Thursday, March 19, 2020

Surprise Perks (another COVID-19 post)

As many of you saw on Facebook, my platelets appear to be rebounding (WOO HOO!) and I didn't need a platelet transfusion today. Unfortunately my other counts are still dropping. C'mon neutrophils!!!

Platelets: 33K (21K on Monday; need to be 50K to bike again)
Hemoglobin: 10.8 (11.0 on Monday)
White blood cells: 0.8 (1.4 on Monday), and absolute neutrophils not back yet, but certainly low.

I said something to my nurse about being happy that I didn't need platelets since I knew that blood donations had dropped off and she said that she and so many of her colleagues had heard the call and donated that it wasn't as dire of a situation as it was two days ago. Thank you, health care workers, for going above and beyond in so many ways. You are truly the super heroes in all this. (As are the public health workers, first responders, grocery store employees, truck drivers and all of you who are in the "essential workforce" group.) You are awesome!

And to the rest of you who weren't able to donate blood this week--please consider doing it next week. Or the week after. Let's keep it going for however long it takes.

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I am certainly as put out over this worldwide pandemic as the rest of you, but I was thinking about some of the surprise benefits that have come with "everyone" being home.


  • Lots of my friends who'd left Facebook have returned! (I'd missed seeing your updates and hearing your voices in your posts)
  • There are more posts in general on Facebook, and since that's where I've gotten the majority of my social interaction for the last almost-four months, that's cool.
  • I have been introduced to Zoom and I am loving my Zoom coffees!



Stay safe, everyone--and stay home!

Tuesday, March 17, 2020

Eyes on the Prize (more COVID-19)

In the four days since my last post, even more has happened in the world around COVID 19. It's scary, and I find myself (unhappily) thinking more and more about how this potentially impacts me. I don't like having ME be my primary focus. It leaves me with an icky feeling that is a combination of heart racing and knotted stomach.

But I go on, day by day, as we all are.

My blood counts continue to decrease, but I've avoided needing blood products so far (we'll see what Thursday brings). I got a little freaked out when Froedtert called me today to see if I could go to a "local clinic" for my Thursday lab draw instead of the main clinic to minimize exposure to people. Unfortunately, the satellite clinics can't draw from PICC lines and I need my dressing changed, so I have to go to the main site. They told me to wait for results in my car instead of the waiting room. Eek. Scary times.

There is intense need for blood donation all over the world as blood drives have been canceled and people are not showing up for appointments. Apparently a LOT of blood donations are made at High School and college locations--all of which have closed. Please, if you are able, donate blood! Read online about why it's safe, even now. If you're in the midwest, please consider Versiti--all blood donated there stays local. If you donate at the Milwaukee branch, I might even be the recipient of your donation--especially if it's platelets!  Go online and do the pre-registration to minimize the time you wait. 


I was able to speak with the transplant coordinator and learn more about what my next 6 weeks will (hopefully) look like. And I learned more about why my transplant date was moved back a week (so far).

The primary donor they'd initially identified was international. With all the travel restrictions, there was sufficient concern that it might not work out to have cells from an international donor, so they switched to my back-up donor, who is domestic. In addition, normally the recipient (me) would receive a week of intense chemo to prepare for the transplant, and the donor's cells would arrive "fresh." But (again) with the concerns about travel restrictions and all sorts of uncertainties, the plan is now to harvest the donor cells before I start intensive chemo so that they will be cryogenically preserved on site until I am ready for them. Unfortunately this adds another layer of issues, as many people react to the cryogenic preservative. Ugh.

So if all goes as planned (oh, send those vibes!), I have a calendar full of fun stuff.

March 25: Bone marrow biopsy
March 26-April 1: Vidaza (chemo) daily
April 2: Doctor appointment and platelet infusion to prepare for dental work
April 3: Lots of dental work
April 7: Social work evaluation, transplant education, pulmonary function test, EKG and Echocardiogram, and chest and sinus CT Scans
April 13: Labs, psychologist evaluation, transplant doctor appointment, transplant pharmacy consult
April 23 (Day -6): Labs, PICC replacement, admission to BMT unit in hospital, begin chemo (Fludarabine)
April 24-27 (Days -5 to -2): Double chemo (Fludarabine and Busulfan) daily
April 28 (Day -1): Start anti-rejection med (Tacrolimus)
April 29 (Day 0): Receive transplant!!!
April 30, May 2, May 5 & May 10: Anti-rejection med (Methotrexate)
Week of May 17: possible discharge

Whew! LOTS of stuff. And I need to just keep focusing on the end game. I have to keep myself isolated and healthy to be able to make it to transplant, and to be the strongest I can be for transplant. Despite my fears, I have to keep moving forward. Hopefully it'll all work out.


Friday, March 13, 2020

What does COVID-19 mean for me?

Yesterday was Day 15 and an appointment with Dr. Atallah.

My labs are holding ok:
White blood cells: 2.3 (from 2.4 on Monday)
Absolute neutrophils: 1.3 (same as Monday)
Hemoglobin: 10.4 (down from 10.7)
Platelets: 25K (down from 33K, and because they're so close to 20K, I need to go in for labs tomorrow)

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I have started and re-started a post on SARS-CoV-2/COVID-19 so many times, but before I could post, information and recommendations and seemingly everything that's known has changed!

I won't re-write everything that someone else has already written, although I'll share a few general thoughts (current as of today) and a few great (IMO) links for further reading.

Why is this such a big deal when the flu, suicide, TB, gun violence, etc. all kill more people annually?


Now on to how the COVID-19 pandemic may impact me personally (since this is, after all, my blog about cancer):

I started off, in January, convinced that "the novel coronavirus" was like many other coronaviruses and that influenza was still a much bigger concern. That's definitely not the case now. In the last week or so, I've spent a lot of time thinking (selfishly) how it might impact me, and more specifically my transplant.


  1. I have a weakened immune system. Catching COVID-19 could well prove fatal. I am more likely to catch it if it keeps spreading because people selfishly think it's not a big deal and continue to go out in large groups in public and spread it.
  2. My donor is international. What if travel is not allowed between the country they live in and the US? Would I even be able to get the stem cells?
  3. My donor is young--early 20's. What if they (or their parents) decide that, in these uncertain times, it is too risky to donate stem cells?
  4. There will likely be a surge of patients requiring hospitalization. What if hospitals are overrun with COVID-19 patients and there isn't even a room available for me for the transplant?
  5. Medical providers will likely be stretched by patient care, their own possible illness, being needed to take care of children who are no longer in school or daycare. What if my medical team cannot care for me while I'm in the hospital?
  6. The US gets medical supplies from many other countries, and already many things are becoming scarce. What if I'm in the hospital, but supplies are no longer available, including PPE (important when working with someone immunocompromised) or IV fluids?
  7. I was told that the sooner I get to transplant (after achieving remission), the better. What if my treatment gets pushed back due to all the other priorities, and in that time I fall out of remission and am no longer eligible for a transplant?

At my doctor appointment yesterday I was reassured of some of my fears, but unfortunately not all of them.

I do have to be extra careful to not get sick. But more importantly, my donor is in Europe. I learned yesterday that my transplant has been pushed back by a week. I hope this is the only delay. Unfortunately, pushing it back means that I will require another round of Vidaza. I am trying really hard not to feel sorry for myself.

Round four of Vidaza will be March 26-April 1 (I'll add entries to the google driving spreadsheet when I have exact times).
I'll have a bone marrow biopsy sometime in April.
If nothing else changes, I will be admitted to the hospital for pre-transplant chemo on April 23.
My transplant day will be April 29.

I did learn that they will not start the pre-transplant chemo until they have the stem cells "in the refrigerator" at the hospital, so that at least means that I won't end up with no bone marrow and none coming! I just hope that this schedule is not put off any further. And I need my body to be awesome about keeping me in remission. I am hopeful.

I've been trying really hard to find a silver lining in this delay. I did find one. Last year I signed up for a really cool project, 30 Days of Biking. Essentially you commit to bike every day in April--indoors, outdoors; long, short; fast, slow. I didn't think I'd be able to participate this year, but I'm going to try to ride either 22 Days of Biking or 23 Days of Biking (depending on admission time). I invite any of you to join me in this project--and I will ask for volunteers to ride the remaining days in April FOR me. Kind of like surrogate bikers. Or maybe Handmaid bikers! Will you be a Handmaid biker for me?
If you want to sign up to bike all 30 days yourself, go to: https://30daysofbiking.com

OK, one last thing. I just want to say that since I went to grad school and earned a PhD in Public Health by researching hematopoietic stem cells, I will be SO UNBELIEVABLY PISSED if a pandemic kills me while I'm weakened by my own defective hematopoietic stem cells. I am not a fan of irony. It's time for Buffy the Vampire Slayer to attack COVID-19.

Monday, March 9, 2020

Why you should get vaccinated--for those who cannot.

One more round of chemo down. That's my fourth of any chemos for AML and my third of Vidaza.

I haven't (yet) needed transfusions, as my counts, though I'm technically in nadir, have held okay:

White blood cells: 1.8 Thursday, 2.4 today
Absolute neutrophils: 0.97, 1.3 (able to grocery shop again)
Hemoglobin: 11.4 (wow-that's "normal"), 10.7
Platelets: 50K, 33K (trending downward)

It's interesting that some of the counts are going up, while others down during this period of nadir.

I saw the dentist to prepare for transplant and (unfortunately) I have two cavities that need to be repaired beforehand. I guess you're very limited in dental work (unless an emergency) for a year after a transplant, due to the increased chance of infection. Here's hoping my counts go up before my appointment on April 3rd!

I have started reading more about life after transplant, as it will probably happen in 5-7 weeks from now. The exact timing depends on the donor's availability as well as room in the transplant unit at Froedtert. I'm also trying not to be freaked out by much of it. There's lots on Graft vs. Host Disease (GVHD), which is pretty inevitable--and can range from mild to fatal. If you don't want to read the whole link, here's some highlights:

  • The donated stem cells also include T-cells from the donor. T-cells are a type of white blood cell that target things that can make you sick. 
  • Getting T-cells from a donor provide a benefit in that the donor's T-cells should recognize any remaining cancer cells as foreign, and target them.
  • But a donor's T-cells may also target the host's "normal" cells, which can cause issues ranging from a skin rash to GI upset, vision problems, and even death.
Acute GVHD occurs within the first 100 days after transplant, so this is a particularly vulnerable period. I will be monitored very closely during that time. (Depending on when the transplant actually occurs, that will be until sometime in August, I believe... Missing pretty much all the summer, since among other things, I can't be in the sun while on the anti-GVHD meds.) I will likely need numerous transfusions. I'll be bugging everyone to donate blood, and my colleagues at the North Shore Health Department set up a blood drive for Friday, June 5 from 10-3 in Brown Deer. To sign up as a donor please contact Kala at khardy@nshealthdept.org or 414-371-2985.

I asked about things I can do to prepare for the hospitalization and coming home after. I ordered prescription sunglasses and think I might get a few pairs of sun sleeves, so I can still wear short sleeves and shorts when I get home, but can cover my exposed skin when I go outside. I also learned that when you're in the hospital, they want to minimize disconnecting the IV, so you either have to wear hospital gowns or have shirts that come undone at the sleeve. The nurse mentioned that you can order shirts like that on Etsy, but I think I can make some of my own, using snap tape and the millions of t-shirts that I never wear (of course we just brought a bunch to Goodwill yesterday). Something else to work on while I'm stuck home.

Perhaps the scariest thing that I learned is about vaccines. Because my immune system will be completely knocked out by the transplant, I will essentially be like a newborn baby in terms of immunity--but without the passive immunity provided by breastmilk! I will need to get all my immunizations over again--and I cannot even begin to get until SIX MONTHS after the transplant. Perhaps the most frightening is that I can't receive the two live virus vaccines (MMR & Varicella) for TWO YEARS after transplant. I can only rely on herd immunity--and with recent outbreaks of measles as near as the Twin Cities, that really scares me. 



I could go on and on about the importance of vaccination (I am a public health professional, after all),  and I will say that I was once a delayed vaccinator (before I went to grad school in immunology). However, once I learned about the very real threat to those who could not be vaccinated, weighed against the minuscule risk of vaccines, I realized that it was unfair to put others at risk. 

Additionally, one of the most interesting, compelling, and recent discoveries is that the MMR vaccine is more beneficial to the immune system than getting measles. This is because measles infection actually erases immunological memory, making a person more vulnerable to diseases they'd previously been immune to.  

And so I will be asking friends to stay away if they and/or their children are not vaccinated. If I make it through all this chemo and a transplant, I'm not going to risk my life to a vaccine preventable disease. That risk is just too great. 

Thursday, February 27, 2020

Superstitions and good luck charms

I wouldn't say I'm terribly superstitious, although I think some (ahem, Greg) might disagree. I do know that my mind plays games with me during difficult times, and having items or routines or explanations sometimes get me through those difficult times. As an example, last night I realized that today's appointment with Dr. Atallah would be a big one with potentially lots of scary decisions made, based on information that I did not yet have. I knew that all along, but what I realized was that I was not completely panicked about it. I'd been sleeping pretty well and able to function somewhat normally. And the fact that I wasn't freaked out freaked me out! Whether it's guilt or something else, I made myself think of the bad stuff that could happen at today's appointment as a way of maybe warding it off. (Messed up, huh?)

The other thing that I started with my breast cancer diagnosis is the inclusion of good luck charms (for lack of a more encompassing term). It started with my Buffy the Vampire Slayer visualizations, aided by the fact that Greg and I binge watched the entire series (and Angel) while I was going through treatment. And I also visualized Joan of Arc, and wore the Joan of Arc charm that my neighbor Tracy gave me. Later, my friend Jim gave me a book about Joan of Arc's life. I didn't carry the book around with me, but it held a place of honor in the mini shrine that I created with cards from everyone, and other good luck items from friends and family.

This time around, on important appointment days, I wear an assortment of good luck charms, talismans, memory objects, whatever you'd call them. But I have so many that I can't wear them all at once!

Today I wore:

Three bracelets: "Badass" that matches my amigas; STRENGTH HOPE COURAGE from Coach Kristin; keep fucking going from Cara 
My mother's necklace

One of my Cadence shirts, in honor of my biking friends
My Team Phoenix tattoo :)
My PUT 'EM UP tough girl socks
And I put on ginger essential oil from Meredith.



Some of the other awesome socks and shirts that rotate in include:

hell raiser biking girl socks--one pair from Ashli; one from Meredith


Five Card Studs tee, reminding me of happier times, from Kim

A fat tire tee, from what should have been my first fat tire race, from Mitch

An awesome Buffy tee, from Sarah

At any rate, all my good luck charms seem to have worked, as I had a good visit today.

First of all, every single appointment was not only on time, but early! Greg brought me but had a noon online meeting, so I got to the Cancer Center over an hour before my lab appointment. I was called back fifty minutes early! Then we went up to the Grace Clinic and I got in to that appointment half an hour early. Finally, I got to the Day Hospital for my chemo infusion and was brought back twenty minutes early. I feel bad for complaining in the past (but so happy to not have to sit in a germy waiting room as long). I also was so lucky to run into my Team Phoenix sister Luz at the lab. I wish I'd thought to take a picture of us.

My hemoglobin is up to 10.7
My platelets are up to 87K (Class of '87 rules!)
Unfortunately my white blood cells (and neutrophils) continue to drop, making me neutropenic again, and they will only continue to drop. That means that I need to stop going out in public unless absolutely necessary, and need to curtail visits. The state health department reported this week that we have not yet hit the peak of flu season, and it takes a month after peak to really taper off, so that's kind of scary. I'll be as good and safe as I can, and I believe I can still continue to walk and bike outside--and I intend to do my socializing that way!

The bone marrow biopsy results were back, and while not perfect, they are also very good. Here's a page that describes what tests are done on the marrow.

One way they examine the bone marrow is by flow cytometric analysis. Flow shows only 0.1% residual disease (MRD), keeping me in remission, although any MRD is not good and increases risk of recurrence.

The cytogenetics were also examined, and all previous abnormalities (the 14 mutations in December and 8 mutations in January) were gone! However, there is a more sensitive test done when the initial cytogenetics are clear (Fluorescence in Situ Hybridization, or FISH). Unfortunately my FISH test still found that 1.5% of my cells had an extra copy of chromosome 8 (trisomy 8). A quick search of research articles tells me that Trisomy 8 is one of the most common genetic mutations in AML, and that it puts me in the intermediate risk group for recurrence, and it is recommended that those with Trisomy 8 AML have an allogeneic bone marrow transplant. Luckily, I already have that (somewhat) lined up! :) (A quick note that many AML research papers that compare outcomes don't take into consideration a transplant--they refer to remaining in remission with "only" chemo or other meds.)

Dr. Atallah said that we are "heading in the right direction." While he said he couldn't guarantee it, he expected the transplant would happen in 6-8 weeks(!!!). That means this should be my last round of Vidaza infusions, I should only need one more bone marrow biopsy before the transplant, and because my hemoglobin and platelets look good, that I should only need labs twice a week (those have been added to the google spreadsheet). I will keep taking the Venclexta every day. I also dropped my pre-med Zofran amount by half (I feel better now--hoping it's enough to hold off any nausea and cut back on the icky side effects), and I made an appointment to see the dentist for a check-up before the transplant. Shit is getting real!

And I credit all of my good luck charms because they hold the love, concern, and positive thoughts from you all.



Tuesday, February 25, 2020

Transplant update

It's been awhile since I've given an update on the transplant process.

First of all, I want to share that 96 people have signed up under my code--online or through one of the two bone marrow drives. I know that many of you signed up when I first learned about Be The Match, and before I had a code (LorisLegion), so the number of adds to the registry is likely even higher. If you (or one of your kids) signed up before my code, but because of my prodding, please let me know. I would love to have a better count of how many new registrants we've brought in. :)

The donor match process has been long. Although I was told that I shouldn't worry because given my background it was extremely likely they'd find me a good match, it seemed that everything was taking longer than I'd expected (and certainly longer than I'd hoped).

Over a month ago I heard from the Froedtert transplant coordinator that they'd identified three perfect matches in the registry and that the next step was to bring them in for additional testing. Two weeks ago I had not heard anything, so I called her. Unfortunately none of those three panned out--one was unreachable (had moved, maybe?) and the other two either had test results that didn't make them a good match, or they changed their mind. So it was back to the drawing board, although she said that  they had another three potential matches identified, and that all three were reachable and had scheduled appointments for the follow-up confirmatory testing, but she didn't have results back yet.

Last Friday I again checked in and was told that all three attended their confirmatory testing appointments, but she didn't have the results back. She also explained that the transplant team met weekly on Tuesdays to make donation decisions. So since it was already Friday afternoon and she hadn't received the results, unless they came in on Monday, I should expect to hear something the NEXT Tuesday (March 3rd). I know it's not a race, but I can't help but worry as time goes on.


Today, shortly after the weekly meeting, the coordinator called me and informed me that they have identified both a primary and a back-up donor. That means that they have both made it through the testing and understand the timeline, which fits into their life. I immediately broke down. I am completely overwhelmed by the emotions I'm feeling--alternating huge smiles and sobs--thinking about the generosity of this person. All I know is that the primary donor is in their early 20's (here's why that matters), international, and also matches on my blood type. If all goes well and they are open to it, two years after the transplant we might be able to connect.

When I think back to late November, I wasn't sure I'd ever even leave the hospital. There were so many obstacles thrown my way, and every one of them read "unfavorable." Many of those still exist and I'm not through it yet--not even through the worst of it. But this is at least symbolically a big hurdle and a leap towards hope. I am feeling so very hopeful!

Monday, February 24, 2020

Disability--and depression

First a quick update:
Friday was bone marrow biopsy #4. On a scale of how much it hurt, I'd put it at third. But it healed quicker, allowing me to bike already on Saturday.

I will meet with Dr. Atallah this Thursday to get the results (including cytogenetics) and presumably to start another round of chemo--7 days of Vidaza infusions. I've updated the Google Doc with additional days I'll need rides. Some of those might be longer, if I need transfusions. It will be interesting to see what happens to my counts this time. My hemoglobin and platelets are actually still pretty high (Friday they'd gone up from my Monday appointment--86K!), although my neutrophils are on a steady decline, which means my brief ability to be out in public for coffee is gone again. At any rate, Greg can always come get me post-transfusion if you sign up to drive me but have to leave before I'm done.

Today, Monday, February 24, is my first day on disability. I have been out of work for 90 days. That's the length of a maternity leave (I would much prefer to have a baby to show for this!). It's something I never thought I'd need, but here I am, and I'm so relieved to have it available. I am fortunate, too, to have amazing co-workers who donated sick time to me so that the number of days I went without any pay were minimal. Throughout this whole experience, I have been continually brought to tears by the generosity of all my friends. I cannot imagine how people do something like this without that support. I will say, however, that it has been tough to not be working and using my brain. I worked throughout my breast cancer treatment--first part time and then full time--and it allowed me to feel at least somewhat normal. I miss that normalcy.

And that brings me to the "depression" part of this post.

Facebook has been reminding me of events that led up to my first bought with Major Depressive Disorder with Anxiety. Eleven years ago this week, after a lifetime of nothing more extreme than PMS, I was completely debilitated by a depressive episode. After twelve years of being a stay-at-home mom, my baby was in school and it was time for me to go back into the workforce. I didn't have a plan for what I was going to do beyond "return to the workforce when the kids are in school." I started applying for jobs either in or out of my first career field (education). I was turned down from every job I applied for. I looked into returning to school to be a nurse, which was what I always thought would be a great fit, and every program would have made me start over with 100 level science courses since I'd been out of school so long. (Never mind that I'd taught or tutored those classes, because it was more than 10 years, they didn't count.) I felt useless--my kids didn't need me like they had and I wasn't contributing to the household at all. I felt lost, and I fell apart. I was fortunate to have insurance which covered me to almost immediately see a therapist, while waiting for an appointment to see a psychiatrist and get medication help. I was virtually bed-bound and unable to interact with anyone beyond my immediate family. It was terrifying--for me, but I know for my family, too. And over a period of several months, I was able to learn coping strategies (my therapist was awesome) and of necessity I weaned off of the Zoloft I'd been prescribed (because it was causing my platelets to drop even lower and the psychiatrist was concerned).

Then midway through my second year of grad school, it hit me again. They tried another antidepressant, which spiraled me into further anxiety (I guess this is relatively common), and it took a few months to get out of that episode, too, although I was able to continue to go to school and work through it. My therapist had retired by then, but I used the skills she'd taught me and worked my way back out again. And it wasn't until I found the lump in my breast in November of 2014 that that feeling overtook me again. I went back on Zoloft through my breast cancer treatment, until I couldn't be on it anymore (when I started Tamoxifen). And I found that, despite my fear of not being able to take them, I was again fine without them.

At any rate, I have been thinking a lot about depression lately. Right now I'm in a relatively similar situation to where I was eleven years ago--home full-time, mostly alone. I feel like I don't really have a purpose, as I'm not working. And if you add in the bit about being mostly house-bound plus that diagnosis of a second cancer, it would come as no surprise if I'd again feel depressed.

And yet somehow I'm not. I'm frustrated at my lack of contributions and I fear my brain will forget how to work. I continually list the things that I had planned to do this year, but won't be able to (go to Trav's graduation; bike the 150 mile Scenic Shore; visit Cara in La Crosse; do college visits with Ash...), and I have momentary periods of sadness and "that's not fair!" but I have not fallen into that depressive spiral through any of this.

I have a theory. Eleven years ago, at least in my mind, I felt that depression was not something to talk about. It was something that you hid, and tried not to label. Medication and therapy were both looked down upon. And so I tried to face it mostly alone (not entirely true--Greg totally got me through!). And then my breast cancer diagnosis came, and when I decided to be public with it, the outpouring of support was amazing. Much as now, with my leukemia diagnosis, people flooded me with notes and gifts and general good thoughts. I once read a quote that said simply, "Depression Lies." For me, that's exactly what it did to me during those three depressive incidents--it convinced me that I was useless and that no one needed me. But now, with so many people reaching out after my cancer diagnoses, even without some of those coping skills learned in therapy, there was no way that I could argue with the fact that someone needed me. A hell of a lot of you "needed" me--and cared about me. And there is no "depression" this time.



So my wish is that we, as a society, were able to do that and to be there for people who have mental health issues, too. For that stigma of saying, "I am depressed" or "I can't get out of bed today" to go away, and for us all to completely embrace people with mental illness like we do for physical illness. Because you know what? Those scary depressive episodes I had were worse than any of the cancer treatments I've had. And just as I know that no one would judge a cancer patient who is utterly exhausted by their surgery, chemo or radiation treatments, there should be no shame in being bed bound by anxiety or depression. A card, a note, a text, flowers, a visit, a gift certificate, a lunch date... all of these things that people did for me after my cancer diagnoses would have been helpful when I was struggling with depression, too. (Although I didn't know it at the time and certainly didn't share it.)

If you are dealing with depression, whether you feel you can label it or not, if you want to, please know that you can tell me. Because depression is a filthy dirty liar that makes you feel worse than any physical pain. And I will be the first to tell you what a horrible liar it is, and I would love to help you see your worth. You are needed. You are wanted. You are important. And you are loved. And there are better days ahead.