A Note on Dawn

Not feeling so pretty good (to be expected) sitting up on the bed, setting in a chair and taking short walks (assisted). Difficult to talk and take a breath due to a tube - we got it removed, but not before nearly choking to death - sometimes you must demand what you know is right.

The pain medication is taking the edge off and Dawn is handling it with grace.

6:30 am Dawn is feeling better than yesterday, sounding clear and ready for the kids to visit.

The day started out great but turned bad in the afternoon - we expect there will be many days like this.

She has been walking about 75 feet (round trip) actually had a piece of toast and some kind of soup.

Our thanks go to all that know Dawn, Prayed for her and helped us get past this first hurdle.

Now comes the difficult road of eradicating the remaining bit of the devils work with Chemo therapy.

Dawn is recovering, and those of you that have gone through similar situations know that it can be slow and arduous at times. Friends and family have helped - don't know where we would be without their support.

Hello to all my Dear Friends! I am getting stronger every day, this is my first email to let every one know that I am getting better. I had Tom take a picture of me today as I had 15 inches of my hair cut off today. I have grown my hair long for over 15 years. I will be starting my Chemo treatments the first week of March and my Doctor said it would be better to get a short hair cut. It was a hard thing to do after wearing it long for so long, but I got a nice short cut. Hair will grow back.

I want to thank all of you that have kept me and my family in your prayers. It has meant a lot to all of us. All of the cards and flowers sure have made my days happy. Some of our family members and friends here in Michigan have made meals for us and brought them to our home. It has helped Tom as he sure has his hands full. I will be sending out thank you notes soon . My eyes just have been a little blurry so I have not been able to write very well.

I will be starting the next part of my journey with the cancer. My Doctor feels that he removed 95%. I am scheduled to receive 12 Chemo treatments. Please keep us in your thoughts and prayers for the months ahead.

This allows blood to be drawn or fluids to be put in - such as Chemo - poison - to help kill the Cancer that has attacked Dawn.

It is attached so that it is hooked up to the jugular vein - we are going after this demon with gusto.

On a lighter note, we have celebrated our 40th wedding anniversary at Molly's restaurant in Midland with

The first treatment has been given on March the 4th. Everything went well. Dawn made it through the treatment just fine.

We will be watching for the side effects in the days ahead. We hope that the side effects are mild ones if any.

Just a note to let every one know that I had my second chemo treatment yesterday. Before the treatment I had a Doctor visit with Dr Boike. Before my operation for the cancer my CT markers were over 1200. A normal reading is 35 or below for a woman. Mine was off the charts so that is one way they knew that I had cancer besides other test that were given .

I have blood work done 2 days before every chemo treatment. When I saw Dr. Boike my CT markers were down to 30!!!!!!!! That is wonderful. The cancer is still with me but what a drop. That means the chemo plus the operation is working. I have started to lose my hair. I am getting very thinned out on the top and sides. I will wait a little longer that have the rest buzzed off. Tom says this is a good sign as it means the chemo is working.

Thank you all for keeping us all in your prayers and thoughts as I go forward on my journey to become a cancer survivor.

We are sorry that we have not up dated the notes to you all. We hope that you folks have not been worried.

I have had chemo treatment number 3 on the April the 15th. The week before my treatment I had a bladder infection and had to be put on a medicine to over come the infection. My infection did clear up thank the Good Lord.

After this chemo treatment I have had the side effect of being very fatigued. We have been taking a morning rest and a afternoon nap. That is what one has to do with the cancer fatigue.

The Midland Cancer Society has a treatment call Reiki to help people over come the pain and to relax and be at peace with-in your self. I have started the treatments and I think they will help me with worry and stress. I also went to a class offer by the American Cancer Society to help cancer patients feel good about themselves. They taught us about make up and things to do for our bald heads and our skin. We were given all kinds of make up and skin care products. It was all given to us at no charge.

You can see by the pictures above that I am now bald. it is a hard thing to handle but hair will grow back once I finish my chemo. My dear husband Tom bought me a wig but it kind of bothers me. Little Dylan say's he loves me with hair or without!! Leave it to a child to make you feel better about yourself.

I will be having my 4th chemo treatment on the 6th of May. 8 more after that. It is a long day being hooked up to a IV for almost 5 hours.

We want to thank you all for the prayers and all the e-mails asking how we are all doing. friends and family sure have helped us keep our out looks high. We are trying to be positive.

I hope that this up date finds you all in the best of health and good spirits. A lot has been happening

with me. When I had my 4th chemo treatment they could not get a blood return. This has happened every time I had a chemo treatment. It was decided by Doctor Boike that I needed to have dye put in my Med port and then a x-ray to see what the problem was. During that time I developed a bad cough and a cold.

Having that I was not able to have the test or my chemo. I was put on medicine to get me over the cold and cough. It took me two different medicines to fight that off. Because of getting sick I lost another week of chemo. I had to have the Med port removed today the 5th of June and a new one put in. No one knows what happened to cause a kink in the old Med port plus it had moved up into my neck and that is why it was not working right.

I am home tonight and glad that the Med port is replaced if it needed to be. I just want to get back to my schedule for my chemo which should be every three weeks.

Our children are now out of school so they will be here to help me. They are good kids and they realize that they have to pitch in and help.

I am scheduled to have my next chemo on the 11 0f June. I just hope and pray that I am able to keep this appointment as it will be 6 weeks since I had a treatment. I just want to get it done.

When I had my 4th chemo my blood work showed that my CA 125 levels had dropped to 15. That is wonderful. I thank the Lord that He is making the chemo treatments kill the cancer. I have 8 more to go and we hope that I will continue to improve.

I hope that this update finds you all in the best of health and good spirits. Yesterday was the 4th of July 2009, it was a beautiful sunny day here in Michigan. We had a quite day of rest. Tom grilled out and we took Dylan to see the fireworks right next door at the church camp. The fireworks were beautiful and little Dylan enjoyed them as did Tom and I.

On the 1st of July I had my 6th chemo treatment. Before going for my treatment I went to see Dr Boike.

My CA 125 count is staying the same at 15. This is great as often they stay the same for a while.

Because I am half way through my chemo I need to have CT scans of my brain, chest and abdomen to make sure every thing is OK and verify the CA125 marker. This will take place on the 14 of July. I pray that all will be fine.

There are many side affects to Chemo Therapy and most people do not have them all and you generally only hear about the most prevalent effects - each individual is unique in their reaction to the treatments. I am experiencing a dramatic loss of vision (nearly blind) in my right eye due to the chemo attacking the nerve endings in my cranium - this also can cause a loss of the ability to process information and decision making. While this is frustrating it is also usually temporary and the effects go away after treatment is completed.

I want to thank everyone who has been praying for myself and my Family. It sure means a lot to all of us.

I have some very good news to share with my dear Family and Friends. Last week I had CT scans on my brain and my chest and my abdomen. We are happy to say when I went to see Doctor Boike on Wednesday the 22 of July that no tumors were seen. I was so scared to hear what he would have to say. I am half way through the chemo so this is a critical point. My CA 125 level is now 14 so it dropped a number too. It was a great report for Tom and I to hear.

I have a wonderful husband. He goes with me to all of my doctor appointments and wants to hear my reports. Then he goes with me to my chemo treatment and sets with me while I am hooked up to the IV for 5 hours. Tom goes and brings us lunch to help break up the time. He might fall asleep in the chair next to me but, he is right by my side.

People do not realize how important it is to have strong family and friends to help someone through a serious illness. I can not express how much I love my Family.

We are all enjoying the summer as much as we can. The kids are swimming almost every day.

I can not be in the sun because of the chemo treatments so I have not been able to swim. I look forward to next year!! It is hard to believe that July is almost over.

I had my 9th chemo on the 2 of September and I saw my doctor also. As you may know when I have my chemo treatments

I receive Carboplatin and Taxol. For my last three treatments I will be receiving only Taxol. My CA 125 level is at 14 which is good.

I am still suffering from fatigue and require a lot of rest. I have to take lots of naps (Tom does not seem to mind the naps as he is required to attend). Also I have fatigue because I have anemia, I could get a blood transfusion but I will see how my blood count is in three weeks. I want to get done with my treatments.

I want to thank everyone for their thoughts and prayers for my and my family. We are doing well but there is still along way to go.

The Lord has blessed us as I keep progressing. We are keeping positive thoughts even on the bad days.

We will be sending the children back to school next week so that will get things kind of back to normal.

I had my 10th chemo and I had a good treatment. My doctor was out of town so I did not see him before I had a treatment. I guess all my numbers must have been OK or I could not have had a chemo treatment.

I will be having my 11th treatment on the 14th of October. My last chemo (number 12) will be on the 4th of November if all goes as planned. I will find out what the next steps are in my cancer journey. I pray every day that the lord will allow me to be here to raise the children.

I hear very often from friends and family that are praying for my recovery and my family. It means so much to Tom and I and our children.

We are now into the fall here in Michigan and it is very beautiful. Every time I go for a ride I think how lucky we are to be able to enjoy the Lord's handy work.

This is my last chemo in the series of 12. Here I am at the beginning when I just got hooked up to the

This is at the end of the day when I am just about ready to get unhooked .You can tell I am very happy to be done!

I hope that this finds every one well and happy. I am wanting to share how happy that I am to be finished with this part of my Cancer Journey. It has been a long journey but one that I realize I am lucky to have been able to take. At this visit to my Doctor Boike office this morning I found out how we will continue the treatment of the cancer.

Ovarian and uterus cancer are at a high risk of returning. I will be seen every three months by Doctor Boike. I will have a pap smear every visit to check on things and cat scans every so often. I will do this for the next two years every three months. This is why I must keep the med port in my chest so if the cancer shows up Doctor Boike can put me back on chemo again. We are not going to think like that! We are going to be strong and positive. Dylan is going to be 8 years old December the 31 and I want to be here to help raise him and see him graduate.

My family has been so strong and helped me get through the last year. Tom has been very strong and positive for me when I have been sad and felt down. It is so wonderful to have a partner in life like Tom. I know this has been a terrible year for him as well with me being sick and he has not been able to find work since February. He has tried not to show how up set and worried he has been. I want to thank him for being there for me. We have been married 40 years but it does not seem like it!

I also want to thank my sister Pat for being there for me. She has taken time to go with me to my chemo twice when Tom was not able to go. She has made food for our family, come to visit me, given us a gas card, called every week to check on me and just be there as a sister and a friend. Life is so short and we all need to take time and just be thankful for the little things.

I feel as though as we get closer to Thanksgiving I realize the true meaning of being thankful. I am very thankful for a year with my loved ones. I might not say it but I do love and treasure them all. I am also thankful for all of the friends that have kept us in their daily prayers and thoughts. I believe God has heard them and has helped heal my cancer. No matter what happens I will try and be positive.

I wish everyone a blessed Thanks Giving. We will keep you up dated as I go along with my Journey.

The kids are all well in school with Caietlyn looking forward to graduation in 2011. Amanda is into make-up and hair do’s. Dylan is into the Transformers and night vision?

This has been a very difficult year for many people and we consider ourselves blessed.

Remission - Defined

Remission is the state of absence of disease activity in patients with known chronic illness that cannot be cured. It is commonly used to refer to absence of active cancer when these diseases are expected to manifest again in the future. A partial remission may be defined for cancer as 50% or greater reduction in the measurable parameters of tumor growth as may be found on physical examination, radiologic study, or by biomarker levels from a blood or urine test. A complete remission is defined as complete disappearance of all such manifestations of disease. Each disease or even clinical trial can have its own definition of a partial remission.

Some people think that remission means the cancer has been cured, but this is not always the case. Remission is a period of time when the cancer is responding to treatment or is under control. In a complete remission, all the signs and symptoms of the disease go away and cancer cells cannot be detected by any of the tests available for that cancer. It is also possible for a patient to have a partial remission. This is when the cancer shrinks but does not completely disappear. Remissions can last anywhere from several weeks to many years. Complete remissions may go on for years and over time be considered cures. If the disease returns (recurs), another remission may be possible with further treatment.

Today is May the 3, 2010. On the19th of April I had blood work done and a cat scan taken.

This was done because I felt some lumps on my right side and I was concerned.

I received a call from Dr. Boike (my cancer doctor) that my count was up from 14 to 41.

also that I had nodules. I saw Dr. Boike today and I am no longer in remission. I will be starting two new kinds of chemo treatment very soon. If the nodules go away or shrink I

will be on two chemo's for a while. If they do not work then he will try other kinds.

We were hoping that the first chemo would keep me in remission for many years. Perhaps the new drugs will be the ticket.

We are not giving up hope with this set back! I will keep my spirits up and try to be strong

We hope this e-mail finds you all doing well. I thought I would let everyone

know what has been happening in the last 6 weeks. I started two new chemo treatments and I had different side effects than the first kinds of chemo I had.

With this I have a lot of nausea . Nothing smells good or tastes right. I have medicine to help with the nausea.

When I went to see my doctor and have my second chemo treatment my white cell count was too low so the doctor said I needed to wait a week so it could come up.

When I went to see him before my next chemo treatment I was having trouble getting my breath and coughing. He sent me to the emergency room as he was worried I might be having heart failure or a possible blood clot. I was checked into the hospital where I stayed for three days while they ran all kinds of test on me. I was given breathing treatments every 4 hours and that seemed to help. I did not have a blood clot and my heart checked out ok.

They did find 4 spots on my left lung and not sure if cancer has traveled there or not. They are to small to tell at this time. If it is cancer the chemo Treatments will reach everywhere there is cancer cells.

I was put on 8 new kinds of medicine plus breathing treatments. I do not know what caused the breathing problems perhaps it is the cancer? I am feeling a lot better so something is helping me.

I do know that I am happy to be alive every day. I have put my self in the Lords hands to take care of me.

Everyday I wake up is a good day. I have really enjoyed the beautiful spring flowers and the trees so nice and green again.

I will let you know if the new chemo treatments help or if I will be put on a different kind.

On the 7th of August, Saturday: Dawn was having some minor difficulty with memory and speaking, we attributed this to the effects of Chemo.

Monday August 9th: We went to the Midland Emergency Room at Midland Hospital.

We had the test back from the MRI on the 22 of Sept. I went to see Dr. Boike. The MRI shows that I do not have Cancer of the brain. We have been so scared since August the 9th. I did have a stroke.

I will be starting chemo again next week. I will have 5 more of the same kind. Once it is 5 more then we will see how the cancer is doing. If I need a different kind I will go to another kind. We pray that this chemo will help.

We want to thank you for the thoughts and prayers. It has meant a great deal to us. It is hard to understand when people have a long illness how prayers and thoughts do help!

The leaves are starting to turn and this is such a beautiful time of the year. I look at the trees and realize how God has made such a beautiful season.

I went to see my Doctor Boike on Wend. and my numbers have gone from 63 to 45. That is a good sign.

I will be having two more chemo's and we will see what is happening. We pray that things will get better.

Thanksgiving is coming up and it would be a wonderful Thanksgiving to know what things are getting better.

I have had pains on my right side so I will need CT scans to make sure what is happening. Plus a MUGGA scan on my heart to make sure the chemo is not to hard on my heart.

We hope that every one will have a wonderful Thanksgiving with you and your Families. We are having our children over. With the help of Mr. Meyer's we are going to order a meal from there because it is hard for me to do the preparation. I want to have us all together as we do not get to see each other that often.

We hope that every one had a nice Thanksgiving? This is our Family except for Shawn. He was not able to be with us this year. We had the family over for a blessed day. It was work for us but we sure enjoyed having Tim and Heleen and their three children over from Detroit. Kimberly and Larry were also here. Plus Amanda and Caietlyn and Dylan.

I went to see Doctor Boike on the 1st of December. I had a Cat scan the week before as I had felt some pains in my stomach and lumps. I was told that there were three more tumors in my stomach.

I was to have two more chemo's but my Doctor said I needed to be moved to a whole different kind of Chemo. As the one I had was not working. Damn it.

I will now be getting Gemzar and Platinol. I will now be getting these drugs every week for two weeks than I will rest a week and start over again. So one week off and two weeks of chemo. This is a stronger chemo so we pray that it will work. It was quite a let down but we are not giving up. We realize that some times we have set backs. this new chemo as made me very tired. I just do a few things and I have to rest.

We hope and pray that everyone will have a wonderful holiday. You are in our thoughts and prayers .

Thank you for the prayers that folks have been sending out to us. It means a great deal.

Happy New year to all of you. We hope the New Year is a good one for all of you.

We are starting out the New year with a Gemzar and Plational that we started in Dec. Because of my white cell count being low I have had to miss one of my chemo's. I am now going to start shots called Neupogen

that will help get my white cell count up so I will not miss any more chemo's. I will need to take shots for two days after I have had my chemo.

On the good note my CA 125 LEVEL IS AT 29 so that is a good thing. I guess we just have to realize that there are ups and down with this cancer. I pray that this will be a good year for all of us. It is hard to believe that on the 23 0f January it will be two years that I have been on this Journey.

I want to thank all the friends and family that are still praying for me and my family. This is a very hard journey and knowing that I am not alone has helped me.

We had a wonderful surprise on the 31 0f January. Our grown up daughter Kimberly (35) did not know she was PG!! Kimberly delivered a beautiful baby boy 6 pounds all by her self in her bathroom. We received a phone call at 4:30 AM that she was in the Midland Hospital and that she had a baby. We were shocked as she sure did not look PG when we saw her on her birthday on the 13 0f January. Little Larry is sure a wonderful miracle for all of us!! Father and Mother and Baby are doing just fine. This has been a great experience for all of us. It makes me realize how precious life is to have this new baby.

I went to see my Doctor Boike on the 9th of Feb. My CA 125 level had rose to 45. My doctor feels as though

the chemo is really not working. I will need to make some choices about what to do in the near future.

I chose to have another series of chemo. I had it on the 9th after I saw my Doctor. I will have another chemo next week. Then I will have a cat scan to see what is happening in my stomach. It is a hard thing to choose what to do for me. I just wish I could be over with the whole cancer problem but the Lord has not chosen that for my journey. My husband as been wonderful in all the ways possible. If it was not for him I think I would give up sometimes.

I know that I have a lot of family and friends praying for all of us and that really does help.

We have our miracle baby to look forward to in the days ahead. I pray everyday that he will be a wonderful

I went to see Doctor Boike on the 16th of March. My CA 125 was 34. Because I have been on chemo my body is getting very tired. Often when people have been on chemo for a long time they have a rest period from the chemo.

I have decided to take a rest and let my body recover from the chemo. I will rest for 3 months. At that time I will have a Cat scan and also blood work to see if the Cancer is progressing or continues to be stabilized.

If the Cancer is progressing, I will start a different kind of chemo in June.

It was a hard choice to make I just pray that the cancer doesn't go some where else.

We hope that the nice weather is here to stay. The snow is almost all gone. The children are very happy. We hope that everyone has a nice Spring.

Today is a rainy day and kind of cold. I hope that this finds every one in good health. I have been on a rest from chemo since March. Right now I am not feeling too well. I am quite bloated in my stomach and I am having quite bite of pain. I do not feel like eating and when I do I can not eat very much or I feel ill. After eating I have pains in my stomach. I called Dr. Boike and I will be having a Cat Scan on the 16th of May. After Dr. Boike receives the results I will have a visit with him and see what is happening.

Caietlyn will be graduating on the 26 of May from High School. I hope and pray to feel better at that time. I do not want to ruin her special day! It is such a big deal to be finishing High School. Caietlyn also had her 20th Birthday on May the 11th. She is looking forward to getting a job in the next few months.

I hope that all is well with everyone? I sure have enjoyed the beautiful flowering plants

Our little grandson (Little Larry) has brought me a lot of joy. We try and see him every week. He is now up to 10 pounds 12 oz. When he smiles at me it sure makes my day!

I hope all is well with everyone on this nice sunny day? Girls are out sun bathing and Dylan is out roller skating. Today is a great out side day.

I had a cat scan on Monday the 16th of May. I went to see Dr. Boike on Wednesday the 18th. It was not a good report. I have many new lesions in my stomach. I have lost another 12 pounds as I just do not want to eat as I feel full all the time. The stomach is bloated so I feel full most of the time. I will be starting a new chemo on Monday it will be a pill kind of chemo. We hope and pray that it will shrink my lesions.

Because I am not doing very good it is with a very sad heart that I must place my beloved doggies. I have been a breeder of the Shih Tzu doggies for over 34 years. These little doggies have been a part of my life for so long that is hard to not be able to have them in my heart and daily routine. I will not be breeding ever again.

If any one would like to call me about what I have to offer we would sure like to hear from you.

I want to Thank everyone that has kept us in their prayers for the last 2 and a half years. I do believe that prayers have helped me get where I am to day.

Dawn has had a bad outcome from the last series of Chemo (A pill form) and is in critical condition.

While her vital signs are stable, they are stabilized artificially. We will have to see what happens when the efforts of Covenant are removed.

Dawn has been moved to Woodland Hospice in Mount Pleasant MI to await her journey to our Lord.

Your prayers have been a great comfort for her long and difficult battle, and continue help through this transition.

This morning - Dawn was still unresponsive for the most part - we know that she can hear our voices and there are small indicators that she knows we are present.

Yesterday morning, Pat & Bob stopped by (Dear friends of ours) Pat sang her a song and she clearly responded by moving her left arm and opening her eyes just a slight bit (a dramatic moment) - thank you Pat! (Bob - grow your beard back)

Dylan, our 9 year old doesn't believe he can go on without his MOM, he has offered to drop out of school (3rd grade) and stay home to help out - God bless children. He has said that he would sacrifice himself to save his mom (I understand what he is willing to do).

Bobbie stopped by (a true friend since Jr. High) stopped by, I believe Dawn heard her voice and felt the love that her and Dawn have shared all these many years. truly a sweet sweet person.

The girls (Mandy and Caietlyn) are helping me to get through this very difficult time, they are going to miss MOM immensely. I will need their youth and strength to survive. I will have to be better at helping them.

Dale and Brenda (dear friends for many years) were here and are the rock that you reach for when you are drowning and we feel that we are.

Shawn, our oldest son is devastated and is beginning to understand that he is losing his strongest supporter and advocate, And without his mom he thinks he is lost. He is not, we will help him through this, and anything else he needs.

Tim, our second oldest son is our anchor, he has had a difficult time dealing with this situation and for a short time felt that he was a bad son. He has a beautiful wife (smart too) and three grandkids to die for. He has stepped up to the plate and is helping in ways that even I may not know. such as helping to get siblings to see their mom when I have lost the strength to keep going.

Kimberly has found peace with Big Larry and a blessing with Little Larry - Dawn was so happy to hold the baby and know that he gave great joy to Kim and Larry. They are so right for each other. Kim talked to her mom today and told her that she was so thankful for the dancing lessons (ballerina) - the things we remember.

Dawn's sister's (Bev and Pat) have been there, every step of the way and have helped me in ways that I can never repay. Their wisdom and strength for the family cannot be measured. I love them for that.

George & Rick (Dear friends of Dawn's) are helping to find homes for the last few Shih Tzu dogs that Dawn has and their efforts again show what a sweet person that Dawn is that people would would go

A large portion of Dawn's life was raising these little dust mops for families and beginning breeders - she took great joy in this ministry.

As for me, I'm a little tired. There is no way that I have deserved to be in love with and be loved by this beautiful woman for nearly 42 years.

It is not over, but the curtain is slowly coming down and our hearts are being torn to shreds as it does.

Dawn Lee passed into the house of our Lord Jesus Christ on June 19th at 7:03 pm.

Her service will be at Wilson Miller Funeral Home (4210 N. Saginaw Rd. Midland Michigan 48640) on Friday 24th June.

There are no words that can express what the family is going through right now. those of you that have lost a loved one know.

Dawn L. (Ackerman) Shepherd, age 61 of Sanford died Sunday, June 19, 2011 at Woodland Hospice Home in Mt. Pleasant.

The daughter of the late Guerdon and Alice (Perry) Ackerman was born April 5, 1950 in Midland where she was raised and educated. Dawn married Thomas R. Shepherd February 25, 1969 in Basil, Switzerland. She was the manager of Howard Johnson’s Restaurant in Saginaw for many years. Dawn devoted her life to raising, breading and grooming Shih Tzu dogs for international shows and for family.

She will always be remembered as a caring, loving mother, grandmother and friend who was treasured by all who knew her.

Dawn is survived by her husband of 42 years, Thomas; sons, Shawn, Timothy (Heleen) and Dylan Shepherd; daughters, Kimberly (finance’ Larry Dean), Caietlyn and Amanda Shepherd; four grandchildren; sisters, Pat Ginter and Beverly Salisbury.

In addition to her parents, she was predeceased by brothers, Guerdon and William Ackerman; and infant sister, Henrietta Ackerman.

Funeral services will be conducted at 1:00 pm Friday, June 24, 2011 from the Wilson MILLER Funeral Home with the Reverend Father Daniel Fox, OFM-Cap of St. Agnes Catholic Church officiating.

Prayer Before Surgery

Remission - Defined