Posts Tagged ‘cancer’

New Pap Smear Guidelines & Why The Holistic Health of Women is in Jeopardy

Friday, November 20th, 2009

docpatientGood morning, Pinkies.  I just heard the news (calm down, Lissa. Breathe…) In the wake of the U.S. Preventative Services Task Force’s new guidelines for mammography screening, the American College of Obstetricians and Gynecologists just announced new recommendations that cut back on Pap smear screening. My blood is boiling, Pinkies. WHAT IS GOING ON? Why are we recommending cutting back on women’s health screening? Don’t get me started (yet). Let me fill you in on the news.

New Pap Smear Guidelines:

  1. Instead of recommending that Pap smear screening begin after you’re sexually active, new guidelines say that even a sexually active 13 year old should wait until 21 for her first Pap.
  2. After 21, Pap smears are recommended every 1-2 years until age 30.
  3. After 30, if you’ve had three consecutively normal Pap smears with no history of a seriously abnormal Pap, new guidelines say you only need to do Paps every three years.
  4. If you’ve total hysterectomy for benign reasons, new guidelines say you can skip Paps altogether.
  5. New guidelines recommend quitting Paps sometime between 65-70 if you’ve had three consecutively normal Paps with no abnormal Paps in the past 10 years.

Why the Change?

There is evidence to support the changes.  The truth is that you’re unlikely to go from having a normal Pap smear to having cervical cancer in 3 years, even if you contract HPV. Because cervical cancer grows slowly, it’s still likely to be precancerous by the time it gets picked up. And yearly screening does increase the number of procedures performed, and some of those procedures- such as cryotherapy and LEEP procedure can affect fertility and pregnancy in rare cases.  Plus, cutting back on Pap smears saves precious health care dollars. And if we’re not saving lots of lives and potentially causing harm by implementing procedures that may not be necessary, why do annual Pap smears?

So these guidelines aren’t positively ludicrous like the new mammogram guidelines that threaten to kill hundreds of thousands of women. I understand why they’re recommending pushing back the age of first Pap smear.  HPV, the virus that causes cervical cancer and abnormal Pap smears, is almost ubiquitous among teens. As such, doing Paps will lead to many abnormal results and require colposocopies, biopsies, and possibly treatment such as LEEP procedures, which can affect their pregnancies in the future, leading to scarred cervixes and preterm labor. And many of those abnormalities, if left untreated, would have resolved themselves without treatment.

I can also see why they’ve said that women who have had a hysterectomy can stop getting Paps. After all, they don’t have a cervix. And while there may be scant cervical cells left at the surgical scar inside the vagina, the risk of cervical cancer is exceedingly low.

BUT (and this is a gigantic BUT) there is a GINORMOUS problem here that carries far-reaching consequences for women’s health, and I can’t keep this quiet. Though women come to the gynecologist under the guise of their annual Pap smear, they actually come for WAY more than that.

Here are some examples of issues I handle under the guise of an annual Pap smear exam:

  • Sexual problems that threaten your relationship
  • Debilitating depression and anxiety
  • Chronic fatigue that prevents you from living vitally
  • Pelvic pain, often as the result of sexual abuse you have never confessed to anyone until I hold the sacred space for you and invite you to tell the truth
  • Urinary incontinence that causes so much shame and embarrassment that you might not leave the house, much less exercise or pursue your dreams
  • Menstrual disorders like hemorrhaging or menstrual cramps that cause you to miss work and other important life functions.
  • PMS/PMDD that may be hampering a happy life
  • Interstitial cystitis symptoms that make you feel like you constantly have a UTI
  • Menopausal symptoms that threaten a woman’s relationships, sleep, work, and life
  • Relationship counseling
  • Parenting advice
  • Losing your mojo

And that doesn’t even include the oh-so-necessary annual breast exam, internal pelvic exam to check for ovarian tumors and such, and the opportunity to make sure a woman is up to date on other cancer prevention procedures, such as colonoscopy in older women, or the HPV vaccine for teens.

Now, ACOG does say you should still talk to your doctor about getting an annual pelvic exam. (Thank you ACOG.)  But are insurance companies going to cover a routine pelvic exam in the absence of a Pap smear?  Are women going to go? So many women will hear these new guidelines and think, “Cool! I can skip the gyno for 3 years!”

By changing its guidelines, ACOG is going against the other main authorities on cervical cancer. The American Cancer Society and the U. S. Preventative Services Task Force both recommend that women get their first Pap test within three years of having sex, or at age 21- whichever comes first.

I respect evidence-based medicine and understand the rationale for these guidelines. I went to Duke and Northwestern and learned all the ivory tower beliefs about  practicing based on evidence, not anecdotal speculation or emotion-based care.  BUT….

What Do I Think?

Hmmm…I guess I think all the guidelines that have come out this week are missing something critically important in medicine.   As leaders in women’s health, what messages are we putting out there? Somewhere along the way, governing bodies in medicine have forgotten the most vital aspect of what we doctors do. When they are reviewing data to make these guidelines, they are focusing only on what “cures” someone. But they have forgotten that there is a difference between healing and curing.

Let’s take a huge leap and assume that cancer screening is completely worthless and doesn’t prevent cancer at all. Is there not some value to the other types of healing work we doctors provide under the pretext of the annual Pap smear? Women don’t make separate appointments to talk about their sex life or whether they’re living as vitally as they might.  They lump those things under the umbrella of a Pap smear.  Many women feel like they’ve been handed a “You’re worthless” card at birth.  I try to extract that card and replace it with a hot pink one that says, “You’re lovable, valuable, beautiful, and worthy.” This kind of work cannot be proven in a scientific study. But is taking away a woman’s excuse to visit her gynecologist taking away that hot pink card as well?

I’m not suggesting we do unnecessary testing or procedures just for the sake of getting a woman in the door. Ultimately, you have to be your own advocate for your health and wellness. But I worry about the far-reaching effects these kinds of guidelines will have for women who misunderstand and fail to hear the part about annual exams still being a critical part of women’s wellness.  What if they get lost in the system? Especially underprivileged women, who may not be educated enough to advocate for their own well-being.

My fear is that cutting back on cancer screening will not only increase a woman’s risk of cancer. It may also limit a woman’s access to the kind of healing good doctors can provide.  For most of my young patients, I am their primary care provider.  The Pap smear is what gets them in the door.  If you hear that you only need a Pap smear every three years, you may go three years without anyone talking to you about whether you’re living as healthfully and joyfully as you possibly can.

And you can be sure that insurance will cut back your coverage. If ACOG says you don’t need a Pap smear, your visit will likely only get covered if you have an ICD-9 code diagnosis like endometriosis or fibroids. And let me tell you- there’s no ICD-9 diagnosis for losing your mojo or cancer prevention.

You may think I’m biased. After all, I’m a gynecologist. It’s my business to have people come in for Pap smears, so of course, I would oppose these new guidelines. But the truth is that most gynecologists lose money by doing a Pap smear. The cost of the visit exceeds what insurance companies will reimburse most of the time. And since Medicare already doesn’t cover annual Paps, we usually eat the cost for older women who want to get Pap smears but don’t have coverage. So trust me, for most gynecologists, this is not about money.  One of my dear friends in San Francisco (a total Pink God) is closing his practice- declaring bankruptcy- because he simply can’t make ends meet with a busy insurance-based practice. It breaks my heart. He is one of those doctors who, like me, practices love, with medicine on the side.  Why does the system not embrace him? Why have we replaced doctors like him with technology, scientific data, and task forces? (*crying now*)

And why are they cutting back on only women’s health screening? Why not PSA testing for men? Not to be all conspiracy-theorist on you, but you can’t convince me that there aren’t some sexual politics caught up in all this. With all the advances we’ve made in women’s rights and women’s health over the years, why are we going backwards? Won’t somebody please stand up and shine the light on the Emperor’s new clothes?

I get that we need to cut back on health care costs. But come on, people. Must we do it at the expense of women? Can’t we focus our energy on tort reform or capping profits for insurance companies. Is this really the way?

For me, it’s all about advocating for holistic women’s health- the big kind, the kind that looks at a whole human being, not just a breast or a cervix. The only way we can help women holistically is to get them into our offices, provide a safe, sacred space for healing, and show up- fully present- to help them get in touch with what their body needs to be whole.

What Will I Do In My Practice?
I think you should be given a choice. The way I see it, it’s my job to present the data and help you understand the risks and benefits of cancer screening. If you want to get a yearly Pap smear and mammograms after 40- Fine. If you’d prefer to stretch out your screening or skip it altogether, no problem. It’s your body- your choice. I’m just here to help you understand your options and deal with whatever comes up.

The Bottom Line
Please, Pinkies, regardless of what you decide to do about your Pap smear or your mammogram, please don’t stop seeing a doctor every year.

Our Broken System

Thinking of how these new guidelines may limit your access to health care breaks my heart.

This system is so BROKEN. Hand me the suture and a needle driver. I want to stitch the fragmented, fractured, hemorrhaging heart of medicine back together again.sutured heart

Waiting, with hand outstretched- “Suture, please,”

Lissa

The Difference Between Curing and Healing

Tuesday, November 17th, 2009

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The Origins of Pain

I saw a patient today who inspired me- let’s call her Sally.  She suffers from a host of medical conditions that threaten to rob you of your mojo- fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain.  When this young woman walked into my office, she looked like crap. Before looking at her chart, I thought she had cancer.  Gaunt and pale, her skin hung on her skeleton like she was in the last grip of life.  During the first half hour, she didn’t smile once. I felt the anxious tug we doctors feel when we see people like this, the one that says “I’m not going to be able to help this person,” which triggers insecurities and, often, judgments, in our own minds. It becomes about us, rather than being about them. We have a tendency to turn off because we don’t want to fail. But I vowed not to do this.  Sitting in her presence, I was determined to be present for Sally and sit with whatever is true, rather than letting my own stuff get in the way.

What is true for Sally is that she has spent the last decade plagued by pain, fatigue, and a body that is betraying her.  She has been to universities, fancy alternative medical clinics, and specialists. Someone told her that her condition is “incurable,” and somewhere, a while back, she decided to believe them. But she never gave up trying to be well.

When she came to see me for a gynecologic complaint, I heard her words, but what I saw in front of me told me that her condition was deeper than what her words betrayed. This was not about a pain in her pelvis, this was about a core wound.  I listened while she talked about her pelvis, but I focused more energy on watching her, feeling her, being with her in the moment. What rang out loud and clear was this message: “I am not well.” And yet, I could see this glowing, radiant energy beneath the surface, a vision of a vibrant, vital being, leaping in the air and spinning with glee.

Unbidden, she began to tell me about her favorite place, a remote town near Santa Fe, where she owns a vacation house. She fantasizes about quitting her job, living there full time, and spending time with animals in some way. Currently, she owns her own business, selling software to help people maintain their gardens.  She works until 2am many nights, finishing projects and meeting deadlines. A team of people bow to her leadership. Years ago, she gave birth to her company from a place of passion, but lately, she dreads everything about it. It has become her ball and chain, and she suspects it is related to her illness.

The Power to Heal

Last year, fed up with being sick, she considered quitting her job. She went as far as selling her primary residence, with the intention that she would live full time near Santa Fe. With money in the bank to help support her, she settled into a new life. And miraculously, her symptoms disappeared. For two whole months, she felt like a vibrant twenty year old, brimming with energy and vitality.  She hiked every day, ate wholesome food, wrote in her journal, and meditated. “I did everything right,” she said. And her body rewarded her with new life.

Then her mother had a heart attack, and she left Santa Fe to return to California, where she is now caretaking her family. Because she is back in the area, she has resurrected her business. Within days of returning to her old life, her symptoms reappeared. She has been coming to our integrative medicine center almost weekly ever since. Her thick chart belies a series of supplements, laboratory tests, and referral letters that conclude, “There is nothing we can do.”

Yet, to me, seeing Sally for the first time, the answer is obvious. Her body has already told her what it needs to be healed. She needs to release the expectation she has placed on herself to care for her family.  She needs to let go of her business. And she needs to move back to that small village near Santa Fe, where her body knows how to heal itself.  Only I can’t say this to her. It is not my place to give advice.  Advice implies that someone is broken- and nobody is broken.

Instead, I ask her, “What does your body need in order to get better?”

She says, “I need to find care for my mother, let go of my business, and move back to Santa Fe.”

Bingo.

When she says this, I see, for the first time of our visit, a faint smile. I ask her what she will do when she is there. She says, “Hike, ski, paint, play with my dog. Maybe start a new business, something related to animals.” Her smile widens. She begins to talk about the steps she would need to take in order to put this plan in place. Some steps she has already begun, as she has known intuitively what she needs to do. Within moments, she is grinning. I ask her how her pain feels in this present moment- right here, right now, and she says, “It’s gone.”

Then something shifts. A dark cloud wafts across her. She curls her shoulders inward.  Her smile disappears. Her brow furrows. Sally says, “I can’t do this. And what’s the point? My doctor said there was no cure for my condition.”

Healed Versus Cured

I can’t help telling her the story of my father. Dad was diagnosed with a gigantic goomba of a brain tumor when I was 7 months pregnant. A body scan revealed that there was cancer everywhere. A biopsy confirmed metastatic melanoma, which comes with a near certain death sentence. My father, a physician who did his senior thesis on melanoma, knew the facts about his prognosis. So when he called me one morning at 4am to say that he had a vision and that God had come to him to tell him he had been healed, I groaned. “Oh no,” I thought. “The brain tumor is growing. He’s delusional. And he’s in denial.”  I nodded and told Dad I was thrilled that he was healed, but I dreaded the repeat body scan that would tell him the truth. When the body scan showed that the tumors were growing, Dad got quiet. He didn’t speak of his vision again. My heart ached.

A month later, Dad failed to experience any of the expected symptoms of a gigantic brain tumor. He had no headaches, no seizures, no vomiting, no dementia. He was plain old Dad, only with a bald head from the whole brain radiation they gave him.  So when Siena was born and Dad said, “Can I go now?” I wasn’t prepared. What did he mean, “go?” What exactly did he plan to do?  Dad said he was going to quit eating and die a peaceful death. He wanted our permission. Reluctantly, we gave it.

Dad kissed us goodbye, and when I asked whether he was scared, Dad said, “I’m not scared. I’m joyful.” He kissed away our tears, closed his eyes, and died peacefully 48 hours later.

Only in retrospect did I learn a very important lesson- one that has fundamentally changed the way I practice medicine. I realized that, in spite of my skepticism, Dad had been healed- that there is difference between healing and curing. I always thought they were the same.  Now, I realize that you can healed without being cured, and you can be cured without being healed.  I spent 12 years of medical education learning how to cure people, but no one once spoke to me about healing. In fact, we don’t even use the term “Healing” in reference to patients. We might talk about a healing wound, but a healing patient? Nah. Too woo-woo.

The Whole Picture

So when that doctor told Sally that she would never be cured, he failed to look at the whole picture. Yes, there may not be a drug she can take to rid herself of symptoms permanently. But I absolutely believe that she can be healed. Her body has already proven it to her.  The power to heal lies within us all, if only we tap into it.

What about you Pinkies?  What needs to be healed in your body, your soul, your heart, your life?  What would it take to feel better? What steps might you take to put a healing plan into place? How can we support you?

Committed to helping you (and me) heal,

Lissa

Owning Today: What Would You Do Differently If You Didn’t Have Long to Live?

Thursday, November 5th, 2009

lissaprayingI just found out that a doctor/healer I admire, Dr. Lee Lipsenthal, who coached me through a brief but difficult moment in my life, has metastatic cancer with a 10% chance of surviving. My heart broke when I heard this news. And yet- no surprise to me- Lee wrote about this experience on the Huffington Post in a characteristically uplifting fashion. He found himself, rather than depressed, free. With only a small chance to live, he no longer feels tied to obligations he didn’t really feel like doing in the first place. After a life of watching his weight, he can indulge in Ben & Jerry’s ice cream. And after raising his children to be people he deeply admires, he realizes that he must let them go, trusting that they will thrive, even if they have to do it without him.

Blessings, Prayers & Healing Juju to You, Lee

After I wiped away the tears, I thought about how we respond to bad news.  The characteristic Kubler-Ross stages, as Lee reminds us, are not linear, but chaotic and circular. We jump from denial to acceptance to anger to bargaining and back to denial again. Ultimately- hopefully- we accept what is and release the rest, but even then, the old stages may pop up from time to time.

Owning Goodness

In my personal life, there has been so much good news lately. My dreams of Owning Pink are becoming real. Two of my books will be published in 2010. My private practice is growing. My family is thriving.  My long-awaited art show is about to open in January. Life is good. It’s easy to fall into fear, wondering when the other shoe is going to drop.  But I don’t see a reason to go there. Yes, bad news will come.  But as Tama Kieves said in yesterday’s post, if goodness is a bubble about to burst, so is sadness. Why wait in dread for what might go wrong when life is peaceful, joyful, and full.

When bad news does strike, I can only hope I will face it with the inspiring courage of Dr. Lee Lipsenthal.  I hope I will revel in life’s joys and face the bad news with grace. I hope will be able to realize that the rough times are fertile periods of transformation, not only for me, but for those who face the rough times with me- my family, my friends, even you Pinkies. I know that, should I be diagnosed with cancer or lose a family member or go bankrupt, you will walk beside me, just as we all walk beside each other in our Pink Posse community when rough times hit any one of us.

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Hearing about Lee got me thinking about what hit me when I lost my beloved Dad almost four years ago.  If I knew I was probably going to die, what would I do differently in life? Four years ago, when I asked myself this question, I was shocked at my answer. If I knew I was going to die, would I be doing what I was doing then? The answer was a resounding HELL NO!  If I knew I had only one year to live, I would change almost everything about my life. But why must we wait for catastrophic news?  Why do we spend so much time and energy living lives that don’t suit us? Life is simply too short.

If I Knew I Was Dying, I Would Keep On Keeping On

Which is why I quit my job, moved, launched Owning Pink, and began this path of exploration that has led- four years later- to the life I am living now.  Now, I can honestly say that if I knew I was going to die in a year, I would do exactly what I’m doing now (only I might do it in Italy, just for the hell of it. But then again, on second thought- no. My tribe is here).

Did you see the movie Last Holiday? Queen Latifah is working a dead-end job and pining over a guy who doesn’t even know she’s in love with him, when she finds out she has a fatal disease. She decides to spend her life’s savings on a trip to the Czech Republic, where she stays in a suite, goes base jumping, and confesses her love to the guy who chases her halfway across the earth. In the process, she finds the joie de vivre she lost long ago. In the end, she discovers that her doctor made a mistake- that she was not going to die- and she had just spent her life’s savings. So did she do the right thing, or not?

Do You Consider Taking Risks Reckless?

You might argue that Queen Latifah was reckless. After all, what is she going to retire on, now that she blew it on a grand European adventure?  Of course, in the movie, it all ends happily, and you know she’s going to be okay. But in real life, we ask ourselves these questions. We fear. We limit. We shrink.  We skip the grand adventures in favor of safety. Then we wonder why we live lives of quiet desperation.

When I found out Dad was going to die, I decided to go for the adventure and take a Pleap (Pink leap of faith). I spent my life’s savings to buy my freedom, and I don’t regret a penny of what I no longer have in the bank. Instead, I have faith in the process. I have confidence that I will land butter-side-up. I believe that the Universe will meet my needs. And every day, I feel blessed to know that I would change nothing if I knew it would all end soon.

Wow. Things have changed. When I think back to four years ago, I have to smile. What a long, strange trip it’s been.

What about you Pinkies? If you knew you had a fatal diagnosis, what would you change about your life? It’s a very clarifying question.  Maybe some of you have been there before and survived.  Maybe you’ve lost something or someone dear to you and it had the same profound affect.  Must we wait for tragedy to strike? Can’t we start now?

Living like I might die tomorrow,

Lissa

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Dr. Lee Lipsenthal

Owning Life and Celebrating Mojo: The Owning Pink/Nancy’s List Love Fest

Tuesday, November 3rd, 2009
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Pink Goddesses Susan Zelinski and Nancy Novack with Lissa

Hello dear Pinkies,

This weekend’s Love Fest in Sausalito was INCREDIBLE! We wish you all could have been there. We celebrated with Nancy’s List, our co-hosts and beneficiaries of the evening’s proceeds who worked so hard to put on this glorious love-filled event.

First, a bit about Nancy’s List. The organization was founded by Nancy Novack, who five years ago was diagnosed with stage 4 ovarian cancer. Aided by an undying “attitude of gratitude” and a stellar network of support, Nancy made a full and miraculous recovery. She went on to create Nancy’s List (in the same spirit as Craig’s List or Angie’s List) to provide those living with cancer and their loved ones the same kind of support she received – support that responds to the particular needs of the men, women, and children living with the disease. In short, the mission of Nancy’s list is to ensure that no one will ever go through cancer alone.

Oh, and did we mention what a total rock star Nancy is? She is a true Pink goddess who shines with energy, exuberance, and inner and outer beauty. It was she, along with her team of “angels,” who secured the venue, vendors, and auction items; provided donation boxes and volunteer signup sheets; lent their event planning expertise and experience; and attended to all the fine details that made the event so joyfully perfect.

The magnificent Studio 333

The magnificent Studio 333

The art gallery where the party was hosted – Studio 333 – couldn’t have been more perfect for a Love Fest. Everything about the space, from the size to the setup to the vibe, made for a smooth, flowing, and fun celebration of life. Special thanks and big Pink love to Christopher, the adorable, hardworking Pink God of a gallery owner, who bent over backwards to be sure that the evening was hitch-free (and then donned a hot-pink feather boa and tended bar). You rock, Christopher.

The setup included a silent auction room with hundreds of items for bid, from books to wine to private Tai Chi lessons to insanely cool (and valuable!) artwork. A volunteer room gave guests the chance to offer any services they may be able to provide (dog walking, food service, rides, child care, acupuncture, counseling, etc.) to the Nancy’s List community. Also on hand were the lovely ladies from Pinups for Purpose, an organization that creates and was selling) calendars featuring local breast cancer survivors in elegant, retro-style, pinup photographs.

Owning Creativity in the art room

Owning Creativity in the art room

Attendees had the opportunity to Own Spirituality in a sacred altar room, where they were invited to light a candle in honor of a person or intention. We also invited them to Own Surrender by writing down anything they wished to release out into the Universe, and place the slip of paper in a bowl upon the altar designated for that purpose. Upstairs, Owning Creativity was happening in the Love Fest art room, where Pinkies were cutting, drawing, picking and pasting together three fantastic group collages. Guests could even Own Sexuality by purchasing one of the many items donated by Pleasures of the Heart, an intimate apparel and accessories store in Mill Valley, CA.

Owning Sexuality - Merchandise from Pleasures of the Heart

Owning Sexuality: Merchandise from Pleasures of the Heart

Owning and Celebrating Life was at the heart of the festivities, which guests did by munching, mingling, drinking and dancing. Singer/songwriter Susan Zelinsky was the first artist to take the stage, her captivating voice providing a warm, sweet background as decked-out guests were filing in, being welcomed with pink leis, and greeting each other. As things started to swing, the acoustic stylings of the talented Jesse Brewster increased the party’s ambient level of mojo. The energy and dancing reached a whole new level when the Beat deFeet Drumming Circle with Fred and Friends began pounding out rhythms – it was irresistible not to move. Lots of Pinkies owned their bodies long into the night on that dance floor!

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Shaking my groove thang to the Fred and Friends drumming circle

The evening raised thousands of dollars for Nancy’s List- blessings to those of you who came to help us celebrate life and support Nancy’s List. For us, it was a valuable chance to reconnect with some of the Pink community and welcome a slew of new Pinkies into the Posse. As with the Posse Forum, every person came with a story, a need, an offering, and a willing and open heart. We heard stories of survival, inspiration, healing, intrigue; witnessed smiles, hugs, laughter, tears, and arms-around-each-other dancing. As one Pinkie so eloquently put it: “The ‘field’ was rich and potent with so many lovely, rich Beings. Every conversation was fertile and inspired and you could feel the pulse of transformation moving in the room and radiating-flowering through people’s Hearts.” If that doesn’t describe a Love Fest, I can’t imagine what does.

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Pinkies lovin' it up

We bow in thanks to Nancy, her Angels, Christopher, Neil, Matt, Susan, Jesse, Fred and Friends, along with all the volunteers, auction donors, and guests for co-creating such a magical, mojo-filled evening.

Still feelin’ the love,

Lissa & Joy

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