Never Give Up, Never Surrender!

It turns out I have quite a developed opinion regarding insurance. I think this is probably the case for most people who have encountered an expensive illness.

I thought I'd explain my philosophy so people might see why I'm so adamant about getting the in-network exception for the rest of my reconstruction reinstated.

There is only one number I care about in regards to my health insurance--the maximum out of pocket my family has to spend. It's a sure bet we'll meet it this year, as we have every year since I've gotten the bc diagnosis.

This amount is several thousand dollars--roughly the cost of a Hawaiian vacation for my husband and me.

We're happy to have coverage and happy to pay what we owe on time. But I will not pay one dime more.

In appealling this latest goofiness, I have heard too many times that I can just use our out of network benefits to finish up the work. This would trigger a whole new limit, and would mean we would pay 20% instead of 10% and there would be no caps for reasonable and customary charges--so basically, sky's the limit in addition to the in-network maximum that we will still meet.

There is no way I am going to have my family pay for two tropical vacations in one year that we will never take.

If there is not a local doctor who performs the service, our insurance allows for using a doctor who does the work and will cover that at the in-network benefit level even if they are not in-network.

Almost all plastic surgeons who do a lot of DIEPs don't contract with insurance companies as a general rule, and there is no local doctor who can do a DIEP, so getting an in-network exception is the way I have to go.

And I won't give up.

Having Troubles Getting to Second Stage

Remember when I said "peer to peer review" is the phrase you need to know if your insurance rejects your attempts for an in-network exception for DIEP reconstruction if it's not offered locally?

Well, you should also know insurance might try screwy things to keep you from getting this review, which involves their medical director chatting with your plastic surgeon.

Obviously, if that were allowed to happen I'd have a much higher chance of getting the decision overturned than if I and my dr's office wrote a letter, which the insurance co answers by letter in two weeks.

Having their medical director actually speak to my doctor seems imperative in this case, since the director thinks that I can get the second stage of a DIEP reconstruction in my town, which is simply not true. In my opinion, this person is in dire need of some education about the differences in breast reconstruction procedures after a mastectomy.

It's not like I'm asking for an elective boob job, after all.

Anyway, there are two issues that are bugging me about this.

1. When I call to get information about it, I'm told this is strictly between the dr's office and the insurance, though it affects me, the patient. They never let the patient speak with the medical director or any of that staff about the decisions. Apparently, they don't like to let the doctors speak to this person either.

2. The insurance company is saying my only line of appeal now is the letters because there is a 10-day window for asking for a peer to peer review. I have documentation that shows we did this, but they are saying that the window starts from when they made the decision--8 days before they put the decision into a letter and mailed it (a couple more days) to my dr's office. Naturally, my question is "How many, if any, peer to peer reviews do they even grant if this is their procedure?"

Now I'm left with appealling the craziness of their peer to peer process on these two fronts. What's so frustrating about this is it should be a no-brainer for insurance to approve an extension of the earlier in-network exception I had for all three stages of the DIEP back when I started this process. Those agreements come with an expiration date for some not reflective of real life reason, and that's why my doctor applied for the extension.

Trust me, I wanted to wrap up all three phases of this DIEP process as quickly as possible (usually that's first surgery, second surgery three months later and final office work two or three months after that). It would have been cheapest and I would have been even by now, but the reality of life dictated that I needed to wait to see if my new boob would soften up a little and fall a little so it would look more natural.

I hate to wait, but I waited. But I didn't know that when I was ready to move ahead again, I'd have this stupid problem.

I'll keep you posted.

Anniversaries

This month I celebrate being cancer free for three years. This past August, my husband and I celebrated 10 years of marriage.

Each is an accomplishment, and taken together, they are a sign that my little corner of the world is doing pretty well.

Getting a big disease like cancer can wreak havoc on a marriage. A statistic I saw recently said spouses are eight times more likely to leave if this brick comes through the window.

It's a big deal, no doubt, and I see now why it's included in traditional marriage vows.

I'm just very happy we've defied the odds. I think it helps that we were friends for many, many years before we got married. Honestly, I have trouble remembering a time before L. was in my life. Just as it seems like I've been a mom to S. forever.

Cancer has come, and hopefully gone, but it has changed our lives forever. Sometimes I think it's moved us ahead on the continuum of coupledom. It's like we're much older than we actually are and have covered so much more ground than we actually have. I feel we're like my grandparents and older than my parents in some ways.

It's a weird feeling, but a good one in that I know L. gets it. He gets that we will always have to worry about having insurance for the family. He gets that I am not crazy when I wonder aloud about ailments I've noticed. And he'll push me to get things checked out, because he wants me around for the family as much as I want to be around for them.

This all brings me to having my wedding ring redone recently--the original didn't fit after I gained weight from cancer treatment.

I could look at this new ring as just fixing more of the collateral damage, but I've decided to see it as a marker of what we've been through and a promise of many more beautiful miles to explore--together, as a family.

Moving Right Along

I decided to cancel the muga scan until I see the cardiologist. If he can give me a good reason for needing a muga to confirm or add something to the sonogram I got, then I'll consider another test. If not, I don't want to waste my time, money and health.

I personally don't think my low heart function is related to the odd feeling I'm having somewhere in my chest, but it looks like I have to have the heart appt. before I can get any further on checking the other out.

I mentioned to my primary care dr. that I'm still having lower back pain; I first saw him about this 20 months ago. It feels like it's mostly centered on the lower left side now and has been getting worse.

He suggested physical therapy as he did when I first saw him. I said I'd be happy if we move on to a PET scan to check the chest pain because it might be able to rule out anything going on with the bones.

He agreed that there's nothing ruling out bone mets at this point.

I also showed him a skin-colored bump on my left thigh that appeared shortly after I completed Herceptin (20 months ago). I've always kind of wondered if it's skin mets. I'd say it would be unlikely for it to appear so far away from the affected site, but once you get aggressive cancer at age 37, nothing seems impossible. The dr. agreed it's not likely, but to me that says "check it out." Or don't and live with crazy-inducing uncertainty.

So I have a punch biopsy in a few days.

I'll keep you posted.

Taking Heart

The news out of the annual breast cancer meetings is that the A of ACT chemo and Herceptin are each bad for the heart.

It's enough of a problem that some doctors recommend a switch from the A to another chemo drug combination before Herceptin.

Over the last few months I've noticed some odd feelings in my chest--like a rubber band snapping--about once a day at no particular time. It just feels odd, so of course it got me wondering, "Could something be up?"

I read "But Doctor I Hate Pink's" blog about having read the dosing info for Herceptin (which I've never done) and found that the manufacturer recommends every six month followup on the heart for at least two years after Herceptin treatment ends.

So I decided to report my chest pains and get a followup test. I had one after finishing Herceptin, but none since, even though that last muga scan showed my left ventricle ejection fraction (lvef) at 48 (50 is lower level of normal; better is 55 and up).

I'm still at 48. Before chemo et. al. my lvef was in the 60s, so I'd say 48 is a fair drop. Some of this heart function loss is supposedly recoverable, but it doesn't look like it's going that way for me, at least not almost 2 years past ending Herceptin and chemo treatment.

They did an ultrasound on my heart to see where I'm at; now I'm getting a muga scan to make sure the number is correct and then going to see a cardiologist for a consult.

Swell--is there a doctor and specialty that I'm not going to get to visit on this cancer parade?

I'll keep you posted.

Important Stuff about DIEP Reconstruction

I've had appointments with seven plastic surgeons while researching my reconstruction choices. This is the really important stuff I've learned (it's related to the DIEP procedure, because I knew that's what I wanted once I had to have radiation and implants were no longer an option.)

1. Look for someone who has done a lot of the procedure you want (at least 100 a year is good). Ask to see photos of her/his work for the procedure you want. Ask to speak to people who have had good and bad outcomes with the procedure you want.

2. There are two surgery sites with DIEP--the abdomen and breast. Look for a doctor who works as a team with another equally qualified and accomplished doctor to do the work.

3. A DIEP flap is one-half of the fat and skin at and below the belly button and the corresponding vessels (picture your lower stomach cut in half lengthwise). If a ps says you don't have enough material to build a big enough breast to match, and she/he offers to add an implant later and you don't want that, keep looking to find a ps with a lot of practice in the "stacked DIEP" procedure. Here, they use both sides of your belly, two DIEP flaps, to rebuild one breast. There are also GAP, IGAP, SGAP and TUG procedures that use the buttocks, hips and thighs as donor sites. It's all about where you carry your fat. Your ps should be able to evaluate which of these is best. You want a ps who's done many of all these procedures so they are advising you based on what's best for your body and not what's easiest for them to perform.

4. With a DIEP doctors do microsurgery to reconnect blood vessels to support the fat and skin transfer; with a TRAM they remove a portion of the stomach muscle to provide blood flow to the relocated flap. A skilled ps who has done many, many DIEPs should never say "I can't promise you'll get a DIEP. If things don't work out, and if the vessels aren't good enough, etc., etc., I'll have to do a TRAM." If you hear this, keep looking for a more experienced ps. You should get what you ask for.

5. Most doctors remove a portion of rib in order to reconnect the vessels in your chest. A ps who has done a ton of DIEPs will be able to whittle away bone as needed and not remove an entire chunk of rib. Ask what they do about this.

6. While doctors don't remove any stomach muscle in a DIEP, less experienced surgeons entirely cut the muscle to get to the vessels. This weakens the muscle more than teasing the muscles apart to get the vessels but not actually cutting through the muscle--an approach more experienced surgeons take. Ask what they do about this.

7. This can be a very long surgery (mine was 9 1/2 hours for one stacked DIEP). Make sure your doctor runs heart tests to make sure you're healthy enough for such a long time in the OR.

8. If you're like me, you don't live near a medical mecca that features doctors with a lot of experience in DIEPs or other more complicated reconstruction procedures. If you can't get a DIEP in your local area, you can ask your insurance company for an out of network exception to go elsewhere and still pay in-network rates and have in-network benefits apply. You'll most likely still have to pay all travel charges (unless you have some fantastic coverage), but this might get you access to a ps who has the experience required to address your needs.

9. If you decide to go for an out of network exception, have your ps write a letter explaining what's needed and showing pictures. Also have a surgeon or ps in your local area network write a letter referring you to the ps you want to use. Have them state the service isn't provided locally and why it's something that you really need. I asked my breast surgeon because I really liked him. I also used him as my local DIEP follow-up surgeon, which you'll need if you travel for the procedure. Then also write your own letter, stating why the procedure you chose is the best one for you.

10. I can't think of anything else right now, but if I do, I'll put it here.

Good luck!

Peer to Peer Review Time

Turns out my insurance denied my out of network exception because they believe I can get DIEP stage II services in my town.

I invited the person who thinks this to come to my town, get that done and let me see it.

Of course they can't because there is NO doctor in this town who can do a DIEP. I pointed this out, but no one cared that such a simple and big mistake was screwing this up.

Insurance medical approvers are as invisible and untouchable as radiologists, it seems.

If this ever happens to you, the words you need to know are "peer to peer review." You need to have your doctor call the insurance's precertification office and request one of these.

Allegedly, this is much, much faster than the other option--appealling it myself. So it's back in my doctor's court.

I'll keep you posted.

Denied for DIEP Stage 2

I wanted to fit in an appointment with my plastic surgeon before the end of the year so we could start discussing the second stage of my DIEP reconstruction.

But I found out from the office person today that my insurance company is denying my out of network exception.

Swell! I wish I could say I'm surprised, but I'm not.

So I get to call "them" tomorrow and try to get this straightened out. Since that's probably going to take more than one quick call, I've cancelled the appointment with my ps and will wait to start on round 2 until next year.

Here's the totally frustrating thing--it's not like I can pick up a phone and call the one person who can fix this. I will have to start with the 800 number on my insurance card and work from there.

PITA, PITA, PITA, PITA and I'm not talking pocket.

I'll keep you posted.

It's a Loooong Process

The thing about breast reconstruction after breast cancer is it's a process. Usually, a long process.

All the available methods take time and require stages. With implants, expanders are filled on a regular basis and then removed and replaced with the final product.

Tissue transfer procedures like TRAM and DIEP require an initial surgery to move the fat and skin and then another to make things look good and, if needed, to align the other girl.

Then, of course, building the nipples is another stage, and tattooing color for the areolas is yet another.

The time it takes to progress through these stages varies by individual. I'm realizing that I'm at 16 months and have only completed stage I of my DIEP. There's still a lot left to do, and it will take time.

I'm coming up on the third anniversary of finding my cancer--Thanksgiving night 2006. I don't feel like much has changed. I'm still very busy with cancer fallout--determining and then completing a yearly breast check plan and working to get to the next stage in reconstruction.

Gildna Radner got it right--it really does feel like it's always something or it might be something once they load you on the cancer rollercoaster.

I smile when people say, "It must be so good to be past all the cancer." It doesn't work that way.

I wish it did, but it just doesn't.

Is Mastectomy a Better Option if You Have Dense Breasts?

This BBC article says there's an increased risk of breast cancer recurring in dense breasts. The focus here seems to be seeing if women with less-dense breasts might be able to skip radiation after a lumpectomy.

I'd say it also suggests that women with dense breasts should opt for a mastectomy rather than a lumpectomy. It also makes a great case for giving women diagnosed with breast cancer an MRI before surgery to get the clearest picture of what else might be going on in dense breasts before deciding on a lumpectomy or mastectomy.

In my case, an MRI showed two additional areas of concern in another quadrant of the breast, away from the two tumors I found.

After reading this, I know I'm happy I chose mastectomy rather than lumpectomy. I'm also happy I chose to have radiation. Hit it with everything up front so hopefully I'll never have to deal with it again.

To most people who've never had to make the choice, I'm sure a mastectomy seems very drastic, but it gives you more reconstruction options. In my opinion, it's not as horrific as it's held up to be. It ain't no picnic, but it definitely isn't the end of the world.

Cancer CAN Make You Fat

The author of cancervacation.com wrote a great entry about how breast cancer treatment makes most women gain weight--especially if they get the pretreatment steroids for over a year with Herceptin, as I did.

She's right that it sucks. She's also right that it's an element of treatment that most people don't even know about and one there isn't any support for.

When the medicines make you bald, you can get free wigs from many sources, and most insurance will reimburse a "cranial prothesis." The ACS helps you fake eye hair and cure dry skin with their "Look Good, Feel Better" sessions, complete with a fabulous goodie bag of top-name cosmetics. But you're on your own to remake your wardrobe several times through treatment as your body changes more than a teenager's.

I actually was able to put a good portion of my weight gain to good use in building a new DIEP breast after treatment. But, yeah, I've got extra fat elsewhere that I never encountered before. I hate to shop for clothes because I gravitate to things that I would have looked good in before cancer, and I usually don't like and can't easily identify styles that would look good on me now.

Most people have been kind enough not to mention the weight thing, but I remember when a nurse called to do a preop check for my port removal surgery. She started off by asking, "Have you gained a lot of weight?"

Pardon me; who are you?

She said my file was flagged because I'd porked out--of course she didn't use those words, but that's what I heard. I imagined a red flashing computer screen and a hooting car alarm: We've got a fattie here!

So that bothered me a little. And this back fat perplexes me in a constant kind of way. I think I'm actually going to ask my plastic surgeon to get rid of it and generally spruce up the whole middle section during the second stage of my DIEP. That's if I can get over a crippling fear of more surgery, however minor.

I called to schedule an appointment to start working toward DIEP stage II the other day.

I'll keep you posted.

Mammograms Have Flaws

I'm loving the articles questionning the universal value of the mammogram. There are cases when the screening is not enough and when it's too much.

Here's a link to the New York Times article that includes these great sections:

"One risk factor is having dense breast tissue, which is a double threat: cancer is more likely and harder to detect, because X-rays do not penetrate this tissue as well as they pass through fat. The only way to find out whether you have dense breasts is with a mammogram, and the radiologist’s report should mention density, Dr. Esserman said. Patients may have to request the full report."

"Younger women, she said, are less likely to have cancer, and they tend to have dense breast tissue, so mammograms are more likely to miss tumors. For them, she said, “it’s radiation without much benefit.” (Dr. Susan Love)

But the article falls short because it doesn't tell women what they should do if the report says they have dense breast tissue.

I'd say if you're following up about something odd that you or your doctor feel, demand a sonogram and a MRI and biopsy if they're not offered--whatever it takes to find out for sure what you're dealing with.

If it's just annual screening, I'd suggest talking to your doctor about MRI as a better screening tool for you.

A couple key takeaways for me: mammograms aren't good at catching the very aggressive cancers, and they can't penetrate young women's dense breast tissue. Young women very often have more aggressive cancers. So, ergo, let's put more effort behind studying this disease as it affects young women.

My favorite paragraph is this one:

"In a certain sense, I have to confess that I’m happy if the public gets offended or infuriated” by the debate, Dr. Formenti said. “I want taxpayers to say: ‘You have no clarity. Study it. Stop telling us you are a good girl if you get a mammogram.’ ”

Yes, let's talk about it, and then let's really do something about it!!

Got the Plan

As with most things, a good sit-down with my ob/gyn was all I needed to get things sorted out. It would be nice if know-better-than-the-person-who-had-cancer nurses would stay out of the middle, but whatever.

My ob/gyn is taking charge of my yearly breast screenings, and she does agree that my situation requires a mammogram and a MRI.

She showed me the pictures from my last ultrasound that showed no suspicious cysts on the ovaries. With that and knowing I'm not BRAC+, we decided to discontinue every-six month ultrasounds.

We did decide to do a yearly endometrial biopsy to check for endometrial cancer as a result of the tamoxifen. This doesn't happen very often, but there was a very small chance that I should have gotten bc too.

Anyway, it feels like a solid and reasonable program, and I'm happy to know my ob/gyn is behind it 100%.

Maybe Movement Tomorrow

It's been well over two weeks now that I've been trying to get a doctor to endorse an acceptable yearly breast screening program for me and to schedule an MRI as part of it.

I have an appt. with my ob/gyn tomorrow. I scheduled it months ago to go over my pelvic ultrasound scans. Now I guess I'll also be bringing up the breast screening question.

Basically, I want to know who usually schedules and follows up on yearly breast checks. And, if it's the ob/gyn as I suspect, why that can't be the case for me.

If she isn't behind the mammo/MRI combo, I'll just ask her if she'd be okay with just a mammogram after one couldn't find two, 2.5 cm. cancer lumps in her breast.

I'll keep you posted.

What's Your Happy Ending?

The Assertive Cancer Patient asked this of a group of cancer bloggers, and we're responding with our experiences. I'm honored to be included; feel free to comment with your happy ending if you, too, have experienced cancer.

I've spent the last three days taking temperatures, going to doctor's appointments, picking up medicine, pushing fluids and making comfortable.

I'm perfectly healthy; I'm doing this for my husband and son, who have H1N1 and are really suffering with it. I'm happy to be well enough to run things and, hopefully, speed the family to recovery.

Not so long ago, they and other family members were helping me out as I worked my way through 14 months of treatment for breast cancer, which was aggressive because I'm young.

I'm still in the middle of reconstruction, so surgeries aren't over, and checks to make sure nothing comes back are permanently on my calendar. I can't rule out more treatments, but I'm hoping/praying/assuming we won't have to go there. But if we do, we will.

So, for now, I'm looking at a long, happy future with my husband and son. Even though the house is sick now, I know the clouds will part and we'll move on to the fun stuff again.

It's easy when you're in the middle part of life to let work and raising kids and bills and worries suck too much energy.

My happy ending is to not let this happen to me or my family.

I want to find the balance between planning for a long future and enjoying the hell out of today. I want to learn to live with the fear that I might already know what will kill me without waiting for the other shoe to drop, because maybe it never will.

I don't want to lose too much of my life to worry, and I want to teach my son that, too. This will be tough because I'm a worrier, and I've actually been given something to really worry about.

At the same time, I want to be prepared to act if I have to. For me, that means having a cancer follow-up plan that I can trust. I don't have that yet, but I'm working on it. They don't teach you how to do this in college, but I know enough to know what I need so I will ask until I get it. I want to teach my son that too--to be prepared and look out for yourself.

I will count myself the happiest woman in the world if I get to help my family through their illnesses, share in the countless good times I know we will have and figure out how to skate the space between now and forever, because I want them both.

For a Moment, I Thought This Was Settled

OH MY GOSH!!! You have got to be kidding me. I got a call yesterday from my ob/gyn's office saying she had written orders for a bi-lateral breast MRI, and to call them back to schedule.

I did that this morning and was told the nurse wanted to talk over some more things with the doctor, and she would call me back this afternoon.

When she called, she asked how I was doing, and, with that uncharacteristic pleasantry, I knew something was up.

She said the ob/gyn is turning this over to my onc to schedule. I asked what that means for me going forward. She had no answer.

I know the answer: it will continue to be a fight to get both tests arranged, and the farther out from diagnosis I am, the less compelling my need for both tests will seem--to everyone except me.

When I asked the question about who's handling this going forward of my onc's nurse, she said she thought I'd be happy they're making this easy for me.

What's easy about working to get this all with one dr--my ob/gyn--for over a week and still having it split between two?

My ob/gyn's office says they need "guidelines from the onc." But they didn't say they would take over handling this once they have those. And, when my onc's nurse called to make my day, she didn't say they were providing guidelines to the onc so she could do it all in the future.

So--I told the onc's nurse to get my onc and my ob/gyn to work together on this, come up with a yearly plan and decide who's going to run it all. I also said if either one isn't on board to please ask the two of them to find me doctors who will work together to get this done.

It can't be right that I would have to start from scratch and have to make months-out appointments to find doctors who will make this work.

I'll keep you posted.

Sure, Our Health System Works--If You Don't Have to Use It

It's been a little over a week now that I've been trying to set up a bi-lateral breast MRI to finish my checking on things for this year. A nurse from my ob/gyn's office called to set up a left breast MRI--one for my reconstructed side.

She said the doctor wrote orders only for the one side. I'm thinking she's thinking that a clear mammogram and sonogram on the right side should mean that's fine so no need for an MRI on the right. But I know that's not necessarily the case.

After all, I had two, 2.5 cm. lumps that didn't show up on a mammogram--nothing, all clear--according to a mammogram. Except it was really high-grade multifocal invasive ductal carcinoma. And, while a sonogram did identify the lumps as cancer, you can't screen an entire breast with a sonogram.

So, no, a mammogram, and even a mammogram/partial sonogram combination, is never enough ever again for me. I have to have a mammogram so insurance will let me get to the next step. So I will have one, but then I will always need to have an MRI to make sure things are indeed clear.

The nurse said something about the doctor needing to review my history before changing the orders, and someone will let me know. I think I have to make an appointment to discuss this with the doctor. She's not going to find anything wrong unless she knows what she's looking for.

Really, it's an error of omission--the kind people don't usually spot. All my mammograms have said clean, and that's the problem. The first one, done three years before I was 40 because I felt something way off, should NOT have been clear.

I'm frustrated this is so difficult. I'm annoyed that this ob/gyn is not the same one I had when I was first diagnosed, so she doesn't know my story. That ob/gyn never saw me during my cancer diagnosis. She didn't even take over from the PA when it turned out to be the big, bad thing. Her helper called me on Friday to deliver the news; I was putting my son down for a nap.

I'm frustrated there are so many reasons I have to change doctors simply because I actually got sick and now require someone to help me get the monitoring I need. I hope this doctor does get it and schedules the MRI. And I hope she does it soon, because I'd like to move on for this year.

Crisis Nurseries Rock!

I wrote an article about the crisis nursery in our town that took such good care of my child during my breast cancer diagnosis, treatment, etc., etc., etc. It ran in our Families magazine that circulated in the newspaper this weekend.

The nursery is celebrating 25 years of helping kids and families, which was the reason for the article. I really can't ever say enough good things about them. I was just lucky I knew about them before diagnosis so I knew right away to call them for help. No one at the clinic where I was treated ever mentioned them as a resource, though I'm sure I told everyone I saw during those early days that I'd probably need help with my son if I had to attend many more appointments (of course, that was just the start!!!)

Child care is another on the long list of additional issues young women with cancer face. The ACS will give you rides, but have nothing to offer in the way of help with children so you can spend hours at appts. or treatments on a regular basis.

Most people don't understand how time-consuming the early days of diagnosis and treatment planning are. I spent all-day every day for weeks running from appointment to appointment and scan to scan. And these are not run of the mill doctor appointments.

They are wait two hours because the doctors are trying to explain cancer to someone else before you get your turn appointments. And once you realize this, you are happy to wait however long it takes because you want the next person to show you the same courtesy.

They are doctors turning the legal pad sideways appointments because words aren't enough to explain how, why, where and when you got cancer and a straight-up pad just doesn't provide enough space for the story.

They are having every expensive scan in the hospital appointments and not wanting to ask or think about what they're looking for.

They are realizing you can't take the doctor they just assign you appointments and having to figure out how to do and what to make of second, third and fourth opinions.

They are just the start to a long course of treatment, reconstruction and maintenance appointments.

Even the most generous people would not be up for taking your kid for all of this for all the months and years it takes to come out the other side.

Plus, for me, not having to arrange child care that would jive with and be flexible enough to match specialists' shifting schedules was a lifesaver.

Honestly, I can never say enough good things about a place that took good care of my child, showed him a great time and told me on a regular basis how fantastic he is. That alone got me through.

When I die (hopefully at a very old age, of old age), I don't want flowers. Any money anyone feels compelled to part with can go to the crisis nursery.

Give a dime in my name to anything with cancer in its name, and I will haunt you forever!