crucial features for small-across-the-back, large-across-the-front me. And these bras, which are rather roomy and customizable, were fabulous post-surgery at accommodating my dressing and swelling without adding to my discomfort. They’re also great at fitting compression pads, which I need at night as a result of the lymphedema. But these bras are completely unglamorous and bulky under clothes. So when the swelling went down and the dressing was gone, but the prospect of my regular underwire bras sent waves of terror down my spine, I switched to the more streamlined, also adjustable Anita style. It’s sleek, virtually invisible and gives a terrific shape.

Magic Tricks: Coping With Needles

Given how traumatized I am by acupuncture, it probably won’t surprise you that getting my blood drawn used to totally freak me out. And it doesn’t help that I have crappy veins. (I know. I know. I am such a baby!) Now that I am an old hat at it, it’s certainly less scary than it used to be, and I credit a super-kind phlebotomist for making the process almost a snap. He suggested drinking a lot of water and staying really warm prior to the test to help optimize circulation. Dehydration and being cold can all impede it. He noted that the better circulation is, the easier it is to find a vein and actually get blood from it. He also introduced me to the Butterfly Needle, a smaller, thinner number that works better on veins that like to roll over when they’re poked than the standard variety. When he’s not my guy, I always ask for that needle specifically and it makes a huge difference.

Dumbest Move: Hopping on the Lifecycle two days post surgery

A well-meaning friend told my husband that it was really important that I get moving as soon as possible after surgery. And exercise bulimic that I am (“I’m not going to lie around and get fat just because I’m recovering from breast cancer surgery”), I seized upon this advice and went to the gym to peddle furiously on the bike for 45 minutes. The result? I felt faint, nauseous and experienced excruciating pain in my breast. I actually almost passed out in the shower afterwards. From what I understand, there are several types of surgeries where the experts like you to walk and maybe even get on a treadmill almost immediately following surgery. Walking, not intense cycling, being the operative directive here. But breast cancer surgery, at least in my case, is not one of those instances. In fact, when my surgeon called me later that day to check in and deliver my pathology report and I told her of my athletic adventures, her response was, “Really, Cara? I mean, really? I think I’ve been crediting you with having far more IQ points than you actually have.” Ouch.

Bacon-Saving Products
Not to sound superficia, but what the heck? To me, one of the biggest bummers about cancer is that you just don’t look like yourself for what seems like an interminable amount of time. And I didn’t even have chemo so I can only imagine how one feels going through those dramatic changes and acute side-effects, which are typically far more extreme than anything I experienced. I realize what a lucky girl I am. But even without it, I was just shocked to see the reflection staring back at me in the mirror. And even two years later, I don’t really feel like I’m “back.” Perhaps, because of the Tamoxifen? No one can really ‘splain it to me. Anyhow, here are some products that really seem to make a difference.

Aveeno Skin Relief Moisturizing Lotion, Fragrance Free, $9.49 (ulta.com): I found it to be the least greasy, fastest absorbing, least stinky and most comfortable lotion to combat the “sunburn,” and extreme flaking from radiation. My radiologist recommend Aquaphor, which I love for my lips but it was just too unctuous for such a large area and under clothes.
Vaniqa, $90 (by prescription): A godsend for Tamoxifen-induced chin hairs, http://www.carakagan.com/post/2012/07/10/Vaniqa-It-isnt-sexy-But-it-works.aspx
Nioxin Hair System: Successfully manages  Tamoxifen-caused hair-thinning, $37.50,(sleekhair.com),   http://www.carakagan.com/post/2012/04/16/Hair-There-and-Everywhere.aspx.
Bobbi Brown Extra SPF 25 Tinted Moisturizing Balm, $52 (bobbibrowncosmetics.com): Lightweight yet luscious and emollient, this imperceptible cream foundation evens out skin tone and adds just a little bit of a glow.
MAC Fast Response Eye Cream, $30, (nordstrom.com): The only de-puffing eye cream I know that doesn’t dehydrate skin and emphasize crows’ feet.
Nars Bronzer in Laguna, $34; Nars Blush in Amour, $28 (sephora.com): This brownish bronzer shot with gold shimmer topped with the peachy pink blush really enliven the complexion, imparting a fresh, healthy color and radiance.
Nars Matte Velvet Lip Pencil, $24 and Nars Lip Gloss, $24, both in Dolce Vida (sephora.com): The pencil delivers a precise, comfortable application of stay-put color with just the right amount of coverage—not too sheer, not too opaque. The gloss lends extra moisture and a sexy sheen. Dolce Vida, a medium-bright dusty rose, looks like my natural lip color turned up a notch or too. Pretty.
Dr. Dennis Gross Age Erase Recovery Mask, $48 (dgskincare.com): This mask is messy, drips and tastes terrible when it gets into your mouth, which it almost always does. But it’s well worth it. No matter how drawn, pale, exhausted and miserable I look, this mask always makes me look better. Always.

Ciao for now my friends. Stay happy and healthy and get your mammogram!

After years of denim overload, the fashion media is proclaiming the “return of the trouser,” which I’m all for; there is nothing more flattering than a pair of well-fitting pants. But for my body, the new trouser trend is  problematic. The reason? All of today’s pants seem to be skinny and cropped. And since I’m 4ft11 with muscular calves, this style totally sucks for me. So I got to thinking about my favorite pants ever.

One of the biggest regrets I have is succumbing to fashion peer pressure and ditching my Chaiken and Capone Maggie Boot Cut pants in 2000, right after I started at Elle as Beauty Director. They had been my and every other editor’s go-to pants in the mid-90s--a great cotton twill stretch with the perfect rise and a nice baby boot leg. But as with so many things, the fickle fashion industry turned on Chaiken & Capone and they became beyond “out”. High-end consignment stores actually posted signs: “No Chaikens” and an extremely fashionable industry friend harangued me to stop wearing them. So I bundled them up and brought them over to a women’s shelter. I’d kill to have them now. 

I was smarter about another high-fashion trend: The extraordinarily glamorous Fendi Baguette, which came and went in much the same manner. Vogue says it’s back and I am thrilled beyond. I kept mine when everyone else was letting theirs go. Of course I have no place to wear it out here in hippie and hiking country but I remain hopeful.

Retinoids’ Return?

I’ve also been reading about the “Return of Retinoids,” which makes me smile. I wasn’t aware that Retinoids went anywhere, and if they did, they shouldn’t have. Studies have shown beyond a doubt that these vitamin A derivatives stimulate the production of new skin cells and inhibit collagen breakdown. Retinol is the non-prescription, less irritating and less potent wrinkle-fighting form. Prescription-strength tretinoin, which is the key ingredient in Retin-A and Renova, is a powerful line and wrinkle eraser but can cause inflammation and peeling.

Despite the great research behind Retinoids, in recent years other ingredients have been stealing the spotlight. Some of them have promising findings behind them, such as Lycopene, Green Tea Extract, Resveratrol, Genistein (from soy), Co-Enzyme Q-10,  Coffee Berry, Grape Seed Extract, Idebenone, and Copper Peptides. But the research isn’t as solid on any one of these puppies as it is for Retinoids and even for Vitamin C,  which has proven to be one of the strongest catalysts of collagen growth. C’s also a reliable antioxidant, can fade pigmentation spots and impart radiance. But like Retinoids, it can be irritating and increase sun sensitivity, both of which accelerate the signs of aging. So it’s a delicate balance to get the maximum benefits from these two ingredients with the least amount of irritation.

But Retinoids, for now, appear to be the hardest hitting weapon in the anti-aging arsenal. In fact, my new San Francisco derm, David MacGregor, said that along with daily use of an SPF 30 and some form of antioxidant protection, the single best thing that I could do to stop the clock was up my Renova usage from once a week to two or three times—even if it means backing off my Vitamin C, O.T.C. Retinol and exfoliating acid products to avoid irritation. It’s pricey ($210/tube) and my skin was a little angry the first week, but since then it seems to have calmed down. And I am seeing serious improvements plus I can now resume, what I and many experts believe, my killer regimen. Why is it killer?  It not only incorporates vitamin C and Retinoids but many of the other ingredients mentioned above. To me, using as many anti-aging ingredients as possible is like chicken soup for the skin: As long as I avoid irritation and wear sunscreen,  it’s unlikely those extras are going to hurt me and far, far more likely (as some research indicates) that they will help.

The Notorious NYCK Anti-Aging Night-Time Regimen

Mon-Wed-Fri:
Dr. Dennis Gross Extra Strength Alpha Beta Peels, $78 (multi-exfoliating acids, green tea extract, chamomile, anti-oxidant vitamins A, C, E, Co-Q10, retinol, genistein and resveratrol); Dr. Dennis Gross Vitamin C Serum, $95 (18% Vitamin C Complex) and Dr. Dennis Gross Firming Serum, $95 (green tea extract, vitamins A, C, E, peptides, moisture power-house hyaluronic acid, genistein, lycopene and Co-Q10).

I use the peels as directed on clean, dry skin (water droplets can inhibit the absorption of active ingredients), wait a few minutes and then apply the two serums, after first mixing them together in the palms of my hands. I try to engage in this ritual at least one hour before bed so the serums don’t rub off on my pillow.

Tues-Thurs-Sat:  Renova. Again, apply to clean, dry skin, at least one hour before bedtime, you don’t want this cream to slide into your eyes when you lie down; it burns like hell.

Sunday: Rest! I just cleanse and slather on a basic moisturizer to let my skin recover from all of the active ingredients I use throughout the week.

By day, I  keep it simple to avoid stressing my skin: Aveeno Active Naturals Smart Essentials Daily Nourishing Moisturizer with vitamins A, C, & E, $12.47. If I’m going to be outside for an extended period of time, I’ll use Neutrogena Healthy Defense Daily Moisturizer SPF 50 Purescreen, $11.19.

This is a pretty aggressive anti-aging regimen and sometimes my skin gets flaky,  dry and/or red from it, which means it's time to back off.  So then I use the Renova just around my eyes and on my lip lines, instead of all over my face and switch to Dr. Dennis Gross regular Alpha Beta Peels instead of the Extra-Strength variety.

For those seeking non-prescription strength Retinol products, I love Glow by Dr. Brandt Overnight Resurfacing Serum, $85. It contains 2% Retinol, which is high by over-the-counter standards and delivers really respectable results. I recently picked up Vichy Laboratories Reti-C Intensive Corrective Care SPF 15, $42 from the drugstore. To be honest with you, I’m not crazy about the smell and its moderate SPF 15 (I layered my Aveeno SPF 30 on top) but I love that it combines both C and Retinol to smooth wrinkles by “10% in 28 days.”

So as far as Notorious is concerned, trends may come and go, but at least three things remain forever fashionable: Chaiken & Capone Maggie Bootcut pants, the Fendi Baguette and Retinoids. And Puma California's, which the company has somehow stopped making. So I am fiercely hanging onto mine. And hear this industry peeps: No amount of peer pressure is going to make me give them up!  Ciao for now my friends. Stay happy and healthy.

If you’ve ever wanted to visit the inside of  a toilet bowl, simply hop the next flight to Vegas and check into the nearest casino. I recently spent three nights and four days on “The Strip”  and was truly traumatized as a result. Yes, the shopping is spectacular; the ceiling at Cesar’s Palace does look like the sky, there are some great restaurants, the fountains at the Bellagio put on one heck of a show, the pastrami at the Carnegie Deli is authentic and Cirque de Soleil is amazing—well Beatles Love is; Viva Elvis is a travesty (Our hotel sent us for free so I guess it wasn’t as bad as it could have been).

But the thing that made me the craziest, next to the sky-high prices, indoor smoking, the constant dinging of the slots and bumping and thumping of bad music, was how frigging life-sucking the air is there. True, Vegas is in the desert but there is something about the recycled overly air-conditioned air pumped into every room that literally steals years away from your life. Under these circumstances, my bags, wrinkles, lines, red splotches and puffy under eyes grew to epic proportions. And even my husband, who has none of these issues and looks like a kid, was starting to show signs of his age.  My skin was so dry and reactive that I couldn’t even use my regular vitamin C and retinol-based skin care products. In fact, it is so dry in Vegas, that I had to stand under the shower for a full 10-minutes before my body even remotely started to feel “wet.”

So I did what any  New York Beauty Editor would do and checked myself into the Spa at our hotel, the Aria. And true to Vegas’ motto of “thou shalt be over-stimulated at all times”, the lounge wasn’t exactly Zen; it was outfitted with two blaring TVs set to different channels and a stereo blasting bad music. Yes, I am fully aware I am starting to sound like a grumpy old woman. Not attractive is it? But Vegas has that effect on me.

The services were God-awful expensive but very respectable and the amenities are just lovely. The salt room is pretty amazing.  I had an excellent massage ($245 for 80 minutes!) and a really good facial  ($225 for 80 minutes!) and a first class mani/pedi ($60/$95). The body scrub/wrap ($175 for 50 minutes) wasn’t the best ever, but it was fine. But pro-body scrubs are tough because somehow you always end up wet and shivering on the table as salt is rubbed into your shaving nicks and cuts. I am flummoxed that more spas don’t use sugar-based scrubs.

But for my money, I would rather go to the Claremont Spa in Berkeley any day of the week and twice on Sunday. It is less expensive ($200 for an 80-minute massage) and way quieter.  All of the services I have had there have been terrific—even the body scrub/wrap. And  FYI: Janvier is a spectacular massage therapist.

Excellent facial aside, what truly rescued me and my skin from Vegas fall-out was Clinique’s Comfort On Call, which really eased the dryness and irritation that the city of sin left me with for several days after my return to Oakland. This is a really nice cream for over-stressed skin. And so on that note, I am going to stop drinking the Vegas hater-ade and spread a little new-product love for some of the other “ah-ha” beauty solutions that I’ve recently come across.

Aveeno Active Naturals Positively Smooth Shave Gel: It really, really helps you to shave less often. I may be a little late to the party on this one but I am glad I’ve arrived. This is a great product. It minimizes shaving irritation and bumps and truly maximizes your time in between shaves. Target’s copycat  Up & Up Smoothing Shave Gel, btw, is just as good and a little bit cheaper.

Pacifica Body Butter in Malibu Lemon Blossom: Rich, thick, super emollient and absolutely delicious-smelling. It makes your skin feel heavenly. Love!

NYC’s Completely Bare Spa:  I’ve already written about how much I love Completely Bare for hair removal, but I have to mention it again. On a recent trip back East I stopped in at the Lower Fifth Avenue location for a Brazilian and an Intense Pulse Light Therapy (IPL) touch up of areas I had previously treated 10 years ago, and once again I was floored. Renata, who runs the place, is the most wonderful woman ever and Jen did a painless--and I mean painless--wax (no numbing spray required) and thorough IPL job. And since the hairs were so sparse and fine, the treatment didn’t hurt at all, and now those hairs are history. But even when IPL hurts, it’s so worth it. Completely Bare could be one of my favorite places on earth and at least for me, it definitely trumps Vegas. Ciao for now my friends. Stay happy and healthy.