Wednesday, September 18, 2013

Cancer positives

Man, oh, man cancer is exhausting. I want to whine about it so bad, but I remind myself of the women fighting a stage 4 who will never be able to relax- who have no end to the doctor's appointments, the long drives, the theories, the blood draws, the medical bills, the questions. Still, I'm tired.

We had a second opinion on Monday from the wonderful man who was my Daddy's oncologist. He started the visit by asking me what the hell I was doing there and telling me how shocked he was to see me. I was so relieved when he told me that he shared my feeling that there must be a link to Daddy's cancer and that he would be looking for studies we could help with. I learned during that visit that my cancer started growing about two years ago. You know what that means, don't you? That I actually probably had cancer even before we knew about Daddy's. That is SO creepy. All of those hours in that chemo center and I had no idea that could be my recliner in a year. Part of me almost wishes that we had known, that Daddy and I could have shared our journey on an even deeper level, but I know that the stress of that would not have helped him. I'll settle for the thought that when I meet him again in heaven I'll have one hell of a story for him.

Dr. H also said that he will not make a determination on chemo until I have the Oncotype DX test. This is a relatively new technology that will determine my risk of reoccurance. He went so far as to give me a 70/30 chance that I WON'T need chemo. I think this freaked DH out. Chemo is associated with killing the monster and it seems that he's afraid that this technology could be wrong. For now we have to wait for pathology to come back on the tumor. The doc also said that the Tamoxifen is a must for 5-10 years and he wants me to have a hysterectomy. Right now I'm not terribly bothered by that idea. It will eliminate my chances of ovarian and uterine cancer so I know it's a necessary evil. I wonder, though, how I will feel when at age 34 I have virtually nothing of my own that makes me a woman. He is sending us to meet with a surgeon in a bigger city this week. We will explore whether her hospital performs any of the other "flap" surgeries and if I would be a candidate for them. I'm not holding my breath, but it should be interesting.

I'm in a place now that leaves me feeling a little numb. I'm somewhere between being resigned to the idea of this life change and terrified of what lies ahead. Over the last couple of weeks, though, I have been making note of the good things about having cancer. Yep, they exist.

-You never know how much you're loved until you're sick. I wouldn't wish this on anyone, but if everyone could have the opportunity to feel as loved as I feel now, the world would be a much better place.
-The little things become much less important. The only things that really matter right now are my health and the well being of my family. Isn't that how we should all try to view life?
-Cancer forces you to learn how to say 'NO.' I am famous (or infamous) for saying yes until I am completely burned out. It has led to personal and marital distress more than once. There are so many things to which I would love to give my time, but right now there's barely enough time to get to doctor's appointments and raise the girls. While it has been an adjustment, it has also simplified things and given me a really good excuse to avoid distractions.
-I have a built-in excuse to go shopping. After all, I only have one button-down shirt and nothing in pink. I have to wear pink now, right?
-Cancer makes mean people nicer. True story. Especially older people. There's an exceptionally grumpy older man at my work who, prior to this week, referred to me as "that girl" (on a good day) and was wholly disapproving of my entire existence. After he found out about the cancer he began calling me "that pretty little girl" and telling me that I'm doing a good job. And yes, I am going to milk that one a little bit.
-Cancer has helped me grow a pair (and I'm not talking about boobs). Sorry, but it's true. I mean I had a pretty good pair before, but now they're really big. You wanna shoot dye into my arm and shove me in a giant machine? Cool. You wanna put a long needle in my chest and pull the trigger? Sounds good. Cut my boobs off and sew some plastic balloons in there? Let's do it. I don't want my girls to see a fearful person when they see me.  I don't want to see that in myself. So I have no choice but to become stronger and more brave. (As I write this I realize that Daddy probably experienced this same feeling).
-I am humbled. I mean big, big time. It's not in the size of the things people give or do for us, but in the love they put into it. I am so amazed and humbled by the thoughtfulness people have shown me that I know I will come through this as a more thoughtful and loving person. Sometimes I am actually embarrassed by the love and attention, but receiving it is teaching me what it means to truly be humbled.
-Cancer makes you nicer. Those people closest to me might disagree because they have heard a great deal of profanity out of me lately, but truly it makes you so conscious of the fact that everyone is fighting a battle. That person in Wal-Mart or the car in front of you may be fighting a battle even worse than mine. We might as well be nice to each other.
-In my fear I have no choice but to try to become closer to God. I'm not really very good at it, but who else is there to hear my jumbled thoughts at one in the morning? God and I have some major work to do, but I know He's there and I'm working on intentionally building that relationship.

Tuesday, September 10, 2013

Nuns and Mr. Magoo

I have a bad attitude. I'm just going to tell you that right off the bat. I know I'm letting some of you down- I'm letting myself down. I want so badly to set a good example for my girls and to have an attitude of thankfulness, but it's just not there today. Or yesterday. But this blog is about honesty and reality, so here's my reality.

I'm so frustrated and angry and scared that I really want to crawl into a hole and stay there for a good long while. Not because I don't love my life, but because I'm so tired of all of this and I'd like to go somewhere it can't find me for a while.

I miss my 3-weeks-ago-life. More than I could possibly express to you. I miss just being able to enjoy my babies and my new job. Everything now is scarred. My joyful things have the scar of cancer across them- again- and I am really, super angry about it. Some people have said that it's good to get angry- that I can channel it towards the cancer, but this isn't that kind of anger. It's aimless and random- hard to explain. It's not the kind of anger that makes you want to fight- it's the kind that makes you want to run.

I know I said I don't 'hope' for much, but the doctors had given me some concrete (I thought) positive news. There was a chance that I wouldn't need chemo and that I would be able to have a flap reconstruction that would mean a one-step surgery and great results to look forward to. Today I learned that my tumor has already grown in size and I can count on chemo. A few months worth at least. And apparently all of that hard work I put into losing weight and getting healthy means that I don't have enough fat and skin to perform a flap surgery. That means a 6-12 month process before the painful and embarrassing reconstruction process is complete. To make matters worse, I just couldn't stand the surgeon. It's not really anything he did or didn't do- I just don't like him. Of course it didn't work to his favor that he was about the 10th person this week to ask me the same 30 questions and then make me take my clothes off so he could poke me like the guy from the 'Operation' game. Also he appeared to be 80 years old and mostly blind.

I think maybe I was having a premonition yesterday. I woke up depressed and grumpy. Pissed off that I can't even crack an eyeball in the morning without the word 'cancer' being immediately present in my brain. I tried to listen to my 'screw cancer' songs on the way to work, but then got a notification that I had almost reached my data limit, so I had to turn on the radio. There was a nun speaking on the Catholic station and she sounded so old and sweet that I felt guilty changing it, so I started listening. I'll be damned if she didn't start talking about how we need to treat the challenges in our lives as blessings and lessons from God- and accept them with grace. Then she talked about a 45-year-old sister who had very advanced cancer and how much she admired this woman because all she wanted to do was enjoy whatever time she had left with her sisters and her God. Geez. I felt like such a whiny baby. I know that particular message was meant for me, and I tried so hard to soak it in, but it just kind of bounced off my heart. So then when I got the news today from Mr. Magoo I was just so incredibly mad, and not in a good productive way, but in a "I'm going to punch the nearest person and then drink too much" way. Finally the question of which of my many sins brought this particular punishment upon me crossed my mind. Yes, I know that all indications are that God doesn't work that way, but if you have met a sick person who hasn't wondered it nonetheless, I'd like to meet them. (Okay, so that nun probably never wondered that, but she doesn't count). And that's when I really began mourning my three-weeks-ago life.

Three weeks ago I could go to the grocery store without wondering what food I needed for the freezer meals I would make to get my family through. I could go to work without spending the whole day wondering what my new boss would think of me when I'm gone for a month. I could get dressed without staring at myself- trying to take in what it looks like so I can remember next month when it's gone. I could brush my hair without thinking about how much I have taken it for granted and how much I'm going to miss it. I could exercise without wondering what it will feel like after they cut through my muscles. I could look at my husband and not wonder what he will think of me when I'm bald and scarred. I could cuddle with the girls without thinking about how I won't be able to hold them close to my chest for months. I could yell at them without thinking about whether they would have good memories of me if I die on the operating table. And as much as I want to be positive and uplifting, I can't help but wonder what will be next. What if, in a few months, something else happens and THIS becomes my three-weeks ago life? While most days I can be thankful that we caught it early and I am lucky, these are the other kinds of days. The days when I remember that being "lucky" today does not, in fact, exempt me from further unluckiness in the future. And that's just kind of a crapper.

Thursday, September 5, 2013

Miles to go

Man, I love control. I crave it- demand it even. Sometimes I don't even know I'm doing it. I think most Mothers have some level of desire or need to control- just so we don't wake up with one of those pretty white coats on. But there may be some of us who go a smidge too far. I'm one of them. Hi, my name's Angela and I'm a control addict.

Yes, to some degree, when Daddy was sick I learned that control is an illusion. At least as it pertains to our eternal fate. And even now, with my cancer, I find myself wondering what it's all for. The exercise, the healthy diet, the not-smoking. None of it made a damn bit of difference because I couldn't control my destiny when it came to developing cancer anymore than Daddy could. So you'd think that would lighten the grip that this perpetual need to control has on me. It wasn't enough, though. I still found myself panicking over what the girls are going to eat, who is going to drive them around, what if their hair and clothes make them look like rag-a-muffins because I can't dress them, who is going to scrub my toilets, what if the lack of mobility in my arms means I can't wipe my own butt?
Oh dear Lord.

But over the last week, so many people have shown up. I don't mean just verbally. They've brought me lunch (and alcohol), they've cut my hair, they've picked my girls up, done my laundry, forced me to go have a massage and traveled two hours to come to my doctor's visits. Suddenly today, I realized that I was breathing. And not the "into a paper bag" type of breathing. The calm kind. I have no control over my disease, and life or death decisions are being made for me, but I'm (kinda sorta) okay. That's the gift that people have given me- and it's the same one you can give someone when they get sick. You can do something- just one thing- the way they would want it if they were still in control. What an amazing feeling it is to be on the other end of that love. I just hope I don't get too used to it because I'm guessing ya'll are gonna expect me to do my own laundry and drive my own kids around by the time this is all over, right?

Yesterday we got some "good" news. My cancer is Estrogen-receptor positive or ER+/PR+. This is, technically, a good thing. It means that Estrogen causes my cancer to grow, so if I take an estrogen blocker for the next 5-10 years then I have a lower chance of reoccurance. The medicine you take is called Tamoxifen and is difficult for some people to tolerate- it also forces you into menopause. We also learned that my cancer is growing at a rate that causes it to increase in stage every 2-3 months. Wow! Do you know what that would have meant if I would have waited 6 more months to go to the doctor? Do the math. Then make a doctor's appointment. 

As I digested that news, my thoughts went to a healthy 29-year-old mother living with stage 4 metastatic breast cancer, which is essentially incurable. She, like me, went for a regular check-up when her two tumors were discovered- and by that point it had spread to her back and several other locations. No rhyme or reason- no family history. My geneticist said that two things have to happen in your life for cancer to occur. You will probably never know what two things they were. One happens earlier in life, and if the second one occurs, BOOM- hello, tumor. So I sat there thanking God that the odds are so generously in my favor- unlike so many other women. Then the thought occured to me, "is this IT??" Am I going to spend the rest of my life just accepting whatever crappy thing rolls along and begging God just to not make it any worse? Is that how it's supposed to work? I know God is not in the bargaining business, so I realize that any kind of begging is probably a waste of time. So how, then, does God make his decisions? I know it's kind of like asking "where did God  come from?" I'll never be able to answer it. But yesterday I was really miffed that I can no longer be naive and just pray for things like a raise at work or good weather for my yard sale. Those seem like such a waste now that I'm busy praying that my cancer doesn't spread while I wait for surgery.

I experienced some of this during Daddy's illness, though, and while it may sound pessimistic, it's actually been helpful. I don't "hope" for things anymore. When he was first sick, I hoped and hoped and hoped that something would change. It didn't. So I quit hoping and just resigned myself to learning to accept the inevitable. I thought this was "unchristian" of me until I read a life-changing article about how the idea of "having hope" often contributes to cancer patients stress. So now, frankly, "hope" doesn't really cross my mind. Part of me even fears that the more I "hope" it won't happen- the more likely it is that it WILL happen. So I've started asking God to help me deal with whatever He throws my way. And I usually squeeze in, "but if you could stop throwing sucky things at me, that would be AWESOME." Is that wrong? When the bible talks about "faith, hope and love" being the three most important things, am I exhibiting a lack of faith if I don't "hope" for something better? Also, is it wrong to use the word "sucky" when I'm speaking to my Heavenly Father? Just asking.

Tuesday, September 3, 2013

Betty

I went back today and ready every single blog post. Heavyyyy. Ugh. Sorry about that. It was kind of creepy, actually. All of these things that I wrote to Daddy about his cancer- I had forgotten that I had even said them- and now I'm repeating them about my own cancer. I even mentioned the song that is now one of my favorites- Martina McBride's, "I'm gonna love you through it." It seriously made me mad. Like I'm experiencing some kind of divine test- or joke. I know that my job is to show my girls how this is supposed to be done, just like Daddy showed me. I know I can do it, but ya'll. . I really don't want to.

Most of my friends know that what I need most is to laugh. To stay busy with other things besides cancer. Maybe do a couple things that are bad for me and say, "WHAT? Afraid I might get cancer or something?" When one of them complains about something, I like to make them uncomfortable by saying, "trade ya'," or "well, I have a tumor." I told someone last night that I was going to milk that part while I can since someday I won't be able to. ;-) Then I laughed because I said, "milk it," and pretty soon I won't have any boobs with which to milk anyone. The great part about all of that, though, ('that' being cancer, I guess) is that cancer makes everything else seem so freaking AWESOME.

My job was awesome before, but now it's a vacation for me. Somewhere where nobody even knows I'm sick. Somewhere I can be anyone I want to be. Somewhere where I don't have the time to cry. It's so awesome.

My friends are awesome. I've never been one to have a ton of friends. I prefer just a few close ones who really, truly know me. It took me a long time to find that, but I have it now and it is amazing. And I consider every single one of you who takes the time to read this a friend. My friends have touched my heart and made me feel so unworthy of the love they're giving me. Every message, every call, every hug- I am so, so grateful for each of them- and each of you.

My girls are so awesome. Last night they were driving each other nuts in the car and I laughed out loud at them. How awesome that they think that someones knee touching their carseat is the worst thing that has happened this week! It's already like they've forgotten that I'm sick. Of course they can't see it yet, but it gives me hope that they'll brush this off and move on. At the same time, I hope that I can teach them something they'll remember along the way.

My husband is awesome. He's been folding laundry and packing lunches. And when I tell him that my back hurts and I think it must be another tumor, he tells me it's just stress. When I tell him that I'm going to look like a freak, he tells me he didn't marry me for my boobs, that he's really more of a butt man, and that I would never look like a freak.

Exercise is so awesome. I cried in the gym this morning. You see, I've battled my weight since I was a teenager. I've lost more weight and gained it back than I can even count. I hated sweating with a passion- and I used to tell people that I would only run if I was being chased. Two years ago when J was put on blood pressure medication we decided we needed to do something. We started a fitness journey together that changed our lives. I've done things in the last two years that I NEVER thought I would make my body do. I lost 40 pounds, ran in races and began to love sweating.The gym became my second home, and I was so proud of it. I have these fleeting thoughts now that maybe I'm being punished for caring so much about something so cosmetic. On the other hand, if I weren't so strong now, I wouldn't have as much muscle to fight this bi*ch with. That's what made me cry in the gym, though. I'm going to miss it so much. And I'm afraid I'll get fat again. There, I said it. I'm afraid I'm going to be bald and fat with no boobs. Yes, I KNOW I have bigger things to worry about. Yes, I KNOW I'm fighting death. But I would rather not be bald, fat and boobless while I'm doing it. And before you say it, yes I KNOW it's only temporary and I'll get through it. That does not make it any more appealing.

Here's what I've learned that I didn't know- and you probably don't either. They have this thing called "immediate reconstruction," except that it's not really immediate. The only immediate thing is that they put, essentially, balloons in where your boobs were. They blow them up weekly to stretch your skin until you're ready for implants. In the meantime they look all lopsided and uneven. And here's the great part. Apparently, if you need chemo, "immediate reconstruction" isn't even an option. That means I would have NOTHING for several months. NOTHING. How will I even LOOK at that? Isn't that insanely vain? I know it is, but I can't help it right now because I know it's going to be a long time before I will look like something even CLOSE to normal. I am telling myself, even as I write this, that after I get through that, getting ANYthing in there will look and feel awesome for me and I'll never take my body for granted again. See, I really am trying hard to put an upside to every down.

I feel like I have to say this every time. I know that even though cancer sucks, I'm a very lucky woman. There are so many people out there with no hope for themselves or, worse yet, for their babies (by the way, September is Childhood Cancer Awareness Month- talk about a vicious monster). I never want to discount what they're experiencing or compare my pain to theirs. The fact remains, though, that however big or small our battle, our pain is our pain. Thinking about other people's battles can give us important perspective, but it doesn't fix OUR battle. I'm kind of just figuring that out. So when you say you have a cold and I say, "wanna trade?" it doesn't mean that having a cold doesn't still suck.

I named my tumor. Betty. Betty the Bi*ch, actually. Sorry for the language, but she is kind of a bi*ch. And now, even though I know she's only, like, 1 centimeter, she feels like she's the size of my fist. That's kind of a bi*chy thing to do if you ask me. And what kind of bi*ch sets up camp in your body without asking and then, when you evict her, takes your freaking boobs with her? So you see, I think the name fits. It helps me stay mad at her as I sit here and DREAD- I mean full on sweating, heart pounding, can't eat (which is RARE for me)- DREAD tomorrow. Are they going to tell me more unexpected things? Are they going to repeatedly shake their heads when I say, for the 10th time, "YES, I'm 34 and NO there is absolutely no history of breast cancer in my family. Ever. Anywhere. Nobody." Well, my girls will have a much different answer, won't they. I'm praying that the advances in medicine are so great over the next decade that they won't have to fear it as much as we do. But right now it just reiterates what I'm already feeling. I'm 34 and I have a disease that nobody I know has ever had. They even told me not to bother calling the American Cancer Society support hotline because most of the women are retirees and "probably wouldn't be able to relate to my situation." But I know there are more "me's" out there, and I'm going to find them. As soon as this bi*ch hits the road.

Monday, September 2, 2013

365 days

Well, Daddy, this is one letter I never pictured writing. Actually, I had avoided writing anything at all since you left. I like to come back and read your letters, and I kept telling myself that I should tell you about all of the ways the girls remember you. They look out the window and wave at the sky in the morning to tell you hello. When we had a picnic last week, the little ones did their new dance while they looked at the sky and said they were "showing Papa because he likes our dances." L calls you on her "phone" all the time to talk about the games you used to be able to play with her. K is so quiet. I can't get her to say much about you, but I know that's how she protects herself from her sadness.

This week you have been gone one year. 365 days without touching you or seeing your face. 365 days with no cancer in our lives. 365 days of stories that I didn't get to tell you. 365 days of memories you missed out on. 365 days to start to heal.
Then I went to the doctor.

In the midst of this story, let me tell you about all of the amazing ways you played a part. I dream about you pretty frequently. I get frustrated because you are always sick in my dreams. They are so realistic that I can't enjoy seeing and touching you again. A few months ago, I had 3 dreams in the course of about 2 months in which you and I both had cancer. One time I specifically remember telling you that I didn't want to die, and you told me that I wouldn't, but I didn't believe you. Finally, after the third dream and reading a story about a young mother who died of cancer at 38, I decided I must go to the doctor- just to make myself feel better.

I haven't been to the doctor in three years. It's easy to tell me how stupid that was- you're right. But I had just had a baby, so I figured I was good for a year. Then you got sick and I cancelled it last summer because I was too busy, and I figured it had only been two years. Then the dreams came, and I realized it had been three years, so I got the message- from you, the universe, God, whoever- and made an appointment in late June.

I went in on that day two weeks ago without even a second thought. I was excited to see my midwife, whom I hadn't seen since L was born. We talked about the girls, you, vacations, just life. And then she stopped and looked in my eyes and said, "do you feel that?" I realized that she kept touching the same spot. And I did feel it. She said, "It's probably nothing, but I am concerned enough that I want you to get it checked." I think I asked her if she was kidding. She wasn't.

While I waited for the next appointment, it was other people's concern that got me worried. I kept telling myself that we were all overreacting and we were going to feel so stupid when it was nothing. So we went to the follow-up- just to make ourselves feel better.

When you were sick and they made us go to that awful family meeting, I had this overwhelming urge to grab your hand and run. Just run. Because if they couldn't tell us, then we didn't have to know. We could just live. I felt that again as I was walking into the clinic. I felt the need to just run. If I didn't go, they couldn't tell me anything. After all, I've never been this healthy in my life so I'm probably just going through all of this expensive bullshit for nothing anyway.

Of course I didn't run. I didn't even run when they told me they needed "more pictures." I didn't run when they wouldn't say anything to me. I didn't run when they brought us into the quiet room with watercolor paintings and kleenex on the table. I didn't run when two doctors came in instead of one. I didn't run when they gave me a 50/50 chance of cancer. I didn't even run when they told me I had to come back right away for more tests. After all, I knew I was going to feel stupid when it was nothing. So I would go back for more tests- just to make myself feel better.

They did the tests and wouldn't tell me anything. They spoke in generalities and hypotheticals which made me so angry. They told me to sit and wait. Maybe 2 days, maybe 7, who knows. I asked them to call me as soon as they knew. I told them I was prepared.
I wasn't prepared.

They called at 1:20 on August 28th. My midwife was out, so someone else had to call. "Angela, are you at work?"
"Yes, but it's okay."
"Angela, are you alone?"
"Yes, but I'm okay."
"I'm so sorry, but it looks like you have cancer. It's what's called Invasive Ductal Carcinoma. We think it's a Stage 2. I'm sorry, but I'm not an expert so I can't really tell you more than that right now. The doctor can call you later. I'm so sorry."

I cried until I realized that she was just going to sit on the phone feeling sorry for me until I quit. So I quit long enough to convince her I was fine. I was thankful to have a sound proof office. On the way home, I found a friend who fought through the same thing two years ago. She let me ask anything I wanted. All I could think was, "what's going to be the worst part?"
"Pretty much everything for the next year is going to suck."
But I could look at her and see that there is an end. Or a new beginning. Or both. Someday maybe I would have trouble remembering this moment and the horrible depth of fear I was feeling.

The doctor called while I was on my way home to tell me that I could expect a mastectomy and probably four rounds of chemo. And I should know I would lose my hair. Thanks- I hadn't figured that one out already.

I drove really slowly because I wanted J to have as much time as possible living in normalcy before I told him. I thought about staying away for hours so he could be mad at me for being late instead of having to think about what was actually happening to our life. I remember walking into the house and the girls running up to me screaming and grabbing my legs like any other day. I felt so guilty for what they are undoubtedly going to see and experience over the next two years. Then I saw him, and all I had to do was nod my head.
It was a very long night.

I waited a few days to talk to the girls and to Mom. As soon as I asked the girls if they had heard of cancer, Claire said, "that's what Papa had." I explained to them that you can get cancer anywhere, and that not everyone dies. I tried to laugh about what was going to happen to my body so that they wouldn't be scared. They were still scared. The little girls kept asking me if I was going to die and go to heaven. They don't want me to leave them to go to the hospital. They don't want people to see me "with no hair on." But we got through that together. And you would be so happy to see how amazing your son has been. He is there for me every step of the way- taking care of Mom and me. He's brave and strong- just like you.

You know, Daddy, many people have mentioned how sad it is that this is the one year anniversary of you leaving, but to me it's not all sad. I was so scared, so angry when I found out, but I was also ready to fight. I saw you fight more valiantly than any person could imagine. You fought a monster that you could NOT beat- just to show me how it was done. You taught me how to do this, Daddy. You gave me a reason not to have a pity party- because I have a monster that I CAN beat. Remember that day we walked into the chemo room for the first time and we were horrified and scared to death? Well, I've been there with you, so when I do it this time, the monster has a name and I know the end game. Do you see, Daddy? I know why you had to go now. You had to prepare me for this fight. And even in my really, really dark moments when I think about the what-ifs, I am less scared because I know that my Daddy is there waiting for me.

Wednesday I will spend all day in the hospital. I have gained a new appreciation for what you must have experienced. I feel like a science experiment. All of the questions and the tests and the needles. I'll feel mad and scared and sick- and I'll feel like I really want to run away. But then it will be over and I'll go home and try to be Angela again and not the 34-year-old science experiment with a random case of cancer.

So thank you, Daddy. Thank you for showing me what to do. Thank you for holding my hand- in life and in death. I want you to know that God has blessed me with some seriously AMAZING people who will hold my hand now that you can't.
 http://www.youtube.com/watch?v=4ufq8iMYvL0