Saturday, December 26, 2009

Why I'm Always Sad at Christmas

The last time that I saw my Mother alive was at Christmas. She was living in her lovely little apartment in a beautiful converted church building, near the University at which she had worked before I was born. She was the Secretary to the Dean of Women in the 1950's, and she spoke with pride about her time there.

She met my Father when they worked at the same Company; she was his boss' secretary. They fell in love, and against her family's wishes, she married him. He came from "the wrong side of town", and from a much poorer family. The marriage was most likely doomed by their decision to live in the same house as my Mother's parents; this was a common custom at the time. They separated when I was 2, and he moved away when I was 6. My Mother led a very lonely life; unlike today, there were very few "broken homes" in the 60's, so she experienced a lot of social isolation. She focused her entire life on raising me.

When my Grandfather died, and we were forced to close our family's shoe store, she had to find work as a waitress just to get along. Later, she worked for several years in a department store owned by a family friend. Her last job, which she held for over a decade, was the secretary to the Director of a social services agency for senior citizens. Finally, she became unable to work due to her worsening emphysema and congestive heart disease.

Her Sister effectively forced her from the only home which she had ever known as part of settling my Grandmother's estate. This was completely ruthless and unnecessary, as my Aunt's husband had just been awarded a very large sum of money to settle a medical malpractice lawsuit. I urged my Mother to legally contest losing her home, which she had been paying all costs to maintain, but she was emotionally devastated by her own Mother's death, and by her Sister's actions. This affected her health as well, and hastened her decline.

I was able to get my Mother into the church apartment due to her past association with the University. A wonderful husband and wife team were the building's caretakers; they lived on the premises, and kept an eye on the tenants, who were all either elderly or disabled, like my Mother. Sue and Dick often had all of the residents over for dinners and parties. It gave me comfort that my Mother was living there with such caring people. Her apartment was on the ground floor, with a private outside entrance, a combined living/dining/kitchen area, and a separate bedroom. The building's striking architectural details were preserved throughout.

That last Christmas, we visited her in her new place. I had earlier helped her put up the tree; we decorated it together, with the ornaments lovingly collected over the years, and placed our Family's keepsake decorations around her apartment. Everything looked beautiful, and she was so happy; at least some things from her former home were still with her in this next phase of her life.

She was my only parent during my childhood, and had worked very hard during some truly challenging times to make sure that I had whatever I wanted. I fondly remember the Christmas when I got my folk guitar; and the year before, she gave me a sewing machine. These were very meaningful Christmas presents, and not inexpensive. I know that she constantly put aside her needs to fulfill my dreams.

I owed so much to her, and I knew it. So, now that she was ill, I would make sure that she was taken care of in return. My husband had just gotten a better-paying job, and we were really pleased, because it meant that we could do more for her. She had emphysema, had smoked since her teenage years, and even had to have part of a lung removed because it was so severely damaged. As a result, she was unable to walk more than a few steps, or leave her home to go anywhere other than for medical appointments. I did her grocery shopping, housework, banking, got her medicines, and helped however I could. She wanted to live alone, and she liked it that way.

I would see her in person almost every day. I spoke with her on the phone just before my husband and I went away for New Year's; she was going to spend New Year's with the other residents at the caretakers' apartment.

We returned a couple of days after New Year's, and I got a phone call from my Mother's cousin: my Mother wasn't answering her phone, and her cousin was worried. With mounting fear, I called Sue and Dick at my Mother's building with this news. Sue said that she had been at their New Year's party, and had a wonderful time. She sent Dick to my Mother's apartment to check on her.

Dick found my Mother dead in her apartment; she had been dead for at least several hours. He was in tears as he told me the news. It was almost unreal. I was in shock.

In a complete haze of fear and emotion, my husband and I went to her building. Police cars were already there, with lights flashing. Upon entering the apartment, two policemen were standing there; they took my information, and let us go into the bedroom to see my Mother.

She was slumped over, looking so tiny and frail, sitting on a wooden chair; it looked as though she must have died either putting on or taking off her slippers, because one slipper was on, and the other was off. This somehow reassured me that her end came very quickly, because she wasn't able to complete the task. At least she wasn't in a hospital, hooked up to machines, as had been the case so many other times in the past, when her doctors told me that she wouldn't survive. She was only 59 years old.

The funeral home attendants arrived, went into the bedroom, and closed the door. I waited, looking around at all of the Holiday decorations, and the presents that she would now never get to use. Her bedroom door opened. Next, I saw my Mother being wheeled past the Christmas tree, but now she was in a plastic body bag. I will never get that image out of my mind. She was gone, being taken away from me forever, in the midst of a scene which formerly had been so happy. I would never feel the same way about Christmas; even now, 22 years later.

Taking down the Christmas tree and putting away the decorations which she so loved were further reminders of her permanent absence. Years later, I have no interest in decorating my house for Christmas; perhaps I see it as a bad omen, and that I will lose someone I love if I do...the mind works in such mysterious ways. This is why I am always sad at Christmas time.

Friday, December 11, 2009

Another benefit from Fosamax?

As part of my cancer treatment regimen, I was placed on a daily dose of Arimidex, an aromatase inhibitor which effectively brings your circulating blood estrogen to a non-existent level. A five-year course of the drug is now standard procedure for post-menopausal women with estrogen-positive breast cancers. The drug deprives cancer cells of the estrogen which the cancer needs in order to grow, hopefully preventing any recurrence.

Because a total lack of estrogen is extremely harmful to existing bones and bone growth, patients are usually prescribed an osteoporosis drug in tandem with the aromatase inhibitor: I was put on a weekly dose of Fosamax, and I have now taken both drugs for almost 2 years.

On Thursday, Dec. 10th, the results of a new observational study involving more than 150,000 post-menopausal women were announced at the San Antonio Breast Cancer Symposium: women taking Fosamax, or other biphosphonate osteoporosis drugs (Boniva, Actonel) had 32% fewer cases of invasive breast cancer than women who were not taking these drugs. This is a significant finding, both for the percentage of cancers avoided, and because the biphosphonates are now seen to benefit patients in an entirely different manner than for which they were originally intended.

A previous study had already established that breast cancer patients who were given biphosphonate osteoporosis medication (Zometa) intravenously every 6 months developed fewer new contralateral breast cancers in the unaffected breast.

So, treatment with osteoporosis biphosphonate drugs appears both to prevent cancer recurrence in breast cancer patients, and also to reduce initial occurrences of breast cancer in healthy postmenopausal women. The drugs are also seen to prevent breast cancers from spreading to the bones by creating unfavorable conditions for tumor growth in bone tissues.

The chief oncologist behind the latest study stated that the biphosphonates also interfere with growth of blood vessels to tumors, and they simultaneously stimulate immune cells whose role is to seek out and destroy tumor cells.

If this can all be proven, there will be other very good reasons for post-menopausal women to take osteoporosis drugs. Right now, I'm very glad to hear that I might also be reducing my chance of developing a new cancer via both the Arimidex and Fosamax. Hopeful news!

Sunday, November 22, 2009

Mixed Messages About Breast Cancer Screening

Almost 2 weeks ago, the U.S. Preventive Services Task Force (USPSTF) announced a change in their recommended routine breast cancer screening guidelines: "The USPSTF recommends against routine screening mammography in women aged 40 to 49 years." This set off a swarm of controversy and confusion.

The USPSTF's reasoning behind having women delay mammographic screening for an entire decade (!) cited that mammography has the most benefit for women aged 50 to 74, meaning that it is more effective in finding actual breast cancers among women in this age group. Mammography was cited as having "maximum effectiveness" for women aged 60 - 69 years.

For women aged 40 - 49, the recommendation mentions specifically that false-positive results occur more often within this age group. This might well be true, but as roughly 25% of breast cancers are found when women are in their 40s, I cannot begin to understand how delaying screening for 10 years could ever be advised. Also, many of the most aggressive cancers occur when women are in their 40s.

According to the American Cancer Society, for the year 2006, women in their 40s accounted for 17% of the deaths from breast cancer. This is not an insignificant number. If the USPSTF thinks that the ratio of 1900 women screened to 1 life saved is not enough to justify recommending screening for women in their 40s, they are overlooking the fact that most of the patients surveyed for any disease will not have it; that's why they call it "screening". If 17% of breast cancer deaths, and over 25% of breast cancer cases occur in women 40 - 49, their recommendation to do nothing until age 50 is completely outrageous.

And, if you're a gal who is 75 or older, you have apparently lived long enough, according to the USPSTF. There is "insufficient evidence" to recommend mammography screening for this age group. I have read some very heated comments on the web from women in this category: they are planning to live a very long time, and who is to decide that their lives are not worth as much as women in their 60s and 50s...? The answer is, "no one".

The USPSTF also mentions the "psychological harms" of undergoing screening and biopsies; I can tell you from personal experience that the anxiety which you feel while waiting for your biopsy results is nothing, compared to hearing those utterly devastating words, "We found cancer". Most women would rather undergo a temporary period of anxiety about their mammogram or biopsy results, because for most of them, it is followed by the relief that they feel when they find out they are cancer-free.

The entire biopsy process is much easier now than it was when I had my first cancer scare 16 years ago: I had to undergo general anesthesia, have an excisional biopsy/tumor removal in an operating room, then awake from the anesthesia to find out whether or not I had cancer. When my cancer was found in 2007, I underwent a stereotactic biopsy in a surgical suite, where I was awake the entire time, and only needed a tiny incision. A month later, post-MRI, I had to have another stereotactic biopsy of a suspicious growth in my other breast; thankfully, this turned out to be benign, although I had mentally prepared myself for the possibility of having cancer in both breasts.

I am very concerned that women who don't routinely get mammograms will use this as an excuse to delay or forego being screened. We all know friends or co-workers who put off getting their mammograms for one reason or another, and they will use the USPSTF's recommendation to justify their decision. This will ultimately cause more harm, and have women presenting with more advanced cancers, diminishing their chances of survival. This is costly to the patient's quality of life, and to the entire healthcare system, as these cases are more difficult and expensive to treat.

Many medical professionals are now angered by the climate of confusion and conflicting messages which the USPSTF has created: for decades, women have been encouraged to have regular mammograms, which do save lives. My cancer was found by my yearly, non-digital mammogram, and I remain extremely grateful for this. I am convinced that my mammogram saved my life.

The American Cancer Society and the National Cancer Institute still recommend yearly mammograms for women aged 40 to 49. This is the important thing to remember, and please, get screened. Life is precious.

Saturday, November 14, 2009

My Biggest Health Challenge

My biggest health challenge right now is losing the extra pounds I gained during and in the months following my radiation treatments. As I have written here, I have never weighed as much as I do now; besides the aesthetic and wardrobe limitation issues this brings with it, I need to lose weight for my continued health. I was always a tiny little person; now, I'm still tiny vertically... To minimize the risk of my cancer returning, and to prevent heart disease and diabetes, I have to lose weight.

I literally wanted to sleep all of the time during radiation; I even started drinking coffee at work (something I had never done before) just to stay awake. For someone who was always described as "perky" and "bubbly", I barely managed to drag myself through the day, by sheer force of will. The fatigue that I experienced was profound, and it made the slightest effort seem truly overwhelming. Exercising was impossible; everything seemed like exercise!

Sometimes, I would find myself eating just to keep awake, and I could no longer eat the same foods that I formerly enjoyed. At the end of the day, there was no "second wind" to draw upon for my usual working out with weights, or walking on the treadmill. Napping became a major activity; when I finally managed to go out on the weekends for a 4-mile walk, I would have to take a 2-hour nap afterwards just to be able to stay up until my usual bedtime.

Now, I find that I'm running around at work or at home, and I consciously realize that I'm getting my energy back. Last weekend, I walked 4 miles both days, and I'd like to keep it that way! I'm working out with weights regularly, although at times I feel like the photo above; I'm walking on the nature trail near my home, and on the treadmill. It's much easier walking outside than on the treadmill, though, because I feel like I'm enjoying nature, and not "exercising".

My eating habits are better now: whole grains, fruits and vegetables, lots of water, small meals. I try to maintain some of my "old" rules, such as not eating anything after a certain time of day (usually 8PM or so). I don't believe that some foods should be "forbidden"; you will just crave them even more. That's why snack-size candy bars and ice cream cones were invented! My daily medications present challenges to some patients in their efforts to lose weight; I managed not to gain any weight when I fractured my ankle and couldn't even walk for 2 weeks. That, to me, was an achievement! Right now, I'm losing 1 pound a week, and I'm happy with that.

I saw my oncologist Thursday, and said that by the next time I see her, I hope that there's less of me to see. That would be another "milestone" to reach on my way back from July 2007. Wish me luck!

Saturday, October 31, 2009

Over-Screening for Breast Cancer?

Earlier this month, both the American Cancer Society (ACS) and the Journal of the American Medical Association (JAMA) published communications alerting the medical community about over-screening for breast cancer. The estimate now is that 30% of the breast cancers which are found are so slow-growing that they are not life-threatening; and, some of these will disappear completely without any medical intervention at all.

Breast cancer screening has greatly improved the ability to find very small tumors; mine was only 2mm in size, and showed up on my yearly screening mammogram as a concentration of white dots, called microcalcifications, indicating an area of rapid cell turnover. The tumor wasn't found at my OBGYN exam a few weeks before; it would have taken months before it had grown large enough to be felt.

My tumor had already reached the invasive stage; it had broken through the breast duct, and was invading the surrounding tissue. At this point, the cancer cells have had a chance to reach other areas of the body, possibly creating secondary tumors. If the patient is fortunate, there has been no metastases, or tumor formation at other sites, and the cancer cells which did migrate elsewhere have been killed by the patient's immune system.

People have asked me how I feel about undergoing biopsies, 2 lumpectomies, 6 weeks of radiation, several screening scans and MRIs, and taking anti-cancer meds for a 5-year course when there is a 30% chance that my cancer wasn't deadly to begin with.

My response is that there is a 70% chance that my invasive cancer would have killed me, so I am very happy that it was found so early. If I had not gotten my yearly mammograms as recommended, my cancer might have spread to my lymph nodes, greatly decreasing the odds of my survival. Another advantage is that my node-negative status meant that I avoided needing chemotherapy, and I am very grateful for that.

I don't feel that I should have delayed treatment, hoping that my cancer would resolve itself. Once you find out that you have cancer, you just want it out of your body. It would be difficult, if not impossible, to just "do nothing" when you're diagnosed, unless there is an additional means of confirming that the cancer you have is indeed the non-fatal type.

My cancer was Stage 1, but even cancers this small, and some at Stage 0 (non-invasive) have proven deadly. There is so much that we still don't know about what causes some cancers to grow, and others to become dormant, or even totally disappear.

So, until researchers can determine which breast cancers are non-fatal, women shouldn't forego being screened. The ACS is standing by its recommendation of yearly mammograms for women over 40. That is vital for us to remember amid all of the current controversy.

Friday, October 9, 2009

Your "new normal"

As a cancer patient, your goal is to reach the end of your active course of treatment, and to get your life back to where it was before you were diagnosed. But, like so many other things, this is not as easy as it sounds, physically, mentally, or emotionally. And, the truth is: your life will never be the same. You have gone through a life-altering experience. There's a term for what you're attempting to establish: your "new normal"; meaning living as normally as possible, knowing that you cannot restore your pre-cancer life.

Your transition from a "cancer patient" to a "person with cancer" isn't easy. You eagerly hoped for the end of your active treatment period, when it seems as if all of your waking moments are spent going to medical appointments, imaging studies, chemo and/or radiation, lab testing, etc. You know that it's necessary, but you can't wait for it to be over, and you feel more like a patient than a person.

When you're placed on "follow-up", you're going to really miss the personal contact with, and support from, the majority of the wonderful people who got you through a hellish period of your life. You will feel very alone as you face the future. You need to prepare for how you will handle this transition, and what resources you'll need to establish your "new normal".

You may find that emotions which you suppressed during treatment are now coming to the surface, such as anger and sadness. This is similar to post-traumatic stress, or delayed grief. It's vital that you face your feelings and work through them; otherwise, they will prevent you from moving on with your life. Talking to family, close friends, or even joining a support group will help you realize that you are not as alone as you might feel at this time.

Chances are, you'll deal each day with physical reminders of what you've been through as well: I see my scars, and as they are healing, I'm also healing inside. I don't think about my cancer returning, but if it does, I know that I'm strong enough to face it. I won't allow cancer to "co-opt" my present, or my future. I wake up each day seeing the person in the mirror as someone who has "had" cancer, even though I still visit my doctors, take daily meds, and will be doing so for a few more years.

Many people, as part of their "new normal", choose to do something which gives meaning and purpose to their cancer experience. For me, it was deciding to begin this website, writing about my journey. Previously, I wouldn't have had the courage to do something like this, but this is one of the "gifts" of my cancer. I wanted to take something negative and turn it into a positive; I also hoped that sharing my feelings might be of some help to other cancer patients.

People also decide at this time to follow their dreams, do things they never had the chance to do before, or take their future life in an entirely different direction, such as: going on that trip they've only imagined, climbing a mountain, or starting their own business. The rest of your life from this point forward should be defined by you, not by your disease.

For me, the dream is to retire and to move to Maui. After all that I've been through, I'm even more determined to make this my reality. I want to die there, and have my ashes scattered at Keawakapu. When Lindbergh was receiving medical treatment in New York, and it was confirmed that he only had a few days to live, he asked to be flown back to Maui so that he could die at his beloved Kipahulu. I feel the same way.

Focus on your future, and do something meaningful with the life which has been "given back" to you.

Life is precious. Don't waste it!

Friday, September 25, 2009

Do You See Miracles?

"There are two ways to live: you can live as if nothing is a miracle; you can live as if everything is a miracle." Albert Einstein

I read this quote on another website about a cancer patient, and it really hit home. I have always been someone who lives as if everything is miraculous, and this has been greatly magnified by having cancer.

Is life really worth living if you never take delight in what you see around you, who you have around you, and what gifts you have been given? To me, that's not living; it's just existing, and there is a huge difference.

I know that the fact that I'm alive is a miracle: when I was born 2 1/2 months premature, weighing 2 lbs. 7 oz., all that could be done was to baptize me and put me in an incubator. The amazing technology we now have to assist very tiny babies didn't even exist.

For a while, the doctors thought that I was born blind, that I would probably have severe problems ever walking or moving normally, and there was a good chance that my brain would be damaged by the inexact oxygen levels of my contained environment. My chance of survival was slim. All that I had going for me was my will to live, and the tender care of the nursing Sisters of Providence, who were completely devoted to me. I was released from the hospital 3 months later, weighing a whopping 5 pounds, still resembling a doll more than an actual baby. The doctor who delivered me used to call me "the little atom", because I was so small at birth.

I beat the odds, and survived, with no adverse affects. So, perhaps why someone like me sees life as miraculous - for me, it really is.

It's easy to get jaded and cynical about life, but it doesn't have to be that way; and, you don't have to experience life-threatening illness to make you appreciate being alive. There are miracles for you to find each and every day. It all depends on your outlook, as Einstein wisely observed.

So, I ask, "Do You See Miracles?" I hope so...

Monday, September 21, 2009

Back on my feet again - with caution!

I went to the orthopedist today, and I have been medically cleared to put weight on my foot and walk around again. I have to wear the Aircast brace for a couple of weeks or so, but this means that I can now leave the house, drive my car, and...go back to work!

My ankle is healing exceptionally well, even though my ankle and foot still look disgusting; an overall yellow, with a purple undertone, and bruises which will take some time to go away, I'm sure. I will be doing exercises at home to increase the mobility and strength of my ankle, and I'm getting used to walking around with the Aircast.

I'm sure that a lot of my progress is directly due to the terrific care and advice I received from my husband while I was unable to walk. As a former runner who has even done a marathon, he is a veteran of many ankle injuries, and his experience was invaluable to me during this time. We're planning to go out walking again this coming weekend; this is permitted, as long as I'm wearing the Aircast brace. It might not be a 4-mile walk, but I will be out there on the trail again! (Watching out for lurking holes in the grass...)

Just being out of commission for a couple of weeks made me feel truly sorry for anyone who is permanently confined to bed, or housebound. My Irish Nana who raised me used to say, "Every day that you wake up and you put two feet on the floor is a good day", so now I have a greater realization of just what she meant by that.

So, even though I didn't break anything in 1995 when I was run over by a van in Manhattan, but managed to break something just walking near my home, I feel very happy about the way this entire experience worked out. I will be wearing my Aircast, working out with weights soon, and getting back to my usual activities.

I would have been totally lost without my iPod Touch, its fantastic apps, and its wireless Internet, as I couldn't get to the Mac during my non-weightbearing stint. It was a lifesaver!

Monday, September 14, 2009

A Minor Setback

One week ago, I was out for my usual 4-mile walk with my husband, on the nature trail near my home. We were only a few blocks from home, and had just exited the trail, walking at the side of the road on some grass, when I suddenly stepped into a hole several inches deep, slammed into the ground on my forearms and hands, and injured my ankle. The hole was completely covered over by the grass surrounding it, so I didn't see it as I looked ahead.

As I struggled to stand up, I was acutely aware that I had done something terrible to my right ankle. Placing weight on my foot was difficult, coupled with a sharp, scream-inducing pain, which traveled up the outside of my ankle and calf if I moved my leg in the wrong direction. I insisted on "toughing it out" and carefully walking home, with my husband helping me. It was obvious that I needed to be taken to the hospital, as my ankle was swelling up considerably.

At the ER, I was placed in a wheelchair, and wheeled in to be evaluated. I noticed that the NP was wearing a breast cancer pink ribbon pin. When I commented on this, she said that she had been diagnosed with breast cancer at age 36, and had undergone a double mastectomy, and chemo, which "kicked her ass". I told her that I was also a breast cancer patient, and that I was glad that her ass had been kicked, because that meant that she was still here! As I have written before, you really do bond with other cancer patients, which is one "gift" of having had this experience.

I was placed on a gurney, and after a while, was wheeled into the radiology area for several foot/ankle x-rays. At this moment, it occurred to me that this was the first time since being diagnosed that I was NOT here at my "usual" hospital for anything related to my cancer treatment; and it was a positive realization. Today, I was just "the woman with an ankle injury"; how different for someone who had spent many days there seeing doctors, undergoing surgeries, scans and tests, having my radiation treatments, etc.

I was sent home wearing an Aircast, but told to see an orthopedist ASAP, preferably the following day. I managed to get an appointment with a MD at my husband's ortho MD group, and they confirmed that I had a hairline fracture (described as a "good" fracture) where the sprained ligament attaches to the ankle bone. I left the orthopedist's office wearing a knee-length, black "boot" that looks as if it was designed for Darth Vader.

Mine is black, not navy blue (the above photo was the best one I could find on the web), and the ortho nurse told me "Black goes with everything" - hmmm - what would anyone wear with the likes of this futuristic, velcro-laden footwear? The boot makes the ankle feel a lot more protected and better isolates the joint; although, it also evokes images of Frankenstein lumbering around as well...!

I have been home now for a week (one more week to go!), forbidden to walk anywhere except for short trips to the bathroom or other areas on the same level. The pain has gone from a "9" to about a "2", but if I move in the "wrong" direction, or something presses on the outside of my ankle - yeoucchh! My foot is bruised on both sides of my ankle; I have purple bruises at the bottom of my toes (!), and the top surface of my foot is now turning a lovely yellow color, which complements the purple.

I'm seeing the orthopedist one week from today, and hopefully, then I can go back to the Aircast, which means that I can drive a car, and thus, return to work.

My wonderful husband has been taking very good care of me: driving me to the ER and to the orthopedist, preparing and bringing me my meals, getting my pillows, refilling my drinking bottle, helping me get around, and making me laugh, which really is very good medicine. He has been amazing, just as he was when I was recovering from my surgeries.

I'm determined not to gain more weight just because I can't exercise right now, and, as soon as it's medically possible, I'll be back "out there" on the trail, walking my post-cancer pounds away. This is just a setback, and I have already laughed about it! Why, it's as easy as "stepping in a hole"! So now, I know exactly how that expression came to be.

Sunday, September 6, 2009

Healthy Habits Preventing Breast Cancer?

Last Tuesday, a study was published stating that almost 40% of breast cancer cases could be prevented by good health habits. When I was diagnosed, I weighed roughly the same as I had 30 years ago, had been lifting weights since 1980, and had been avoiding alcohol, as I knew that drinking alcohol increased my risk. I also ate healthy foods, limited my red meat intake, drank water instead of soda, and ate a low-fat diet: for example, my daily lunch consisted of carrots, yogurt, and fruit.

Studies like this can mislead women into a false sense of wellbeing- as most breast cancer cases clearly can't be prevented by the behaviors they describe. I hoped that avoiding alcohol would lower my risk, but I never believed that doing this would prevent me from getting breast cancer: all you can do is practice a healthy lifestyle, and hope for the best.
The majority, or 60% of breast cancer cases, are not influenced by someone's health habits, but it is still a good idea to practice healthy behaviors. I was thin when I was diagnosed, and gained weight during treatment; so, I'm happy that I didn't weigh 20 or 30 pounds more at the time of my diagnosis, or, I would be faced with losing even more now as I attempt to reach my precancer body weight.

Preventing breast cancer, unfortunately, isn't as simple as the study makes it seem. I would hate for other women to think that a healthy lifestyle will spare you: mine certainly did not spare me. Be healthy, yes; but most importantly, get screened on a regular basis; this is the health practice which could, and will, actually save your life.

Monday, August 17, 2009

What Cancer Cannot Take From You

When you learn that you have cancer, you'll view your life up to that point as "B.C.": "before cancer", and "A.D.": "after diagnosis". Cancer will be your focus for at least the next few months, mentally and physically. It will take over your life during your active treatment, and you will most likely lose part of your body to it. Cancer has co-opted your present, and your future. Your sense of invulnerability has been stolen from you. You have the right to be angry, but you have to work through this, and ultimately realize what cancer cannot take from you.

Long after your active treatment, cancer will steal things from you on a smaller scale: I take my anti-cancer medicine each day as part of a planned five-year course, knowing that it will greatly increase my chances of long-term survival. The associated side effects of the medicine are a daily reminder that I'm still fighting not just the cancer, but weight gain, greatly increased vasomotor episodes, gastrointestinal issues, and lingering fatigue. I have felt at times as if I'm seeing another "me" in the mirror, and it's difficult to remember the tiny, energetic person whom I no longer see there. Sometimes two years in the past ("B.C.") seems like a lifetime ago. 

When I wrote earlier about the cruelty of Alzheimer's Disease, robbing the patient of his/her identity, gradually taking them from their loved ones right before their eyes, with the only relief being certain death, I said that Alzheimer's is a far crueler fate than cancer; and I still believe it.

I know this beyond any doubt: I am still "me", and cancer is not going to change my personality, or make me focus on what I have lost, instead of what I have gained from this experience. My sense of humor is still intact. I still find joy in each day; I feel very fortunate to be alive, and well. I still have my smile, and I will never lose it! How would I ever have known how strong I could be, and how much I could endure? So, yes, it has taken something from me, but I have found a way to appreciate what it has given to me, also.

We are all tested in one way or another; you will be amazed at what you can overcome, and how powerful your will to live really is. Cancer can take your essence away from you, but only if you allow it. I'm not going to let that happen.  

Thursday, July 23, 2009

Get Your Mammogram!! Take control of your life!!

I just got my regular screening mammogram yesterday, and although it's not entirely without pain for me (especially after my surgeries!), I can't ever imagine postponing it, or thinking that I'll forgo it "this time". And neither should you...
My mammogram in 2007 SAVED MY LIFE, and caught my invasive breast cancer long before it could even have been felt by a physical exam. My cancer hadn't spread to my lymph nodes, but if I had waited another 6 months or a year to be screened, this might not have been the case, and my chances for survival would not be as favorable. Because my cancer was found early, I didn't need chemotherapy, just radiation; another positive aspect of regular screening.

And, my cancer was found on a non-digital mammogram, for those of you who have doubts about the effectiveness of didn't show up on an ultrasound or on a MRI at all!

I have worked in healthcare since 1980, and I have seen the tragic results of women's fear of cancer preventing them from being screened. It's not necessarily a question of being without medical coverage, as many people suppose is the case. Sadly, even when mammograms are offered at no cost, many women choose the "avoidance" approach, because they're so afraid to find out their breast health status. Even more tragic, when the same women later present with symptoms, it's much more serious, and may be too late: their cancer has now advanced to their lymphatic system, and possibly to other organs, such as their lungs, bones, and brain.

Please, do this for you, for your loved ones, your friends - take action, and get a mammogram! Don't wait until you find a lump or see something that doesn't look right. Face your fears, and get screened. I know it's scary; I'm a cancer patient, and I still think of the possibility of a new cancer being found. But, I'd rather find it earlier than later - wouldn't you?

Friday, July 10, 2009

Two Years Later

Today, it has been two years since I was diagnosed with cancer.

Some days, July 10, 2007 seems long ago; but, even now, I can acutely remember exactly how I felt at the moment I found out that my life would be changed forever.

What are my thoughts on this 2-year anniversary of being a person with cancer?

First, I'm truly thankful for being alive, and for the caring and expertise of my physicians, techs, nurses, and medical assistants. I literally wouldn't be here on this earth without you, and I am forever grateful.

I now know that I'm an extremely strong person, mentally, emotionally, and physically; far more than I ever would have realized prior to my illness. I wouldn't wish what I have gone through on anyone; but I am heartened by the fact that I was able to face it, and persevere. Whatever doesn't kill you really does make you stronger; or to put it another way, you will discover your real level of inner strength when you can endure things that you never imagined you could.

Things which formerly would have seemed like a problem now are very insignificant; and things which would have terrified me no longer seem frightening. Cancer has a way of resetting your perspective on the world. As I have written elsewhere, you realize that life is truly about "the little things".

The unfairness of Fate is not easy to accept sometimes. Before this experience, I had never been seriously ill. While I know I'm lucky to have been healthy for so long, it was a major blow to my psyche to have this happen. You feel betrayed by your body somehow. I exercised religiously, never smoked, had good health habits, and boom! - this happened.

My greatest joy in life is the unfailing love and support of my best friend, who is also my husband. He cared for me when I was ill, and he is my hero and protector. When I look my worst, he still tells me that I'm beautiful. There is no greater love that I could ever hope to have. All that I want is to grow old with him, and I believe that I will get my wish.

There are now many other people in my life who have opened their hearts to me. Everywhere I go, I am constantly reminded of the love that I have been given, which is an amazing thing; this is one of the "pluses" of my situation.

I don't fear death, and I can't imagine wanting to live forever; that seems like a terrible fate to me. The important thing is to see beauty in each day, and to live in the present.

I don't worry about my cancer returning; I'm concentrating on what's happening right now, and on my healthy future. Two years later, I am in a very good place.

I have vowed to take something negative and turn it into something positive.

I know that even if I become ill again, cancer may take my life, but it will never claim my smile; because then it will have truly won, and I won't ever allow that to happen.

Thursday, July 9, 2009

An Army of Women

Today, I joined an army: the Love/Avon Army of Women.

The goal is to recruit one million women of every age, ethnicity, and breast cancer risk/status to be available for participation in research studies. The focus of the studies is to learn how breast cancer begins, and then seeing what can be done to prevent it. We have been very successful in finding breast cancer at its earliest stages (my tumor was 2mm, and appeared only as a cluster of microcalcifications (white spots) on a mammogram). Now, we need to go one step further!

So, why not have actual women (instead of lab mice) volunteer to partner with researchers examining the cause(s) of breast cancer? It is a real opportunity for myself and others to take action and change lives. Women who join the Army are e-mailed about studies that need volunteers, and women who match the study criteria respond to the initial e-mail if they're interested in participating. Responding doesn't ensure participation, as all possible candidates must be screened. No one can be forced into joining a study; it's purely voluntary.

Dr. Susan Love is an eminent breast surgeon and author. I read "Dr. Susan Love's Breast Book" before I was officially diagnosed, and I learned everything I needed to know about what I might possibly face as a breast cancer patient. I have immense respect for her dedication to the cause, and this blog has a link to her Research Foundation's informative and helpful website. So, when I found out that she was the force behind this movement, I wanted to be a part of it.

Currently, almost 300,000 women have signed up at the Army of Women website. Just click on the widget at the right of the page to check it out and read about your chance to participate in the effort to prevent breast cancer from ever happening. I know that I would like to do whatever I can to ensure that its days are numbered. This is a real chance for "average" women to really make a difference in others' lives. 

Tuesday, June 30, 2009

Another Day Ends in Maui...

As today ends, I'll think about the ethereal beauty of a Maui sunset...Maui No Ka 'Oi! (Maui Is The Best!).

Images of Maui

Here are some photos from my last trip to Maui. I hope to return soon, because I have "left my heart" there...since 1985, I have been in love with Maui. I'm not a religious person, but it has a spirituality which you can almost feel. The light, the colors, the air, the water, all combine hypnotically to make you want to stay forever. I cried the first time that I left; walking up the huge set of metal steps next to the jet on the tarmac, looking around at the beautiful mountains, and wondering if it was all just a dream.

I was able to return there three years later to confirm that this much beauty could indeed exist in one magical place. It is called "The Magic Isle", and there's truth in the name! On my third, and most recent trip, it was more developed in places, but it still has its magic intact...I will go back, and hopefully, one day, I won't have to leave. 

Saturday, June 27, 2009

A Trip to the Ocean

Last week, I took my first actual vacation in the past 3 years. For me, this is another sign that my life has returned to normality. Being able to "get away" from your home, your job, and to realize that there was a time when this literally wouldn't have been physically possible for me makes me feel very fortunate.

Going to a place which I have held in my heart for many years, and being able to return there with my beloved husband was like a gift. His devotion, care, and patience during my illness meant so much, and to have this special time with him was truly wonderful. Even though the weather was cloudy except for one day, this didn't really matter. We celebrated our 31st wedding anniversary during the trip, and I'm very proud that we have achieved this. Those two "20-somethings" in love are now two "50-somethings" in love, and I can honestly say that our challenges over the years have only brought us closer together. He is my reason for living; his unfailing support and encouragement in everything I do has been invaluable, and I think that he could say the same about me. We're partners for life, through whatever happens to us, or around us.

My vacations almost always involve the ocean; there is something so primal and restorative about seeing the waves, hearing them break and come onshore, the scent of the salt air, the feel of the soft sand. The ocean's sense of permanence is reassuring to us, and perhaps we do feel a connection because our bodies are composed of so much water. Or, just because it's impressive, powerful, and beautiful!

Growing up where the ocean was just a drive away, and now, living on a river which is an ocean estuary, I know that I would never be happy living somewhere far from the ocean. And of course, I dream about living in Maui, where your daily activities always involve communing with the magical waters surrounding the island. Maybe someday...


Tuesday, June 9, 2009

National Cancer Survivors' Day

Sunday was National Cancer Survivors' Day, which is held on the first Sunday in June. The first thought I have about this is how wonderful it is that there are so many people now considered "cancer survivors" (over 10 million). The second thought is that I still don't consider myself a "survivor" just yet, 23 months post-diagnosis. I think that passing the 5-year mark would meet my personal definition of the term. I won't be celebrating just yet, but I certainly hope to someday...

Can you recall when hearing that someone had "cancer", that you immediately thought they were going to die? I do; and I also remember as a child hearing people whisper the word in hushed tones, or calling it 'the big C". They were afraid to say it out loud, as if it was something shameful or secret.

The very word held immeasurable power over us. It no longer does, due to the advances in research and treatment for almost all types of cancer. Also, brave people in the public eye were not afraid to let the world know that they had cancer, so others could follow their example and seek treatment. Lifting the veil on cancer demystifies it, and diminishes its power to terrify us and paralyze us into inaction.

I will never forget my first experience with cancer. A childhood friend, several years older than me, died of leukemia when he was eleven years old. He had always watched out for me when I was around, helped me ride my bike, find my lost toys, and I'll never forget how he rescued me when I fell face-first into a rosebush. I really looked up to him; he was like my "big brother". It was so hard to understand why he got sick, and when he died, I couldn't imagine how this could happen. It was so unfair. Now, the 5-year survival rate for his type of leukemia is 80%. I sadly wish that Paul had been a survivor, but I'm happy that the disease no longer claims as many children as it did decades ago.

I think that the entire survivorship movement is valuable; some kind of framework is needed to support people with cancer facing other physical, emotional, financial, workplace, and societal issues. It's not just enough to get the person through treatment; each individual, including myself, will have additional challenges that they will have to face on an ongoing basis.

Some people are consumed with the fear that their cancer will return, which effectively prevents them from enjoying whatever days they indeed do have remaining; others experience side effects from the daily medications needed to prevent their cancer from recurring; patients who have finished their treatment experience now feel confused and alone as they face their future; families are financially and emotionally strained by the treatment and caregiving experience. Most cancer patients now will have to plan for their "post-cancer" life, which is a positive development in our continuing campaign against the disease.

May we not all just survive, but learn to thrive...

Sunday, May 24, 2009

The Little Things

Many persons with cancer have written that their diagnosis caused them to focus on life as it happens; to "live in the now", to find great joy and wonderment in things that they normally wouldn't have even noticed before. I can attest that this is true.

I have always believed that life is all about "the little things", which in our busy, fast-paced, stressful schedules, frequently go unnoticed. If you become aware of life on this level, you will find that every day brings many sights, sounds, and experiences which make you aware of how wonderful it is to be you, and to be alive. You don't have to be a person with cancer or a life-threatening condition to see being alive in this way. Living in the present, and being open to these "little things" puts your life in perspective. If you're always in a hurry, overwhelmed by your schedule, your job, and whatever other responsibilities you have, try to view life at a much smaller level of detail for a change. This will truly change your life, if you let it happen.

For example: I love to go outside very early in the morning, when all that I can hear are the birds in my yard greeting the new day. To me, this is an almost magical time; everything is awakening, the light is beautiful, and the mood is truly peaceful. Several times throughout the day, I'm privileged to hear the mockingbird as he serenades the neighborhood, and my favorite is when he sings as the day is ending. His song is one of the most beautiful things that I have ever heard, and I'm always saddened when he leaves for the winter.

I also love to see my plants coming up again, such as the hostas that my Father and I planted years ago around the base of the dogwood tree. After the harshness of Winter, I admire their ability to endure, persevere, and present us with such great beauty. It is truly cheering and comforting when my plants emerge again. Their return signifies that life does go on, even if my Father has been gone for almost eight years now...

Nothing makes me as happy as being near my husband. Just to quietly be in the same room with him brings me so much happiness. I love to hear him laugh, see his beautiful smile, wake him up each morning, greet him when he comes home. He makes me laugh every day, is my "rock" when everything else seems overwhelming, and he is the reason that I wanted to go on living. I truly hate to be away from him, because we enjoy being with each other so much. We have been fortunate enough to have some "milestone" experiences that people dream of, but I would trade them all for having him look into my eyes with the love that I see there each day.

There are so many overlooked opportunities for wonderful moments with other people on a daily basis: I get hugs everywhere I go, and believe me, they are great "medicine"! Take the time to say a kind word, give someone your smile, help others, and you will be contributing to their experience of "living in the now" as well. Life really is all about "the little things". Don't lose sight of this on your journey.

Sunday, May 3, 2009

Another Disease That Changed My Life

I saw this morning that HBO is going to be broadcasting a series of documentaries called "The Alzheimer's Project":

My childhood was profoundly affected by this terrible disease, and more recently, my wonderful Mother-in-law succumbed to Alzheimer's after suffering from it for several years.

Anyone who has watched a loved one be stolen from them by this insidious, progressive, cruel disease knows how vitally important it is to prevent as many people as possible from ever being touched by it.

I'm planning to watch "The Alzheimer's Project", and I recommend that everyone do the same. As we "baby boomers" age, something must be done to ensure that as many of us as possible, and those of future generations, escape this fate.

I wrote a tribute today on The Alzheimer's Project site in memory of my beloved Grandfather, who died from Alzheimer's when I was ten years old. I have added it as part of this website.

"Poppa" was my Father until I was 10, and gave me so much love and adoration. To this day I realize how lucky I am to have had the love of such a wonderful, kind, and caring man like him. It made all the difference to a little girl who would have been damaged without a male role model's love and encouragement. Alzheimer's began taking him from me, little by little, when I was 5 years old. When he died, I was absolutely devastated.
Today, I may have cancer, but I am still fully and wholly myself. Alzheimer's steals your mind and your personality from yourself and from those who love you, which I believe is even more fundamentally tragic. We must eradicate it from our future, in the same way that we have been working to eliminate cancer.

Saturday, April 11, 2009


Tomorrow is Easter, so our thoughts turn to the subject of rebirth. Some religions believe in reincarnation; that concept exists in many cultures throughout the centuries. In addition to the religious concept of rebirth, I have found that cancer does lead to your own personal "rebirth".

From the moment you are diagnosed, you assume a new identity: you are now a person with cancer. You have become part of a greater community which you never wanted to join; from this point on, your life is irrevocably changed. You will confront your own fragility and mortality; it will be thrust upon you, in a whirlwind of thoughts and fears.

If you can manage to see something negative as also having a positive aspect, you can see your treatment path as a kind of journey toward this "rebirth". The road to the end of treatment is challenging, scary, and exhausting: it will change you both physically and mentally. You will never see things the same way again.

When you reach the point when you're on your "maintenance" treatment path, you are experiencing a kind of rebirth. Your life, with the help and caring of so many wonderful and dedicated individuals, has literally been given back to you. It is up to you to find joy in yourself, cherish being alive, and concentrate on living the rest of your life as the person who you really are, not just a "cancer patient". You are now so much more than your disease, and you have a new life.

Tuesday, March 24, 2009

An Unlikely Source of Inspiration

When I was six, my Father moved out of State, and I didn't see him for the next 35 years. When he and my Mother separated, we lived with my maternal grandparents, who were rather well-off financially, owning their own business. So, when he left, there was no need to legally pursue him for child support. I'm sure that they all thought that there was nothing that my Father could ever really provide for me, and that I didn't need him in my life; but Fate had other plans.

Fast-forward to me at age 41; I had heard that my Father's second wife had died of cancer after a long illness. Shortly after this happened, he began writing to me, and I wanted absolutely nothing to do with him! He wrote that there had never been a single day in his life when he didn't think of me, and asked for my forgiveness.

I was adamant that he didn't deserve a chance to get to know the daughter he had so willfully neglected, but my husband made me realize that I should at least hear his side of the story. He said that if I turned my own Father away without giving him a chance, that I would most likely regret it later on: if my Father passed away without me knowing the answers to so many of my questions, how would I feel then?

Reluctantly, and fearful of being hurt even further, I began corresponding with him on a regular basis. This grew into weekly, lengthy telephone calls where we both learned a lot about each other. My Father never maligned my Mother; he just said, as she always had, that they loved each other, but the relationship didn't work out. I also found out the reason why he couldn't have stayed in the marriage, and realized that he was entirely justified in leaving. It was a very sad situation. I finally understood that their breakup wasn't my fault; children often blame themselves when a parent leaves the family.

Finally, the day came when my Father knocked on my door after 35 years, and it was as if a part of myself had been restored. Knowing him helped me to truly understand many aspects of my personality: my love of poetry and literature, singing and performing, history and architecture, and many other qualities that I could trace back to him. It was comparable to finding a "me" that I had never really known. I had been given a great gift, and I was very thankful for this second chance to love and be loved by my own Father. I had my "closure", and my life was so much richer for it.

Sadly, three years after our reunion, and 1 year after his marriage to a wonderful woman, he was diagnosed with terminal stomach cancer. From the beginning, he was stoic and pragmatic. He patently refused chemotherapy, and I remember being so angry at him about his decision. I had just found him again, and now, I was going to have to lose him, just like I had experienced at age 6. This time, it would be forever - how could he possibly justify making this choice?

My Father's reasoning was that he had known a very close friend with the same type of cancer. This friend was treated with chemotherapy and lived in excruciating pain, with no quality of life, until he died an agonizing death a few months later. So, although my Father was given a few months to live, he decided that as there was no hope of saving his life, that he would live "as fully as possible, for as long as humanly possible". He turned out to be absolutely right.

He remained his entertaining, larger-than-life self throughout, for almost the next two years. He romped and took naps with his beloved Boston Terrier, "Teddie" (a gift from my Stepmother on his return from the hospital following his cancer surgery). He gardened, traveled, danced weekly at his social club, wrote poetry, watched hours (and hours!) of boxing matches, growing more gaunt and haunted-looking each time I visited him. All of his food had to be put through the blender so he could even try to eat, and several procedures were done to stretch his esophagus, but nothing really helped. He became a shadow of my cute, dear, funny Daddy, and it truly broke my heart.

Whenever the tears would come, he would always say,"No crying!", and I obeyed. He really didn't allow anyone to be negative or depressed around him; it was his way, and we all respected that. You could tell that he was in pain, but he refused to acknowledge it, and never once did I hear him complain about his circumstance. If something couldn't be changed, you accepted it, and that was that. He always wanted to concentrate on what was still good about life, and that was a valuable lesson to me.

About a month before he died, I flew down to Florida for what was our last visit. He loved black raspberry ice cream, and we managed to get him in the car for the short drive to the ice cream shop. He was in his pajamas, looking terribly weak and unwell. He couldn't walk, so I brought the ice cream out to the car. I could tell that he really enjoyed it, and I wondered how many days he would have left...

When I was diagnosed with cancer, I decided to follow my Father's example, and not ever feel sorry for myself. His strength and his unfailing ability to see the good in every day gave me so much inspiration, and they still do. I never could have imagined that his cancer experience would be a source of strength for me several years later as I made my own journey through treatment. Thank you, Daddy; I love you today and always...

Sunday, March 8, 2009

Body Image

One overriding concern, before and after breast surgery, is "What will I look like afterwards?"  I had already had surgery on the same breast with the cancer, in almost exactly the same area, almost 14 years before. The earlier surgery was an excisional biopsy to rule out cancer on a palpable mass, which turned out to be a cyst. I was left with a semi-circular scar about an inch long, which was barely noticeable.

Because breasts are such an important part of our feminine image, it's traumatic to think that in order to remain alive, we might have to relinquish a part of our body, or be left with a body that has been disfigured by surgery. Although, given the choice, naturally you would choose life. Reconstructive surgery post-mastectomy has been a mandated benefit for more than a decade, so at least women now don't have to experience what women of previous generations did. 

With my cancer treatment, I had two separate lumpectomy surgeries, so this was something I had to get myself through twice. My cosmetic result, 17 months post-surgeries, is wonderful, and I am very fortunate and grateful. My husband was, as always, incredibly supportive, and repeatedly told me that nothing could ever change his love for me.

One resource available on the Intranet which might dispel any patient's fears about being left "abnormal" post-surgery is called "The Normal Breasts Gallery" (the site is not suitable for the workplace or for children, of course). Personally, I haven't seen a lot of other women's breasts; and the breasts which are displayed via our print and electronic media are Photoshopped into our "ideal" images. This website serves to show women what "normal" women's breasts look like, and it has helped me immensely. I want to mention this resource for women who are wondering about their own body image, because I didn't find out about it until very recently (thanks, Jezebel!).

Friday, February 20, 2009


In the past, I was compared frequently to the Energizer Bunny, but at this point in my life, I can say that I am no longer a stranger to overwhelming mental and physical fatigue.

The emotional toll of your diagnosis is one thing; it takes a huge amount of your energy to marshal all of your remaining wit and courage to put your psyche back together. This is when you find out what you're really made of. You try to maintain your focus, while wondering if everything you're going through will work: will you be one of the "success stories" in those statistics that you turn to, trying to reassure yourself? How will you plan for dying? Should you? Can you confront the possibility that your life may be coming to an end before you ever imagined it would?

Learning that I had to go through surgery a second time, when I had felt some degree of achievement at getting through the first operation, was quite a mental setback. About 40% of lumpectomy patients must undergo a second surgery, because there are still cancer cells on the margins of their surgery site. I wish that I hadn't needed to wait weeks for the site to heal, only to be cut open again. That was pretty terrible to anticipate, but at least the site was "clean" following the revision surgery. The post-operative infection was also something that I would rather have not experienced; I was truly very ill, and frightened.

Radiation left me a shadow of my former self, and even the smallest task seemed like a huge effort. I would walk a couple of blocks to and from my daily treatment, managing to do this only by sheer will. I had been someone who exercised regularly for decades, and now, I could feel myself becoming less physically powerful, which was frightening. Foods tasted different, and things that I could formerly eat with no problems would upset my stomach. Exercising wasn't possible, and napping became a major "activity". I would awake every morning wondering how I was ever going to drag myself through the day.

One month post-radiation, I began taking an aromatase inhibitor (AI) to prevent my estrogen-positive tumor from returning. I have to take this drug for five years, and I have now been on it for 1 year. It prevents your body from producing estrogen, so it really plays havoc with several aspects of your health. The side effects: "Weakness" - check! "Tiredness" - check! "Mental fuzziness" - check! "Frequent Hot Flashes" - check! "Weight gain" - major check!

I now weigh more than I ever have in my entire life, and I have read numerous accounts from patients who have gained significant weight while taking the AI drugs. These women also emphatically say that eating less and exercising does very little to counteract the effects of taking the AI, which is slowing down your metabolism even more in changing your hormone balance to fight the cancer. My physician swears that all of these drugs make you gain weight. It would be the height of irony to have a heart attack or become diabetic from taking a drug to fight your cancer, but this thought has occurred to me...

I am now keeping track of what I eat, and exercising regularly, hoping that I'll be able to kick-start my metabolism again. It's better to be tired from exercising than from inactivity; it's a whole different kind of tired, a "good" tired. I hope that in a few weeks I'll recognize my lower body again, because there's someone I've never seen before looking back at me in the mirror...