The neatest thing since sliced bread, the internet

The neatest thing since sliced bread, the internet
01MAY20105 Comments

On April 14th, 2009 the alarm went off. My hand went to the snooze button, my husband’s hand went to my breasts. I’ll help you out here, by skipping ahead of a few details of that morning….to this part. He said, I keep forgetting to tell you, but your breast is swollen, did you know? I hadn’t noticed, until I thought about it later. I had just gotten back from a spring vacation trip and had noticed my bra seemed tight on the left side and was leaving marks on my left breast. But when I put on weight, I totally gain in my breasts, so I had chalked it up to that. Later that day, I looked in the mirror to see what was going on. Almost half of my left breast was pinkish, red. It was substantially larger than my right breast. Those of you that have breasts certainly know that one can be larger than the other, but this was more than that. I had an area of noticeably thickened skin. It was impossible to pinch the skin on this part of the breast because it was hard. I really hadn’t noticed all that before. So, I did what any normal person would do, I googled it. At first, all I came up with was mastitis. But this didn’t make sense as I was way, way past the breastfeeding days. Instead of typing in swollen as a keyword, I typed in inflamed and the results I got back made my heart just sink. I had several symptoms of inflammatory breast cancer (IBC). A web site I was looking at said something like: “Do not go to your nice family doctor down the street if you have symptoms of IBC. They will not know. They will tell you that you have mastitis and prescribe antibiotics and in the meantime, this aggressive cancer will grow and spread. It can come on as quickly as overnight. Mastitis is uncommon unless you are breastfeeding.” You’ll never guess what I did then, so I’ll just tell you. I picked up the phone and called my nice family doctor down the street because I had no idea where else to start. I saw him that afternoon.

At the doctors office, my blood pressure was through the roof, but, thankfully, I only had mastitis and I dutifully went to the pharmacy to pick up my antibiotic. And before I left his office, we had a little conversation about patients researching things on the internet and how it can wreak some havoc. And I was relieved, for about two seconds, until I got back on the internet and googled some more. I made several calls searching for an appointment for a second opinion. I had an appointment scheduled with OHSU, but they couldn’t get me in for two weeks. After several phone calls, the best I was able to do was get in the following week with a general surgeon at Meridian Park. I thought the appointment was with a woman. But, the doctor whose first name was Kim, turned out to be a man, and he was a man that wasn’t interested in doing the skin punch biopsy that I requested when I saw him a week later. How did I know that I needed to ask for a skin punch biopsy you ask? Why the internet, of course. IBC grows in sheets in the skin. In addition, a tumor may be present, but not always. So a skin punch biopsy takes a sample of the affected area about the size of a pencil eraser and they test it to see if they can find any cancer cells. Sometimes they can’t detect the cancer cells, because they are not condensed in a tumor and are too diffuse to detect, so IBC is often a clinical diagnosis. Meaning, someone who has seen it before and knows what they are looking at, should be able to look at it, and tell you if it’s IBC or not. Hmm… He couldn’t feel any lump, but I told him I could. I kept trying to tell him that I had several symptoms of IBC and finally he said that he had seen a lot of cases of IBC and I didn’t have it. Which made me wonder, just how many cases of IBC this general surgeon had seen in his lifetime. I mean, it’s pretty rare. It makes up 1%-4% of newly diagnosed breast cancers each year. Out of 240,000 new cases of breast cancer each year, that would equal 2,400-9,600 cases of IBC per year. I mean, I can’t see them all flocking from around the country each year to seek out a male general surgeon named Kim in Tualatin, Oregon, with no expertise in the area of breasts in particular. I’m pretty sure I’m the only dumbshit that did that.

In the meantime, I discovered that THE place to go if you think you have IBC is MD Anderson Cancer Center in Houston, TX. They had recently started the first Inflammatory Breast Cancer Clinic in the world, led by Dr. Masimmo Cristofanilli. He was the best doctor in the world for this, from what I could tell with my stealth and nimble google skills. I called down to the clinic, they took down all my information and symptoms and called me back and said they had run it by the medical director in the undiagnosed breast clinic and my symptoms sounded alarming and they would like to schedule an appointment to see me. And I was totally stoked that someone was finally listening to me, but then snapped back into the reality that I am in Oregon, which is a long damn way from Houston.  So I told them I would think about it and get back to them.  And I didn’t call the clinic back. But a few days later, they called me to see if I wanted to schedule that appointment and I said, you know, I think I’m overreacting, I’m going to hold off on scheduling that appointment.  What if I spent a bunch of money flying to Texas, renting a car, having all these appointments, paying for a motel and it turned out to be a big, fat nothing. Then I would feel really stupid and guilty for spending the money, which would be way more fun to spend on just about anything else, instead of on figuring out you don‘t really have cancer after all.

And then, at 3:50 in the afternoon on Friday, May 1, 2009, I got the call from Kim. The same man that had told me two weeks prior that I didn‘t have IBC. But to humor me since I was so persistent, he had ordered an ultrasound to see if I might just have a cyst. The ultrasound technician poked around over my inflamed area and was going to call it good when I asked her to check out the other side of my breast.  One wave of the magic wand and she said, I’m going to go get the radiologist to look at this (never a good sign). The radiologist waved the magic wand on me again with another whole tube of ky jelly (on the outside of my breast, head out of gutter) and ordered a mammogram and then ordered an ultrasound guided biopsy, which turned out to be a 6 cm tumor (which grew from nothing to holy shit, this is a big hard lump, in about a week, literally). Anyway, back to 3:50. I was in my car with all my kids driving them home after school. I had to keep the doctor on the line long enough to get into my driveway so I could get away from my kids to have the conversation.

Doc: “I’m sorry to tell you that you DO have cancer. Based on your age, you‘ll probably need chemo.” And based on that comment, with my superior google MD knowledge, I knew that he didn’t really know jack shit about my cancer, at all.

Me: “What are the odds that I have IBC since I have several of the symptoms that you said weren’t IBC.”

Doc: “Well, often times it comes down to a clinical diagnosis, so come see me Monday.”

And now picture the bubble over my cartoon head with this in it: “Fuck that, I already saw you, idiot and you were wrong the first time. I laid on my back on your exam table with my breasts out while you patted my leg and told me there’s nothing wrong here, just a little mastitis. We’re going to change your antibiotics.”

And then he started to sense how freaked the fuck out I was because I kept pressing him for more information and a plan and he had nothing, and it was Friday afternoon, and it was his day off. But he did say he would put in a call to an oncologist and try to work me in as soon as possible. Now, if you google IBC, it says you’re supposed to start chemo right away, before you do any kind of surgery, because if you cut into IBC, it just spreads, you have to kill it first with chemo. And my head was spinning.

So I called my husband and I had to tell him I had cancer. That sucked. Needless to say, he didn’t take it very well, but I was reminded why I married him in the first place. He told me I was his whole world and he couldn’t live without me.
Then, I called my nice family doctor down the street. He wasn’t in the office, but I told the receptionist, “Can you call him and tell him that Sarah has BREAST CANCER and would really like to speak to him tonight if possible?” And he did call, right away. And I told him I had gone to get a second opinion because I just had the gut instinct that I knew something was wrong. I told him that I was thinking about getting on a plane Sunday to get down to MD Anderson Cancer Center and just be there first thing Monday morning. He said there was no way they would see me as it takes weeks to get appointments at a major cancer center. But he didn’t know I had already talked to them about an appointment. (And you know, the level of knowledge and expertise at a major cancer center is really priceless. Even the nurse practitioner in the undiagnosed breast clinic at MD Anderson took one look at my breast and said, yep, that’s IBC. Correct clinical diagnosis in under 2 minutes by someone who actually HAS seen hundreds of cases of IBC per year.) And for the record, I do not find any fault with my nice family doctor down the street, because that is exactly what he is, a good old family doctor practicing in a small town. And now, he knows what IBC can look like and he is aware that young women can and do get breast cancer.

That was a shitty day, but deep down I already knew I had it. The frustrating thing for two and half weeks was that neither of the doctors I saw thought I had it. It was really the worst, lonely nightmare. But, I’m a pushy bitch and reading about IBC on the internet scared the living shit out of me and it only took me from April 14th to May 4rth to get the correct diagnosis. And I was really, truly ecstatic when Dr. Cristofanilli told me I was only stage IIIC, because I was so worried about where it might have already spread in my body. I had been having strange back aches since my spring break trip, which was the same time as the onset of my other symptoms. The next stage after IIIC is stage IV, which the internet basically says is a terminal stage because the cancer has spread to distant organs and you will eventually die from it. Fucking stupid internet. But you know what the internet also says, is that some stage IV cancer patients can live for decades if they can find the right mix of treatments, although there is no rhyme or reason to why some cancers respond to certain treatments while others don‘t. It‘s all still a big puzzle, waiting to be solved. And for those that are able to make it, new treatments are coming down the pike every year, and at some point, stage IV will not be terminal, because there will be a cure. But like I said, I was excited to be a IIIC, especially because the day before I was supposed to fly home from Houston, I put in a call to the scheduler at MD Anderson to confirm my last appointment the next day with Dr. Cristofanilli. He was going to go over all the tests and tell me where all the cancer might be in my body and give me my treatment plan, which I was taking back to Oregon to complete. The scheduler, Miss Sherique, told me that my appointment had been cancelled and I needed to be there at 7:00 am for blood work and more tests and I was to start chemo the next day. So I really thought, Houston, we have a problem. She didn’t know why my appointment schedule had changed or why I needed to start chemo the next day and finally just got short with me and said, you need to come to these appointments and just wait until we reschedule you with Dr. Cristofanilli to ask him what’s going on. Which didn’t work for me, Miss Sherique, seeing as how I had plane reservations for the next afternoon in hand. As it turns out, even a major cancer center can hire a complete airhead who pulls up someone else’s schedule and proceed to freak someone out completely with false information. And still get to keep their job.

So the nitty gritty is that the IBC statistics state you have a 40% chance of surviving 5 years, 25% survive 10 years. WTF? I mean really, try to wrap your head around that. It’s a huge mind fuck, actually mind rape might be a better term! Now I have to say, I have since, been back on that internet and discovered some interesting things about cancer statistics. Such as, these statistics are based on studies that were conducted 10+ years ago. And some major advancements in treatment have been introduced since then. So while these are the most current statistics and this is what MD Anderson stuck by when I discussed statistics with them, the reality very well could be, oh hell, let‘s just say the reality is, that more than 40% are surviving past 5 years now and more than 25% are surviving past 10 years. I guess if I was 80 when I was diagnosed, that might seem hopeful. But I was 39, hoping to make it to 80, wondering if I would see 5 or 10 more years. The thought had never before crossed my mind that I may not be around to see my grandchildren. But I have a lot of good things about my cancer in my corner, which I’ll talk about later. So I’m really thinking I’ll be around for a long, long time. And thank you once again, oh so rockin’ awesome internet, for helping me to find the information that makes me believe it.

Here’s another interesting statistic. The average weight gain for a breast cancer patient undergoing chemotherapy is 13 pounds. Yeah, you read that right, average weight gain, not loss. Needless to say, I was really looking forward to being bald, packing on more weight and having a surgery after chemo to remove my diseased breast before moving on to 6 weeks of radiation, one year of the IV drug herceptin and 5 years of popping a pill called tamoxifen. The nurse at MD Anderson sternly told me to STOP looking on the internet and take this one day at a time. This was after I broke down in tears and was practically sobbing, asking her, “Am I going to get all fat from all these treatments and steroids?” She told me that was the least of my worries. She was really very professional come to think of it, because she was blessed with curves and probably wanted to just slap me. And it’s probably a good thing that happened. Because I realized I can be a completely insensitive person who has no idea what the right thing is to say and do in a crisis. I do think I’m a good person, just a good person who lets stupid shit fly out of her mouth at inappropriate times either because I didn‘t think before I spoke or I just really didn‘t know what to say. I am also a person that just might say nothing at all, even though something touches my heart, because I really don’t know what to say to express how I feel. And it’s good that I realized this, because I have gotten comments about cancer related stuff that just rubbed me the wrong way. I won’t go into detail, but I just have chalked it up to the fact that some people are a whole lot like me. And if you’re wondering what the right thing is to say to someone who has recently been diagnosed with cancer? Well, I’ll tell you specifically the big secret, the perfect thing to say, works every time. What are you kidding? Did you really expect it? Who the hell knows what that would be? Honestly, that person’s emotions might be completely different than where you think they are. They might be all positive one minute, in denial the next, totally angry or completely sad. But honestly, here’s my best guess. Something like, I’m sorry this is happening to you. I will be here to listen to you or just sit with you or play a card game with you. I’ll be here for you. And then you have to be there for them. Or call the spouse and tell them you will be dropping off a meal on Thursday evening, what time would be convenient? If you do really want to help, make a specific, concrete offer, because if you just say call me I will do anything you need me to, will not result in a call to you to ask for some sort of help, it just won’t. (I am famous for saying things just like this and so wishing the person would call me, for anything.) Just bake some cookies, bring some flowers, drop off a teddy bear or game for the kids, send a card, call to check up on or stop by to chat and catch up on normal things.

Back to the story. I came home to Oregon and started chemotherapy, which pissed me off. My husband or my BFF had to drive me and sit with me, which pissed me off (I know, I‘m stupid, because I should have been feeling honored that they care so much about me). Then my head started to ache and my hair fell out, which really pissed me off. This was for me, the worst. If you‘re bald, you must be really sick (or you’re just a bald man, but I don‘t know what I would do with appendages swinging between my legs, and besides, I had cancer, not a penis). Back to bald, really sick, like sick with cancer, like those bald people you see on the Lifetime channel movies that you need a box of Kleenex to get through, because they die at the end of the stupid movie. Then, anything I put in my mouth tasted like slimy metal, and that pissed me off. Which means that even beer was undrinkable, which doubly pissed me off. And my body ached, which pissed me off, and about one day between every chemo session I just felt like I couldn’t get out of bed, which pissed me off too. And then, 4 1/2 months later (which is a relatively short period of time and treatment cycle for cancer patients) I was done with chemo. And I was not pissed for a whole week, because I went back to MD Anderson Cancer Center and they ran some tests and Dr. Cristofanilli said, congratulations, you had a complete clinical response to chemo. The internet says that means, based on imaging and clinical exam, their best guess is that my cancer is gone, but you really need to wait until you have surgery, and have the tissue examined, and get your real results from the formal pathology report. So like I said, I was happy for a week, because I felt like I was cancer free. And then it hit me. I realized I was going to have to have this damn surgery in two weeks. And somehow, I went to sleep the night before, and woke up the morning of, and showered and got dressed and got in the car and let my husband drive me to the hospital and walked back to the pre-op room and got into another fucking gown with my ass hanging out this time, instead of my breasts. And bawled my eyes out until the breast surgeon called the lovely anesthesiologist in to give me a little something in my IV to calm me down. And I woke up a few hours later, missing a very intimate body part, and my husband was relieved, because that was all part of the solution and he couldn’t live without me and he was so happy any little left over cancer cells that might have dodged the chemo bullet, were out of my body, but I was really, really pissed off!

Not only do they remove your breast, but they also take lymph nodes from your axilla (which is a polite way of saying armpit). I still can’t move my arm in the full range of motion I used to have, which, yes you guessed it, pisses me off. Nonetheless, I started 6 weeks of daily radiation (which, the internet will tell you that daily actually means Monday through Friday). Since I had IBC, I had an extra strong dose of radiation, that included the radiation technicians trying to burn the crap out of my skin, by placing a piece of rubber on my skin. This allowed the radiation beams that usually target areas underneath the skin, to really focus on the surface of my skin. I had four fields of radiation. Four different areas they targeted. I got my very first tattoos, which is how they line you up perfectly for the radiation beams. I know, pretty lame, I have one pinpoint tattoo on each side of my ribcage, one in the middle of my chest and then at the last minute they had to place one on the top of where my breast used to be. Which pissed me off, because it was a different technician and that last one is larger, and more noticeable to me. I was one of the lucky ones though, because I came away with minimal burning. It was a cake walk compared to chemo and surgery. But I must say, having to bare your scars to different radiation technicians every day really, really sucked. During my simulation session, where they do your initial tattoos and then a ct scan to line you up to map the field of radiation, I had tears streaming down my face the whole time. You have to lie perfectly still on a hard table with your hands above your head and I just kept crying silently, trying not to move. They kept coming out to ask me if I needed a minute and said they knew how scared I must be. When in reality, I wasn’t scared, I was just completely mortified that my mutilated body was exposed for all of them to see. Nothing they hadn’t seen before a million times, but my first time baring my new body. And before I knew it, I was done with radiation.

And here is some cancer technical mumbo jumbo, skip ahead to the next paragraph if you like. First, my actual factual pathology report from surgery stated that I had a complete pathological response to chemo. I really didn’t realize until I got on that ever famous internet that having a complete response to chemo was as kick ass as it sounded. If you have a complete response, your overall recurrence rate decreases and survival rates increase. So during chemo, instead of some cancer cells floating through your bloodstream or lymph system to try to settle and grow in a new and distant playground in your body, they were actually busy getting killed by chemo.   My cancer tested positive for growing off of estrogen, progesterone and a protein called Her2. Research has shown that HER2-positive breast cancer is a more aggressive disease with a greater likelihood of recurrence, a poorer prognosis, and a decreased chance of survival compared with HER2-negative breast cancer. I was told this is a bad and good thing. Bad because of the greater likelihood of recurrence, poorer prognosis and decreased chance of survival, but good because a drug called herceptin may work to kill the cancer and keep it away. It is a targeted therapy to stop the Her2 protein from attaching to cancer cells which make it grow. This drug was approved by the FDA for breast cancer in 1998. I have been going in every three weeks for an IV infusion of  herceptin since last May. I also received this drug during chemotherapy. Herceptin is administered for one year in my case, so my last infusion for this is coming up later this month, that is if the chemo nurse can find any good vein left to administer it.  And you just don’t know which Her2 positive cancers it will work on and which ones it won’t, until you try it. When you’re faced with craplike this, there are many internet chat boards you can turn to for support. Except that sometimes, there are women on the chat boards looking for support, whose cancer has the same characteristics that yours does, and none of the treatments are working and they seem fine one day and are chatting away, and two weeks later, you hear that they have died. And that doesn’t feel at all supportive. And you wonder why you were one of the lucky ones, when these perfectly amazing women, who seem to do more with their life and their cancer experience than you could ever dream of, died, while you’re still breathing. Additionally, because my cancer tested positive for growing off of estrogen and progesterone, I was prescribed an oral pill, tamoxifen, to take for 5 years. This pill somehow miraculously targets estrogen and progesterone that the body normally produces and blocks it from attaching to any cancer cells, when it works. Again, it usually does, but some women fail on this drug and their cancer returns. Some women choose to have their ovaries removed and have a hysterectomy, so that they are sure they are not producing estrogen and progesterone, but the doctor at MD Anderson didn’t seem to think I needed to do that and I trust him, because I’m still alive. Many women choose to have their other healthy breast removed as well. Some have tested positive for a breast cancer gene that shows they have a greater likelihood of having a cancer appear in their remaining, healthy breast at some point in their lives and others just do not want to risk having to go through it all again. I did not have this gene test as I have no history of cancer in my family. The doctor said mine was most likely caused by environmental factors and no reason to lose them both. And I trust that man, because I’m still breathing. So, I had some good things about my cancer. It was positive for these things, which means I have more treatment available to me that those whose cancer doesn’t grow off of these things. And back to the statistics, I really, really believe that herceptin is a miracle drug. I believe that when the studies are reported, that we will see a very large increase in survival rates for Her2 positive cancer patients (which makes up about 20% of breast cancer patients in general). In fact, a movie was made about the making and approval by the FDA of herceptin. Apparently the doctor responsible put his family and career on the line because he believed in this drug so much. And this movie plays every so often on, you guessed it, the Lifetime movie channel. I have yet to see it, but look forward to it.

OK, no more technical stuff. You wake up one day and find you’re done with chemo, had your surgery and finished radiation. You meet with your oncologist who is in the room with you for all of two minutes while he says, you’re looking good, feeling good, you must be good, see you in three months. We had already had the discussion about follow up care. You think if you have cancer that they might want to scope you out at least once a year to see if it came back, but nope, most oncologists do not do that. Unless you have a symptom, you are considered cancer free. If you do have a symptom they will look into it and possibly order a scan to see if your symptom is in fact the return or spread of your cancer. My oncologist said that research shows that finding a recurrence or spread of cancer earlier with a scan does not increase your survival time over finding it based on a symptom. And so you find the problem earlier, and begin to treat the problem, which is what makes you feel like shit, the treatments, not the cancer, initially. And you end up with a poorer quality of life because of the treatments, because you will ultimately die at about the same time, according to the research. But here is where I’d like call the bullshit on that theory, but with a disclaimer.  I call bullshit on this theory because of my emotions, not because of any logic, so yes, I am probably wrong about this, but I just go with my gut feelings, as usual.  New treatments are in clinical trials all the time. This leads to new treatments being approved by the FDA. This leads to possibly keeping you alive longer. And the doctor at MD Anderson routinely scans his patients with a PET/CT scan and brain MRI within the first year after treatment. He said that Her2 positive cancers tend to spread to the brain, because chemo is unable to reach the brain through the blood vessels, so if they find cancer in your brain, they just zap it with radiation and it kills it. And so I looked on the internet and found some research that supported the notion that you are better off finding breast cancer that has spread to the brain, sooner, rather than later. And if you can catch cancer that has spread only to your bones, there are many treatments that can keep the cancer away for many years for some, but if you don’t catch it, it may spread to other organs, which is a more dire situation. I really don’t know what is better, waiting until you have a symptom or the stress of getting scanned and waiting for results. The problem with no scanning is that you have just gone balls out in trying to kill the cancer and now it feels like you’re doing nothing. And you have no idea what symptoms might be arthritis or migraines or stomach aches or a bad cold that make you cough and which ones might indicate that cancer has returned and spread to your bones, your brain your liver or your lungs. So that is the new reality. Hopeful and positive one minute and the next, thinking the shoe will drop, or will somehow be whacked against my head really hard. How can I be a lucky one that makes it many, many years?  Now my doc at MD Anderson has since left to open a new IBC clinic at Fox Chase Cancer Center in Philadelphia.  And because of his departure, the scan policies have since changed at MD Anderson, which match the policy of my local oncologist.  And I haven’t called Fox Chase.  I’m thinking I’ll keep that in my back pocket in case the unmentionable happens.  But in the meantime, I found a new local oncologist, with the help of the internet of course, and I meet with her for the first time next week.  And the receptionist told me I would be seeing the actual doctor for 1 to 1 1/2 hours.  I won’t even know how to act with a doctor in the room for that long.  And she may not do annual scans, but I think she does.  And I would just like the option to either have them or turn them down myself, instead of the doctor making that decision for me.

And finally, moving on to the aftermath of it all, breasts. What do you do when you are missing one and the other one is just the shell of its former self because you have lost 45 pounds since you were diagnosed. I know, the average weight gain of a woman in chemo is 13 pounds, but apparently I am no average woman. I let the stress of this situation stew inside and whittled away 45 pounds over the course of 12 months. And here’s another fun fact, my left breast weighed almost 5 whopping pounds. So I guess if you need to drop a quick 10 and you’re large chested, this could be an option (see, inappropriatecrap still spews out). I don’t know, one of the chemo agents I was on had a possible side effect of anorexia. That sounded promising to me, since I was so far from being an anorexic. The steroids they give women to counteract the effects of chemo usually are part of the weight gain equation. Somehow I lucked out. But back to the breasts. There are a couple of options for re-creating them. And there are new ones in clinical trials, such as a trial to re-grow your own breasts which is a real clinical trial happening right now in Australia. That would just be something else. But, that is not currently available. So, I had surgery two and a half weeks ago and eventually in about 6 months, I’ll be all put back together. I had told my husband the last couple years that I really needed to do something about my chest, what with having three kids and getting older and gravity. But he just looked me dead in the eye every time I mentioned it and said, I love you just the way you are.  But here I am in a roundabout way, doing something about my chest. Be careful what you wish for.

And to sum it up, I couldn’t have made it through this last year without the love and support of my husband and my kids.  I know it hasn’t been any easy year for you at all and I wish I could have a do over on how I handled a lot of things.  But, I am who I am and I reacted the way I reacted and I love you all more than the air I breathe.  There is nothing more important to me than each of you all and I am totally excited to get on with life with you.  I couldn’t ask for a better husband or kids.  And my BFF Carrie, who took my kids for 12 days while I took off to Texas and orchestrated a meal calendar and took me to chemo and to the look good, feel better class for bald, sick women, and for so much more (like cleaning my house, holy crap! that was awesome), and for my other BFF Elizabeth who kept tons of people updated on my happenings (which resulted in a prayer group saying prayers for little old me and by some miracle, it worked) and for trying to make me laugh, and helping me get a new primary doc and so much more and my other BFF Kim J who was the best listener and somehow seemed to know the right thing to say and I know you’ll be thinking to yourself that we didn’t see eachother that much, but honestly, you gave me just what I needed, and to my family and extended family who have been my cheerleaders and just getting together for normal family functions even though it may have seemed like I was checked out, was so damn good for my soul, and Jillian who wrote me the best letter ever which I still have and cherish and to all the countless people who brought me meals and gifts and flowers and all the people who have prayed for me and supported me and sent me cards and thought about me and offered to help me. It means more than I can ever express.  Thank you!

And for those of you who are thinking, why did she hide under a rock all year, to then come out with all these personal details and share them with the world?  And I have realized this last year that writing it down and hitting the send button somehow sets me free.

And of course, a big thank you to all my internet sisters out there.  Where we can discuss bowel problems, other unmentionable side effects, stupid people, recurrence scares, sorrow, joy, dying and living.  Thank you for that safe and honest place!

Copyright May 1, 2010 by Sarah Zander