We now have another clue about why we are so tired during chemotherapy and for months afterward. It's one of those "Dem Bones" issues. You know the old spiritual that says, "Toe bone connected to the foot bone, foot bone connected to the heel bone, heel bone connected to the ankle bone," and so on. In this case, according to researchers at the Winship Cancer Institute at Emory University in Atlanta, Georgia, chemotherapy is connected to an epigenetic imprint in the DNA of breast cancer patients' blood and the imprint is connected to inflammation and inflammation is connected to fatigue.The changes to the DNA are very complex, which I don't want to explain to you when I don't understand them. Suffice it to say that they are finding that these changes are in the DNA at six months post chemotherapy. If you want to read the details you can find them in the journal Brain, Behavior, and Immunity. More researchers than ever are focusing on inflammation and its relationship to cancer. Ironically, this study appeared just when we were preparing the spring issue to go to press, and in it you will find a feature on inflammation as it relates to cancer and recurrence of cancer. In the article we add another line to Dem Bones as we look at the impact of sress on inflammation. Stress does lots of nasty stuff in the body, including, perhaps, suppressing the immune system and encouraging inflammation. So what does this all mean for those who cannot get off the couch because they are so fatigued, which, in turn, causes stress because we need to get off the couch to live. Well, it's time to take some control and find ways to fit exercise into our lives. I know, I know, you are tired of hearing it, but you will have to plug your ears if you want it to go away. I am not talking about getting up and doing a 5 k. Just lie there and do leg lifts or get small weights and use those to get your oxygen level up. Get your blood pumping, which you can also do by raising and lowering your arms. Yoga has evidence that it helps. Exercise and other stress reducing activities also impact your chances of recurrence. There are also inflammation reducing foods, spices and movement just as there are those foods that increase inflammation.Check out what survivor and healthy living guru Kris Carr says about inflammation. Her response to a cancer diagnosis was to become a nutritionist. No one thing is the answer to fatigue, but even small changes show our body we love it. So to wrap up . . .Chemotherapy is connected to epigenetic changes in the DNA and they are connected to inflammation and it is connected to fatigue/ conversely less stress is connected to less inflammation and exercise is connected to less inflammation because it reduces stress. No one said it would be easy.