Bioelectrical Impedance Analysis (BIA) ratios can effectively assess a woman's risk of lymphedema after breast cancer surgery that includes lymph node removal, according to a study published in the journal Lymphology. BIAs operate on low frequency electronic current, which cannot travel through cell membranes, therefore providing a direct measure of lymph fluid outside the cells.
“To lessen breast cancer survivors’ worry about lymphedema development, the BIA may have a role in clinical practice by adding confidence in the detection of arm lymphedema among breast cancer survivors,” says Mei R. Fu, PhD, RN, ACNS-BC, associate professor of Chronic Disease Management at the New York University College of Nursing and lead researcher in the study.
The objective of the study was to examine the reliability, sensitivity, and specificity of cross-sectional assessment of BIA in detecting lymphedema in a large metropolitan clinical setting.
Measuring lymphedema is challenging because most methods cannot distinguish bone and soft tissues from extracellular fluid. BIA is time-efficient, easy to operate and easy to interpret, making it ideal for clinical practice.
Researchers collected data from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema.
The American Cancer society estimates that in 2013 approximately 232,340 new cases of breast cancer are detected, adding to the already 2.9 million breast cancer survivors, all with a at a lifetime risk of Lymphedema.
“Giving that all the women who are treated for breast cancer are at a life-time risk for lymphedema, using assessment methods that can accurately identify true lymphedema cases among at-risk breast cancer survivors is of the ultimate importance for clinical practice,” Fu says.
Showing posts with label breast cancer. Show all posts
Showing posts with label breast cancer. Show all posts
Wednesday, November 13, 2013
Saturday, February 16, 2008
Breast Cancer Web Info Generally Accurate
Patients can depend on the information in most breast cancer Web sites, according to a study published in the journal Cancer. Researchers at the University of Texas looked at 343 Web sites and found only 41 inaccurate statements on 18 of the sites, meaning a 5.2 percent rate of error. Information about complementary and alternative medicine (CAM), they said, was 15.6 times more likely to be inaccurate than information on Western medicine. They tested accuracy by asking clinician-reviewers to assess content.
There is not much online about hormone-negative-breast cancer, but it is good to know that what is there is likely to be on target. And the coverage is increasing—most likely because of increased research on negative.
I found the Web invaluable when I was diagnosed. Apparently being a bit of an egghead, I used the cancer sites as a starting point, then dug into the research itself for a deeper perspective. Few folks want to read medical journals, though, and the sites I have listed on the left do an excellent job of presenting up-to-date research in accessible language. Research articles were especially important in my quest for information about hormone-negative. I especially like breastcancer.org’s research updates
My advice on using Web information:
• Use multiple sites for multiple perspectives. This will help guard against accuracy problems—you’ll see inconsistencies and know which information might be suspect. This is true of all media—you're more likely to get a broader base of information if you have a broad base of media use. Depending too much on television can be especially problematic, as TV reporters have only a minute or two to decode complex information—and you have no opportunity to go back and reread the data for clarity.
There is not much online about hormone-negative-breast cancer, but it is good to know that what is there is likely to be on target. And the coverage is increasing—most likely because of increased research on negative.
I found the Web invaluable when I was diagnosed. Apparently being a bit of an egghead, I used the cancer sites as a starting point, then dug into the research itself for a deeper perspective. Few folks want to read medical journals, though, and the sites I have listed on the left do an excellent job of presenting up-to-date research in accessible language. Research articles were especially important in my quest for information about hormone-negative. I especially like breastcancer.org’s research updates
My advice on using Web information:
• Use multiple sites for multiple perspectives. This will help guard against accuracy problems—you’ll see inconsistencies and know which information might be suspect. This is true of all media—you're more likely to get a broader base of information if you have a broad base of media use. Depending too much on television can be especially problematic, as TV reporters have only a minute or two to decode complex information—and you have no opportunity to go back and reread the data for clarity.
• Use sites associated with known organizations, or that come recommended by others.
• Don’t look to cancer chat rooms for information. These are OK for support, perhaps, but it’s too easy for a person to share her misinformation in these arenas.
• Don’t forget good old-fashioned books. In an earlier post, I recommended my favorites .
• Talk to your doctor or nurse about questions you have, and don’t let them dismiss your research or your concerns. They are medical experts, but it is your body and your life. If you don’t feel your doctor is on the right track, get another opinion. This is too important an issue to leave to somebody you might not entirely trust or who does not answer your questions with clarity and respect. My favorite doctor—my radiation oncologist—even drew me a picture of how radiation works.
• Don’t look to cancer chat rooms for information. These are OK for support, perhaps, but it’s too easy for a person to share her misinformation in these arenas.
• Don’t forget good old-fashioned books. In an earlier post, I recommended my favorites .
• Talk to your doctor or nurse about questions you have, and don’t let them dismiss your research or your concerns. They are medical experts, but it is your body and your life. If you don’t feel your doctor is on the right track, get another opinion. This is too important an issue to leave to somebody you might not entirely trust or who does not answer your questions with clarity and respect. My favorite doctor—my radiation oncologist—even drew me a picture of how radiation works.
Sunday, February 10, 2008
Alcohol Raises the Risk of Breast Cancer; Folic Acid Can Help
One lovely ritual my husband and I enjoy is a martini in front of the fire as we listen to Prairie Home Companion on Saturday evening. Alcohol can be a pleasant addition to a social occasion—or a cause for one. I have relaxed over an Irish coffee with family on the Colorado ski slopes; watched the sun set over the island of Lesbos, Greece, while sipping a glass of the Greek’s legendary retsina (which tastes a little like turpentine); and warmed up with the Slovene pear brandy slivovka while shopping for a Christmas tree in the Ljubljana open market.
I like the taste of alcohol and I love its rituals, so it has been difficult for me to step back and cut down my drinking, but I have done it because several studies have linked alcohol and the risk of breast cancer. The most recent, by Kaiser Permanente researchers and presented to the European Cancer Conference in September 2007, showed that one drink a day of alcohol of any type—beer, wine, spirits—increased breast cancer risk by ten percent. The risk rose by the drink—three drinks equaled a 30 percent risk. This is a relative risk—it is compared to the risk faced by a woman who drinks no alcohol or less than one drink a day.
Folic acid can help—just 600 micrograms can reduce the effect of alcohol on breast cancer risk, according to research in the Journal of the American Medical Association. Folic acid is the synthetic form of the B-vitamin folate. Folic acid can also reduce the risk of colon cancer, control the side effects of the cancer drug methotrexate and help with everything from inflammatory bowel disease to rheumatoid arthritis. The National Institute of Health gives a good overview of folic acid—where you can get it, how it can help with various medical conditions, how much you need, plus some cautionary notes about how it interacts with B12. They warn again too large a dose—1000 micrograms or more.
My daily green drink and my broccoli snack both have folate. Fortified breakfast cereals have a good deal of the stuff, as does beef liver. Ugh! Natural foods, though, are not as good a source of folic acid as dietary supplements—I'd have to eat six cups of broccoli to get my 600 micrograms—so I take a B-complex capsule every day, plus a multivitamin with folic acid.
With ample fortification, I feel I can still enjoy the one martini. And, occasionally, a glass of wine or a beer during the week. I find I do not miss alcohol as much as I thought I would. I often sip pure black cherry juice in a wine glass and find it highly satisfying—the ritual without the risk. And when I go back to Greece, I may just enjoy its beauty without the turpentine.
Please consider a donation to Positives About Negative to keep this site going. This work is entirely supported by readers. Just click on the Donate button in the right of the page. Thank you!
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
I like the taste of alcohol and I love its rituals, so it has been difficult for me to step back and cut down my drinking, but I have done it because several studies have linked alcohol and the risk of breast cancer. The most recent, by Kaiser Permanente researchers and presented to the European Cancer Conference in September 2007, showed that one drink a day of alcohol of any type—beer, wine, spirits—increased breast cancer risk by ten percent. The risk rose by the drink—three drinks equaled a 30 percent risk. This is a relative risk—it is compared to the risk faced by a woman who drinks no alcohol or less than one drink a day.
Folic acid can help—just 600 micrograms can reduce the effect of alcohol on breast cancer risk, according to research in the Journal of the American Medical Association. Folic acid is the synthetic form of the B-vitamin folate. Folic acid can also reduce the risk of colon cancer, control the side effects of the cancer drug methotrexate and help with everything from inflammatory bowel disease to rheumatoid arthritis. The National Institute of Health gives a good overview of folic acid—where you can get it, how it can help with various medical conditions, how much you need, plus some cautionary notes about how it interacts with B12. They warn again too large a dose—1000 micrograms or more.
My daily green drink and my broccoli snack both have folate. Fortified breakfast cereals have a good deal of the stuff, as does beef liver. Ugh! Natural foods, though, are not as good a source of folic acid as dietary supplements—I'd have to eat six cups of broccoli to get my 600 micrograms—so I take a B-complex capsule every day, plus a multivitamin with folic acid.
With ample fortification, I feel I can still enjoy the one martini. And, occasionally, a glass of wine or a beer during the week. I find I do not miss alcohol as much as I thought I would. I often sip pure black cherry juice in a wine glass and find it highly satisfying—the ritual without the risk. And when I go back to Greece, I may just enjoy its beauty without the turpentine.
Please consider a donation to Positives About Negative to keep this site going. This work is entirely supported by readers. Just click on the Donate button in the right of the page. Thank you!
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
Wednesday, January 2, 2008
Rah! Raw Broccoli: Indole-3-carbinol (I3C) and Breast Cancer
A diet rich in cruciferous vegetables, like kale, cabbage, broccoli, cauliflower, can help fight breast cancer, according to research published in the journal Carcinogenesis. Studies in Milan show much the same effect.
Cruciferous veggies have high amounts of Indole-3-carbinol (I3C) , which has been shown in tests to combat the development of breast cancer cells. The Carcinogenesis researchers, from the University of California-Berkeley and the Kochi Medical School in Japan wrote that “Indole-3-carbinol (I3C), a naturally occurring compound of brassica vegetables, has promising anti-cancer properties.” The Italian studies used synthetic I3C and concluded that it “may be a considered a new, promising therapeutic agent for both ER+ and ER- breast cancer.”
So, the juice I started when I was first diagnosed, thanks to my sister Phyllis and the juicer she sent me, turns out to be a solid cancer fighter. My husband, God love his vegetable-slicing heart, juices 1-2 cups of kale, a half cup of cabbage, 2-3 ounces of wheatgrass, 2-3 carrots, and half an apple, to make roughly 2 cups of juice. Occasionally he adds a beet. It tastes about how you would expect, sort of like grazing in a swamp. I don’t care—if it keeps cancer away, I’ll even grow a cud. Lately, he has added about a quarter of a lemon and that makes the thing a whole lot more palatable.
I also have about a cup of raw broccoli every day with homemade hummus—my daughter Ellen’s recipe—for a mid-afternoon snack. That is actually tasty. Rah! Raw broccoli.
Cruciferous veggies have high amounts of Indole-3-carbinol (I3C) , which has been shown in tests to combat the development of breast cancer cells. The Carcinogenesis researchers, from the University of California-Berkeley and the Kochi Medical School in Japan wrote that “Indole-3-carbinol (I3C), a naturally occurring compound of brassica vegetables, has promising anti-cancer properties.” The Italian studies used synthetic I3C and concluded that it “may be a considered a new, promising therapeutic agent for both ER+ and ER- breast cancer.”
So, the juice I started when I was first diagnosed, thanks to my sister Phyllis and the juicer she sent me, turns out to be a solid cancer fighter. My husband, God love his vegetable-slicing heart, juices 1-2 cups of kale, a half cup of cabbage, 2-3 ounces of wheatgrass, 2-3 carrots, and half an apple, to make roughly 2 cups of juice. Occasionally he adds a beet. It tastes about how you would expect, sort of like grazing in a swamp. I don’t care—if it keeps cancer away, I’ll even grow a cud. Lately, he has added about a quarter of a lemon and that makes the thing a whole lot more palatable.
I also have about a cup of raw broccoli every day with homemade hummus—my daughter Ellen’s recipe—for a mid-afternoon snack. That is actually tasty. Rah! Raw broccoli.
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
Please consider a donation to Positives About Negative to keep this site going. This work is entirely supported by readers. Just click on the Donate button in the right of the page. Thank you!
Friday, December 28, 2007
My Personal Survival Tools
A colleague recently told me that if she got cancer, she would rail at God: “Why me, Lord, why me?” She said my attitude toward breast cancer was an inspiration. While being considered inspirational was flattering, it was also off-base. Blaming God gets you nowhere and it makes you miserable on the way.
I love solving problems, so I saw my cancer as the biggest challenge I have ever faced and I was determined it wasn’t going to beat me. Plus, I think trying to change the course of divine decisions is a bit arrogant, not to mention self-defeating. I don’t think God would listen to my whining and say, “Oh, you have a good point there, Pat. Never mind. Cancel that cancer. My mistake.”
I told my husband that, of all the illnesses I thought I might get, I had never thought I would get breast cancer. “What did you think you would get?” he asked. I had to think a while. “Nothing,” I finally answered.
I suspect that I am normal in that respect, that most of us expect the other guy to get the nasty illness. But once cancer decided to take up residence in my breast, I decided to make it clear that it was unwelcome, that I planned to replace it with healthy tissue and, in the process, get on with a meaningful life.
Before my diagnosis, I thought I knew how to pray. This whole experience changed that and made my prayers more thoughtful and introspective and less demanding. Oddly enough, by moving outside of myself, my chats with God now suit my earthly needs better than before. And I have to believe they also reach heaven’s ears more effectively.
Instead of praying for God to cure me, I began to pray for the tools to help cure myself. I figured if I were God I would get tired of people complaining and asking me to solve things. I would appreciate somebody who was willing to do the work herself, but who just wanted to make sure she had the proper equipment.
Plus, I thought that if I gave into the negatives, I would be acknowledging that the cancer was stronger than me. I was not about to give it that advantage. So I prayed for the strength to make the right decisions on my treatment, the knowledge to take care of my health beyond medical intervention, the courage to trust others, the wisdom to live with whatever my illness brought.
On the morning before my third chemo treatment, I awoke with a palpable sense of wellbeing, as though I had just been kissed by an angel or touched by the hand of God. Or my mother, who had died in 1993. I felt surrounded by love and warmth. I smiled. I was softened and strengthened at the same time, ready to fight, but calmly, meditatively, wisely, thoughtfully. I knew my toolbox had been delivered. I had the tools I needed to heal. Whenever I get the least bit discouraged, I remember that moment and am once again revived.
After that, I began to inexplicably awake with a smile. My response: “Thank you, God, for another beautiful day.” This continued throughout treatment and sometimes it was a conscious act, but most often it just happened without thought.
Prayer was the box that held my healing gear and provided the texture and structure of my life through treatment. The most essential tool was the support of those around me whose love became even that much more obvious and strong. I have been blessed with a devoted husband and family who reminded me in words and acts that they loved me. My sister Phyllis mailed us her juicing machine and my husband began making me fresh vegetable juice daily, high in antioxidants, vitamins and minerals—something he still does every day. My kids bought me books: Ellen got me the breast book that became my bible and Josh bought me a wonderful book of cartoons that made me laugh. Both took a week off to fly home to Iowa from the East Coast to help care for me. My brother John remembered how, during Lent, he and I used to sneak to the store to buy Hostess Cupcakes and sit on the curb gorging ourselves on them; he brought me a 12-pack of the goodies, which jump-started my sagging appetite and reminded me of a shared life of love. My sister Kathleen came from Memphis and brought me an inspirational book, plus her inimitable gift of laughter.
And people had enough faith in me to treat me normally, not to coddle me. When I told my brother Ed I was sorry we could not go to Colorado and help build a fence on mountain land we share, he said, “Oh, you wouldn’t have been much help anyway,” in just the way he would have treated me had I not been his Sister with Cancer. He then built our part of the fence himself, so I now have a thousand feet of wood and wire that was built with a good amount of muscle and even more love.
John once asked how I was handling the illness. I told him I was in generally good spirits, but that I had recently been shopping and decided not to buy any clothes because I might not be around to wear them, a truly unusual thought, but one that does still pop into my head when I am not looking. I figure I have the right to be pitiful on occasion. My brother didn’t give into my pathos. “Yeah,” he said. “Better not buy any green bananas, either.” My husband once called my illness “Pat’s little diversion,” showing his own attitude—this was a short-term setback and we would get through it.
My friends, colleagues, students, and the alums who knew of my illness sent cards and flowers, and stopped by to visit, bringing healthy goodies as well as extravagances---coffee mocha, energy smoothies, and fresh fruit. My favorite cards were those that did not allow we to wallow, but told me to kick this thing. One even came with a cutout boot to kick with.
Chemotherapy and radiation, while nobody’s choice of a fun time, were not as difficult as I thought they might be, largely because I was equipped to handle them. My husband made sure I continued to walk two miles a day, except for the day after chemo when I was too weak and nauseated. I walked around the lake by our house throughout the summer with a mixed assortment of children and siblings and I ate well and rested.
I felt completely cherished, safe, and at peace. And I thrived.
My tumor was small and had not spread, so my prognosis is quite good. It was aggressive, though, which is why I needed chemo. Like other cancer patients, I live with the knowledge that the disease can return anytime. Everybody dies of something eventually, though, and we all have challenges and trials, so if this is mine, I will live with it, but my spirit has been strengthened and I feel up to whatever fight I have ahead of me.
Eventually, as I returned to work and the stress and demands of my job as a professor and university administrator, the morning smiles disappeared and I did not even notice. Treatment was over, I was a busy woman, and all that cancer stuff was behind me, so I awoke with a “to do” list and the sense that I was already late for something. I had shut the toolbox and moved on.
Then, in a conversation with a friend who was also dealing with cancer, I mentioned how my smile-a-day had given me strength. That made me realize I hadn’t awakened with a smile in months. It was no longer an automatic gesture, but I missed it. It was time for human intervention. I started to make myself smile upon awakening, no matter what—rain, sleet, snow, or a snoring husband— and follow the smile with, “Thank you, God, for another beautiful day.” And that gives the day a far better chance at beauty. Now, I have added, “Help me use it well.”
And now when I pray, I first offer a prayer of thanks for the tools I have always had but never appreciated fully—my health, that loving family, a mind that can keep me focused in the right direction, enough resources to take care of our temporal needs, and a strong body that I am trying to train to reject any recurrence of cancer.
My diagnosis of breast cancer was stunning, but it was the beginning of a deeper, more fulfilling life. My nightly prayers now include all the women in the world with breast cancer, that they be given the tools they need to combat the disease and live a life of meaning and wisdom.
And I pray that, occasionally, they awake to a smile.
I love solving problems, so I saw my cancer as the biggest challenge I have ever faced and I was determined it wasn’t going to beat me. Plus, I think trying to change the course of divine decisions is a bit arrogant, not to mention self-defeating. I don’t think God would listen to my whining and say, “Oh, you have a good point there, Pat. Never mind. Cancel that cancer. My mistake.”
I told my husband that, of all the illnesses I thought I might get, I had never thought I would get breast cancer. “What did you think you would get?” he asked. I had to think a while. “Nothing,” I finally answered.
I suspect that I am normal in that respect, that most of us expect the other guy to get the nasty illness. But once cancer decided to take up residence in my breast, I decided to make it clear that it was unwelcome, that I planned to replace it with healthy tissue and, in the process, get on with a meaningful life.
Before my diagnosis, I thought I knew how to pray. This whole experience changed that and made my prayers more thoughtful and introspective and less demanding. Oddly enough, by moving outside of myself, my chats with God now suit my earthly needs better than before. And I have to believe they also reach heaven’s ears more effectively.
Instead of praying for God to cure me, I began to pray for the tools to help cure myself. I figured if I were God I would get tired of people complaining and asking me to solve things. I would appreciate somebody who was willing to do the work herself, but who just wanted to make sure she had the proper equipment.
Plus, I thought that if I gave into the negatives, I would be acknowledging that the cancer was stronger than me. I was not about to give it that advantage. So I prayed for the strength to make the right decisions on my treatment, the knowledge to take care of my health beyond medical intervention, the courage to trust others, the wisdom to live with whatever my illness brought.
On the morning before my third chemo treatment, I awoke with a palpable sense of wellbeing, as though I had just been kissed by an angel or touched by the hand of God. Or my mother, who had died in 1993. I felt surrounded by love and warmth. I smiled. I was softened and strengthened at the same time, ready to fight, but calmly, meditatively, wisely, thoughtfully. I knew my toolbox had been delivered. I had the tools I needed to heal. Whenever I get the least bit discouraged, I remember that moment and am once again revived.
After that, I began to inexplicably awake with a smile. My response: “Thank you, God, for another beautiful day.” This continued throughout treatment and sometimes it was a conscious act, but most often it just happened without thought.
Prayer was the box that held my healing gear and provided the texture and structure of my life through treatment. The most essential tool was the support of those around me whose love became even that much more obvious and strong. I have been blessed with a devoted husband and family who reminded me in words and acts that they loved me. My sister Phyllis mailed us her juicing machine and my husband began making me fresh vegetable juice daily, high in antioxidants, vitamins and minerals—something he still does every day. My kids bought me books: Ellen got me the breast book that became my bible and Josh bought me a wonderful book of cartoons that made me laugh. Both took a week off to fly home to Iowa from the East Coast to help care for me. My brother John remembered how, during Lent, he and I used to sneak to the store to buy Hostess Cupcakes and sit on the curb gorging ourselves on them; he brought me a 12-pack of the goodies, which jump-started my sagging appetite and reminded me of a shared life of love. My sister Kathleen came from Memphis and brought me an inspirational book, plus her inimitable gift of laughter.
And people had enough faith in me to treat me normally, not to coddle me. When I told my brother Ed I was sorry we could not go to Colorado and help build a fence on mountain land we share, he said, “Oh, you wouldn’t have been much help anyway,” in just the way he would have treated me had I not been his Sister with Cancer. He then built our part of the fence himself, so I now have a thousand feet of wood and wire that was built with a good amount of muscle and even more love.
John once asked how I was handling the illness. I told him I was in generally good spirits, but that I had recently been shopping and decided not to buy any clothes because I might not be around to wear them, a truly unusual thought, but one that does still pop into my head when I am not looking. I figure I have the right to be pitiful on occasion. My brother didn’t give into my pathos. “Yeah,” he said. “Better not buy any green bananas, either.” My husband once called my illness “Pat’s little diversion,” showing his own attitude—this was a short-term setback and we would get through it.
My friends, colleagues, students, and the alums who knew of my illness sent cards and flowers, and stopped by to visit, bringing healthy goodies as well as extravagances---coffee mocha, energy smoothies, and fresh fruit. My favorite cards were those that did not allow we to wallow, but told me to kick this thing. One even came with a cutout boot to kick with.
Chemotherapy and radiation, while nobody’s choice of a fun time, were not as difficult as I thought they might be, largely because I was equipped to handle them. My husband made sure I continued to walk two miles a day, except for the day after chemo when I was too weak and nauseated. I walked around the lake by our house throughout the summer with a mixed assortment of children and siblings and I ate well and rested.
I felt completely cherished, safe, and at peace. And I thrived.
My tumor was small and had not spread, so my prognosis is quite good. It was aggressive, though, which is why I needed chemo. Like other cancer patients, I live with the knowledge that the disease can return anytime. Everybody dies of something eventually, though, and we all have challenges and trials, so if this is mine, I will live with it, but my spirit has been strengthened and I feel up to whatever fight I have ahead of me.
Eventually, as I returned to work and the stress and demands of my job as a professor and university administrator, the morning smiles disappeared and I did not even notice. Treatment was over, I was a busy woman, and all that cancer stuff was behind me, so I awoke with a “to do” list and the sense that I was already late for something. I had shut the toolbox and moved on.
Then, in a conversation with a friend who was also dealing with cancer, I mentioned how my smile-a-day had given me strength. That made me realize I hadn’t awakened with a smile in months. It was no longer an automatic gesture, but I missed it. It was time for human intervention. I started to make myself smile upon awakening, no matter what—rain, sleet, snow, or a snoring husband— and follow the smile with, “Thank you, God, for another beautiful day.” And that gives the day a far better chance at beauty. Now, I have added, “Help me use it well.”
And now when I pray, I first offer a prayer of thanks for the tools I have always had but never appreciated fully—my health, that loving family, a mind that can keep me focused in the right direction, enough resources to take care of our temporal needs, and a strong body that I am trying to train to reject any recurrence of cancer.
My diagnosis of breast cancer was stunning, but it was the beginning of a deeper, more fulfilling life. My nightly prayers now include all the women in the world with breast cancer, that they be given the tools they need to combat the disease and live a life of meaning and wisdom.
And I pray that, occasionally, they awake to a smile.
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