Way back when we first got married, my husband thought we might have a big family with a lot of kids. Â He was from a family of 6 siblings, so that’s what he was accustomed to. Â I am an only child so I wasn’t sure about having so many.
I needn’t have worried.
In January 1974 I had a miscarriage. Â I was devastated. My father revealed that my mother had also had a miscarriage. Â I had no idea.
At some point later I tried fertility drugs. Â Clomid and another drug. Â One or both drugs made me very angry/depressed/bitchy (one dwarf I left off the image) Â Little did I know that these meds were a waste of time.
Eventually, Â I did get pregnant and our wonderful son, Michael was born. Â It wasn’t until he was seven that I was finally, actually diagnosed with Cushing’s.
When I had my early Cushing’s symptoms, I thought I was pregnant again but it was not to be.
I’ll never forget the fall when he was in second grade. Â He was leaving for school and I said goodbye to him. Â I knew I was going into NIH that day for at least 6 weeks and my future was very iffy. Â The night before, I had signed my will – just in case. Â He just turned and headed off with his friends…and I felt a little betrayed.
Michael wrote this paper on Cushing’s when he was in the 7th grade. From the quality of the pages, he typed this on typing paper – no computers yet!
Click on each page to enlarge.
When Michael started having headache issues in middle school, I had him tested for Cushing’s. Â I had no idea yet if it could be familial but I wasn’t taking any chances. Â It turned out that my father had also had some unnamed endocrine issues. Â Hmmm…
I survived my time and surgery at NIH and Michael grew up to be a wonderful young man, if an only child. Â đ
After I survived kidney cancer (Day Twelve, Cushingâs Awareness Challenge 2015) Michael and I went zip-lining – a goal of mine after surviving that surgery.  This photo was taken in a treetop restaurant in Belize.
For the mathematically inclined, this is his blog. Â Xor’s Hammer. Â I understand none of it. Â He also has a page of Math and Music, which I also don’t understand.
Myth: After a “cure” for Cushingâs, everyone heals and goes back to normal. All Cushing’s patients can easily heal with no repercussions after Cushing’s. After pituitary surgery or a Bilateral Adrenalectomy (BLA), life is great and being “cured” means having a “normal” life! After all, surgery is a “cure” and about 6 weeks later, you are back to normal. “Say, you had surgery XYZ long ago! Shouldn’t you be better by now?!!!!”
Fact: I can not even tell you how many people asked me “aren’t you better yet?!” after both of my surgeries! There are too many to count! There is a misperception that surgery means a cure and therefore, healing should happen magically and quickly. No! No! No! This is far from the truth.
The sad reality is that even some medical doctors buy into this myth and expect quick healing in their patients. However, they are not living in their patients bodies nor have they obviously read the extensive research on this. Research has shown that the healing process after surgery is a long and extensive one. One endocrinologist, expert from Northwestern, even referred to the first year after pituitary surgery for patients as “the year from hell”! He literally quoted that on a slide presentation.
It takes at least one year after pituitary surgery, for instance, to even manage hormones effectively. Surgery is invasive and hard. However, the hardest part comes AFTER surgery. This is when the body is compensating for all of the years of hormonal dysregulation and the patient is trying to get his/her levels back to normal.
There is a higher rate of recurrence of Cushing’s then we once thought. This means that after a patient has achieved remission from this illness, it is likely to come back. In these cases, a patient faces other treatments that may include radiation, the same type of surgery, or an alternative surgery.
For many pituitary patients who experience multiple recurrences, the last resort is to attack the source by removing both adrenal glands. This procedure is known as a Bilateral Adrenalectomy or BLA. In these cases, it is said that the patient “trades one disease for another”, now becoming adrenally insufficient and having Addison’s Disease. Both Pituitary and Adrenal patients are faced with a lifetime of either Secondary or Primary Adrenal Insufficiency.
Adrenal Insufficiency is also life threatening and adrenal crises can potentially lead to death. Additionally, research says that BLA patients take, on average, 3-5 years for their bodies to readjust and get anywhere near “normal”. Most patients will tell you that they never feel “normal” again!
Think of these facts the next time you feel tempted to ask your friend, family, or loved one, “why is it taking so long to get better after surgery?”. Remember that in addition to the aforementioned points; problems from Cushing’s can linger for years after surgery! One Cushing’s patient stated, “I’m 5 years post-op and I STILL have problems!” This mirrors the sentiments of many of us in the Cushing’s community. Please be conscious of this when supporting your loved one after treatment.
You can find more information in the following links:
Cushingâs Conventions have always been special times for me â we learn a lot, get to meet other Cushies, even get referrals to endos!
As early as 2001 (or before) my pituitary function was dropping. Â My former endo tested annually but did nothing to help me with the symptoms.
In the fall of 2002 my endo refused to discuss my fatigue or anything at all with me until I lost 10 pounds. He said I wasnât worth treating in my overweight condition and that I was setting myself up for a heart attack. He gave me 3 months to lose this weight. Those 3 months included Thanksgiving, Christmas and New Years. Â Needless to say, I left his office in tears, again.
Fast forward 2 years to 2004. Â I had tried for a while to get my records from this endo. He wouldnât send them, even at doctorsâ or my requests.
I wanted to go see Dr. Vance at UVa but I had no records so she wouldnât see me until I could get them.
Finally, my husband went to the former endoâs office and threatened him with a court order. The office manager managed to come up with about 13 pages of records. For going to him from 1986 to 2001 including weeks and weeks at NIH and pituitary surgery, that didnât seem like enough records to me.
In April of 2004, many of us from the message boards went to the UVa Pituitary Days Convention. Thatâs where the picture above comes in. Â Other pictures from that convention are here.
By chance, we met a wonderful woman named Barbara Craven. She sat at our table for lunch on the last day and, after we learned that she was a dietitian who had had Cushingâs, one of us jokingly asked her if sheâd do a guest chat for us. I didnât follow through on this until she emailed me later. In the email, she asked how I was doing. Usually I say âfineâ or âokâ but for some reason, I told her exactly how awful I was feeling.
Barbara emailed me back and said I should see a doctor at Johns Hopkins. I said I didnât think I could get a recommendation to there, so SHE referred me. The doctor got right back to me, set up an appointment. Between his vacation and mine, that first appointment turned out to be Tuesday, Sept 14, 2004.
Just getting through the maze at Johns Hopkins was amazing. They have the whole system down to a science, moving from one place to another to sign in, then go here, then window 6, then⌠But it was very efficient.
My new doctor was wonderful. Understanding, knowledgeable. He never once said that I was âtoo fatâ or âdepressedâ or that all this was my own fault. I feel so validated, finally.
He looked through my records, especially at my 2 previous Insulin Tolerance Tests (ITT). From those, he determined that my growth hormone has been low since at least August 2001 and Iâve been adrenal insufficient since at least Fall, 1999 â possibly as much as 17 years! I was amazed to hear all this, and astounded that my former endo not only didnât tell me any of this, he did nothing. He had known both of these things â they were in the past records that I took with me. Perhaps that was why he had been so reluctant to share copies of those records. He had given me Cortef in the fall of 1999 to take just in case I had âstressâ and that was it.
The new endo took a lot of blood (no urine!) for cortisol and thyroid stuff. I went back on Sept. 28, 2004 for arginine, cortrosyn and IGF testing.
He said that I would end up on daily cortisone â a âsprinklingâ â and some form of GH, based on the testing the 28th.
For those who are interested, my new endo was Roberto Salvatori, M.D.
Assistant Professor of Medicine at Johns Hopkins
Medical School: Catholic University School of Medicine, Rome, Italy
Residency: Montefiore Medical Center
Fellowship: Cornell University, Johns Hopkins University
Board Certification: Endocrinology and Metabolism, Internal Medicine
Research Interests: Control of growth hormone secretion, genetic causes of growth hormone deficiency, consequences of growth hormone deficiency.
Although I have this wonderful doctor, a specialist in growth hormone deficiency at Johns Hopkins, in November, 2004, my insurance company saw fit to over-ride his opinions and his test results based on my past pharmaceutical history! Hello??? How could I have a history of taking GH when Iâve never taken it before?
Of course, I found out late on a Friday afternoon. By then it was too late to call my case worker at the drug company, so we had to appeal on Monday. My local insurance person also worked on an appeal, but the whole thing was just another long ordeal of finding paperwork, calling people, FedExing stuff, too much work when I just wanted to start feeling better by Thanksgiving.
As it turned out the insurance company rejected the brand of hGH that was prescribed for me. They gave me the ok for a growth hormone was just FDA-approved for adults on 11/4/04. The day this medication was approved for adults was the day after my insurance said thatâs what is preferred for me. In the past, this form of hGH was only approved for children with height issues. Was I going to be a guinea pig again?
The new GH company assigned a rep for me, submitted info to pharmacy, and waited for insurance approval, again.
I finally started the Growth Hormone December 7, 2004.
In March of 1987, after the endo finally confirmed that I had Cushingâs, I was sent to a local hospital where they repeated all those same tests for another week and decided that it was not my adrenal gland (Cushingâs Syndrome) creating the problem. The doctors and nurses had no idea what to do with me, so they put me on the brain cancer ward.
When I left this hospital after a week, we didnât know any more than we had before.
As luck would have it, NIH (National Institutes of Health, Bethesda, Maryland) was doing a clinical trial of Cushingâs. I live in the same area as NIH so it was not too inconvenient but very scary at first to think of being tested there. At that time I only had a choice of NIH, Mayo Clinic and a place in Quebec to do this then-rare pituitary surgery called a Transsphenoidal Resection.
My husband asked my endo if it were his wife, if he would recommend this surgery. Â The endo responded that he was divorcing his wife â he didnât care what happened to her. Â Oh, my!
I chose NIH â closest and free. After I was interviewed by the doctors there, I got a letter that I had been accepted into the clinical trial.
The night before I was admitted, I signed my will. Â I was sure I was going to die there. Â If not during testing, as a result of surgery.
The first time I was there was for 6 weeks as an inpatient. More of the same tests.
There were about 12 of us there and it was nice not to be alone with this mystery disease. Many of these Cushies (mostly women) were getting bald, couldnât walk, having strokes, had diabetes. One was blind, one had a heart attack while I was there. Several were from Greece.
My first roommate was a nurse. Â She spent the entire first night screaming in pain. Â I was very glad when they moved me to a new room!
Towards the end of my testing period, I was looking forward to the surgery just to get this whole mess over with â either a cure or dying. While I was at NIH, I was gaining about a pound a day!
During the time I was home the weekend  before surgery, a college classmate of mine (I didnât know her) DID die at NIH of a Cushingâs-related problem. Iâm so glad I didnât find out until reading the alumnae magazine a couple months later!  She was the same class, same major, same home-town, same diseaseâŚ
We have a Scottish doctor named James Lind to thank for the clinical trial.  He  conducted the first ever clinical trial in 1747 and developed the theory that citrus fruits cured scurvy.  Lind  compared the effects of various different acidic substances, ranging from vinegar to cider, on groups of afflicted sailors, and found that the group who were given oranges and lemons had largely recovered from scurvy after 6 days.
Iâd like to think that I advanced the knowledge of Cushingâs at least a little bit by being a guinea pig in 1987-1989.
Several components of the National Institutes of Health (NIH) conduct and support research on Cushingâs syndrome and other disorders of the endocrine system, including the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Child Health and Human Development (NICHD), the National Institute of Neurological Disorders and Stroke, the National Cancer Institute, and the National Center for Research Resources.
NIH-supported scientists are conducting intensive research into the normal and abnormal function of the major endocrine glands and the many hormones of the endocrine system. Researchers continue to study the effects of excess cortisol, including its effect on brain structure and function. To refine the diagnostic process, studies are under way to assess the accuracy of existing screening tests and the effectiveness of new imaging techniques to evaluate patients with ectopic ACTH syndrome. Researchers are also investigating jugular vein sampling as a less invasive alternative to petrosal sinus sampling. Research into treatment options includes study of a new drug to treat the symptoms of Cushingâs syndrome caused by ectopic ACTH secretion.
Studies are under way to understand the causes of benign endocrine tumor formation, such as those that cause most cases of Cushingâs syndrome. In a few pituitary adenomas, specific gene defects have been identified and may provide important clues to understanding tumor formation. Endocrine factors may also play a role. Increasing evidence suggests that tumor formation is a multistep process. Understanding the basis of Cushingâs syndrome will yield new approaches to therapy.
The NIH supports research related to Cushingâs syndrome at medical centers throughout the United States. Scientists are also treating patients with Cushingâs syndrome at the NIH Clinical Center in Bethesda, MD. Physicians who are interested in referring an adult patient may contact Lynnette Nieman, M.D., at NICHD, 10 Center Drive, Room 1-3140, Bethesda, MD 20892-1109, or by phone at 301-496-8935. Physicians interested in referring a child or adolescent may contact Constantine Stratakis, M.D., D.Sc., at NICHD, 10 Center Drive, Room 1-3330, Bethesda, MD 20892-1103, or by phone at 301-402-1998.
A Conference Designed to Inform, Equip, and Connect the Adrenal Insufficiency Community
Living with adrenal insufficiencyâor caring for someone who doesârequires knowledge, preparation, and a strong support network. This yearâs conference is designed to bring together patients, families, caregivers, and medical professionals for a time of learning, encouragement, and connection.
Through a variety of planned sessions and breakout discussions, attendees will explore the latest medical advances, practical strategies for daily life, and ways to advocate for better care and understanding.
Learning from Experts
Several sessions will focus on the science and medical care of adrenal insufficiency, helping participants stay informed about current treatments and emerging therapies.
Topics include:
Cortisol Pump Health & Nutrition
Advances in Adrenal Insufficiency Therapy
Risk Factors for Acquired Adrenal Insufficiency
Adrenal Insufficiency & Fatigue
Menopause and Adrenal Insufficiency
Adrenal Insufficiency in Children
These presentations will provide valuable insights from experts who are working to improve treatment and quality of life for those affected by adrenal insufficiency.
Navigating Healthcare and Emergencies
Understanding how to interact with healthcare systems can be critical for people with adrenal insufficiency. Several sessions are designed to empower attendees with practical knowledge and confidence.
Participants will learn about:
Understanding EMS & ER Systems
Health Literacy
Self Advocacy
Tactical Planning for Adrenal Insufficiency
These sessions aim to give attendees tools to navigate medical settings, communicate effectively with healthcare providers, and prepare for emergencies.
Real-Life Perspectives
The conference will also feature sessions that focus on the lived experiences of those managing adrenal insufficiency every day.
Highlights include:
Adults with Adrenal Insufficiency â A Panel Discussion for Parents
Parent and Spouse Support
Service Dogs and Their Role in Support
These discussions provide a space to hear firsthand stories, share experiences, and learn from others who truly understand the challenges and successes of living with adrenal insufficiency.
Looking Ahead: Technology and Innovation
As technology continues to evolve, the conference will also explore how new tools may affect patient care and education. One session will examine the positives and potential concerns of using artificial intelligence as a tool, helping attendees better understand how AI might support healthcare decisions and information gathering.
Building Community
Beyond the sessions themselves, the conference is an opportunity to connect with others who share similar experiences, build lasting relationships, and strengthen the adrenal insufficiency community.
Whether you are newly diagnosed, a longtime patient, a parent, spouse, or healthcare professional, this conference offers valuable information and meaningful support.
Together, we can continue learning, advocating, and improving life for everyone affected by adrenal insufficiency.
Myth: “It is MY fault that I got Cushing’s. I did something wrong that caused me to be sick! If I would have just done XYZ, this would not be happening to me!”
Fact: This is a very controversial topic because we don’t like to talk about it. However, many people struggle with this myth. We NEED to dispel this myth my friends! Patients themselves assume responsibility, accountability, and self blame for becoming ill.
To compound all of that, patients are often told by loved ones, family, and sometimes even their churches or other supports that there is something that THEY could be doing or haven’t done that has caused their declining health. “If you would just follow that raw food diet, then all of your symptoms would go away”, “Juicing is the answer! I told you to juice and you wouldn’t get those tumors!”, Sometimes, you are told that if you would just pray harder or have greater faith, then there is no way that you would be sick right now. And my absolute favorite, “you are just too obsessed with being sick and having Cushing’s! Â Stop thinking that you have it and it will go away!”.
Now, don’t get me wrong, I find value in “positive thinking” and affirming health, wealth, and all kinds of great things. This helps build up strength and personally keeps me motivated, especially during the times that I feel like absolutely throwing in the towel and giving up!
However, I am NOT the reason and YOU are not the reason for this war with this dreadful disease. What many people don’t understand is how tenacious, brave, courageous, and INDOMITABLE you are! Cushing’s patients do not just get surgery and then everything is magically OK.
Many patients have to go through multiple surgeries, sometimes radiation, sometimes years of testing to find the ultimate source of the disease, even after having several organs messed with. Even after patients obtain their “cure”, they are faced with residual and lingering negative effects of the illness, other hormone dysregulation issues, and the anxiety and fear of a recurrence which is based in absolute reality.
There are people, like myself, who are in remission from Cushing’s, BUT we now have Addison’s Disease/Adrenal Insufficiency as a result of removing vital organs in order to save our lives from Cushing’s. So, are we to think that Adrenal Insufficiency is ALSO our faults every time we near death after an adrenal crisis?! NO! NO! NO!
This is NOT your fault! This is NOT your doing! STOP blaming yourself! The best you can do is to FIGHT! Take an empowered stance by saying “NO” to those who won’t listen. Say “NO” to those who project blame onto you and tell you that this is just a “fat person’s excuse to stay fat”. You are not just a “fat person”! YOU are an amazing person who is fighting for your life!
Let me be clear that this blaming is common and we all do it. In my “5 stages of Loss” series on Youtube; I address the “Bargaining” stage of loss, in which we assume responsibility for getting sick or even for getting better.
Everyone should watch this to understand why and how we do this:
Remember, you are a survivor! YOU are Indomitable!!! This is NOT your fault! You WILL overcome!
It’s Sunday again, so this is another semi-religious post so feel free to skip it đ
I’m sure that many would think that Abide With Me is a pretty strange choice for my all-time favorite hymn, especially since it often shows up at funerals and memorial services.
My dad was a Congregational (now United Church of Christ) minister so I was pretty regular in church attendance in my younger years.
Some Sunday evenings, he would preach on a circuit and I’d go with him to some of these tiny churches. The people there, mostly older folks, liked the old hymns best – Fanny Crosby and so on.
So, some of my “favorite hymns” are those that I sang when I was out with my Dad. Fond memories from long ago.
In 1986 I was finally diagnosed with Cushing’s after struggling with doctors and trying to get them to test for about 5 years. I was going to go into the NIH (National Institutes of Health) in Bethesda, MD for final testing and then-experimental pituitary surgery.
I was terrified and sure that I wouldn’t survive the surgery.
Somehow, I found a 3-cassette tape set of Reader’s Digest Hymns and Songs of Inspiration and ordered that. The set came just before I went to NIH and I had it with me.
At NIH I set up a daily “routine” of sorts and listening to these tapes was a very important part of my day and helped me get through the ordeal of more testing, surgery, post-op and more.
When I had my kidney cancer surgery, those tapes were long broken and irreplaceable, but I had replaced all the songs – this time on my iPod.
Abide With Me was on this original tape set and it remains a favorite to this day. Whenever we have an opportunity in church to pick a favorite, my hand always shoots up and I request page 700. When someone in one of my handbell groups moves away, we always sign a hymnbook and give it to them. I sign page 700.
I think that many people would probably think that this hymn is depressing. Maybe it is but to me it signifies times in my life when I thought I might die and I was so comforted by the sentiments here.
This hymn is often associated with funeral services and has given hope and comfort to so many over the years – me included.
If you abide in Me, and My words abide in you, you will ask what you desire, and it shall be done for you.
~John 15:7
Abide With Me
Words: Henry F. Lyte, 1847.
Music: Eventide, William H. Monk, 1861. Mrs. Monk described the setting:
This tune was written at a time of great sorrowâwhen together we watched, as we did daily, the glories of the setting sun. As the last golden ray faded, he took some paper and penciled that tune which has gone all over the earth.
Lyte was inspired to write this hymn as he was dying of tuberculosis; he finished it the Sunday he gave his farewell sermon in the parish he served so many years. The next day, he left for Italy to regain his health. He didnât make it, thoughâhe died in Nice, France, three weeks after writing these words. Here is an excerpt from his farewell sermon:
O brethren, I stand here among you today, as alive from the dead, if I may hope to impress it upon you, and induce you to prepare for that solemn hour which must come to all, by a timely acquaintance with the death of Christ.
For over a century, the bells of his church at All Saints in Lower Brixham, Devonshire, have rung out âAbide with Meâ daily. The hymn was sung at the wedding of King George VI, at the wedding of his daughter, the future Queen Elizabeth II, and at the funeral of Nobel peace prize winner Mother Teresa of Calcutta in1997.
Abide with me; fast falls the eventide;
The darkness deepens; Lord with me abide.
When other helpers fail and comforts flee,
Help of the helpless, O abide with me.
Swift to its close ebbs out lifeâs little day;
Earthâs joys grow dim; its glories pass away;
Change and decay in all around I see;
O Thou who changest not, abide with me.
Not a brief glance I beg, a passing word;
But as Thou dwellâst with Thy disciples, Lord,
Familiar, condescending, patient, free.
Come not to sojourn, but abide with me.
Come not in terrors, as the King of kings,
But kind and good, with healing in Thy wings,
Tears for all woes, a heart for every pleaâ
Come, Friend of sinners, and thus bide with me.
Thou on my head in early youth didst smile;
And, though rebellious and perverse meanwhile,
Thou hast not left me, oft as I left Thee,
On to the close, O Lord, abide with me.
I need Thy presence every passing hour.
What but Thy grace can foil the tempterâs power?
Who, like Thyself, my guide and stay can be?
Through cloud and sunshine, Lord, abide with me.
I fear no foe, with Thee at hand to bless;
Ills have no weight, and tears no bitterness.
Where is deathâs sting? Where, grave, thy victory?
I triumph still, if Thou abide with me.
Hold Thou Thy cross before my closing eyes;
Shine through the gloom and point me to the skies.
Heavenâs morning breaks, and earthâs vain shadows flee;
What have you learned about the medical community since you have become sick?
This one is so easy. I’ve said it a thousand times – you know your own body better than any doctor will. Most doctors have never seen a Cushing’s patient, few ever will in the future.
If you believe you have Cushing’s (or any other rare disease), learn what you can about it, connect with other patients, make a timeline of symptoms and photographs. Read, take notes, save all your doctors’ notes, keep your lab findings, get second/third/ten or more opinions. Â Make a calendar showing which days you had what symptoms. Â Google calendars are great for this.
This is your life, your one and only shot (no pun intended!) at it. Make it the best and healthiest that you can.
When my friend and fellow e-patient Dave deBronkart learned he had a rare and terminal kidney cancer, he turned to a group of fellow patients online and found a medical treatment that even his own doctors didn’t know. It saved his life.
In this video, he calls on all patients to talk with one another, know their own health data, and make health care better one e-Patient at a time.
Fact: In the words of our dear friend and advocate, Robin Ess, “There are many genetic varieties with quite a few discovered in the past couple of years. Plus, there are several types such as adrenal, ectopic, and pituitary. And so on”….Amazingly, some doctors do not realize that there are different varieties of Cushing’s and that the symptoms can come from a different source.
For instance, a doctor might rule out a pituitary tumor and completely dismiss the patient, even with biochemical evidence of Cushing’s. That doctor, instead of dismissing the patient, should thoroughly look for other potential sources, such as an adrenal tumor, or yet another source. Did you know that tumors on one’s lungs can even cause Cushing’s? Most people don’t know that.
MaryONote: Folks might be interested in listening to this podcast episode with Jayne, a Cushing’s patient who had pituitary surgeries and a bilateral adrenalectomy before finding the true source of her ectopic Cushing’s – lung tumors.
What have you learned about the medical community since you have become sick?
This one is so easy. I’ve said it a thousand times – you know your own body better than any doctor will. Most doctors have never seen a Cushing’s patient, few ever will in the future.
If you believe you have Cushing’s (or any other rare disease), learn what you can about it, connect with other patients, make a timeline of symptoms and photographs. Read, take notes, save all your doctors notes, keep your lab findings, get second/third/ten or more opinions. Â Make a calendar showing which days you had what symptoms. Â Google calendars are great for this.
This is your life, your one and only shot (no pun intended!) at it. Make it the best and healthiest that you can.
When my friend and fellow e-patient Dave deBronkart learned he had a rare and terminal kidney cancer, he turned to a group of fellow patients online and found a medical treatment that even his own doctors didn’t know. It saved his life.
In this video he calls on all patients to talk with one another, know their own health data, and make health care better one e-Patient at a time.
After I survived kidney cancer (Day Twelve, Cushingâs Awareness Challenge 2015) Michael and I went zip-lining – a goal of mine after surviving that surgery.  This photo was taken in a treetop restaurant in Belize.
