diagnosis

Lessons Learned: Anna's Navigation through her AN Diagnosis

joanne — Mon, 01 Feb 2021 15:33:35 +0000

Lessons Learned: Anna's Navigation through her AN Diagnosis joanne Mon, 02/01/2021 - 10:33

Anna Gurdon is an ANAC board member who learned some valuable lessons navigating through her AN diagnosis.

Anna Gurdon

Arriving at an AN diagnosis often requires the “Squeaky Wheel” approach. After a boating accident in 2012, I immediately developed tinnitus and muffled hearing on my right side. I did go see my family doctor as well as an ENT specialist, but unfortunately there was no official diagnosis. My symptoms showed signs of a concussion as a result of the boating accident. As the years went on, I noticed my hearing getting worse, the tinnitus was unbearable some days, and I was getting headaches all the time.

Once again, I followed up with my doctor in 2016, who sent me to a second ENT specialist. My symptoms were again related back to the accident. Although the loss of hearing was noted, nothing further was investigated.

In January 2019, I went back to my family doctor and expressed, “something is really wrong with me”. I re-explained my symptoms and shared with my doctor, “I feel like I have a bad day, every day”. At the same time, I continued to do my own research, and everything pointed to an Acoustic Neuroma. When I had a third ENT specialist appointment, I went in telling him that I think I have AN. He gave me some validation and ordered a balance (VNG) test, and an MRI. The immediate data from the VNG test indicated my balance was significantly compromised. Both tests eventually confirmed my suspicion, and I was officially diagnosed in August 2019 with an acoustic neuroma. It was 2.2cm in size.

Like everyone, I was overwhelmed with emotions and not sure on next steps. I just kept thinking, how can this happen? We have so much going on at home. I have two teenage children, a very stressful job, and so many family commitments. What are we going to do? I didn’t want this to change my world. My husband and I decided to talk to the kids and the extended family; we told them what was going on and used the ANAC website to help explain the issue. Our kids were old enough to understand the severity, and we assured them that I was going to be just fine. I also talked to my work, and they were extremely understanding. I decided to slow down at work to part-time, affording me time to do some research, attend appointments, and take some time to myself.

Thankfully, I also had ANAC to help. I reached out and had a very lengthy conversation with Carole Humphries, Executive Director about my diagnosis. Timing worked out for me; that week there was a support group meeting which helped me understand my prognosis and options.

I was referred to Sunnybrook, and had appointments with two surgeons. I learned that the two best options, based on my age, tumour size, and amount of hearing loss, were either radiation or surgery. The approach for surgery was explained in detail. After my appointment, I did my own research and elected to undergo surgery using the translabryinthine approach. Accepting the fact that my hearing was not serviceable, and that I would be single sided deaf (SSD), was not an easy pill to swallow.

In the months leading up to surgery, I prepared as much as possible. I exercised daily, prepared freezer meals, arranged a support system to help with the kids and their sports commitments, while I was recovering. Thankfully I have an amazing, caring, and understanding family, all willing to help.

My surgery was on December 5, 2019 and lasted 8 hours. We couldn’t have asked for a better outcome. The full tumour was removed and the facial nerve was preserved. I am forever grateful to the team of surgeons, nurses and medical staff at Sunnybrook Health Sciences Centre.

One week post-operatively, I developed mild facial paralysis. My right side showed signs of palsy, with difficulty to blink my eye, and a sloped smile. During my post op appointment, I was advised it was temporary and would go away with warm compress and massaging. This all happened during the holidays, so I did my best to still attend family gatherings. However, it was only three weeks post-op so I was fatigued and felt a little awkward with the facial palsy. At the fourth week, I really feel like I made a turnaround. On New Year’s Eve, we celebrated and I went out for dinner with my family.

My recovery consisted of long walks every day and going to the mall before it opened and doing laps of power walking. By the sixth week, I returned to the gym: did longer walks on the treadmill; increasing intensity; introduced gentle yoga and engaged in social activities with friends and family. I started to re-gain my balance and also saw a vestibular therapist. In addition, I returned to normal parental activities by driving my kids to and from school and attending their competitive sports games.

The SSD has taken some time to get used to, and I can honestly say that at ten weeks post-op I am still not completely used to it. I have learned to use an ear plug in noisy situations such as my son’s hockey games. In social settings, I selectively pick my seat knowing that I can’t hear out of my right side. As well I have learned to be honest with colleagues and friends by telling people upfront of my SSD, or telling people to have one conversation at a time.

Finding out about your AN diagnosis and options is not an easy process, but going through this has taught me some very valuable lessons.

Be an advocate for your own health and get a second, sometimes third opinion.
Use a support system of family and friends, and be thankful for their love and support.
ANAC is an excellent resource for help, and their services are invaluable too.
We are lucky to live in Canada; we have access to excellent health care.

My greatest advice and learning from all this are to embrace the change, do your research, and find your new normal. It won’t be easy, but please remember there is support.

The Silver Lining: Nicole's Journey with an AN

joanne — Fri, 04 Dec 2020 15:48:32 +0000

The Silver Lining: Nicole's Journey with an AN joanne Fri, 12/04/2020 - 10:48

Nicole Poulin is a Retired Registered Nurse living in Hawkesbury, Ontario with her two daughters.

Nicole Poulin

I was asked to share my journey with an acoustic neuroma and I agreed because if this could only help one person, it was totally worth it. First, let me share with you a little bit about me. I am a single mom of two beautiful daughters I adopted from China who are now both university students. They are my pride and joy and cannot imagine my life without them.

I worked as a registered nurse for 39 years in different departments such as ICU, and dialysis followed by 5 years, in a diabetic clinic of a hospital in my hometown in Eastern Ontario. I was still working when I started my AN journey in July 2017.

I was enjoying a beautiful summer with my girls and friends and by mid-July I started feeling a numbness on the right side of my tongue. I had been to the dentist a few weeks before so I thought it was probably related to the freezing for the tooth repair. I was feeling good except for headaches, but this wasn’t unusual to me so I thought nothing of it. A few more weeks went by and the numbness became more pronounced. I consulted my dentist as the numbness was on the same side the freezing was done. After some x-ray and exams, the dentist told me he did not think it had anything to do with the freezing. I still believed nothing serious was going on, a s I was feeling good except for the numbness. For a few months, I had noticed some slight balance issues when I was walking to work but I had not related that to the numbness. I became concerned at the end of August, when the right side of my face also started to be numb and there was a feeling of fullness in my right ear.

I had been planning for retirement, so at the end of August, I notified human resources that I was officially retiring January 1st 2018 and taking the month of December for holidays. I was so excited about the last few months left at work after 39 years. Suddenly, one morning, getting ready for work I started having tinnitus in my right ear. At that moment, I knew it was time to call my doctor and after listening to my symptoms, he wanted to see me at the end of my shift. My wonderful family doctor that I had known for the past 30 some years looked quite concerned and asked for an urgent MRI and audiogram. Since the beginning of the tinnitus I had started to be worried and now it was getting worse by the minute.

The next day, I called for an audiogram appointment. They had a cancellation that morning and they offered me the spot. As soon as the audiogram was done, the audiologist told me I needed to see a specialist asap. I came out of that office thinking the worst. Back in my department at work, I was in tears when I called one of my best friends at the hospital. After we hung up she happened to see two doctors who I had worked with before and they arranged for me to see an ENT that same day.

I was very anxious. My MRI which was scheduled for Sunday September the 24th. I am sure that all of you know it can be quite a claustrophobic experience. As I was leaving the x-ray department, the technician looked at me and in a very soft voice she said, ‘’ Good luck madam, your doctor will get the result within a week.’’ Right then I had a feeling it wasn’t good news. The next day, I went to work and in the afternoon my doctor called and asked me to drop in at the office at the end of my shift. I was so anxious but managed to finish my work, and got my charts ready for the next day not knowing that would be my last day at work. I called my sister and asked her to come with me to my appointment as I knew I needed support. As I entered my doctor’s office, being the last appointment of the day, it was very quiet. The lights had been dimmed and as I sat in the waiting room, I told my sister, that this was not normal. The secretary and nurse I had known for many years were also avoiding eye contact with me. After a few minutes, my doctor, not the nurse, came to get me and I knew it was not going to be good news. I had shared many things with my doctor, we worked together, he helped me with the adoptions of both my girls and had always been very good to me and my family. He told me the MRI showed a brain tumour but he could not tell me what type of tumour at that time. He told me he would arrange for me to see a neurosurgeon in Ottawa, gave me a note for sick time for my work, and told me we would keep in touch.

Leaving the office, I was devastated. I tried very hard to calm down as it was time to go home to my youngest daughter. She could not see me like that as we were still not sure of the final diagnosis and I didn’t want to worry her too much. I will spare you the next few weeks where I had very bad days thinking the worst. I had a lot of support from my family and daughters but especially from my oldest daughter who was studying biology at university and said that all

my symptoms looked more like an acoustic neuroma, something I had never heard about before. Doing some personal research, I had hope. By now however, I had completely lost my hearing on the right side.

Finally, my appointment on October 2 with the neurosurgeon, Dr John Sinclair at the Ottawa Hospital arrived. I was so anxious waiting to see him because in a few minutes I could receive the worst news ever and my life would never be the same BUT it turned out to be one of the best days of the last few weeks. He was one of the most reassuring doctors and proceeded to tell me all about my tumour, which was most probably an acoustic neuroma. The tumour was approximately 3 cm and compressing my brainstem. He ordered an MRI with contrast. He indicated the need to proceed to surgery urgently due to the compression if the next test confirmed his diagnosis. He discussed radiosurgery but according to him, the tumour was too large and the compression of the brainstem was too severe. He indicated surgery would be done with facial nerve monitoring to protect the facial nerve function and that they would most probably have to leave a small residual tumour to protect my facial nerve.

Depending on the size of the remaining tumour and further MRI post-surgery there could be indication for radiosurgery called CyberKnife to make sure the remainder of the tumour would not grow back. I was told that I would most probably not regain my hearing, but believe it or not I left the office in a state of euphoria thinking I will get through this. I did not have a glioblastoma (cancerous tumour), something that had been on my mind for the past few weeks. I did not mind the surgery at that time, as there was a cure and I was so relieved. I called my girls, my family and friends and from that point on I felt positive about the whole thing. Life was good to me after all.

Within the next few days, I had another MRI with contrast, a scan, and I was back in Dr Sinclair’s office a week later; on the 19th of October to get the final diagnosis of a 3 cm vestibular schwannoma with compression on the brainstem. I was told the surgery would be booked within the next few weeks but to go to the emergency room if I ever got worse headaches, nausea and vomiting. I came home, got ready for the surgery, and spent time with friends and family.

Finally, on November 9th, I underwent surgery for eight hours. Everything went smoothly, 92% of the tumour was removed with no facial nerve damage. I spent the first 24 hours in an acute care recovery room. I was a little nauseated and the pain was well managed with the medications. I was transferred to an intensive care neuro floor for the next three days and things continued to improve. Six days post operatively I was discharged home.

The road to recovery went well. By January 2018, I officially became a retired nurse and I started to walk on a training track in my hometown to regain my strength. In late January, I got another

MRI and at my second post op follow up appointment, it was discussed that the CyberKnife radio treatment could be a good option for me to make sure the remaining tumour would not grow back. Six months after the surgery, on May 1, 2018, after more scans and a head mask molding done, I received a 45-minute CyberKnife treatment. I was a little apprehensive but the technician took her time explaining what was going to happen throughout the treatment. She was very reassuring. It was pain free, and time passed quickly as I was invited to select a movie to watch on the ceiling during the treatment. I experienced no side effects.

MRIs have been scheduled every 6 months since my surgery, and on my last one it showed the remaining tumour was now getting slightly smaller and I have graduated to once yearly. I cannot thank enough both my doctors for the great care I have received. I am now enjoying my retirement; life is really beautiful. The deafness on the right side is not a big problem for me at the moment so I have not yet looked into any kind of hearing aid. As time goes by, my balance is getting much better and I can say I feel like my own self again.

Managing Tinnitus: What's All The Noise in My Head?

admin — Tue, 24 Oct 2017 22:13:39 +0000

Managing Tinnitus: What's All The Noise in My Head? admin Tue, 10/24/2017 - 18:13

Most people would be surprised to learn that there is an internal alarm system located within their brain that is constantly monitoring the world around them. Basically, our central nervous system is idling in a state of readiness to respond to any type of "red alert" it may encounter. This idling causes "brain noise" that runs in the background. The majority of us are completely unaware of this brain noise until something triggers it to cross a threshold to become audible to some in the form of what’s called tinnitus.

Tinnitus is an auditory perception of a sound in the in the ear that can only be heard by the person experiencing it. Each person who has tinnitus describes it in their own way. Many people report that it sounds like a ringing, buzzing, humming, clicking, whistling or roaring. It can be loud or soft, constant or intermittent, can change in pitch, and be heard in one or both ears. About 15% of the population experiences tinnitus with 5% reporting severely intrusive tinnitus that affects their day-to-day activities.

It’s important to understand tinnitus itself is not a disease, but a symptom. It’s your body’s internal alarm system going off and telling you that something is not quite right. Tinnitus can be caused by a number of health conditions including high blood pressure, head trauma, dental problems, certain types of tumours, hearing loss and much more. Your ears are always working but relax when they find a soothing background sound to listen to. They are geared to naturally want to listen to sound and are always scanning the environment for it. For people with hearing loss, the amount of environmental sound they are exposed to is reduced. This causes their ears to strain to hear what’s around them and all of this straining increases their sensitivity to their internal brain noise which manifests as tinnitus.

So if you do have tinnitus, you should avoid silence as it only intensifies your sensitivity to your internal brain noise. For this reason, hearing aids are often recommended as a front line defence against tinnitus because hearing aids expose people with hearing loss to sound. For those who experience tinnitus but don't have hearing loss, custom ear sound generators may be recommended. In a nutshell, external sound decreases your sensitivity to internal sound.

Tinnitus can also be managed with the implementation of Tinnitus Retraining Therapy (TRT). Developed in 1990 by neurologist Dr Pawel Jastreboff, and audiologist Jonathan Hazell, TRT is the gold standard for tinnitus treatment. For those individuals whose tinnitus has become a significant annoyance, a systematic approach to "habituate" to their condition can be delivered through TRT. To understand how TRT works, it is important to understand tinnitus in greater detail. Tinnitus can be divided into two components.

The first component is the auditory component, or the perception of the tinnitus (arises from the inner ear and auditory centres in the brain).

The second component is the non-auditory component, and this refers to the ‘bothersome’ nature of tinnitus. This non-auditory component arises from the limbic system (the emotional centre of the brain) and the autonomic nervous system (the brain’s ‘alert system’ designed to give the message to the individual of ‘fight’ or ‘flee’ from a dangerous situation). When the limbic system is activated by the tinnitus, the person may feel a sense of extreme discomfort or panic.

TRT can help a person ‘habituate’ to their tinnitus. To ‘habituate’ to something means to grow accustomed to it. To habituate to tinnitus means to reach a state of mind where there is no longer a negative emotional response to the tinnitus. Tinnitus Retraining Therapy is delivered by Audiologists, who have received specialised training in this therapeutic model. TRT includes:

Directive Counselling: Intensive client education about the auditory mechanism and the role of the brain plays in tinnitus perception. With education, the tinnitus will be demystified. This will help reduce distress and anxiety about the tinnitus.

Sound Therapy: Use of ear level or table-top sound generators and/or hearing aids to provide continuous stimulation of the auditory system to interfere with the perception of tinnitus. This would also include the use of environmental sounds. This will also help reduce distress and anxiety about the tinnitus.

Time: It takes time for the brain to habituate to the perception of tinnitus. Most clients report a noticeable improvement is as little as 6-8 weeks. The duration of the TRT program can last between 16 – 24 months.

Regardless of the cause of the tinnitus, with or without hearings loss, the success rate of TRT is 80%. This is the highest success rate of any treatment or therapy currently available. The effects of TRT are long lasting, and there are no side effects.

If you have difficulty understanding speech or following a conversation in background noise if sounds seem muffled or you are suffering from tinnitus – you are probably experiencing hearing loss. Make an appointment with an audiologist to get your hearing checked and get advice on how to manage your hearing loss and how to prevent more from occurring. Whether you need a hearing aid, assistive listening device, tinnitus therapy or strategies for communication, an audiologist can help you get reconnected to the world around you.

Rex Banks

Rex Banks, Au.D., has been an audiologist since 1989 and is the Director of Audiology at the Canadian Hearing Society. In addition to being registered with the College of Audiologists and Speech Language Pathologists of Ontario (CASLPO), Rex is also a certified member of the American Speech Language Hearing Association (ASHA) and holds the Certificate of Clinical Competency in Audiology (CCC-A) designation.

tinnitus

hearing

diagnosis

Managing Tinnitus: What’s All The Noise in My Head?

joanne — Mon, 07 Nov 2016 16:53:31 +0000

Managing Tinnitus: What’s All The Noise in My Head? joanne Mon, 11/07/2016 - 11:53

Dr. Rex Banks, Doctor of Audiology, Chief Audiologist and Director of Audiology, Canadian Hearing Society

Rex Banks, Au.D

The first component is the auditory component, or the perception of the tinnitus (arises from the inner ear and auditory centres in the brain).

1. Directive Counselling
Intensive client education about the auditory mechanism and the role of the brain plays in tinnitus perception. With education, the tinnitus will be demystified. This will help reduce distress and anxiety about the tinnitus.

2. Sound Therapy
Use of ear level or table-top sound generators and/or hearing aids to provide continuous stimulation of the auditory system to interfere with the perception of tinnitus. This would also include the use of environmental sounds. This will also help reduce distress and anxiety about the tinnitus.

3. Time
It takes time for the brain to habituate to the perception of tinnitus. Most clients report a noticeable improvement is as little as 6-8 weeks. The duration of the TRT program can last between 16 – 24 months.

Watch and Wait: The Waiting Game

joanne — Fri, 04 Nov 2016 15:46:16 +0000

Watch and Wait: The Waiting Game joanne Fri, 11/04/2016 - 11:46

Carol Krucoff is a former Washington Post writer and editor, yoga teacher at Duke Integrative Medicine in Durham, N.C., and author of "Yoga Sparks: 108 Easy Practices for Stress Relief in a Minute or Less." Visit her website healingmoves.com

Watching my little brain tumour grow slowly over the past decade has been an extraordinary exercise in courage, patience, gratitude, and faith. I learned about my tumour by accident in 2003 around my 50th birthday when I'd had an MRI scan after collapsing from drinking too much water during a marathon.

Fortunately, my tumour is a benign and generally slow-growing type called an acoustic neuroma. Located inside my skull on the nerve responsible for hearing and balance, it measured just three millimetres - about the size of a sesame seed - when discovered. Although I had no symptoms, an expert I consulted recommended two possible treatments: surgery to remove it or radiation to stop its growth. While this tumour wouldn't metastasize, its growth could impair my facial nerves, balance and hearing, or even threaten crucial brain function. She advised acting early when the tumour was small. Instead, I decided on a course of action known as "watch and wait."

Also called "expectant management," "active surveillance," and "watchful waiting," this involves closely monitoring an ailment but withholding treatment unless symptoms appear or progress. Often used with slow-growing or precancerous lesions and with conditions where treatment risks may outweigh benefits, this strategy does not mean doing nothing. It involves regular checkups - which could mean blood tests, biopsies or imaging scans, all involving some physical, emotional and financial stress. And it requires a tolerance for uncertainty, the willingness to live with something that could be a ticking time bomb or a harmless growth.

Over a decade of watchful waiting, I've had 10 MRIs. Each of these scans was followed by a hearing test and a meeting with my doctor. I'm grateful to have health insurance, which means - in the most recent case - I paid $160 coinsurance for the $3,579 MRI, and $50 for the $960 hearing test/doctor's appointment.

The emotional cost, however, is harder to calculate.

When first diagnosed, I immediately went on the Internet and learned that most acoustic neuromas are slow-growing - but others increase rapidly. Anytime I felt dizzy or had trouble hearing, I worried. I joined a support group and met a woman whose surgery to remove an asymptomatic two-millimeter tumour had left her with crippling headaches and facial pain. I logged on to the discussion forum on the Acoustic Neuroma Association's website and read horror stories of botched treatments as well as wonderful examples of excellent results. After several months of almost daily trips to the forum, I became overwhelmed by the anxiety these posts aroused and signed off.

I tried to remain calm over the years as I watched my tumour's creeping growth, at a rate of about one millimetre - the size of a grain of sugar - a year.

Navigating an emotional tightrope between responsible vigilance and anxious obsession, I gratefully clung to the fact that I had no symptoms. My hearing and balance seemed unaffected. My yoga practice proved extremely helpful since a central teaching is finding equilibrium - that steady place between effort and surrender - which is the key to watchful waiting. I found comfort in viewing the experience as an opportunity to cultivate gratitude and faith, and I meditated daily on visualising the dissolving of my tumour.

By 2006, about three years after it was discovered, my tumour had grown to six millimetres - about the size of a pea. At my doctor's urging, I met with a radiation oncologist, who recommended that I undergo radiation treatment intended to halt the growth. But since I was still asymptomatic and the tumour was still small, I chose to continue watchful waiting. I'd read that some tumours stop growing on their own, and I hoped this would be the case with mine.

In April 2013, based on an article I had written about the accidental discovery of my tumour, I was asked to testify before the Presidential Commission for the Study of Bioethical Issues at a meeting devoted to the ethical implications of incidental findings. Representing the patient's perspective, I told the panel, "As a health journalist I'd always thought there was a great benefit in early detection. However, my experience has made me question the wisdom of learning about an abnormality if all it offers is anxiety - as well as potential harm from treatments for something that might never affect my health."

Yet when a panel member asked me, "Do you really wish that you simply had never been told?" I had to admit, "Definitely no. If [the doctors] know, I want to know. I wouldn't want to be shielded for my own protection. That's my decision; this is my brain." I urged the panel to keep patients informed "in simple, direct language of what's been found and its implications for health" and to "consider adding a support person to the health-care team, such as a social worker or psychologist, to help the patient and their family process the information and decide on a course of action."

Ironically, four months after my testimony, I had my scheduled MRI and hearing tests and learned that my tumour measured 1.2 centimetres - about the size of a small walnut.

While I still had no symptoms, tests of my vestibular function - the sensory system that contributes to balance - on the affected side were abnormal even though I had not experienced balance problems. Continued growth would now mean a strong likelihood of negative effects on my hearing and facial nerves. A common way people learn of an acoustic neuroma is experiencing sudden, one-sided hearing loss, which may be permanent. So perhaps my incidental finding had been a blessing after all. It was time to take action.

I spent six weeks visiting brain surgeons and radiation oncologists, spoke with patients who had chosen each approach. I made the decision to have what is known as gamma knife radiosurgery.

In my decade of waiting, there had been significant advances in this minimally invasive treatment option, which uses imaging to direct gamma radiation very precisely to a target point. The radiation is designed to inactivate further growth of the tumour. In the large majority of cases it is successful, but sometimes the tumour continues to grow, and further treatment is necessary. And there are scary reports of rare instances where benign tumours turned malignant through radiation. Yet weighed against the potential risks of brain surgery - including a likely hearing loss in one ear - the gamma knife seemed right for me.

In February 2014, I had the morning-long outpatient procedure, which involved being given a mild sedative and having a head frame attached to my skull, then lying very still, similar to what you do while having an MRI. I left the hospital in the afternoon with gauze wrapped around my head, feeling just a little unsteady, and rested the next few days. By the following week, I felt fine, and I was back to teaching yoga.

MRI and hearing tests were done six months and then one year later showed that my hearing and the tumour were stable. Thankfully, I have felt no ill effects from the procedure, although I have been told that effects of radiation may emerge years later.

It could take at least two years after the radiosurgery to learn whether my tumour has stopped growing. After that, further scans are recommended at two, four and eight years. So I will be watching and waiting for some time. And I am not alone.

The boom in life expectancy - from about 47 years in 1900 to about 78 in 2012 - has resulted in an unprecedented "silver tsunami" of older adults, and technological advances mean an increased likelihood of finding some abnormality during those extra decades of life. While humans have always been aware of our mortality, we have never been able to see the approaching train that may take us out so clearly.

For me, this unsettling knowledge presents a spiritual opportunity. Like the ancient yogis who were taught to imagine death sitting on their shoulder, having a heightened awareness of impermanence can serve to make the present moment that much sweeter.

And in my case, watchful waiting involves more than my little brain tumour. As with the old joke "What do you always look for but hope never to find?" (Answer: a run in your stocking), I'm continually monitoring a variety of conditions. I have regular echocardiograms to check my prosthetic bovine aortic heart valve. (I acquired this valve during open-heart surgery in 2008 to replace a congenitally abnormal valve that had become dangerously narrow and created an aneurysm that needed repair.) I have twice-yearly examinations by a retina specialist for a potentially precancerous "eye freckle" called a choroidal nevus. A dermatologist checks multiple moles on my skin once or twice a year, and every five to 10 years I have a colonoscopy to check for polyps since there's a family history of colon cancer.

That said, I'm grateful to feel quite well, thank you. I walk my dog several miles every morning, practice yoga daily and teach yoga classes. My friends marvel at how such a healthy person can have such a long list of medical problems, and they often compliment me on my bravery.

The truth is, I've been terrified facing brain radiation, open-heart surgery, and other challenges, and I have had some dark moments. But I'm grateful to have wonderful family and friends to support me, and I don't want to weigh them or myself down with prolonged upset. Life is too short to waste precious time wallowing in worry.

And I've learned that courage isn't the absence of fear - it's being afraid, but doing what you need to do anyway.