Knowledge is not Necessarily Power

May 19, 2006 at 11:40 am (Uncategorized)

Ever heard of a disease called carcinoid syndrome? Me either until Wednesday when I saw the illustrious Dr. X.

As you already know, he was shocked at the number of tests I have had done by my specialists in New York. As an antidote he proposed….another test.

“I’m just perplexed why they haven’t done a basic test for carcinoid syndrome,” he said, after asking me if I’d ever had diarrhea. This seemed like a fairly broad diagnostic category.  I mean, has anyone ever not had diarrhea? To be fair, carcinoid syndrome can also cause an enlarged right heart, a symptom I have that has baffled doctors across the nation. You see, cardiac sarcoidosis causes the heart’s electrical system to malfunction, but it doesn’t typically cause one side of the heart to just get bigger.

Contrary to my wishes otherwise, an enlarged heart doesn’t translate simply into a capacity to love more fully or to be extra gutsy. A bigger heart gets thicker; and a thicker heart doesn’t pump blood as effectively as it should. Eventually this can lead to bad stuff. This is about the extent of my knowledge of cardiac functioning.

What has puzzled my doctors is that the horse dose of prednisone I’ve been taking for over a year has improved the electrical problems in my heart, but the right side keeps getting bigger every three months.

According to Dr. X, carcinoid syndrome occurs when a tumor develops in the GI tract. Apparently, this tumor excretes hormones, such as serotonin, that are activated in the lungs and then go on to impact the right side of the heart. He was blase about it all and made it sound like the tumor was really no big deal. Take the tumor out, he seemed to suggest, and you’ve fixed the problem.

He sent a note to my primary care doctor to order the necessary test. I won’t have to be injected with substances that are so radioactive I’ll have to stay away from my son for eight hours, like I did when I had my cardiac PET scan in February. All I have to do is pee in a container for 24 hours and then bring it to the lab to be analyzed. They’ll check my urine for extra quantities of the hormones that could be released by the carcinoid tumor. Hah. And they call this a test. If it ain’t invasive, it ain’t worth having, that’s my new motto.
Last night was Jay’s turn to put Andrew to bed. This is a process that can take quite some time. Andrew has many fine qualities; sleeping, however, is not one of them. I’ve actually seen the little fellow repeatedly slap himself in the face to stay awake on long drives. Knowing that I likely had at least a half hour to myself, I padded downstairs to check my e-mail and waste time on the Internet.

“Hey,” I thought. “I should see if there’s any information about this carcinoid stuff online.”

Unfortunately, I’m a pro at finding things on the web. I once wrote a book for high school students about conducting on-line research, and another writing project involved tracking down information about the most obscure Latino artists imaginable. I found stuff that no one else could.

There was a lot of material about carcinoid syndrome. Most of it was bleak. Apparently, the initial tumor is frequently malignant, which means it is cancerous. I’m not sure how that carcino prefix in carcinoid syndrome slipped by my radar. Even worse, the hormones it releases don’t hit the lungs until the cancer has metastisized to the liver. Metastisize is another word I don’t like, especially when it involves my liver, of which I only have one. Moreover, chemotherapy and radiation treatment are virtually ineffective against carcinoid tumors. If the tumor can’t be excised–which can’t be done if the cancer has played world domination in your body–you’re screwed. The median survival rate is five to eight years.

As so many of these medical web sites do, the Carcinoid Syndrome site had a handy checklist of the symptoms you’ll experience if your have the syndrome. You typically only get the syndrome once the disease has progressed into your liver. Diarrhea, heart palpitations, flushed cheeks, swollen face. “Shit,” I thought, as my fingers got damp and slippery on the keyboard. “Shit. Shit. Shit.” I didn’t notice the symptoms I didn’t have.

My heart dropped into my stomach, which was surging with extra bile. I felt panicked and really, really angry. “Great,” I thought, through the chaos of my swirling thoughts. “Not only do I have one rare disease; now I have some rare fucking cancer that’s going to kill me in five years.”

Jay should have come downstairs by this point to coax me to watch TV. But he hadn’t appeared after nearly forty-five minutes. I assumed that he was simply having a hard time getting Andrew to sleep, but I should have known better. After another half an hour, I snuck upstairs, now in full-blown panic mode, and heard both my boys gurgling and snoring from Andrew’s bed. Jay had cuddled up with Andrew and drifted off to sleep.

I’d like to digress now and talk about Jay’s sleeping prowess. He hates falling asleep, because he believes that time spent snoozing is time wasted. But he’s so very, very good at it. A friend of his swears that one time Jay fell asleep on his feet while leaning against an amp at a Therapy? concert. For those of you not familiar with Therapy?, I can only say that it is not soothing, restful music. Listening to it usually makes me feel like someone is scraping a fork against my teeth– a rusty, twisted fork. (But then I’ll take Therapy? any day over another of Jay’s favorite bands, Tool, who produced the poetic masterpiece, “Prison Sex.”) When we were going to our birthing classes, our lovely instructor, Lucy, would have us meditate for a few minutes before we practiced our controlled breathing. Jay would routinely fall asleep and start snoring during these centering exercises. I’m not sure we inspired Lucy with much confidence in our teamwork potential because Jay’s snoring so embarrassed and irritated me that I would resort to unfolding my legs from my lotus position and kicking him repeatedly until he jolted awake.

But that is neither here nor there. I tiptoed over to the bed and poked him hard. “What?” he said right away. He probably knows that particular jab spells trouble.

“You fell asleep,” I said in a stage whisper in a tone that suggested he had just been unfaithful in our bed with my best friend. “And I looked up that thing that Dr. X mentioned. And it doesn’t look good.”

I love Jay for many, many reasons, but his ability to talk me down from psychic ledges is one of his better qualities. As is his capacity to let my stricken tones slide off him. He knew simply to hold me and tell me he was so sorry that I even had to think about stuff like this. He told me everything would be OK and that he loved me. And then he told me that maybe I shouldn’t look things up on the Internet with quite such zeal.

He’s right. Living in the information age can make us feel only more clueless. I’m all for patients empowering themselves with as much knowledge as possible. But we have to exercise restraint. Look up any disease on the Internet, and it’ll sound like you have it. You could lose your mind typing your symptoms into Google and seeing what the search engine comes up with. One of the worst mistakes I ever made was searching for cardiac sarcoidosis in the newspaper and magazine database I use. It found dozens of autopsy reports. “So and so died at the age of 42 from complications from cardiac sarcoidosis.” And so on. For a disease that was so rare, a whole lot of people died of it. It took me days to shake off the gloom and fatalism that settled over me after that research session.

A good starting rule might be to only research diseases you know you have. Why worry about something that might not be? I’ll have the carcinoid syndrome test done next week and we’ll take it from there.

My mother often misquotes cliches. It provides the whole family with hours of amusement at her expense. But frequently her mangled versions are more insightful than the original, tired sayings. For instance, one time she said, “We’ll cross that bridge when we’re over it.” That, I think, is a hell of a good way to live.

After I had shut the computer down, Jay and I settled down to watch the season finale of The OC. There’s nothing like bad television to make you feel like you’re living.

Permalink Leave a Comment

Limits – Or the Lack Thereof

May 18, 2006 at 1:03 pm (Uncategorized)

I’ve never been much of a believer in physical limitations. Perhaps I should be more specific. I’ve never been much of a believer in physical limitations when it comes to myself. I’m all for other people taking it easy when they’re sick. For instance, yesterday, when I bumped into an old friend who is struggling with maintaining her full-time job while undergoing chemotherapy, I lectured her on the importance of rest.

However, I have a hard time resting. When Andrew lays down for his afternoon nap, I feel absurdly lazy when I try to sleep at the same time. As I toss and turn and tangle myself up in my sheets, I think, “I should be getting some exercise” or “I should be writing something important”or “I should be excavating the kitchen table from its crushing load of junk mail and old magazines” or, my all-time favorite, “I should do laundry.” (As a side note, how is it within the natural laws of the universe for three people–one of whom is only three feet tall–to generate so many dirty clothes?) If I do drift off to sleep, I feel as if I’ve done something morally suspect

The problem is that I really do need to rest. The main symptom of both sarcoidosis and motherhood is crushing fatigue. I get so tired that my bones ache and the process of keeping my eyes propped open feels overwhelming. Plus, the prednisone compromises my immune system, so I’m always sick with something.

This new reality is really hard for me. I’m the type of person who likes doing things–and doing them intensely. I don’t usually let anything or anyone (especially my own body rebelling against the commands I give it) tell me I can’t. I’ve always been this way. When I was slimmer and younger, I was a competitive cyclist. I was pretty good, mostly because I was ridiculously stubborn. I would ride until I puked. One time I rode until I passed out. I leg pressed 900 pounds when I was still in a full leg cast a few weeks after having my ankle reconstructed. I distinctly remember feeling lame that I couldn’t do squats because of the cast.

When I was finished with cycling and decided to rebel against my old squeaky-clean self, I took up smoking. And let me tell you, I was quite a smoker. I got myself up to a pack a day habit in no time, and nothing would make me stop–not chest colds, not bronchitis, not pneumonia. God help me if I ever decide that heroin is in my future.

I gave up smoking and most of insane behavior with help from Jay. But I still liked to push myself. A significant aspect of the equation was being hard on myself. If I made it to the gym only four days in a week, I lectured myself. Publishing an article in a third-tier magazine wasn’t good enough, I told myself. Better work harder and get in the New Yorker. When Jay and I went to live abroad, I didn’t cut myself a whole lot slack. We arrived in Palau, an island nation in the middle of the Pacific, with no contacts. Three months later, I had two writing jobs and was teaching part-time at the college. I still think I should have produced a book from those experiences.

I have a sense that this mind set is partially genetic. Without compromising anyone’s privacy too much, I will say that I recently had an interaction with my mother involving her torn Achilles tendon, her standing for three hours on the injury and organizing my closet, and the phrase “push through the pain.” Clearly I come by this honestly. I was raised by parents that got (and get) things done. When the shit hits the fan, they don’t spend much time analyzing the trajectory of the mess or wringing their hands or “processing” the whole experience. They get to work and try to clean up and move forward. I admire this outlook.

The only problem is that now, when I push myself, I only get more tired. I have levels of fatigue I never knew existed. And the harder I flog myself to do more, more, MORE, the more tired and dejected I get, the more I feel like I really have been flogged. I physically collapse. If I make it to the gym five days a week, do my work, take care of Andrew, cook dinner, and stay up late enough to see my husband after work, I will literally break down in about a week. I’ll get a kidney infection or a sinus infection or a flu. I’ve become like an unreliable car. I run just fine most of the time, unless you drive me up a hill, try to make me go faster than fifty miles an hour, or take me out in the heat.

Someone suggested that I try to cultivate the belief that resting and getting well are my full-time job. Her thinking was that I would then push myself to take more naps and generally just chill out. Needless to say, my neuroses are too highly developed for parlor tricks like these. My new approach is to try this weird thing I’ve heard about called moderation. I go to the gym, but I don’t go all out. I lay down for an hour a day. If I can’t sleep, I read. I don’t berate myself for more than a half an hour a day for needing to have a babysitter to help me take care of my own son. We’ll see how it goes. I’m sure I can do better with this moderation thing.

Permalink 1 Comment

You are a Pawn of Academic Medicine

May 17, 2006 at 2:05 pm (Uncategorized)

Going to doctors has become a part-time job for me. It’s a rare week when I don’t have to show up at some generic medical office and fill out a variation of the same form.

Today, I had to visit Dr. X, one of the two cardiologists in Helena. The specialists in New York and Philadelphia who treat my sarcoidosis quite rightly want me to have a local heart doctor to contact in case any emergencies arise.

Dr. X had the misfortune of doing his residency at Emory University, one of the “top cardiac centers in the country,” and he made sure to tell me this before he had both feet in the doorway. I’m not sure exactly what happened to Dr. X at Emory. Maybe someone put crazy glue on the earpieces of his stethoscope or exchanged a water balloon for the angioplasty one. Who knows. But he definitely had some unresolved issues about the practice of medicine in an academic setting.

“Who diagnosed you with cardiac sarcoidosis?” he asked right off the bat, in a waspish tone.

I’d had an extra cup coffee this morning, so I was on the punchy side. “Oh. I made it up,” I said. The pre-sarcoidosis me tended to be more deferential towards the White Coats. But after spending so many hours at appointments with them, I’ve lost a good bit of my patience and I’m rarely in the mood for ass-kissing. I mean, come on. Where else in the business world do you get away talking to your customers like that?

Dr. X had seen several patients with cardiac sarcoidosis back in the day at Emory. I could tell right off the bat that I was locked in an office with a small-town doctor with a big-city sized inferiority complex. There were those comments about “top cardiac centers,” there was his overly-stylish tie, and then there were the framed commendations all over the place. If NAMBLA had recognized this guy as a good doctor, he would have framed the certificate and stuck it up on the wall. And then, there were the dozens of remarks he made that insinuated that anyone who practiced medicine within forty miles of a major university was in cahoots with the forces of evil.

“I read your chart, and I see someone who has been tested for the sake of testing.” It’s true. I have had nearly every diagnostic test known to man–EKGs, echocardiograms, MRIs, PET scans, heart catherizations, stress tests, tilt table tests, nerve conduction tests. “You are a pawn of academic medicine,” he announced, shaking his head.

Apparently when Dr. X, was at Emory twenty years ago, they mostly didn’t treat cardiac sarcoidosis. However, now the standard treatment is to start people on a high dose of prednisone–the only proven agent to minimize the inflammation caused by the disease–and monitor the hell out of you. The risk with cardiac sarcoidosis is what is tactfully called “sudden death” in the medical literature. Most of the cases of cardiac sarcoidosis are detected posthumously upon autopsy–usually after someone has dropped dead from heart problems. But Dr. X has a patient, God help her, with cardiac sarcoidosis who he doesn’t treat. “She’s just fine,” he said. I thought about all those poor people who were just fine, until one day the electrical systems of their hearts, which were compromised by the disease, short-circuited –unannounced and without provocation–and ZAP, another “sudden death” to add to the statistics.

I wasn’t in the mood to debate treatment protocols. That’s why I spend most of my and Jay’s disposable income on doctors. If I wanted to know this stuff so freaking well, I would go to medical school. All I want is a lackey who will take orders from the experts and do an EKG if my heart starts flip-flopping around in my chest. I have enough experts to cast a Broadway musical. I don’t need another one.

“Why are you brow beating me?” I finally asked. “What do you want me to do? Ignore three major medical centers, go home, and stop taking my prednisone?” He backed off and became extra-charming. “No, of course not,” he said. “It just seems to me that the treatment is making you a lot sicker than the illness.” And then he added that I should be aware that academic doctors don’t always solely have your best interests at heart. Those devious doctor/professors are more interested in publishing about a weird case than actually curing you. Duh. Does this jackass think I don’t watch House?

So, with two hours of my time sucked down the seemingly bottomless vortex of medical appointments, our session ended with him reassuringly touching my shoulder and proclaiming that he was going to write a letter to Mt. Sinai Hospital in New York to try to discern their reasoning. I wanted to say that this was all way past reason, but my coffee had worn off.

The reality is, he’s mostly right. I am nothing but a guinea pig. Nobody knows anything about my illness. The patient populations in articles I’ve read about cardiac sarcoidosis in academic journal are of eleven or twelve people. Some get as high as twenty-five. It’s pretty hard to make sound scientific conclusions based on data like that. So, my doctors do their best. Yes, I think I have been unnecessarily tested. Yes, I bet I do crop up in a paper some day. And I know that all the monitoring and poking and prodding they do will benefit future patients more than me. How else does medicine move forward? Did they really know that the first heart transplant would work? Or the first chemotherapy treatment? But I need to believe that my super-specialists have my best interest at least somewhere in their hearts.

Dr. X was also accurate that the treatment has been far worse than the disease. I’ve gained 60 pounds on the prednisone. My face is bloated; my fingers look more like Vienna sausages than appendages. I used to be able to ride my bike for 120 miles, but now, I’m pretty proud of myself for eking out 40 minutes on the elliptical trainer. The prednisone is eating away at my bones and makes it likelier I will get cancer some day. And it might not be enough. When they last tried to taper me off the prednisone, my EKG immediately got funky. The drugs they have lined up next are no nicer than the prednisone.

But there comes a point when you have to trust someone with medical decisions. I stay as well-informed as I can, but I pay for good care (and travel a hell of a long way for it), precisely so that I don’t have to think about it all the time. I don’t like being fat; I don’t like my shiny moon face. But sudden death sounds a whole lot worse than plus size clothing.

Permalink 2 Comments

Diagnosis Part I: Sarca-What?

May 16, 2006 at 9:59 am (Uncategorized)

I’ve always been a hypochondriac. If I have a headache, I immediately assume that I’ve been stricken with a fatal brain tumor. If I’m feeling extra tired, I just know I have leukemia. A strange rash? It must be lyme’s disease. A sudden fever? The onset of a rare tropical illness. To be fair to myself, though, I have had my share of bad medical luck. Those last two were true. Within a single year, a tick gave me lyme’s disease and a mosquito, dengue fever. I’m also prone to developing the worst form of any given condition. Take ten people with a cold, and I’m the only one who will get first bronchitis and then pneumonia. Send a busload of tourists to Mexico and have them all brush their teeth with tap water (bad idea, I know), and I’m the one who contracts Hepatitis A. I don’t sprain my ankle, I snap the ligament. My husband Jay looks on the bright side and points out that we always get our dollar value from our health insurance premiums.

Given my innate pessimism and my track record, I wasn’t completely shocked when the doc-in-a-box I saw for a bad chest cold called me at home one fine Saturday and told me that the routine chest x-ray he had taken at his clinic had been re-read by a hospital radiologist who detected enlarged lymph nodes. “It’s probably nothing,” he said. “But you need to get it checked out with a CT scan.” When I prodded him for specifics, he mentioned lymphoma. ( need to interject here that I visited this clinic a few years earlier when I experienced vertigo, dizziness, and ringing in my ears. The same doctor sagely told me that I either had an ear infection or multiple sclerosis, referred me to a neurologist, and sent me home to stew for the weekend in a morass of panic and dread.) Jay tried to keep me from worrying too much for the days before I had the CT scan. Of course, Jay’s concept of taking your mind off of things is to watch either sports or disturbing TV dramas like “The Shield.” So, it came down to brooding, March Madness, or a drug dealer getting his face burned on the stove by a corrupt cop shaking him down. I chose brooding–always a sound decision for a pessimist.

Truth be told, I had a lot to brood about. I was thirty-three, and had a three month old son. We had just moved back to Helena, Montana, a place I love. Dying young and dramatically had little appeal when I could hold my gurgling, burbling baby boy who had learned to smile and focus his almond eyes on books. I loved him with a fierceness that struck me in my gut as much as my heart.

The CT scan came back abnormal too. The doc-in-a-box washed his hands of the case. I was beyond his area of expertise and needed to see a pulmonologist. Since Helena’s pulmonologist only sees patients once a month, I needed to go to Billings–a four hour drive to the other side of the state. Jay had just started a new job and couldn’t afford to miss a couple of days right away. So I decided to drive up on my own with Andrew. I was in my invincible martyr mode, a bad combination. In this state of being, I simultaneously believe I can take on any challenge while fully expecting to be wounded and to suffer. Jay hates the invincible martyr because it’s a lose-lose situation for him. By overriding invincible woman, he suggests I am weak and incapable of accomplishing a task. Ignoring the martyr leaves him open to accusations of being a rat bastard who has abandoned his wife.

Andrew was merciful and slept for a chunk of the drive to my parents’ house outside Billings. I’m ashamed to say that I resorted to listening to cheesy, uplifting pop music to keep myself from crying. I even played Jimmy Eats World’s “The Middle Lyrics,” with its chirpy refrainof “Everything, everything will be just fine/Everything, everything it’ll be alright” over and over while I shamelessly bargained with God. “Please. I will appreciate every day if you let this not be something terrible. Please. I will not complain to mysef about trivial things anymore like why I can’t lose the baby weight from my thighs or why Jay won’t unpack more boxes. Please. I will savor every minute of every day. Please, please, please. I want to watch my son grow up.” If I were God, I would find displays such as this intensely annoying. I would say back to me, “People never spontaneously chat with me on the good days. When the sky is blue and your lymph nodes are small, the phone doesn’t ring…” As it was, I didn’t get a response. There was only the thud of the music’s base on the car stereo, Andrew’s steady breathing, and the miles of open fields just beginning to emerge from winter flying by the car window.

I spent the night at my parents’, and they delivered the line that they surely must now regret: “Whatever it takes, we will be with you through this.” No one has been truer to their word than my Mom and Dad when they said this. But that’s getting ahead of myself.

The next morning I went to see the pulmonologist in Billings. Andrew experienced the first of many exciting hours spent in physicians’ waiting rooms. The doctor was reassuring and genuinely sweet. He ordered another CT scan, this one with contrast dye injected into my veins. Since I was breast-feeding Andrew, I frantically nursed him before the test and fretted about not being able to feed the little guy for the next 24 hours until the junk cleared my system. He had his first taste of formula a few hours later and promptly went on a hunger strike that lasted until I could nurse him again.

“I don’t think this is lymphoma,” the doctor said when the test results came in. With this news, I took what was probably my first full breath in several days. “It’s likely something called sarcoidosis, which is usually a fairly benign condition,” he continued. Benign. A good word. He said to be sure, though, I should have a biopsy done of one of the enlarged lymph nodes. The operation is called a mediastinoscopy; they would examine the tissue to see if it contained granulomae, which meant it was sarcoidosis, or malignant cells, which indicated lymphoma. I would have a two inch scar on my neck, but I could live with that. I wouldn’t even have to spend the night in the hospital. The doctor did mention, almost off-handedly, that if I did have this sarca-thing instead of cancer, he would need to do a bunch of additional testing because, although the sarcadoidadoodle or whatever usually stayed in people’s lungs and didn’t do much damage before it spontaneously went away, some people–“but not many at all”–got it in other places in their bodies, like their hearts and brains. But that was very unlikely.

The night before I was scheduled for surgery, I got a stomach flu and vomited so intensely and persistently that I had to go to the emergency room. See? I wasn’t exaggerating in my opening paragraph about my medical misadventures. A few days later, I finally had the operation. As expected, the tissue in my lymph nodes contained these granulomae. I had sarcoidosis. Life was good.

Permalink Leave a Comment

Mother’s Day

May 15, 2006 at 9:28 am (Uncategorized)

Yesterday was Mother’s Day. It’s supposed to be a day to give thanks to mothers for all they do. I had a parallel response. I felt so grateful to my two-year old son Andrew for coming into my life that it hurt to breathe at times. Andrew keeps me sane; Andrew keeps me feeling alive; Andrew keeps the world in focus.

I should caveat this by mentioning that on the eve of Mother’s Day, Andrew had a typical night’s sleep. This involved awakening in his room around 2 AM and calling out, “Mommy, are you there?” After I hollered back and reassured him that it’s sleepy time and yes, I’m always right across the hall, he drifted back to sleep. An hour later, he bellowed out his latest request: “Daddy, come take my water cup out of my hand,” which is a new low (albeit one heavily laden with disturbing Biblical images in the “Father, let this cup pass from me” vein) in our ongoing “I’m thirsty” wars that every parent experiences. Daddy, who will also appear in this blog as my husband, Jay, refused to budge and encouraged Andrew to “just put the cup down.” (Wow. Just imagine how different things would be if the original exchange had gone down like that.) Somehow, Jay managed not to modify his response with the four letter adjectives I was imagining, and after a few sobs and quavering “pleases,” Andrew slept again. He must have toddled across the hall and into our bed without waking us because he shook me out of a dream around 7 AM to announce, “I’m poopy.” Needless to say, Andrew does not keep me sane at those moments.

All grousing aside, Andrew makes life worth living and he makes it imperative that I keep on living. This gets to the heart of why I am writing this blog. I am one of the millions of mothers with a chronic illness. Mine is called sarcoidosis, which no one has ever heard of (including me, pre-diagnosis). But there are infinite rolls of women with cancer and lupus and MS and God only knows what else, who want nothing more keenly than the privilege of watching their children grow–and the energy to enjoy it.

So, why, oh audience of three or four, am I writing this? Well, I am that self-centered. I’m ashamed to say it, but I do think that my experiences can be meaningful to others. I got sick at almost the exact moment that I became a mother, and I believe I’ve learned a hell of a lot about both these states of being because of their close proximity. I like to think of it as the X-Treme version of motherhood. Can’t you just see me catching Big Air on ESPN2? It goes something like this. I’ve had a doctor tell me, in his warped version of giving comfort, “This is what is going to kill you. But don’t worry. It probably won’t in the next ten years.” And I’ve calculated where Andrew will be in the ten years, and I’ve wept furiously and bitterly on the drive home. Then, I’ve wiped my eyes, reclaimed my beautiful boy from the babysitter, and taken him to the park.

I know how lonely and weird this dichotomy can make a person feel. But I also know how thankful I am for every day I have with Andrew. He grounds me.  I think it gives me perspective, or at least a perspective.  And I’d like to share it with you.

Permalink 3 Comments

« Previous page