some days are bluer than others

January 28, 2009

I have been feeling kind of blue these last few days.

I’m always relieved after I get good scan results but a feeling of let-down seems to follow almost every time and I find myself, once again, channelling Peggy Lee and asking “Is that all there is?”

I just finished the latest round of edits on my book (coming out this spring with Women’s Press!) and I have been left wondering, ‘so, what’s next?’

I haven’t looked at the outline for my novel since I submitted it for my writing course on December 31st. The course is over and I am feeling kind of daunted. I’ve been asking myself, “Can I do this?” and “What purpose would it serve?”

This morning, I had an appointment with my wonderful oncologist who confirmed my CT results. He also referred to my “normal” life.

I told him that I have been feeling kind of “ground down” by the emotional wear and tear of treatment, as much as the buildup of toxins.

He gently reminded me that I need to think of myself as having a chronic illness, “like diabetes”, that needs to be managed but that doesn’t stop me from living my life.

I told him that I know how lucky I am and that I am very grateful not to be dead (at which point he rolled his eyes) and that I’ve been doing other things to keep my life full and interesting (like writing) but that I miss the more fast-paced, structured work environment.

My oncologist was sympathetic but said that we are working at keeping treatment “as innocuous as possible.” I only go for treatment every four weeks and I phone in for every other appointment with him. And he’s right.

The truth is that I couldn’t go back to the kind of long hours that I worked before cancer. Even if I could miss three or four days on treatment weeks, my body couldn’t tolerate the stress or long hours. And I am not sure that I really want that back or if I am just missing the sense of identity that I got from my job.

My oncologist suggested that I skip a cycle over the summer and I’ll do that. I’ll also keep working at doing the things that make me happy.

I have the chance to work at making art (and writing is art). I have to embrace this rare privilege, not feel guilty about it or self-censuring and just see what happens.

Some days are easier than others.

I asked my oncologist whether there were any restrictions on my activities. He said, “No.” He added that there were also “No restrictions on lifestyle” – this is the same oncologist who suggested that dope would help me to cope with the side effects of chemo (it did!) and who routinely suggests I go out for a drink to celebrate any kind of news (wine for good news, scotch for bad) – “The liver is healthy. So you can party.”

To which my spouse replied, “As if she needs any encouragement.”

However, given the fact that I have gained 30 pounds since I was first diagnosed (10 of those in the last two months), I think I’ll be living a more ascetic existence for a while.

Cross-posted to Not Just About Cancer.


People’s HealthBlogger Awards

December 21, 2008

A few weeks ago I thought it might be a good idea to enter Mothers With Cancer in the People’s HealthBlogger Awards. The Awards are for any bloggers who write primarily about health or healthy living topics. That’s certainly MWC! Plus, the Awards are sponsored or invented or made up… (whatever) by a website that is forever sending me all sorts of email invitations that I quite rudely delete and ignore. A little more visibility with our target audience would be nice compensation for the probable carpal tunnel I’ll eventually get in my Delete Finger.

Anyway, that great idea was a few weeks ago (I think). But, as I’ve been discovering, my mind is as water tight as a leaky dinghy at best… and a colander at worst. So I applied and promptly forgot all about it. That’s me. Memory like a steel trap! At least that used to be the case. *sigh*

Frankly, I’ve been a bit worried about my memory issues of late. I can’t seem to remember anything anymore. This isn’t the run of the mill Chemo Brain. On Wednesday Ben had an appointment with Dr. Flaton at 10:30. I saw it on the kitchen calendar that morning. I left Daddy-O a note reminding him to let the school know I’d be picking Ben up. I told Ben about the appointment. I even remembered to grab the medication evaluation paperwork from the bookcase. Next thing I know, my cell phone is ringing and it’s Dr. Flaton’s office calling to ask if we were keeping our appointment. It was 10:45! Gah!

The day before I discussed with Wonder Sitter keeping Danny home from preschool the next day. I agreed to call his therapists & let them know not to show up. I couldn’t even remember that long enough for the 3 block drive home. I did finally remember it 24 hours later as I was driving home from our office Christmas party. I am not going to go into the dozens of messages and reminders I have forgotten to give Daddy-O.

Seriously!  This is a major problem when I am the calendar keeper for the family.  I’m sure most of you mothers can vouch for that!  If I can’t remember who is supposed to be where and when… well, I don’t even want to contemplate the level of chaos that will ensue.

Of course, I worry about breast cancer metastasis to the brain. At least that’s what I worry about when I remember there is something to worry about. Directly after the thought of mets enters my head I hear a resounding “Pshaw!” bouncing around between my ears. I guess I don’t really believe I have a brain metastasis. It’s just that I have always had a near perfect memory – particularly for daily minutia. It’s frustrating to completely forget entire appointments and conversations. I imagine it’s much like being a man…

Just in case someone Googles brain mets looking for some useful information and got my drivel instead, I will include a list of the 7 Typical Signs or Symptoms of Brain or Spinal Metastisis.

In any patient previously diagnosed with cancer, the following should raise the suspicion for a brain tumor:

  1. A persistent headache with or without vomiting.
  2. Seizures (Change in type or frequency )
  3. Double vision, mental changes, speech difficulty.
  4. Stroke (brain hemorrhage). Certain brain metastases, such as melanoma, renal carcinoma, and choriocarcinoma bleed easily.
  5. Confusion
  6. Any numbness, arm or leg weakness, back pain, difficulty walking.
  7. Loss of control of bowel or bladder.

Numbers 6,7 are more common with spinal metastases.

Fortunately, I’m just forgetful (probably getting old) and a hypochondriac as the only symptom I can lay claim to is “mental changes”. If I can remember long enough I’ll say a little thank you for that during my prayers tonight.

In the meantime, click on the handy little button on the right and give a vote for MWC.

Cross posted from I can’t complain any more than usual

“it makes you mean as a snake”

November 18, 2008

I called the group leader of the cancer support group today, H., to see if she knew what the video tonight would be about. I just told her my concern that if it was an “End of Time” video, that I didn’t think I could take it right now.

I also told her that I’ve been excessively cranky/moody lately and I didn’t know if it was getting used to Tamoxifen or what. Her words:

It’s the chemo, Judy. It makes you mean as a snake. I don’t care if you haven’t had the full dose in months; it takes a long time for that stuff to get out of you. But it will. But I’ll tell you that the stress you’ve been under for nearly a year plus the chemo just makes you as mean as a snake.

I told H. that I had to stop, that I’ve been arguing with people like I don’t typically do, that I usually let things go at a certain point, but lately I’m just going ON and ON and ON about things and I won’t let go and that isn’t like me. I tell her I’m afraid I’m going to lose some friends over things.

You won’t, Judy. You won’t if they’re real friends. And you can tell them about the chemo. It’s real. You can have them call me; I’ll tell them!!

and she laughs.

I tell her how I’ve been to Frank but Frank doesn’t seem to mind or is just kind of oblivious to it. She just says, “That’s true love, huh?” We laugh about it, because what can you do, after all, but laugh. Well, I cry these days too, over the simplest things.

This damn disease. H. told me that it absolutely does change you forever. Oh, not that the meanness will stay forever; she did say that would eventually get better, thank the Good Lord. But that we’re changed in ways that will stay with us forever. That priorities change, that opinions change. She did say that she’s much more outspoken because ever since she was diagnosed she feels like she just doesn’t have the time that she used to; she has to get her words out now. Hmmmm . . . . yes, I do believe I’m getting even more outspoken than I was, and that’s a mixed blessing, I believe.

Have I ever mentioned that I hate cancer? OK, I know hate is a strong word, but I’ll use it in this case . . .

because I do.

Cross-posted to Just Enjoy Him.

Who Knew?

October 29, 2008

My church has recently launched a Women’s Website and Blog and I’ve been thrilled to be a part of it.  I’ve written a few posts specifically for Breast Cancer Awareness month and this one seemed appropriate for repeating.  It’s not all specific to breast cancer, however.  A lot of the issues I talk about deal with chemotherapy in general.  I’m interested to know what things the rest of you “learned” about cancer and treatment.

Before I had kids I knew the proper way to raise perfect children.  I would do this and wouldn’t do that — it was so simple.  Then I became a parent and found out just how much I didn’t know.  It was the same way with cancer.  I thought I would have the surgery, go through chemo, grow my hair back, have reconstruction and then my life would be the same as it had been before.  How wrong I was.

My misconceptions about chemotherapy was my first schooling.  The comments I made to Todd about the silver lining to the diagnosis were nearly all blown to bits.

Chemotherapy as a weight loss aid:  I didn’t lose any weight.  In fact I gained 30 pounds over the six months of treatment.  I blame my oncologist and the chemo nurses for telling me to eat an ice cream sundae every day.  Oh, all right.  What they said was if the only thing I felt I could eat and keep down was an ice cream sundae then eat an ice cream sundae every day because it was better than not eating anything at all.

Chemo didn’t make me sick.  I had a few days of feeling icky after treatment, like I’d eaten something to sour my stomach; however, I wasn’t actually nauseous.  My food consumption didn’t change much, but I was suddenly living a sedentary life.  Another factor was the large amounts of steroids which accompanied each infusion and caused water retention and munchies for a couple days every three weeks. 

Loss of unwanted body hair:  This one was pretty weird.  I lost all the hair from the most personal of my parts to the top of my head.  My legs, however, didn’t cooperate.   They were as furry as ever.  To add insult to injury I wasn’t even allowed to shave.  A simple little nick could turn into a horrible infection due to my low white blood cell counts.  Thank the Lord above for the invention of Veet!

A lot of time to read:  Before all this I averaged a few books a week, about twelve books a month.  But my purchases were not in direct proportion to my reading and the bookshelves were bulging.  If my family hadn’t expected certain things from me – dinner, clean clothes, attention, etc., – I would have read a lot more.  So the thought of six months of guilt-free reading was enough to make me slightly giddy.  But it turned out to be nothing more than a thought.  The chemo made focusing nearly impossible so I read only a few books the whole time.  What’s just as sad, if not more so, is that I still haven’t gotten up to speed and my bookshelves continue to bulge.

A set of new, improved, perky boobs:  This isn’t related to chemotherapy, but my comment was blurted out without any understanding of the process.  Many women choose not to have reconstruction, but the majority of mastectomy patients, especially among younger women, do decide on some form.  There are a lot of emotions that accompany the loss of a breast and reconstruction is a way for women to feel better about their bodies.  But the plain truth is, even if reconstruction makes a woman look normal, it doesn’t feel normal.  Whether it’s implants or some type of flap procedure, the breast tissue, including nerves, is removed.  There’s little to no sensitivity and sometimes it feels like a foreign appendage on your chest.  So the boobs are new, they’re not necessarily improved and because I had a flap procedure instead of implants they’re really not all that perky.  Frankly I’d rather have the old, small, slightly saggy boobs any day.

Then there’s all the weird stuff you never know about until you or someone close to you goes through treatment.

Chemopause:  Chemotherapy shuts down the ovaries in premenopausal women causing chemically-induced menopause.  While not all women experience hot flashes and night sweats during menopause, each chemopauser I’ve ever known suffered from spontaneous combustion on a regular basis.  My family always knew when I was about to incinerate by the way I would whip off my bandana and fan my bald head.  More often than not I’d end up with two kids blowing on my noggin in an effort to cool me off.

Chemo Brain:  For a very long time this was considered the imagination of chemotherapy patients.  There have been many studies done, however, and oncologists now take it seriously.  Lack of concentration and forgetfulness are the results and it lasts much longer than treatment.  Five years used to be the magic oncological number, but now they’re finding it lasts far beyond that for some patients.  I deal with it and as frustrating as it can be at times, I can cover a multitude of forgetful sins by claiming chemo brain.

Lymphedema:  In breast cancer patients this is the result of either 1) having lymph nodes removed during lumpectomy or mastectomy to check for the spread of cancer; and/or 2) damage to the lymph system from radiation.  It causes painful and sometimes debilitating swelling of the surgical arm and there is no cure for it, only physical therapy to help reduce it.  It can occur weeks, months or even years after surgery and there is no guarantee it won’t eventually happen.  I’m thankful not to have lymphedema at this time and pray I never do.  Not all oncologists agree with this, but my doctor advises against any trauma to my left arm including shaving.  Again, praises for the invention of Veet.

It’s for this very reason that I decided to see my tattoo artist for laser hair removal of my underarms.  If you’re thinking Miami Ink, think again.  My “tattoo artist” is the medical aesthetician at my plastic surgeon’s office who tattooed my nipples after reconstruction.  Calling her a tattoo artist is misleading because all she knows how to do is circles.  I asked about flowers or Celtic knots, but she doesn’t have either in her repertoire.  As it happens, she also does laser hair removal so I decided to have that done.  It was well worth the searing pain and the money, though I have to go back for a touch up.  (Note to self: Remember the leather strip and shot of whiskey.)

Osteoporosis:  If a premenopausal woman’s cancer is caused by estrogen then it’s in that woman’s best interest to shut off the production of the hormone.  Oftentimes chemotherapy is enough to shrivel the ovaries until they die, but sometimes an oophorectomy – the surgical removal of the ovaries and a fun word to say – is required.  In my case I had to have the surgery which threw me into instant menopause.  It was like winning the lottery because I went through the symptoms of menopause three times in two years.  Not every woman is so lucky.  But yanking those puppies and cutting off the major portion of estrogen causes the deterioration of bone.  As my oncologist put it, it’s not a matter of IF I’ll get osteoporosis; it’s a matter of WHEN.  Thankfully there is a lot in the way of nutrition and exercise that can put it off.

Arthritis/Joint Pain/Stiffness:  Some chemotherapies and post-chemotherapy drugs can cause arthritic changes, joint pain and stiffness.  It’s kind of a catch 22.  The best thing for these conditions is exercise, but exercise can be difficult when you’re suffering from these conditions.  I try to walk at least 30 minutes every day yet I still hobble and wince every time I get up after sitting for 10 minutes or more.  I’m hopeful this will go away after I finish my post-chemo drug in two years, two months and a week or so.

Sexual Dysfunction:  I hate to bring this one up.  It’s just so personal, but it’s a very real fact.  There are a lucky few who never deal with this issue.  Then there are the rest of us.  This subject alone could be a whole series of posts but I’ll try to condense it into one paragraph.  There is the emotional side – self-image, fear of the disease, depression, fear of rejection.  Then there is the physical side, especially when the estrogen has been staunched.  Loss of libido, vaginal dryness, pain or discomfort.  Not every woman deals with every aspect but they are each valid problems.  It’s a hard knock when you go from a healthy sex life to no sex life seemingly overnight.  Sadly marriages have failed due to this issue.

There are also things that have no explanation, but are most likely caused by the chemical changes from chemotherapy. 

For several months after my reconstruction I had inexplicable skin problems that never were diagnosed even though I had several biopsies and saw a specialist.  I still have small breakouts which resemble hives, but only a few at a time as opposed to nearly 100 at one point last year.  The only thing my oncologist, gynecologist, dermatologist and specialist agreed on – it was most likely a latent result of the chemotherapy.

With each treatment of my second chemotherapy round I had a terrible case of thrush brought on by my dangerously low white blood count.  I would take Diflucan – typically prescribed for yeast infections – and swish and swallow a horrible tasting liquid containing nystatin and lidocaine and all would be well until the next treatment.  Ever since then my tongue has been continually swollen and I’m very susceptible to thrush.  When I haven’t gotten enough rest or I let myself get stressed my tongue, gums and interior cheeks swell up even further.  There’s no known reason for it so I just have to deal with it and hope it will eventually go away.

I didn’t know any of this when I started this unwelcomed journey.  Of course everybody is different and while some may experience low white blood counts, which suppress the immune system, others experience low red counts, which cause extreme fatigue.  Some patients may be ill through chemotherapy and lose dangerous amounts of weight while others, such as me, never get sick and actually gain weight.  You never know until you go through treatment how you will react.

The not knowing to me was always the worst part.  Not knowing what stage or grade cancer I had, not knowing my prognosis, not knowing how I would handle treatment, not knowing if my head was lumpy or if I’d look okay bald – the list is nearly endless.  There was one thing I knew from the very beginning, though.  God was with me and He was going to take care of me.  He took my fears and gave me peace; He took my uncertainties and gave me hope; and He showed me that there is humor in just about everything if I’d only look for it.  I honestly can’t imagine going through something like cancer without Him and I’m so glad I didn’t have to.






burn, baby, burn

October 8, 2008

So, I now have a radiation burn, right where the elastic of your bra would hit the skin. That means: no bra which means: no prosthesis. Not even any fluff. Yes, I’m Judy One Boob these days. I can’t even use the sports bra that kind of smushes Righty, the one boob that I have left to make it less obvious that I’m walking about with just one boob and then Notatata on the left side. On Monday, I wore a scarf to kinda/sorta camoflage the fact that Notatata was accompanying me. Today, I’m not bothering. I bought a camisole from Target just to keep the One Girl from flappety-flapping all over the place, but other than that, I’m not doing anything else. There just comes a time when you figure: if it’s obvious, it’s obvious, and “oh well.” I’m burned, it hurts, and my comfort is worth more than looking good. Besides that, I won’t heal if I wear bras and the prosthesis, which, by the way, does have a name. Oh yes, I saw on the side of her box that she actually has three names, but I can’t remember all three. They sounded kind of hoity-toity, all put together, but the first name is Harmony, so Harmony it is, and that’s how I refer to her. Harmony, however, is in her box for now and probably for the remainder of radiation. Dr. Radiation Oncologist (Dr. RO) gave me a prescription for burn cream that I’m to put on the burn twice a day, after radiation and before bedtime.

It’s amazing how going through all of this treatment and its accompanying side effects changes you. I never in a million years would have guessed that I would ever be somewhat nonchalant about going to work as Judy One Boob, but here I am. I say somewhat because I am still a bit self-conscious, but not so much that I’m trying all sorts of things to hide the fact that I only have one breast. I’m wearing a shirt that is more likely to hide that fact, but other than that, anyone who is the least bit perceptive would be able to tell. This is how it’s going to be, though. My skin needs to heal. No more “anything for fashion.”

I’ve gone through a lot with all of the treatment that I’ve endured. I’ve lost my hair, my eyebrows, my eyelashes. I lost the taste for a lot of food and drinks. I stopped drinking coffee during chemotherapy because I lost the taste for it, and since it’s healthier not to start up again, I haven’t. Not such a big deal really, but I was once a huge coffee drinker. I stopped drinking all forms of alcohol since the cancer spread to my liver and I want to, as I say, “protect my little liver.” My one friend wants my next CT scan to show that there’s no cancer in my liver so I can start drinking again. ???? Why would one necessarily mean the other? Why would a clean scan mean that I would start drinking again? Why should I start drinking again? I didn’t drink much before anyways. It doesn’t mean I won’t ever drink again; it just means that the decision rests with me, not with the results of a test and not with peer pressure. That seemed very odd to me.

I’ve lost a sense of innocence, I guess you’d call it — but maybe that’s not the right word. I don’t know if by that age I was really “innocent.” But I lost something. I lost assuming that I would live until a ripe old age. I lost many assumptions. But I gained an appreciation for life, and I gained the knowledge that life is a gift, that growing older and growing old period is a gift.

I got weak, then weaker. I took poisons, toxins into my body, toxins that would weaken me so that they would save me. I got bloated from the steroids. I would sleep most of some weeks away. I lost some time with my son to gain some time with my son. I gained more faith in the Lord. I got closer to God and closer to many people. More people came into my life, through my blog, through my church, and through my cancer support group. Through the chemo room. Through serendipity. I loved and I love more.

So here I am, Judy One Boob because of a radiation burn. It hurts. It seemed to come on suddenly. Dr. RO told me that those burns are fairly typical because they occur where skin folds are. So it makes sense that I would get a burn where there’s a skin fold is, where the bra would hit the chest, the elastic part of the bra. I have incredibly fair skin and very sensitive skin as well. My chart in the oncology clinic says that the nurses should use paper tape on my skin, but they don’t always check the chart and I don’t always remind them. It’s just the regular tape or a bandaid leaves a mark on my skin if it’s used. I tell them I’m a petite delicate little flower, and then they laugh heartily.

This burn is just a side effect, after all. Just a bump on the way to health. I’ll take it . . . as I’ve taken the other side effects, indignities, discomforts . . .

I’ll take them all

for more time.
Cross-posted to Just Enjoy Him.


September 19, 2008

When I was getting ready to start my second round of chemotherapy, Taxotere, my oncologist told me most people had an easier time with it than the adromycin/cytoxin I had been given for the first round. However, joint pain or stiffness is a common side effect.

I had my last Taxotere treatment at the end of November 2005 and it wasn’t until late February or early March of 2006 that I didn’t need a steaming hot shower to loosen up enough to walk half way normal. Still, I have dealt with a certain degree of stiffness ever since.

After the chemo I was put on Tamoxifen. When my estrogen levels finally came down following the removal of my ovaries last year I was switched to Arimidex. One of its side effects is joint pain or stiffness. Mornings and late evenings are the worst, making my fingers hard to manipulate.

So this is my new Arimindex prescription:



Crossposted at Jenster’s Musings

Alpha Males are Hot

September 18, 2008

How’s that for a title?  I wonder what kind of hits it will get.  heehee

Some friends of mine are coming to the Philadelphia area in October.  They’re only going to have less than a full day in the city and one of them asked about what they should plan on doing.  She mentioned they want to at least see the Liberty Bell.  I concur.  It just seems wrong to be in Philly and not see the Liberty Bell.

So I sketched out a plausible itinerary and told her that, contrary to National Treasure, the Liberty Bell is not in Independence Hall anymore.  I also mentioned it’s free, but you have to go through a security line which rivals that of airport security.  And then I remembered…

July of 2005.  Todd had been living and working in Pennsylvania for two months by this time.  Wanting to take the kids to Pennsylvania so they could see where we would eventually be living, I had asked my oncologist if I could fly.  “Not just no, but absolutely no,” was her reply.  To say I was disappointed is a huge understatement.  If I’m not mistaken, I cried to my mom when I told her.  It was definitely one of those “I hate cancer” moments, which is pretty silly when you think I wouldn’t have been in that predicament to begin with if it hadn’t been for the stupid disease.

Either later that day or the next my mom called me back and said she and my dad had been talking and if it was okay with my doctor they would drive me and the kids the 1200 miles to hang out with Todd for a week.  My oncologist thought that was a brilliant idea.  So plans were made for us to drive to Pennsylvania the day after my third treatment.

The week before number three my white count was low, as usual.  I received the Neupagen shots and the doctor told me whether I got treatment the next week or not, I was to go visit my husband and have a grand time.  Wednesday, July 13 my counts were perfect, I received my chemo, and the next morning we were off on our adventure.

A 1200 mile road trip the day after a chemo treatment is probably not the best time to travel.  Then again, it wasn’t so bad.  The worst part was all the water I was drinking to flush my system which meant frequent stops.  But we made it and it was wonderful!  Here are my calendar entries:

Thursday, July 14:  Drove all day!!!  slept and stopped a lot!

Friday, July 15:  Arrived PA!  Yay!

Saturday, July 16:  Tour of control room w/ Tom – very interesting.  Drove around and looked @ waytoo big houses.  LOL  Filly [sic] Cheesesteak from Pudgies.

Sunday, July 17:  Went into Philly.  Took City Trolley tour.  Can’t wait to explore the city further.  Italian from Bertucci’s.

Monday, July 18:  KOP Mall – Big lunch @ Rock Bottom Breweries.

Tuesday, July 19:  Leave for home.  I drove mostly.

Wednesday, July 20:  Drove the rest of the way home.  Whooped by that time!!

Thursday, July 21 is a list of my blood counts, each one followed by a frownie face because each one was low, and the notation Felt crappy all day!  Between my full calendar and my blood work it’s obvious I overdid it.  But I didn’t care in the least because it was so well worth it!

And now we get to the reason for the title.  As the Sunday entry states, we went into Philadelphia for the day and took in the Liberty Bell while we were there.  The whole time I was bald I never wore a wig, preferring either hats or bandanas.  This particular day I sported a navy blue ball cap with a pink ribbon on the front, thinking it would make the reason for my baldness obvious.  When it was my turn to go through the metal detector the security guard told me to take off my hat and put it on the x-ray belt.  At first I didn’t understand what he was telling me.  I knew he couldn’t be telling me to expose my baldness to the masses.  That would be so insensitive.  Besides, what in the world could I be hiding under my hat?

Turns out he WAS telling me to expose my baldness.  Todd started to argue with him, but I figured that would just make a bigger scene.  So I took off the hat, tossed it on the belt and walked through.  I remember looking down as I walked through so I wouldn’t have to see anyone staring at me.  I may have been red with embarrassment, but Todd was red with anger.

The ball cap was so light it couldn’t push through the plastic curtain so Todd reached in, snatched the hat and said something to put the security guard in his place.  I didn’t hear it, but the dude had the good grace to look chagrinned.  And I have to say, seeing my husband go all cave man on my account was kind of exciting.  Just like the Alpha males in the romance novels I like to read some times.