Sandra Mahncke thought she was coming down with the flu in late April, but instead of a quick recovery, she has spent the last five months in a race for her life.

She started feeling bad at work. "I had body aches and felt like I had a fever," says Sandra, "by the time I got home and changed my clothes I noticed that my left breast was very inflamed and bright red."

Those are classic symptoms of inflammatory breast cancer or IBC. According to the National Cancer Institute, IBC is "a rare but very aggressive type of breast cancer." It accounts for 1 to 5 percent of all breast cancer cases in the United States.

As with many other cases of IBC, Sandra's wasn't diagnosed right away. Her gynecologist thought she might have mastitis, a fairly common breast infection. When the redness and swelling didn't clear up after one course of antibiotics, the doctor ordered a mammogram. That's when Sandra first knew something was wrong.

"Obviously, I was kind of shell-shocked and in disbelief," recalls Sandra. A breast surgeon broke the news that Sandra's biopsy tested positive for cancer. Sandra says, "It's very frightening and because it's an uncommon disease and we haven't heard a lot of stories from other people."

In spite of its name, Inflammatory breast cancer isn't caused by an inflammation or infection. Experts say IBC occurs when cancer cells block the lymph vessels in the skin of the breast. Surgical Oncologist Sheryl Gabram of the Winship Cancer Institute at Emory University in Atlanta, Georgia, says IBC "presents itself like an infection with redness and swelling, but unlike traditional breast cancer, there usually isn't a mass."

There can also be ridging on the breast and an inverted nipple. A mammogram might reveal thickening skin.
Dr. Gabram says the best way to make the diagnosis is by looking at a woman's breast and obtaining a biopsy. While there are no specific risk factors, experts believe it is more common among African American women and those with a higher body mass index. Typically, IBC is diagnosed in younger women. Sandra is a 48-year-old mother of three teenage boys.

"Twenty years ago, women did not live beyond two years with this disease," says Dr. Gabram. Now, the National Cancer Institute puts the five-year survival rate between 25 and 50 percent. Part of the reason is early diagnosis, the other is aggressive treatment.

"Starting with chemotherapy first, to get control of the disease in the breast as well as throughout the body, followed by surgery and then radiation therapy can definitely decrease the local recurrence as well as increase survival," states Dr. Gabram.

Sandra is halfway through her chemotherapy sessions. She'll have a mastectomy in a couple of weeks. Her husband, Peter, is by her side as she's hooked up to an IV drip and administered chemo. Her doctors don't think the cancer has spread, but Dr. Gabram says IBC can be tricky and is more likely to metastasize than other cancers.

Despite her health crisis, Sandra believes she's lucky, and she's been told her prognosis is good. She advises other women not to wait and make an appointment with their doctor immediately if they notice any unusual changes in their breasts.

She says "it's a totally different world. You really have to shift gears and look at everything in a totally different way...it's definitely not easy. Having the support of doctors and nurses, friends and family makes a world of difference."
-  Judy Fortin, CNN

Most health experts agree that if you are trying to stay in shape or lose weight, eating late at night is not a good idea.

Of course, it is not as easy as it sounds. Many of us get up early, exercise, and work a full day. By the time Jay Leno or David Letterman come on the TV screen, our stomachs are growling. For others, it is simply a habit: TV remote in one hand, a bag of chips in the other.

But late-night eating habits can be one of the surest ways to add numbers to the bathroom scale in the morning, experts say. Too much protein and too many carbohydrates at night can lead to weight gain, and the key is to find a moderate mixture of the two, according to celebrity fitness trainer Michael George.

George has trained A-list celebrities such as Reese Witherspoon, Tobey Maguire and Meg Ryan, has appeared on ABC's "Extreme Makeover," and is the author of the fitness book "Body Express Makeover."

Getting A Good Mix

George said that many people are not aware of the importance of mixing carbohydrates and protein, especially late at night. People think that if they are trying to lose weight they should just eat an apple or a banana before going to sleep. But George said this habit of taking in pure carbohydrates can lead to weight gain.

"If you don't have any protein, you spike your insulin levels. The hormone of insulin is what we call the fat-storing hormone. If you start spiking your insulin levels, that tells your body to store fat," says George.

Nancy Clark, a registered dietician and author of "Nancy Clark's Sports Nutrition Guidebook," agrees that mixing carbohydrates and protein late at night is the best way to keep your weight down. She also points out that protein is filling.

"(Protein) stays in the stomach longer, it takes longer to digest and empty from the stomach," says Clark. "So protein is more satiating, it stays longer."

Eat More During The Day

According to Clark, one way to avoid the late-night munchies is to eat more during the day. Clark said that most Americans eat in reverse -- they have a light breakfast or skip it, a simple lunch and then a big dinner. Clark advises her clients to do the reverse by starting with a big breakfast and even working in a second lunch. By the time dinner rolls around, they aren't as hungry.

"I have my clients eat every four hours of the day," said Clark. "They have a good breakfast at eight, lunch at 12, a second lunch at 4, so that second lunch uses up a lot of night-time calories after eating earlier in the day. So, instead of having cookies at 10, why not have cookies at 4? The purpose of those first three meals is to ruin the appetite for dinner."

The experts seem to agree that it is best to avoid late-night snacks if you want to keep your weight down. However, many of us, despite our best efforts, still get the late-night munchies and have a hard time going to sleep feeling hungry.

So, if you must, here are five suggestions for late-night snacks that the experts say will not increase your waist size. The key in all these snacks is a mixture of carbohydrates with a small amount of protein.
"Having a little bit of protein with each and every meal, that's the key," says George.

Vegetables and dip
 You can never go wrong with vegetables, and don't forget to mix in a little bit of protein for a healthy snack.
"I typically like having things like vegetables -- whether it be carrot sticks, broccoli, cauliflower -- and maybe a little bit of string cheese," said George. "You can also use ranch dressing to dip the veggies in."

Fruits and cottage cheese
If you crave something a little bit sweeter than a celery stick, an apple or a banana is a better way to satisfy your sweet tooth than a pint of ice cream.
"A little bit of fruit with some cottage cheese is a good idea, like a tablespoon of cottage cheese and a handful of berries or strawberries, or half an apple," said George.
Nuts and yogurt
Nuts are a good source of protein, and go well with some yogurt, which can also help satisfy your sweet tooth.
"You could have a handful of nuts with a little bit of cottage cheese or some yogurt. Not much, just maybe a tablespoon of yogurt," said George. "Basically, what people are looking for is just a little something to hold them over until they go to sleep so they don't go to bed hungry."

English muffin and peanut butter
Peanut butter -- even just a little -- can be very filling. But make sure not to have too much, the experts say.
"It can be cashew peanut butter or almond peanut butter. And the fat is going to satiate you and give you a little more flavor," said George. "Just make sure that it's no more that a tablespoon, max."

When Jennifer Portnick wanted to be a Jazzercise franchisee, she says, she was denied. The reason: The company had a policy that required exercise instructors to appear fit. Portnick, who weighed 240 pounds, didn't pass.

So she filed a civil complaint under a San Francisco ordinance that bans discrimination based on weight and height. The company changed its policy, and she dropped her complaint.

Portnick's story is just one example of how physical appearance can affect employment. A growing body of research supports what many suspect: In the workplace, an employee's physical appearance is a powerful symbol that affects job success.

"The issue was my image. I never thought I'd be complaining about discrimination," says 41-year-old Portnick, who now is a personal trainer and teaches intermediate aerobics classes every other Saturday for people of all sizes at World Gym. "We talk so much in workplaces about diversity. Do we want everyone to fit into one mold? I don't think that helps any company."

Jazzercise officials say they don't believe they discriminated against Portnick.

The new research, as well as high-profile lawsuits alleging appearance-based discrimination, is raising new awareness about how looks hurt -- or help -- careers. It also has some organizations such as the International Size Acceptance Association calling for legal protections based on appearance.

In some cases, they're getting it. Michigan bans discrimination based on height and weight. Santa Cruz, Calif., bars discrimination based on height, weight or physical characteristics. Washington, D.C., outlaws employment discrimination based on personal appearance. In San Francisco, it's illegal to discriminate against employees because of their weight and height.

But, for the most part, employees have no protection from appearance-based discrimination unless policies also single out workers based on their race, gender or age.

"Employers are free to be unfair," says Bill O'Brien, a Minneapolis-based employment lawyer. "Other than some protected classes, there isn't a great deal employees can do about it. We saw it first on the playground, when the popular people who were the leaders chose other people like them as friends."

But what began on the playground can have a profound impact on paychecks. In a recent analysis, the Federal Reserve Bank of St. Louis reviewed various economic studies to find possible links between looks and wages. The study's conclusion: A worker with below-average looks tended to earn significantly less -- on average 9% less -- per hour than an above-average-looking employee. And those with above-average looks tended to earn 5% more than their average-looking colleagues.

Looking good on the job is an intangible asset that can be important, just as sharp technology skills or the ability to be a team player can give certain workers an edge.

Height and weight factors
It's not just a pretty face that helps boost wages. An employee's height and weight also play a role. A study done in part by New York University sociologist Dalton Conley found that an increase in a woman's body mass results in a decrease in her family income and her job prestige. Men, however, experience no such negative effect.

For women, a 1% increase in body mass as measured by the body mass index results in a 0.6 percentage point decrease in family income. The work, sponsored by the National Bureau of Economic Research, was based on 3,335 men and women.

As health care costs climb and national attention turns to the problem of obesity in the USA, overweight workers are feeling pressure to slim down. The latest data from the National Center for Health Statistics show that 30% of U.S. adults age 20 and older (more than 60 million people) are obese.

The question of whether weight is a disability under the federal Americans with Disabilities Act is still being decided in the courts, but in many cases courts have determined that being obese is not a disability protected by the law.

Richard Chaifetz, president of ComPsych, a Chicago-based employee assistance provider, says overweight employees may not be as productive.

More than 20% of very overweight employees have low morale - almost twice that of employees of healthy weights, according to a June survey by ComPsych. The survey was based on a poll of more than 1,000 client organizations.

Dressing to Get Ahead
A variety of workplace studies have also indicated that, in addition to being fit, most successful people are also well dressed.

“They dress in a way to inspire trust and confidence. People are reluctant to do business with someone who is careless, casual and doesn't respect his appearance,” said Mariam Davidian, wardrobe columnist and color consultant.

“Clothes can enhance your professional image and influence the way people respond to you. The cut and style of your clothes reveal your attitudes towards yourself. If you know you look your best, you feel confident and will give the best to your job-part of the image of success,” Davidian continued.

According to Davidian, if you feel you have been going to work dressed too hurriedly and shabbily, it’s time to work on your image - to dispel that uncomfortable feeling you get when you arrive at the office and notice your shirt collar is frayed or there are makeup spots on your blouse. If you are busy hoping "no one will notice," it will be difficult to muster any self confidence to impress people you are dealing with.

Clothes may not make the woman, but they can help make a deal, so buying them should be a serious and thoughtful endeavor. When selecting your wardrobe, allow enough time to adequately examine fabric, quality and workmanship. Invest in good quality clothes with good classic lines, even though you may have to buy fewer.

For more tips on dressing for success, click here.

Sources:
Armour, Stephanie. “Your Appearance – Good or Bad – Can Affect the Size of Your Paycheck.” USA Today. July 20, 2005.

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Check out these great opportunities to mix up your fitness routine this fall:

SEE JANE TRI - Sat, Sept. 29, 2007: A women-only triathlon (400 yd swim/11 mile bike/3.1 mile run) benefiting the Breast Cancer Fund.

TALL SHIP EDUCATION ACADEMY WOMEN'S SAILING CHALLENGE - Oct 11-14, 2007 and May 1-4, 2008: Join a small crew of women and learn to sail a large schooner on the Bay and along the Northern CA coast. No sailing experience is necessary - just a willingness to expand your horizons.

SAN FRANCISCO OYSTER - Sat., Oct. 14, 2007: Run, bike, skate, and raft in the region's ultimate urban adventure race while raising funds for Outward Bound.

Bay Area Boot Camp is pleased to announce the opening of three new locations: Martinez, Pleasanton, and Willow Glen. Don’t forget to reserve your spot at a fall boot camp session near you!

San Francisco
Crissy Field – Sept 17-Oct 12 (AM sessions for women only + PM co-ed class)
Golden Gate Park – Sept 24-Oct 19 (AM women-only classes)

Peninsula
Central Park (San Mateo) – Sept 17-Oct 12 (AM sessions for women only + PM co-ed class)
Rinconada Park (Palo Alto) - Sept 24-Oct 19 (AM women-only classes)

South Bay
De Anza Park (Sunnyvale): Sept 17-Oct 12 (AM sessions for women only + PM co-ed class)
Campbell Park (Campbell): Sept 24-Oct 19 (AM sessions for women-only)
Bramhall Park (Willow Glen): Sept 17-Oct 12 (AM co-ed class) – NEW!

East Bay
Heather Farms Park (Walnut Creek): Sept 17-Oct 12 (AM women-only classes)
Hidden Lakes Park (Martinez): Sept 24-Oct 19 (AM sessions for women-only) – NEW!
Pleasanton Sports Park (Pleasanton): Oct 15-Nov 9 (AM sessions for women-only) – NEW!

Register for Boot Camp