Job Stress

It's been awhile again, I know. I apologize. The drains of work at times, more frequent than not, are overwhelming. With changes and added responsibilities requiring later nights periodically and the fear of increased frequency has been wearing on me.

I remember my health struggle just to work. My doctor told my parents when I was a child I could apply for social security disability and I'd have a good chance of approval. My parents never did, they wanted to see what I could handle first and knew even if I had to one day, I may still require their assistance throughout life. And so that's what we did. I tried my best and they helped me along the way. And with the help of my schools I made it through that struggle. Sometimes having to be homeschooled others home study with the public school. But I made it through. And I made it through college in spite of a minimum of two hospitalizations a year. My next challenge was a full time job. Would I be as fortunate?

I worked for six months, that's all my body would allow after school as it threatened to send me back to the dreaded hospital. I was so scared for my health and if the future. The stress caused severe SBS, reminiscent of the SBS struggles in high school when my life was nothing but restrooms, pain, and ever looming death. The time when I felt death's hands on my shoulders and I felt urged to prepare my parents they were losing their little girl. I could see all this once again on the horizon. My parents agreed I had to stop, they would help me. Just after a few weeks away from that first time employer, I felt my health returning. I wanted to try again. Maybe it was the job, the employer or that it was my first full time job and I had yet to develop the right coping for this arena. I'm not sure, maybe it was all of it. But I tried again and I did better the second time. I didn't have to travel anymore and for awhile my employer was supportive and helpful. Even when it became hostile and I was overwhelmed with depression, my body withstood all the stress being thrown at it. I was amazed and relieved! Maybe I do have a fighting chance after all.

And so I've been with my current employer a few years now. I still have bad days that my body warns me to take easy and so far I've been supported. But that fear always remains. What exactly is the limit, when will I be pushed too far, when will my body rebel and force me to that dreaded hospital again? I don't know, I don't want to know and so I keep my guard up and I try to protect myself from myself.

FAPulously Overwhelmed

I apologize for not posting for such a long time. Sometimes it's hard to do this, sometimes I feel so drained by the end of the day I don't want to do anything and other times I feel so good I want to go out and enjoy it for a change.

A few things have happened since my last post. As you may recall from Energy Rescue, I have difficulty with B12 like many FAPers. My B12 has jumped to 1095 after another month on B12 microlozenges, that's just 5 points below that to range! I definitely recommend anyone with low B12 to talk to their doctor about these microlozenges. My hemoglobin still remains below normal, even though a good B12 helps with absorption of iron. However, I have so many stools, and some body, that I don't think it can be helped. So I keep taking iron every time I eat. My last scope didn't show any ulcers or anything to explain how I'm continually losing blood. I believe my intestine becomes easily irritated if I'm unable to have a bowel movement or if I delay a movement for too long, in this case diarrhea and SBS are my friends!

I have even restarted taking the sulindac to reduce polyp growth.

In Ending the Family Cycle, I've mentioned my plans to have a surrogate and use only my eggs that don't have the FAP gene in order to have a child. Well as the time to try this continues to near, the more I've been overran with a desire for a child. Even to the point that I started double guessing my plan and considering risking having a child with FAP if the doctors refused to only use my non-FAP infested eggs. I don't condemn anyone's reproductive choices, there's nothing wrong to have a child with FAP. My personal decision had just always been then that if I can't have a surrogate and only use my non-FAP eggs, then I wouldn't have a child. I've based my personal decision on two things: I'd love to be the last person in my family with this disease and end it and secondly, I don't want to risk my child going through what I have gone through with so many complications from the surgeries even though the medical techniques and procedures are much better now.

In spite of this long standing decision, baby fever started to get me. But that fever may be over as another kind of feverish feeling has started.
The last couple of weeks I've experienced a sudden change in body temperature. Although my temperature has actually been low, I've been experiencing hot flashes. I've even enjoyed being outside in 32° weather with just regular clothing on, my only complaint was that my hands were cold. I'm going to contact my doctor, some have mentioned possible thyroid issues. Which got me thinking, there's a connection between FAP and thyroid. So I started reviewing articles about FAP again. I remembered risk of thyroid cancer but I didn't remember risk of liver, pancreatic adrenal, bile duct, and even a brain cancer!

What the hell!? As if claiming our whole GI tracts isn't enough, FAP has to try to lay claim to other parts of our bodies so we can possibly develop other cancers. Who the hell thought up this disease. There's plenty of other diseases I'd rather not have, namely any of the autoimmune diseases. Now I think FAP is another lottery jackpot of diseases, symptoms and complications just waiting to happen even more.

So needless to say, this helped my over zealous baby fever to return to a low simmer.
And after a few moments of self pity, I'm not worried that maybe I have thyroid cancer. I hope I don't, but I will get it checked out and I'll update with the results. Fingers crossed!

Mod Bod

We all look at things in different ways and respond differently. Our backgrounds, experiences, and personalities shape our views and contribute to how we respond. Sometimes I think I'm in the lone though in my views. Perhaps it's hindsight from past health battles and navigating all the newbie issues. Hindsight always seems so apparent after making it through to the other side and sometimes it's hard to remember what it was like to be new with FAP. Also, I tend to just do things on my own.

I'm reminded of all this when I'm asked how do you decide who and what to share with others about health details and ostomies. I've never quite understood this question, probably because I didn't really struggle with it. I didn't tell anyone details and I actually only told a handful of people that I had an ostomy. It never crossed my mind to share a lot with others, especially if they weren't in the same health circles as myself. The only people who know all my details are my parents and my husband. I always followed the rule of share what's comfortable, that not everyone needed to know and no one didn't need to know none either. It can't be black and white, it's going to vary based on who, what and why. I found it bizarre when told stories that a child's entire class or school were told the child had an ostomy. Never understood that, but my parents also didn't openly share my health details with others either. There's no wrong or right way about sharing health information. We all share in our own ways and based on our sharing philosophies, other's will seem different and even odd to some.

Another sharing I've never been comfortable with is the open visibility of an ostomy. I don't think anyone should be ashamed of having an ostomy, it's just something I was always very modest about. I didn't think others needed to see me walking around with my pouch hanging out, I don't see the need in it. I find the social awareness campaigns, such as Uncover Ostomy, to be  very well executed in it's portrayal and ability to raise awareness of ostomies and health issues. But we each choose to raise awareness and educate others in different ways and approaches. Each approach will be best received by different groups.

I remind myself of this when I see others completing every day public activities with their ostomies visible, I know the intent and I agree with the intent. I just chose a more timid route of education. It would be nice to be less inhibited but I tend to stick to the philosophy that my health issues aren't everyone's business and not everyone needs to know everything. And those who I do share everything with probably wouldn't mind if I didn't always share everything with them either. Haha.

To each his own.

PTSD Tailspin

I don't think one ever stops having PTSD, the symptoms can be managed and even lie dormant for years but they can always be triggered again to the surface.

I was reminded of this a couple weeks ago when I attended a conference at my hospital. I parked in the public parking rather than the parking building I usually park at when I'm getting lab drawn. This was a mistake.

I walked in through the main entrance toward the elevators to head for the concourse. As I walked further into the building, closer to the elevators an overwhelming sense of anxiety and a flood of memories washed over me. These were the same elevators that had taken me to the pediatric and once women's floor so many times for almost seven years. I walked the main and the outpatient entrances countless times, past the gift shop I loved to walk to when I felt better and past the chapel. It was all too familiar and it was all coming back. I just wanted to get to the concourse where I could relax, there was nothing frightening about the concourse. With ten floors, it takes the elevators a while. As I waited, the anxiety increased until my mind kept repeating "Run, Run, Run". My body said to listen, turn around and run out of the building immediately. My feet were ancy, torn between running and waiting. I had to get control of myself before I had a panic attack. I focused on my breathing until I could get to the concourse and I made it. I was nervous until I got to my seat and tried to ignore the memories awoken that morning. By the end of the day, it was too much. I had to walk through the main entrance again to get to my car. The strain of anxiety and flashbacks were showing on my face and others could tell something was wrong. Once I was back in my car I finally released the build up from the day and sobbed, called my husband and my parents for support.

For about a week I felt the lingering effects of that day and I wasn't expecting any of it. I couldn't sleep, I woke up worrying about when I'll have to change doctors and the never ending risk of hospitalizations and what would happen to me. I cried and felt unusual anger. I missed being able to go to my therapist, who recently retired. She was my therapist since high school and understood my health and mental health struggles and helped me manage my PTSD and depression. Although my health hadn't changed, I was faced with the past and what that could mean for my future and how life changes would affect future health complications and flare ups. And it was terrifying.

We can never escape the demons of our past, but how we decide to handle what we are faced with, recognizing what we're feeling and utilizing support we can make it through each hurdle and when we're pushed into the past and the possibilities of the future.

Energy Rescue

My new order of B12 came today! Insert happy dance here. I've been unable to get B12 for over a month now due to the shortage of injectable B12. However, I convinced my doctor to change me to oral B12. Before she advised that the oral form doesn't absorb as well as injections. My aunt, who is also a colon cancer survivor, was advised by her doctor of continued recent evidence showing oral form is as effective as the injection form.
This is great news and allowed for my own experiment. I will be able to be completely compliant with oral B12 as there's no fear or pain associated with a pill and taking pills doesn't bother me, I had to get used to pills when I was taking about thirty a day. No big deal. And what's even better is this B12 is a microlozenge and is cherry flavored. Jackpot!

I chose to get my B12 from Puritan Pride but any place would do. I like Puritan though because they have great discount deals for their supplements. I bought 5 bottles for the price of 2, a total of about $25 for them all! And the more you buy, the more you save!

I've been anxious for my new B12 to arrive, I was already low and the symptoms had been worsening. It may not seem like a big deal to have low vitamins but it can be dangerous. Please take care of yourself and listen to your doctor, even when it's hard.

Low B12 common symptoms include:

• Weakness and fatigue
• Light-headedness and dizziness
• Palpitations and rapid heartbeat
• Shortness of breath
• A sore tongue that has a red, beefy appearance
• Nausea or poor appetite
• Weight loss
• Diarrhea
• Yellowish tinge to the skin and eyes 

If low levels of B12 remain for a long time, the condition also can lead to irreversible damage to nerve cells, which can cause the following symptoms:

• Numbness and tingling in the hands and feet
• Difficulty walking
• Muscle weakness
• Irritability
• Memory loss
• Dementia
• Depression
• Psychosis
  
  
  
  
  

Accomplished

What does it take for you to feel accomplished? Does it change day to day and place to place?
At work I keep busy and as I mark off items from my to do list I feel accomplished. But at home, I feel accomplished if I do the dishes and vacuum the house. This weekend I felt really accomplished. I did five loads of laundry, did the dishes, cleaned up clutter, and did a few errands. Is that all my life has been reduced to? Accomplishment is house chores!? Is it from lack of motivation, lack of energy, exhaustion from looking after 105 people at work, or something else or even all the above?

I'm not completely sure. Usually when I have something I need to do I can muster the energy to complete the tasks, but really only if it's scheduled and I don't really have an alternative. So is it motivation?
But I'm falling asleep without intention long before bedtime and I do have anemia and low B12, which I'm out of due to a shortage that had delayed my refills. And I only nap when my B12 or anemia have become too much. It must play a part.
At the end of the day, I don't usually want to do anything, not even something fun. Occasionally when it's nice weather and I feel good I want to go out on the town. Sometimes I'm so mentally drained, I don't have the energy to discuss my day and especially not in detail. To relive events is exhausting. Talking is draining. That's why there are long intervals sometimes in between posts. It's exhausting!

I think it's a mix. When we have to, we often muster the energy we need to participate in an activity even when we really rather rest but when we are active our body energizes itself. This is a common and helpful reaction to activity. We tend to feel better and have more energy and better mental health if we are active, even just once a day.

We're going to have good and bad days. Depending on which day our activity falls on, it may be a big accomplishment and that's ok. Take it more easy on bad days and go crazy with activity and to do lists on good days.

Here's a good, low strenuous 10 Minute Exercise to get you started on your good days.

Phantom Pain

I hate when I have phantom stoma pain! I just hate it. I've lived without an ostomy for over ten years now and I still getting the feeling that I still have an ostomy, stoma and all. Last night I spent half the night in a shallow sleep rubbing at my last stoma scar because it felt like I had raw skin around my "stoma". My sleep was shallow enough that although I didn't fully wake every time I touched my scar, I did stir enough awake to realize what was happening. And the most frustrating thing is even though I could tell what reality was, the phantom pain wouldn't stop so every so often it would hit me. I even was having dreams that I still had an ostomy. Had I been in a deeper sleep I would have truly believed I still had an ostomy, it was that vivid of a pain.

This isn't a one time occurrence unfortunately. Every few months my body reminds me what once was. As if I could forget anyway!  In high school during a rough health patch I dreamt I had an ostomy still and it was so vivid that I was an emotional wreck all day, I even awoke in a panic crying. I was terrified that my straight pull thru would be taken down and replaced with an ostomy once again. That all I had worked toward had been for nothing.

I've had other phantom pains before too. I'm reminded of the pain of a central line, I can't even tell you how many I've had it's been so many. The worst was during that stent in high school when I had a central line for six months due to having to be on TPN because I wasn't allowed to eat or drink for months on account of a hole in my intestine. I finally had the central line removed when it was literally hanging by only one stitch, the rest had pulled free and were no longer there. Oh that was a constant pain, not sharp but a background pain that you couldn't forget about as the central line was slightly pulled and released with movement. To this day I still have that pain if I touch or something irritates those scars or if I start to think about it too deeply.

The same happens with my arms and hands where I have blood drawn or IVs placed. Thought or touch rings those memories and they're reawakening with phantom pain of needles.

The pain we've experienced is imprinted upon our bodies and our memories without realizing it or our consent. We are not to forget the trials we've endured. Our bodies can take us back to that moment without notice in a heartbeat. Perhaps that's not completely bad though. We remember and so we can join with others and help others endure their trials as well.

Ending the Family Cycle

At last my GI doctor appointment, my doctor gave me a study to read about colon cancer in families, who is at elevated risk and it also included FAP. It was an interesting read and I urge you to also read it when you get a chance. Preferably after you've finished reading this post ;)

The study reminded me of my own desperate need to stop this familial cycle so that I may be the last one in my family with FAP. In a Medical Angels and Demons, I discussed my gynecologist who performed the Essure sterilization procedure for me so that I may not have to worry about passing on FAP. I respect that this choice is not for everyone. For me it was though. I've seen what FAP is capable of with my grandfather, mother and myself. Others in my family have also been affected by FAP and colon cancer. I've seen the horrors and I don't want to risk that for a child of my own. My mother was diagnosed with FAP and colorectal cancer before I was even 3 months old. At 3 months, I almost lost my mother because of the FAP and cancer. I don't know if my mother would have taken the chance of passing on FAP had she known that she also had FAP and how it would affect her and me. My grandfather had already battled colon cancer prior to this and he would again battle the cancer causing FAP as I neared adulthood. After my diagnosis and surgeries in grade school, I became enraged and depressed. I blamed my mother for all the medical misfortune I experienced. Afterall, she was the one to give me FAP so in my darkened mind, it was her fault. I blamed her and my doctors for years. I was consumed by hate and despair and wanted nothing but revenge. It took me several years to accept what happened to me and to realize that it wasn't my mother's fault. It was a very tough time for her, to watch her child suffer mentally and physically because of the FAP and what it's capabilities.
That 50% chance is too great for me. In my family, the FAP polyps have increased earlier in age with each generation. That isn't to say that it would for my own child, but it's not something I wish to discover. And in the study I referred to earlier, colon cancer is still an elevated risk for first degree relatives even when it was diagnosed over the age of 60! Colon cancer isn't slowing down and I've seen enough of it.

The risk of pregnancy and childbirth for myself is also far too great. In Medical Angels and Demons, I also discussed why pregnancy and childbirth is dangerous for me. Even as a child, I  knew that pregnancy wasn't right for me. Although I didn't fully understand pregnancy and childbirth at that age, I knew it wasn't the right choice for me and it seems as if everything that has happened to me in life has helped to ensure that it would be difficult to even attempt pregnancy. And I'm absolutely fine with that!

But just because I don't want to risk having my own child with FAP doesn't mean that I'm stopping there. Because I would really like to have my own child, just not with FAP. I've researched IVF studies and have come across successful cases of individuals using IVF to only utilize eggs without FAP. Unless something changes, I have a surrogate on the wings who has agreed to undergo IVF with the fertilized egg of myself and my husband so that we may have a chance of a child. Even then it may not work due to the inability to have a guaranteed full term pregnancy and childbirth, but this is a risk I'm willing to take. There isn't any other option in my mind in order to have a biological child without FAP. We've located a fertility clinic that we're hopeful about and after harvesting eggs, we're given 6 attempts at IVF. We'll have one shot at this, and if it still doesn't work then fate has spoken. My husband and I have discussed adoption as an alternative if the IVF is unsuccessful but at this point we don't feel like it's the best choice for us. That may change though and we're open to revisiting adoption.

Right now, IVF is our plan and as hopeful as we are about it's success we know that it may only be hopes. This has been the long time plan of mine and fortunately I married someone who is on board with it. As the time approaches for us to start the IVF process, the further I'm conflicted between hopefulness and fear. I don't want to plan too much or become too hopeful as the spiral downward if those hopes are dashed would be devastating. In an effort to protect myself, at least some, I focus on the improbability of IVF working for us and I try to not think of a future with a child so that if IVF is successful with a pregnancy, then I can enjoy planning for a child's life and future. There are so many things I'd love to experience with a child, so many things I'd like to do for a child. I'd love to plan vacations, educational activities, birthday parties for a child. But until then, if I let myself escape in a bubble of hope in these fantasies, I may just be own worse torturer. And so I wait, we wait, and hope.

Should it not work out as planned, we will accept the decisions we've made and with the help of counseling move forward. It is all too great of a risk for me to allow a child of mine to live with and endure a life of FAP. Again, let me reiterate that this decision is not for everyone and I whole heartedly respect anyone else's decisions regarding their family planning without judgment.

Surreal

It's been so long ago, the medical tests and procedures, the surgeries and the struggle for life. It's been a lifetime ago but it doesn't always seem like my life. I have to remind myself that it was my life and not someone else's life. I feel like I'm looking through a looking glass, peering into someone else's memories and past. Not my own. And yet it is mine. Every horrible moment, every joyous cause. It's all mine.

I never thought the terror and the battles would fade so much. They don't occupy my mind all the time anymore. I remember everyday but it's just in passing. When my stomach rumbles, when I have to run to the bathroom, when I'm sore. But it's only brief reminders. Even when I have flare ups,  it's just for a night and I can forget the next day. No more constant reminders and complete worry about what I'm eating or what I'm doing. I still feel concerned but it doesn't consume me anymore. How has this change happened?? I've become so far removed from it all. I have my regular check up every three months but I don't have anymore medical tests or procedures. Not even routine. I should have an annual scope but I haven't in 5 years. My doctor knows I'm not budging on this one, I'm not going through the torture of laxatives and enemas. Find another way, I'm not doing it. That's how. I haven't had to go through pain and torture in five years except for flare ups and 1 CT Scan with dye. I'm not being forced to relive the nightmares. I've been granted a pardon, even if only for a short while.

I have to make myself remember the details of those awful years of pain and struggle. It doesn't seem possible that it all happened to me. That it was me going through it all. I swear it happened to someone else, not me. Why are people worried about my health? I'm fine, that wasn't me. But it was. It was me. And they remember. They remember the countless hospital stays and trips. The never ending medical tests and procedures. The need for another surgery. The fear and worry in the doctor's face, the nurses, the surgeons, the team of specialists. The terror I expressed, my screams and cries. My pleas for it to end, to let me die. They remember.

Once I'm thrown back into the medical den it will come flooding back and I'll be consumed again. But for now, for now I've been given mercy.

To Keep My Mouth Shut

I don't think I'll ever learn when to keep my mouth shut. There are so many times I wish I had for my sake. We need to listen to our bodies, especially when our body is screaming at us! Our body knows what it needs, we just need to listen.

I try not to drink anything close to or after bed because it upsets my stomach and causes bloating, gas, and pain all night long. Instead of getting up about three times during the night like usual, when I drink before our after bed I end up being up and down close to eight times during the night! Last night was one of those nights and I knew better but that cold liquid kept calling me. I'm probably dehydrated at night because of the SBS, which is why it's so tempting to take a drink at night.

 In the Evils of Food I discussed the challenges I have with food and activity. I also have a hard time listening when I need to not eat or stop eating. I had lunch today and shortly after my body rid me I shouldn't have eaten, I should have just waited. After almost six hours my stomach is finally reducing in level of pain and discomfort. There are many times that I ignore warning signs and keep eating because the food tastes so good or I think I'm still hungry and then I end up with a SBS flare up within about an hour later. For a long period I wasn't able to eat any ethnic foods, they were too rich for me and I experienced severe bloating and pain for the remainder of the day. For several years I was devout about avoiding ethnic foods in order to prevent such occurrences and over time my body began to recover from the surgery traumas and to adapt to more foods thereby allowing me to have more of a varied diet.

The way our bodies are today isn't how they will be forever. Our bodies change and adapt and even regress. The key is to adapt with our bodies and to listen to what our bodies need in order to enjoy life without unnecessary pain and discomfort.

Stress Effects

This last week has been very stressful work wise, 5 days felt like 2 weeks! And I could tell it was starting to wear on me physically. There's always those telltale signs warning you of impending danger if immediate action isn't taken. And I was starting become leery of those alarms.

The first couple nights of the week I was so exhausted that I slept through the whole night. This may be the norm for some, but it isn't for me. I'm usually up 2-3 times a night to use the restroom so if I'm sleeping through those bodily alarms, I know I'm needing the sleep. Well the last couple nights of the week I changed the routine and started having stress dreams, so I wasn't getting much sleep at all. When I wasn't in a deep sleep, I was dozing with stress dreams. This is also a dangerous pattern as there isn't any rest or recuperation obtainable in such a state.

My lip became tender and I just knew my body was about to explode with it's own rebellion against stress in the form of fever blisters. Throughout childhood and until the end of the collegiate career, I was a fever blister queen. Anytime my immune system became threatened, I had at least one giant, painful, eye sore of a fever blister. And most of the time I had 2-3 of them, even to the point that for a period I even developed impetigo - blisters on the skin that break open and become crusty. I've had fever blisters and impetigo so severe that the skin around my bottom lip is scarred. My GI doctor said that I'd likely outgrow these fever blisters and she was right, I have a fever blister maybe one or two times a year now. But even so, I remain leery of this ticking time bomb.

Because of the stress, I started to notice some depressive symptoms as well. I started to become withdrawn and saddened. I started to have meltdowns at work and home, moments where I couldn't hold back the tears. All I wanted to do was stay in bed and cry but I knew that I needed to force myself to talk to others or I'd easily get sucked into the deep spiral of depression. The emotional and physical sides of health are linked, they affect one another. So anytime one is in danger, so is the other. It's important to balance both for one's own well-being.

I also tend to stress eat, I want to eat anything or everything and this leads to overeating which upsets my digestive system. I felt miserable - bloating and SBS are not wonderful symptoms nor are they when combined.

These were the loudest alarms and I knew if I didn't get a handle on this stress, my body was going to rebel further. In the past, under extreme stress my intestine rebelled by constant SBS flare ups to the point that functioning was nearly impossible. I'm terrified of this happening again as I wouldn't be able to maintain employment in such a state.
I started to let others in, sometimes it's hard to accept help from others. I'm an independent worker and I usually figure there isn't much someone else can help me with - that it's not going to save time or effort. I leaned on friends and made a bit of time for a mental break - such as tagging along on a lunch run just for the change of scenery for 10 minutes. I used some free drink coupons and got a special treat to help me through the day. One evening I vegged out and just watched television with my husband and cooked a healthy meal. I quit beating myself up over things out of my control and started giving myself pep talks. So today, I feel better. I feel ready to be let back into the ring for another fight tomorrow. Here's to hoping this week is better too!

Away from Home

For the Memorial Holiday we went on a camping trip and while preparing for our holiday getaway there were many concerns to account for in an attempt to allow for the most enjoyable trip.
Anytime I want to participate in physical activities, particularly away from home, I must consider a number of factors such as food, restroom access, breaks and the amount of physical activity. Each of these contribute to my health, severity of bothersome symptoms, and level of activity.

In Evils of Food, I discussed all the concerns surrounding food and how food affects my daily life. For our camping trip, I tried to stay away from just the usual camp foods of hamburgers and hotdogs as these foods are very greasy and almost always cause a SBS flare up. One evening we had grilled chicken and vegetables with a rice mixture. But even for this healthy meal, I still had to consider which vegetables to have as some vegetables such as fried potatoes are typically upsetting. I relented for one of our  lunches to having Mexican food. I was able to combat the SBS flare up into a mild flare up by taking an extra Lomotil  in the late afternoon, being careful of the timing in order to prevent an adverse side effect of extreme constipation if taken too late in the evening thereby altering the usual satisfactory effectiveness of my daily Lomotil on the following day. If I took an extra Lomotil too late, it would still be in effect the next morning thereby altering my whole medication schedule for the next day resulting in too much binding. Later that evening we made Smores, I had to limit myself to 1 Smore as another one would have pushed my intestine over edge especially after a Mexican lunch.

Restroom access is an absolute concern for any outing away from home.  In Access Denied, the ongoing concens and fears of being denied restroom access and restroom restrictions were discussed. When we reserved our camp site, I made sure to reserve a site that was close to restrooms in order to reduce wait time when a restroom was necessary. Even with having a restroom within 100 - 200 feet, at night I had to drive to the restroom in order to arrive in time and to reduce the amount of physical activity that inevitably increases SBS.  At times I even considered sleeping upright in the car parked at the restrooms during the nights but after 3 trips a night, I was able to endure until morning.

I also have to take care to watch my activity as movement increases my SBS and is futher complicated by restroom accessibility. There were many nature trails and hiking that we could embark upon and that I would have loved to have completed, but once again I had to mind the amount of activity and the proximity to a restroom in order to prevent SBS and accompanying misery. Even to go for a swim takes careful consideration of the timing of eating, walking to the swim area and the length of time between preparing for swimming and actually going swimming. The planning and participation of activities also depends on the severity of bothersome symptoms, if only slightly bothersome I'm able to enjoy activities for a longer time period and a fuller range of activities. However, if symptoms are severe then I'm rather limited to sitting still with little food or fluid intake or will be faced with increased SBS symptoms.

None of these concerns stopped me from enjoying or participating in activities on our camping trip, I just simply had to be aware of the possible side effects so that I could plan accordingly which allowed me to make decisions and alter activities to reduce the risk of such side effects for a more enjoyable trip.

I can't think of any activities that I haven't been able to partcipate in in some way because of my health.
Knowing our bodies and how they react to varying situations is vital for our survival. By being able to predict based on previous experiences, I'm able to make decisions to allow for optimal activity participation and comfortability.

The Non-Sick

I'd group people into the following categories to describe their frame of reference for understanding chronic illness and empathy.

1. The Sick. These are people with chronic illness, not with bowel disease though. This group can relate to us with bowel disease because they too understand chronic illness. This group is usually very empathetic toward others with health issues and have a medical understanding.
2. The Bowel Sick. This is our group of people, all with some bowel disease. We relate to each other better than any others with health issues. Again, we tend to emphasize with each other a lot.
3. The Non-Sick with Empathy. This group doesn't really have any health issues but sincerely want to understand what we go through. They may or may not have any medical understanding, but are willing to learn. Someone with empathy doesn't require medical knowledge in order to empathize and often have tendencies to have a basic understanding simply due to their inclination to empathize and imagine what life is like for someone with illness. This understanding also tends to be present for not only physical but also emotional symptoms and effects.
4. The Non-Sick with No Empathy. This group doesn't really have any health issues or experience and don't really care to sincerely understand or learn about our conditions or that of others. They may inquire but it is usually due to etiquette or to satisfy curiosity.

 I don't really have any patience for the non-empathetic non-sick and dealing with this group is highly vexing for me. I don't mind and even typically enjoy educating others, answering questions and helping to better understand and support others in their lives. But when a person doesn't have any interest in such things and only feigns interest for their own hidden benefit, I don't really care to answers questions. I don't want to be a part of their games or help them in their games. I also don't really care for such people to pry into my life and know details of my health or my day to day health and symptoms. So it's no surprise that I have very little patience and a short fuse with such people.

I don't have the energy nor the patience to teach an adult how to empathize or how chronic illness affects one mentally, emotionally as well as physically, especially when it's not a sincere interest. I'd rather maintain my privacy and steer clear of my health as topic of discussion. I've encountered several people like this and I don't trust individuals with such behaviors. There are people who will use knowledge about someone's health and chronic illness to manipulate the person, others involved with the person or a situation with such personal information. We must especially be weary of this with employers. Recently I had an individual ask about my PTSD and they didn't understand how I could have PTSD now when my physical health has been stable. This person was also trying to use my health as a tool for religious debate and manipulation. So I'm confident that this person belongs to the last group. It doesn't take a psychologist to understand basic tenants of PTSD as long as they know a summary of what PTSD is.
 Simply, PTSD is the mental effect of a traumatic event causing an individual to have depression and negative stressful symptoms that are triggered by the trauma experience being relived. Such symptoms include night terrors, severe anxiety, fear, flash backs, emotional numbing and avoidance. Most people have a basic understanding of PTSD due to the prevalence among war veterans. Therefore, I find it hard to believe that an educated, aware adult doesn't have any reference to PTSD to draw from, especially if that person has a capacity for empathy.

My PTSD symptoms have subsided in frequency and severity over the years due to counseling and medication treatment. I don't believe that an individual ever truly stops having PTSD, just that symptoms can improve as well as better coping mechanisms may be learned and utilized. Although my health is fairly stable now and I don't have as many regular invasive tests and procedures, when I am placed back in that medical environment and those situations I begin to experience those same PTSD symptoms that I've had before although now I'm better equipped to cope with the situation so that the symptoms aren't as severe or debilitating as they were previously. But I'm never rid of it all and sometimes without provocation I begin to have symptoms again. I have to be cautious of what I watch, read, listen to and even what I think because I am easily transported back into time to any one of those traumatic medical experiences and am reminded of it all again. If I'm not cautious, I'll quickly be reliving the traumas. I'm so in tune with the pain and those memories are etched into my mind so deeply that seeing or hearing others' pain is physically felt on my body.
I also believe that one is never truly free of depression completely. A person may stop having depression but I've found that after having depression, one is much more susceptible to have depression again at a later time when under duress. I've found this also occurs with suicidal tendencies. Once a person has become suicidal, even after no longer being suicidal one is much more likely to experience suicidal ideations when under duress. It's as if once that those doors are opened, they're easy to open again even if not intentionally.

I acknowledge that these can be difficult things and notions for others to understand.    Chronic illness runs in my family but it's still hard for my parents to understand how deeply I've been affected by my health even though my parents are better able to relate than most. My husband has a hard time understanding my morbidity, how warped my mind has become due to such traumas. Yet they empathize and support, they listen and they show that I am understood and accepted. A close friend with similar health issues probably knows me best as he better understands the mental effects during his years of medical traumas than anyone else I know and is as warped as much if not more than myself. Most people have capacity for empathy and if they don't you are better off befriending someone who does. Without empathy, there isn't room for a true friendship - only a one sided benefit.

Compliance

Through the years my GI specialist has come to know me extremely well. She knows when I tell her I'm not doing something, I mean it. She knows when I'm not being completely compliant like I should and she even knows some of my tricks sometimes. She knows my limits and she knows not to push me further than what I can handle physically and emotionally. She knows how to advocate for me, she knows my mistrust and paranoia, and how to ensure my safety, comfort and well being. She knows my coping regiment and she knows how I best respond to care. She knows me.

I've told her I'm not allowing any rectal exams without sedation nor will I take any laxatives, enemas, or suppositories for a colonoscopy or endoscopy. Hence, why I haven't had either exam since 2007. She's brought up having another scope done since 2007, and I have agreed to undergo another scope if I can fast, and only fast, for the scope. But I also know that if I don't remind her to schedule the scope, I won't have to mess with it at all.  Yes, this could prove a grievous error on my part. I was advised I'd have stomach cancer by age 30 - in 2 more years. But that was 2 or more scopes ago and my last scope there weren't any polyps of any kind found that time. I don't know what I'd do if I had cancer that couldn't be treated by surgery. I don't know if I would consent to chemo or radiation. My grandfather had radiation and it shattered the rest of his intestines. Yes, that was back in the 1980's so a lot has improved since then. Yet, I can't forget the complications my grandfather suffered. I don't know if I could withstand the physical and emotional toil that accompanies chemo or radiation. I just don't know. But I do know, that I'm not worried about it.
I did have a CT scan with dye in 2011 that didn't show anything remarkable, so I know at least at that time I didn't have any large polyps or tumors. I did discover that my kidneys are connected in the back instead of the front, as they're supposed to be. I don't know why there is always something abnormal about my kidney design. My right kidney is small and in front of the pelvis instead of behind the pelvis, so it's not protected.

I've stopped medications, such as Sulindac and Celebrex, simply because I got tired of taking them. I am faithful in my Lomotil and my Iron though. After not taking Sulindac and Celebrex for so many years, when I finally felt guilty and asked if I should start taking them, my doctor must have known better because she told me not to worry about them!

I've been horrible about taking my B12 regularly since I got married. I usually miss 2 months and do great the 3rd month - before my regular GI appointments. Then I dose up quickly on my B12 to make it look good. This month she caught on though, she questioned the date of B12 and the date of lab. She just smiled her knowing smile at me and suggested I take my B12 regularly. Which I've been dong better at. This month I haven't missed my series at all. I also got new syringes - insulin syringes - and boy do they make a difference! They're much easier for me to sit through and much easier for my husband to use.
Yet, I feel more tired this month than I have in several months of not taking my B12 regularly. Every day I end up taking an involuntary nap - sometimes multiple! In discussion with other FAPers, I've noticed that some also have trouble with Vitamin D and even their Thyroid that makes them fatigued. If this continues, I plan to ask my doctor about these as well.

Then sometimes you're compliant and a doctor labels you as non-compliant. For instance, my GI doctor wants me to have a 2nd bone density scan. My first bone density scan was in high school  so well over 10 years ago. I agreed to go for the scan again, I've even called to remind my doctor's office about it. However, the bone density doctor has me labeled as non-compliant for supposedly cancelling an appointment and not rescheduled in 2010. Two things beg the question here.

1. Why would I have a random, sudden appointment scheduled at minimum 7 years later without my GI doctor or myself knowing about it?  I never had a follow up appointment with this doctor after the bone scan. My GI doctor reviewed the results with me beyond any that were given at the time of the scan. Why would I need a follow up appointment 7 years later and not more regularly in between?

2. Why would I recognize the doctor's name after 7 years when I had been to the doctor one time? I know the names of my past doctors and I even know the names of a couple doctors who regularly consulted with my GI. I do not remember the names of doctors I met one time. 

And yet, this doctor won't see me again in spite of the unraveling of her office's excuses. I actually take offense to this. My doctor is amazing and obviously finds reason to keep me as her patient when I should have transferred to an adult GI 10 years ago. When I am forced to transfer, my doctor already has information prepared for my future adult GI as to how to care for me and how to respect my limits due to my past trauma. Even the adult GI, who I plan to transfer to when so forced, asks my GI doctor about me regularly in preparation of taking over my care.

So sometimes, even when you're compliant, someone or something will attempt to make it appear otherwise. In such cases, it's a great thing to have a strong doctor advocating for you. And if you don't have such a doctor, I highly recommend finding someone else. I've been there with a negligent, uncaring doctor and I paid for it. When you find that strong doctor, who knows you, your body, strengths and limits, so well - hang on to them for dear life. There are a great many of doctors like that I've found.

Pardon Me?

We've all experienced it, someone just has to say or do something that is inappropriate and even downright offensive to someone with conditions like ours. In such cases, it's all we can do to control our impulse to give a thorough tongue lashing or even a punch to the offensive person. Such insults are common etiquette, however most people don't have a real understanding of bowel diseases and all that's involved nor do most people seem to understand how their actions or words affect others, not that it's truly meant to be offensive or insulting - it's just a lack of knowledge and understanding.

Photo Borrowed from Jezebel Article

• We are much more sensitive to movement than those without such diseases.

While recovering from surgery, some church friends came to visit and their children decided to play in my wheelchair and repeatedly hit my hospital bed in the process. Not only was this annoying but also excruciating and nauseating! Or when someone bounces around next to you. I have to remind my husband to stop making so many movements as I become nauseated and the jostling also upsets my intestine - even just from someone walking heavily nearby me.

• Eating or drinking around us when we're not allowed to eat or drink is mere torture. 

During most of my hospital stays, I wasn't allowed to eat or drink and it was torture watching and hearing visitors eating, drinking and talking about food/drink in my presence. I finally stopped allowing anyone to visit if they were going to eat/drink or talk about food/drink in front of me in my hospital room. I even had church member try to eat MY gift of cookies when I couldn't eat anything yet, and she tried to eat them in front of me! Thankfully one of my aunts was there to quickly snap her back into line.

• Commenting about our bathroom habits is extremely rude.

I just cringe when someone comments about my stomach rumblings,  my frequent visits to a restroom, and especially if the topic of odor comes up - I just want to scream in a fit of rage and hide from embarassment. None of these things require commenting, so why are others compelled to call attention?? We are aware of our own bathroom visits, urges and about odor. We don't need help bringing more attention to our bowel diseases nor do we appreciate the attention. Keep such thoughts to yourself and please don't snicker or laugh at our problems.

• Denying or ignoring restroom access and needs.

A similar vein to this is when others ignore our requests and need for a restroom break. It is nerve racking when we don't have control over access to a restroom, whether it's worrying about a business denying us access, not knowing where a nearby restroom is, or those we're with driving or walking that don't want to take the time for us to use a restroom. When I was a child and had an ostomy I was riding with my aunt and uncle. I needed to use the restroom as my ostomy pouch was becoming too full. Although I repeatedly requested to stop at the next gas station for a restroom, my uncle refused to stop. My aunt made him stop finally after my ostomy appliance began leaking from becoming too full. Even to this day, I'm leary about riding with my aunt and uncle.

• "Advice" from non-professionals and others unfamiliar with our conditions.

I don't know how many times I've been given unwanted "advice" about my health by individuals who are not A) doctors, B) don't know my history or symptoms, and C) aren't familiar with my condition or similar conditions. Bowel disease isn't a simple condition nor does it have simple answers.
Recently I was advised that "If you took your B12 regularly then you wouldn't be anemic".
Really now?? Perhaps that's enough for some, but considering I took B12 regularly for nearly 15 years and never stopped being anemic I wouldn't say that B12 is enough to cure my anemia, regardless how often I take my B12. Nice try though.
Or perhaps when my mother was told that the reason I was so sick was because she didn't pray enough.  Oh is that all it takes to cure someone?? Gee, we'll just give that a try then. Not to mention that my mother is a religious person and does her fair share of praying. And my parents will do anything they possibly can for my health and well being. Needless to say, this was a very wrong thing to say to someone - blaming a parent for their child's poor health or blaming an individual for their poor health.

• You don't look sick or that sick.

Illness isn't always blatantly visible. You can't see the internal battle my body is going through and I don't always show the pain I'm experiencing. I have a wheelchair and a handicap placard for when I have difficulty walking when my SBS flares up. As I discussed in SBS SOS, You can't see when my SBS flares up other than I walk funny, sit funny and am running to a restroom as quickly as I can and am doing so very frequently. I am often questioned, and rudely harassed, about my use of my wheelchair and my handicap placard. Yet, without these aids I am not able to leave my residence at times.

• Weight isn't such a light topic.

Chronic illness affects our weight drastically at times - from one extreme to the other. Most of us aren't at a good medium. Medications can cause weight gain and bowel disease flare ups affect our nourishment and often causes weight loss. At my lowest during bad health periods, I was at 87 pounds and some of my doctors considered me anorexic after my health started to stabilize. Not only was I not able to eat for the most part of a year from repeated procedures and surgeries, my stomach shrank from not being allowed to eat and when I could eat, I was losing most of my nutrients. In the 6th grade I was placed on a diet to gain weight. After the weight gain I was still only at 100 pounds until my junior year in high school. It was only at this time that I was able to gain anymore weight because I was placed on TPN as I wasn't allowed to eat due to a hole in my intestine, which is explained in more detail in A Look Back. Since that time, my weight has been up and down as my metabolism and appetite has been altered. I'm at a healthy weight now, although I would like to lose a few pounds. Regardless what my weight is curently or what it has been in the past, there is never been a short supply of comments by others about my weight - whether about being too skinny or too heavy.

• You were fine earlier.

Bowel disease isn't constant. We have good days and bad days and sometimes it changes during the same day. We are deeply affected by food and even a specific diet isn't a cure all. Some foods may make us sick one time and not another. The Evils of Food depicts some of the considerations I have to make every time I eat something. This greatly affects the ability to participate in activities. There are a lot of times that I think I'll be able to do an activity and when the time approaches, I'm just not able to participate. Our energy, sleep, mobility, and mood are affected by our conditions. Most of us are continuously battling malnourishment which affects all these areas.

So what would be appropriate????

• Just supporting us and being there for us.
• Please don't make any negative comments or bring attention to our needs to embarras us. 
• Ask if there's anything that would be helpful.
• Please don't hold it against us when we're not able to do something. 
• Feel free to ask questions to better understand our condition and what we're experiencing. 

We appreciate the concern and care of our loved ones and are thankful to have you in our lives.

Mental Prep

We all have our routines, our rituals that we employ when dealing with health issues or health needs. Techniques utilized vary from person to person and even from situation to situation. In Stressed Indeed I discussed some of the techniques I utilize to reduce anxiety and stress, especially in times of medical crisis or procedures. There are a lot of different situations and procedures that require mental preparation to tackle what's at hand.

For instance, I always request for my blood to be drawn and any IV to be placed on my left arm. When I receive my B12 shots, I prefer to receive the first shot in my left arm and then my right arm. I chose my left over my right because I'm right handed and want to maintain use of my right arm and hand. This habitual preference though also has aided in my mental preparation for the impending needle stick.
Prior to each needle stick I employ other habitual behaviors as well, such as looking away, taking a deep breath, and focusing on digging my thumb nail into my finger while making sure to remain absolutely still. If I falter from this routine then my mental preparation is altered.

Not only does having a method to mentally prepare for health routines, it also reduces anxiety before, during and after. And when we're able to remain calm during a routine or procedure, the better the outome for us - physically and emotionally. It is less traumatizing and reduces risk of mistakes or errors due to erratic behavior that can be a result of extreme anxiety.
Of course there are times or situations when mental prep techniques aren't able to place us in a fully calm state but such techniques will still envoke calmness and allow one to better cope with the situation and endure.

Discovering what the best methods are for an individual and for various situations takes time and experimentation to determine which methods are easiest to employ and are most effective. Once the best methods are discovered, it is well worth the time invested and will greatly serve one in the future.
What are your mental prep rituals?

A Scarred Life

Throughout the day while at my desk, clothes shopping, getting ready for a function, or even just lying in bed I'm reminded of what once was and what threatens the future by a single scar and it's never healing abnormality. This single spot as well as occasional tingles along and under the scar lines will never let me forget. On occasion, I still have the sensations of an active stoma and am urged to reassure myself that my reversal wasn't a dream, but remains reality.

Of course I have the typical, vertically long slice down the middle - from the groin to the rib cage. And after repeated slicing in the same line,  it has become rather deep as it curves around my belly button. Accompanying this is a scar on each side of the abdominal length reminder of the previous stomas - one in the shape of a hash mark and another a deep single slash with it's own peculiar complication presented as a knob at the end that never truly heals itself.
This spot is a constant source of irritation and serves as a constant reminder of what I've endured. The knob presents itself as if a stitch is lodged deep inside, forever trying to work it's way to the surface to be released from the captivity of the body. Alas, whether a stitch is embedded in my skin or not, there isn't any hope for discovery. This pustule like spot becomes irritated periodically and collects within itself a clear liquid that pushes its way to the surface that vexes the skin until without conscious act, my fingers are led to this knob to kindly relieve the area of its' building pressure. Once it's devoid of the liquid, it lies flat again against the skin and maintains a slightly open red dot that taunts me to attempt to discover what may lie beneath the skin. The few times I have relented to the taunting of this red spot has been painful as I dug under the skin as deeply as I could allow myself with needles to attempt to catch what may be the cause of such irritation without any success. This spot is also indifferent to hot compresses and ointments. The only time this spot has begun to heal was when I tanned for a month's time, the heat acted to dry out the gradual collection of liquid. However, after tanning completed, the collection was again started. Like most of my health, this also is an anomaly that my doctor and others have been unable to explain.

And then there are other scars that aren't as blatant although continue to serve as visible reminders. Multiple scars on my chest from the repeated placements of central lines and their stitches, a scar on my lower abdomen from a drainage tube, and countless scars on my hands and crook of the elbows where IVs were inserted and needles for lab draws. I do worry about future accessibility for IVs and needles though from all the scarring.

I know some are deeply bothered by the presence of scars and view scars as bodily imperfections and reflections of one's self worth. I don't subscribe to this perception or interpretation of the role of scars on one's life or meaning and I urge you to refrain from such a perception as well. The visibility of my scars have never been bothersome to me, I rather view them as a badge of survival, an so it's never mattered to me when others see or even comment on my scars. In fact, I find it a bit humorous when strangers react to seeing such a scarred up abdomen as they try to ascertain what the cause is of such scars.

It was this attitude that kept me from ever considering products and procedures to lessen the scars. However, when my gynecologist asked to complete a series of laser procedures on my abdominal scars to allow the scars to lessen in color and size as part of a research study, I consented to undergo the procedure. The laser procedures were short repeated sessions and the heat of the laser was uncomfortable, although not unbearable. The heat was most bothersome on my freshest scar, the deep single slash with the slightly open knob. Each session let my abdomen red from the laser's intense heat and it was a display of gradual changes. I was surprised at the results, not only did my scars reduce their pink or red hues and blend in more with the surrounding skin, they also became less puffy and less deep so that they're more level with my skin. I wouldn't have sought such a procedure if it hadn't been part of a research study at no cost to me but I'm glad I had the opportunity to benefit from the laser procedures.

With or without treatments to reduce the visibility of scars, don't let your scars hold you back. Scars don't define us and aren't a reflection of negativity, imperfection or damage to the body. Rather, they are merely reminders of what has been survived. And that, indeed, makes a pretty awesome, empowering statement of self.
I leave you with quotes that speak to the strength of a life with scars.

• Scars remind us where we've been. They don't have to dictate where we're going. - Agent Rossi, Criminal Minds
• Out of suffering have emerged the strongest souls; the most massive characters are seared with scars. - Kahlil Gibran
• In nature, nothing is perfect and everything is perfect. Trees can be contorted, bent in weird ways, and they're still beautiful. - Alice Walker
• A pearl is a beautiful thing that is produced by an injured life. It is the tear [that results] from the injury of the oyster. The treasure of our being in this world is also produced by an injured life. If we had not been wounded, if we had not been injured, then we will not produce the pearl. - Stephan Hoeller

Numbing

The ostomy world lost another inspiring individual with great vision and drive, who helped start a revolution of education, support and life preparedness for youth with bowel and bladder dysfunction or disorders - the Youth Rally.

In our world of chronic illness it seems that life is so ever short and although these losses aren't on a regular basis, it isn't all that unexpected either. We have a lot we are contending with for survival and quality of life - most have several diagnoses competing for treatment. Whenever one deals with the GI tract, there's always a threat of malnutrition and dehydration interfering with one's daily tasks, one's health, one's life. This is why it's so serious of an issue for so many of us - our bodies are in a battle to survive when they aren't working properly to obtain life's necessities. Cancer seems to be another common sideline occurrence, whether it's within the GI system or elsewhere. And of course for those of us with FAP, cancer's always a constant threat. This is not intended to scare or stress anyone, only for others to better understand the daily risks we live with, why it's not a walk in the park. Because of being under attack so frequently, we each find our ways to cope and we must or we'll be eaten alive emotionally and mentally as well.

When people are faced with many losses of life, we tend to start coping by compartmentalizing and dissociating from the event, essentially numbing ourselves. This is extremely common and necessary for anyone working the medical field and it's a mechanism I've grown quite accustomed to utilizing.
Throughout my life, since I was a few months old, I've been surrounded by death. I have lost more family and friends than I care to recall. And working in the medical field, I've lost more patients with chronic or terminal illness than I can track. Although I am saddened by the death of anyone I know, I don't grieve for everyone the same way. When I've lost very close friends and family members, I grieve heavily for months, even years but when it's someone I'm not extremely close to or I have a professional relationship with, I pay homage to their life but there isn't really a grieving period allowed. When my grandfather died, I couldn't speak of him for close to 2 years without crying. When my aunt died, all I could manage to do was attend work and school, every spare moment I had I spent with my family for months sharing family stories. When my best friend died, I didn't sleep for over 24 hours and cried incessantly with his father for close to 6 hours.

I can't menally afford to grieve so deeply for everyone though and that's when the mind protects itself and compartmentalizes experiences. And thank goodness for the mind's own capabilities! I believe this ability of the mind also lends itself to the ability of those with chronic illness or in the medical field to often have warped perceptions of life and morbid humors.
So please don't be harsh on someone if they appear to not be affected as deeply by a death as another person, it may be all the person can manage for they're own surival.

Stressed Indeed

Living with chronic illness almost mandates that one becomes accustomed to a high level of stress. Not only are we dealing with the physical stress of health issues and the stress of worrying about our health, we also have the stress of how our health is affecting or interfering with the other aspects of our lives.

I think I have a naturally high stress level, I can't think of a time when I'm not experiencing some type of stress - whether it's about my health, fears for others, or related to my responsibilities. I've always placed a large amount of stress on myself since I was a child, I was beginning to develop ulcers when I was in the 3rd grade! Sometimes when I look back on my life or focus on the stress I've endured, I'm amazed at how I've coped with it from such an early age. We all cope with stress differently and hopefully we improve our skills over time.

I don't know how I coped with stress before adulthood, and I'm not really even sure how I cope with it now. It's just been part of my life. It's similar to the concept that I don't know what it is like to feel good anymore, this is my normal and I don't know any different. Prior to adulthood, I maintained the attitude that I was completing what was required of me as I didn't view or believe that I had any other choice myself. I was under the care of my parents, who were making my healthcare choices for me. I gained my strength from my parents and had faith they were making choices in my best interest. I don't know how I deal with stress any differently now than I did 4 years ago when working full time at my 1st post-graduate job was so stressful on my body that I began to really question my health's durability for full time work. Now I work full time with a different company and at times I also do contract services on the side without any negative effects on my health. Although sometimes I worry that the mounting stress will begin to affect my health again.

Through our trials and errors we discover little tips and tricks that work best for us to cope with stress or fears. To reduce stress associated with responsibilities I've learned to keep a to-do list so that I'm not stressing about trying to remember all that needs to be done, to organize information to be easily accessible when needed, and to maintain up to date lists of upcoming deadlines. When dealing with health stress, I employ several old fashioned stress reduction and relaxation techniques to attempt to regain calmness. During health procedures or tests, I complete deep breathing, progressive relaxation, positive imagery, focusing, mantras, and I keep a special stuffed toy with me for added comfort and sometimes listen to music. When I'm feel stressed by overwhelming fears or stress of how my current health is or may become, I lean on my parents or spouse for support - for physical comfort, reassurance and to voice my concerns - as well as deep breathing or progressive relaxation. And many times I eventually collapse with exhaustion after pouring my fears out verbally and through tears, a much needed emotional release at times, leaving me feeling much more refreshed the next day.

There are times that stress can be good for us, it can serve as a great source of motivation. When stressed, we may become motivated to stop procrastinating on starting or completing tasks, set new goals, change our attitudes or behaviors. Stress can be trigger we need to finally start something we've been meaning to tackle and achieve.

Stress all depends on our mindset and how we view the stressor. We must decide how we're going to approach stress and discover how we best manage the stress. Only then can we let go of some of it or even all of it, to enjoy more of life. What stress management skills have you learned?

Life Lost

The loss of life isn't anything to be taken lightly, whether it's naturally or by actions of one's self or others. I've shared before in previous posts how chronic illness warps our minds and perception, even in the realms of death. I was reminded of these effects when I heard about Mindy McCready's suicide last week and listening to the negative outlash toward her decision, I felt defensive of her. She endured a lot of pain and difficulty during her life, she was in a spiral of despair and although I cannot speak for her motives, I am not first led to believe her decision was of a selfish nature as many label anyone who has suicidal ideations, attempts or completion.

One thing I've learned during my journey with chronic illness and my time with friends of similar circumstances, is that we really can't judge what others are going through. This is primarily campaigned when discussing invisible illness but it's also in regards how life affects one's mental health, especially when chronic illness is involved. One of my best friends committed suicide, the pain of his chronic health issues became too unbearable for him. Although I deeply grieved for him, I couldn't be angry with him for his decision. I understood his decision too well, I too experienced health misery so great in my life that in a spiral of depression and pain, I longed for nothing more than peaceful death and for several years was suicidal myself. It is this personal understanding that I'm in favor of euthanasia, if solely of the individual's decision without manipulation or exploitation. I am not of the mindset that we are only given things in life that we are able to handle, there are experiences that way too heavy on the body and the psyche that are unthinkable and far too damaging. Those who are able to survive such experiences, I applaud them. However for me, there are several events that I would rather seek that eternal peace than to endure such experiences. Each person is different and so is each experience - but we can all empathize with the turmoil, the despair that another feels if only we try. Instead of blaming someone for their decisions or their desired intentions, let us be there for them and help them through the darkness the best we can.

I do not say such things to cast gloom on the hearts of others, but merely to remind us of empathy for the suffering others experience and to bring insight on their decisions. There are many examples of individuals who commit suicide as a manipulative exploit, to hurt others and for their own selfish gains. But there are many who are simply so hurt themselves or threatened with heavy pain - physical or psychological - that the only peace the individual is able to see is within death.
We need to support one another and any individual with suicidal ideations or plans most often are receptive to support, if only asked about what they're experiencing. Sometimes we miss the signs of how deeply hurt someone is, how close they are to the edge. We cannot blame ourselves if we miss those signs, but we can arm ourselves so that we may be better prepared.
Please visit Suicide Awareness Voiced of Education for information on suicide, warning signs, and ways to help and support someone experiencing such deep turmoil and perhaps together, we can bring more back from the edge.

Mere Exhaustion

Exhaustion; physical, emotional and mental exhaustion must be a mandatory symptom of chronic illness that we just seem to not be able to forgo no matter how hard we try. Sometimes exhaustion is inescapable, but we can combat it.

Physical exhaustion from the symptoms of chronic illness can leave us at times with very little energy, that even voicing words is too much. As a child, my parents began to understand my hand signs as a communication of my needs as talking simply took too much out of me. But that's not the only source of exhaustion that we've become oh so accustomed to in our daily lives.

Besides symptoms of the chronic illness, associated issues may arise that further complicate how we feel physically. For example, anemia and low B-12 is a common occurrence for individuals with ileostomies due to poor absorption of nutrients. Other electrolytes may also be out of balance that may affect energy levels.

I would be able to be so much more productive if after a day of work I didn't feel completely exhausted of all energies. I seem to have the most energy in mid morning to early afternoon - 9 am to 1 pm. But my energy begins to wane as the day draws on. I'm currently at my most healthy state since childhood, so it's not even only physical exhaustion that overcomes me but it's also emotional and mental. Part of it is because of my job, it by itself is mentally and emotionally draining. But it's also more than that. The stress of chronic illness can't escape any realm of our lives or our beings. Even when we physically feel well, the stress remains and will affect our emotional and mental selves in some fashion, even when we are coping appropriately as well. It's just a lot to bear.

Recharging ourselves as much as we can is a necessity. Taking a break to do something enjoyable or relaxing, meditation, taking a brief nap, talking with others to share daily stresses, volunteering, physical activity and similar actions help to recharge us and shed the stresses of the day so that we may focus elsewhere.

Depression is very draining on the psyche as it continually spirals down as long as the vicious cycle between thoughts, behaviors, and emotions remains constant and change is held at bay. It's depression's nature to lead us into a withdrawn state, so emotionally exhausted that we're almost incapable of reaching out to others, to maintaining communication. Merely speaking is too much energy.

This cycle must be broken though for us to push through and reclaim our lives. Such a simple, yet intensely difficult task of just changing our thoughts, behaviors or our emotions will make the difference to allow for a gradual climb out of the darkness. Anti-depressants, specifically in combination with counseling, are helpful in combating depression and this combination is most effective for despiraling the despair. Additional support resources such as support groups, patient hot lines, summer camps, activity groups are examples of some of many resources available. There are resources specific to illnesses as well as for care giving, mental health, and general.

Arming ourselves with a holistic approach to address each realm we are best suited for the chronic illness of exhaustion that accompanies all chronic illnesses. Keeping our energy levels at a manageable level will help us to keep our other symptoms in better check and will help us to cope with our daily struggles.