Sister just diagnosed

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LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 10/2/2008 8:29 AM (GMT -7)   
Hello forum members.  I am on the Prostate Cancer forum and just finished surgery and I am on the road to recovery.  Unfortunately, my sister had a biopsy that showed cancer in her left breast.  She isn't very well informed just yet so she didn't have much information other than the lump was about the size of a walnut.  She is scheduled to talk with an oncologist next week for more information.
 
A few questions I have here for this forum:
 
1.  Does her tumor size remove the possibility of surgery?
2.  Is BCa have a score of how aggressive it is like PCa?
3.  How is BCa staged and is it possible to tell from the above what stage she is?
 
Thanks for a great community here at Healingwell.  I will look forward to some responses.
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 


gma
Veteran Member


Date Joined Jul 2003
Total Posts : 2921
   Posted 10/3/2008 4:53 AM (GMT -7)   
I can help with question Number 1. There are a lot of considerations making the decision for surgery. And surgery takes many forms. It is possible to have a surgical biopsy to remove the tumor followed by radiation or radiation and chemo. When a surgical biopsy is done it is possible that a sentinel node biopsy could also be done. Dye is injected to find the sentinel node leading from the cancer site to see if it has gone into the lymph system. Or a mastectomy may be recommended for many reasons including size of tumor. BTW when a tumor is quite large it is possible to have chemo first to shrink the tumor before surgery. The position of the cancer is another reason for a mastectomy. Close to the chest wall tumors require a mastectomy. The best thing for your sister to do is to learn all she can so she can make an informed choice, because she may have a choice. There is a lot of information about breast cancer out there on the internet. Some can be found right here on Healingwell. There are many books written with personal stories, factual details, etc. Just tell her not to overload, sometimes too much reading can scare you to death. We are here to help answer any questions.

I don't know a thing about BCa. I know there are tests for tumor markers and some doctors don't believe they are accurate for breast cancer. Some doctors rely on them. My daughter recently told me of her tumor marker score which sounded really great compared to other numbers I have heard but I doubt the tests are the same because she has pretty serious Stage IV BC and the number seems to be lower than normals I have heard. I guess I need to ask her what kind of test it is.

Looks like you have had a round of it with prostate cancer. My husband had very high numbers in his PSA test but showed no evidence of cancer in biopsies. Now his PSA has dropped back closer to normal, so go figure.

Give your sister a hug from all of us.
MK


Superbigmac
Regular Member


Date Joined Sep 2008
Total Posts : 23
   Posted 10/3/2008 9:14 PM (GMT -7)   
Les,
 
I'm assuming your sister has the typical invasive ductal type rather than DCIS(non-invasive type)? 
 
1)  There are three main types of treatment for invasive breast cancer ):  Surgical excision, radiation, and chemotherapy/hormonal therapy. 
 
  Re:  Surgical Therapy.  Most people have a choice between 1) Mastectomy or 2) Lumpectomy with Radiation therapy.  If you opt for mastectomy, you generally do not need radiation, unless there is a possible chest wall, skin or adjacent structure or matted axillary lymph node involvement.  If you opt for lumpectomy (surgical excision of lump only with good margins), you definitely need radiation therapy for rest of the breast.  This is an absolute must because there is always a possibility that there may be a few cells around the original cancer site or elsewhere that can grow later to spread.  So you definitely need radiation to kill the few cells that generally can linger, even with great margins.  Studies have proven this.  I personally know two people who opted out of radiation and had a recurrence 2 and 3 years later. The decision whether you are a candidate for lumpectomy is mainly cosmetic and whether you can handle the many trips to radiation therapy.  If the tumor is too big and you can't get a decent cosmetic result with just a lumpectomy, the surgeon will not offer it.  There is no definite size criteria.  It may also depend on the size of the breast.  Also, if the tumor is big, sometimes the oncologist will offer neoadjuvant chemotherapy to shrink it down before lumpectomy like MK said.  Also, after trying lumpectomy, if the margins are not clear, and the surgeon tries for reexcision and the margins are still not clear, the surgeon will generally recommend mastectomy.  Also, radiation therapy requires multiple sessions monday through friday for 5 to 8 weeks (There is newer techniques to shorten this (brachytherapy)). 
 
The second part to surgical therapy is the Sentinel Lymph Node surgery.  Either a radionuclide (Tc sulfur colloid) or blue dye (or both) is injected into the skin of the breast.  The idea is that the tracer or dye will go the first lymph node in the axilla.  The surgeon will take out only this lymph node (one or a few) and do a frozen section to see if the sentinel lymph node is positive.  If this is positive, the surgeon will go ahead and do a full axillary dissection (take out a bunch more, 10-12) mainly for staging purposes.  If it is negative, we're assuming that the rest are negative as well. 
 
Re:  Radiation Therapy.  Required for lumpectomy.  (Sometimes not if pathology is non-invasive lower grade DCIS)  Generally not required after mastectomy except as above.  Sometimes if you have lots of positive axillary lymph nodes, and especially if they're matted (stuck together), the radiation oncologist may irradate the axilla regardless of mastectomy or lumpectomy. 
 
Re:  Chemotherapy/hormonal therapy.  Most people are recommend hormonal therapy.  Tamoxifen for pre-menopausal women and Arimidex for post-menopausal women, especially if the cancer is ER/PR positive (estrogen, progesterone receptor positive).  The side effects are generally ok and most people should get this.  As for Chemotherapy, this is an option people should decide.  Chemo does prolong life, but you really have to weigh the pros and cons since it is pretty hard to take.  The marker used is her 2 neu.  Positive generally means the cancer is more receptive to chemo.  This should all be discussed the medial oncologist. 
 
2)  Breast cancer aggressiveness like most cancers is measured in two ways.  Grade and Stage.
 
     Grade:  There are Grades I, II, III.  This tells you how aggressive the type of tumor you have, III being the most aggresive.  Younger women generally have more aggressive cancers, and older women can have any aggressiveness.  However, this is not as important as Stage. 
 
     Stage:  There are 4 stages (true for most cancers).  Staging takes into account the T - tumor size, N - number of positive axillary lymph nodes, and M - presence of Mets.  To put it simply, Stage I:  small (<2cm) tumor with negative lymph nodes.  Stage II:  Either bigger tumor and/or positive axillary lymph nodes.  Stage III:  Either very large/chest wall involvement and/or multiple positive lymph nodes, matted together.  Stage IV:  spread to distant areas.  This is a very simplified version of staging.  The most important issue is whether you have positive lymph nodes. 
 
I hope this information is useful. 
 
Good luck Les,
 
Superbigmac

 

barkyboys
Veteran Member


Date Joined Jul 2003
Total Posts : 1564
   Posted 10/5/2008 4:06 PM (GMT -7)   
wow. You have gotten some good answers above, and i don't really have anything to add, as far as information goes. However, just wanted to say how sorry I am to hear that your sister was diagnosed with this darned disease. I'm a 14-year breast cancer survivor, and my brother is a 5-year prostate cancer survivor. He undergoes a colonoscopy tomorrow, for suspected colon cancer. Our mom passed away from cancer at age 45. I was 7, he was 12. My heart is just breaking, thinking that he might have to deal with cancer yet again. I'm sure you feel the same way about your sister. Let us know how your sis is doing, and recommend our site to her! I tried to get my brother to the prostate board, but he doesn't have a home computer...although I'm not sure that this forum is his cup of tea, anyway. It has been a lifesaver for me, many times!

Take care.

BEV
"There's a difference between a philosophy and a bumper sticker."  --Charles Schulz


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 10/6/2008 11:14 AM (GMT -7)   
Thank you all for your responses...She is to see her oncologist next week and so hopefully more information will be forth coming. I definitely appreciate the answers so far. I do know that she had a bone density test which I believe was necessary in fine tuning the upcoming treatments she will under go. Since our last converstation, she is leaning towards reducing the size of the tumor and then having the lumpectomy...all of course depending on all the other factors.

Regardless of what type of cancer you have...it is a waiting game...wait for this test result, then wait for that test result. I am use to it...but poor sis, this is just driving her crazy right now.

Thanks again to all...will update as I get more info.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 10/9/2008 7:20 AM (GMT -7)   
Okay here is the update. She has a 2cm tumor in the ductal? area. Treatment selected was a mastectomy with reconstructive surgery at the same time. Basically the way she explained to me, is that the preliminary test indicate no involvement in the lymph nodes and was given a Stage II due to the size of the tumor. They will test for lymph nodes at the beginning of the surgery and if positive will switch to a radical procedure. However if negative as expected then they will perform the mastectomy and reconstruction. Then she will follow-up with hormone therapy, although I don't know for how long. She said this is considered a day surgery and will be released the same day. Not so sure I would want her to go home the same day because too often patients are rushed out of the hospital too soon in my opinion.

Anyway, this sounds like she is on a path that should have a good outcome and can be cured given her stage and type of treatment. I feel very good inside and much relieved. I know she isn't out of the woods so to speak...but certainly not deep into the woods either.

Thanks to all for listening. This is going to be a very special Thanksgiving this year for my mother...both her children have cancer and are expected to be cured all in the same year. That is something to be truly thankful for.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 


JUJU8872
Regular Member


Date Joined Jun 2005
Total Posts : 349
   Posted 10/9/2008 2:52 PM (GMT -7)   
Hi, I've been following your post. This is a "typical" surgery for her "presentation". It is good that she has chosen a mastectomy rather than a lumpectomy.  Also, surgeon will do other testing on this tumor to see if she might need more therapy such as chemo. For a Stage II, they might try one of those new lab tests to see if she will benefit from chemo. I, too, had 2 cm tumor, but unfortunately had positive 5 lymph nodes, so I was a Stage III, I believe C. She is one lucky lady to have a brother such as you. We're here when you need other information.
 
Judy

gma
Veteran Member


Date Joined Jul 2003
Total Posts : 2921
   Posted 10/9/2008 3:17 PM (GMT -7)   
I have a concern about the day surgery, also. There are many kinds of reconstruction and some are definitely not day surgery!!!! Possibly they are doing the mastectomy saving the nipple and outer skin and using an implant. I guess that could be considered day surgery but like you I think it is crazy to send people home so quickly!! My daughter had a mastectomy and reconstruction at the same time, but she had a tram flap which is taking the abdominal muscle and tunneling through the midriff area to make the breast. The outer skin is made from an elliptical shaped piece of skin from the abdomen and the result is a tummy tuck as a bonus. The next morning after her surgery a nurse came to change her bandage and bent her forward with such force that a blood vessel broke. If her doctor hadn't been making morning rounds, she could have bled to death internally. So conceivable someone could go home and do something to rupture a blood vessel, also. You'd think they would want vital signs for a couple of days at least. Keep us posted. MK


babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 10/9/2008 4:27 PM (GMT -7)   
That is good that they don't think it's in the lymph nodes.  Stage II is very treatable.  I was stage III.  My main tumor was 5cm and also ductal.  I had a mastectomy and had one lymph node involved.  That was 4 years ago and I'm here to tell the story.  I agree - your mother will have a very special Thanksgiving, as will you and your sister.  You are a very special brother.  Please keep us posted on both of your journeys.
L & H,
Kathy


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 10/15/2008 6:17 AM (GMT -7)   
Another update. I spoke to her the other night (we live in different states) and she is outright scared to death. Not so much from the cancer or surgery, but more of the after effects...which I can understand. Her biggest fear is not being able to care for herself immediately after the surgery...like not being able to dress herself, wash her hair, won't be able to drive her car..she is left handed and this is her left breast so trying to use her right hand just to eat and cook etc. She lives alone with her grown son. She doesn't want to be a burden and I know that feeling as well. And to make it even worse on her is the thought of the hormone treatments for the next five years. Menopause was extremely hard on her..emotionally and physically.

Questions:

What and how was the recovery for those in similar situations as hers?
What is the best way to lift her spirits in light of what she is facing right now? Remember we are long distant from each other.
I want to be able to be her cheerleader and greatest fan through this and somethings I can say been there and done that...but my cancer is different than hers.

Again I truly appreciate all the responses I have received and I know that all of you have felt the same as my sister at some point during your journey as well.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 


babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 10/15/2008 4:28 PM (GMT -7)   
Les,
 
She shouldn't worry too much about the fact that it's her left side and she's left handed.  I am right handed and my mastectomy was on my right.  If she doesn't have any lymph nodes removed under her arm, it shouldn't be too bad.  That was the hardest part and most painful for me.  Eating and cooking shouldn't be a problem.  You may find this an odd thing to say, but my mastectomy was really very easy to deal with.  I had a lumpectomy and lymph nodes removed 3 weeks prior to that and in comparison, the mast was a breeze.  There will be drains (probably one), but I'm not sure, since she is doing reconstruction at the same time.  Do you know what type of procedure is being done for that?  With a drain, it is difficult to shower and move around, but they usually stay in for a week or less, depending on the drainage.  She will need to do things very slowly for a while.   
 
As for hormone treatments, even though everyone handles them differently, they are usually not a big deal.  If she doesn't need chemo, that is great.  That is usually the hardest thing to deal with. 
 
Where does your sister live?  Sorry if you said already and I just can't remember.  That's the chemo brain!  LOL  Maybe someone here lives near her and can call her or arrange a visit.  Does she have a computer?  It might be a good idea to have her log in here herself so we can guide her through.
 
You are a great brother!!!
L & H,
Kathy


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/6/2008 11:32 AM (GMT -7)   
Hi all once again. Just an update. My sister had her surgery on Nov 4 and everything came out very good. She had the mastectomy and the sentinel lymph node appeared to be clean. We are waiting on the final path report next week but the surgeon said it had all the appearance of being clean and free of cancer. The optimism is guarded as we all know that microscopically it could show something different. But an experienced surgeon wouldn't make that kind of remark without some basis from experience. She is in great spirits and said she slept last night for the first time in a long time all the way through the night. I know from my own experience that trying to sleep at night was impossible with all that goes through your mind thinking about cancer so that was a very good sign that she is emotionally winding down from all this.

She will be dealing with the drains for a few more days and then the next couple of months with the reconstruction. Hopefully any followup treatment will be minimum for her from this point on.

Thanks a bunch to all of you here at HealingWell. Great site and great people here.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 11/6/2008 9:29 PM (GMT -7)   
Les,
 
That is good news.  I'm glad she is in better spirits and the surgery went well.  Rest is very important for her right now.  Her body needs that time to heal itself.  Please tell her that we are thinking of her and wishing her well. 
L & H,
Kathy


meadow36
New Member


Date Joined Nov 2008
Total Posts : 2
   Posted 11/8/2008 10:11 PM (GMT -7)   
Hello everyone,
I have been quietly following along in this forum since I found out I may have a problem - some lumps found on physial exam and I'm waiting on my mammogram/ultrasound appointment in 2 weeks. I don't mean to highjack this thread but I was just wondering what "reconstruction" means when talking about mastectomy - is this placement of an implant at the same time as the other procedure? Sorry if this is a stupid question, I'm still new to all this. Thanks!

JUJU8872
Regular Member


Date Joined Jun 2005
Total Posts : 349
   Posted 11/9/2008 6:18 PM (GMT -7)   

Hello, there. Thought I would issue a quick reply to your question. Lots of ladies seem to be out this week-end or someone would have already replied. 

Yes, that is what "reconstruction" means. After the breast is removed, there are several techniques that can be used to "build" another breast.  Sometimes it can be coordinated with the mastectomy and at other times, breast reconstruction is done later. There are positives and negatives to each type of reconstruction. Some use implants, and others use your own tissue to do the reconstruction. Firstly, I'd get through the mammos and u/s. Most of these issues turn out to be negative, so let's not worry about these things until you get through with testing.  Please feel free to come here and keep us updated on your progress as well as your feelings.  It can be a stressful time.

Perhaps our administrator can copy up your message to a new thread or if you like, you can start a new thread altogether. Regardless, we'll be happy to help with your concerns or questions.

Judy


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/10/2008 8:16 AM (GMT -7)   
Another Update...Gave my sis a few days to recover so I waited until this weekend to call her. She is doing absolutely fantastic. She said she kept waiting for the pain to come and it never did. She was getting a little sick with the pain meds she was given so she stopped them and was just taking Tylenol as a regimen to keep the pain away. She is extremely happy that all of her fears are gone now. She has two drains and one of them is no longer draining and she is going to have them removed on Wednesday and will get the path report on the lymph node that was removed.

As she said...Fear of the unknown was her biggest fear. Now if she has to face any followup she is going forth with a positive attitude and no fear.

Kuddos to all you ladies out there that have to endure this...remain strong and positive.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


babyseeester
Veteran Member


Date Joined Oct 2004
Total Posts : 826
   Posted 11/11/2008 5:10 PM (GMT -7)   
Les,
 
That is great to hear.  Many of us were exactly like her - fear of the unknown.  I know I was, that's for sure.  But, now that she has made it through this, she can tackle the rest, whatever it may be.  She sounds like she's on the right path.  I am very happy that her surgery went so well.
L & H,
Kathy


meadow36
New Member


Date Joined Nov 2008
Total Posts : 2
   Posted 11/12/2008 1:06 AM (GMT -7)   
Thanks for the answer to my question, and Les I hope your sister has a speedy and uneventful recovery !!!!

Meadow

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/13/2008 2:36 PM (GMT -7)   
One more update....biopsy came back CLEAN!!!...WOOHOO She is absolutely elated. The tumor size was 3 cm but all margins were inked and clear. The two sentinel nodes were completely clear of cancer. She is one lucky lady. Her cancer was deemed contained and removed completely. She will have hormone therapy for a while, but that is to only kill off any cells that might have remained during the surgery. Not a big deal and she will handle that just fine.

Now for the reconstruction which mostly likely will take a few months as the chest muscles are stretched before the final implant is done.

I will sign off here and give a very BIG thank you to all of you for your kind support and words of wisdom.

I will return to my own battle with cancer now.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


ticklemepink316
New Member


Date Joined Dec 2008
Total Posts : 5
   Posted 12/16/2008 4:02 AM (GMT -7)   
I hope you have someone to help you Les as you have helped your sister. Remember, you to are an important person
Leisa 

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