Do I Need Patience or a Thyroid "Vitamin"?

I went to see Dr. P., my oncologist, for a follow up visit yesterday. She began by asking me how I felt. For the most part, I feel very good, with two exceptions. I do have a lot of joint pain. Everyone in my "support group" has acknowledged experiencing joint pain. Initially, it was most noticeable in my knees, but now it has moved to my shoulders, and is worst at night. Dr. P. indicated that she is seeing a lot of this ... arthritis-like symptoms following chemo, especially in young women. She said it should resolve itself in months, or a small number of years...

Next I mentioned that I am still going to physical therapy twice a week to improve my range of motion. I feel very bound up and my movements are still pretty restricted, especially on the right side. (Erica, my physical therapist observed last week that while we have made significant gains in resolving the scar tissue and "congestion", the muscle was pulled really tight during surgery, and she is not sure if I will ever regain 100% of my pre-surgical movement.) Dr. P. noticed that there is still a lot of edema on the right side which will take awhile longer to dissipate. She agreed that the muscle is tight and said that after the fluid is gone, we can do a chest MRI and see what we are dealing with.

I mentioned that my hot flashes seemed to be on the decline and asked if that could be a sign that my periods may be returning. She said that was a possibility. I said, “Do we want my periods to return?” She responded, “For estrogen receptor positive breast cancer, we don’t. For heart health and bone health, we do.” Lovely. The future is bright - breast cancer with awesome bones and a reliable ticker, or cancer free with brittle bones and a feeble heart. Well, forgot that. To the extent that I can control it, I intend to be cancer free with strong bones and a healthy heart!

To prevent the recurrence of breast cancer, I will shortly start taking a drug called Tamoxifen. I will stay on this drug for two years. If my periods return, I will continue on the Tamoxifen. If my periods don’t return after the two years, I will be put on an aromatase inhibitor, which has been shown to be more efffective at preventing recurrences in post-menopausal women than Tamoxifen. Dr. P. said that most young women don’t experience many side effects from the Tamoxifen. (Dr. H. told me at my last appointment that the most common side effect is severe hot flashes. A dangerous, but highly unlikely side effect is blood clots.) I prefer Dr. P’s briefing of the medication as she obviously subscribes to my theory that ignorance of possible side effects reduces the likelihood of expperiencing the side effects. Prior to the Tamoxifen, I will have a bone density scan to provide a baseline measurement of my bone health.

I showed her my hair and remarked on the lack of progress. Instead of telling me to be patient, she agreed that the growth was not what would be expected nearly five months after the completion of chemo. Oh great. “Well, what would cause that?” I asked tentatively. “Low thyroid,” was the immediate and matter-of-fact response, an answer I wasn’t prepared to hear and certainly didn’t want to hear. She said that the lack of growth on the outside of my eyebrows was another possible sign of low thyroid. Yeah, I was wondering why my eyebrows hadn’t filled back in to their pre-chemo fullness....

I automatically slipped into interrogation mode. I asked her what would cause low thyroid and if there was any connection to the chemo. She indicated that it was an auto-immune response and that the chemo would not have triggered it. “It’s good if that is what it is,” she said, “It’s a quick fix. You would just go on medication.” I eyed her suspiciously. She knows of my disdain for any form of "unnatural" medical intervention. (Yes, I know that chemo, radiation, surgery, and tamoxifen definitely fall into the unnatural category, but I was compelled to make some exceptions in light of the diagnosis and my unwillingness to put my life on the line with unverifiable natural treatments.) “It’s just giving your body what it needs, like a vitamin,” she assured me. Still skeptical, I asked if this quick fix was a short-term thing or a long-term. “Long term,” was the response, as in the rest of my life. My disappointment was obvious. “You’ll just need to take a vitamin every day,” she said trying to reassure me.

“Well, what if it isn’t my thyroid?” I asked. “Then it’s the chemo,” was her answer. I asked her for other symptoms, and she mentioned fatigue and dry skin. I have a little of both, but then so does almost every working mother with three young children whose husband just returned to work after being home for eight years and who now has to do everything he did plus run a business, during the winter months while living in house with very dry heat. That didn’t help us much. She ordered two additional tests to be run with the other blood work.

We discussed how I would be monitored moving forward. She said that after my next six week visit, I would graduate to three month appointments for a period of two years. Then I matriculate to six month appointments. At each appointment, I’ll have blood drawn to monitor blood counts, bone and liver enzymes, salts, and other “stuff” to determine the presence of cancer. Instead of mammograms, I will have chest wall MRIs to detect a local recurrence of the cancer.

I then went somewhere I wasn’t sure I wanted to go, but I did anyway. A few weeks ago I was explaining the staging of breast cancer to my aunt and cousin and referring to a chart that was given to me int the beginning. It suddenly hit me that the presence of tumors in three quadrants of my breast seemed to fit the criteria for Stage III. I felt sick about it and was quite concerned about it for my customary 24 hour worry period. I thought about calling Dr. P because I wasn't sure if I could wait until our next scheduled appointment to learn the answer even though knowing the answer wouldn't change anything. I finally talked myself off the ledge, but when I saw Dr. P today, I just couldn't help myself, and I went there.

I told her that knowing the answer wouldn’t make a difference in what we had done or how we would proceed, but that I still felt the need to know. It's just the way I am, and I shouldn't try to analyze it beyond that. The initial staging of my breast cancer put me at IIB due to the size of the tumor and the lymph node involvement. I asked if the post-surgical pathology showing that the cancer had spread into breast tissue beyond the primary tumor bumped me up to Stage III? She never really answered the question. She said that she would have to review the lab report. She did mention that what they do know for sure is that any node involvement of more than three has a significantly higher rate of recurrence. I had two. After chemo. So we will never know. How many were positive. Before chemo.

I know that staging is imprecise, and I know regardless of how we choose to label or categorize the breast cancer that was, ultimately, the outcome will be whatever it is going to be. I also know statistics are on my side, and when doubts creep in, as they occasionally do, statistics are how I choose to reassure myself. (Kind of ironic for a gal who found no comfort from statistics while enduring that class in college.) So I left without the specific question answered, but it doesn’t matter. I won’t ask again. She understood the real question I was asking, and she responded in the way I needed.

Dr. P. asked me if I was depressed. I told her that contrary to what she may have observed during this appointment, I am generally very happy. The thyroid announcement certainly didn’t do much for my mood. Also, if one is ever able to conveniently forget about having had cancer, a visit to the oncologist is a sure-fire, slap-in-the face, alarm-ringing reminder! It’s difficult to have real positive associations with that office, so psychologically and emotionally speaking, just walking into the office can be a downer! We also discussed the feelings that accompany the completion of treatment, the kind of disorientation I described in my last posting. All things considered though, I feel really good, and I am happy.

So, I left the office and felt like crying. Low thyroid? Come on! Do you know how frustrating that is? I have altered my lifestyle significantly. I gave up coffee, for God’s sake, not to mention, alcohol, meat, stress, soda, and dessert (most of the time.) I exercise at least four times a week. I do yoga and meditation. I make sure I get at least eight hours of sleep. I am boring! And for what? I thought I was on the road to great health! I wasn’t sure whether to go to a bar or to Starbucks to drown my sorrows. I just feel that I deserve to be healthy now!

So what did I do? The boring thing, of course. I hit the treadmill and pounded out my frustrations in a productive way. I also did what I have been doing for as long I can remember when I needed to talk (excluding the turbulent adolescent years when he went through a stage when he really didn’t know what he was talking about)…. I called Dad. We talked for most of my 45 minute workout on the treadmill. Dad helped me release my emotions, and the treadmill helped me release endorphins, so I felt much better afterwards. I didn’t race to the computer to google “low thyroid.” I decided not to worry about it until such time that I received a more definitive diagnosis. If and when that happens, I will go into research mode and develop a comprehensive list of questions for the next doctor in my future.

As usual, it took about 24 hours for me to absorb and adjust to the new information. I wasn’t completely surprised or alarmed when the phone rang this afternoon and the oncology office's info appeared on the caller id. Dr. P's assistant said that Dr. P had left a message earlier. (Dr. P must have called when I walked to the bus stop to get the Cole and Clay, so I hadn't heard it.) The assistant was calling to tell me when I needed to come in to the office in the morning to have more blood drawn since one of my tests was abnormal.

I felt like I had been kicked in the stomach. “Which test?” I asked. “One of the thyroid tests,” was the reply. "But the cancer tests were all fine," I asked. I felt a huge sense of relief when the response was, "Yes." Thank God it is only the thyroid! (It’s all about perspective, isn’t it?) One of the thyroid tests came back normal, and the other was abnormal. A call to an endocrinologist resulted in a recommendation that I return for more blood work. I have an appointment for 9:00 a.m.

I almost called this posting "Approaching the last straw," but I don't want to tempt fate, and truth be told, I am far from the last straw. I have far more goodness in my life than, for lack of a better word, crap, but I sure would appreciate fewer items appearing in the crap column. No, I don't want to have thyroid issues on top of everything else right now, but if I do, I will deal with it. For one, I really don't have much of a choice. I can only control how I choose to respond to the latest challenge. Second, if it is my thyroid, all I have to do is start popping those vitamins, and I'll finally get my hair back!

Freedom?

It has been two weeks since my release. Release from what, you ask? Well, in my last posting, I likened the end of my radiation sessions to graduation from breast cancer treatment. Not! Although I did receive a humorous certificate of completion from the radiation staff (turns out the toaster was merely a carrot), there was little to distinguish this day from any other. There was no pomp and circumstance, zero, nada. I am not sure what I expected to feel or to happen as I departed the facility and put an end to this chapter. It seems as though fireworks should have been exploding, confetti flying, champagne bottles breaking (or flowing), and bands booming, but instead, it was strangely and unexpectedly anticlimactic. (I still haven't really done anything to celebrate or mark the occasion, but that is probably because I see each and every day as a celebration now.)

So, I discovered that the experience probably better correlates to being released from the state penitentiary - not that I would know what that feels like, but I imagine the feelings must be similar. You have probably seen movies where the prisoner dresses in civilian clothes for the first time in ages, stands before the opening gates of the penitentiary, and then pausing for a moment, walks through the gates into the great unknown. Yea, that’s what it feels like.

In so many ways over the last nine months, my life has not been my own. Rather, my life has been controlled by the medical community telling me where to go, when to be there, how I can expect to feel physically and emotionally, what treatments to follow, what drugs to take, what foods to avoid, etc. I was tethered to Williamsburg and couldn't wander too far away, especially during the radiation treatment requiring my presence five days a week. For the last nine months, while the rest of the world revolved around me, I had one primary focus – my health. Now, I have walked through the gates, and I find myself asking these questions: Where do I go? What do I do? Where do I start?

My life will never be the same again, and that’s fine. I don’t want it to be. That’s not to say I didn’t love my life before cancer (BC). It’s just that my BC life was full of so much beauty and abundance and goodness, and I failed to see much of it. I stressed myself out over things that seemed so important at the time but were so insignificant that I can’t even dredge up the faintest memories of the anxiety producing stuff now. Stress free life zone, that's my mantra now. And really, compared to facing a life threatening illness, most other stuff is pretty insignificant; although, unfortunately, it often takes the life threatening illness to make one realize this fundamental truth.

While getting out of bed each morning is still a challenge for me (once a night owl, always a night owl?), I try to greet each day with gratitude and recommit myself each day to spreading joy and love through my actions and interactions. I try not to take things for granted; although it is difficult to have awareness of all your gifts until they are absent. (For example, how many of you are consciously appreciative of your eyelashes from day to day? Be honest! Now how about if you didn't have them anymore? You would appreciate them, right?) I try to see beauty in everything and everyone and to experience and enjoy each moment without always thinking about the next task to be checked off the "to do" list or the next activity on the calendar. I try to live in awe of life, not in fear of death.

So, yes, I would say that my life after breast cancer is better than life before breast cancer, but that being said, what now? My physical health must obviously always remain a priority for me (as it should for everyone), but now, like the newly released ex-prisoner, I find myself struggling to establish a new identity in a world that just lost its structure and focus. What will life be like as a breast cancer survivor instead of a breast cancer patient? How will I relegate the breast cancer experience to my past while embodying the lessons I learned in the present? Will I be able to release, or at least manage the fear of recurrence in my future? (And am I getting way too dramatic?!) I guess time will tell, but I am not stressing over it. I just intend to enjoy the next leg of the journey as the road unwinds ahead of me.

While eating out with my friend, Kim, last week, I came across the following saying painted on the wall of the restaurant: “Yesterday is only a dream and tomorrow a vision. Yet each day well lived makes every yesterday a dream of happiness and tomorrow a vision of hope. Look therefore to this one day for it alone is life.”

Those words describe better than anything I could ever write, the gift that breast cancer has given me. That quote is how I plan to approach the journey that when examined in retrospect is the compilation of our life - one beautiful day at at time.

Butterfly Kisses

What happened to the month of January? It flew by. It took me so long to tell my tale of radiation that I didn’t touch on some of the other events of the last month. Not to mention, I usually write my updates in the evening, and I found myself pretty well drained by the end of each day. Instead of getting my second wind and tackling all of the tasks I usually reserve until the kids have gone to bed, I found myself just hanging out. That weariness was probably attributable to my daily sessions on the “tanning bed”. I am still getting zapped daily, but I seemed to have regained my “normal” pre-radiation energy levels. This is a relief as I was really becoming quite unorganized and wasn’t able to stay on top of simple, but important things like getting the bills out on time and writing thank you notes. Anyway, I am starting to get caught up again, and I will use this posting to give a quick summary of some of the highlights of the past month.

I saw Dr. P, my oncologist, in January. I told her about the rather negative experience I had during my initial visit to the radiation center, and how I felt both scared and diminished following that particular appointment. What was the sense of urgency about the radiation? Had I missed some important detail along the way? Should I be worried? I thought the radiation was merely insurance to reduce the risk of recurrence. Dr. P assured me that the radiation was just “icing on the cake” and postulated that the radiation doctor was probably just anxious to keep me on schedule. Phew! Dr. P truly understands how much of her role of healer is as mental as it is physical…

She said I looked “fabulous.” Nine months ago when this saga began and all of my body parts were still intact, I would have responded with, “Thanks. You are very kind.” and I would have thought, “But you are out of your mind!” BC (before cancer) I reserved the term fabulous for women far more attractive than me and with much better figures than mine. Now I have long, purple scars where my breasts once were, and I am still quite challenged in the hair department, but you know what? I do look fabulous! When I look in the mirror, I am so grateful for my body. Cellulite? So what! Stretch marks? Badges of honor! Long purple scars? Symbols of victory! Scraggly hair? Signs of health, vitality, and healing. I love my body! As I return to health, I truly am grateful for my body and will never take it for granted again.

I also had a visit with Dr. H last month. It was actually the first time I had seen him since the surgery as he had to have surgery himself shortly after my operation. He said he had just returned from a meeting where results of recent studies from M.D. Anderson (Cancer Research Center) were presented. What I understood him to say is that aggressive tumors responded better to chemo; however, the long term prognosis (15 and 20 years out) was better when there wasn’t a complete response. I had a partial response to the chemo, probably because my tumor was a less aggressive type (well-differentiated and estrogen receptor positive), and that bodes well for my long term prognosis. (I remember being a little concerned that I hadn’t had a complete response to the chemo, but now I am glad I didn’t!) He cited a recurrence rate of 15%, and Dr. P had told me about 10%. Either way, I can live with that - literally!

My brother, Jeff, came for another visit, and I am happy to report that my “chemo brain” is apparently on the mend. At least, I won a few of the many Scrabble games we played that weekend. Although a recent study reported that the effects of chemo can remain in your brain up to ten years... I guess I have a legitimate excuse for forgetfulness and other mental deficiencies for the next decade, and after that I can blame any cognitive weakness on hitting my 50s!

I haven’t talked about my hair for awhile so indulge me for a few paragraphs. I am still wearing hats, and not just because it is cold outside (20 degrees Fahrenheit today, in fact). I was just a tiny bit discouraged at my last “Tea and Talk” gathering. One of the women stopped chemo about a month after me, and instead of wearing her customary scarf, she was proudly displaying a head full of short, beautiful, new hair. I have a hypothesis: she had four chemo treatments, compared to my eight, so her body may be detoxing more quickly than mine. (I am evolving, but patience is still not one of my virtues, especially when it comes to my hair!) Of course, I was so happy for her, and she looked absolutely radiant!

My hair is returning slowly, and as I have reported in previous postings, in the same male pattern baldness manner in which it departed. The sides and back of my head are actually pretty well covered, but the top and front is still sparse. There is more head visible than hair. My widow’s peak has been the last to see any new growth, but it, too, is finally sprouting finely textured, kind of wavy, mostly pepper colored hair, with some well-deserved salt thrown in for contrast. My hair used to be so thick and coarse that I always selected shampoo that would at least claim to make an effort at taming it. Last week when I was scanning the shampoo aisle for just the right product to coax my hair back to its former glory, I found myself again paying careful attention to the labels. This time it was the one promising 70% more volume that found its way into my grocery cart!

Chemo has a real twisted sense of humor, so naturally the hair on my legs has reclaimed its territory, so I am back to shaving on a regular basis. My eyebrows are starting to fill in, and the very fine, very light "fuzz" on my face is also back from its hiatus. I remember looking in the mirror and thinking how different I looked while I was undergoing the chemo treatments, but I couldn’t quite put my finger on it. Certainly my color was a little off. Of course, my eyebrows were barely there, and my eyelashes were just plain AWOL, but. that fine down departed with so little fanfare that I never noticed it was gone and how its absence contributed to the “chemo look” until it returned.

My eyelashes are short but full! I have tried mascara a couple of times, but it gives them a kind of spiky, blunt look instead of enhancing them. No biggie there, but the following moment was a biggie. Clay, my six year old, and I were cuddling one evening, and he leaned over to give me butterfly kisses on my cheek. He loves giving and receiving butterfly kisses. Over the past several months, he had frequently asked why I couldn’t give him butterfly kisses back, to which I would matter-of-factly respond, “Because you need eyelashes, and I don’t have any, silly!” Well, I can now give butterfly kisses to my precious son again, and what a celebration that is! And, look, no smudgy mascara on occasions like that when the eyes well up with happy tears .

Many of you have been asking about Bo. After having an MRI, x-ray, ultrasound, CAT scan, and all types of blood tests, Bo still does not have a definitive answer as to why his right leg is filling with fluid every night. Dr. #4 thinks that he may have had a blood clot that has since dissolved but is continuing to affect him. That doesn’t explain many of the other symptoms, but at this point, Bo has given up on getting any more of a diagnosis than that. The good news is that between the four doctors and the forty gazillion dollars worth of tests, all the “bad” stuff that Bo could have had has been ruled out.

Bo went back to work yesterday for the first time in over seven years. He has been a stay-at- home Dad since shortly after the birth of our first son, Cole. It was so great that he could be around for me and for the boys last year during the drama that we found ourselves living. My diagnosis occurred only two months after I had just launched a new business, and obviously my priority shifted from growing a business to one of pure survival. I put the business on the back burner where it belonged and focused on my physical health. As a result, our financial health kind of went into cardiac arrest, so we are now taking the necessary steps to resuscitate it. Not to worry though. We were fortunate to have very comprehensive health insurance and that my conservative approach to money in the past ensured some financial stability during this crisis. We were also blessed to have extremely generous family members, and even friends, standing by and offering to assist if/when we needed it, so we never had to worry, as many people do, about our finances while we were concentrating on more important things, like life! How lucky are we! I am so grateful!

Bo had mixed emotions about returning to work - outside the home, that is. (It would be crazy to suggest that caring for three young boys was not serious work!) He is ready to return to a paid position, but he also knows how much he will miss spending time with the boys. The timing is good as I finish all treatment this week, but there will be adjustments for all of us, as we move into this new phase our lives as a family.

I am off to pick up that toaster. Today is my last dose of radiation, and in another hour, I will be a bona fide graduate of breast cancer treatment!!!!!!!!!!!!

Answering the Call

As you may have gathered from reading previous postings, my life is forever altered as a result of the journey of breast cancer. Aside from the obvious, and to me relatively unimportant physical alterations caused by the double mastectomy, are the less visible, but far more significant changes to my approach to life and consideration of what is meaningful. I have mentioned in previous postings that I want to use my experience in ways that will help others, whether that is advocacy, education, or support. A couple of opportunities presented themselves this past week...

My friend, Kathi, sent the following e-mail to me.

So I was watching the Today Show this morning while I was getting ready for work and they were doing a thing about the Susan G. Komen Foundation (probably had something to do with their new initiatives...) and they had their house doctor Nancy Schneiderman on debunking common breast cancer myths. And the first one was that breast self-exams were important for catching early cancers. The doctor was saying there is no data to support that doing self exams was at all advantageous in catching cancers any sooner, and that mammography was much more adept at catching cancer.

So Ann Curry kept asking her “but it’s still a good idea to do self-exams, right?” and while she never would come right out and say that she was encouraging people not to do them, she just kept saying there was no data to support their effectiveness and that if women weren’t comfortable doing them, that they shouldn’t worry, just make sure they got their mammographies. I just thought that seemed so odd... it would seem that it couldn’t hurt, and there are going to be women who do find cancerous lumps before (or a month after!) a mammography, and it seemed counter productive to basically advocate against self exams! Anyway, thought you might find that interesting.

Well, I did find it interesting, and I found it shocking as well, so I jumped on my high horse, I trotted over to my computer, and I sent the following message to the Today Show cyberspace Pony Express e-mail.

I was disappointed and concerned to hear that Dr. Nancy Schneiderman was downplaying the importance of self breast exams for detecting breast cancer on your show last week. Although I didn’t see your show that day, a friend of mine was left with the following impression after watching your show: Women who aren’t comfortable examining their own bodies for lumps shouldn’t worry about performing self breast exams as long as they are getting regular mammograms. (Dr. Schneiderman based her comments on studies that do not confirm a conclusive link between self breast exams and early detection.) While Dr. Schneiderman’s comments were surely made in the spirit of alleviating women’s anxieties about self breast exams, and while she was citing actual studies, I believe Dr. Schneiderman’s comments were at best, irresponsible, and at worst, potentially life threatening to your women viewers.

For one, studies aren’t flawless, and follow up studies often report conflicting data. Second, mammography is not 100% accurate. In fact, for young women and women with dense breast tissue, conventional mammography is about 70% effective in detecting tumors. Furthermore, as reported on your website, studies show that dense breast tissue, in addition to being more difficult to examine with mammography, is actual more prone to cancer. (If this isn’t a strong message for self breast exams, I am not sure what is!) Additionally, about 20% of tumors are detected between mammograms, so mammograms can actual give women a false sense of security that they are good to go for another year. Then, there are the women who, for whatever reasons (including finances, accessibility to clinics with the equipment, or time constraints), do not get mammograms on a regular basis. Self breast exams are cheap, quick, and easy.

Instead of encouraging women to rely on imperfect medical technology to detect illness in their own bodies, shouldn’t we instead be teaching women how to become comfortable with their bodies and how to own their health? Afterall, who knows her body better than the woman who occupies it?

I am not a medical professional. I am just a breast cancer survivor. Last year, at the age of 41, I found a large tumor in my breast one month after a mammogram detected nothing. I actually had breast cancer in three quadrants of my breast, and the mammogram showed nothing. If I hadn’t felt the tumor myself and had instead waited another year for my next mammogram, my prognosis would be far different than it is today. I have encountered many women in the past year who also detected their lumps themselves. I am confident that I could fill your studio with women who found their breast cancers through self breast exams. Maybe we are anecdotal, but study or no study, we are living proof that self breast exams work.

I am wondering how many other women walked away with the same message my friend did and who may now feel it unnecessary to monitor the health of their breasts and ultimately their bodies. Since my experience with breast cancer, I have made an effort to educate women about the importance of early detection through both self breast exams and the latest medical technology. Your show is watched by so many women (and their husbands, partners, sons, fathers, etc.). It is unfortunate that the opportunity to urge women to take control of their own health was lost. I may be just an anecdote, but if you wish to communicate a message of empowerment to women, I would be happy to tell the world, via your show.

I received the expected and customary form e-mail response thanking me for my comments and advising me that they receive hundreds of e-mail responses a day and while all e-mails are read, all e-mails do not receive a personalized response. Nonetheless, I felt better for having gotten it off my chest, what's left of it anyway. (Smile)

Also this week, I received a call from the "Tea and Talk" founder, aka the Good Health Fairy, about a young woman in Williamsburg who was just diagnosed with breast cancer two weeks ago at the age of 34. I called the woman, and we spoke for awhile. She has already had a lumpectomy, and two lymph nodes were found positive, so she will begin chemotherapy this month. I offered to meet with her in person and then asked if her husband might benefit from talking to my husband. She thought he would find it helpful, so we are all getting together. I am excited that they are both coming over for dinner tomorrow night and bringing their young daughter as well. The woman is also very interested in joining "Tea and Talk", our informal support group for young breast cancer victors, and now she will have at least met one of us before our next gathering.

While I have a strong desire to turn my breast cancer experience into a positive for others (and for myself as well), I think the challenge moving forward for me is twofold and will require establishing balance. I mustn't allow my newfound passion to interfere with the time and attention that I need to devote to an income producing business. Second, I must take care not to turn this passion into my identity. I am not breast cancer, and I don't want that one chapter of my life to dominate my future. As always, a work in progress I am.