The Leukemia & Lymphoma Society Blog

A Story of Hope and Persistence

communityreply@lls.org — Mon, 16 Nov 2009 17:40:54 GMT

John Haluck became part of the LLS family almost a decade ago. He is now a trustee of the Greater Sacramento Area chapter and is not only a survivor but is a huge supporter of LLS.

When I was diagnosed with chronic lymphocytic leukemia (CLL) in 2000, I was no stranger to leukemia, having lost a good friend to the disease. Still, going in for a routine physical and finding out I had an "incurable" form of cancer was a massive shock to both me and my family. I looked at my three kids and I wondered if I would be around to see any of them graduate from college or get married. It was the worst weekend of my life.

My doctor recommended a "watch and wait" approach, since my form of leukemia was chronic, not acute, and some people have lived twenty years with CLL.

However, my cancer progressed much faster than my hematologist could foresee. By 2004, he recommended that I start chemotherapy soon, as the cancerous lymphocytes were increasing in number and could cause a stroke. He told me that there was no hope for a cure and advised me against looking for a clinical trial.

By this time, I was volunteering with my local chapter of The Leukemia & Lymphoma Society, chairing and helping organize the annual Light The Night Walk. I also learned about a doctor who has been funded by LLS and does leading edge research in CLL - Michael Keating, MD, at the MD Anderson Cancer Center in Houston. I contacted him and heard back immediately - he would see me as soon as I was ready.

The morning after the Light The Night Walk, I boarded a Southwest flight for Houston. After a battery of tests, I waited to see Dr. Keating. In walked this big, burly man (a rugby player, no less) who grabbed my hand and then gave me a big bear-hug. To my surprise, he said, "John, I think that we have a very promising treatment for you!"

I called my wife, who flew in, and I started a clinical trial the next day of a new targeted drug, Rituxan®, which was developed with the help of funding from LLS. The rest is history. After four days of therapy, my white cell count had dropped to normal! A week later, the lumpy cancerous lymphocytes had disappeared from my lymph nodes. It was happening just as Dr. Keating had described.

Now I've had 53 months in complete remission. I feel a debt of gratitude to Dr. Keating and LLS, whose funding helped make Rituxan a reality. I have my life, and am able to enjoy it. And I have hope!

-- John Haluck

You can also listen to a short audio clip of John sharing his support of LLS.

If you've been diagnosed with a blood cancer, LLS is here for you:
To speak to an information specialist, call (800) 955-4572, chat online at www.lls.org, or email infocenter@LLS.org.
Find peer support on the Blood Cancer Discussion Boards.
Support the fight against blood cancers with a tax-deductibe year-end gift to LLS.

Basketball Legend Kareem Abdul-Jabar Diagnosed with CML

todd.whitley@lls.org — Thu, 12 Nov 2009 22:51:21 GMT

This week the public was shocked to learn that one of basketball’s most famous players had been diagnosed with early stage chronic myelogenous leukemia (CML). Kareem Abdul-Jabar, NBA hall of famer and a former player with the Los Angeles Lakers, was diagnosed with CML last December. Abdul-Jabar is known for being an intensely private person, but he decided recently to go public with the disease to shine a spotlight on CML. In an interview with CBS News (see: http://www.cbsnews.com/stories/2009/11/10/eveningnews/main5605532.shtml) he shared that his intention for sharing his diagnosis with the public was to give a message of hope and that he intends on continuing to live a normal life.

A key reason why he can live a normal life is because he takes daily oral medication for his CML. While he has not revealed what drug he is taking, most people diagnosed with CML are started on Gleevec®, a drug that was developed several years ago through LLS-funded research by Dr. Brian Druker (as you may recall, Dr. Druker and two colleagues were recently awarded the prestigious Lasker~DeBakey Clinical Medical Research Award for their work on Gleevec). Gleevec was a big breakthrough in treatment for CML, and now there are two other oral medications that are also approved to treat CML. Today many people who have early-stage CML are doing great -- thanks to staying in treatment -- and seeing their doctors regularly to make sure their medication and dosage are still the best choices for them.

What is CML?

There are four different types of leukemia, which means that receiving a leukemia diagnosis does not mean that every patient’s experience will be the same. Chronic myelogenous (or myeloid) leukemia is a slow-growing blood cancer that is more commonly diagnosed in adults, although some children do get CML. There are several different signs and symptoms of CML include a high white blood count, tiring more easily and having night sweats. However these signs and symptoms do not mean that a person has CML since they can be associated with other more common conditions. We always recommend that if you suspect that your health is not what it should be that you talk with your doctor. Learn more about CML on www.lls.org.

If you or someone you know has been diagnosed with CML and you are looking for information and support, you may access several of our free resources listed below.

Download or order any of the following free education materials

Chronic Myelogenous Leukemia (CML)

The CML Guide: Information for Patients and Caregivers

My CML Tracker (An online tool)

Find Support from LLS or those living with CML

Information Resource Center – Call 1-800-955-4572 or ask us a question online

Co-Pay Assistance Program

Family Support Groups

LLS Blood Cancer Discussion Boards – Living with CML

As Abdul-Jabar says, there is hope for those who have received a CML diagnosis. If you have a positive story to share about your experience with CML we encourage you to post it on The Leukemia & Lymphoma Society Community in the Tell Us Your Story section as inspiration to others.

Clinical Trials and Transportation Barriers

communityreply@lls.org — Mon, 19 Oct 2009 18:00:39 GMT

The following post is from our Public Policy department.

Currently, only 3 to 5 percent of adult cancer patients participate in clinical trials. The leading reason for the low participation is barriers that hinder access to clinical trials. The Leukemia & Lymphoma Society (LLS) is pursuing several avenues to increase patient access to clinical trials so that blood cancer patients can have access to all of the treatment options available to combat their disease.

In February, patients were asked in this forum to share their personal stories about one of the potential barriers to enrolling in clinical trials: health insurance coverage. Specifically, we asked if, and how, insurance company denial of coverage for enrollment in a clinical trial might have influenced their decision whether to participate in a trial. Now, LLS is searching for personal anecdotes about how patients have been affected by other hurdles to patient participation in clinical trials: transportation and communication.

Some clinical trials are only conducted at one institution, or at locations that require travel on the part of the patient, making transportation to that location for treatment and follow-up care a major concern, and a barrier for participation, for a number of patients.

In New York, LLS is pushing legislation that would break down these barriers to clinical trials access. Bills introduced in Albany by Assembly member Dick Gottfried (A. 1805) and Sen. Tom Duane (S. 4492) would create a state grant program to cover costs associated with clinical trials education and transportation, and patient navigation to find out about available clinical trials. Organizations such as LLS would then apply for these funds to provide financial assistance to patients in need.

LLS would also like to address this issue nationally. To do this we need your help in gaining a better understanding of how many blood cancer patients are being affected by transportation and communication issues. How many more patients would be willing to enter a clinical trial if they simply knew they were being offered? How many know about a clinical trial that would help their disease, but cannot afford to travel to the center where it is being conducted? Would patients be able to participate in a trial if LLS gave financial assistance to help cover these transportation costs that can sometimes be crippling? Please share your experience and thoughts with us.

Patient Story: Christen’s little miracle of hope

communityreply@lls.org — Wed, 14 Oct 2009 15:55:35 GMT

Christen Reilert was diagnosed with non-Hodgkin lymphoma (NHL) when she was just 27-years-old. She took some time out to answer our questions on what it meant for her to be diagnosed with cancer as a young adult, as well as the fertility issues she faced.

LLS: How did you find out that you had NHL?

Christen: I found out I had NHL when I started having trouble taking deep breaths. Every time I took a deep breath it hurt which prompted me to go to my doctor. Twice I was misdiagnosed with walking pneumonia, given antibiotics and sent on my way. Two months later the symptoms returned and I ended up going to the hospital where they did a chest x-ray and found a large mass in my chest. That was the 4th of July in 2002 when I was diagnosed with NHL.

LLS: That sounds frustrating. Can you describe how you handled the diagnosis, as well as how it affected your day to day life?

Christen: The news was a total shock, being 27-years-old and a two-year newlywed with my husband, Josh. I was devastated. After the shock, I decided I was going to do whatever it took to survive. At the time, I didn't want to know anything about the cancer, I just wanted to fight it. Every day I went in for my chemo treatments I had a smile on my face and I knew at that moment, I was a survivor. I went through six chemo treatments over an 18-week period and 18 days of radiation. I lost all of my hair on my body, got severe thrush*, became extremely fatigued and was out of work for seven months. Since that dreadful day of diagnosis, I look at every day as a gift. Every day I wake up, I thank God for letting me enjoy another day of life. There is nothing in life that be that bad. In my life, there are no bad hair days, no feeling sorry for myself, just living everyday as it comes.

LLS: Do you mind sharing if and how your diagnosis affected your plans to have children?

Christen: Just two months prior to my diagnosis, we had just started trying to have a family. I had always dreamed of becoming a mother and when I was told I had cancer, my dreams were shattered and put on hold. There was no definite answer if I'd ever be able to have children. I sought out professional advice from an infertility specialist in Manhattan. Josh and I traveled there by car and she told me I could freeze embryos but I'd have to wait until my next cycle when I ovulated again. Unfortunately my tumor was so aggressive I couldn't postpone chemotherapy and I was not able to freeze any embryos to preserve my fertility. Needless to say, I cried all the way home.

LLS: Was there anything you could try at that point?

Christen: My chances of becoming a mother were slim. I took a chance and the doctor put me on a birth control pill to suppress my period for the duration of chemo (which was 18 weeks as well as 18 days of radiation) in hopes the chemo would bypass my reproductive system. The chemo I endured was very aggressive and harsh, and basically prayer and hope was all that was going to ensure any sort of fertility.

I was very ecstatic when I found out I was pregnant in April of 2008. When I took that pregnancy test, I literally did a double take. All the prior tests were always negative and to get a positive result was just shocking. When the doctor confirmed my pregnancy with a blood test I didn't waste any time breaking the news to family and friends!

LLS: Congratulations!

Christen: Yes, on December 23rd, 2008, our miracle baby born. Our son, Jaden was born! My motto which I've been saying since I found out I was pregnant has been "CANCER SURVIVOR'S HAVE MIRACLES TOO". We are so blessed to have him. What more could a cancer survivor ask for?

LLS: How is your health now?

Christen: I am currently in remission and have been cancer free for the last seven years now.

LLS: We hear that you’re actively involved with The Leukemia & Lymphoma Society (LLS).

Christen: After I completed radiation in early 2003, I ended up calling LLS to become involved in fundraising because felt like I owed the world a big fat thanks! For everyone who helped me beat this disease, I felt like I had to give something back. So in 2003 I started doing the Light The Night Walk and formed my own team, Christy's "Cure"ators. I have been the team captain for the last six years and an honored patient hero for the last five years. Everyone who walks with Light The Night Walk has been following my story. Last year at Citibank Park I was speaking (as I do every year) and was able to announce my pregnancy. I unveiled my seven month pregnant belly in front of hundreds of people with a zip of my jacket and the crowd roared for me. It was so exhilarating. This year, I get to introduce my son Jaden to everyone at Citibank Park, I can't wait.

In addition to being a team captain and honored patient hero I also volunteer my time anywhere I can. I am also a First Connection Volunteer for those who are diagnosed with similar diagnosis and who are around my age - I am like a mentor to them.

* ”Some people may develop a white, shiny coating or white patches on their tongue, inside of the cheeks or on the floor of the mouth. This symptom may indicate a yeast infection, also called ‘thrush’ or ‘oral candidiasis.’” From the free booklet, Understanding Drug Therapy and Managing Side Effects.

If you’re a young adult who has been diagnosed with blood cancer, you can give our Information Resource Center a call at (800) 955-4572 and someone will be able to help you or point you in the right direction.

Free Telephone Education Programs for Patients and Caregivers

communityreply@lls.org — Wed, 07 Oct 2009 15:35:27 GMT

The Leukemia & Lymphoma Society (LLS) is proud to offer telephone education programs for blood cancer patients and their caregivers. These programs, which require free registration, are both informative and interactive for those dealing with specific types of blood cancer or certain treatment topics.

Free registration is now available for these upcoming October programs.

October 14, 2009 - Treating Uncommon Lymphomas: Dialogue with an Expert on T-Cell, Malt, and Waldenström Macroglobulinemia

October 29, 2009 – Managing Myeloma: An Expert’s Update

Check the National Education Programs page often to see what is available, or visit any of the archive pages to listen to past programs, download transcripts or to access highlights from many of the past programs (archive pages can be found in each disease education series section – for example, there is a link to the archived programs on the Myeloma Education Series page).

Need assistance? Call the Information Resource Center at (800) 955-4572 and someone will be able to answer your question or steer you in the right direction.

Resources for the Young Adult with Blood Cancer

communityreply@lls.org — Fri, 18 Sep 2009 16:21:06 GMT

It was probably the last thing you expected, but here you are, a young adult with a cancer diagnosis that has taken center stage.

The Leukemia & Lymphoma Society (LLS) wants to help you deal with the challenges you face and has many resources for you. Here are just a few:

Audio and Web Programs

Cancer Survivorship: Practical Tips for Managing Your Financial and Insurance Issues Part 1 | Part 2
Cancer Survivorship for Young Adults
Sexuality and Intimacy After Cancer
Sexuality and Intimacy in Cancer Survivorship

Free Materials (Download or Order)

Additionally, young adults are welcome to join and participate in the LLS Blood Cancer Discussion Boards where there is a section specifically devoted to the young adult cancer community.

As always, young adults are encouraged to bring their questions to our Information Resource Center by calling (800) 955-4572 or contacting us online.

LLS-funded researcher Brian Druker receives the Lasker~DeBakey Award

communityreply@lls.org — Tue, 15 Sep 2009 16:24:55 GMT

The Leukemia & Lymphoma Society (LLS) is proud to congratulate Dr. Brian Druker for receiving the prestigious 2009 Lasker~DeBakey Clinical Medical Research Award. Dr. Druker, along with Dr. Nicholas Lydon and Dr. Charles Sawyers, is receiving the award because of their discovery of and successful clinical trials with Gleevec®, a drug that benefits chronic myelogenous leukemia (CML) patients.

Dr. Druker received critical funding from LLS in 1995 for his research on the tyrosine kinase inhibitor, STI-571, later named Gleevec, through the Translational Research Program. He discovered that CML cells that had been taken from patients were killed by this inhibitor. In 1998, Dr. Druker was able to test Gleevec in clinical trials and 53 of the 54 patients who participated achieved normal blood counts.

Dr. Druker continued to receive funding, and in 2000 was awarded additional funds through LLS’s Specialized Center of Research (SCOR) program. In 2001, Gleevec was approved by the FDA.

Many CML patients, who once may have considered their diagnosis terminal, are now leading normal and healthy lives because of Dr. Brian Druker’s breakthrough research. LLS is proud to have funded this innovative research, and appreciates the valuable work that Dr. Druker continues to provide to our patients and their families.

Visit the Lasker Foundation website to learn more about the Lasker~DeBakey Clinical Medial Research Award, and watch this eight-minute video that highlights the important research of these three doctors.

Have a question about CML or Gleevec? Call the Information Resource Center at 1-800-955-4572 or send us an email.

Get Well Mike!

communityreply@lls.org — Tue, 01 Sep 2009 16:32:55 GMT

We just learned that Mike Hamel was in a car accident last week and broke his back. As you all recall Mike is the one who did a superb job interviewing his oncologist, as well as lending us one of his blog posts last year. As always, his humor has stayed intact and he is still actively writing updates on his blog, Open Mike.

One of his recent posts asks readers to share suggestions for superhero names since he’s now wearing some heavy duty armor to protect his back. Why don’t you head on over there and share some ideas as well as your own good wishes?

Feel better Mike! And thank you for keeping everyone in the loop on your blog!

-Your friends at The Leukemia & Lymphoma Society

New Online Chat for Chronic Myelogenous Leukemia Patients

communityreply@lls.org — Mon, 24 Aug 2009 13:38:56 GMT

The Leukemia & Lymphoma Society (LLS) is proud to now offer live online chat for chronic myelogenous leukemia (CML) patients, which launches its first session this Tuesday, August 25. This live chat, called Living with CML, runs for two hours every Tuesday evening from 8:00 p.m. to 10:00 p.m. ET. Living with CML joins the long-running Living with NHL: Gaining a Sense of Balance chat, which runs every Monday and Wednesday evening from 8:00 p.m. to 10:00 p.m. ET.

Each chat session is hosted and run by an IRC Moderator, who is responsible for making sure that chat participants stay on topic and are respectful of each other and differing opinions. The purpose of each chat is to provide patients a safe place to discuss their stresses and triumphs through any aspect of their experience with CML or NHL.

Learn more about live online chat, and visit the registration page to sign up for either chat.

Not sure online chat is for you, but you still want to connect with other patients? Try out the LLS Blood Cancer Discussion Boards, an online forum devoted to the blood cancer patient and caregiver community.

Cancer Patient Interviews His Oncologist (Video)

communityreply@lls.org — Wed, 19 Aug 2009 18:36:41 GMT

If you are a regular reader of The Leukemia & Lymphoma Society Blog you will remember a blog post that was shared by non-Hodgkin lymphoma patient Mike Hamel from his blog, Cells Behaving Badly. In that post, Mike talked about the value of approaching cancer treatment with the mindset of a client rather than a patient.

Since that time, Mike has gone into remission once, had a return of his cancer and has been undergoing treatment during most of that time. The entire time, he has still managed to provide frequent updates and thought-provoking posts through his blog, renamed OPEN Mike.

In a recent post Mike shared a video interview he did with his oncologist, Dr. Dax Kurbegov, Director of the Memorial Cancer Clinic in Colorado Springs, CO. It’s an informative look into the patient/doctor relationship, and it’s clear that Dr. Kurbegov loves both his job and patients. Take a look.

Just diagnosed with cancer? Download these question guides to take with you to your medical appointments, and learn how to make the most out of your doctor’s visits by reviewing Communicating with a Blood Cancer Specialist.

If you have a question about leukemia, lymphoma or myeloma give us a call at 1-800-955-4572 or contact us online. We’re available Monday through Friday from 9am to 6pm EST.

Online Support Groups Now Available

communityreply@lls.org — Mon, 17 Aug 2009 18:06:11 GMT

The Leukemia & Lymphoma Society (LLS) and The Wellness Community (TWC) have teamed up again to bring blood cancer patients and caregivers online support groups. These groups are unique in that they are designed for participants to come together at pre-determined times online and be led by trained professionals.

Currently the LLS-specific groups available to patients are the LLS Lymphoma Group, which meets on Monday evenings online, and LLS All Blood Cancers, which meets on Tuesday evenings. TWC provides other groups which are more general in nature, but still provide a safe and welcoming online space for those dealing with any of the blood cancers.

To learn more or to join these groups, visit The Wellness Community.

We also encourage you to participate in the LLS Blood Cancer Discussion Boards, an online community devoted to all those touched by blood cancer.

In the News: A Possible Link between 9/11 and Myeloma

communityreply@lls.org — Mon, 10 Aug 2009 19:30:18 GMT

A report in the news this week suggests that 9/11 responders to the World Trade Center may be at an increased risk for myeloma. The report’s authors caution that their findings are very preliminary, however so far eight responders have been diagnosed with myeloma, four of whom are men who were diagnosed when they were younger than 45 years. Myeloma typically is diagnosed in persons who are aged 50 years or older.

While some say that it is possible for these myeloma cases to be linked to these patients’ time at Ground Zero, there is also admission that it could just be a coincidence. "In all fairness, it is unusual for this patient population to have multiple myeloma but it's not unheard of," explains Dr. Denise Pereira, assistant professor of clinical medicine at the University of Miami Miller School of Medicine. "But a lot of the things they were exposed to, such as benzene, have in the past possibly been implicated with an increased incidence in the cancer. It does make theoretical sense."

This report appears in the August issue of the Journal of Occupational and Environmental Medicine; to read the full news article visit HealthDay.

If you’d like to learn more about myeloma, here are some myeloma resources you can find on The Leukemia & Lymphoma Society (LLS) website.

Find out about causes, signs and symptoms and much more in the Myeloma section on www.LLS.org.
Order or download these free booklets, Myeloma and The Myeloma Guide: Information for Patients and Caregivers.
Already living with myeloma or are taking care of a loved one with myeloma? Some myeloma patients may qualify for the Co-Pay Assistance Program.

As always, our Information Resource Center specialists are available to take your questions Monday through Friday, 9 a.m. to 6 p.m. EST at (800) 955-4572. You may also contact them online.

Blood Cancer Researchers Can Now Apply for Awards through proposalCENTRAL

communityreply@lls.org — Fri, 24 Jul 2009 16:14:31 GMT

Critical research is being done on a daily basis by tireless blood cancer researchers to find out more about blood cancers and how they work. Most research cannot be completed without necessary funds, and The Leukemia & Lymphoma Society (LLS) has devoted more than $600 million to blood cancer research since the first funding in 1954

LLS allows blood cancer researchers to apply for funding for their research projects through the Career Development Program (CDP). This program supports blood cancer researchers early in their careers to ensure that they have the opportunity to work on innovative life-saving research as well as the ability to learn more about blood cancers and the diseases’ challenges.

In order to qualify, research projects must be relevant to LLS’s mission: cure leukemia, lymphoma, Hodgkin’s disease and myeloma, and improve the quality of life of patients and their families. Examples of relevant research areas are experimental therapeutics, cell growth regulation and DNA damage and repair.

If you are a researcher or know a researcher that could benefit from LLS funding, please visit the Career Development Program page on www.LLS.org for deadlines, detailed guidelines and a link to proposalCENTRAL.

Learn more about our research initiatives, and discover how LLS has been an innovative non-profit organization for 60 years.

“My Sister’s Keeper” Film Similar to Real Life Story

communityreply@lls.org — Mon, 20 Jul 2009 16:12:00 GMT

June 26th marked the release of the new film “My Sister’s Keeper.” This fictional story, starring Cameron Diaz and directed by Nick Cassevetes, is about a girl conceived to donate her bone marrow to her leukemia-stricken sister. The real life version of that story can be seen in the Ayala sisters of Orange County.

At age 16, Anissa Ayala was diagnosed with leukemia. A bone marrow transplant was given as her only option for survival. Since no bone marrow donor match was available, her parents chose to conceive a child in the hopes that he or she would be a matching donor. Born in 1991, Anissa’s sister, Marissa-Eve was a perfect match. At 14 months of age, Marissa-Eve provided her sister with a life-saving bone marrow donation, making Anissa cancer-free for the last 18 years.

As “My Sister’s Keeper” gains more and more media attention, so does the Ayala sister’s story. You can read a piece in the June 22 issue of People Magazine and this article from Inside Edition. Anissa, who currently works as the director of business development for The Orange County/Inland Empire Chapter of The Leukemia & Lymphoma Society, is happy to be sharing their story.

The Ayala sisters have started a fund to fight blood cancers locally in the Orange County/Inland Empire region of California. To date, the fund has raised nearly $1,000 to help fight blood cancers. Join the fight and donate in honor of their brave, true story.

Learn more about leukemia, treatment options and how to participate in ground breaking research.

Related Resources:
Blood & Marrow Stem Cell Transplantation (PDF)
Understanding Leukemia (PDF)

Myeloma Patients Should Apply for Co-Pay Assistance

communityreply@lls.org — Thu, 25 Jun 2009 13:45:17 GMT

A few weeks ago we shared a post on financial insecurity and blood cancer treatment, sharing with you some helpful links to information and programs provided by The Leukemia & Lymphoma Society (LLS). In this post, we wanted to highlight the personal side of our Co-Pay Assistance Program and share with you a couple of stories about myeloma patients who have benefited from this program.

Kalimah Jenkins, a 44-year-old African American from Atlanta, GA, was stunned to find out that her bone pain and fatigue were symptoms of myeloma, a difficult blood cancer. She was equally as shocked when she found out how expensive her treatment would be, and wasn’t sure how she would be able to pay for the drugs she needed. It was in her favor that her doctors knew about LLS’s Co-Pay Assistance Program, which helped her pay for her critical treatment.

Cislyn Blackwood, a 60-year-old from Fresno, CA, also a myeloma patient, has also benefited from the Co-Pay Assistance Program. Her treatment was already very expensive, but after being laid off from her job and her COBRA benefits running out, her financial situation became ever more challenging. She received the funds she needed through LLS's Co-Pay Assistance Program and was able to pay for her medication.

Both women say that LLS’s program has been a tremendous help, and are grateful that they found out about it; unfortunately, some myeloma patients who can’t afford it wind up going off of life-saving treatment.

If you or a loved one has been diagnosed with myeloma, visit www.lls.org/copay or call (877) LLS-COPAY to find out if you or they qualify for assistance. Note that other blood cancer patients may quality for assistance as well.

If you are a doctor, visit www.lls.org/copayproviders to find out how you can apply for the Co-Pay Assistance Program on behalf of your patients.

Learn more about Kalimah’s and Cislyn’s stories.