CHAPTER 9
LIFE AFTER TREATMENT
Congratulations, beautiful!!!!! You made it to the other side. Now that all that nonsense is done, it’s time to celebrate! If you are anything like me, you haven’t spent a lot of time thinking about what happens now. I get it—you’ve been a little busy having surgery, heading to chemo and radiation appointments, and basically living in your doctor’s office. The good news is you are now, officially, a survivor (holla!!!). That alone, makes you friggin’ fabulous!!!
Getting used to your post-cancer body requires a bit of an adjustment period. For me, this was the toughest part—partially because I felt unprepared for how my body changed from chemopause (chemically included menopause). I’m not going to lie, some of the physical changes really suck. I want to spare you the drama; being prepared is half the battle. Whether it’s dealing with hot flashes or weight gain—all are manageable. Listen, you handled cancer like a boss—this is nothing compared to that. You got this, girl!
bye-bye estrogen, hello menopause!
It was about six months after I started taking Tamoxifen that I started to see a difference in my physical appearance. I had made it up until that point pretty much resembling my old self—except, of course, for my new knockers. I felt pretty good too—all things considered. But once I was in full-blown menopause, my hair texture changed, my nails began peeling and breaking, my skin lost its resilience and glow, and hot flashes would leave me dripping in sweat—several times a day. And if that wasn’t bad enough, my girly bits became as dry and lifeless as the Sahara. Talk about adding insult to injury!
I don’t say this to scare you. But menopause is often a shitty side effect caused by chemotherapy and cancer drugs, including Tamoxifen or aromatase inhibitors. While my doctors told me to anticipate menopausal changes, I wasn’t really prepared for how they would play out. By the time it was in full effect, I felt like I was living in a remake of Revenge of the Body Snatchers. I didn’t recognize my body anymore.
I came to learn, over time, that this is a common feeling among survivors. At first, I thought the struggles were singularly mine. But once I started talking openly about it and writing articles on hush-hush topics—I instantly learned that I wasn’t alone. In fact, I learned that I was luckier than most. Many of our sisters experience really harsh side effects—some even painful. Surprisingly, there are some easy things you can do to mellow the harsh.
But first, let’s take a step back: What’s actually happening in your body?
“Menopause is when you have a loss of estrogen and all the things that estrogen helps,” says Dr. Heidi Waldorf, dermatologist and breast cancer survivor. “Estrogen helps reduce wrinkles. Estrogen helps improve elasticity and keeps the collagen healthy. It keeps your skin hydrated and plump. It keeps your hair growing in the right places and not the wrong places. It also helps maintain that very sensitive vaginal mucosa.”
Everyone’s menopause experience will be different. How your body reacts depends on a few variables including your age and the overall condition of your health at the time of your diagnosis. Regardless, many survivors worry about the long-term physical effects of treatment and cancer drugs. It’s a valid concern. When faced with skin that seemed less resilient, hair that appeared dull, a slower metabolism, and a dry vagina, I was alarmed. And that’s putting it mildly.
cancer drugs 101
By now, you’ve probably heard about Tamoxifen or the class of drugs called aromatase inhibitors. But what are they? How do they work? What are the side effects you can expect when you start on them? To help answer these questions, I turned to Dr. Jennifer Litton, a breast medical oncologist at the University of Texas MD Anderson Cancer Center—one of the top nationally ranked cancer institutes in the United States—to give us the 411.
Let’s start with Tamoxifen. Tamoxifen is a pill generally given to premenopausal women. It can also be used by postmenopausal women, but only when aromatase inhibitors don’t work or cause side effects that impede quality of life issues. “Tamoxifen is a selective estrogen receptor modulator,” says Dr. Litton. What does that mean? “Basically, it is very similar to estrogen. It binds to a lot of those receptors that estrogen would normally bind to and feed those tumor cells. But it binds there, it doesn’t feed the tumor cells, and it doesn’t get out of the receptor. It just sits there. So the cells starve off because they are not getting the estrogen.”
Women who are already in menopause when they are diagnosed or for those who are induced into menopause either with shots or because they’ve had their ovaries removed, are put on an aromatase inhibitor. There are three: Arimidex (generic name: anastrozole), Femara (generic name: letrozole), and Aromasin (generic name: exemestane). “Aromatase inhibitors shut down the final formation of estrogen that you make outside of your ovaries,” says Dr. Litton. “So, for postmenopausal women, even though it’s low, I think that’s a big surprise that women still make estrogen in other parts of their body—like in the fat cells. Aromatase inhibitors have a completely different mechanism of action than Tamoxifen. What they do is shut down the last chemical conversion. Tamoxifen sits and binds to a receptor and sits there like the flag that sees the estrogen.”
While the functions of these drugs are very different, the side effects are largely the same. They include hot flashes, weight gain, vaginal atrophy, joint aches and pains, and a decrease in bone density. “One of the things not really in the literature but that I’ve seen with these drugs is some hair thinning too,” says Dr. Litton. “Sometimes that can be really upsetting.”
Whether you experience any—or all—of these side effects depends on so many variables. The good news is that each can be managed. Let’s talk about the ones that can mess with your beauty mojo.
feelin’ the heat: hot flashes and night sweats
There is still debate in the medical community about what causes hot flashes and night sweats. The Mayo Clinic points out that not all women who lose estrogen also experience hot flashes or a shift in body temperature. What the evidence does show is that menopause-driven estrogen loss is linked to changes in the hypothalamus. The hypothalamus is an almond-sized area in the brain that regulates body temperature, hunger, thirst, fatigue, and sleep—among other things. The leading theory is that when there is a decrease in estrogen in the body, the hypothalamus detects it as too much body heat. The brain’s natural response is to release hormones that lower the body temp, which causes the heart rate to rise and blood vessels to dilate to allow more blood to flow through and dissipate the heat. The increased blood flow sets off the body’s natural cooling method: sweat. This series of events—the heated, flushed sweaty situation—is what we call a “hot flash” or “night sweats,” depending on the time of day they happen. Bottom line: a.m. or p.m.—they are uncomfortable, irritating, and inconvenient.
While hot flashes and night sweats are out of a woman’s control, there are some things that bring them on or make them worse. To help minimize your hot flashes, it’s important to pay attention to the things that could be triggers. To help lessen the number and severity of hot flashes, try avoiding:
One surprising thing I found that helped my hot flashes was a bit of unexpected intel I learned from Dr. Larry Norton, medical oncologist and the deputy physician-in-chief for breast cancer programs at Memorial Sloan Kettering. Dr. Norton was giving a talk at the 92nd Street Y in Manhattan when he said some women found that their hot flashes were more manageable when they switched the time that they took their Tamoxifen. He said that when these women took their pills at night, rather than in the morning, they reported shorter, less severe hot flashes and night sweats. He was quick to add that there was no scientific data to back up this claim but for women struggling with this side effect, it might be worth trying. I was one such woman and started taking my pill that very night. Within two weeks my hot flashes, and especially my night sweats, started to subside. While they didn’t go away entirely, they aren’t as hard-core as they were before.
Dr. Litton also adds a little tidbit of encouraging information, “For most people, hot flashes are most pronounced the first five or six months and then often they get slightly better,” she says. “I really try to encourage my patients to get through those first months because it gets easier after that.”
weighty matters: taking a pounding after cancer
I never had a muffin top until I started taking Tamoxifen. A year into taking the anticancer drug, I walked past my bedroom mirror only to catch a glimpse of my belly jiggling. I almost had a heart attack. No matter how hard I worked out—three or four times a week—I couldn’t shed the weight. Studies show that the average weight gain from hormonal changes brought on by Tamoxifen or an aromatase inhibitor ranges from “seven to ten pounds,” says Dr. Litton. Because estrogen levels are lower, it makes fat harder to shed. This “sticky weight” generally settles around the abdomen. But cancer drugs aren’t the only culprit. The natural aging process plays a role as well, slowing the metabolism and diminishing muscle mass and bone density, among other things. When your body is forced into menopause all of these things happen at the same time—and the effects can be startling.
Here’s the thing you don’t want to hear: It is imperative that you are disciplined with your diet and exercise. Before cancer, it used to be a cinch for me to shed five pounds in less than two weeks if I was strict with my food and workouts. Today, my muffin top hangs around like an ex-boyfriend I can’t seem to ditch. Anything that disappears into my mouth, shows up on my waist within days. It’s a cruel existence.
Here’s how to manage it like a pro.
make a nutritionist part of your squad
When you are being treated for cancer, you will have a team of medical experts overseeing each phase of your care. A nutritionist should be one of them. Most patients either don’t think to consult with a nutritionist or don’t want to deal with going to one more appointment. But a nutritionist’s advice and guidance can make a huge impact on how you look and feel during and after treatment. Most, if not all, cancer hospitals have nutritionists on staff who are there to help you create meal plans and shopping lists, and provide recipes when your taste buds and food restrictions will be at their worst. They are also there to help you figure out how to adjust your diet for life after. My advice is to make the most out of your trips to the hospital by piggybacking your appointments. After you see the oncologist, stop by the nutritionist’s office. You can also make use of the hours you are sitting in the chemo suite by having the nutritionist come to you. Either way, the sooner you can get on a healthy eating plan and establish good habits, the better it will be for your look—waistline, skin, nails.
minute on the lips=lifetime on the hips
You’ve heard this expression a hundred times but it’s especially true after cancer treatment. After I was diagnosed, I decided I was going to make myself happy by eating all of my favorite foods. “Cheat nights” became everyday “treat nights.” Chicken scarparelli, enchiladas suizas, and pizza (duh) became regular meals in the Kiernan household. And pretty soon, they became regulars on my stomach, thighs, and arms. I think dealing with cancer is two-fold: You have to be kind to yourself and give yourself a break. On the other hand, you have to remember that you are going to live, so you can’t throw in the towel like there is no tomorrow. You have to maintain a sense of control so you can maintain a sense of yourself in the long run. Consider this: Once you are on drugs that will put you into menopause, you will have to eat about two hundred calories less per day just to maintain your pre-cancer weight. And that doesn’t even take into account the additional weight you will gain from treatment. The less you consume, the less weight you will gain. It’s that simple. Treat yourself, but do so in moderation. I still allow myself “treat nights” with meals that have a higher calorie counts than Bill Gate’s net worth, but I limit them to weekends or a night out. Trust me when I say, making a disciplined choice of salad over pasta is waaaaay less painful than the hours you will have to log in at the gym to burn off the calories later on.
shake what your mama gave you!
Working up a sweat is going to keep your bod healthy and hot. But hitting the gym or heading out into the great outdoors for a brisk walk has more benefits than just losing or maintaining your weight. More than a hundred epidemiologic studies prove that thirty to sixty minutes of moderate to vigorous exercise per day drives down the risk of reoccurrence. The findings also show a 20 to 30 percent risk reduction, which is even higher for postmenopausal women. Here’s why working out is such an effective anticancer tool:
Estrogen doesn’t just come from your ovaries. It is also produced and stored in fat tissue. The more excess fat you have, the higher the level of estrogen that remains in your body. This leads to the development of more fat tissue and more estrogen. It’s a vicious cycle that ups the chances of your cancer coming back.
Exercises triggers apoptosis, programmed cell death, helping kill off cancerous cells before they become cancerous.
Physical activity increases circulation of the blood and lymph systems. If you’ve ever heard of, or had, a lymphatic massage, then you know how important it is to “get your juices flowing.” While the circulatory system relies on the heart to pump blood through our bodies, the lymphatic system (made up of tissues and organs) relies on exercise to flush out the body’s toxins and waste, called lymph. Lymph nodes help “catch” or filter cancer cells that might be floating in the fluid in the body. This is why surgical oncologists remove some of the nodes located in the armpit during breast cancer surgery. Examining them helps doctors figure out the extent of the cancer in the body. When we sit on our asses and don’t move around, those toxic, acidic liquids pool around the tissue and can cause issues like lymphedema.
The loss of bone density is an expected side effect of menopause. Weight-bearing exercises help build muscle and bone mass and strength, reducing the risk of osteoporotic fractures.
Exercise can limit the intensity and length of hot flashes and night sweats.
Working out boosts your brain’s feel-good neurotransmitters, called endorphins, which reduce stress and elevate your mood. Working up a sweat in the gym will ensure you “don’t sweat the small stuff” in the rest of your life.
the effects of cancer on your (whispered voice here)… vagina!
It amazes me how nobody prepares you for how your vagina is going to change once you have cancer. Most of us are so focused on the battle and the area of our body that is being gutted by the cancer that we don’t even think to ask about our vajajays. Well, prepare yourself, because cancer treatment and menopause brought on by chemo or cancer drugs change things—drastically. Normally, the vagina is lubricated with a thin layer of clear fluid. The physical evidence of this is what we call “discharge” often seen in the lining of our underwear. Estrogen helps maintain that fluid and keeps the walls and lining of the vagina healthy, thick, and elastic. When estrogen levels bottom out, the fluid dries up and the lining and tissue become thinner and less elastic. This is called vagina atrophy, vulvovaginal atrophy, and genital urinary syndrome menopause.
This can be the toughest part of being a survivor. The hits just keep on coming. As an editor, what saddens me the most is that many doctors and the media really don’t want to talk about this life-altering side effect. Survivors are often left to grapple with the issue alone. I can’t tell you how many times I have pitched this topic to my editors only to have the line go dead the minute they hear the word “vagina.” What the f*ck is this, 1950?
In a day and age when a celebrity sex tape can launch a Vogue-cover career, why is it still taboo to discuss a dry vagina after cancer? It’s our responsibility as survivors to force this dialogue and remove the stigma once and for all! We have a right to the information—especially when it impacts our quality of life.
My vagina got dry after chemo. Soon after, I couldn’t achieve an orgasm without a lot of work. I felt “dead” down there. As a single woman, it was a nightmare. I am not alone.
According to published studies, 90 percent of cancer survivors will experience some form of vaginal atrophy and sexual dysfunction. Ninety percent!!!! That’s almost all of us!
And you know that if this were a male-related issue, there would be a pill for it by now.
“Let’s talk about survivorship because the chances are your doctor never ever talked to you about your sex life beyond cancer,” says Dr. Lauren F. Streicher, associate clinical professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University and the medical director of Northwestern Medicine Center for Sexual Medicine. She is also the author of Sex Rx: Hormones, Health, and Your Best Sex Ever and The Essential Guide to Hysterectomy. According to Dr. Streicher, the most common side effects include: decreased libido, affected arousal, limited orgasmic ability and dyspareunia (painful intercourse), bleeding—oh, and this doozey—chemotherapy-induced oral mucositis in the genital tract. “The mucosal lining in the mouth is similar to that of the vagina so it makes sense that patients could get sores there,” she says. “But nobody ever tells you to expect that or what you might do to treat them when they occur.”
That’s true of most of the topics centered around this part of your body. Here’s information that can help.
the sahara syndrome: dealing with a vagina as dry as a desert
Since a dry vagina is at the root of a lot of these problems—including itching, bleeding, and painful intercourse—let’s start here. The most obvious fix is lubricants. “All lubricants are not created equal,” says Dr. Streicher. “I steer women away from water-based lubricants particularly if they have propylene glycol in them because they tend to get sticky and gloppy and irritating. The post-cancer vagina does not need anything that is going to be irritating.” She recommends Pre-Seed (a lube for couples who are trying to conceive) because it is the least irritating for cancer patients with inflamed tissue. Unlike most lubricants, Pre-Seed does not harm sperm and helps mimic cervical fluids—so its great for couples who are trying to conceive after cancer. However, it is contraindicated for women like myself who have estrogen-based cancers. But not to worry! There is another great option: Replens Silky Smooth, a vaginal moisturizer often mistaken for a lubricant. “You put it in the vagina twice a week and it makes the water absorption in the vaginal tissue increase,” she says. “In many women it works as well as a local vaginal estrogen. In the clinical trials, the biopsies of the vaginal tissue showed the same changes/results.”
corpse crotch—damaged, diminished, and feeling “dead” down there
It’s not just survivors in chemopause that will experience changes to their vaginal tissue. Women who have had pelvic radiation to treat cervical, vulvar, rectal, anal, or uterine cancers will also experience changes in the shape and size of their vagina and the vaginal tissue. Lubrication won’t fix this. What will? “Right now, you have a number of different options,” Dr. Streicher says. “One is using a local vaginal estrogen product.” These come in many forms—creams, gels, lubricants, and now even serums. Among the most popular picks: Vagifem (a pill inserted into the vagina), Estring (inserted vaginal ring), Estrace (cream), Esphina, and the soon-to-be-released Lasovoxigen (serums).
Now, I know many of you who had estrogen-based cancers will think it’s too risky to use an estrogen-based product. I felt the same way. But Dr. Streicher says the science proves these products are safe to use. In her book Sex Rx: Hormones, Health and Your Best Sex Ever, Dr. Streicher cites a paper published in Breast Journal that calculated the total amount of estrogen delivered in one year of using a local vaginal estrogen product. I would like to share her intel because it is important that the FACTS of this issue—not the fear—lead the conversation:
Vagifem delivered 1.14 milligrams, with an average blood level of 4. 6 picograms per millimeter. Estring delivered 2.74 milligrams, with an average blood level of 8.0 picograms per milliliter, and Estrace cream had a maximum yearly average of 7.1 milligrams, with a variable blood level (since doses vary). As a point of reference, the average serum estrogen level in a postmenopausal woman who takes no estrogen is 10.0 picograms per milliliter or less. Women who take systemic estrogen therapy take one milligram each day. Women who use a vaginal estrogen take one to 7 milligrams per year.
During our interview, Dr. Streicher added this interesting tidbit: “I did a survey of 1,000 academic female gynecologists and I asked them, ‘If you personally had an estrogen-positive breast cancer and had problems with vaginal atrophy would you personally use a local vaginal estrogen for the rest of your life?’” she says. “Ninety-three percent said yes, they would.” As with all medical issues like this, be sure to check with your doctor before using any sort of local vaginal estrogen to make sure they’re right for you, but these findings are certainly encouraging.
For those who opt out of using estrogen-based products, there are a few other things that can help.
use it or lose it
The first one is a DIY. “There is something to be said about ‘use it or lose it,’” says Dr. Streicher. “We know women who are having intercourse on a regular basis tend to have better lubrication and elasticity than women who’ve had a long hiatus.” Most of us battling cancer go months—if not the entire duration of treatment—without having sex. That’s normal, so don’t knock yourself. But don’t be surprised when you get frisky again that you have a Sahara Situation down below. “One thing women can do proactively to keep the tissue elastic is use a Rabbit-style vibrator,” she advises. “The Rabbit is a penis-shaped dildo with an external component for clitoral stimulation” that helps you get revved on the inside and out. Talk about a win-win.
laser focused
The second thing that can help are lasers. “Lasers in my vagina?” you ask. As crazy as it sounds, that’s exactly what I’m talking about. Most of us are aware of the use of lasers in cosmetic dermatology. Instead of having to go under the knife for even the smallest nip and tuck, lasers allow us to lift, tone, tighten with little (and in some cases, no) downtime. Hence, their popularity and expensive price. But these lasers aren’t just for the face. Now, doctors are also using them to reinvigorate the vagina. Whether you’ve had a baby, are getting older, or are in post-chemo menopause, these lasers are nothing short of miracle workers. They tighten the vaginal tissue, minimize incontinence, restore moisture, and heighten sensitivity. Within the last few years, four new noninvasive lasers have launched in the United States: MonaLisa Touch and FemiLift (fractional CO2—just like Fraxel for the face), IntimaLase (YAG lasers), and ThermiVa (radio frequency).
Fractional CO2 lasers use a beam to create microscopic cuts in the vaginal lining. As the wounds heal, “the physical response is an increase in blood vessel growth and collagen in the supportive tissue,” says Dr. Elizabeth Eden, a New York City–based gynecologist in private practice and president of the New York Gynecological Society. Dr. Eden is also the clinical assistant professor of gynecology at NYU School of Medicine. “The end result is thicker, stronger vaginal walls, an increase in moisture, and an improvement in atrophy and laxity.” A side benefit is that the pH levels and natural bacteria even out—so women experience less urinary tract and yeast infections.
Radio frequencies lasers, like ThermiVa, use controlled heat to warm the tissue until it contracts and tightens. While the fractional and YAG lasers can only be used on the inside of the vagina, lasers using RF can also be used on the outside to tighten the labia majora. This is a big benefit for those who want to tighten up everywhere after childbirth. While research is ongoing to determine which of the lasers deliver the best result, early reviews recommend MonaLisa and FemiLift for atrophy and ThermiVa for tightening.
The procedure for each laser is slightly different but each starts like a regular gynecological visit—with the patient reclined and their feet up in the stirrups. The doctor inserts a wand in the vaginal canal and sweeps it 360 degrees with pulses of energy. Each laser session varies between five and twenty minutes. To get the best results, three sessions, spaced a month apart, are required. One “touchup” session is recommended once a year or on an as-needed basis. The cost ranges from $600 to $1,500 per session. Some of the lasers also have a one-time fee for the wand that will be used during each appointment. Unfortunately, none of these are covered by insurance.
(Quick side note here: I understand these laser treatments are a big out-of-pocket expense and not in everyone’s budget. I wish there was a cheaper alternative. One of the reasons I wrote this book was to help share information about the latest treatments and products that have quality-of-life benefits. These lasers do. My opinion is that they should be covered by insurance for cancer patients because they aren’t “cosmetic” procedures but are used to improve a survivor’s physical (and emotional) health. I encourage you to write a letter urging your congressman or senator to push for insurance coverage for these treatments. It’s our responsibility as survivors to make the journey easier for those after us! (Stepping off my soapbox now…))
So… the big question: Does it hurt? I had the FemiLift laser treatments and I can tell you from personal experience—there is absolutely no pain whatsoever. How can that be? “The nerves that innervate the vagina are not the kind of nerves that send a signal to the brain that says it hurt,” says Dr. Eden. “They are not traditional pain receptor nerves that you have elsewhere on your body.”
The only downside—for me—was that I couldn’t have sex for a week after each treatment. Which, let’s be honest, is not really that big of a deal. I could still work out, bathe, and proceed with life as normal. And I saw and felt immediate results. It has made a huge improvement in the health of my vagina and my sex life. And while I still keep lube on the nightstand, it isn’t the slip ’n’ slide situation I required before. The laser treatment has allowed me to get back in touch with a part of myself that had been missing since my first chemo session—a part of me I thought I’d never feel again. And I couldn’t be happier about that.
Cab to VSPOT Medi-Spa: $23
Three FemiLift Laser treatments: $2,500
Reusable laser wand: $200
Moist, youthful vagina: Priceless
getting your booty mojo back
There is nothing like cancer that puts a serious damper on your sex life. I’ll admit, it’s hard to feel sexy and “in the mood” after having had your tits taken off and toxic chemicals pulsed through your veins. I wanted no part of it. Plus, I was just flat-out tired. When I was done with reconstruction, I thought I might get back on the horse (so to speak), but just as things were winding up, along came menopause. Before I knew it, I had no libido and was having trouble achieving an orgasm. This was difficult to deal with. A lot of the survivors I talked with shared similar experiences. And it’s even harder when intercourse is painful. Local vaginal estrogens will help bring your vagina to the party, but you may still be hesitant to join in the festivities. “Menopause does affect the ability to become aroused,” says Dr. Streicher. “Lower levels of estrogen decrease blood flow to the vagina and the clitoris—and that can be a roadblock to achieving orgasm.” So, what will help? Here are some of her suggestions:
keep your eyes on the prize
If you are having a hard time achieving the “big O,” don’t let it get to you. Often, when we focus on what’s not happening, it actually prevents it from happening. You hear stories about women that really want to get pregnant but can’t. Then, the minute they adopt a baby, they get pregnant. It’s the same thing. Don’t be your own cock-block. It might take work but it will happen.
don’t keep secrets
Your partner isn’t a mind reader. If you don’t let them in on the secret that you are having a difficult time getting in the mood or achieving an orgasm, they won’t know to help, let alone be able to. Sharing this news can be scary but it will encourage the both of you to be more patient—maybe even more playful—in bed. This advice also goes for your doctor. They can help—but only when they have the intel.
werk it
Dr. Streicher said it best before: “Use it or lose it.” There is scientific evidence that women who mastur-bate on a regular basis have an easier time achieving orgasm. Since blood flow to the vagina and clitoris lowers after treatment and menopause, self-stimulating will help keep the blood flowing there. Doing it when you are alone will make it easier when you are with your partner.
try pelvic floor therapy
If painful intercourse and/or incontinence are issues that aren’t being resolved with local vaginal estrogens or lasers, try pelvic floor therapy. This specialized physical therapy targets the muscles, ligaments, connective tissue, and nerves that support the bladder, uterus, vagina, and rectum so they can function properly. “Orgasms require contraction and release of the pelvic floor muscles,” says Dr. Streicher. “So, if achieving an orgasm is an issue, these exercises can help with that. They can also help make them stronger and last longer.”
As a survivor, every day is a new experience, especially when getting used to my new body. But even with all the changes—most of which are admittedly unpleasant—I feel stronger—both physically and mentally—than I ever did before. You and I have powered through what will probably be the most difficult thing we will ever face in our lives—and we are still here living life, laughing, and looking good. I’d call that a win.