Wednesday, December 25, 2013

My Phenomenal Oncologists


If you have been following my cancer journey, then you are probably well aware of my deep adoration of my amazing oncologists – Dr. George Fisher and Dr. Holbrook Kohrt (and their fabulous teams). After talking to other cancer patients, I have come to realize that it is rare to find an oncologist who is both brilliant and extraordinarily kind. I am so lucky that both of my oncologists have these qualities in spades. Furthermore, they are aggressive and creative with my care as well as incredibly responsive. Unfortunately for them, sometimes they have had to act as my therapist, too. They have both calmed me down and lifted me up when I’ve been filled with worry and fear. I owe my life to them and I am grateful every single day that they are my team.

Sometimes I wonder what motivates them to do what they do. Why do they put themselves in a line of work where they see such suffering? How do they stay upbeat and dedicated when so many of their patients don’t make it? Who are these amazing souls?

Interestingly enough, an article that came out on Monday in the NY Times helps answer that question. I wanted to share this article with you about Holbrook because I am just so very proud of him. As you will read, he has beaten the odds to be alive today and he continues to fight so that patients, like me, can also beat the odds. Thank you, Holbrook and George for holding my hand and being by my side during this cancer journey.  I love you.


A Doctor's Intimate View of Hemophilia

Dr. Holbrook Kohrt is a physician and researcher who has spent a lifetime as a patient. A 36-year-old hematologist at the Stanford University School of Medicine, he has an extreme form of hemophilia, the bleeding disease. We spoke about his life and work for two hours in person, and later by telephone. An edited and condensed version of the conversations follows.

Hemophilia is thought to be hereditary. Do other members of your family have it?

No. None. When I was born in 1977, my parents didn’t even know I had it. After circumcision, I bled profusely. And then, during the first month of life, I kept bleeding. Though my father was a pediatrician and my mother a nurse, they didn’t even consider hemophilia.

They took me to the hospital, where the doctors thought my mother was abusing me — I had all these unexplained bruises. After some testing, it was determined that I had a very unusual type of hemophilia that comes from a random mutation.

Once that was known, my parents became centered on taking care of a child with severe hemophilia. So I grew up in a room that was padded so I wouldn’t bleed to death if I fell. I wore a helmet every day. There were frequent trips to the children’s hospital for emergencies, three hours from where we lived, in Lake Wallenpaupack, Pa.

Was it possible to have a normal childhood under those circumstances?

I wouldn’t say so. We lived in a small town. Many people there did not understand about hemophilia.

To stay alive, I had to have transfusions of a blood product — clotting factor — every other day. We had neighbors who were members of a religion that opposed transfusions. People from that family would ring our doorbell and scream that we were going to hell.

On the school bus, the others made fun of me. This got even worse during my adolescence because people first began reading about AIDS. To uninformed people, AIDS and hemophilia were the same thing.

To make the situation even worse, large numbers of hemophiliacs developed H.I.V. At the beginning of the H.I.V. epidemic, the blood banks didn’t test their donors for the virus. To stay alive, hemophiliacs often require transfusions of the clotting factor. It’s a protein that our bodies can’t make naturally, and it’s made up from the blood of hundreds, perhaps thousands of donors. Well, if one of those donors had H.I.V., it could be transmitted to anyone who received the blood product. In those years, of the severe hemophiliacs, 95 percent died after contracting H.I.V. from transfusions.

I remember, from the time I was 8 years old, I went to this special summer camp for hemophiliac children. The first year I attended, there were about 200 campers. Eight years later, they stopped having the camp altogether because there were just two of us left.

I think that there’s something very strong about the fact that I was a teenager at the time when all this was happening. When young kids encounter death, you don’t understand the full magnitude of it. You experience it, but then you feel like life goes on.

Why didn’t you contract H.I.V. like the others?

I was lucky. I did, at the age of 13, get hepatitis C, from contaminated blood. I was in the hospital for two months. And then something truly fortunate occurred. I had what’s called a “full antibody response,” which means that my immune system naturally cleared the infection.

 Today, happily, the blood products hemophiliacs take are safer. Scientists have figured out a way to produce an engineered version of the clotting factor. That means that we don’t have to go to hundreds of human donors for blood anymore. They take the protein we need, insert it into the ovary of a tiny hamster and make the clotting factor from that.

Did your childhood experiences lead you to become a hematologist?

Oh, absolutely. In my childhood, it was doctors who I related to more than my peers.

The thing that really attracted me, though, was seeing translational medicine happen in my lifetime. By the time I applied to medical school in 2000, the H.I.V. epidemic had become a chronic disease in the developed world. Breakthroughs in biochemistry promised the same for hemophilia. I wanted to help with that.

As you recall, I had this experience where my own immune system had naturally cleared a hepatitis C infection. I wondered if there might not be ways to get the immune system to respond to cancer in that same way. Today, that’s the focus of my research.

Tell us about your research.

A few years ago, I joined the Stanford laboratory of Ron Levy, who developed the antilymphoma chemotherapy Rituxan. My focus there has been to try to get it to work better against non-Hodgkin’s lymphoma by adding Rituxan to another antibody in the hope of finding a combination that attacks the cancer.

 The experiment has been to inject mice with lymphoma, go down a couple days later, give the mice Rituxan, and then a couple days later, give them whatever molecule I choose. About four years ago we did this, and we had a whole cage full of mice where the tumor completely melted away.

Recently, we gave that combination to a human patient. And now, almost a year later, she has no evidence of the lymphoma whatsoever. Of course, one patient isn’t enough to make for a clinical trial. So now we are going for full-scale trials to show that it is not only effective for lymphoma but, hopefully, for other cancers, too.

 You’ve been doing a clinical trial in Cuba. Is that for the same therapy?

No. In Cuba, we’ve been taking little portions of cancer cells — the peptides — and vaccinating patients against them. Actually, we’ve taken this idea and applied it to cervical cancer in Cuba, ovarian cancer in Australia, leukemia in Europe, and at Stanford.

Our goal is to ultimately use this approach to teach transplanted bone marrow what the cancer looks like so when cancer attempts to come back, the immune system is smart enough to recognize and attack it.

Why study this in Cuba?

There is a large population of underserved patients with cervical cancer there. They had doctors there who wanted to work with us. Right now, we’re in Phase 1 of trials there, which means that we’re testing for safety and the immune response. Patients who already have cancer receive the vaccine, and we’ll see if the immune system responds and mobilizes.

Is there anything about your own condition that pushes you forward?

Oh, yes, but it’s more philosophical than physical. I realized early on that I have to do everything I want to do as soon as possible because I didn’t know what the future could be. That’s been useful in terms of the research and the science. I have the stamina and the commitment to keep trying things.

It’s not been so good in terms of personal relationships. I’ve been married twice. But that knowledge forces me to take the time I have to give the maximum to science and to my patients. Research requires great tenacity. When you’ve had a serious illness since infancy, you know to make the most of every single day.

Tuesday, December 10, 2013

Surgery #13...and #14

I'm exhausted tonight, so I'm just going to give you all the basic facts. Yesterday's surgery (to put the stent in my kidney) did not go well. The tumor was pressing so hard on the ureter that they were unable to put the stent in. There was only a 10% chance things would go wrong. Unfortunately, I was in that 10%. They also found a mass in my bladder. They removed the mass and sent it to pathology to see if it is a tumor. Needless to say, it was a pretty bad night and I didn't sleep well (thus my need to quickly write you and then go to bed).

The problem is that my urine is truly caught in this kidney. They need to get it out quickly or I will lose the kidney. Therefore, tomorrow I will be heading to Stanford for surgery #13 - to put in a nephrostomy tube which will drain my kidney immediately. Unfortunately, I'll also be left with a bag. Draining the kidney will give us a little breathing room to figure out what to do next.

I'm pretty sad right now. It was a rough night and today was rough, too. Tomorrow night at this time I'll have a bag (at least it won't be a colostomy bag). The hope is that they won't have to leave the bag on too long. My colleague suggested that I bedazzle it - because everything looks better with glitter!

So - off I go for Surgery #14. I'll be spending the night at Stanford, but should be back on Thursday morning. This rollercoaster ride never ends....

Thursday, November 28, 2013

Miracles and Gratitude

Last night, the first night of Chanukah, we began the celebration of miracles. Today was Thanksgiving – when we as a nation focus on gratitude. What an amazing combination and so poignant at this stage in my cancer journey.

Over the last few days I’ve had a constant stream of e-mails and texts with my oncologists regarding last Friday’s CT scan. Yes, the five tumors that have stubbornly refused to leave my gut for the past year are stable (a couple went up a little, a couple went down and one stayed the same size). And most significantly, no new tumors have emerged.

I’ve been struggling with this disease for so long. Each time that I went off chemo the cancer would come back with a vengeance. But now, I have the incredible opportunity to be a pioneer in this new world of immunotherapy. Not only did it work while we put “PDL-1” in my body every three weeks, but we just proved that it taught my immune system how to recognize cancer and stop it from growing.

One of the tumors that grew just a little bit is pressing against my kidney and is creating a blockage. So – next week I’ll be going down to Stanford for outpatient surgery to put a stent in to make sure that I don’t lose my kidney. But that’s no big deal. That I can handle. That isn’t threatening my life or forcing me to revisit chemo.

The doctors are planning for me to go another three months without treatment and do another CT scan then. A friend asked me the other night “so how long do they think it will work?” No one knows. I’m the one creating the data that will inform everyone who comes after me. It’s a scary place to be, but an exciting place, too. My body is making history by fighting cancer and winning.

It’s truly a miracle. We are entering a whole new world for cancer care. I am filled with gratitude today – for Stanford Cancer Center, for Drs. Fisher and Kohrt, for Genentech, for my family, for my friends, for my colleagues, for my many other doctors, and for my phenomenally tough body that continues to amaze me. 

Happy Thanksgivukkah.

Monday, November 25, 2013

46

Last Wednesday, I hit the big “46.” It has been almost 6 years since my diagnosis. Little did I know on my 40th birthday that I would soon be starting the toughest and longest battle of my life.  But here I am. Living a full life. Defying the odds.

Many of you know that last Friday I went in for my 3 month CT scan. I was going to wait to tell you the results until I knew more, but I’ve decided to go ahead and share what I know….

The results of my 3 months without treatment are mixed. Apparently, some of the tumors are bigger, some are smaller.  Dr. Kohrt said that by measurement, the disease is stable. The biggest concern is that there is a tumor in my abdomen that is blocking one of my kidneys.  Apparently, they need to get rid of the blockage or there is a potential that I could lose a kidney.

Unfortunately, that’s all I know now. I am waiting for direction from my fabulous team. They are looking at multiple options for next steps and hopefully I’ll know soon what our next course of treatment will be.

As we get closer to Thanksgiving day, I keep reminding myself how grateful that I am for my amazing family and friends and my extraordinary healthcare. The fact that Dr. Kohrt e-mailed me over the weekend just because he knew that I’d be nervous about my results speaks volumes about the phenomenal team that I have working on me.

Thank you all for praying for me, sending me positive energy and quite frankly, just for being there. I don’t know what the future brings, but I know that because of my incredible support network, I’ll be just fine, whatever is in store.
 

Sunday, September 15, 2013

Keeping Busy

As many of you know, I lead a very busy life – I have a high stress job that has many evening events, have enrolled the girls in many activities, love spending time with friends, am involved in cancer-fighting causes and, of course, am running back and forth to Stanford for cancer treatment. 

I realize that I’m fairly frenetic.  Everyone tells me to slow down and relax.  Breathe.  Meditate.  Just Be.

But – it’s my coping mechanism.  If I’m constantly busy, then I don’t have time to think about my fears.  I don’t have time to think about what may come to be.  I don’t have time to think about not being here for my children.

Every time that I do stop, I feel fear clench at my chest.  Different pains pop up that make me crazy with the belief that they are tumors.  When I run around, I don’t notice pain.  I forget about my fear.  I’m focused on the task at hand and don’t wallow in my grief or make myself crazy with self-pity.

Being forced to stop and think during Yom Kippur is both a blessing and a curse.  I so want to be inscribed in the book of life for next year, but then I question whether I have done or am doing the things that I should be doing that would make me worthy of getting to live for another year. 

Did I attend synagogue regularly?  No.  Did I eat right?  Not really.  Did I exercise as often as I should have? No.  Did I engage in tikkun olam (healing of the world) over the past year?  Not enough.  Did I spend enough time with my daughters helping them to grow into amazing children?  No – but thank goodness they became amazing in spite of me.

These are the thoughts that go through my head.  My chest tightens up just writing this.  As we embark on the year 5774, I vow that if I’m given another year that I’ll be better.  I’ll stop running from event to event.  I’ll take time for me and for my family.  And when I’m with my family, I won’t just spend the time driving from errand to errand or activity to activity.  I’ll take the time to stop and just be. 

I have 2 months before my next CT scan.  Perhaps I should just focus on that time frame.  I’ll start there.  I have 2 months to focus on healthy living – eating right, exercise, family, breathing.  In two months, I’ll know whether my body has been able to fight the tumors without medication.  I’m really scared right now.  But – rather than react by adding to my “to do” list, I’m going to react by taking unimportant items off of that list.   I’m going to focus on the items that really matter.

I have been blessed with a strong body and phenomenal medical care.  It’s time for me to refocus on my healing and give myself the best chance of seeing 5775.

Happy New Year.

Sunday, August 25, 2013

A Mixed Bag


I’m going to warn all of you.  This will be a very disjointed post.  It represents the uncertainty and craziness of this cancer journey.  I’m in a strange place – where there are a lot of unknowns and not a lot of answers.  We are looking at many different options because there isn’t a clear path forward.  Just wanted to start this off with that word of warning for the confusion that is about to ensue...
I must apologize for the delay in giving you all the results of last Monday’s CT.  I had a crazy week.  After leaving Stanford on Tuesday, I had to rush back to Sacramento for meetings and a work dinner.  And on went the week without a minute of pause. I finally arrived home late on Friday night and – quite honestly – I wasn’t up to doing anything but watching “How to Lose a Guy in 10 Days.”  If you haven’t seen this movie – I highly recommend it.  It’s hilarious.  And yesterday was spent running around doing a million errands. 
Enough with the excuses.  In a nutshell – my results overall were good.  On the positive side, there was no tumor growth.  My current tumors didn’t get any larger (not even a mm) and there was no sign of new tumors.  This is tremendous news.  It proves that the treatment is continuing to work.
However, on the not-so-great side, my tumors did not decrease either.  Interestingly, because my tumors neither increased nor decreased, Stanford is not able to make a case to Genentech to keep me on the study.    
But, remember the other study I had written about?! When I asked about it, I was told that unfortunately they have lost $3 million of the funding. The donor’s loved one passed and so he is no longer inspired to give to support the study.  Stanford is trying to regroup quickly and find a way to fill this enormous funding gap.  Have any ideas? 
I am not joking.  If you have any suggestions or know of any donors that are looking for an opportunity to fund a phenomenal study, let me know. 
Basically, the study consists of 4 different parts.  The phase that I’m most interested in would combine infusing PDL-1 with injections of ipi directly into the tumors.  As I stated in my last blog – they believe that this will increase the efficacy of the drugs while dramatically decreasing the toxicity levels. I have all of the information on the study and would be thrilled to connect you/your contacts with Dr. Kohrt.  He would be happy to meet and walk through it with anyone who may be able to help.  At the end of one of his recent emails to me, he wrote “I promised everyone, you and all the patients, that I will make this happen.  Even if I need to go beg on the streets.”  I really adore him.
Since that study isn’t funded and I’ve finished my 16 rounds with Genentech—and I’ve gone through all of the chemos out there—our plan is to watch and see how my body does without any drugs for the next 3 months.  If the tumors increase over the next 3 months, they will go back to Genentech and ask to put me back on the study as a ‘compassionate use’ since we know that the treatment works for me.
Drs. Fisher and Kohrt have promised to watch me carefully over the 3 months. They are concerned because my CEA has continued to rise (normally indicating cancer growth).  They have told me that they’ll give me a CT earlier if they believe things are escalating.
This is a remarkable time.  I will no longer have drugs to fight this disease.  I will have to call upon all of the non-western medicine that I have learned over the past 5 ½ years to get me through this – prayer, acupuncture, breathing, green leafy vegetables, yoga (my knee surgeon just cleared me to do yoga!), reiki and a lot of laughter.  
Over the next 3 months, we’ll see what my body can do. I feel both scared and elated. I feel like a child learning to ride a bike when the training wheels are taken off.  Hopefully, that bike will stay upright.
And – that dinner that I rushed to after my final round of PDL-1 on Tuesday?  Interestingly enough, it was with some executives at Onyx to discuss the legislative year.  During the dinner, I told them about my journey.  With excitement, they told me about one of their drugs and its potential use for colon cancer in combination with PDL-1. When I told Drs. Fisher and Kohrt about this new possibility, they were very interested in exploring this option and are now following up with Onyx. 
 
You never know what’s around the next corner…
 

Sunday, August 18, 2013

Scanxiety


Tomorrow, early on a Monday morning, I will be back at Stanford for my next CT scan.  No matter how many times that I do this, it never gets easier.  I had a fitful night of sleep.  Not knowing whether my entire life is going to change in the blink of an eye is so scary.  What if the tumors have grown?  What if the tumors have spread?  Am I about to be subjected to chemo or surgery?  Or what if the information is worse? 

No matter how fearful tomorrow may be, I remain grateful for this past year.  I had a wonderful, relatively pain free summer (except recovering from the knee surgery from my ski accident).  We recently got back from spending 3 glorious weeks in Europe, visiting the sights of London and enjoying the company of friends and family in Belgium and Spain.  We then headed off to our annual Lair of the Bear trip in the Sierras for a week of rustic fun.  What a blessing to have a relatively worry-free summer without chemo.  This was the first summer since 2007 that I was not taking chemo.  I cannot overemphasize how great it felt.  My hope is that thousands of other cancer patients will also be blessed with the same opportunity to have access to this treatment and will get a little bit of relief from the worry and the chemo. PDL-1 gave me an amazing year of life.  Oh - how I love Stanford and Genentech.

So – what happens next?  We’re not sure.  The standard protocol for patients on PDL-1 is that they are approved for 16 cycles.  I have already had 15.  Officially, I’ll be kicked off of the study after this week.  My oncologists have told me that if tomorrow’s scan shows that the tumors are holding steady or decreasing in size, that they will go back to Genentech and request that I remain on the study.  If Genentech turns them down, then they are considering putting me on an investigator-funded study (paid for by Stanford) that they are about to launch which would combine PDL-1 with a drug by Bristol-Myers Squibb called Ipilimumab (known as ipi).  While ipi has been infused in the past, because of the high level of toxicity associated with this delivery system, Stanford is planning to inject ipi directly into the tumors.  This will act much like the radiation treatment that I had back in February, which broke down the tumors so that the immune system has “bite sized” pieces to absorb and learn from.  Stanford is the only cancer institute in the world that will be doing this protocol.  It looks like I'll continue to be one of the guinea pigs of colon cancer....

Of course, my biggest concern is that the tumors grew or spread.  In that case, I’m really not sure what the plan will be.  Fortunately, I have the best oncologists a girl could hope to have to create our plan of action.

At 9 am tomorrow, I will be getting my CT scan and then will be meeting with Drs. Fisher and Kohrt to talk about next steps.  (Please send some prayers/good thoughts my way tomorrow morning....)

I’ll keep you all posted when I know more – now it’s time for me to get some rest….


Sunday, July 21, 2013

Yes- I'm Finally Posting (although I'm having some technical difficulties...)

I know it has been a very very long time since I have written on this blog.  I'm assuming that everyone who is reading this has had to look up my blog, since, for some strange reason, it has stopped forwarding my blog posts and, for the life of me, I don't know what happened.  Because it stopped sending them out, I ended up just not writing anymore because I figured that no one would actually go to the blog and it would be a waste of time.

However, I have been getting emails and calls from many folks who are concerned that they haven't heard any news. Therefore, I've decided to just go ahead and post and hopefully I'll soon figure out how to fix the automatic sending of the blog (BTW - if you know how to fix the RSS feed - please let me know!)

Ok - now that you know why it has been so long since I've posted - I'll give you brief synopsis of the latest and greatest.

Bottom line?  I'm doing great.  My latest scan from around a month ago showed 4 tumors remaining stable in size.  One even went down dramatically (from 1.7 cm to .4 cm).  There has been no spreading and no new growth.  This basically means that the treatment is working and my body is effectively keeping the cancer in check.  Would I have liked to have seen the tumors decrease even more in size (or go away)?  Absolutely.  But, I'll take these  results.  I'm able to remain on my PDL-1 treatment and enjoy my amazing life without any nasty side effects.

So - what's next?  Well, I've been approved for two more rounds of treatment by Genentech (standard for the study is 16 cycles, but my oncologists are asking that Genentech allow me to have a few more rounds to see if we can lessen/eliminate my tumors).  If Genentech says "no" then Stanford has yet another study that they want to try utilizing PDL-1 and they would inject another drug directly into my tumors.  I need to learn more about this, but Dr. Kohrt is very excited about this and is very enthusiastic about trying it out on me.    Stanford is the only cancer center in the world doing this new protocol. And - this one also has NO SIDE EFFECTS!  Have I mentioned how much I love Stanford?

I'll keep you all posted as we know more, but for now, I'm just enjoying feeling great!

I'm also loving my new job fighting for innovation in healthcare.  I get to spend every day focused on something that I truly care about.  What a gift.

I'm also getting to help causes I care about.  Just recently I was honored to speak at the American Cancer Society's annual breakfast which was focused on breakthroughs in cancer research.  It was wonderful making this speech representing both the California Healthcare Institute and as a patient who is a poster child for why it is important to fund cutting edge research.

Most importantly, I've been able to spend time with my wonderful daughters. Just two weeks ago they turned 10 and, against all odds, I'm here to celebrate with them.

As we see the young ladies they've become, Pat and I are both incredibly proud that they are our children.  Living with cancer has made them loving and empathetic.  They have weathered some rough times, but have come out stronger in the end.

There's much more I could write about, but I think I've covered the basics.  Hopefully, I've eased any concerns that any of you had about my well- being and I'll try to blog more often (and if anyone can help me fix my RSS feed, I'd be so grateful).

I hope that all of you are having a glorious summer and living life to its fullest.

Ellie needs help with a puzzle, so I've gotta run....


Sunday, May 12, 2013

Before Mother's Day Ends - A Word or Two for Shirley


Today, as I was calling my mother to wish her Happy Mother’s Day, it occurred to me how very fortunate I have been to have had Shirley Grossman as my mom during the past 5 ½ years as I battled cancer.  I have paid tribute to a lot of folks over the years in this blog – particularly my doctors, husband and children.  However, the unsung hero throughout this entire ordeal has been my mom.

I can’t possibly imagine the pain of finding out that your child has cancer.  From the beginning, I have said on multiple occasions, “Thank God that I’m the one that has cancer and not one of the girls.  I can handle this as my struggle, but to watch one of the girls go through it – that would be more than I could bear.”  A few years ago, we had a brief period when we thought that Ariel had cancer and I felt like curling up in a ball every time I thought about it. 

From Day 1, second to Pat, my mom has been my biggest cheerleader.  She jumped into action, reading everything she could get her hands on about how to beat this disease.  She flew down for each surgery that I had.  She came with me to oncology appointments.  She took care of the girls.  She took care of Pat.  And – she took care of me.  Not just my physical needs, but my spirit, too.  She never is without her necklace that reads simply “Hope.”

I can’t imagine the fear that she has endured.  My rollercoaster has been hers, too.  But she has been strong and confident that I’m going to beat this.  I’ve written multiple times on this blog about this cancer battle being a mental struggle as much as it is a physical one.  I’m constantly looking for clues that the cancer is going away or that it’s growing.  Every pain in my body I attribute to cancer growth (Pat finally said the other day, “Eve – you have pain in your hip because you’re getting old – not because you grew more cancer.”)  Just a few weeks ago, a sharp pain in my gut had me on the verge of tears for 3 days because the docs told me that it was possible that the pain signaled tumor growth in my colon (they eventually decided that it was either a gas bubble or someone with an “Eve Voodoo Doll” poking at it.)  Every scan creates a huge amount of anxiety.  It’s exhausting.  And I know it’s exhausting for her, too.

But – through it all, she never showed anything but confidence in my ability to fight this disease and win.  She is so determined.  Her will is so strong that it lifts me up and makes me fight harder.  For those of you who know my mom, you know how disciplined she is – exercising every day, never eating sweets, working harder than everyone else, always excelling at everything she takes on.  Which makes me so lucky to have her in my corner – fighting this battle along side me.

So – today – I want to pay tribute to my mom and say a special thanks to her for her strength, wisdom and love.  I am so very grateful. 

Happy Mother’s Day to you, mom, and to all of the other wonderful moms who are fighting for their children's health and happiness every single day.

Sunday, April 14, 2013

A Reminder


Yesterday, we took the girls to see the Broadway production of Billy Elliott.  It is truly a phenomenal show.  I had seen it many years ago, but I had forgotten the story.

About a third of the way through the show you learn that Billy Elliott’s mother is dead.  They don’t say how she died – but apparently she died when he was young.   At this point in the show, 11 year-old Billy reads a letter that she wrote to him that he wasn’t to open until he was 18 years old.

This is what she wrote:

I know I must seem like a distant memory to you.
Which is probably a good thing.
It will have been a long time…
And I will have missed seeing you grow,
Missed you crying, laughing and shouting and….
I will have missed telling you off.
But please know that I was always there
With you through everything.
And I always will be…
---And I’m proud that you were mine.
Always be yourself.
I’ll love you forever.

As Billy and his dance teacher recited the letter, tears streamed down my face.  Every so often I have moments like these.  When the reality of what I’m dealing with and what may come to be is like a punch in the stomach.

Fortunately, Ariel had wrapped her arms around mine and had her head on my shoulder during this scene.  I grabbed her tight and vowed that I would continue to fight as long and as hard as I could to stay alive.  I am excited about where I’m at on the health front.  I’m feeling better than I have in years.   But it’s when I feel well that I have to remember all that I have learned over the last 5 years.  It’s easy to forget all of my lessons regarding appreciating every moment, eating right, not working until all hours, taking time to breathe, focusing on the things that matter and so many more…

I guess that yesterday’s show was a helpful reminder for me.  I realized that no matter how long I have, whether it’s a year, 5 years or 30 years, that it is my responsibility to make sure that my daughters know how much they are loved and cherished.  And I’m going to make sure that they hear it every day.