Why Double Mastectomy?

A guest post by an anonymous writer, which will be an ongoing series. 

Please join us on her journey!

Many people have been surprised that mastectomy would EVER be a treatment for Stage 0 breast cancer.  Honestly, I was as well. I had the idea that it would be a simple, non-invasive procedure that would be complete in a matter of days, not months.  I now understand it and do believe this is the best course of action for me.

The standard of care for DCIS is generally lumpectomy or excision biopsy followed by possible radiation and Tamoxifen (a hormone blocker), depending on hormone receptor status.  I am hormone receptor positive (ER+/PR+).  Additionally, I have six centimeters of affected tissue and am very small breasted.  Of the two (of six) spots biopsied, one tested mid-grade and one tested high-grade.  High-Grade DCIS may have a higher chance of developing into invasive cancer than low-grade DCIS.  Overall rates of DCIS patients developing invasive cancer, if not treated, is 36-50% depending on the study.  Standard of care if it does become invasive is then surgery followed by chemotherapy.

There are many options for DCIS.  It is sometimes over-treated (immediate surgery followed by radiation, which has shown marginal benefit)

Options for treatment include:

• Active Holistic Surveillance - "watch and wait approach".  DCIS is managed by frequent follow-up scans as well as diet and lifestyle changes
• Lumpectomy or biopsy excision only
• Lumpectomy or biopsy excision with radiation
• Lupectomy or biopsy excision with radiation and Tamoxifen
• Mastectomy on the affected side or both with or without reconstruction.  Sometimes radiation and Tamoxifen are recommended depending on the case.

Chemotherapy is not generally recommended.

I did my research.  In the beginning, I thought I might be a candidate for Active Holistic Surveillance.  In the end, I decided against this option.  I could not find a doctor to monitor me in my area. The holistic practitioners near me do alternative therapies in conjunction with standard of care.  I am not comfortable taking this approach without monitoring by a doctor.

I then thought I was a candidate for lumpectomy without radiation or Tamoxifen.  I decided this was a good option, as I did not want radiation or Tamoxifen under any circumstances, given the possible side effects.  I would simply deny those treatments.

After I found out I had six centimeters of affected tissue, mastectomy was recommended (with the removal of one lymph node to test for invasive cancer to be sure invasive cancer is not present).  This is for a few reasons.  One reason is that with a large percentage of the breast affected, cosmetic result is poor.  Another reason is that the surgeon wants to make sure to have good margins.  I went back and forth between thinking this was a good idea.  At first, I considered only having the mastectomy on the affected side.  My doctor told me it was totally up to me, but that he did not recommend a double mastectomy.  I went for a second opinion and that doctor did recommend double mastectomy with removal of 2 or 3 lymph nodes.   

In the end, I decided on double mastectomy for the following reasons:

• I was not comfortable, in the end, with having an invasive cancer risk of up to 50%, if I considered Active Holistic Surveillance.  That is a LARGE risk to take, especially being young and having young children.  I thought of it like this.  If someone told me if you do X or keep doing X, you will have a 50% chance of invasive cancer, I would change immediately.  How would this be any different?  Get rid of the affected tissue to reduce that risk to minimal.
• I had read many accounts of people who did a lumpectomy on a large area and were very dissatisfied with the result - even people who thought they would not care about the cosmetic result (like me).
• I read many accounts of people choosing a single mastectomy and later going back to have a mastectomy on the other side.  I do NOT want to do this surgery more than one time in my life.  
• I wanted complete symmetry.  If I am having a mastectomy with reconstruction, I may as well go up a cup size to where I feel most comfortable.  I could have an implant and possible lift in my unaffected breast, but I am not convinced it would provide complete symmetry.  The good news is I am a good candidate for nipple-sparing mastectomy unless the surgeon finds cancer cells on the back of my nipple during surgery.

I realize I do not have to do a double mastectomy, but it is the option I feel most comfortable with.  I also realize that mastectomy does not prevent future breast cancer.  In fact, this is one reason many cite for choosing Active Holistic Surveillance.  However, with mastectomy, the risk is reduced from 36-50% down to around 3%.  My doctor will monitor the remaining tissue (about 10% of breast tissue that is not removed).  This is standard for mastectomy now, as "radical mastectomy" is no longer standard of care for most breast cancer and poses too many risks. 

This was a difficult decision for me to make.  I did my research and felt the most comfortable with this choice.  I am at peace with this decision and am ready to face whatever challenges will come.  Recovery is going to be a long road.  I do not naively believe it will be easy by any means. However, I can do it with help.  I went to a support group today and was told that total recovery can take up to a year.  It will be okay.  I can do hard things!

Read other posts in this series:
Maxed Out Minivan

To start at part one go here:
Part 1: Stage Zero What?

Broken Things Beautiful: A DCIS Stage 0 Breast Cancer Story Part 1 - Stage Zero What?

A guest post by an anonymous writer, which will be an ongoing series. 
Please join us on her journey!

So here I am, two months and one week into my diagnosis with DCIS. In short, DCIS (ductal carcinoma in situ) is a cancer inside the milk duct(s) that is not invasive, therefore considered stage 0. However, it can, over time, invade other breast tissue or grow into invasive cancer. So the practice today is to take it out. This is my story. It is a story (I am determined it will be) of broken things made beautiful. Thank you for coming along with me. 

Since November 9, the day of my diagnosis to today, my "best treatment option" went from a simple, small lumpectomy to mastectomy (recommended by two doctors). I am currently trying to make sense of this and make the best decisions I can regarding treatment. 

Timeline:

August 2016: I turned 40! It was a big milestone and I was SO happy with my post-pregnancy body. I celebrated and wore a dress (probably a style too young for me) out to dinner with my friend and decided that 40 was a great age to be! 

February 2017: I had my first mammogram. I was not concerned in the least. I am healthy and always have been, so I had absolutely no question that everything would come back normal. An hour after I left the mammogram, I was called by the imaging center and asked to come back the next day. At that appointment, the technician told me that small calcifications (tiny salt-like crystals) were found in my right breast and need to be monitored. I was asked to come back in six months. Again, I was not concerned and assumed it must be due to changing breast tissue from weaning along with hormone changes.

October 26, 2017: I went for my follow-up mammogram (two months late) and was told that the calcifications grew. I was told that most times they are obviously nothing and sometimes they are obviously cancer but that mine fell into the grey area so a biopsy would be needed. I was told this very seriously. The nurses and radiologist seemed very surprised that I was calm and that I didn't ask any questions. I didn't freak out/cry/awfulize, which many people must do. They were slow to speak, soft-spoken and gentle as if I should be upset. I wasn't. I honestly thought "oh well, I am sure it is nothing". In fact, I went home and told my sister who was visiting and nonchalantly said "the calcifications grew so I need a biopsy" and "worst case, I can get new boobs", not knowing what was to come!

November 2, 2017: I had my needle biopsy. Again, the doctor and nurses were surprised that I was calm and no one came with me. I was even joking with them during the procedure. I was thinking "what is the big deal"? People get biopsies all the time and most often it turns out to be nothing. Calcifications are often nothing to worry about. After the biopsy, I went home and mostly didn't think about it until I didn't get results by November 9, as I was told I would have results by November 6.

November 9, 2017: I was going to call to get results that morning, but my OBGYN called me before I had the chance to call. He told me the news and later a nurse called to give me a referral to my current doctor, a surgical oncologist. I was in shock but I still didn't believe anything other than they would take it out in a minor procedure (I am overly idealistic until I have a reason not to be). After all, it is tiny salt-like crystals, stage 0 and non-invasive, so what more could be necessary? At this point, I had not done any research on calcifications or DCIS so I did not even know mastectomy was ever done for this cancer.

November 15, 2017: I was told by my doctor at my initial appointment that usual treatment for DCIS is lumpectomy followed by radiation and Tamoxifen for five years (a hormone blocker), for patients with positive hormone receptors (which I have). Some patients refuse radiation and Tamoxifen, so it seemed like an easy fix in my mind. I was also scheduled for a second opinion mammogram and breast MRI, which the doctor said would give him a more complete picture in order to come up with a treatment plan. This entire time, I was under the impression that I had one milk duct affected and would deny radiation and Tamoxifen, in that case, because of side effects. I went to the MRI and mammogram on November 27 and November 30, respectively.

November 30, 2017: All of my understanding of my case changed! I waited a long time to get the mammogram, then I waited another 90 minutes to see the radiologist. She told me that the original films showed three more affected areas and mentioned breast conservation. I said "wait...what? I thought there was one tiny spot. Are you talking about mastectomy"? She said, "Yes, that is the recommended treatment with so many spots, but you can talk to your doctor more about that". She said that some people go ahead and schedule the mastectomy with no further testing, given that the spots look similar enough to the original spot to assume they are also DCIS. However, if biopsied may show benign if concerned about breast conservation.

I was so floored how much changed in a matter of minutes. I couldn't care less about looks, but considering I am still nursing my son and didn't want to wean abruptly I was not quite so accepting. My plan was to have a lumpectomy and nurse on the unaffected side. I then went upstairs to my doctor and waited another hour in the waiting room and 30 minutes in the office, with may questions and concerns. 

I was told that the other spots look like DCIS and if I want to consider breast conservation I can opt to biopsy another spot and see if it is DCIS or benign. I asked if he could biopsy all three. I was told that if I do need a mastectomy, it is skin and nipple sparing, so that was the good news. Also, no radiation or Tamoxifen would be needed. 

December 15, 2017: I went in for my second biopsy. It was a core biopsy and AWFUL. I had two spots taken. The samples were huge dime sized sphere shaped samples and the biopsy took about an hour, awake in an uncomfortable position. The biopsy left marks about 1/16 inch by 1/2 inch rectangles, which will be scars.

December 20, 2017: I went to see my doctor to go over biopsy results and come up with a plan for surgery. I never saw my doctor, only the Nurse Practitioner because my doctor was in surgery. I was told that the biopsy came back positive for DCIS so the best option is mastectomy on the right breast. Some people opt for surgery on both sides, but it isn't necessary because there are other options for symmetry (slight lift, small implant). Insurance has to cover any and all options for both sides. I was also told the process, which seems terrible. Mastectomy surgery is only one inpatient night (I was hoping for more). Reconstruction starts immediately after mastectomy (same surgery) where saline expanders are places and filled with saline every so often until healing is complete and skin and muscle are stretched enough for reconstruction to be completed (usually 8-12 weeks). I also have to wear drain bags after surgery for up to a month and will take about six weeks to heal. I was set up to meet with the plastic surgeon January 10.

The options for surgery are:

• do one side or both, with or without reconstruction (seems like a long ordeal)
• with augmentation or not
• do one side only with a small procedure for symmetry

The Nurse Practitioner was great and I did get a lot of questions answered, though it wasn't as helpful as I had hoped. I was hoping for a clearer best decision but only got more confused. After my appointment, my doctor sent me a text apologizing for not being able to see me and giving me some information. I was impressed. I have never had a doctor text me!

January 10, 2018: I had my pre-surgery meeting with my doctor who answered more questions regarding my specific case. I felt better about mastectomy, but still had some doubts, so I decided to get a second opinion from another top surgery oncologist. I was unable to meet with the plastic surgeon and my appointment was changed to January 12 (which was later changed to January 16, then January 17). 

January 16, 2018: I met with the second opinion doctor and she answered even more questions and recommended bilateral mastectomy (both sides), but said it was my decision. This gave me more confidence that mastectomy is the only choice.

January 17, 2018: I met with the plastic surgeon and went over my options. He told me the same options I was previously given and told me if it was his wife he would recommend doing bilateral mastectomy with reconstruction, but that isn't necessary because there are other options for symmetry. I was told that it is actually three surgeries (during mastectomy, 8-12 weeks later for reconstruction completion and later for an adjustment). I will also have 2 drain bags on each side for up to a month (one is taken out after a week or two). He also told me that when I wake up from the surgery with the expanders, I won't be totally flat and "in fact will look arguably better than you do now" (with my natural breasts...gee thanks! I think they look pretty awesome, albeit small, for my age and having birthed and nursed three kids). 

Surgery will be scheduled for February and I have to make a final decision about the left breast soon. I am working on weaning, which is going relatively well, but still difficult. I have had so many thoughts and feelings about this. I cannot believe that I have to go through this for several salt sized crystals. The problem is that I am so small it would be near impossible to take out all of the affected tissue with lumpectomy and get good margins and a good cosmetic result. In addition, radiation and Tamoxifen would be recommended. Tamoxifen would also be recommended if I decide to have a mastectomy on only the affected breast. It is ironic that this is happening to begin with, given I nursed my kids for over seven years collectively! Nursing is supposed to greatly reduce the incidence of breast cancer and I don't know anyone who nursed that long!

In dealing with the options, I am tired of people saying "just do both" like this is an easy decision. It isn't. However, I am leaning that way just to avoid possibly having to do this again in the future, Additionally, I can look a bit better (would go up from barely a B to a full C). I don't actually care very much about what I look like, but if I have to go through this, I might as well get something to better fit my body. I feel terrible about this too because I hate the idea of waking up with totally numb, useless breasts that have no purpose besides looking nice. It's a lot to go through to look nice. I would rather be whole and have useful breasts that have feeling in them. Anyone who thinks that early detection means simple is wrong. It is still hard and complicated, just not so much treatment is needed and it isn't life threatening (Thank God). 

The most amazing thing through this whole ordeal (so far) is that I have been positive and practical most of the time. I only cried three times, so far. The first day was November 30 at the thought of weaning abruptly. Two other times I cried after appointments. Most of the time I don't think about it much and go about and enjoy my life. I'm so grateful for the simple things. All of my friends and family who know what I am going through are totally surprised by my attitude about it, so that's something. 

I am still convinced that this experience will turn out, in the end, displaying more beauty than pain.

After all, God makes broken things beautiful! 

Read other posts in this series: 
Maxed Out Minivan

Thirteen Reasons It Could've Been Me (but wasn't)

In my last post Thirteen Reasons Why I Hated This Show, I talked about why this show was not my cup of tea. Many readers may have thought "What does she know? She probably can't relate to being raped or bullied. She probably had a perfect life growing up." I am here to tell you that is not so. I had much worse happen to me on top or being raped and bullied. My ACEs (Adverse Childhood Experiences) score was very high, yet I made it through somehow and am a well-adjusted and productive adult.

Here are my 13 reasons why it could have been me but wasn't:

1. Age 9-my sister and father both died suddenly within 6 months or each other.
2. Age 12/13-all of  7th and 8th grade my sister and I had the nickname lesbian twins.
3. Age 13-my mother remarried.
4. Age 14-witnessed stepdad being arrested for selling marijuana.
5. Age 14-my first sexual experience, never even been kissed, and I was raped by a boy I just met that day. The next day at school I earned the reputation of being easy, since I would sleep with someone I just met. 
6. Age 14- earned the nickname "black and decker pecker wrecker". I made out with a much older boy and when he went to school the next day his neck was covered in hickeys. OOPS! 
7. Age 14-I got wasted and was molested in the back seat of a car by a 7th grader.
8. Age 15-Black and Decker guy had sex with me at a party immediately after having sex with my friend. I didn't know at the time and actually thought I was his girlfriend. At school, I was teased about "sloppy seconds". 
9. Age 15-got my first real boyfriend, gave him sex and blowjobs willingly only to be dumped 2 weeks before prom. He took one of my friends instead. I spent 2 weeks crying in bed. Everyone at school still thought I was slutty.
10. Age 15- had a one night stand with Black and Decker guy. The next day he went to school and told everyone I smelled like tuna.
11. Age 16-I was raped for the second time. 
12. I witnessed drug/alcohol use in my home throughout my teens.
13. I was called stupid bitch almost daily throughout my teens.

This is not my whole story, just 13 things that could have pushed me over the edge but didn't. I don't know how I made it through all these events, but I do know I was not going to lay down and quit at life. I knew logically all of it was temporary and would be over when I graduated and that then I could start over. I am happy to report that I have a very happy life, 5 gorgeous kids and a great husband of 20 years!

 

Do you want to read my whole story? If so tell me in the comments. I just may write a memoir of my life. 

Thirteen Reasons Why I Hated This Show

After a never-ending slew of people either raving about or revolting against this show based on the book by Jay Asher, I decided I had better check it out to see what all the fuss was about. I have to say I was not impressed.

In the spirit of the subject, here are my thirteen reasons why.

1. Bullying does not cause suicide. Experts agree that there needs to be an underlying issue such as abuse and/or neglect or mental in order for bullying to trigger a suicide attempt. 
2. Hannah is a mean whiny girl. She can be just as mean as the people she accused of bullying her, including the one person who cared about her deeply.
3. The parents blame the school. I am sorry but the so called bullying Hannah experienced was so subtle there is no way the school staff could have caught it especially since she never went to turn anyone in. Suing the school will only hurt the students left there.
4. Most of what happened to Hannah is typical High School bullshit. These things happen to just about every high schooler at some point. Rape is the only exception. 1/4 of high schoolers have been raped and that many to not commit suicide. 
5. What Hannah did making the tapes is vengeful and vindictive. Leaving the tapes behind is cruel, just the same as the bullying Hannah experienced. To get revenge from the grave is not right. It helps nothing.
6. Rape does not cause suicide. If it did, 1/4 of kids would be dead. 
7. The suicide is too graphic. There is no reason to show Hannah slitting her wrists and blood spurting out. It would have sufficed to show her in the tub with the razor blade, then a painful face, then her dead in the bloody water.
8. Alex's suicide is not a realistic scenario. Guilt about a list would not make him do that.
9. This show should not be touted as an educational tool. It is more for entertainment if you ask me. 
10. The beating of Clay was just too much. I do not understand why this had to be shown. 
11. This show glorifies drinking and drugs. The show portrays this all to be a great fun part of high school. None of it has to be. High school can be a lot of fun without drinking and drug parties. 
12. This show glorifies rape. Showing the rapes makes it look like a fun thing to do and may turn some boys on and give them the idea.
13. This show glorifies suicide. Hannah gets so much attention, care, tears shed over her, and love after the suicide and paints her as a heroin, so much that some teens may fantasize about all the attention they will get if they commit suicide, and it will drive them to do it. 

There you have it. My opinion about this awful show. Tell me what you thought of the show in the comments.

Twins-A Blessing or a Curse?

Are twins a blessing or a curse?

The first 31 years of my life, if I had been asked this, I would have said a curse. I grew up with an identical twin sister and I always felt as if I never measured up to her. She was the leader and I was the follower. She was the smart pretty thin good twin. I was the dumb ugly fat evil twin. She was always better than I was in every way. By the time I was 32 I would change my mind and say twins are a blessing.

I was at my twelve-week prenatal appointment and everything checked out great. The doctor asked if I had and questions and I asked her if I was measuring big because I was showing a lot and had gained twelve pounds already. She said I was measuring where I was supposed to and that it was probably because it was my fourth pregnancy in quick succession. She told me we could do a dating ultrasound to be sure I wasn't farther along than I thought I was.

I knew for a fact my due date was correct because I had been keeping track of ovulation. I reluctantly agreed. As I walked to outpatient scheduling I thought "this lady is stupid, my due date is not off." I scheduled the ultrasound for the following week anyway.

The day of the appointment I almost just didn't go. I would have to pick up a babysitter, take a one, three, and five year old out by myself and have them sit in the tiny radiology waiting area with the babysitter during the ultrasound. I was thinking "This is such a waste of time, I know my damn due date is correct." I went anyway. That's when things got real!

As I lay on the ultrasound table and the ultrasound technician started to scan my already huge belly I saw two babies on the screen and nearly screamed "NO ******* WAY, THIS CANNOT BE TRUE, KILL ME NOW." I stayed silent and waited for her to say something. She then said in the most cheerful of voices "oh, look, two babies!" I snapped "I know, I saw that already!" She kept talking incessantly about all the cool stuff she was doing but I was too pissed to look and just stared at the ceiling. When she said " Here is baby A's heartbeat, here is baby B's heartbeat," I snapped "I do not want to look at any of this crap, just do whatever it is you need to do so I can go home." I spent the next twenty minutes staring at the ceiling, pissed as hell, having racing thoughts about what this meant for us.Thankfully she was silent the rest of the time until she asked if I wanted pictures. Of course, I did because how else was I going to prove that it was true to myself or to my husband?

I told my twin sister I was having twins and that they were due on September 21st, 2008. She thought it was so cool and said that maybe they would be born on our birthday which is August 15th. I told her that would be impossible since that was 5 weeks before they were due and it would be too early. What are the chances?

I was pretty upset for the first few weeks. I wanted 4 kids not 5, and surely not twins. I didn’t want them to have the experience I had of competing with a twin and always feeling inferior. However, as the weeks passed I got used to the idea of having twins. I started telling everyone we were getting a bonus baby. I loved and wanted them both and talked to them constantly, and when there were growth issues with one of them I would tell her “come on baby grow”.

My water broke abruptly on August 14th, 2008 at 10 PM and by 2 AM August 15th they were here! YES! They were born on my and my twin sister’s 32nd birthday! What are the odds of that? Well, according to the Minnesota Twin and Family Study it is a 1 in 3.8 million chance! WOW!

After being flown on a life flight to another hospital they spent a short 6 days in NICU then were sent home. Caring for them was much harder to do than it had been with all my others. I had never had a preemie and never two babies at once. I slept very little and spent all my time nursing two babies. They grew and thrived. They were fun babies, very content and quiet. As toddlers, they found ways to get in trouble together. As preschoolers there was a lot of fighting, scratching, biting and hair pulling. There was also a lot of laughter and play. As kindergarteners and first graders they were in different classrooms and began to come into their own. It was a little sad for me to send them to school, since they are my youngest children, and to start seeing them more as individuals than a pair. It has been very good for them though.

Today my twins are eight years old and about to enter the second grade and if you ask me now if they are a blessing or a curse, as a mother of twins, I would say a blessing. We still call our youngest twin our little bonus baby!

What do you think? Blessing or Curse?

Tearing Down the Walls

The day after Trump became president my daughter went to school crying because she was sure her Hispanic friend would be sent back to Mexico.

That very day at the bus stop a group of kids were chanting "build that wall" over and over to a group of Hispanic children.

Families and children are afraid and confused. People are being bullied, mistreated and abused.

This hate has got to stop. It seems hate is being encouraged these days.

Here is a novel idea. Instead of building new walls of exclusion, how about we tear down some existing ones.

There are many groups of people that have walls they need to get over in order to be accepted.

Just to name a few: those with mental illness, those with disabilities, those with addiction issues, minority races, the LGBTQ community, those of different religious beliefs, those that participate in social programs and more.

America is a melting pot. It was meant to be a place of acceptance for all people. This is not the America I see today. It is not what it should be. ALL of us need to start to tear down these walls that separate us instead of creating new ones. Although they are invisible, they are a barrier as strong as any physical wall could ever be.

Can we love all people? Can we accept those that are not like us? Can we see and try to understand their struggles? Can we include them? Can we give it a try?

Let's all do that. Let's start today!

ADHD in Aisle 3

Last week 3 of my children had dentist appointments 20 miles from my home in the town I usually do all my errands. I usually do errands alone to avoid behavior problems, this time, however, in order to save a trip back to town, I decided to do my errands after the dentist appointments. Keep in mind we were at the dentist for 2 hours.

After the dentist, we went to Target to get a few birthday gifts for parties coming up. After Target my 13-year-old son and I needed hair cuts so we went to Great Clips. My other son who is 9 years old and has moderate ADHD started getting antsy and was peeking behind the curtain to see me, standing on a chair, wandering back and forth from the product shelves to the opposite wall. All the while, my 7 yr old daughter was sitting nicely and being quiet. By the time the hair cuts were completed we had been gone for four hours.

Looking back, I now see the error of my ways.
I guess I should have known better than to think my 9 yr old could make it through another store, judging by the way he acted at Great Clips, but I pressed my luck. Next stop, the grocery store.

We began the shopping trip with the kids each being asked to retrieve a grocery item. I allowed them to choose fruit and put things into the cart to keep them busy. Five minutes into the trip, my 9-year-old started running. I begged, I pleaded, I nearly cried.

After a bit, I grabbed his neck so he would look at me and quietly said, "Please slow down." This is when things got a little out of hand. We only had dairy and frozen left to get through, so I thought we could manage. He immediately began walking is super slow motion. He loudly said, also super slowly "I can't keep up." He looked ridiculous and I was mortified. People were staring. Others were shaking their heads as if to say "She can't control her own kid." I ignored all the looks and told him I was not waiting and the other kids and I went to the frozen foods without him.

Eventually, he showed up. I assumed this would be the easy part because I was allowing each of them to choose a TV dinner, which I rarely get. He chose his quickly then decided it would be a good time to begin writing the word "poop" on every freezer door since I was distracted trying to choose dinners for myself, my husband, and the 2 kids left at home. I had no idea he had done this until he had written it on every freezer door in that aisle. I held onto him while my 13-year-old went to all of the doors and rubbed the word away.

This concluded the shopping and all the kids were super helpful putting the groceries on the belt, but then after they were done, the 9-year-old was goofing off at the end where everyone walks through and he was getting in people's way.

What people do not understand is that ADHD kids do not have the same impulse control as the rest of us and often display behaviors 3-5 years behind their actual age. He will be 10 in July. Yes, he looks like a normally developed 5th grader. But behavior reflects that of a 5-7-year-old. It seems as if he has bad parenting. I will tell you, none of my other kids act like that. I actually spend double or triple the amount of time correcting his behaviors than I do on the rest of the children. He really is a very sweet kid with a ton of amazing qualities. They are just difficult to see through all the rambunctious behavior.

Next time you see a seemingly normal looking child acting out at a store, keep in mind that there is maybe something you do not know that can not be seen. Consider that this tired mama works hard to help her child overcome these obstacles but can not possibly stay on top of it every second of every day. Consider the daily struggle this family encounters and the judgments by others they face. Above all else, recognize the treasure each child is and realize there are probably amazing things about this "terror" that you are not seeing. It makes me very sad that people can not see the amazing kid under all of the crazy behaviors. I am the only one who really knows him. Let me tell you-I am oh so blessed!

Do you have a child with struggles that are hard for others to see? What are your solutions?