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Archives for January 2012

How to Enhance Your Mood with Environmental Changes

January 30, 2012 by

Your mood is linked with your surroundings, and a change in your environment can make a tremendous difference in your feelings. To calm or enhance your mood, try some of these simple modifications to your environment.

Soothing colors.

Color has an amazing ability to affect mood. We know someone whose employer painted the office walls a deep reddish-burgundy color. She said it was far from calming; in fact, she noticed a difference in her stress levels compared with the previous color, which was pale lavender. The color also hurt her eyes until she was used to it. Soothing colors, such as pale blue and green, improve your mood and reduce stress. Think of how calm you are in nature and the colors you see.

You don’t have to repaint your home—adding splashes of soothing colors can be very helpful. For example, buy some blue pillows or green curtains, or find an art print of a relaxing scene. Bright artwork can cheer you up not only by its colors, but also by its design. If you work from home, perhaps a blue mouse or purple post-its will help your mood.

Relaxing music.

Sound affects us to our core, and our moods reflect the vibration of the music. If you don’t care for a particular type of music, your mood will change for the worse if you hear it, and then if you hear music you love, your mood will improve—and both changes happen very quickly.

To relax and soothe yourself, try listening to yoga music or to an instrumental radio or satellite TV station. Classical music can be intense for some, yet soothing for others.

Living things.

Watching living things move and grow is incredibly soothing and relaxing. If you don’t have a pet, perhaps now is the time to adopt one. Stroking a cat or a dog reduces blood pressure and increases endorphins. Watching fish is so relaxing that you may find yourself mesmerized.

If you’d rather not have a pet, surround yourself with live plants. Not only will they clean the air in your home, but they’ll also give you a touch of nature and a splash of color. Good choices are ferns, bamboo palms, spider plants, and African violets.

How do you create a soothing environment?

 

 

 

 

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Your Questions about DIEP Flap Breast Reconstruction Answered

January 27, 2012 by

The below questions are answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What are the most common reasons a diep flap will fail?

Specifics may vary from case to case and practice to practice, but all failures involve interruption of the blood supply. This can be caused from a clot forming at the arterial or venous anastomosis, or from a conformational change in the blood vessel which produces “kinking” and subsequent interruption of blood supply. Most surgical teams experience dramatically lower failure rates as their experience expands, and it can get very difficult to determine precise reasons for failure (and ways to prevent it) when failure is a very rare event, i.e., success rates of 98-99%, which is typical for experienced surgeons. The best teams will nonetheless strive, whenever they have a failure, to find some “take home message” which they can use to hopefully further minimize their failure rate.

If you had a failure with Diep on one side does that increase your chances of failing again if another flap procedure were done in the future?

In our experience, no, although in a large enough series it may. We have always been able to use the internal mammary vessels, supplied through collaterals, to successfully supply blood to a second flap after an initial flap failed. Generally speaking, the collateral supply to the internal mammary from one intercostal artery is probably sufficient to supply a new flap. I do think that it is advisable, however, to wait at least 3 months following an initial flap failure before attempting a second flap, as this gives time for tissue edema to resolve, and serum protein levels to return to normal.

My Diep Flap failed on one side. I wound up with a silicone implant on the right side, and it is not healing quickly. What should I be watching for ?

That depends on what you mean by “not healing quickly.” If you have an unhealed wound, then something is really wrong, and you should see your surgeon. If it simply hurts or “doesn’t feel right,” then it may improve with time, or you may be developing capsular contracture (a common problem with implants), which may not go away. If you still want a flap, you may well still be able to have one from your buttock or elsewhere.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.



 

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5 Ways to Reduce Sudden Anxiety

January 25, 2012 by

Sudden anxiety can be frightening and challenging to deal with, and if you’ve ever had it happen, it’s something you hope never to repeat. Following are five ways to deal with a moment of sudden anxiety.

Don’t squelch the first twinges of anxiety, but try to identify their source.

If you feel severe or sudden anxiety begin, you’ll be tempted to ignore the feelings and keep doing what you’re doing. Don’t try to ignore or resist the feelings, but step into them. The moment the anxiety begins, ask yourself what’s happening, and see if you can identify what’s causing the sudden anxiety. If you can, fix the immediate problem; if not, get away from what you’re doing and find a quiet place until the anxiety goes away.

The sooner you can identify and remedy the immediate problem, the faster the anxiety will fade.

Breathe.

Many people tend to hold their breath when they have sudden anxiety, which makes the problem worse. Take a deep, cleansing breath in through your nose—you should feel your abdomen expand—and blow it out forcefully and completely through the mouth. Keep on deep breathing, and you’ll feel your anxiety lessen.

Let the anxiety wash over you.

If the first twinges develop into a full-blown bout of anxiety, let it happen. When you can accept the anxiety, it will go away much faster than if you try to fight it. Think of it as a rush of water that will envelop you for a moment and then fade away.

Don’t leap to conclusions.

Often, people having sudden anxiety let their minds wander and imagine all kinds of possible scenarios. They may think about someone dying, or losing everything they have, which of course increases the anxiety. Clear your mind, as much as you can, and don’t let your thoughts move to places or circumstances that frighten you.

Remember that it’s not forever.

Anxiety passes on its own, but you need to make sure you don’t cause yourself greater harm. Relax as much as you can. That is easier said than done, and if you have frequent anxiety, practicing these steps will become second nature over time.

Do you have any tips for dealing with sudden anxiety?

 

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3 Trending Gym Classes that Will Get You Excited and Toned

January 23, 2012 by

If you enjoy getting out of the house to exercise, you may want to try one of these trendy gym classes.

Zumba

Created by Beto Perez of Colombia, Zumba is a high-energy dance program that gives you amazing fitness benefits. One day, Beto forgot the music for an aerobics class he was teaching, so he improvised with his own music—and Zumba was born. Today, you can choose from Zumba dance, Zumba toning, Zumbatomic for kids, Zumba in the Circuit, and Aqua Zumba classes. You can also purchase DVDs and dance at home.

Exhilarating and fun, Zumba burns hundreds of calories an hour, tones and tightens the body, and makes you feel like you’re at a party.

Pure Barre

Pure Barre’s website claims it to be the fastest, most effective way to change the shape of your body by using small isometric movements while standing at the ballet barre. Pure Barre clients typically see results within a few weeks.

Dancer and choreographer Carrie Rezabek Dorr created Pure Barre 10 years ago to help women and men achieve a strong, lean body. The Pure Barre technique does not involve any high-impact jumping and requires intense focus to do properly, much as yoga and meditation do. The exercises work the abdominals and lower body. Classes are small, and the exercises move along swiftly, driven by the music.

Spinning

The ideal way for bicyclists to stay in shape in the off-season, spinning is indoor cycling that anyone can do. It’s adaptable to every level of fitness and experience. Most spinners burn about 500 calories per class, and spinning differs from simply riding an indoor bike in the energy and enthusiasm of the instructor, the support from the group, and the motivating music.

According to the website, spinning has five core movements. Seated flat builds your stamina, seated climb works your lower body, and standing flat helps improve core strength.  The standing climb defines leg muscles, and jumps help you become more coordinated.

Have you tried any of these gym workouts?

 

 

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Tips for Reducing Restless Nights of Tossing and Turning

January 20, 2012 by

It happens to all of us: nights we can’t sleep no matter what we do. Even if your insomnia is caused by stress or some other outside influence, simply changing a few habits will help you sleep like a baby.

Don’t sleep during the day.

We know how refreshing naps are during a hectic day. However, they can also be responsible for an awful night’s sleep. If you feel drowsy during the day, resist the urge to nap. Get out of the house—go for a walk, visit a friend, or try some retail therapy.

You may be sleepy during the day due to your food choices. Try adding a little more healthy protein to your lunch, reduce sugar or simple carbs, and drink more water. Too much caffeine can leave you tired later, so perhaps you should stop drinking coffee midmorning.

Go to bed at the same time every night, and get up at the same time every morning.

If you’re having trouble sleeping, it’s time to set up a sleep schedule. While sleeping in on the weekends is a glorious thing, a schedule will keep you alert and refreshed every day.

Make sure your mattress is right for you and in good shape.

A worn-out mattress set does more harm than just keeping you awake—it can cause back and joint pain. If your mattress is more than 5 years old, it may be time to replace it. Make sure it is big enough for you and your partner to stretch out without disturbing the other. A queen mattress is the minimum size you should have if you sleep with someone else or with pets.

Avoid drinking alcohol or caffeine before bed.

Not only can caffeine and alcohol stimulate you and keep you from falling asleep, but they can also wake you up in the middle of the night. You don’t want to go to bed hungry or overly full for the same reasons. If you feel hungry before bed, have a light snack, such as a piece of cheese or half an apple with peanut butter.

Do any vigorous exercising a few hours before bed. Meditating or yoga is fine to do closer to bedtime, as it relaxes you.

Create an environment that helps you sleep.

Everyone’s preferences are different, but some general tips will help you sleep. Wind down by reading a book or creating your own calming ritual. Keep the room dark and cool, and turn your alarm clock around so you don’t see its light. If your neighborhood tends to be noisy, use a white noise machine or a fan.

If your insomnia lasts longer than a week or two, contact your doctor.

What do you do to help yourself sleep?

 

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Top Fitness Equipment to Help Increase Strength

January 18, 2012 by

We’ve found so many different types of great fitness equipment that we had to share them with you. All of them will help you increase strength, get in shape, and feel better. Any sporting goods store or website will have a range of equipment. Pick your favorite and start!

Fitness balls

These fun PVC plastic balls give you a total body workout, and simply sitting on them while working and watching TV will strengthen your core (abdominals and lower back) and stretch your muscles. Look for a burst-resistant ball that comes with its own pump and a DVD or booklet outlining exercises.

Fitness balls come in different sizes and are gauged by the user’s height, so be sure to read the packaging or website information before buying. When you sit on the fully inflated ball, your knees should be bent at a 90-degree angle—if they aren’t, move up or down one size. If you’re heavy for your height, you may need to go one ball size bigger, or if you’re very light, you may need one size smaller.

Medicine balls

Medicine balls are smaller than fitness balls, and they’re weighted to help you improve strength in your hands, arms, core, and legs. Use them as an alternative to weights, or simply play catch with them. These bouncy balls come in a wide variety of sizes and are typically made of rubber for easy grip.

Resistance cables

Also known as toning cables, toning tubes, or resistance tubes, resistance cables are a convenient, inexpensive alternative to free weights or machines. Typically made of latex or rubber, they have handle grips, and you can use more than one to increase the resistance. Many are versatile enough to strengthen any area of your body, depending on how they’re used.

Jump rope

Still as fun as they were when you were a kid, a jump rope gives you a cardio workout with a twist: the handles hold weights to help you strengthen and tone your arms, shoulders, and back.

Wobble boards and stability discs

Much like the fitness balls, these flat boards and rounded discs help you strengthen your upper and lower body while improving your stamina, stability, and balance. Wobble boards are typically used during yoga or Pilates work to strengthen your core and legs. Stability discs can be used sitting, kneeling, lying, or standing, and you have the option of inflating them to your desired size.

Have you tried any of these fitness helpers, and how did you like them?

 

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5 Ways to Minimizing Your Risk of Developing Breast Cancer

January 16, 2012 by

We’re finding that a very small percentage—perhaps 10%—of breast cancer has a genetic link. You can take several steps to reduce your breast cancer risk, and we’ll touch on some of them here.

Avoid toxins as much as possible. (Possibly link to hazardous chemicals article here)

We live in a polluted environment and breathe air full of toxins from factories and vehicles. We eat food and drink water that is full of chemicals and stored in plastic containers that leach bisphenol-A. We clean our homes with harsh, hazardous cleansers. We use shampoos, soaps, cosmetics, lotions, and potions that contain ingredients we can’t even pronounce, much less know what they are.

Every step you take to reduce your exposure to these harmful products is not only a step away from breast cancer, but it’s also a step away from other cancers and serious illnesses. Use nontoxic cleaning products, such as vinegar and baking soda. Try some mineral makeup and goat’s milk soap. Avoid plastic containers with the number 7 on the bottom, and toss out scratched or worn plastic items. Filter your water, and choose homegrown or organically grown food.

Maintain a healthy weight and exercise.

Obesity and a sedentary lifestyle increase your breast cancer risk, but the good news is that even a small reduction in weight or moderate, regular exercise are helpful. Find activities you enjoy doing, and focus on moving rather than exercising.

An easy way to start losing weight is to eat as naturally as possible. Take it easy and don’t overwhelm yourself. Start by substituting a piece of fruit for a piece of candy, or add a few vegetables to your evening meal. When you’re used to the first step, take the next step. Before you know it, you’ll be losing weight and feeling amazing.

Have no more than one alcoholic drink a day.

Red wine is beneficial to the heart, but drinking more than one glass a day ups your risk of cancer. Enjoy that one glass of wine and know you’re doing something healthy for yourself, but stop there.

Breastfeed.

According to the Mayo Clinic, breastfeeding appears to protect women against breast cancer, and the longer you breastfeed, the more protection it gives you.

Avoid hormone therapy when possible.

Long-term hormone therapy increases breast cancer risk. Ask your doctor about other options if you’re taking hormones, as you may be able to relieve symptoms with non-pharmaceutical means. If you do decide to continue with hormone therapy, use the lowest dosage you can, and have a goal date to stop using it.

We hope this post has been helpful—do you have any tips to help other women start exercising, lose weight, or avoid toxins?

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Mastectomy and Breast Reconstruction Questions Answered

January 13, 2012 by

nipple sparing mastectomyThe below questions are answered by Dr. Richard M. Kline, Jr., Charleston breast surgeon for The Center of Natural Breast Reconstruction:

What kind of breast expander do you recommend and employ?

We usually use either Mentor contoured tissue expanders, which have more projection at the bottom than the top, or Mentor round expanders with a remote port. If patients are using tissue expanders only as a “bridge” during post-mastectomy radiation until they can receive a flap reconstruction, then we prefer the remote port model, because it won’t interfere with the MRI we like to get prior to flap surgery to look at the vessels. If the patient is planning on having a permanent implant reconstruction, then the contoured expander (which is not compatible with MRI) may produce a better initial shape.

If I choose immediate breast reconstruction, what happens if it is discovered I need radiation treatment during the mastectomy? What happens then?

It depends on what type of reconstruction you have chosen. If you choose implant reconstruction, radiation doesn’t hurt the tissue expander or implant, although it significantly decreases the chance of achieving an acceptable result. If you have had an immediate flap reconstruction, then learn (unexpectedly) that you need radiation, then the flap may be in serious jeopardy. Experienced oncologic breast surgeons are usually pretty good at anticipating whether a patient will need radiation or not. If significant doubt exists, however, and a flap reconstruction is planned, it is best either place temporary tissue expanders at the time of mastectomy, or delay all reconstruction until after radiation.

What are the disadvantages of postponing breast reconstruction after mastectomy? (scarring, skin sparing options, nipple options)

The only significant disadvantage to postponing reconstruction is potential contraction of skin if a skin-sparing or nipple-sparing mastectomy is used. Depending on the amount of skin present and the ultimate desired breast size, however, this may present a problem for some patients, but not others. The advantages of delaying reconstruction include a decreased incidence of complications, and shorter anesthetics.

For breast reconstruction, what are the options for nipples?

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.

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How One Breast Cancer Survivor Found Hope by Making Informed and Proactive Decisions

January 11, 2012 by

breast reconstructionThe team at The Center for Natural Breast Reconstruction is honored to share with you an In Her Words post written by a recent patient of ours, Linda Burkholder. She is an inspiration to all women who are facing breast cancer or who are at risk for hereditary breast cancer.

See below for Linda’s story:

Breast cancer—you can’t say I didn’t see it coming, but being the eternal optimist, I hoped I would dodge the bullet.  Several members of my family have died from breast cancer, including my grandmother, mother, aunt, and sister. After my sister died in 2006, I began to seriously consider prophylactic surgery. I quickly learned that there is little support in the medical community or among friends for this procedure.

After a benign biopsy two years ago I found F.O.R.C.E. (Facing Our Risk of Cancer Empowered) on the Internet.  F.O.R.C.E. is a support group for those with hereditary breast and ovarian cancer. They posted an application for a scholarship to their annual conference. I applied and much to my surprise I was granted an expense paid trip to the conference in Orlando in 2010. I can’t tell you how that changed my life. I learned so much about everything I wanted to know about breast cancer and I met several plastic surgeons who stood out to me, especially Dr. Kline from The Center for Natural Breast Reconstruction. I made a mental note to keep him in mind and took home a beach towel with his phone number splashed across it.

During the next year I struggled with my decision to have prophylactic surgery. Intellectually, I knew what to do, but emotionally I was really struggling. I joined a local F.O.R.C.E. group and kept learning and thinking and meeting cancer survivors, assuming I would have surgery when I felt more comfortable with the idea. Fast forward to June 2011. It was time for my annual mammogram. I told my family doctor I also wanted an MRI, to which she reluctantly agreed. To make a long story short, the mammogram came back normal, but the MRI showed a 1.2 cm questionable spot—a spot, I was told, because of its location, would never have been seen on any mammogram. It was a Stage 1 cancer.

This was almost 2 years to the date from my previous benign lumpectomy. In July, 2011 I had a second lumpectomy performed by one of the most respected surgeons in my area. Without consulting me she automatically scheduled me for radiation. I refused the radiation because I felt that all treatment was my decision and I wanted to consult with an oncologist first. Also, I had learned at the F.O.R.C.E. convention that radiated tissue is harder to reconstruct and I already knew I ultimately wanted mastectomies with natural breast reconstruction, not implants.

When I told the surgeon I didn’t want implants, she hit the ceiling. Clearly, no one had ever before challenged her standard treatment plan. Thanks to F.O.R.C.E., I was empowered. The next convention was two weeks away and I knew this would be where I would make my final decision, and it was. I talked with EVERY plastic surgeon at the conference. I spoke with Kathy Steligo, author of The Breast Reconstruction Guidebook, for 45 minutes at the round table breakfast. I had read her book for the third time on the plane to Orlando two days before. After the conference I came back to my hometown and started chemotherapy. I also scheduled my surgery for November at The Center for Natural Breast Reconstruction.

After consulting with my oncologist, I elected to have bilateral mastectomies with autologous reconstruction. In September my husband and I made a trip to South Carolina to meet with Dr. Kline and Dr. Baron, the general surgeon. I wanted my husband to meet my doctors. I wanted to make sure I had his full support and I wanted to make sure any lingering questions by either of us were answered.

After that meeting I was sure I wanted to go forward with the DIEP procedure. I felt very confident that everything would be alright. On November 30, 2011 I had the procedure. It was an 8-hour surgery, and everything went very well. I was in East Cooper Medical Center for four days. My nurses were great, especially Angela. I thought of her as my special angel since she was able to anticipate what was needed before being asked and was especially kind. She really took good care of me.

After my discharge from the hospital my husband and I stayed in Charleston another 10 days. I got a handicapped room at a local long-stay hotel. There was a handicapped shower and a recliner in the room. I really appreciated that recliner and I slept in it most nights. It helped to keep my feet elevated.  Every day, at least one time, I took a short, slow walk up and down the hall for exercise. I saw Dr. Kline 3 times during the next 10 days and he assured me everything was fine and my breasts looked “beautiful”—although at that time I didn’t think they looked so beautiful. Now, 5 weeks later, I can see how nicely everything is shaping up and I don’t think I will require a lot of revision at the Stage 2 procedure. I am glad I chose the DIEP procedure. The recovery is long, but it is worth it.

Did I ever seriously consider implants? The answer is yes, because implants represented the path of least resistance. I could have had the surgery done locally and I wouldn’t have had the additional expense of the trip from Indiana to South Carolina. Also, I would have had my entire support system around me. In making my decision I talked to many women who had implants and it seemed to me that they either loved them or hated them. Those that loved them seemed to love them only after 2-3 additional procedures due to complications. Everyone complained about the fills being painful and some found the implants to be cold or uncomfortable. Also there was the risk of capsular contracture and the necessity of replacing the implants every 10-15 years. I also talked with many women I met through F.O.R.C.E. who had flap procedures. I saw their results and they were fabulous. Short of a few fading scars, you could not tell that their breasts were not original. All of them seemed quite pleased with their new breasts.

Yes, recovery is a bit prolonged with DIEP. You definitely need someone very devoted to you to help out those first few weeks. I needed help getting up and down, showering, dressing, and emptying my surgical drains. My husband helped me with everything, dispensed my medications and gave me a blood thinning shot daily. I could do very little without his assistance the first 10 days following surgery, and I slept much of the time. Still, I was able to get around slowly and even went out to local restaurants my two weeks in Charleston. I also had pain medication, which made life bearable.

As the weeks have progressed, I feel my strength slowly returning. I am not yet 100% but I am planning to return to my job part-time on January 9th, with hopes of returning fulltime the following week. For anyone considering a flap procedure but fearful of the recovery, I would advise them that it is doable. It’s not as bad as you think. A certain amount of fear is normal if, like me, you have never had a major surgery. But for me, everything went fine, even though I am 59 years of age, older than any one I have met who had DIEP. So, I think if I can do it, anyone can.

My only regret is that I didn’t come to my decision for prophylactic surgery before I got cancer. Time ran out to make that decision but I am thankful my cancer was found early and I am thankful for my husband of 29 years, Larry, was by my side supporting me every step of the way. I would advise anyone facing cancer to not panic, do your homework, and be very proactive in your treatment. Learn everything about breast cancer that you can so you can understand your options. Choose your doctors carefully. Get second opinions and do what YOU think is best for you. You have many options; don’t let anyone take any of them away from you. Make your own decisions.

Having cancer has changed my view of life. It seems much more precious and much more vulnerable than before. I am thankful for a second chance and thankful that I had so many options that my mother and grandmother did not have. My mother had radical mastectomies, which are very disfiguring. I am glad that I still look much like I did before. I had nipple-sparing surgery and when I look at my breasts I still see me in there. I can’t wait to see the results following my final revisions. I am very grateful for Dr. Kline, Chris Murakami, RN and Clinical Coordinator, and all the staff at The Center for Natural Breast Reconstruction for a very positive reconstructive experience.

About Linda Burkholder

My name is Linda Burkholder and I have lived in Kokomo, Indiana the past 22 years. I am the proud mother of two adult children, a daughter 23 years-old and a son age 21. I have been married to my husband, Larry, for 29 years. I work fulltime at Indiana University as an Administrative Secretary to the Dean of the School of Public and Environmental Affairs. I love animals and have two Pembroke Welsh Corgis and four cats. In my spare time I enjoy reading and knitting.

Do you have a question for one of our doctors? Ask us!

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Healthier Ways to Make Your Favorite Winter Comfort Foods

January 9, 2012 by

comfort foodsAh, winter comfort foods—is anything better than curling up in a blanket and eating your favorite?

However, many comfort foods, such as macaroni and cheese, fried chicken, and creamy stews and soups, are full of fat and calories we don’t need. Following are a few tips to reduce the fat and calories without sacrificing the taste and comfort you want.

Cut down the butter.

If a recipe calls for three tablespoons of butter, try using only two tablespoons (or less). Chances are you won’t notice a difference in taste. Using margarine presents its own problems, as most of them have hydrogenated oil you need to completely stay away from.

Try using lower-fat dairy products.

Instead of heavy cream, try using half-and-half, or use 2% milk instead of full-fat milk. Sour cream and cottage cheese come in low-fat varieties. You can find lower-fat cheeses, or use a smaller amount of high-quality cheese.

For some recipes, a lower-fat substitution might not work, but it’s certainly worth a try.

Reduce sugar by half.

While sugar doesn’t have that many calories, reducing it is always a good idea when trying to eat healthier. If you don’t like the taste with less sugar, try adding a little bit of honey.

Add more lean protein, fruit, and vegetables.

If you’re making a chicken potpie, use the leanest cuts of the chicken and add more vegetables. Try some broccoli, cauliflower, and beans.

Try pan-frying instead of deep-frying.

You’ll use less oil and have fewer calories. Try frying in olive oil or coconut oil for a change of taste. Taking the skin off will reduce fat, as will baking or oven-frying.

If all else fails, simply eat smaller portions, or make adjustments elsewhere in your diet.

If you can’t stand the way your mac ‘n cheese tastes with lower-fat substitutions, by all means, cook it the right way—just eat from a smaller bowl or plate. If you don’t want to do that, then plan your mac feast and eat less during the other meals of the day.

What do you do to reduce the fat and calories in your comfort foods?

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