December 21, 2015 - I am

It had robbed me of every ounce of energy I had and left me with very little left to give. The "it" was a combination of things (old house, new house, holidays, disease, shoulders, work, etc), but the outcome was cumulative. We are in the middle of selling our house and buying another house, and that alone can put your calendar into a tail spin. I've never encountered so much paper work, so many tasks, so much to pack and sort, so many discussions to discuss. Back and forth. Banter this. Banter that. Negotiate. Re-negotiate. Remind them that was not part of the deal. Be reminded it was part of the deal. IT WAS ENOUGH TO MAKE ANYONE SCREAM!....except. 

Except I was on autopilot. Getting it done. Marking it off the list. Heading from this appointment to that. Hold out this arm for this blood work. Grab this box for that glass bowl. Wrap this gift for that person. I was finding blessings in trials and motivation from another task complete. And that was all working out very well for me....until. 

Until I got the "good news" about my fibrosis diagnosis. And then it was as if the switch went from on to off and everything I had been holding inside suddenly spilled over the dam. That release of fear also led to a release of everything else I had stored up inside. I simply went from together to nothing left to give. It all came tumbling out, and I became acutely aware of how I was no longer holding it together. My emotions, all bundled up in a fabric ball, became an unraveled mess of messes. I now loathed every minute of my day. Every single aspect of life was grating every single fiber of my sanity. I'm not sleeping. I'm not navigating. I'm not socializing with any form of success. I'm not graceful. I'm not celebratory. I'm not eager. I'm not relieved. In one simple word...I'm not. 

I had reached the end of my end last week when at an event I was very much looking forward to took a sharp turn from my planned expectations to their unplanned reality. And then again, when someone asked me to do one more house thing after thinking it was all done. And then again when the tape wouldn't hold the paper to the gift despite 4 attempts of repositioning. And once again when for the umpteenth night in a row I found no sleep.  I'm a lover of Christmas who now can't find it's silent night. I can't even be sure how I got here, but I am suspicious that I conformed myself into "gotta get through this day" while sorting through my fibrosis. I'm guessing I numbed myself and pushed aside my fear so I could keep functioning through that while selling and buying a house during the holiday season. I simply had to stay focused to get it done. It resulted in an emotional shut down to maintain task driven.  I wrapped myself  up in a foil lined package and covered it with a red velvet bow...until last week....when the seams started to unseal, the bow untie, and the contents unpackage. I went from holding it all together and feeling very little to finding that every single moment in life was grinding at my every nerve. "I'm able" quickly revealed itself as "I'm not."

I know you've been there. You may even be there now. In fact, I know some of you are. Your circumstances may be different, but the outcome is similar or maybe even worse. (Rest assured, we will get through this together!) This time of year is the master of its production, not by fault of its own, but rather by fault of our inability to focus our hearts and minds on the restoration it can bring. I usually navigate this season with triumph and sanity not only maintained, but in excel, but this year the events at hand (juggling 2 houses, fear in an uncharted diagnosis, Ron's torn rotator cuff now needing surgery, Oliver's death then back to life, a lack of holiday events, etc) were too much for my weary mind to contain. They are admittedly first-world problems that still pack a punch. You go from all-worked-up over the task staring you in the face to all-dulled-out because you have nothing left to give. It's the most primal version of exhaustion that leaves you waking up each morning hoping today will be the day you turn the sanity corner. And then it's not.

The past 3 years have been an ongoing reminder of Matthew 11:28: Come to me, all you who are weary and burdened, and I will give you rest.

I'm learning that rest is not always immediate. It's a process of gradually unwrapping the weary and finding truth underneath. Truth never changes. It's always there underneath waiting to be focused on once again. We simply smother truth with circumstance, self-doubt, fear, and misdirection, but it's there just as it has always been.  I'm desperate for this coming week where I have true faith that refocus will be found. I'm physically removing myself from the causes with great anticipation of ridding myself of the effect. I'm purposely putting myself in a place where purposeful and intentional focus will mend and where family heals, tradition triumphs, and God replenishes.  It will be a moment when I will remember that "I'm not", when unwrapped and rediscovered, can transform you back into His "I am". 


"I am not what I ought to be. I am not what I want to be. I am not what I hope to be in another world; but still I am not what I once used to be, and by the grace of God I am what I am." (John Newton)



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December 15, 2015 - All in a day's work

“It’s the best news we could have gotten in the situation.”

 Mom summed it up pretty well. We’ve been waiting about 2 months, and more recently about a week, but it feels like a year! Time rolls by at a snail’s pace when the situation matters to you. You want to go on that trip to Jamaica…well the week leading up to it is like 5 instead. You find out you might have a progressive disease and a week feels like a year! I’m not the only instant gratifier out there. I know it to be true.

As a highlight overview (see previous the five posts for the minute to minute details):

·     For the past year- I’ve had new respiratory symptoms
o   It takes forever for me to clear a cold
o   After climbing only one flight of stairs, I’m gasping for air
o   I can walk 2 miles on a flat surface no problem and do that often, but put me on any set of incline and I get about 20 feet.
o   These symptoms were new, and they seem to be more persistent from day to day.
·        Late in October- my lung function tests showed a restrictive process (Asthma is an obstructive process. I had no obstruction.).
o   Restrictive processes are often a sign of pulmonary fibrosis; and rarely anything else.
o   There are basically 2 kinds of fibrosis – “immunologic” and or idiopathic which carries a very quick timeline with very dismal outcomes often requiring lung transplant; and “radiation induced” that happens years after radiation treatments to the chest. I had significant radiation as a teenager for my lymphoma and which also result in my need for a double mastectomy 3 years ago.
o   It seemed very probable I would have radiation induced with my history, but my grandfather died of fibrosis, and I have a strong immunologic history so we couldn’t rule those out.
·        Early November- I had a cardiac pulmonary test which showed normal cardiac function but showed oxygen desaturations during exercise.
·        A week ago (Monday)- I have my appointment with the most Delightful Fibrosis Guru (DFG) and she confirms I need a fibrosis workup to see what is going on.
·        Monday evening- I have a chest CT and some immunologic lab work.
·        Wednesday- I find out I do in fact have pulmonary fibrosis (mild on CT scan).
·        Thursday-  I find out 2 of my immunologic tests come back positive. 6 or 7 others are negative.
·        Thursday night and into Friday- there is a meeting of the fibrosis minds to review my case to try and rule in or out radiation induced or Immunologic
·        Monday (today)- DFG calls me to update me on ongoing discussions and where they landed

Delightful Fibrosis Guru is quite confident I have the radiation induced version of pulmonary fibrosis. She feels she can say this with confidence based on the following things: 
  •  I have had extensive amounts of radiation to my chest
  • While my grandfather died of fibrosis, my immunologic markers are all negative except 2, and those 2 can be positive for a plethora of reasons.
  • The pattern of my fibrosis on the scan is isolated to regions where I had radiation. Think of an apple. Immunologic and aggressive fibrosis occurs all around the outside portion of the apple just under the skin (the peripheral parts of the lung) and spreads in a short time from there. My fibrosis is in the stem portion of the apple (upper regions of the lung). My fibrosis is mild, and so far, isolated to that region.

We now feel confident we can call this radiation induced fibrosis (huge sigh of relief and cheer from the gallery!). What we don’t yet fully know and understand is:
  • Where in the process is my fibrosis. We have no reason thus far to think it is aggressive. It may have even been in play for many years. We will have to continue to do lung function tests over time to see if we can see if it has stabilized. We don’t anticipate significant changes over time long as I don’t ever develop the immunologic kind. I will do another lung function test within the next year (an then annually, or sooner if symptoms progress) If those were to show changes, then we do another CT scan.
  • We don’t understand why I am dropping my oxygen saturations during activity. This occurs in fibrosis, but usually only in moderate to severe cases. When fibrosis patients drop their oxygen on a consistent basis (for a majority of their day) to the upper 80s, they are considered lung transplant candidates. I hit 93 (during exercise; 99-100 at rest). This does not happen in “normal” lungs. We should continually maintain 99-100% despite our activity level. Since my CT results do not show moderate or severe fibrosis, why is this occurring? Is there a blood clot? Is there another lung process occurring? We are going to redo this test to see if it occurs consistently, and if it does we will now have to work that up. Our organs need oxygen, so we need to do better than 93%.
  • We have to figure out my asthma. Do I have asthma (we think I do) or was that misdiagnosed back in college and instead I had fibrosis then that wasn’t picked up? To be determined.
Put all of this together and it’s the best news I could have gotten given the fact that I now know I have fibrosis. It’s mild thus far, we have no reason to think it will play out as the immunologic form does, and maybe this is the most symptoms I will ever have. How is that not a score and a reason to celebrate (Ron and I plan to do just that)?! And as for the symptoms, she said I shouldn’t discredit the fact that my heart and lungs have taken significant hits from radiation. They will not “act normal” like most people. Little triggers can cause big effects. Case and point, 6 surgeries to the chest in the past 3 years. That is going to take a toll on radiated lungs. And don’t be offended if I now avoid you like the plague if I know you are sick with a respiratory illness. I used to avoid you for work reasons (as I work with Bone Marrow Transplant patients), now I will do that for self-protection reasons as rebounding from a cold can be prolonged with both asthma (or whatever is happening in my lungs) and fibrosis. Maybe this now explains why Ron sails through a cold or the flu at twice my speed of recovery. I will avoid you, don’t take it personally, and I ask you to return the stigma and avoid me as well. = )

Ok, so are you caught up now? We still have some stuff to sort out related to the oxygenation and my pulmonary symptoms, but I know I can “breathe easier” (pun intended) now knowing I am not in a race against the clock! I can’t tell you how heavily that weighs on a mind. My next appointment with Delightful Fibrosis Guru is in mid-February (that was her earliest appointment). We will check the oxygen saturations while running up and down stairs.  Sounds delightful doesn’t it! I told you she was delightful. I think I am going to make her run them with me.

I had gotten to a place of peace. You can see my post of yesterday (Sunday) of how God supernaturally grabbed hold of my mind and heart and gave me calm. While I was prepared for either outcome, where it actually landed with what we know at this time gives me a little happy dance in my chair. And maybe even more so for Ron. He was beaming from ear to ear when he got home to hear the news. (It’s not lost on me how all of this has impacted him). Diseases without cures can certainly stop you in your tracks. You can’t help but long for what might not be. But I’ve also found you can find calm and peace along the way. God is still revealing his plan to me in all of this, but I am grateful for the extra gift we got today all tidied up in a Merry Christmas bow. 

Thank you for your ongoing prayers as we continue to navigate.  I am celebrating in the extra blessing he has provided in giving me more physical hope, and also still aware blessings can come in trials. In the meantime, please don’t stop to make fun of me when you find me in a pulmonary heap at the top of only one flight of stairs. Simply help me up, tell me to hold my head proud, and remind me I don’t have the immunologic version. That will do the trick! All in a day’s work (ok, maybe it was 2 months).


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December 13, 2015 - Absent is the excuse to choose the timing

The lyric has captured my heart this morning.

All creatures of our God and King, Lift up your voice and with us sing, Oh, praise Him, Oh, praise Him, Alleluia.

Nowhere in the verses did it say if your circumstance allows. Nowhere in the verse did it say, if you get good news.

Thou burning sun with golden beam, Thou silver moon with softer gleam, Oh, praise Him, Oh, praise Him, Alleluia
I see not, if you have life go your way. I see not, if the blessings come at the quality and pace that we command.
Thou rushing wind that art so strong, Ye clouds that sail in heav'n along, Oh, praise Him, Oh, praise Him, Alleluia
I can’t find, when everything is happy go lucky. I can’t find, on the days when the plan unfolds exactly as planned.
Thou rising moon in praise rejoice, Ye lights of evening find a voice, Oh, praise Him, Oh, praise Him, Alleluia
Gone is the verse of, when you feel like it. Gone is the verse of, if the situation allows.
Let all things their creator bless, And worship Him in humbleness, Oh, praise Him, Oh, praise Him, Alleluia
Absent is the excuse to choose the timing. Absent is the excuse to insert self-pride.

Praise, praise the Father praise the Son, And praise the Spirit three in one, Oh, praise Him, Oh, praise Him, Alleluia, Alleluia, Alleluia!

Present is the delight in the promise of his plan!  Present is the sting that we live in a fallen world but delight in the restoration of Christ! How can we not sing his praises as we enter this Christmas season and see He came, he died, and he rose to provide restoration and purpose in any circumstance! What rejuvenation it brings when the sting of life finds your doorstep, that the sting is temporary, and that the sting refocuses life around you.  If you don’t know the song, “All creatures of our God and King”, you know not what you miss. Promise me you will listen to it once at the link below.  Let the lyrics and melody fill your soul with purpose in hardship. With thankfulness in calm. It can bring back focus as it did me today that He Rules the World with Truth and Grace! Dare me to break out another song that rings truth, I’m on fire! (You can blame church this morning.)
It suddenly just clicks as my emotions slip from the forefront to the back. There are certainly more dire trials to face. Ask the unwanted. Ask the unloved. Ask those who face each day simply in search of purpose other than to find their next meal. Ask those that society has forgotten. Ask those whom this life has abandoned. Those are the circumstances worth mourning. I’m surrounded by desire. I am surrounded by love. Purpose is in my clutch therefore making anything this fallen world can bring me, worthy as a reminder of His saving grace. Our circumstances don't change His truth.

I still know not my pulmonary fate. The doctors are still discussing. The tests still to be revealed. We have brought in my radiation oncologist to help delineate the fibrosis location in relation to lung fields. And still, I wait. BUT TODAY (and hopefully lasting longer than today), I wait without fear and dismay.  Oh, praise Him, Oh, praise Him
link (except when I hear it in my head it is the old hymnal version): David Crowder - All Creatures of our God and King



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December 11, 2015 - Humpty Dumpty

I've surprised myself with how raw all of this feels. I think part of it is that the information keeps trickling in over several days. I'm reactive at baseline. I get news, I react to it (not always well), I process it, I pull it together, I move on. However, this trickling in of details has me processing minute-by-minute and over and over again with each passing hour/day. You keep asking me how I am feeling. And I don't even know how to reply. Some moments, I am perfectly normal. And other moments, I'm teary eyed and full of doubt.  I think if I could just hear "Sally, you have lung fibrosis and it is the progressive kind", I would react to and then process that and then be back to my peaceful deal-with-it self. Or if I could hear "Sally, you have lung fibrosis, but at this very moment it's as bad as it will ever be" I would process that and dive back into every day packing-up-my-house kind-of-life. The waiting, the trickling, has me re-feeling every nuance with each new test result or conversation. Four more immunology labs came back negative. (If you are playing fantasy fibrosis that brings the score to 2 positives, 8 negatives, and a field goal of fibrosis.) I feel awful waiting to open a new result up. I feel fine after I do. With the new 4 negatives, Ron and I looked at each other and mentally gave each other a high five. It's as we had accomplished some Mount Everest Trek feat. I somehow produced a "negative" on a lab result. Wow, I am top notch!

The potential severity and implications of a bad form of fibrosis creates the raw fear. With a malignancy (caught early) you dive in with the therapy you need and hopes of response. Time may change the level of hope in either direction, but you have some level of hope when you start.  It's this lack of cure, or potential for lung transplant, that has my bumble all in a jumble. Tell me I've got radiation induced fibrosis that doesn't progress, I've got it. I can do that. No problem. We all have ailments. We all know there is toxicity to be expected from cancer treatments. I just simply don't want to hear the next words we are waiting for.... what kind and how will this progress.

I've given you the straight forward facts of all of this mumbo jumbo. I've laid out the medical jargon as I know it. One friend actually thanked me for the medical lecture. That made me chuckle. I haven't yet fully dived into the emotions of all of this, but I think it is important for those of you facing similar boats in your future. If there is anything I know from sharing bad news with others or receiving bad news myself, it's that it is crucial to maintain hope. Once hope is gone, you've basically lost the ballgame. Everyone wants options. We need to know there is something else to try, something left up the sleeve for later use. We need to know that even with 99% chance of death, that there is 1% chance you will survive. That 1% can set the pace for the rest of time. It's so strategically aligned with perspective. Debbie downers tend to fair far worse in medical studies. Optimistic Olivias can drastically change time lines. The mind is the most powerful medication or procedure in use. It can cure tumors. It can bring about disease. It is the master of it's own domain.  It truly can be a game changer. So when you get faced with a malignancy (or anything else detrimental), you want to hear you have options you can try and that you can choose, or not choose, to know you gave it your all. You simply want the option.With disease states with no cures and a progressive timeline, it can feel as though you've lost choice. You learn you have no say so and the hope for cure is no where to be found. It doesn't remove spiritual hope, but certainly changes the landscape of physical hope. The spiritual gets you through life, the physical is crucial for that individual moment. Too bad we don't carry around physical hope in a bottle to sprinkle on circumstance. And praise God that Christ brings the spiritual hope to get you though it. Even when you know death is coming (physical hope is gone), spiritual hope can restore peace.

The emotions being used here to describe my current situation are drastic. Meaning, I recognize I am starring at all kinds of physical hope because I am more likely to have the good kind than the bad kind of fibrosis (surely), I simply mention them for extrapolation into life's circumstances as all of us will face moving forward. We all are facing some giant. The most difficult journeys are most often the private ones not displayed on a computer screen. I am aware there are a whole set of new emotions I may feel if I get a poor diagnosis in upcoming weeks, but for the here and now, during this trickle-in-of-information time frame, I simply feel volatile. The fibrosis part doesn't even bother me anymore ( a full 4 days later; see that's volatile), but trust me, it did earlier this week. I was a basket case waiting for the diagnosis because it was an unknown. But I now know I have fibrosis. Now it is a known. I've got it. Done! Let's go decorate my Christmas tree!  But I still dread opening a new test result for fear of what "chip at hope" outcome it may bring. An unopened test is an unknown. Once I get over the opening part, it becomes a known. I just want to know...whatever there is to know. Then, we adjust and move forward in some manner and time frame. Twenty-two hours of my day, I am good to go. The other 2 fluctuate based on what I just learned or what I see waiting for me to learn in my inbox. In those 2 hours I am fearful, I am sad, I am anxious, I am doubting, I am less physically hopeful. But I praise God in every moment that I have spiritual hope to keep me afloat, despite circumstance. I imagine you can relate quite well if you reflect back to one of your own circumstances. You remember well the loneliness of a diagnosis when the rest of life is moving forward around you at break neck speed. And you recall the days when you feel like you are right in the middle of a heart-breaking Steel Magnolias moment. But you also know the hysterical moment of when M'Lynn slaps Ouiser (Weezie) is coming in the next frame. There is always something coming and there is always a Truvy Jones to get you through it.

We all spend some time as humpty dumpty sitting on that emotional wall, We wobble too and fro in the middle of the moment, we teeter and we totter with the passing wind, but in the end most of us refuse to fall down. We simply find a new way to balance and find a new center of gravity. This is me, waiting for my new center of gravity. Then we grab hold and face life with this new set point. I once walked in fear of mastectomy. Now I wouldn't change that experience for anything. Lymphoma grounded me, mastectomy grew me....and fibrosis, well, we just have to wait and see what it it brings.


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December 10, 2015 - Rosy Fog-filled Glasses

I can definitely say this is an evolving story. We still have results and opinions coming back and with each one your brain rapidly shifts in a new direction. I imagine that is my fear playing out. It definitely has my attention. To catch you up on events between now and last Monday, yesterday we had our house inspection on the house we are purchasing. As I reach for my phone in the middle of the inspection, I start to see test results coming back in. There sits the scan in my inbox waiting for me. I was torn between opening the results and getting great news and awareness of opening the results and 12/09/15 turning into a day of before and after. I let them sit there for over an hour unread, but plaguing my every thought. Enough was enough, I couldn’t concentrate anymore. I grabbed my phone and went to my car and opened the scan report.

We now know the following:
The CT results did show mild fibrosis in the upper portion of the lungs.
The CT also showed a small lung nodule (likely not even worth mentioning as nodules are known to appear and go away without any intervention. They are seen all the time on scans.)
The CT showed a few other things that likely have no relevance here (a small splenic splenule, some notes about the location of some of the great vessels, etc)
The CT showed I do in fact have breast implants. I can now prove that Lead Plastic surgeon did in fact what he said he did in the last 6 surgeries. It gave me a chuckle when I was climbing on the CT scan table to tell the tech “hey FYI, in case you need to know because I never know when people do need to know…I have had a mastectomy and have breast implants.” Well, she evidently didn’t need to know.

You will be happy to know I kept it together quite nicely. I guess I kind of deep down knew they would see fibrosis. It just made sense that they would with my symptoms and history. I was able to drive back to the inspection ( I had left to go pick up Ron's phone) and enter back into the house with smile in tow. It wasn't until later, when I told Ron, that I had tearful moments. And then again when I typed it out to my family and prayer warriors. I may be stoic some times, but i'm a sucker when relaying emotional news to my family.

We also now know (12 hours later):
As we were suspecting fibrosis as a possibility (and now proven by the CT scan) we had also sent off labs to check for an auto-immune process. In the last 24 hours, two of those labs came back positive.

Honestly, this new finding got under my skin. Albeit, the slugger is that this specific test can be positive in any autoimmune process/disease (lupus, sjogren’s, scleroderma). It can also be positive in idiopathic pulmonary fibrosis. The titer result was "low" and not severe, so I have that going for me. So while we want to trust that this fibrosis is radiation induced, we have a family history and now a positive immune marker that is muddying the waters. Earlier I was 100% sure in my mind this had to be radiation induced. I’ve had massive amounts of chest radiation. Radiation causes fibrosis. I have fibrosis.

I’ve reached out to Delightful Fibrosis Guru (DFG), I guess she now deserves to have her own name, and I get the impression she is a little baffled too. We both had hoped the CT would come back negative, and instead maybe I was dealing with an asthma process. Now that the CT came back positive, I am sure we were both hopeful the lab markers would be negative so we could more assuredly point to radiation induced fibrosis. She keeps saying my history is complicated and that she isn’t sure what to make of things yet. My grandfather having had fibrosis complicates the picture, and my suspected history (though biopsy negative) of sjogren’s syndrome complicates the picture further as it can also cause pulmonary fibrosis.   In efforts to cover all bases and perspectives, DFG has decided to take my case to the pulmonary rounds this week where the experts from pathology, radiology, and pulmonary disease come together to discuss complicated cases. She continues to be delightful, and I am grateful for her thorough approach.

I’m truly hopeful the lab marker is positive for some separate process and not an indicator of idiopathic/immunologic fibrosis which is a ballgame changer. And if it is radiation induced, like I truly want it to be, I still don’t have a full grasp on what that will mean in the long run. Has it just started and is still evolving? Has it been going on for years (as I have had asthma symptoms since college)? Is it going to progress? Has it already peaked?  Just a lot of unknowns right now. Are you completely confused yet?

So where does this leave me: we have a diagnosis (fibrosis); we now have a positive immune marker (do I have sjogren’s as some physicians have suspected? do I have something else? do I have nothing and it is inconsequential?) And what is causing the fibrosis (Radiation induced? Idiopathic?)? And where is this going and at what pace? The very last thing I want is for this blog to become "Trading in the Airbags". We just don't have time for such nonsense.

It also leaves me feeling a little out of sorts. It’s moving at a fast pace with labs coming back day by day, but also very slowly as a lot of the results alone aren’t leading us anywhere. You also know I am an instant gratifier so this waiting game is for the birds. I am beyond grateful to have DFG leading the way for me and pulling in the expert minds. I still want to be very confident this is radiation induced, and maybe the damage has peaked and I will be left with just these symptoms and nothing more. I won’t lie though, it’s hard to focus. I have on my rosy glasses but they have intermittent fogging. I do have peace in the overall journey (I know blessings are already here and still coming), yet I am also cognizant that there may be some other emotions coming to play. It’s also smack in the middle of our house sell and purchase. I have boxes up to my rosy fog filled glasses and lots of paper work crossing the screen. It’s busy, and we are tired, and all of this fibrosis stuff makes each day of balancing life, house, and work a little more cumbersome.

That’s all I’ve got for now. It’s a story being played out sentence by sentence. He is the master of my story, so I know it will be worth telling. Anxiously awaiting what Act 2 will bring.  And because I need to be reminded daily…… “The blessing of God is not the absence of trials, but rather the glory of God through them.” Let’s all say that 3 times together.

(P.S. I'm very grateful for all of your encouraging words through texts and emails and FB posts. Forgive me if I didn't get back to someone yet. It's incredible to have an army of warriors to do life with. This still may all turn out to be trivial, but the journey along the way feels very raw, and you make it less so.)



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December 8, 2015 - It's not the absence of trials

“The blessing of God is not the absence of trials, but rather the glory of God through them.”

Wow. I probably should stop right there and not type another word. Isn't that powerful? Isn't that focusing? Isn't that...hard to claim in the middle of the moment? I’ve eluded before that I often find myself in a state of entitlement expecting God to shower me with blessings, of my choosing, and blessings of my expected quantity, quality and value. It’s as if I am the only one who can define what meets criteria to be further labeled as “blessing” instead of trusting in his plan.

There is a piece of my story I have not yet shared publicly. A piece that in this very moment is still unfolding. It's new and frightening with one option being manageable, and the other option being shattering. “Blessing” is still yet to be grasped and claimed. I've been private about it because quite honestly I didn't want to utter the words for fear of what would come. I was sorting and juggling a rash of emotions that felt better left untyped. But more recently as I have been meditating on this quote, I quickly find myself shifting to the pursuit of discovering his blessing despite outcome as his glory is entirely more relevant than my longevity. My story, in reflection of and in spite of each individual sentence composing the narrative, is for him to define and for me to be blessed in and through. Facing trials with grace and peace becomes so much more attainable when I claim this revelation. But let me say, it took a very long month of November living in fear and doubt to come to this inner peace that is approaching my horizon. The story is still unfolding. This story is a reminder of life after malignancy. And this story is an example of how fear can grip you, when you don't even know the outcome yet. But I hope later this story will be a reflection of growth in my heart, no matter what the outcome.

Ron and I were standing in the check-in line at her office. Her office carried a very different atmosphere than the breast clinic. It told a different story. Wheel chairs more prevalent than not. Oxygen tanks flanking each side, instead of breast drains. The room felt less “hopeful” and more aware of current state, or so as I perceived. The line was moving slowly so Ron went to grab a pair of chairs in the now crowded space while I continued to wait. It only took 30 seconds after the young man went by with his equally young wife in the wheel chair for me to see the water pool in my vision. My heart was breaking for the occupants of this room, who did not have advocates of pink ribbons and benefit walks pushing them forward, and my heart was fearful for self and the “what ifs” that now plague my thoughts. I had spent the last month both craving this day (for knowledge and potential hopeful news) and dreading this day (for potential very bad news). I had spent nights in tears out of "what ifs" and I had spent days with all consuming thoughts. The potential had engulfed my being. I glanced up to see the sign above the check in desk: Heart and Lung Transplant Clinic. And now I was standing, after a month of turmoil, in this room, in this line, next to be checked in.

It was found during routine follow-up testing for my lymphoma of 25 years previous. You will recall I had scheduled dermatology (check!), colonoscopy (upcoming), cardiac (check!) and pulmonology testing (ongoing). Remember, we aren't simply survivors but rather in a continual process of surviving.  It was the pesky pulmonology that stumped my traversing toe.  Breathing tests suggested a restrictive process, suggestive of the development of fibrosis. As it turns out, after much reading, pulmonary fibrosis turns out to be a much bigger bird than I thought. Knowing my radiation history, it was plausible that I have developed radiation-induce pulmonary fibrosis, though there is another form, “immunologic” and/or “idiopathic”, that would have to be considered. Regardless of the cause, the physical changes are consistent: a scarring of the lung that reduces lung volume and inhibits oxygenation. While the physical changes are similar the progression and outcomes can be drastically different.

In the case of radiation induced, it is thought that the damage occurs but that the damage does not progress. Meaning, once found, you in theory could maintain that same level of damage throughout the rest of life.  Impact could be minimal or extensive, but likely not progressive as time goes on. There is no cure and it is not reversible, but can be stable. A very different picture is the idiopathic and immunologic forms, also incurable and not reversible, which can progress very aggressively to the need for a lung transplant. Survival rates are frightening and progression rapid. No one knows what causes it, why it happens, to whom it will happen to, and how quickly it will progress, but once it does it is a race against the clock to get the patient to lung transplant, assuming they are a candidate, find a match, and are chosen. Some studies report average life expectancy to be 5 years from time of diagnosis. It’s the predictability, the rapid progression, yet lack of cure or knowledge of cause that puts a crazy spin on this disease. In two words: It’s dismal.

My lung function tests were showing the restrictive process, which most often is caused by fibrosis, and which can often occur (like breast cancer) after extensive radiation to the chest. I knew this was not something to play around with so I scheduled an appointment with a fibrosis expert so we can figure out if in fact fibrosis is now in play, and if so, what was the cause (radiation induced or idiopathic as my grandfather died of fibrosis). And this is how I found myself finally standing in this check in line surrounded by lung transplant patients after a month long dance with fear. To say I have been afraid would be an understatement. The possibility of aggressive death or impending lung transplant had gripped my soul. I had spent the last 3 years in avoidance of breast cancer, only to find myself starring in the eyes of another, potentially more aggressive, beast. Very simply put, I wanted to grow old with Ron, and I wanted absolutely nothing to do with fibrosis. I wanted it off my dance card, and I wanted normalcy to return to my thoughts.

She, Delightful Lung Guru, was the most delightful person to meet. A compassionate heart, and thoughtful dialogue, an aggressive approach to help us figure out what was at stake. She agreed that the lung function tests in combination with my very complicated history would lead us down the fibrosis workup. She recognized that my radiation history makes the radiation induced form a strong contender, but the familial history with my grandfather and my historical dance with other immunologic processes places idiopathic/immunologic into play as well, and therefore we should do the work up for both.  The cause was a huge predictor in outcomes and progression. She scheduled the chest CT scan to prove or disprove the presence of fibrosis and ordered the appropriate immunologic studies to determine cause. And then she flashed me the most compassionate smile and said we will figure it out together. And that is what we are doing.

Best case scenario: The CT shows no fibrosis and we are good to go! The lesser ideal is the CT shows fibrosis and then we need to try and sort out the cause. Radiation induced should show scarring only in the areas of the lung that were radiated. If that is the case, maybe this is the extent of damage/symptoms I will face (I learned this option of “no progression” yesterday in our dialogue and it alleviated many of my fears now knowing radiation induced was a real option yet could offer some hope in its stable path). If the pattern is more varied, well, we follow this much more closely while waiting to see when it starts progressing. When it does as it almost always does, I guess we race the clock to see if I would be a candidate for a lung transplant. Cart before the horse, but boy does that cart weigh heavily in this waiting period. We expect the lab and scan results to come back sometime this week. This week, after some newly found knowledge in the appointment, feels a little more manageable and hopeful.  Now we wait.

“The blessing of God is not the absence of trials, but rather the glory of God through them.” It’s one thing for me to claim this truth in hindsight, when the saga has revealed itself and we’ve pulled ourselves up and over the hurdle and back to manageable life. It’s entirely different for me to utter this truth in foresight when the future looks undecipherable, the edges are blurry, a little less bright and a little more forlorn. I’m learning to master the former and find myself a far cry from the latter. I want to be a woman who faces trials as though they are blessings. Not after they prove themselves worthy, but before the outcome is even in view. I know there will still be sting as life sometimes brings disappointment, but I want there to be way more faith, and faith that lasts longer than a 12 hours. My disclosing is not an effort to exude sympathy, but rather encouragement through prayer to continue to run the race with head held high, heart in check, and faith as my driver. Hope is where the heart is.

In the midst of my fear, I want to transition to thanksgiving for his blessing as HE defines it. I think this would absolutely rock my world to find this perspective. And I’m working on it with each new trial....um, I mean blessing.


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