Side Effect Smorgasbord

Side effects from cancer treatments often feel like they are heaped onto an overflowing plate from a smorgasbord at the cancer cafe. Every treatment comes with a long list of possible effects with the caveats that most people don’t experience all the effects and they range in severity. That’s true enough. I’ve experienced many of them over time due to the reality of being on multiple treatments. The list below is not complete. Side effects I’ve had the displeasure of having include:

  • Nausea and vomiting
  • Hair loss
  • Fatigue
  • Neuropathy
  • Insomnia
  • Mood changes
  • Higher risk of infection (low white blood cell counts)
  • Anemia (low red blood cell counts)
  • Easy bruising and slower healing
  • UTIs
  • Chemo Brain
  • Appetite changes
  • Weight changes
  • Diarrhea
  • Constipation
  • Hand foot syndrome
  • Dry skin
  • Dryness of mucous membranes
  • Chemo induced menopause

An entire separate buffet needs to be set out to adequately serve all the undesirable dishes that accompany chemo induced menopause. Sexual side effects are a big part of menopause. Entering it as a chemo induced experience brings some unique spices and flavors to the smorgasbord. Fortunately, there are ways to address these effects so women are more comfortable and happier.

Emotional side effects like anxiety, depression, grief, and identity questions may not directly be caused by a cancer drug, but they certainly can develop or become magnified from diagnosis, throughout treatment, after treatment, or carry into what’s next. Trauma also can develop from a myriad of cancer moments. These are available at the smorgasbord and it’s all you can eat. 

Addressing mental health side effects are just as important as addressing physical side effects. No, a person doesn’t have to suck it up or get over it. Positivity is not a cure all. I may not feel like gutting myself emotionally and exposing all my pain as a casual conversation. Someone may look just fine on the outside and be struggling within.

Unfortunately, I have added a new side effect to my list in the past month:

  • Mouth, tongue, and throat problems such as sores and pain with swallowing

Fun fact: a person can’t swallow and breathe at the same time. I have had three of these esophageal spasms, triggered by taking oral medications and supplements. I’ve described it as comparable to a swallow getting stuck but there is nothing causing an obstruction. It feels like I imagine a heart attack would because I can’t breathe. Scary isn’t a strong enough word. And it’s painful.

It’s a triple F moment for sure.

The same week as one of these spasms, I discovered I had mouth sores. They were on the inside lining of my mouth in both cheeks. Perhaps as far back as my throat. No wonder my mouth hurt! It explained my ongoing pain and difficulties eating and speaking in addition to swallowing. I called the triage line two days in a row. The previous day I called because my throat still hurt from the spasm episode and I discovered one whole pinky toe had turned into a flaming blister. The blister is a sign of hand foot syndrome. It turns out I need to keep rinsing my mouth throughout the day with warm salt water and keep my mouth as clean as possible. This easy at home solution worked quickly and the sores have resolved. Omneprozole is successfully preventing any more spasms.

Drugs are often prescribed to deal with side effects and they also have side effects of their own. It becomes a vicious cycle.

Serious side effects (more serious than those covered) like heart, liver, and kidney damage can also result from cancer treatments. The term side effect seems like it’s lacking when major organs can suffer permanent damage.

So . . . which side effect is the worst?

Whichever one is happening at the present moment.

Rarely are side effects ever on the side.

This smorgasbord sucks. I want to order off the menu and go straight to desserts. Ice cream sounds delightful.

Consider responding:

  • I know my list is not complete as there are side effects I’ve dodged. Please share others if you’re comfortable.
  • What side effects have you found challenging? What has worked well to manage them? Please add your comments so others may benefit.

Scalp Cooling and Cancer

Using a cold cap marks another first for me.

It’s my third time facing a treatment that has a strong (almost certain) chance of hair loss listed as a side effect. Total hair loss was a sure thing the first time I needed chemo. I went to the salon and had my head shaved. I had a wig but didn’t plan on wearing it. It didn’t look like me, feel like me, and it felt uncomfortable. I felt I retained my identity in a head wrap.

Cold caps at this time were being used in Germany but not in the U.S.

The second time where I was likely to experience hair loss was when new treatment followed oral capecitabine where my hair had already thinned considerably. My next line of treatment was likely to cause me to lose even more. This time around, I looked into cold caps. Some had been FDA approved and were being used in the U.S. I wanted to do it. The more I learned, the less of an option it became. Caps needed to be changed every twenty minutes. You needed someone to help change the caps. It needed to be worn before and after treatment – how long depended on the specific treatment you were receiving. I learned I would need to wear the cap a couple hours prior to and after treatment. I lived alone and I doubted I was going to find anyone who had full days to devote to cap changing. I also learned a person still lost up to half their hair. I didn’t have any more to lose since I already felt I had lost about half from my previous line of treatment. It was too much effort for something that maybe would sort of possibly work hopefully a little bit. I didn’t shave my head. I decided just to let hair fall out if it was going to. Most of it did with effects similar to if I had shaved it. I opted for a wig. I could avoid stares when out in public. It suited me. I felt like me. It was comfortable. I felt more normal and like myself.

I wigged for three years.

I finally had my hair back by last November. I love how it feels. It’s been a beautiful mess during the time quarantining during COVID. I found that ironic that I had all this lovely hair that no one ever saw and I couldn’t get done.

God sure has a sense of humor.

Then came the blow that I needed to change treatments and the best option would probably wipe out my hair for a third time. I didn’t want to see my hair go again. The emotions and tears attached to hair loss are intense. I decided to revisit the cold cap world and was somewhat relieved to learn there is now a machine at my treatment site provided by Paxman Scalp Cooling that a patient pays out of pocket to use. Please note my only connection to the company is as a customer using their product.

Everything is managed while you are on site receiving treatment. Nothing needs to happen at home. You are hooked up to this machine that pumps and keeps the cap cold. A nurse gets you ready, secures the cap, and runs the machine. You eventually take over and get ready on your own.

Why do I write I was only “somewhat” relieved? I still had to willingly freeze my head for a shot at keeping some hair and pay for the privilege of doing so. It still was probably going to thin, but I’d be starting with a full head of hair this time.

I would take a shot.

Cold caps or scalp cooling systems work when the scalp is cooled to reduce the amount of chemotherapy that reaches the hair follicles. The hope is hair may be less likely to fall out if less chemo gets there.

My head isn’t really frozen. The scalp is brought down from around 98.6°F to between 64°-72°F. It wasn’t an all over football Saturday in November kind of cold. It was more of an unnatural numbness of combined cold and heavy sensations that you could still feel. It does get better.

Time is broken down into four parts. There is a 30 minute pre cooling time to get your scalped cooled and ready to receive treatment. Doxil (doxorubicin liposomal) is what I’m getting and that takes 60 minutes to infuse. Then there is a 60 minute post cooling time period. Lastly, you thaw for about 15-20 minutes so hair isn’t ripped out of your head that is frozen to your inner cap when you remove it. It all adds up to just about 3 hours from start to finish.

I hope you agree it doesn’t suit me. I assure you it is not comfortable. I want to keep being the me that I see in the mirror. I’ve been told I look like a pilot or an astronaut of the past. And yes, I know my mask matches my eyes.

What is it like?

It’s rather hilarious the process is called scalp cooling. I think the word cooling is used for some type of psychological effect. The machine was turned on and there is a whoosh of cold filling the cap. Seconds tick by and it indeed gets intensely cold in an instant.

A person is forewarned that the first ten to twenty minutes are the worst. After that, the scalp is numbed enough so it doesn’t feel as cold. I want to be crystal clear on what I feel. Fear fills almost every fiber of my being as I fight through the first ten minutes of each session. I wonder if I can get through this torture I’ve willingly chosen. The feeling of desperation is almost more unbearable than the intense cold. I have fought back tears for the few minutes every time. My tolerance for pain and discomfort is quite high. Living with metastatic breast cancer does that. I can barely keep it together.

But then I acclimate and focus on other distractions to pass my time.

The cold didn’t bother me as much as the tightness and chin strap. The chin strap is the worst part and almost intolerable. The covering worn over the cap must be kept on tightly so that the inner cap stays snug on your scalp. This makes it hard to talk and eat because it’s that tight.

Wearing a mask added another layer to my discomfort.

Feeling a little sick added yet another layer. I was fighting it and waffled back in forth from the root cause of feeling light-headed and woozy. Was it the drug? Was it the cold cap?

Both? Or was it just all in my head?

After I was disconnected from the Paxman cooling machine, there is a thawing out period of around fifteen minutes before the cold cap is removed so your hair isn’t adhered to the cap when taken off. Getting the chin strap released helped a lot.

Nurses are special humans. No ifs, and, or buts about it. I wasn’t feeling so hot after my first session. My lovely nurse gave me a head start to go get the car. Meredith wheeled my carry-on suitcase outside to the drop off lane and waited for me there so I wouldn’t have to lug it all the way to ramp and up flights of stairs. I still had two bags to carry on my own. Scalp cooling requires me to bring much more to my sessions.

How’s the cap working?

I’ve told very few people I’m scalp cooling. I wanted to see what happened. Nor did I see the point of a grand announcement since I don’t go very many places thanks to the pandemic. My new treatment qualifies as one that causes immunosuppression. Even fewer people see me.

I have had two rounds of Doxil (doxorubicin liposomal) so far. Cycle two went more smoothly. I didn’t feel sickish from the drug or the capping experience. Time passed a little more quickly. I am expecting each time to feel easier. I know what to expect and how to manage it all.

Success rates vary with different treatments. Paxman considers the cap successful if you keep 50% or more of your hair. My bar is higher. I want minimal loss with no visible bald spots. I’ve seen many pictures of women with bald spots on their crowns. Seeing these discourages me. Time will tell. Shedding is expected. Lots of shedding apparently.

Shedding is normal. Normal shedding is normal. There is NOTHING normal about chemo. Absolutely nothing. The bald spots on someone’s crown and other places on the head are referred to as shedding. Shedding on chemo goes far beyond normal shedding. A person is bald. My definition differs from Paxman.

Maybe I’m splitting hairs.

When a snake loses its skin, new skin is there to take its place. It’s not even a close call. A snake doesn’t have some bare spots where new skin didn’t develop. Shedding crosses a line quickly with certain chemos and it becomes hair loss. Call it what it is.

I should be wearing a wig or wrap by now if I weren’t scalp cooling. It’s been 45 days since my first cycle with Doxil. My hair doesn’t feel the same or look the same. I can wash it only weekly. There are many cautions against styling it. I am to refrain from getting it colored or cut. I even need to be careful combing it. But I still have it. I will count every day I have it as a win. So far, I’ve experienced minimal hair loss (or ahem, shedding).

I am fed up with accepting hair loss in my life. I’m hoping this third time is the charm and I have found a way to keep it.

If not, you’ll see me sporting a variety of looks and you will know it isn’t working as well as I hoped.

A bit messy, but a realistic look for me. So far, I’m hairy happy with the results.

During, Now, and Next

I often read about someone’s cancer experience in terms of before and after cancer. I also often read that there is no after for those living with metastatic breast cancer because we will always be in treatment. Extreme outliers push what is possible. They keep living with cancer year after year. People living with metastatic disease need words that aren’t in terms of before or after.

I prefer during, now, and next.

A Brief Look at Before Cancer

Before cancer was a golden time of no worries. People lived with no physical limitations. They had job security and careers stretching out ahead of them. Dreams were plentiful and ranged from travel, starting families, professional accomplishments, and personal goals. Normal life expectancies were part of the plan. Life was busy with many friends. Five-year plans were achievable and plans were made for the future without doubting the future.

I felt as others did.

Life was good then. I knew it, but I didn’t realize how good I had it.

I didn’t know the meaning of a bad hair day.

I liked October.

Thoughts About After Cancer

For many, after cancer means getting back to normal, returning to work, growing hair, and putting cancer forever in the past. Survivors post side-by-side photos of their cancer days when they were bald next to photos of a year post treatment when they feel they are once and for all done with cancer where it no longer looks like they ever had cancer.

Life after cancer may mean changes in diet and exercise. Maybe there are new considerations for returning to work or career changes. Life may bring changes in income, changes in health insurance, and changes with how bodies look. There are some who reclaim their past and work to make their life after cancer as much like their before cancer life as possible. For some it means continued support groups, giving back to cancer organizations, and participating in other ways to make a difference in the cancer community.

October becomes a month to celebrate the wonderful and misleading world of awareness. A few reminisce about their cancer days almost as if they were remembering summer camp or a crazy story from high school. I figure it’s easy to reminisce when you are on the other side and treatment is done. There are plenty who see cancer far in their past and it doesn’t affect day-to-day life one bit.

Before cancer is only a memory. After cancer is in the present. After cancer is the future.

It’s a strong possibility I would feel the same if I were in their shoes, but I’m not. I don’t know what it’s like to be “cancer free” as they say. I think it’s the same as how someone without cancer doesn’t know what it’s like for someone with cancer. Those of us with cancer don’t even completely understand what it’s like for another person with cancer. We come close. We can identify and empathize with emotional and physical pain. I have been fortunate to connect with many who write exactly what I feel. I think of these people as my friends even though I haven’t met them.

After cancer means returning to normal or the so called new normal.  In my opinion there is no normal or new normal. I describe my life as a new abnormal and wrote about it in an earlier post you can read here.

Long Ago

It’s hard for me to remember my before cancer days. It feels like another lifetime. I have grieved those days as I would a person. Grief resurfaces with some memories of the past. My eyes water lately when looking at old photos. Who was that person that used to be me? It was someone with dreams that have been shattered.

Even photos from childhood cause some sadness.

Teaching was a huge part of my adult life. I am so far away from those days now that it’s hard to remember elements that were driving forces. So many faces have changed where I taught.

Even some memories of my mom, dad, and grandma have drifted almost too far away. I hate that and I miss them.

What was it like to have boundless energy? What was it like to see my future?

I can’t remember.

The world of before is out of reach.

During, Now, and Next

Good words I use to mark time are during, now, and next.

During is like an umbrella held over now and next. It’s all the time from diagnosis onward. It includes a lot of enduring cancer related life like scans, labs, other tests, office visits, treatments, and waiting. Too much time is filled with enduring cancer when treatment days, side effects, and large chunks of time filled with anxieties or sadness take hold. Instead of after cancer I have an undefined during.

During cancer isn’t all bad. I still taught for four years during cancer. Many are able to keep working. I still live independently. I am still active. I still take vacations (just not presently). Many do all these things, too. Many retire and tell others they finally get to do whatever they want because there is no schedule to keep or boss in charge. I don’t do whatever I want because my health can get in the way, but I try. Living well while living with cancer is possible.

During cancer is a time where nothing ever lasts. I’ve lived in this time labeled during so long that I feel like my life before cancer was lived by an entirely different person.

At my core I still have the same values and main personality traits. Cancer has exaggerated some of them. I have more anxieties and more sensitivities. I am quick to cry. Heck, I’ve cried writing this post. I am more intense and more driven which I possibly could attribute to aging and becoming more confident. I put more emphasis on hope and kindness. I can still crack a joke in the midst of personal misery.

Now is an excellent word. Living in the now enables me to focus on the present moment. I appreciate my wildflowers. I listen to the rumble of thunder. I walk barefoot in the grass. I drink refreshing pink lemonade. Now is where I find joy, hope, and positivity. I work hard not to let anything crush my sense of now. I try to enjoy each day. There is always something. Waking up to greet a new day and gratefully closing my eyes to dream at night are bookends for every day.

Now is the present. Savoring the moment when moments are good stretch out my enjoyment. I savor my breakfast. I savor walks in nature when I’m surrounded by trees and see the sun shining though the leaves. I savor gentle breezes on my skin. I savor laughing and feeling loved. None of these moments can be bottled. They can be replicated as often as possible. Many moments living in the now make up a day. It’s where I live when days are good. Those days add up. I am very lucky for the now I have carved out and the now where I live. Now is all I really have. It’s all any of us truly have.

Living my life involves multiple treatment plans. The word next comes into play when I switch to the next treatment. It also applies to my next cycle of whatever current drug I’m receiving. My treatment visits number into the hundreds. Life is filled with more worries and anxieties. I worry I’ll never again have hair when I’m without it. I worry I’ll soon lose it when I have it. It’s one of my big current worries.

Next is my future. I think about next week or next month. I think about my next piece of writing. I think about what I want to work on next with my trainer and my next physical goal. I have goals for next year. I cautiously make plans knowing they may change. I make them with the intention they will happen. I even think long term because that is energy I want the universe to have. I envision a positive and healthy future because I’m not willing to give up dreaming of my future. It may not be the future I planned before cancer, but it is mine now.

I apologize if this all sounds a bit disjointed. These markers in time are fluid and won’t hold still. Referring to words as nouns that usually function as other parts of speech may not come across in the way I hope they do. Living during metastatic breast cancer means living in an ongoing state of flux. I need sets of words to help mark different spots in the spaces where I live. During, now, and next are working well for me.

Summer Challenge 2020

According to the ancient Greeks and Romans, the dog days of summer occurred in late July when Sirius rose just before the sun. The days were referred to as the hottest days of the year. They have arrived where I live with heat indices in the triple digits. Taking a break from the heat and participating in a summer blog hop challenge through Nancy’s Point is a welcomed break from temperatures I don’t tolerate well. A huge thank you goes out to Nancy for organizing this opportunity for bloggers to connect and giving everyone getting a chance to discover new blogs.

Here are my responses to her questions:

Who are you? Tell us whatever you want about you and your blog.

How do I answer succinctly? I am Kristie Konsoer and was born and raised in Wisconsin where I still live. Jump to 2012 when I was diagnosed with metastatic breast cancer. I retired from teaching second grade in 2016. Writing has been one of my lifelong interests. I started Finding A Way in the summer of 2018 because it tied together writing I was already doing with a way to communicate with others. I initially focused on living well while living with metastatic breast cancer. This still remains a main focus although there are times I dwell more on one than the other. I have written a lot about strength, hope, identity, feelings, thoughts about cancer, and my experiences. I share what’s on my mind. I also include a quote midweek on something that has inspired me or I feel is important to share.

What has been your biggest blogging challenge during this pandemic, and how have you been tackling it (or trying to)?

I didn’t feel challenged with blogging during the beginning stages of the pandemic. I found blogging a reassuring constant. I struggled a bit more as the months dragged into summer. Sometimes feelings I have about cancer are awfully heavy and these added to feelings I have about my world becoming smaller and more isolated with no end for the pandemic in sight gets hard. I keep tackling this struggle and others day by day. Focusing on positive moments throughout my day helps a lot.

I have written before that cancer doesn’t wait for curves to flatten or quarantines to end in a post from May you can read here. Continuing to push for more funding for metastatic breast cancer research has been a challenge when there is also a needed focus on COVID research and treatments. I paused briefly in my life and with my writing. There was the feeling that others have also expressed that they were uncertain about sticking to usual topics during this time. I don’t know how to describe it other than I woke up one day and just snapped out of it because I had had enough of hearing some of my efforts to raise money for more research were on hold.

What is something you’ve accomplished with your blog that you’re most proud of?

I am very proud of the body of work that I’ve created over the past two years that reflects my experience. I’ve developed my voice. I’ve written about topics that have been important to me. I have hopefully helped others.

Share two of your best blogging tips.

  1. Stick to a schedule. Have a reserve of upcoming posts that you can move around or schedule in advance in case life gets too busy and you don’t have the time or energy to give to your blog.
  2. Write about what you know. Read other blogs but be authentic to your goals and vision. The cancer blogs I read aren’t the same. I like them because they all offer me something different.

What is one of your blogging goals this year?

I need to work on marketing my blog. I want to continue to build my audience while maintaining consistent readership.

When things get hard, what keeps you blogging, even if not regularly?

Sharing my blog is sharing a part of me. I always find meaning in it. It’s cathartic. Sometimes I wind up with something different than what I planned. I find that quite amazing when that happens because my heart takes over and gives me something I didn’t know I needed. Blogging grounds me.

What is a dream you have for your blog?

A dream is that its reach becomes wider. Perhaps someday it would lead to other writing opportunities.

Share a link to a favorite post you’ve written that you want more people to read.

It’s between a story that provides a metaphor for living with cancer and a post that highlights work being done at the Carbone Cancer Center where I receive treatment. Both reflect the scope of what can be read on Finding A Way. I’ve decided to include both.

Dodgeball 

Research Lab Tour

That’s it from me!  Thanks for reading. Hopefully, I’ve linked everything back correctly to Nancy and technology works as expected. Be sure to check out Nancy’s Point and the other bloggers participating in Nancy’s summer challenge. Click on the link at the bottom of the post to read more posts on the hop. Discovering new blogs is a perfect way to spend some time during the dog days of summer wherever you are.

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Trust Suckers and Trust Blowers

A person can be either a Trust Sucker or a Trust Blower.

A Trust Sucker functions exactly how you would expect. Trust is sucked right out of you over time. Maybe it’s through belittling, embarrassment, manipulation, non-shared values as to what is public vs. private information, or repeated poor judgment. It feels like air is being pumped out of your lungs and you are left gasping for breath. The sucker sucks because of what he or she needs, not because of what you are doing or not doing. My theory is trust suckers feel very alone and are unhappy with the success, independence, closeness, or whatever it is that someone else has that they do not.

Trust Blowers are the polar opposites of the suckers. Just as you feel emotionally spent after being with a sucker but may not realize exactly why, you feel differently after being in the company of a blower. Blowers send supportive, positive, and uplifting energy your way. Inhaling is easy. They truly want what is best for you. There is an overwhelming feeling of safety with blowers. They are easy to trust because you know a confidence will stay confidential.

I need to dwell with the blowers as someone living with metastatic breast cancer. It’s about not spending essential energy on people or situations that don’t serve my best health. It’s about taking care of myself and not trying to fix someone else. It’s about feeling loved and trusting myself. I don’t have the energy to waste on someone I can’t trust.

I am extremely cautious about whom I trust in my personal life. As I age, I’ve gotten better at reading people and being able to discern whether to trust a person or not. In general, I use the following as guidelines to help make decisions:

  1. Does the person share private information about others when it isn’t their place to share? Someone who talks a lot about others is likely blabbing about me.
  2. Does the person remember what I’ve shared or take an interest in my life? Or are this person’s actions usually self-serving? Why does it matter? Self-serving people will not care when they break a trust because they lack compassion and empathy. They will not think they did anything wrong and that you are the one making too big of deal of things.
  3. Is the person a giver or a taker? Givers have others’ interests at heart. Takers take and move on to the next opportunity.

Cancer has messed with my ability to trust. Before I was diagnosed, I trusted I would remain healthy and be able to work until a normal retirement age. I trusted annual mammograms and results from ultrasounds. When I went on leave, I trusted that the long-term disability company that my school district contracted with was looking out for my best interest. I now feel the goal of this company was to get me on social security disability income so they wouldn’t have to pay as much. I’ve trusted scan results and later received information that contradicted those facts. Facts aren’t up to interpretation.

There are days where I don’t even trust myself.

I’ve struggled trusting medical information. Sometimes I want to scream at the medical world just as I often did with education. There have been times where I’ve felt like a problem or a difficult patient, rather than a fellow human being. I only have minimum access to information posted regarding test results and I feel like information is being hidden from me when I ask for more. It’s my body and I have right to know. I didn’t lie in a scanner for two hours because it was fun. I do better with more information but it is a balance as too much overwhelms me. Then there have been times where I have felt I was not liked. It’s hard to entrust your care to someone when you feel that someone doesn’t care.

One recent instant surrounds a recent cancer medication I took. I had been told it was important to take it consistently in the morning at around the same time for best results. This is true for most medication. However, this apparently didn’t hold true on treatment days because it was more important to make sure labs were all good. It would be okay to take said drug in the afternoon on those days. I had to keep a patient diary to provide data for a study I was involved with on when I took it, what dose, and its side effects. I took the diary seriously. Months later I was told that no one cared when I took the med by the nurse who collected the data. Even while I stared at this person in disbelief, I told myself I would take it in the mornings even on treatment days if no one cared.

I cared.

I still have diaries that haven’t been collected because I am not on that drug any longer and I no longer have contact with this nurse. How important could this data be? What was entered in its place? Was anything entered? I also still have a one to two month supply of this drug that I was supposed to return when I moved off the study. I haven’t been asked to do so since this nurse hasn’t come knocking for it.

Guess who doesn’t care now?

I’m not going out of my way to return any of it. Chalk it up to medical protocols and schedules in the life of COVID. There are more important things our health professionals need to deal with other than my patient diary and unused pills. Yet, I can’t help but question developments in my patient experience when scenarios like this unfold over time. Details deemed important one day were discarded the next. The inconsistency still surprises me.

Trust matters in a patient doctor relationship. I try hard to trust my oncologist, other doctors, and nurses. I do most of the time. I am not the same patient I was at the start of my metastatic cancer diagnosis. I will speak up. I will ask questions. I will disagree. I will persist and ask again if a question goes unanswered. This may not be a matter of distrust as much as needing information so I understand.

I am part of the team.

I expect to walk together.

I won’t follow blindly.

Trust is built over time and is a strong foundation for solid relationships. I will always look for the blowers rather than the suckers in my life whether it’s personally or medically. Whenever there is uncertainty, and there is plenty of uncertainty, I want people I trust with me so we can walk together.