Retire Early Lifestyle
Retirement; like your parents, but way cooler

In 1991 Billy and Akaisha Kaderli retired at the age of 38. Now, into their 4th decade of this financially independent lifestyle, they invite you to take advantage of their wisdom and experience.

The Question That Bothered Me So

Billy Kaderli

Akaisha

I’ve been pondering this question since Akaisha passed away.

Thank you for giving me this platform to think and write honestly, from the heart.

The question that bothers me is this: what did I miss? Some people say, “It was her time. Don’t blame yourself.” I understand that, and I am not blaming myself. I am curious by nature. If there was something I missed that could have changed the outcome, I would like to know what it was.

In October 2024 she was cleared of the breast cancer she had after surgery and radiation. After the surgery, Akaisha had abnormal fluid buildup in the breast area for too long. With each drainage we thought it would be the last. Every sample was tested, and no cancer was found.

From Mexico we left for Nevis, West Indies, in November of that year for a few months, then returned to Chapala.

We flew to the U.S. in April for a few months, then to Thailand in August and September 2025, then back to the U.S. in October and November. Between Thailand and the States, Akaisha was receiving treatments for a sore lower back that we associated with moving furniture at our place in AZ.. Those treatments seemed to help, but the discomfort would return after a week or so. Our plan was to start physical therapy in Chapala.

On December 4, 2025, we flew into Guadalajara, and the wheels of the cart came off. Akaisha struggled going through the airports, and I texted a doctor to meet us at our place on the 5th. He gave her an injection, and the next day she told me it was the best she had felt in months. He also told us to get an MRI. That’s when things turned south.

Fourteen months after her breast-cancer clearance, she was struggling to walk. What did I miss?

Fourteen months from that clearance. Twenty months of living before she passed.

Let’s guess. Suppose another test had discovered an issue. At that point they almost certainly would have recommended heavy doses of chemo and surgery. At 73, healing is not like that of a professional athlete. We don’t bounce back. We flop.

Guessing again — and guessing is all I can do — at least six of those twenty months would have been spent dealing with the side effects of chemo and the pain of surgery, if it worked at all. She did not want to go through that, and I cannot imagine putting her through it. I definitely did not want her dying on an operating table.

I can only write from firsthand knowledge and observation. I am not medically trained.

Was it the right call? Was there ever a call? We continued to see improvement from the treatments she was receiving, including alternatives in Mexico. We have always gone with the motto: if it don’t fit, don’t force it. Go with the flow.

No, I don’t blame myself. I know I did everything I could. But if I had to do it all over again, what would I do?

If it were me, I would have made the same decisions we did.

Does cancer just go dormant and then come back with a vengeance? I’m trying to make sense of it all.

So I asked Doc Grok:

Does cancer just go dormant and then come back with a vengeance in another location? She was clean. Every breast sample showed no cancer. What did I miss?

The answer, in short, was yes.

This is my understanding after asking questions. It is not medical advice.

Akaisha’s original cancer in 2024 was hormone-receptor-positive: ER-positive, PR-negative, Grade I, node-positive, and relatively large. That combination is known for a specific behavior. Cells can leave the breast and lymph nodes early, even before surgery. Some of those cells travel through the blood or lymph and settle in bone, bone marrow, or other sites as micrometastases — tiny clusters too small to show up on a scan, a blood test, or a physical exam.

Those cells can then go dormant. They stop growing, hide from the immune system, and sit quietly for months or years. Later, something wakes them up: time, stress on the body, changes in the bone environment, or simply the biology of the cells themselves. Once they start growing again, they can spread through bone and nearby tissue.

That is why she could have clean breast exams, mammograms, and follow-up visits after mastectomy and radiation, and still develop widespread bone and abdominal disease 15 or 16 months later. The original tumor in the breast was removed. The cells that had already escaped were never visible.

This is also why it felt like it came back with a vengeance. ER-positive breast cancer that has been dormant can grow slowly at first, then accelerate once it becomes established in bone. Bone is a favorable environment for these cells. By the time the back pain appeared in late November 2025, the disease was already widespread — multiple levels of the spine, the sacrum, the pelvis, and a mass affecting the ureter. That is why the MRI and CT looked so extensive so quickly.

This pattern — a late recurrence in bone after apparently successful local treatment — is recognized in ER-positive disease. It is one reason doctors often recommend long-term endocrine therapy, which in her case included letrozole and then tamoxifen, and why bone-targeted drugs are sometimes started even when scans look clear.

What I did not miss was the protocol we followed: surgery, radiation, and hormone therapy. The clean local exams were real. They simply could not see cells that were already hiding elsewhere. No routine blood test or standard imaging at that time would have reliably detected micrometastases.

The Mesa visit in November 2025 came after the disease had already become symptomatic. A more thorough history and earlier imaging might have diagnosed it days or weeks sooner, but by then the cancer was already advanced.

This is the biology of the disease, not a failure of the care she received or the care I tried to give her. Many families go through this same sequence and ask the same question: how could it look so clean and then explode?

I’m glad I did not know all of this beforehand. Akaisha and I never lost hope, and we both believed in miracles.

Now I understand.

It was frustrating because I had been able to help Akaisha twice before. Once in Portugal in 1979, with a 104° fever in a small mountain village. Once in Antigua, Guatemala, when she degloved her finger, was bleeding out with each heart beat on the side of the road, and went into shock.

She believed in me, and we both thought I could get her out of this as well.

It wasn’t meant to happen. I guess it really was her time.

I hope this helps others who are struggling to understand.

Billy  

Retire Early Lifestyle appeals to a different kind of person – the person who prizes their independence, values their time, and who doesn’t want to mindlessly follow the crowd.

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