Sometimes it is hard to put pen to paper, or fingers to keyboard as it were. The last two weeks I have felt in many ways that the words are trapped inside and I can't let them out for fear of what I might say and in turn might feel. Somehow it feels as though if I don't write the words, then I won't have to feel them, believe them. I can hide them away and pretend.

Those of us who have had and are dealing with cancer know all too well how much we wish we could take back the words, "you have cancer." We remember the time, place, the tone of the doctor's voice, and every detail of the exact moment we heard the words. I remember what I did, how I reacted, what I felt, where I went, and what I didn't feel. The odd combination of sorrow and determination swirled in my head with no direction, not yet knowing its purpose, causing me to ask questions even though I never heard the answers. Saving the onset of a memory-robbing disease, I will take that moment with me to my grave instantly feeling that twinge of pain like a knife through the heart every time that page of the calendar is turned.

Until recently, I never thought any words would make me feel more helpless, angry, and yet even more determined. I remember the exact time of day, the sound of her voice, where I was, how I reacted, what I felt, and what I didn't feel when my mother bravely said to me, as she said it for the first time, "I don't want you to be shocked, but I have cancer."

Years ago my mother began having nosebleeds thought to be brought on by blood thinning medications prescribed to reduce the chance of stroke. Even with minimal medication, the nosebleeds persisted. They tried cauterizing the veins and even letting specialists take a look. Finally at our persistence, a new specialist took a more thorough look and spotted a polyp that needed a closer look. After a painful biopsy procedure, it was confirmed that it was a nasal adenocarcinoma. After more tests and consultation we will determine a course of treatment. These aren't very common, but luckily this one is slow growing and low grade. For this I am grateful. For its existence alone I am devastated.

I could list story after story about the loving, generous, selfless, faithful woman that is my mother. One would think that somewhere out there in the cosmos, the balance of the universe might tilt a little in her favor just once and not send cancer to her or her family one more time. One might also think that since she has had her fair share of crap already, that perhaps she might be spared dealing with this at this stage in her life. It doesn't seem fair, but nothing about cancer is fair. If there was a way I could take this from her, without hesitation I would volunteer in a heartbeat. The thought of my mother having just one moment of discomfort, sadness, worry, or pain hurts in way I cannot describe. More than words could ever express.

Girl enters the church of oncology, genuflects, kneels, and says a prayer.
She then proceeds to the confessional, opens the door, and enters.

"Bless me doctor for I have sinned. It has been one year since my last chemo and these are my sins:
--I have not always had faith that it worked 100 percent.
--I have not been grateful for the chemo as I worry and complain about lingering, bothersome side-effects.
--I have cursed it for the way it changed my perspective on how bad I have to feel before I realize I'm sick and need medical attention.
--I have resented it for what it has done to my ovaries.
For these and all the chemo sins of my life, I ask forgiveness."

It seems as though the passage of time is marked by doctor's visits, lab draws, and anniversaries of doctor visits and treatment. In just two weeks it will be a year since my last chemo. At my most recent follow-up appointment I learned a few things. The numbness in my toes is permanent, butI can live with it. My ovaries are confused, but we'll see how they are in January. In the meantime, I've had a reprieve from the hot flashes and other menopausal symptoms. I also found out that my tumor markers (CA27-29) are still within the normal range, though slightly elevated. Nothing to worry about this time. I go back in January for my fourth three-month follow-up (also known as the one-year check up). At that time we should have a better understanding on the state of my ovaries and start the five-year maintenance drug (we have been waiting until after surgery). And then it is a matter of waiting until the next lab draws, the next appointment, the next . . . or should I say, my penance.

I have no expectation of getting bad lab results on any of my blood tests. Honestly, I don't. Yet soon as I leave the lab, I do find the worry setting in and the sigh of relief when I get the results. Somewhere deep inside my subconscious I do fret and likely always will. This is the cycle that has become my life.

I have also come to realize how much the chemo impacted my life. It truly has changd my perspective on things. I developed the ability to physically "power through" the physical adversity. I find myself still doing that, not knowing if a cold has become bronchitis, not knowing if a twisted ankele is actually a fractured ankle. Somehow I turned off the discomfort/pain switch and I think I need to switch it back on. Perhaps I'll wait to unravel that mystery until after surgery (in less than a month, God willing).

Even still, complaints (and whining) and all, I am grateful that the chemo improved my odds of survival and tracked down any possible wayward cancer cells and destroyed them. I'm just repenting. Trying to cleanse myself of the experience and move forward in grace and healing (with my sarcasm still in tact).

Who knew that new responsibilities at work, a new school term, a mom having surgery, and a badly sprained (or slightly fractured) ankle would cause me to take my longest blog break of record. If that is the combination that silences me, then a lot of people in my life just learned a magic combination.

I realized something today. I have often made reference to my small town life. Oh sure, I am close to the very metropolitan Los Angeles, spend plenty of time in the Rose Parade's own Pasadena, but I live in a rather small town. I went to college here. And grad school. I also work for said same small town. Oh yes, I am also an adjunct professor at the same small university located in the same small town. No, this is not a twisted version of the Children of the Corn. I am not trapped by some cult in a Nebraska cornfield (though would that be more believable?).

I like it here. I am lucky that the place where I make a living is also where I make a life. I like being part of the community. I don't know if other people really feel like they belong in their communities or if they feel more like they own a house there. It is a completely different feeling. It's a feeling that overwhelms you when after a breast cancer diagnosis, a community that you serve, suddenly serves you.

I have been very blessed to be surrounded by such wonderful friends. Friends that drag their spouses out for a very long night of inside jokes they may not find funny and a lovely dinner that arrives cold. Friends that leave their son's soccer game and race through Los Angeles freeways just to show their support. Friends that give up tickets to a Los Angeles Clippers game just to be with you (well, maybe that isn't so much of a sacrifice). Friends that hug you, encourage you, never forget your birthday, and are amazing all the time, long before I became their friend with the breast cancer.

I have been blessed with a very supportive family. My mother, who is miserably suffering from surgery last Wednesday and first asks me how I'm feeling when I see her, instilled in us the virtues of being of service to others. It is evident when you look at how my wonderfully thoughtful sisters lead their lives and when you see the values that my nephews embrace. It is who we are because of the example we have in my mother.

I have been blessed with a co-survivor for whom there are no words to describe her support. Without even asking, my sister is by my side through everything asking nothing in return. Joyce's support reminds me of the poem by 12th Century Persian poet Hafiz,

Even after all this time
The sun never says to the earth,
"You owe Me."

Look what happens with
A love like that,
It lights the Whole Sky.

I was reminded today that having all of this makes me rich beyond all worldly treasure. That even though I have struggled through treatment and surgery and face life with cancer on a daily basis, I am rich. That even though I am frustrated with waiting for my next surgery (in a month, God willing), I have everything I need right now. Nothing else matters. The life I have right now, at this moment, is all I need.

"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." --EM Forster

There are times that no matter how positive I try to remain, my heart is heavy from all things cancer. It is just the nature of the beast. I understand the cycle of life and I understand the statistics. It doesn't make it any easier to understand or accept. I want to thank some people for having the courage to tell their story and for bringing light to something formerly only talked about in hushed whispers. Sadly, their story has come to an end. I have never personally met these people outside of Internet, but their lives have touched me.

J's Daughter shared the story of her mom's battle with ovarian cancer. The relationship she shared with her mother was beautiful and she let us see the pain, the hope, the desperation, and the love. Thank you for sharing your mother's legacy with us all.

Mom's Recovery is also a family's story. When their mother was diagnosed with lung cancer, the son wrote a comic strip (which is becoming a book) and the daughter wrote a screenplay. The family commitment is a testament to love. They have beautifully supported one another while helping to create a legacy for their mom and enlightening so many others in the process.

Margaret's Life sadly ended today. She was 22 and had battled ovarian cancer three times. She had a beautiful smile and a tremendous faith that she shared in her writing even in her last post written on Saturday. There was something about Margaret that drew you to her, even across the Internet. I think I will always remember her smile.

If you feel it in your heart to offer some kind words, please follow the links to their sites. I hope we all take a moment to recognize the frailty of life, hug those we love, and cast all regrets aside. Life is about loving boldly, without fear, every moment.

Last week when I was in and out of the doctor's office trying to get air into my lungs, the nurse practitioner* unknowingly gave me an amazing gift. In trying to juggle the various inhalers and antibiotics, I asked her if I should still be taking the cough medicine I had been taking prior to the breathing treatments. We talked about the coughing keeping me awake and she wanted me to get a good night's rest so she prescribed the really yummy cough medicine with enough codeine to knock a girl out for the night. Given my terrible sleep patterns since surgery last December, I was up for anything. I followed her orders and not only did I not cough, I had my first full night's sleep in nearly a year. No waking up due to discomfort, awkward positions, or pain. The next morning I felt so amazingly refreshed. Why didn't I think of drugging myself to sleep before this?

The next night I took the cough medicine again, but I used both of the inhalers too close to bedtime and they kept me a little wired. I was having restless spurts of sleep between waking flashbacks. It was a strange experience. I had a flashback that was so powerful, it made me sit straight up in shock that I hadn't had this memory sooner.

When I was a child, cancer was not a foreign subject in my family. Besides hearing about neighbors and relatives who were ill from cancer, my oldest sister had battled brain cancer at the age of 16 when I was just under a year old. Although I have no memory of her sugery and treatment, I do have memories of her long recovery and rehabilitation (even her commitment to this day to wake at 4:00 a.m. just to get her therapy exercises completed before going to work -- sheesh! and I complain about leaving for the gym at 5:00 a.m., but I digress). As a result, cancer was not a word said in hushed tones so the children wouldn't hear. It was a word used as commonly as, well, as commonly as I use it today.

I had a memory of a time when I was perhaps 9 years old. It was just as my breasts were budding (yes, I developed early and was wearing my first bra in the fourth grade). I remember touching my right breast and feeling as if there was a big lump in it. I told my mom and we talked to my dad about it. They agreed I was way too young to worry about such things, but we agreed to mention it to the doctor when I went in for my upcoming physical.

I went to see the "hippie" doctor as my parents called him. I liked him because he was young, had the coolest feathered hair, and wore jeans under his white coat. He was nice, but I was a very shy, if not painfully shy, child. I remember sitting there on the examining table in my little girl white panties and white socks, nervously swinging my legs crossed at the ankles, with my head down, as my mom told him about my right breast. He felt it and said it was just dense tissue that was experiencing a growth spurt and the breasts would feel different now that they were developing. With that it was over and I was so very thankful that I could breathe again, get dressed, and not be sitting there half naked while the cool hippie doctor talked about my little bumps. I was his last appointment of the day so with that, he took off his white doctorly coat, popped on his denim jacket, grabbed his motorcycle helmet and was off (he was the coolest!). I happily walked to the car with my mom savoring the red cherry lollipop just awarded to me by the nurse.

I'm not sure if the open use of the "c" word made me uber aware of the possibility of cancer, but how odd is it that at 9 years old I was noticing changes in my right breast? I have been aware of breast cancer for as long as I can remember. And how odd is it that thirty years later I would find the same changes in tissue in the same breast, in the same area, but this time there was no happy hippie doctor, no easy resolution, no skipping to the car holding my mom's hand, and no cherry lollipop. Somehow that little girl intuitively knew something, and you know, she probably saved my life.



* For the record, I think nurse practitioners rock! She gave me the best, most compassionate care I have ever received in a non-onc office visit.

I'm eternally grateful for the public relations machine that has grown into the annual retail marketer's dream known as Breast Cancer Awareness Month. If I had not been "aware" of the risks of breast cancer and how to examine my breasts, I may have been unphased when I felt a strange lump in my breast last year. I could have possibly dismissed it as "lumpy" breasts and gone on ingorantly while the evil cancer beast grew and spread within me. I am lucky. I found it early. I was aware.

There remains a part of me that wonders how much of the "awareness" in the retail world finds its way to fund mammograms and research or simply finds its way to the cash register. How much extra did I just pay for that product emblazoned with my little pink friend? And does that money support the cause or is the ribbon itself adding to the awareness factor? I find it difficult to conceive of the concept of little round choclatey candies promoting breast cancer awareness when a high fat diet is believed to contribute to cancer risk. I'll take the fifty cents though. Eventually it all adds up. And yes, each year I do fall victim to the annual commemorative bracelet. In fact I get one for myself and one for my sister. All of us bracelet wearers help a donation of $1,000,000 be made to support breast cancer research. It can't all be bad? Right? Especially not the little heart on the bracelet engraved with "You are a miracle," right?

I won't typically wear a pink ribbon (other than the bracelet), because there is a trail of "pink ribbons" all across my chest. I wear them all year, without fail, every moment of every day. My awareness starts in the middle of the night when I roll over only to be greeted by discomfort from the tissue expanders still below my skin. My awareness continues when I see my reflection as I step out of the shower. My awareness is magnified as I slip the prosthetics into my special bra. It continues as I slip on my suit jacket only to notice that the top puckers a little where my cups once runneth over. And as I try to style my too short hair, though grateful for its return, the awareness smacks me in the face yet again. And then as someone shares joyful news of a pregnancy or a new grandchild, the awareness punches me right in the gut and takes the air from my lungs. Breast cancer awareness is my waking (and sleepless) reality.

I will admit, there are many times during the day when I think about the business at hand, when my laughter fills the room rather than sadness, when I think of all things joyful rather than all things lost. Awareness isn't about the sadness and loss. Awareness is also about hope. When I hear that a friend's diagnosis is excellent because the cancer was caught at such an early stage, that breast conserving strategy coupled with radiation is all that is needed, then awareness makes me smile. When I meet a ten-year survivor who joyfully embraces life and does not live in constant fear of the cancer monster, awareness brings me joy. When I see a young woman emblazoned with a pink ribbon survivor tattoo, with her young children in tow, then awareness gives me hope. There are some who believe that promoting the hype about disease compromises the quality of life with unnecessary worry. I am here to dispute that. Knowledge is power. I can attest to that.

Let's look at the most recent statistics from the American Cancer Society:

• Incidents of death have come down every year since 1991.
• Five-year relative survival rate for localized stage is 98%.
• Nearly all breast cancers can be treated successfully if detected early.

That sure sounds like hope and the power of awareness to me. Don't you think? It doesn't mean we can relax about testing and exams. It is the awareness raised and funding provided to fund mammograms that have made this difference.

Let's look at the risk factors provided by the Susan G. Komen Foundation:

• Having a first menstrual period before age 12 or entering menopause at age 55 or later increases a woman's exposure to estrogen and may therefore increase risk.
• Not having children or having the first child after age 30, as well as not breast feeding, increases risk.
• HRT after menopause increases risk and the risk increases the longer the hormones are taken.
• Women with inherited BRCA genetic mutations have a much higher risk; however, only 5 - 10% of all breast cancer cases are in women with the BRCA mutation.
• A family history of breast, ovarian, and prostate cancer are also risk factors.
• Current or recent use of birth control pills, being tall, being overweight, lack of exercise, drinking alcohol, a higher socioeconomic background, and high density breast tissue on mammograms all increase risk.

Being a woman is the greatest risk factor. We can't control our genetic make-up or when we started our menstrual cycle. Many of the other factors are related to lifestyle. That we can control. This is where awareness helps. We have to weigh the pros and cons of our lifestyles and discuss it with our doctors.

• If there is a strong family presence of breast cancer, we need to evaluate the relative benefits of using birth control or HRT.
• If there is already a personal history of breast cancer, we need to evaluate our diets, exercise, and alcohol consumption.
• If multiple risk factors are present, we certainly can never miss our mammograms, breast self-exams, and clinical breast exams. Ever.

Early detection is the best defense. You are aware now. What are you waiting for? Go examine yourself already (or go examine the women in your life). Schedule your mammogram (or schedule one for the women you love).

Okay. I'm done being preachy and teachy. I challenge my fellow bloggers to post something related to breast cancer this month, even if it is only a link. Join me in making this month mean more than pink candy and accessories. Join me in spreading hope.