Wednesday 30 September 2015

Pinktober.....give me a break!

 
Author: Kim

So it's that time of year again, Breast Cancer Awareness month!

October last year I was diagnosed with breast cancer for the first time.

This October I will be recovering from a 2nd mastectomy and going through chemo for my 2nd breast cancer diagnosis.

As I was waiting in hospital, waiting for them to take my only remaining breast away, leaving me flat chested, a new 'awareness campaign' was launched. Take a bow Breast Cancer Now and Marks & Spencer for your insensitive #showyourstrap. Take a selfie showing your bra strap, donate £3 and nominate other people. I get that the whole point is the donating bit but please?! Showing a bra strap, when thousands of women have had a double mastectomy and do not wear a bra. Or the men going through breast cancer that don't wear a bloody bra! Is there not a way you can raise actual awareness as well as just the funds? Maybe hold a sign up stating a symptom of breast cancer and then donate?? Sounds much better!


This is to be alongside their launch of new 'post surgery bras' designed by Rosie Huntington-Whiteley and modelled by breast cancer survivors. Whilst I admire all the ladies taking part in this, I'm not sure how they are post surgery bras. All wired and none have pockets for prothesis!! Ridiculous!

The day after surgery and another brilliant awareness idea! This time Danielle Lloyd stripped naked and painted pink for a party at the Playboy house for Zeo Pink & breast cancer awareness. Yeh seeing her perfect body with her perfect looking breasts is really raising awareness! Just an excuse to flaunt your body and to advertise that product! Just do one



How exactly does this help?!

I'm sure there are many more but these two have got my goat and it's only 30th September, we are not even in October yet, we are in for a lot more crap like this to come!

Come on people, do some proper thinking when doing an awareness campaign, speak to lots of people that have been affected by the disease and see what they think.

October is a tough month for anyone that has been affected by breast cancer, please think of them if you are going to try and raise awareness or funds.

Tuesday 29 September 2015

Breast Cancer Awareness Month is nearly here....

... and on the Young Women's Breast Cancer Blog UK we're going to be telling it as it really is!

Don't miss out - follow us on Facebook and Twitter, and please share with others too.

Monday 28 September 2015

For the junior doctors

Author: Caroline McConnell

For the surgical registrar who took the biopsies which confirmed the cancer.

For the GP who gave me 40 minutes of her time when my appointment was only booked for 10, because I’d just been diagnosed and was numb with shock. And for the many more consultations following, when I was poorly from chemo and feeling isolated.

For the anaesthetic SHO who sent me off the sleep and took me safely through investigative surgery. Who would later review me on the ward because I was intensely nauseous, even though he’d finished his shift.

For the surgical registrar who removed my lymph nodes to determine if the cancer had spread and assisted on my subsequent mastectomy and reconstruction.

For a colleague, a surgical SHO, who at the end of her shift visited me in recovery and stayed for two hours to keep me company. She did the same during every day of my admission, despite upcoming exams and a need to study.

For the registrar who repeatedly drained the fluid that built up in my back in the weeks following surgery. Who listened when I dismissed back pain and bruising as a side effect of chemotherapy, only for him to examine me and point out that I had a pretty nasty infection, which if left any longer, would have required a hospital admission.

For the oncology registrar who talked through my treatment plan, patiently answered my many questions and consented me for chemotherapy. Who later took time out of his clinic to see me in the chemotherapy unit, to reassure me that the treatment induced loss of sensation to my fingers was unlikely permanent. Who listened with a genuine empathy and didn’t push me when I said that I didn’t want to suppress my ovaries, even if it would improve prognosis.

For the A&E SHO who recognised the early signs of sepsis and gave me rapid IV antibiotics when I turned up at hospital feeling “not quite right” in one of the days following my last cycle of chemotherapy.

For the the medical registrars who gently guided and supported me following my return to work. Who never complained at my slow management of patients, my continual stream of questions and my need for reassurance. Who gave me back my confidence. And to foundation trainees and core trainees who took up the slack created by me, without complaint, whilst I found my feet.

For the radiology registrar who examined my latest scans, one year post diagnosis and confirmed that my cancer hasn’t returned.

Some of these junior doctors have less than a years experience, others more than a decade, as the Department of Health terms all doctors who are not consultant grade as junior.

They don’t deserve a 30% pay cut. They don’t deserve to be in work on every weekend. They don’t deserve to have the protections which ensure employers cannot make them work excessive hours, removed.

For each of these junior doctors, this junior doctor will strike.

Wednesday 23 September 2015

Cancer messed with the wrong chick

Author: Christina B

Dear breast cancer,


You are a great leveller. You delivered your verdict to me two weeks before my 40th birthday last year. I had spent all year planning my party and you thought you could rob my joy. You didn't manage, it was still amazing and not a pity party. You instantly made me stop worrying about being 40. I don't care about being 40 now, I love it and desperately want to be 41, would feel honoured to be 50 and to be 65 would be amazing.

Breast cancer I'm not changing myself to accommodate you, I even told my surgeon he should move a mini procedure as it interfered with my party plans. He moved it.

Breast cancer you think you can take away friends and leave me lonely, you can't. I've met an amazing group of women online all under 45 who have breast cancer. Our sisterhood Is amazing and I wake up and log in just to connect with them and despite never having met them empathise and connect with them in a away I didn't know was possible.

So breast cancer you think you can make me less of a woman by having my breast removed, well I'm now going to be a national model on a London catwalk in front of celebrities friends and family to raise money and awareness. I'm going to be looking glamorous as I will have a professional fashion and make up stylist and I will rock that catwalk.

Breast cancer you think you can make me bald with the chemo, I was wearing false hair before you came along and I can rock a wig like you wouldn't believe. When the chemo nurse told me I would lose my hair I laughed and pointed to my red wig on my head saying this is a wig darling!!

Breast cancer so you think you can put fear and sadness on my son who is the centre of my world? Well breast cancer since diagnosis he has been so kind to me and our relationship is stronger than ever. We do things we never used to do and laugh and hug so so much more. He's almost a teenager but his favourite place is still lying on my stomach with me stroking his cheek. He knows compassion, he has maturity beyond his years.

Breast cancer you've opened my eyes, you've made me hungry for the life I want. You can keep my old life I'm not yearning for it, I'm going to be a new normal a better version of the old me...

Tuesday 22 September 2015

It's nearly breast cancer awareness month....

In just over a week's time it will be October - also known as "Breast Cancer Awareness Month".

The Young Women's Breast Cancer Blog UK will be sharing posts every single day throughout October, written by young women who have had a breast cancer diagnosis. We want to share the reality of living with breast cancer - the good, the bad, the ugly, (also the funny, the scary, the messy, the sad - the whole picture).

To give you a flavour, below are some quotes from some of the posts we have lined up already.

We would love to have even more posts lined up - if you are a young woman in the UK who has/had breast cancer, please have a read through our call out for submissions, and consider sharing your story here too.

If you would like to follow our blog you can do so on our website, Facebook page and Twitter feed.

And please - share this post as far and wide as possible to help us reach more people.

Thank you,
Sarah



*******
"A voice in my head said ‘of course, I knew it would be’. Not negatively, just calmly. Shaking at first, taking long breaths, I sat down with my husband and a Breast Care Nurse to talk through my feelings, my options, the road ahead."

 *******

"Wow you don't even have to pull on the hair, just touch it and it just comes out in your hand, it's everywhere. Think I'm beating the dog on the malting stakes. It's horrible having your hand full of hair..."

 *******

"...it was grade 3 triple negative, the most aggressive and hard to treat of all breast cancers. I needed to start chemo as soon as possible... the chemo I needed I couldn't have while pregnant!"
 

*******

"I was taken to hospital, redressed, and the [seroma] in my armpit was drained. About a week later my boob popped again in spectacular fashion, all over me, my poor son and my hall carpet. I held myself over the sink and I could see the hole in my boob so I supported it with my hand. What I hadn't realised was my boob had taken in air and upon supporting it the air pushed out and my boob farted!!!!! I laughed until the tears came."

*******

"Being a single parent with a cancer diagnosis opened up all those horrendous questions such as "who will care for my son if I die". I want to see my son go to school. I want to see my son play his first footie match. I need to see my son grow up into the most remarkable young man I know he will be."

*******


"I am a different person now and I am still trying to get used to my new normal. I may not be running marathons and nor am I loving every minute of every day. I still get annoyed and upset at the trials and tribulations of life and still occasionally “sweat the small stuff” but I’m getting through every day as best I can. Moving on has not been easy and I’m still working through things. I saw this quote “Sometimes you have to go through things and not around them”. That’s what I did I, got through it."

 ******

"What is my lasting memory of what cancer gave me after 13 months, it brought me back to my family, brought me new friends, renewed friendships with old friends. It's given me more than it ever took. I know I'm one of the lucky ones, but one thing that was a constant, I never stopped believing in life."


*******
 
(Our pink photo ribbon was created by the wonderful Melissa Fletcher )
 

Sunday 20 September 2015

To the woman on the train

Author: Anonymous

To the woman on the train who was so aggressive to me for being sat in "her" seat....

You didn't really give me any chance to explain, and it's been bothering me since. So I will tell my side here in case one day you happen to read this.

It was Friday night and I was getting a train home. The train was packed and the train manager kept announcing that all reservations were cancelled, all tickets for all seats. I must have heard the announcement ten times. I sat down in the seat next to me. I put my earphones in and felt relieved to have a seat. The train filled up, there were no seats left, and people were standing.

You came along and told me that was your seat. My heart sank. I said I'm sorry, they'd announced it was all tickets for all seats and that reservations were cancelled. In my mind I was working out what to do. I would normally just apologise and get straight up, but I didn't know if I physically had the energy to stand for over an hour's train journey.

Unfortunately you didn't give me any chance to explain. You instantly got aggressive and started raising your voice at me. Everyone around was staring. I wanted to cry. Not only do I hate confrontation but I didn't want to announce to the whole carriage that I was desperate for a seat because the treatment I have just gone through for cancer means sometimes all it takes is to get up and have a shower before I feel exhausted enough to return to bed again.

Your aggression was also pretty intimidating. I didn't actually know what to say. You left the carriage but not before shouting at me. The women sat opposite me shouted back at you, and when you were gone I explained to them that I just really needed the seat, I was exhausted, I'd just had a lot of cancer treatment and it had taken it out of me. They were really kind.

A few minutes later a member of train staff came and told me to move. I started to get up - I wasn't in any way inclined to argue the case, while I didn't know if I had the energy to stand, I knew I certainly didn't have the energy for a fight. All around me people started chiming in. Telling the woman that they had been announcing on the loudspeakers continuously it was all tickets for all seats and reservations were cancelled. Telling me to stay put in my seat, I shouldn't have to move. But I got up, and went to the other end of the carriage, and spent the next hour and twenty minutes leaning against the toilet door. There wasn't even room to sit on the floor it was so crowded. At one point I nearly fell because I'd actually started to fall asleep standing up.

I got home, and I cried.

Two days later I've cancelled popping round to a friend's house for a cup of tea and a catch up. I still don't have the energy to leave the house.

Perhaps next time someone is sat in a seat that you believe to be yours, you could consider whether they might actually really need it. Perhaps you could ask if they really need it, give them a chance to explain at least before starting to shout at them. There are lots of illnesses and disabilities that aren't visible. Just because someone isn't very elderly, or obviously heavily pregnant, or have their leg in a plaster cast - it doesn't mean that there is nothing wrong with them.

My body has been destroyed this last year, by chemotherapy, radiotherapy, surgery, endless drugs... and that's just the treatment. The cancer has an impact too. I'm tired. I'm in pain. All I wanted to do was sit down. I did not deserve to be shouted at like that.

Wednesday 16 September 2015

More submissions needed for October Breast Cancer Awareness Month!


Hello everyone!


October is breast cancer awareness month and on 1st September I shared a call out for submissions to the blog from young women who have/had breast cancer. (A copy of this is below).


Thank you so much to everyone who has sent in blog posts for October so far - there have been 21 already. I have been absolutely blown away reading them. I've laughed, cried, felt angry at cancer, and felt incredibly inspired by the young women dealing with breast cancer - the newly diagnosed, those currently going through treatment, those who are living their "new normal" post treatment, and those who are dealing with a secondary diagnosis and treatment. The range of stories and voices of young women facing breast cancer in these posts in so powerful. It's going to be an honour to share them throughout October and help raise awareness of the impact of breast cancer on young women's lives.


We still need more though! I am hoping for at least one post a day during October (and two a day would be fantastic!)


So I am copying below the original call out for submissions. Please, please share this far and wide so we can reach as many people as possible.


Thank you,


Sarah


*************************


October, is breast cancer awareness month. Last year during October I was going through chemo myself, and if I'm honest I found breast cancer awareness month to be at best annoying and at worst upsetting. I saw lots of pink ribbons, lots of cake sales, lots of businesses using breast cancer to make a profit - ranging from the silly to the downright offensive ("Buy our limited edition pink toilet brush and 5% of profit will go to breast cancer awareness!"). Lots of sexy images of glamorous, white, large-breasted women in pink bras "raising awareness". It drove me mad!
 



This year, during October, I want this blog to do some real breast cancer awareness. I've set a target of at least one new post every day.



So if you are a young woman in the UK who has, or has previously had breast cancer please submit a post for the blog for October. It doesn't matter whether you are an experienced blogger, or if you have never written for a blog in your life. The Young Women's Breast Cancer Blog needs YOU!



I am calling out for posts about anything related to your personal experience of breast cancer (primary and secondary). These might include, but are not limited to, posts about:
  • The signs, symptoms and events that led to your diagnosis
  • What happened when, and immediately after you were diagnosed
  • How breast cancer treatment has affected you
  • Anything you know now that you wish you had known before you were diagnosed with breast cancer
  • The impact of breast cancer on your life (for example, relationships, work, sex and intimacy, children, hobbies and interests)
  • A letter to the newly diagnosed (from women who have completed treatment)
  • Things you think it would be helpful for friends, families, colleagues and neighbours of young women with breast cancer to know (eg how they might be able to support/what things never to say/gift ideas)
  • The aspects of breast cancer that you don't think are talked about enough, or honestly enough.
  • Recognising a relevant family history prior to diagnosis.
  • Anything else you would like to share during breast cancer awareness month.
Submissions can be emailed to ywbcblog@yahoo.co.uk. (I'm collecting from now - it would be wonderful to get as many as possible submitted in September so I can get them ready for publishing from October 1st). If you are planning to submit a post, please have a read of the general guidance.


(Additional info added 13 September 2015: There is no word limit, and you can write in any style you wish. For example, tell a story, write a letter, create a list, share a poem... your blog post is your space to express yourself in the way that you want. If you would like to write but have no idea where to start - have a look and see if any of these ideas work for you: http://youngwomensbreastcancerblog.blogspot.co.uk/p/want-to-write-but-dont-know-where-to.html)



If you have any queries, please send them to ywbcblog@yahoo.co.uk.
 

And please share this post far and wide!



Thank you
Sarah




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Monday 14 September 2015

Déjà vu

Author: Kim

'Has that lump always been there?'

That is not the words you want to hear from your oncologist when he is doing a routine check on your remaining boob!

Three months ago I finished treatment for Triple Negative breast cancer on the right breast. This involved chemotherapy, node clearance, mastectomy and radiotherapy. I was just starting to get back to some sort of normality with my husband and two small boys.

I had not even noticed the lump myself and I check a lot! He said there are plenty of reasons for a lump but best to get it checked out. He wants me to have a mammogram and ultrasound ASAP. He used the word urgent and that sent me into panic!

6 days later and I was in the same waiting room that I was sat in 11 months before. Memories came flooding back and I was not in a good place. I got called into the room and I pretty much broke down as soon as I got in. I cried throughout the mammogram and ultrasound. The radiographer couldn't determine what the lump was and kept using the word curious, is curious and good or bad word?!?! She would have to take a biopsy......and also biopsy under my arm. That was enough to send me into a complete panic. My breast care nurse was with me the whole time and tried to reassure me that they were just being thorough because of my history. She made an appointment for clinic for three days time to get the results, thankfully not long to wait but long enough!!

Day of results and I was a nervous wreck. In the waiting room I was pacing up and down trying not to run away crying. We got called in and looking at the breast surgeon I instantly knew it was bad news.

'I'm really sorry but it is cancer again'

WTF, how is this possible!? I remember screaming, crying, hitting things, hugging my husband, walking up and down the room not knowing what to do, crouching down in the corner of the room, basically losing the plot! It's a cancerous lymph node in the breast but that's all they know at the moment. I will need a CT and bone scan to check for spread. Already I pretty much know that it's spread. What are the chances of getting a new primary diagnosis in the other boob so soon, so it must be the original cancer spread to the other side, which must mean it's gone elsewhere!

I had to wait 5 days for the scans. Thankfully my BCN gave me some pills to help me sleep and I got some Diazapam from my GP to take the edge off the anxiety during the days.
The CT scan was awful, they set you up in there and then leave you alone. Then come back to turn you around so they can scan your head. Scared is an understatement! Next up bone scan! This wasn't as bad as I was able to listen to my iPod (thank you Answer Me This podcast!) and someone is in the room with you. But it's still 20 mins of lying still whilst a machine checked your body for cancer!

I only had to wait two days for an appointment in clinic for the results but it was tough. I started thinking about how much time I have left, how awful it's going to be for my boys, they are only 3 and 1 far too young to lose their mummy. What we can we do as a family before I go. There were lots of tears! I went out the night before results for a friends birthday, I'm so glad I did. We drank prosecco, did the pub quiz and laughed lots. And I drank so much prosecco I pretty much passed out in my bed! Morning came and I instantly felt sick. My appointment isn't until 1.30pm so My husband leaves me in bed as I do not want to get up and face the day yet. But I hear the phone ring and listening to him answer it and say the name of my BCN. He passes the phone to me....my hands are shaking. They can't be telling me bad news, I have the appointment for that, maybe it's changed times that's why she's phoning.

'Just to let you know your scans have come back clear'

OMG!! I cry with relief, it's a miracle!! They still don't know if it's a new cancer or the original one. But after me and my husband get back from holiday (we have a cruise booked the next week) I will have another mastectomy and nodes clearance and probably more chemo. I'm elated, absolutely ecstatic! We celebrate that evening with friends and I go to sleep without the aid of pills for the first time that week. Who would think that we would be celebrating only having Breast cancer, it's a strange world I live in now.

But now reality has hit home, I have cancer again! I have to have more surgery and go through chemotherapy again. I'm angry and sad but I've done it once and can do it again!! And with the help of my friends, family and my amazing YBCN girls I will get through it.




Thursday 10 September 2015

Me and secondary breast cancer - 7 years on

Author: Heather L

Today is the day.


Seven years since Mark and I sat in that consulting room at the hospital that is still all too familiar and was told that my breast cancer had spread to my liver and bones.

Seven years later I have forgotten what it's like to live without cancer.

Me and the cancer, it's like we've discovered the art of being in the same room at a party while studiously ignoring each other, although I don't think either of us can help the odd furtive glance in the other's direction every once in a while. I guess what I'm trying to say in a roundabout way is that while the shitty days have been beyond shitty, the good days mean so much more because of it, and I've discovered an equilibrium between those two extremes: I have found a way to live with cancer and be ok.

Seven years ago today I was pushed to the lowest ebb possible and found a way to become strong again because I didn't have a choice. But I was lucky that all the operations, IV chemotherapy and countless pills I have had access to on the NHS over the past 7 years have put me into remission.

Its not ok to take vital cancer drugs away from people when they're at their lowest most vulnerable point if there's the chance that drug will allow them to become strong again, whether that's for seven months, or seven years. Please, please, please don't think that the announced cuts to the cancer drugs fund are ok, because the NHS simply doesn't have the money to pay exorbitant prices set by the pharmaceutical companies. Its not about delaying the inevitability of death from cancer. Its about allowing cancer patients at their lowest point, like I was seven years ago, to become strong again. The government and the NHS need to find a solution where people with cancer aren't left in fear, not knowing which drugs will be available to treat them. And that's on top of trying to cope with living with cancer! I'm not writing this to ask you to act by signing a petition or donating money. If you've read the news about the cuts and thought, "well those hard choices need to be made because our NHS cant fund everything", I simply want to try and change your mind.


 
******
 
(Note from Sarah: This is a news article from 4 September 2015 which gives some context to the last part of Heather's post. Cancer Drugs Fund cuts 23 treatments)

Sunday 6 September 2015

My cancerversary

Author: Zoe F

This time, exactly one year ago today, I was sat in a little room hearing the words "sadly, it's cancer". I knew it was, from the moment I had the ultrasound, heard the words "this is cause for concern" and saw the tumour on the screen. The breast care nurse sat in the corner was a bit of a giveaway too. I felt my mum's hand go into mine, but I couldn't look at her and I felt the tears well up. Then my consultant said "but, I think it's very treatable" and the tears stopped and I pulled myself together. I even took mum to Tesco afterwards! I was very naïve at the beginning and it took a while for the enormity and seriousness of it all to kick in, especially after I learned about my type of cancer. The consultant kept that bit quiet. After all, I felt fine. I didn't feel ill at all.

I went into organisational mode from then on. No one tells you that there is so much you have to do and buy to prepare yourself for surgery and treatment. Cancer is bloody expensive. I had my birthday 3 days later and carried on as normal, went to work and carried on as normal until I went off for my op. So then followed 10 months of surgery, fertility treatment, chemo and radiotherapy. It was very hard and emotional. I couldn't watch a cancer advert without crying. Cancer was everywhere. I'd have breakdowns to my mum sobbing "I don't want to die". Some days I couldn't even get out of bed, not even to wash or brush my teeth. The night following my first chemo I was in tears begging my mum to call the doctor out. It was horrific. I told her I couldn't do it again. But of course I did and with the right drugs to counteract the side effects it was still hard, but doable.

Once all the treatments are over people expect you to be happy, but you feel sad. When the last of the chemo drugs dripped through I wasn't smiling, I wanted to cry. When I had my last radiotherapy session I cried my eyes out on the radiologist. You're on your own then, back out into the world, and it's scary.

So, a year on. Has it changed me? Yes and no. I never had much confidence before, but the cancer knocked a lot more out of me. I'm a stone and a half heavier than before thanks to the steroids and I'm struggling to get rid of it. I have hair again and while having short hair isn't as bad as I thought it would be I still want it longer. It's also going curly. The little things still annoy me. I may never have children. I treat myself more.

The biggest change is that I've found myself doing things I would never have done before because I've realised that life is too short. It's a cliche but it's true. The cancer could come back, it may still be lurking somewhere, but if the worst happens I don't want to look back and think "I wish I'd done..."



************************************

Are you a young woman in the UK who has/had breast cancer? If so, please read this post about Breast Cancer Awareness Month this October (2015).

Tuesday 1 September 2015

October: Breast Cancer Awareness Month - Call for submissions

Hello!

Next month, October, is breast cancer awareness month. Last year during October I was going through chemo myself, and if I'm honest I found breast cancer awareness month to be at best annoying and at worst upsetting. I saw lots of pink ribbons, lots of cake sales, lots of businesses using breast cancer to make a profit - ranging from the silly to the downright offensive ("Buy our limited edition pink toilet brush and 5% of profit will go to breast cancer awareness!"). Lots of sexy images of glamorous, white, large-breasted women in pink bras "raising awareness". It drove me mad!
 

This year, during October, I want this blog to do some real breast cancer awareness. I've set a target of at least one new post every day.

So if you are a young woman in the UK who has, or has previously had breast cancer please submit a post for the blog for October. It doesn't matter whether you are an experienced blogger, or if you have never written for a blog in your life. The Young Women's Breast Cancer Blog needs YOU!

I am calling out for posts about anything related to your personal experience of breast cancer (primary and secondary). These might include, but are not limited to, posts about:
  • The signs, symptoms and events that led to your diagnosis
  • What happened when, and immediately after you were diagnosed
  • How breast cancer treatment has affected you
  • Anything you know now that you wish you had known before you were diagnosed with breast cancer
  • The impact of breast cancer on your life (for example, relationships, work, sex and intimacy, children, hobbies and interests)
  • A letter to the newly diagnosed (from women who have completed treatment)
  • Things you think it would be helpful for friends, families, colleagues and neighbours of young women with breast cancer to know (eg how they might be able to support/what things never to say/gift ideas)
  • The aspects of breast cancer that you don't think are talked about enough, or honestly enough.
  • Recognising a relevant family history prior to diagnosis.
  • Anything else you would like to share during breast cancer awareness month.
Submissions can be emailed to ywbcblog@yahoo.co.uk. (I'm collecting from now - it would be wonderful to get as many as possible submitted in September so I can get them ready for publishing from October 1st). If you are planning to submit a post, please have a read of the general guidance here too: http://youngwomensbreastcancerblog.blogspot.co.uk/p/blog-posts-about-breast-cancer.html.

If you have any queries, please send them to ywbcblog@yahoo.co.uk.

And please share this post far and wide!

Thank you
Sarah