Category Archives: Patients


Breathlessness A Medical Approach

This is part 2 of our Breathless Series. In Part 1, we looked at some of the reasons for breathlessness in cancer patients. I also shared my husband’s experience with shortness of breath to the point he nearly died. There are both medical and non-medical approaches to alleviate the symptoms of breathlessness. In this post, we will talk about the medical approach.

The Lung Cancer Alliance

In 2017, the Lung Cancer Alliance recently held a webinar called, “Breathing Easier.” It was the first webinar in their Coping Series. This is a series designed to educate and provide practical ways to manage the most common symptoms and side effects experienced by lung cancer patients and survivors. Because Approximately half of all cancer patients complain of breathlessness at some point. (1) The information they shared is valuable to an even wider audience of cancer survivors.

Much of the information in this post comes from the webinar. I appreciate the Lung Cancer Alliance allowing me to share it (originally at Heather Erickson Author/Writer/Speaker). I encourage you to go to their website to learn more ways of coping with lung cancer.

Treat the Cancer

Dr. Lynn Reinke, Ph.D., ARNP, FAAN (University of Washington) is a nurse practitioner, recognized nationally and internationally as a dyspnea crisis management expert. She says that the first key to managing shortness of breath is to treat the lung cancer [or any cancer that has metastasized to the lungs] along with its symptoms.

Our Story

When my husband, Dan, experienced severe shortness of breath, it was because his cancer was out of control. It prompted his doctors to order a new CT scan. The results told us that it was time to change treatments. The following month, there were more scans and his treatment plan changed with each one until they found one that worked. That was when he could breathe again! Until then, several other medications were used to help with his cough and breathlessness.

Medications for Breathlessness

As we learned in the first post in this series, there are many causes of breathlessness. Talk to your provider about what medications are appropriate for you.

Also, learn the correct way to use these medications to maximize the effectiveness.  Because many of these medications are inhaled, the technique you use is very important. When you are being prescribed an inhaled medication, a doctor or nurse will be happy to demonstrate the proper way technique. They can also give you a “spacer.” The Asthma Society of Canada has a great illustration and instructions on their site for using a spacer.

Bronchodilators such as albuterol are fast acting and helpful to use prior to activity that may cause shortness of breath.

Breathlessness
(2)

Long-acting bronchodilators last 12 hours. Some use steroids and some reduce inflammation in the lungs.

Nebulizers are helpful for acute breathlessness. A nebulizer is a portable machine which delivers the medication in the form of a breathable mist.

 

 

Other medications:

Opioids, such as low doses of morphine (10-30 mg) are widely used to manage breathlessness. Even experts don’t fully understand why they work. The anxiety-reducing and cough-relieving effects of diamorphine make it ideal for lung cancer. Even patients with COPD can safely use oral morphine for shortness of breath, The patient starts on a low dose, and which is raised per response and side-effects. This level of morphine is well below the amount that patients are prescribed for pain.

Anti-anxiety medications such as lorazepam. Shortness of breath can trigger anxiety attacks. Anxiety, in turn, causes people to tense up and this further reduces lung capacity. It can become a vicious cycle. Anxiety medications can end this cycle.

Oxygen

Oxygen is only helpful if the blood levels of oxygen are low. You can still experience breathlessness without having a low blood-oxygen level. To see whether oxygen is appropriate for you, doctors will test your oxygen level with an oximeter. That’s the little clamp they place on your finger that has a red light in it. Normal blood oxygen levels are between 75 and 100 mmHg (millimeters of mercury). A level of 60 mmHg or lower indicates the need for supplemental oxygen.

Our Story

People often asked why the doctors didn’t put Dan on oxygen when he was so sick. His numbers were always borderline, but not low enough to merit oxygen therapy. It was counter-intuitive to us since he was struggling to breathe. Yet, these guidelines are in place for a very good reason. Too much oxygen can be dangerous, as well. Levels of over 110 mmHg can damage the cells in your lungs.

Next Post…

Non-medical interventions are often the most effective way to cope with long-term treatment of breathlessness. In the next post, we will look at non-medical approaches to breathlessness, including breathing techniques and exercises. If you haven’t already signed up to receive alerts when our weekly post is up, do that now. If you know someone who is living with cancer, pass this along to them.

WHAT ARE YOUR THOUGHTS?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

I also blog at Heather Erickson Author/Writer/Speaker

Footnotes:

1 Virtual Medical Center, Breathlessness in Cancer; https://www.myvmc.com/symptoms/breathlessness-in-cancer/

2 By Trainer2a (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

 

 

Originally posted 2018-11-12 07:00:39.


Baby Steps for resilience

Realistic goals are an essential part of becoming resilient on a cancer journey. Unfortunately, too many people have unrealistic goals. This leads to frustration; frustration with others and frustration with themselves. Thankfully, with some time and practice, these habits can be changed.

Baby Steps toward Your Realistic Goals

Realistic goals start by realizing that life is made up of baby steps, more than grand leaps and bounds. If you’ve ever been a runner, you know that a person can sprint at a very high speed for a short distance, but they could never run a marathon at that same speed. They would quickly burn out. It’s all about pacing, to ensure they can go the distance.

Starting is Easy

In the beginning, we start with a lot of drive and energy. Much of it comes from the adrenalin. You get yourself mentally pumped up to reach a certain goal. But, if the goal is one that will be difficult to reach, that initial drive will eventually wear off. So having smaller, more realistic goals that you can reach can help you to utilize that initial energy. Then, once you’ve reached that goal, celebrate your victory and set a new one.

Constancy is Hard

This is especially true when you are facing a cancer battle. Some days, just getting out of bed can be a herculean task. Other days you feel energized and ready to face the world. And, it’s not just physical.  Your emotional well-being plays a huge role in your ability to stay consistent.  Setting realistic goals will help make this easier.

It is also important to be gentle with yourself. Talk to yourself like you would a friend, with compassion and understanding.  Too many people mentally beat themselves up for not reaching some arbitrary level of achievement each day. So often they don’t even have realistic goals, so it’s unfair to pour out that self-criticism.

Strengths Focused Goals

Know what you can do, now, not back before you were a patient or caregiver. Those are 2 different worlds. Also, do the things you have the strength for. If you are physically weak, it might be a day to quietly read to your grandchildren. if you have extra energy, you may want to fix the leaky faucet in the kitchen.

We began a system of “One Thing a Day.” When we look at our calendar, we should only have one big thing to do each day. It might be a doctor’s appointment or going to breakfast with a friend or cleaning the bathroom. Once you’ve achieved that realistic goal, give yourself permission to take the rest of the day off with no guilt attached.

Realistic Goals don’t include Comparisons

The biggest hindrance to this is comparison. You see the things your friends are doing on social media and you wonder why you can only do this one thing each day before wearing out. One of my mottos is, “Comparison is the devil’s favorite weapon.” Don’t let him use it on you by comparing yourself to someone else.  It will only lead to frustration.

How do you ensure that your goals are realistic goals?

WHAT ARE YOUR THOUGHTS?

There is so much more that could be said about this, but I will leave that up to you, my readers. Tell me your thoughts in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

facing cancer as a parent

Now Available!!

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace.

My books are available at Amazon.com:

The Memory Maker’s Journal 

Facing Cancer as a Friend: How to Support Someone Who Has Cancer

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

I also blog at Heather Erickson Author/Writer/Speaker


Shortness of breath and cancer

The most common side effect of lung cancer is dyspnea, better known as shortness of breath. 90% of Lung cancer patients experience this at some point, during, and even long after treatment has ended. In a Lung Cancer Alliance survey, lung cancer survivors of 5 or more years, still rated it as their most problematic issue. It isn’t only lung cancer patients who suffer from breathlessness. Approximately half of all cancer patients complain of breathlessness at some point. (1) Shortness of breath is sometimes called air hunger. Unfortunately, for many cancer patients, it’s a part of their everyday life, negatively impacting their ability to do the things they need and want to do.

Our Story

In the fall of 2015, Dan’s stage IV lung cancer had progressed in his lungs and had metastasized to his brain so it was time to change his treatment.  They put him on a new type of treatment called immunotherapy, specifically, Opdivo. We had big hopes for this new drug which had been having great results in many patients.

Within 3 weeks, Dan developed a cough.  Coughing was a known side effect of Opdivo. It was getting worse by the week. In November, less than two months into the treatment, we went away for a romantic weekend in St. Paul. We went on a tour of the St. Paul Cathedral and visited Landmark Center. We stayed at the Covington Inn, a floating bed and breakfast on a tug-boat sitting on the Mississippi River. Before leaving St. Paul, we walked along Summit Avenue, a historic district lined with well-preserved Victorian homes, including the Governor’s Mansion.

It was a turning point in our lives.

We got home in the afternoon and went to bed exhausted. Dan was in bed for days. It became nearly impossible for him to speak without breaking into a coughing fit. He had just walked over a mile down Summit Avenue, and a week later, could no longer walk across the room without having to sit down. He couldn’t get a deep breath.

“Helpless. Frustrating. Scary.”

Shortness of breath can feel like a tightness in the chest or an inability to take a deep enough breath. In 2015, my husband suffered from severe breathlessness.  I asked Dan to tell me in a few words what this felt like. He said, “Helpless. Frustrating. Scary, because as you continue to lose your breath, you know there’s a limit to what you can lose before you have a big problem. You see your everyday life getting more and more difficult. Just taking a shower is exhausting. Soon, you’re bedridden and hospice is the only thing you have to help. It’s really very sad.”

There are many causes of shortness of breath.

Among the causes of breathlessness in cancer patients (especially with advanced cancer) are:

  • pleural effusion (fluid on the lungs)
  • anemia (insufficient red blood cells to transport oxygen)
  • obstruction of airways due to tumors
  • lymphangitis (thickening of the lymphatics in the lung, sometimes caused by cancer cells)
  • removal of part of all of a lung
  • smoking-related lung issues
  • heart failure or damage
  • pulmonary toxicity caused by chemotherapy and/or radiation
  • fatigue and pain which make taking a deep breath difficult
  • an anxiety cycle which causes panic and a sensation of breathlessness.

Treatment Options

Shortness of breath
Lung function tests

Once your doctor determines the cause of your breathlessness, they will be able to give you some treatment options. The treatment for shortness of breath will depend on the cause of it. For example, if it’s caused by pleural effusion, the fluid around the lungs will need to be drained.

shortness of breath

We began an investigation into the matter with his medical team, including an oncologist and a pulmonologist. He had bloodwork, scans, breathing tests, and a bronchoscopy. We were told that Dan’s cough and shortness of breath were was not a side effect of the immunotherapy, as was previously thought. The treatment wasn’t working, so the cancer had been progressing. He had lymphangitic spread (2). This is a term used to describe the spread of cancer throughout the lungs. Cancer was filling his lungs and he couldn’t breathe.

“Do you have a healthcare directive?”

The doctors began talking about decisions that needed to be made at the end of life. “What about intubation?” “Have you reassessed your healthcare directive?” We had lived with Dan’s terminal cancer for over three years and yet we were surprised by these questions. It was like having cold water thrown on us.  It quickly brought the reality we were facing, into focus.

Along with attempts to ease the discomfort of breathlessness, Dan began one treatment after another. First, a traditional chemotherapy, and then two different targeted therapies, recently released by the FDA, each one after another. Finally, one worked, Tagrisso. It began killing cancer cells and he soon regained his lung function.

Next post…

Treatment options for shortness of breath include medical interventions, environmental changes, breathing techniques, and exercises to improve breathing. Be sure to read my next post to learn more about some solutions to shortness of breath. The link will go live when the post is published.

 

WHAT ARE YOUR THOUGHTS?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

I also blog at Heather Erickson Author/Writer/Speaker

Footnotes:

1 Virtual Medical Center, Breathlessness in Cancer; https://www.myvmc.com/symptoms/breathlessness-in-cancer/

2 lymphangitic carcinomatosis (LIM-fan-JIH-tik KAR-sih-NOH-muh-TOH-sis) A condition in which cancer cells spread from the original (primary) tumor and invade lymph vessels (thin tubes that carry lymph and white blood cells through the body’s lymph system). The invaded lymph vessels then fill up with cancer cells and become blocked. Although lymphangitic carcinomatosis can occur anywhere in the body, it commonly happens in the lungs. It can happen in many types of cancer but is most common in breast, lung, colon, stomach, pancreatic, and prostate cancer. Also called carcinomatous lymphangitis. (NCI Dictionary of Cancer Terms)

 

Originally posted 2018-11-05 07:00:33.


Priceless4purpose

We’ve recommended Priceless4Purpose and Mystic Views to several friends facing cancer and they have had as good an experience as we did.

Spotlight on Giving Back: Priceless4Purpose

Being diagnosed with cancer plunges patients and family members into the quicksand of physical, financial, mental, and emotional overwhelm. It can be hard for patients to take a break in order to refreshPriceless4Purpose: The Steve Bartlett Cancer Non-Profit Organization. is doing something about this by providing an opportunity for patients and a companion to stay at Mystic Views, a bed and breakfast in northern Minnesota.

Cindy Bartlett knows the strain that cancer can put on people, as much as anyone.

The story of this unique respite service began in 2005 when Cindy and her husband Steve decided to start a bed and breakfast in northern Minnesota.

After 3 years, they had finally found their new home. Their Realtor showed them the lakeside property about 30 minutes north of Brainerd in the peak of winter. Even with the cold Minnesota snow surrounding them, they knew that this was the place for them.

By the time they were ready to receive guests in 2008, Steve was diagnosed with colon cancer. He had been awfully tired, but they attributed that to all of the work that was going into getting Mystic Views ready.

Priceless4Purpose

Steve’s battle lasted 20 months.

Over the course of Steve’s treatment at Hubert Humphrey Cancer Center, he and Cindy met many other couples walking the same journey as they were. Some survived, but others didn’t. Steve died in 2010.

“At first,” says Cindy, “I thought, what did we do that was so bad, to deserve this? But then, it didn’t take me long to say, why not us?”

One day, about 6 months after Steve’s death, Cindy took a break, herself, to enjoy one of the hot tub’s at Mystic Views. As she relaxed, she thought about other couples she and Steve had become friends with at treatments. She wanted them to be able to experience rest in the midst of their battle. She remembered that Steve would always say, “I’m the luckiest person to be able to come back here to recoup between treatments.” That was the birth of Priceless4Purpose.

Cindy went to work, making her vision a reality.

It took about 2 years to transition Mystic Views from a for-profit business to the 501c3, Priceless4Purpose. Cindy became an expert in grant writing. Along with her 3 sons, she set out to find the funding to make Priceless4Purpose a reality.

Since 2013, over 100 cancer patients have been able to experience the rest and relaxation that comes from time away in the quiet of nature because of Priceless4Purpose.

Priceless4Purpose is unique, in that it serves adult patients undergoing active cancer treatment in Minnesota, regardless of stage, sex, or type of cancer. Patients can come alone or with an adult loved one of their choosing.

Priceless4Purpose grants guests up to 3 nights respite with both breakfast and dinner, served in their suite. The room includes a king-sized bed and a Jacuzzi. There’s also a private deck which overlooks a private, environmental lake.

Priceless4Purpose
Cindy Bartlett made us some amazing meals during our stay at Mystic Views.

You can help Priceless4Purpose when you shop on Amazon.com.

Support the Mystic Views Adult Cancer respite program whenever you make a purchase on Amazon, at no cost to yourself!

Whenever you make a purchase at Amazon, just use http://smile.amazon.com/ch/45-2602288. Amazon will donate to Priceless4Purpose through the Amazon Smile Program. It’s super easy!

You can also patronize Mystic Views. Paying customers who don’t have cancer, but who are looking for a peaceful B&B are welcome. You can find Mystic Views “north of the tension zone,” near the Minnesota resort towns of Nisswa and Pequot Lakes, so if you decide to head to town, unique shops and activities abound.

Whether you decide to take in the sites or enjoy the tranquil atmosphere at Mystic Views, you will leave feeling rejuvenated.

 

What are YOUR thoughts?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

About Heather Erickson

I am an author, writer, and speaker and homeschooling mom of 3. Since 2012, when my husband, Dan was diagnosed with stage IV lung cancer, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

The Erickson Family, Photo by Everbranch Photography

Originally posted 2017-12-12 00:06:55.


fatigue is why cancer patients are so tired all the time

This is a picture of my husband, Dan, during a 2-hour visit to the American Swedish Institute in Minneapolis. He became so tired on this trip, that he had to lay down. Most people experience fatigue at some point in their lives, but it usually doesn’t last long. Once you sleep or even just quietly rest for a while, the fatigue goes away and you feel refreshed. Have you ever wondered why cancer patients are always so tired?

Healing takes energy

I remember the fatigue of early pregnancy. When I asked my doctor about it, he said that building a human being within my body was the equivalent of climbing a mountain. I had never thought of it that way. It takes that same energy to fight off a deadly disease! Cells are the building blocks of life, and apparently, they are heavy to hoist! That’s why cancer patients are always so tired.

Treatment is a major reason why cancer patients are so tired

The first cancer treatment that doctors prescribed for Dan was a targeted treatment called, Tarceva. It’s considered an easier treatment than traditional chemotherapies. Yet, within a week, Dan felt completely drained.  “It’s like you’re a car that isn’t running on all cylinders,” he says. “It always feels like bedtime. You fool yourself into thinking, ‘I’ll just go to bed and rest up and then I’ll get up and do it.’” Dan chuckled. “Sure you will.”

Then, two years into his cancer journey, Dan’s doctor put him on a traditional chemotherapy, and things went from bad to worse. Taking a shower, using the bathroom, even eating, were exhausting. After a chemotherapy appointment, he would spend days in bed, only getting up when he absolutely needed to.

It became a cycle

He had no strength and no endurance.

It only got worse over time because he didn’t exercise much.

His muscles atrophied.

He had no strength and no endurance.

It only got worse over time because he didn’t exercise much.

His muscles atrophied.

With fatigue comes a lack of drive and desire to do anything

“You have stuff to do, but you don’t want to do anything,” he says. “If you try to push through anyway, you pay for it and end up in bed for a few days, so you live within the boundaries of the fatigue.”

This can lead to frustration, irritability, and depression. It can be hard at times to know whether what you’re experiencing is fatigue or depression since they share many of the same symptoms. This is one of the reasons it’s so important to discuss what you’re feeling with your doctor. While fatigue is one of the most common symptoms in cancer patients, it’s also one of the least discussed.

Mental Fatigue

Along with the physical fatigue, Dan also experienced mental fatigue. It was often hard to concentrate for any length of time. He describes it as having a cloudy mind. “It’s like your mind is yawning,” he said.

Talking to people was also difficult. Dan would push himself through a conversation in order to stay engaged, But, by the end of the conversation, he would realize that he was wiped out.

He knows he’s crossed the line when he can no longer think of the words he wants to say. He recalls a visit with a friend. “Twice during that conversation, I was convinced that nothing I said made any sense at all.’’

Over time, the fatigue got worse.

Dan used to enjoy going for walks and biking. After a year of treatment, Dan would walk to the end of the cul-de-sac in our neighborhood and had to rest. He just couldn’t keep going. walking up steps was hard. He was breathless all the time.

There are a lot of possible reasons why cancer patients are so tired. Doctors were especially concerned about Dan’s breathlessness and fatigue because he has lung cancer. They needed to know whether it was cancer or the treatment that was causing his shortness of breath and fatigue.

Dan’s doctor ordered lab work to make sure Dan didn’t have another underlying problem that needed to be addressed such as low blood counts or anemia. She checked his lung function and ran a CT scan to ensure that his cancer wasn’t progressing. After the doctor ruled out several possible reasons for fatigue, she said that his fatigue was due to his treatment.

Getting Some Pep

Dan asked for the drug, Ritalin. Ritalin is best known as an ADHD drug given to children. Ironically, it can give adults more energy. Ritalin is a controlled substance, and it certainly isn’t the answer for all fatigue. Only you and your doctor can decide on the best way to address you fatigue. For Dan, the fatigue was so debilitating that this was worth trying. And, it worked! It didn’t completely fix the problem, but it made a noticeable difference in his energy levels.

Dan also drinks a caffeinated beverage each evening with dinner. For most of us, this would cause disturbed sleep patterns. But it gave Dan a boost, just long enough to get through until bedtime.

Know your best time of day.

Dan learned that he functioned best an hour after waking up in the morning. By that time, he’s slept all night and then had a cup of coffee. This is the best time for him to do anything that requires a lot of energy or a clear head.

Dan also listens to what his body is saying. It’s not worth the consequences of ignoring it. When he plans his schedule, he knows that he can only do one thing each day. It might be visiting with a friend, a real estate appointment, or going to church. Dan has learned that if the day will involve expending more energy than normal, it will need to come from somewhere. To prepare, he rests both the day before and the day after.

Every treatment is different

They will all have one thing in common—fatigue. Dan isn’t on any treatment at this time, yet after over 5 years of various targeted treatments and chemotherapies, he still struggles with fatigue. Once you have cancer, and especially after years of treatment, you are never the same again. Finding ways of coping with cancer-related fatigue will go a long way toward enjoying life a lot more.

Now Available!!

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

What Are YOUR Thoughts?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace. My books are available at Amazon.com:

The Memory Maker’s Journal 

Facing Cancer as a Friend: How to Support Someone Who Has Cancer

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

I also blog at Heather Erickson Author/Writer/Speaker

Originally posted 2018-07-23 07:00:18.


a shift in perspective

Today we’ll continue to look at resilience and how when things get hard, we can bounce. We will look at 4 ways a shift in perspective can make a big difference in our lives as we face cancer (whether our own, or cancer in the life of a loved one).

Avoid seeing crises

A shift in perspective doesn’t mean going into denial or sticking your head in the sand like an ostrich (which by the way, they don’t actually do). It just means that you reserve crisis mode for a real crisis, rather than situations that might someday turn into a crisis.

Some people are natural worry warts. They do what a former pastor of ours called horriblizing. They find the drama in every situation and amplify it as much as possible. They don’t realize they are doing it, but it only makes things worse. There is so much that we can’t control. A shift in perspective is about taking what you can control, what you choose to focus on, and reining it in.

I’m not minimizing the worry that accompanies a cancer diagnosis. There’s plenty to be concerned about. Every test and scan can have you on the edge of your seat. But don’t dig your own grave yet. Even the prognosis your doctor gives you is only an estimate based on statistics. While they are good at their jobs, doctors don’t have crystal balls.

Our Story

My husband was given a prognosis of 6-9 months (of course we heard the worst—6 months). They couldn’t have guessed that he would have a mutation which researchers were beginning to understand and for which they were formulating new treatments. Six years later, he is still doing relatively well.

Focus on solutions

At the beginning of our journey, I felt like our world was falling apart. I was afraid to make plans and every decision filled me with anxiety. A pastor we knew gave me some good advice. He told me to focus on what I have rather than what I could lose. That shift in perspective made a tremendous difference. There were still times when I worried, but I was more in control of those fears, rather than letting them control me.

Making decisions based on fear is never a wise thing to do. Once you have a shift in perspective you can make a decision, based on the reality you are experiencing in the here and now. This is especially helpful when you are making treatment decisions.

Our shift in Perspective

In 2015, Dan had his first metastasis to the brain. That was particularly scary. Most people can imagine living without a limb or even losing one of their senses, but when it comes to the brain, it’s a whole other matter. We see our brain function as who we are as a person, rather than part of who we are. Our brains control our intellect, our creativity, our moods, even our personality. So when something threatens to affect our brain, we get worried.

I heard horror stories about the effect of radiation on the brain. When we spoke to the radiologist, he put our minds at ease in an unusual way. He told us that the effects of radiation on the brain usually aren’t seen until a year or two later, and the truth of the matter was that Dan likely wouldn’t live long enough to experience those effects if they did happen.  That might not sound reassuring, but it gave us a shift in perspective. We would worry about today’s problems today and leave those belonging to tomorrow, alone, until we get to tomorrow. It turns out, his brain is still doing well, 14 mets (and radiation treatments for the mets) later.

a shift in perspective

Mindfulness

“Mindfulness” seems to be the new buzz word in health and wellness circles. But, that doesn’t mean it’s a shallow concept. Mindfulness is about being present in the moment. When you are present in the moment, you don’t horriblize. Your mind doesn’t race to every potential pitfall. Instead, you say, “right now…”

  • “Right now…things we are okay.”
  • “Right now… insurance is covering these treatments.”
  • “Right now…the cancer is stable.”
  • “Right now…we are able to make our house payments.”
  • “Right now… we can make memories.”

Sometimes you may have to search to find a positive “right now” statement, but there will be something that you can focus on.

Breathing for a shift in perspective

Have you ever noticed that when you get tense, you stop breathing? Sure, you take in enough air to survive, but by concentrating on how you breathe, you can actually thrive. Check out a post I wrote about progressive muscle relaxation. It’s an easy technique that can help give you a shift in perspective. It will relax you and allow you to breathe, lowering your heart rate and improving your ability to focus.

I have also written a post on a breathing technique. This is something you can do anywhere, at any time. The post was originally intended for people with breathing problems related to cancer affecting their lungs, but it is helpful for healthy people, as well.

As you practice either of these techniques consider a positive “right now” statement that you can focus on.  At first, this will be something you have to be intentional about doing. Eventually, this will become a reflex.

Spinout

My 16-year-old and I were recently talking about driving on Minnesota roads in the winter. She had recently hit a patch of ice and spun out. She was able to completely relax when it happened. This is the best thing to do to minimize injury in case of an impact.

The same thing is true when stress impacts our lives. We will be much better off if we have a shift in perspective and make our next move when we are relaxed, rather than out of a tense, reflexive state of mind. Our decisions will be better and we will be more open to living well in the present moment.

What Are Your Thoughts?

What helps you make a shift in perspective? I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

Now Available!!

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace. My books are available at Amazon.com:

The Memory Maker’s Journal 

Facing Cancer as a Friend: How to Support Someone Who Has Cancer

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

I also blog at Heather Erickson Author/Writer/Speaker


cancer survivorship tip

When people hear that my husband has survived for 6 years with stage IV non-small cell lung cancer they often ask me what our top cancer survivorship tip would be. So in honor of his 6th cancerversary, I have put together some of the best advice we have used and continue to use.

Cancer Survivorship Tip #1

Get Educated

I don’t mean that you should read articles filled with pseudoscience. You should find out exactly what kind of cancer you have and what the newest and older treatments for this cancer are. How can you expect this cancer to affect your life in the near future? One of your best resources will be your oncology team. That brings us to the next tip…

Cancer Survivorship Tip #2

Build a Trusting Relationship with your Oncology Team

Don’t be afraid to ask questions. Your appointments are a time to check in with your doctor and to get any unanswered questions addressed. It’s helpful to write down these questions in advance. When you see your doctor, fire away. He or she will be glad to know what’s been happening with you since your last visit. As you doctor answers your questions, write down what he or she says. It’s easy to forget if it’s not written down. Better yet, bring your caregiver along so they can write everything down. Two sets of ears are better than one.

Also, be honest and open about medications you are taking (including over the counter meds like Tylenol or antacid) and symptoms you may be experiencing. Those details can have a big impact on your treatment. Some cancer treatments don’t work properly if you are also taking antacids, but your doctor can give you a special antacid that is safe to take with your treatment. Some symptoms are important indicators of whether or not you are getting too much treatment or that the treatment isn’t working and it’s time to change to something new.

Oncology Care Teams

Cancer Survivorship Tip #3

Don’t be afraid to get a second opinion

This is especially true if you don’t trust your oncologist for some reason.  Check in with another clinic and see what they have to offer.Atn the beginning of my husband’s cancer journey, he visited the Mayo Clinic for a 2nd opinion. They told him he was already getting top notch treatment. This helped him feel more secure about the plan his oncologist had put together for him. Later on, when his oncologist ran out of options, she sent him back to the Mayo Clinic to be enrolled in a clinical trial. This opened up a new avenue of treatments to try. There is no room for ego in cancer treatment.

Cancer Survivorship Tip #4

Ask about Genome Testing[1]

Checking for genetic mutations can help your doctor find targeted treatments for your specific cancer. These treatments are often more easily tolerated than traditional chemotherapy. Many are available in oral form, making them easier to take. By trying a treatment specially targeted for your mutation, you increase the likelihood of it working. That’s a win-win!

Also, get retested after a couple of years. This area of oncology is a rapidly changing one. New mutations are being discovered all the time, and with them, new targeted treatments are being developed.

Cancer Survivorship Tip #5

Don’t shun older treatments

Sometimes patients get discouraged when their only available option is an older, traditional chemotherapy. No doubt, this is a tough pill to swallow (or more accurately, a tough infusion to take), but this can also be the treatment that gives you extra time. That extra time might mean a new treatment becomes available. That’s what happened three years ago when my Tagrisso came on the market. The time a traditional chemotherapy gives you might also mean that a trial becomes available. That’s what happened recently for my husband. And even if neither of those happens, a traditional chemotherapy is often the ideal treatment option for a cancer patient. It could bring you into remission or treat your cancer altogether. Your doctor will be able to give tell you what to expect.

Cancer Survivorship Tip #6

Have a good support system in place—and use it.

This could include a primary caregiver, family, friends, online cancer support communities, your oncology care team, your faith community, long-distance support, and neighbors. A communication tool like CaringBridge is an ideal way to tell your loved ones what’s happening with you.[2] You can help coordinate help via the planner. You can schedule more than just meals with it. Consider using the planner to ask for help with errands and rides to the doctor as well. It is as useful as you allow it to be.  Family and friends wish more than anything that they could cure your cancer. Since they can’t, let them do the next best thing by allowing them to help you and your family out during this difficult time.

Cancer Survivorship Tip #7

It’s okay to change direction in your journey

We often hear the message that you have to stay strong and fight. Sometimes, the thing that requires the greatest amount of strength is knowing when it’s time to take the gloves off. This is not a failure. This is another part of your journey. It is a time of inner healing and relational healing as you pull your loved ones close and say the things that are often left unsaid until the end of a life. In the United States, we are so focused on how to live well. One thing we don’t teach in our society is how to die well. There is an art to it. It takes a community. Only you know when it’s time to transition from one leg of the journey to the next. Hospice is the ideal way to make this transition. It’s a team approach to end of life care. It isn’t just for the last week of your life. Anyone with a life expectancy of 6 months or less qualifies for hospice care. It has been proven that patients on hospice actually live longer, more comfortable lives than their non-hospice counterparts.

Cancer Survivorship Tip #8

Pray

Our family prays, not just for our situation, but for other families we know or hear of who are going through this same thing. If you have a faith life, I highly recommend praying. I’m not the only one. I suffer from rheumatoid arthritis and fibromyalgia. My 1st rheumatologist was an amazing doctor. He was a devout Muslim who ended up going back to his home in Pakistan. Before he left he gave me a parting piece of advice. “You believe in God? Pray. I truly believe that prayer will help you. It will center you and give you greater peace. This will help to reduce pain.” That was non-denominational advice from a highly respected rheumatologist. To get through this cancer journey, we have prayed and continue to do so.

Cancer Survivorship Tip #9

Your Journey is Unique

No two cancers are alike. No two lives are alike. Because of this, it’s important that you don’t chase after fad cure-alls. Instead, get really grounded. Gather your tools, your support system, and your knowledge. Decide what you can do today. Tomorrow things may change, but today, there’s one thing you can do. Maybe it’s some information you need to read up on from your doctor, or setting up your CaringBridge.  Perhaps you have to look into help to get your kids through this. Whatever it is, just take it a step at a time.

What Are YOUR Thoughts?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSONThe Erickson Family

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace. My books are available at Amazon.com:

The Memory Maker’s Journal 

Facing Cancer as a Friend: How to Support Someone Who Has Cancer

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

I also blog at Heather Erickson Author/Writer/Speaker

Footnotes:

[1] Not all patients have mutations with treatments available, but it is worth asking about.

[2] There are other sites available, but after trying several, I have found CaringBridge to be the easiest to use and the one my support system used the most. Feel free to use whatever site works for you and your family.

Originally posted 2018-10-22 07:00:21.


Metastasis

One of the most frightening words a cancer patient can hear is, “metastasis.” We learned in the post, Cancer Cells: Juvenile Delinquent Zombies, that one of the reasons that cancer is such a deadly disease is its ability to metastasize, or spread from one part of the body to another. Depending on what kind of cancer the patient has, the most serious form is known as “metastatic.”

How Cancer Metastasizes

  • The place where cancer first develops is called the primary tumor site.
  • From there, cancer spreads locally, invading nearby healthy tissue.
  • If too much time passes between the emergence of the primary tumor and treatment or treatment is unsuccessful, cancer cells will break away from the primary tumor site.
  • They then move through the walls of nearby lymph nodes or blood vessels.
  • Cancer cells proceed to travel through the patient’s bloodstream or lymphatic system.
  • They can get lodged in small blood vessels in distant locations, lymph nodes, or other organs. Like when they initially began growing, the cells invade the blood vessel walls and surrounding tissue. New blood vessels to form, providing an abundant blood supply to nourish the tumor as it grows.
  • After that, they can continue to spread to more distant parts of the body. Most of these cancer cells die along the way, but some continue the invasion and form more new tumors in different parts of the body.

The Same Cancer

Even though they’re in a new location, these metastatic tumors are the same type of cancer as the primary

tumor. Doctors can see what kind of cancer the cells are through a microscope when they do a biopsy.

This is important because the treatment options that are most likely to be successful, are dependent on the type of cancer rather than the location of the cancer.

My husband, Dan, has stage IV, metastatic lung cancer. The primary tumor in his lung was very small. Yet, in a short amount of time, it spread to his spine and his lymph nodes. Eventually, it spread to his brain. This is called a brain “met.” The cancer cells in his brain were lung cancer cells, not brain cancer cells.

Sometimes, a patient gets cancer again, months or years after they were treated cancer. Usually, this cancer is the same type of cancer the patient had before. Occasionally, the cancer is a different kind of cancer. This is known as a second primary cancer. Thankfully, second primary cancers are rare, but they do happen.

Where does a cancer metastasis travel?

Most forms of cancer can spread nearly anywhere in the body, but some cancers are more likely to spread to certain locations than others. The following is a table of the most common sites of metastasis (not including the lymph nodes) of various cancers. (1)

Common Sites of Metastasis

Cancer Type Main Sites of Metastasis
Bladder Bone, liver, lung
Breast Bone, brain, liver, lung
Colon Liver, lung, peritoneum
Kidney Adrenal gland, bone, brain, liver, lung
Lung Adrenal gland, bone, brain, liver, other lung
Melanoma Bone, brain, liver, lung, skin, muscle
Ovary Liver, lung, peritoneum
Pancreas Liver, lung, peritoneum
Prostate Adrenal gland, bone, liver, lung
Rectal Liver, lung, peritoneum
Stomach Liver, lung, peritoneum
Thyroid Bone, liver, lung
Uterus Bone, liver, lung, peritoneum, vagina

What are the symptoms of a metastasis?

Even metastatic cancer can be asymptomatic. Your doctor will be keeping a close eye on you if you have already been diagnosed with cancer. They will see you in the clinic on a regular basis, and order scans at regular intervals.

There are some symptoms to be aware of. Headaches, lack of balance and seizures, are a symptom of a brain met. Shortness of breath is a symptom of metastasis to the lung. Bone metastasis is suspected when there is bone pain. Sometimes they aren’t discovered until there is a fracture. If cancer has metastasized to the liver, the patient’s skin will often become jaundice (yellow) and there may be abdominal swelling.

A Word About Brain Mets…

One of the reasons brain metastasis are common, even when treatment is working for cancer in the rest of the body, is the blood-brain barrier. A semi-permeable membrane that selectively allows nutrients in while protecting the brain from toxins. As far as your brain is concerned, cancer treatments are toxic. Because of that tumors often retreat to the safety of the brain.

Thankfully, doctors have gotten very good at zapping those nasty mets with precision radiation. By keeping a close eye on your cancer and following your treatment plan, you have the best chance of being able to get a metastasis under control.

What Are YOUR Thoughts?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSONThe Erickson Family

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace. My books are available at Amazon.com:

The Memory Maker’s Journal 

Facing Cancer as a Friend: How to Support Someone Who Has Cancer

Facing Cancer as a Parent: Helping Your Children Cope with Your Cancer

I also blog at Heather Erickson Author/Writer/Speaker

Footnotes:

  1. National Cancer Institute, Metastatic Cancer: Where Cancer Spreads; Common Sites of Metastasis. February 6, 2017

mesothelioma advocate

As an advocate for cancer patients and their families, I daily hear from people facing cancer. Recently, a gentleman named Virgil wrote to me about his experience, Doctors recently diagnosed Virgil with mesothelioma. This diagnosis turned Virgil’s life upside down.

What is Mesothelioma?

Mesothelioma is a rare cancer that forms in the thin protective tissues which cover the lungs and the abdomen. Exposure to asbestos causes cancer in the mesothelium tissues. This cancer is caused by exposure to asbestos. Asbestos is a group of silicate minerals that are fibrous in nature and functions well as a fire retardant. It was once a commonly used insulator. Now that the dangers of asbestos are well known, it has fallen out of use. It can still be found in old buildings and machines. The United States is one of the only developed countries that has not outlawed the use of asbestos, entirely.

Virgil’s Story

Throughout his life, Virgil has had many jobs that have exposed him to asbestos, including automotive and demolition work, I’ve. He says, “On some jobs, the air was so thick with debris and asbestos you could taste it in your mouth.”

Virgil can no longer work and now, mostly lives off of social security disability. Because of fluid buildup in his lungs, he has to be careful about overexerting himself. He has a portable oxygen tank which gives him some mobility. Still, he must limit his activities, Virgil spends a lot of his time spreading awareness and informing others about the resources that helped him on his journey.

Finding resources isn’t always easy

Virgil says, “When I was diagnosed I needed immediate medical attention. I contacted all the top websites on the internet that are supposed to help people with my type of cancer but nobody got back to me.” Then he found Mesothelioma.net. “Even though I contacted them on a Sunday one of their patient advocates gave me a call back within minutes.”

Virgil found valuable information at Mesothelioma.net; information on mesothelioma treatments and doctors, asbestos trust funds for victims, and a lot more. They also sponsor The American Cancer Society, the MD Cancer Center, and the Make a Wish Foundation “They gave me a great deal of helpful information on doctors and resources available to me.”

Mesothelioma advocate

Virgil is now receiving cancer treatment at the National Cancer Institute. The patient advocates have even provided him with financial assistance so he could afford a place to live during his cancer treatments. “If I had not reached out to mesothelioma.net, I would likely be homeless and more importantly in hospice waiting to die. These people gave me my only chance at survival.”

Advocate: Paying it Forward

One of the most important things you can do to ensure your survival is to advocate for yourself. Virgil is an amazing example of an advocate. He searched for information and assistance and is now sharing that information with others. If you have Mesothelioma, check out the information at mesothelioma.net and the mesothelioma resource page at Facing Cancer with Grace.

WHAT ARE YOUR THOUGHTS?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

I also blog at Heather Erickson Author/Writer/Speaker

Originally posted 2018-03-05 07:00:27.


Good Nutrition

Getting good nutrition can be difficult when you have cancer, both because of the disease and side effects of the treatment. There are some things you can do to overcome this obstacle to your healing.

Cancer can make good nutrition more difficult

Patients with head and neck cancer often have malnutrition before they start treatment. This is due to pain and trouble swallowing, swelling, and bleeding. Often a patient needs to consider a feeding tube as a temporary way of receiving the nutrients they need during their treatment.  Eating softer foods is important when you have cancer of the head and neck.

The pancreas makes an enzyme which helps break down fats, proteins, and carbohydrates. This enzyme aids digestion and helps to neutralize stomach acid as it enters the small intestine. If the pancreas isn’t working properly, there can be a shortage of these enzymes. This often means the body doesn’t get enough fat and fat-soluble vitamins from the food you digest. Proteins may not be completely digested, leading to the formation of toxins or allergies. Your pancreas also might not break down carbohydrates, leading to diarrhea and other problems with your digestive system as a result of a malfunctioning pancreas.

There are so many reasons why it can be difficult for patients with gastric cancers to get good nutrition. Patients may experience loss of appetite, both from treatment and cancer itself. The stomach may not empty properly. This can cause the patient to feel full longer.

 

Cancer treatment can make good nutrition difficult

Surgeries and radiation can make eating and digestion painful. Chemotherapy and radiation can cause severe nausea and vomiting. Mouth sores can also make eating a painful experience. Ask your doctor for advice on ways to ease discomfort and nausea.

Chemotherapy

Chemotherapy affects rapidly dividing cells like the cells that line your mouth, throat, stomach, and digestive tract. This can quickly affect your ability to get good nutrition by changing the way things taste and your appetite.

The time and duration of your chemotherapy can affect the severity of your appetite loss. Your appetite will most likely return to normal within 2-6 weeks of ending chemotherapy. Even if you don’t feel like eating, it’s important to try to get the good nutrition you need to fight infection and repair tissue damaged by cancer and its treatment. Getting good nutrition also helps fight fatigue and weakness

See a Nutritionist

Ask if your cancer center has a nutritionist on staff, or can refer you to a nutritionist who specialized in oncology nutrition. Oncology patients have special nutrition needs as well as oncology-related issues that can interfere with meeting those needs. They might be able to prescribe extra vitamins or supplements. There are also prescription medications that can help with appetite problems. If thing don’t improve and you begin to lose too much weight, your doctor can help you decide if temporary tube feeding or getting extra nutrients via IV is a good idea.

When Dan was first diagnosed, he saw a nutritionist who was able to give us some great advice about what he should be eating and how to make meeting his nutritional needs easier. She knew the issues that could crop up and make doing this harder. She gave us some easy recipes for shakes and smoothies that made getting the right kind of protein possible, even if Dan wasn’t up to eating solids.

Good Nutrition

Other Tips for getting Good Nutrition

Most cancer patients have higher energy and protein needs. Meal replacement beverages can help supplement those needs. Ensure with Revigor is one example of these. You can make some great tasting shakes at home in your blender and even add protein powder to give them an extra boost.

Along with smoothies, try making Popsicles from blended fruits. This can help increase your caloric and nutritional intake while soothing an inflamed mouth or throat.

Watch the spices! You may need to eliminate certain spices that bother your system. On the other hand, if irritation isn’t a problem, adding new and interesting flavors and spices to your food might be just the thing to entice your palate.

Chemotherapy often changes the taste of your foods. Sometimes the food you eat tastes metallic. Reduce this effect by eating with plasticware rather than metal utensils. Cooking in glass or enamelware can also help.

Choose foods that are high in calories and protein, as well. Stir some protein powder into your ice cream or pudding. Every little bit helps.

Eat what you can, when you can.

When Dan started having trouble with his appetite, we went to the store and walked down all of the aisles. When he saw something that looked appetizing we tossed it in the cart. He keeps his snacks nearby so when he’s ready to nibble, they are there. He ate frequent, smaller meals rather than 3 large meals every day.  He found it easier to eat more in the morning, so that became the main meal of his day rather than dinner when he found it hardest to eat.

If you find it hard to eat solids, don’t waste your fluids on non-caloric ones. You are doing the opposite of dieting. Instead, drink fruit juices, milk, and other beverages that have calories and nutrients. It may not be the optimal way to get calories and nutrients, but at this point, you just do the best you can.

If sitting down at the dinner table feels overwhelming, take your mind off of it and eat while watching your favorite show. People are often told that it’s not a good idea to eat in front of the TV because they will eat more than they realize, without meaning to. Again, you are doing the opposite of dieting. This is your chance to break all of the rules.

If you are finding that you never feel hungry, eat on a set schedule. Every couple of hours eat a small meal. It might just be a banana or a half a sandwich, or maybe a scoop of ice cream. These small meals will give you nutrition and maybe even some good nutrition to pull you through and fuel your body.

 

What are YOUR thoughts?

I’d love to hear in the comment section, below. I appreciate my readers as well as the writing community. To show that appreciation, I use Comment Luv. Just leave a comment below and your latest post will get a link next to it. Thank you!

ABOUT HEATHER ERICKSON

In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

I also blog at Heather Erickson Author/Writer/Speaker

Originally posted 2018-02-19 07:00:34.

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