When I'm Asked How I'm Doing

When you have a chronic illness, sometimes it's hard to know how to answer when asked how you're doing. The odds are, we're not doing very well. We have daily symptoms we're contending with and most of the time we don't feel well but we don't want to admit that to others. We question the sincerity of the question and what is considered to be too much information when we answer. So we lie usually instead of answering the truth - the truth being that we aren't doing well.

I always question does someone really want the truth or just the brief, expected answer so that conversation can move along. I rarely answer honestly. I entered the habit of answering "okay" or "good" even though it was a lie. I was tolerating the moment even though internally, I felt like death warmed over.

I became tired of answering with a lie and a superficial glancing over my daily health. I wanted a more sincere answer but I also didn't want to dwell on the answer, particularly if my well being is only being sought after on a superficial level, out of societal nicities. I hate the looks of pity when I answer with a truthful "I'm doing horrible" type of answer.

I tried out different answers that felt genuine for me but none felt right. To say I'm functioning is true but it invites additional questioning and feelings of pity I thought. I'm alive didn't work well either for me. I finally settled on "I'm hanging in".

I'm hanging in provides a truthful answer without the invite for pity from others. It allows for further conversation but doesn't require additional questioning. It's clear and to the point - I'm managing but I could be doing better but I'm not worse either.

How do you answer others when asked how you're doing? What have you found works best for you? Share with me.

What I Learned From Divorce

When I divorced, I never could have been prepared for what to expect. No one tells you what you should expect, there is no handbook. Your world is turned upside down and you feel like your life is out of control. You simply live in trial and error and commiserate with other divorcees who can relate to your experiences. There is so much you learn during this period that can last for years even. The navigating, the learning may never cease. I'm only two years post divorce and although my married days feel like a lifetime ago, they remain with me although diminished in intensity.

From the initial moment I made the final and clear decision to end my marriage I began to experience an exhilarating time; I was filled with emotions of relief that were freeing to my mind and soul. I no longer had to hold on to the stress and worry that had accompanied me for the months previously while I battled depression and the stress of trying to hold on to everything while maintaining my sanity. With all this freedom, my energy levels soared as I was no longer burdened by immense stress. I started exercising, I could hardly sleep due to my abundance of energy and my excitement for the possibilities of the future. I felt limitless and carefree, unburdened by my final decision.

I began to re-enter the dating world shortly after, as is a common occurrence. Looking back, I realize now that a divorced individual is a mess for at least a year following the divorce and for that person's own sanity and sake, really shouldn't enter into relationships during this time. Refraining from re-entering the dating world for a year would be a very difficult commitment for most individuals. As humans, we long for companionship and intimacy with others. We tend to enjoy the thrill of finding potential new partners and participating in the dating realm. We feel desired by others giving us attention after an ordeal such as a divorce. The options for potential partners is an exciting new world that is reopened to us. It's a thrill that is hard to deny. The first year particularly is for a time of healing and rediscovering one's self. I had an intense amount of energy and drive for my limitless future but my mind was so scattered and pulled apart by all the options that now laid available to me. My mind raced between options and even though I set goals and plans for myself, I didn't stay with a plan for long before racing to another idea and option. It must have been exhausting for anyone listening to my rambling ideas and trying to keep up with my racing mind. Just as I wasn't ready to commit to another relationship, I wasn't ready to commit to even a singular life plan.

I was not ready for an emotionally invested relationship. I began to become terrified of relationships and kept a cold, emotional distance between myself and others. I've never had a great record of dating and I figured this time around wouldn't be any different; only this time I wouldn't marry again. I would forever be entering and exiting dating relationships. I vowed to myself that I would never allow myself to become lost to another, I would maintain my physical, financial, and emotional independence from another. Relationships became an "easy come, easy go" mentality for me as I kept distance between myself and a partner. I began to view relationships as impermanent. I survived what I thought I wouldn't - losing the person I considered my soulmate and life partner. If I could survive that and be happy again, then the same is true for any future relationship; I will survive any relationship ending. I wouldn't allow myself to become overly emotionally invested and as a result, a failed relationship was merely an inconvenience that could soon be replaced by another potential suitor. I spent a year dating men younger than myself and I learned to appreciate men who were closer to my own age. Not only was I not emotionally available but I also didn't want to deal with immaturity or drama. I had experienced enough drama with my own divorce, I didn't need or want additional drama brought into my life by another individual. I wanted simplicity and partners who themselves were an emotionally strong individual. I was tired of being the emotionally strong person all the time. I wanted someone who could stand their own. Although I have allowed myself to find a deep love again with the intent for building a lifetime together, I maintain a conscious eye on my independence. I've learned that with the right person, I don't have to keep a cold, emotional distance between ourselves as a means to protect myself. I can let another into my heart and remain independent and maintain a healthy self. Becoming cold and distant does not make a healthy relationship and now that I've re-opened myself to a deep and loving relationship, I am much happier than I was in previous relationships. In spite of finding a deep love, for good or bad, without any effort I maintain the view of relationships being impermanent.

While navigating the divorced world, I realized that all my new moments are tainted by past memories and experiences during my marriage. This has lessened with time, but there are stinging moments that cross my heart as I remember a time with my now former spouse or when I am embarking upon a new adventure that would have been with my former spouse if divorce had not occurred. It was quite painful as such events would trigger a flood of memories and grief over what was and what was supposed to be. I had a difficult time coping with vacationing and buying a home on my own rather than with my former spouse. I felt as though everywhere I turned, there was a tainted moment that should have been experienced with my former spouse but now was my sole experience. The sting has diminished in intensity and length, but it remains even though fleeting as it is.

My life changed drastically upon my decision to divorce. I gave up a lot but gained a lot in the end. Divorce was not an easy decision; working my way to that final decision was soul wrenching and I spiraled in a well of anger and depression. It was not an easy transition to make, the transformation of myself couldn't be rushed. But as my heart and mind began to heal though from the aftermath, I've come to love my life and everyday I am grateful for this new, even surreal life.

The upheaval of divorce varies from person to person and situation to situation. This may be
exacerbated any time divorce is contested or involves minor children or property. The entanglement of finances alone can cause extreme stress and friction.

Even when you do your best to maintain independent finances and property from your spouse, I learned that there is always entanglement. If your spouse has financial difficulties, it can be linked to you even when you didn't share finances or property. With this ongoing entanglement due to a previous legal connection to an individual, I realized I wished I had changed my phone number after the finalization of divorce. Years later and I still receive random phone calls connected to my former spouse.

Fortunately my divorce was civil; we even said we would always be there for one another if the other needed. Perhaps this was naivety and wishful thinking in the freshness of our separation. We still have one another's phone numbers and whenever I have questions about anything, he's always willing to provide answers. But would I be able to truly count on him if I needed something? I'm not so sure of that now with the passing of time. Perhaps but perhaps not. With all our civility and promises to one another, I was shocked when I suddenly discovered he had removed and blocked me from his social media platforms. I should have expected it. We weren't what anyone would consider friends anymore. But it was still a shocking realization for me. With one less person in my support system, I had to accept that I may need to lean on my existing support system more heavily due to my health but I also needed to be more independent myself. Our mutual friends now became his and mine; I no longer had his family and friends to call on.

Divorcing was a heart wrenching decision but ultimately it was the best decision for me. It would have been nice for things to have turned out differently, but they didn't. For myself, I must let go of any regrets and instead find my peace and enjoyment in everyday life wherever and whenever I can as I navigate the divorced world.


Other divorcees shared with me what they wish they had known to expect or what they had learned from divorce. See what others had to say:

• When dealing with property there is the risk of both individual's credit being ruined.
• Splitting up pets can be emotionally wrenching. - Wendy
• You may end up taking care of the children all by yourself - Joe
• You learn who your true friends are and there may not be as many as you thought there were - Tricia
•  Sometime it's worth asking "is it more important to be happy or to be right?" when considering remaining in a marriage - Amanda
• Men and women react differently. Where one may act devastated the other may act in the complete opposite. For example "I was devestated and upset, he behaved in a very matter of fact way, was switched off from me completely and had metaphorically closed the door on me and our relationship. It was as if I suddenly had no part in his life or in his relationshp with the children". - Lynley, Top Lady Talks
• You lose friends, other women may look at you as a treat to them even though you did nothing wrong in the relationship, and it took bravery to walk away - Bree
• "I lost a lot of things but my mantra was 'I have my freedom'!" - Aileen
• "It's the kids that matter the most, to make sure they are treated right and always told that they're loved." - Amanda

What are some lessons you wish you had known prior to divorce?

Living for Work

My pediatric GI doctor talked to me and my parents about my chances for Social Security Disability (SSD) Benefits to ease the financial burden associated with my chronic illness since I was a child. I grew up hearing about how I would be able to obtain SSD benefits if I applied. My parents opted to never apply for SSD benefits for myself as they didn't want me to see myself as different from other children and teenagers and were fortunately financially able to withstand the financial burden my health placed upon them.

For me, SSD benefits was never an option truly placed upon the table but I also knew that my doctor and my parents hoped I would be able to physically complete my schooling and obtain full time employment and become a financially independent person - but that this was not a given but rather a hope as none of us were sure how my health would withstand the such physical stress.

So I put forth my full effort into the tasks of life. My parents home schooled me for a year in grade school due to my health not allowing me to meet the attendance requirements of public school during the first year of my surgeries. And in high school I risked inability to graduate on time during another physically trying year with medical tests, procedures, surgeries, and multiple hospitalizations. I was only able graduate high school due to the kindness of one of my high school teachers agreeing to tutor me during my home study absence period.

In college, I endured regular hospitalizations due to difficulty maintaining my electrolytes. My college professors worked with me to allow me to complete my assignments and exams around my hospitalizations as needed. My health stabilized the year I graduated college affording me attendance to graduate school and my practicums with minimal difficulty.

However, when I started my first full time job the stress would become too much for my body. I was traveling around the state on a daily basis, even to the borders of my state on a bimonthly basis. My employer was not overly accepting of my health. After consulting with my parents about my health and financial situation, I was forced to resign for the sake of my health.

I was not defeated though. I allowed myself a month of rest before re-entering the work place with a different employer. I had learned new ways to cope with the stress of full time employment and how to deal with an employer. I succeeded at maintaining my health even when this employer entered the realm of a hostile work environment. I found a new position with yet another employer who works with me on my health issues and have been able to maintain full time employment ever since without difficulty for 7 years now.

With abrupt health changes over the last two years, especially during this year, I began to worry about my ability to maintain full time employment. Without my employment I would become dependent upon attempting to obtain SSD benefit approval and assistance from my parents in the meantime. SSD benefit approval is not necessarily an easy task to achieve and can take years. Even after approval, you are often required to wait another two years for Medicare health insurance to become available.

My greatest fears in life include not being able to financially support myself and to become nursing home dependent or homeless and to be able to care for my parents as needed. When I was married, I was less fearful of these risks as my home was a two person income home. However, I had to weigh the financial risks I could potentially be under when I divorced. When I divorced, I was accepting that I am solely responsible for my financial well-being regardless of my health. I would be at greater risk of my greatest fears becoming a reality if unable to maintain employment. When I divorced, I learned a new level of independence that I vowed to fiercley protect and cherish for all my days on Earth even if that I meant I had to work until my death. No longer would I allow myself fairy tale dreams of being a stay at home wife - I would forever be a working woman for as long as I required and am able.

And with this new attitude and determination, I admit that I live to work. It's not out of enjoyment or because I'm a workaholic but rather out of necessity for my surival and mental sanity. My health has always been unpredictable causing my future to be unpredictable. I will ferociously hold onto the few things I can control in my life with an intense tenacity. It is due to this outlook, that I dismiss others when they say it's no life to live to work. For others this may be true, but it doesn't hold true for me. Rather, I increase my ability to survive physically and mentally when I focus on maintaining my employment ability for as long as I am able - even if that means I work past retirement age. The more I work, the more financially stable I become, the more I am able to prepare for the uncertain turns my health will take that is chronic illness.

Life with Chronic Nausea

Nausea is easy to understand, right? It's simply of feeling of sickness with the inclination to vomit. Seems pretty straight forward. Not so much for me though, at least not my chronic nausea.

For me, chronic nausea is something different than just the inclination to vomit. It's different from nausea that can accompany a stomach virus, food poisoning, or over indulging on alcohol. I don't typically even vomit from my chronic nausea. My mouth doesn't start to salivate in preparation for the impending upchuck, I don't start heaving, I don't have to stop talking or risk vomitting. None of the usual signs I experience when I'm inclined to vomit. No, typically if I were to vomit from my chronic nausea, it's because I forced myself not because my body forced me. Although, frequently I wish I would vomit when I'm nauseated as I believe it would help provide relief. This is a predicament I find myself struggling with regularly and unfortunately, not new to me.

Instead of the typical response to nausea, my whole body reacts to my chronic nausea. My nausea has various triggers and although I can usually predict when the nausea will hit based on my behaviors, it is not always known to expect it crashing in upon me. Ingesting food or liquid often triggers the nausea as it fills my stomach and causes discomfort or if I become overheated I will become nauseated. Other times physical or visual motions will send me overboard. The slightly shaking is too much for my stomach and at times even the movement of a computer mouse or the scrolling of a computer screen will act as a trigger. And even with these triggers, there are times that I will simply awake nauseated. But whatever the reason for it, it always feels the same.

Typical nausea that subsides upon the expultation of the irritating source, I would welcome that. But that is not my experience. I can usually feel the nausea crashing over my body like the waves of a tide. I feel like complete and utter rubbish when the nausea hits. My body has a generalized, overwhelming sickness to it; my stomach hurts and feels uneasy, I feel full and bloated. On particularly worse occasions my head will slightly hurt and if I close my eyes to rest, I feel as though the room is spinning about me. I feel as though if I could just vomit or empty my bowel, I would feel better. I have the urge to lie down in a ball and hold onto my stomach. At times it becomes too much and the tears fill my eyes as I'm overcome with frustration at my physical status.


I regularly utilize my anti-nausea remedies- Compazine and Phenergan tablets, peppermint candies, and Peppermint Oil. I even have Phenergan gel as well. But nothing makes the nausea dissipate immediately, it's a gradual overthrowing of the nausea. And in the meantime, I'm left wanting to make myself vomit in an effort to make it stop yet knowing that it's not healthy to make ourselves vomit.

The chronic nausea is there with me, almost every day without warning, it is never cured. It's simply managed and so I must continue functioning in spite of the discomfort. I can't stop living my life or completing my responsibilities over nausea. In spite of my efforts to fight through the nausea, there are times that it is simply too overwhelming and all I can manage is to rest. But it sure would be nice to return to my pre-chronic nausea days.

Probiotics and the Immune System

I attended a seminar about Probiotics, Food, and the Immune System presented by the Institute for Natural Resources. This is just one of the many topics INR Seminars provides for healthcare professionals. The material is written by an expert and then presented by various educators. This particular seminar's syllabus was written by Dr. Nikita Katz, M.D., Ph.D. and was presented by Dr. Laura Pawlak, Ph.D., R.D. emerita.

This 6 hour seminar covered an intense amount of information about how the immune system works and is affected by foods and probiotics (healthy bacteria) with a specific focus on pro-inflammatory and anti-inflammatory influences. I will not be going into as much detail as the seminar provided.


Dr. Pawlak began by explaining that in the big picture there is a reciprocal interaction between food and environment on the immune system and on an individual's microbiota that then may affect the brain. The particular focus was placed upon the effects of pro or anti inflammatory properties that may protect or hinder the body as genes become expressed and diseases occur. Food and the probiotics that are found within our food or through medicinal supplements impact these protective or harmful factors and how our immune system functions.

Probiotics are commonly recommended for individuals with digestive disorders or diseases to help maintain a healthy gut flora that is easily disrupted by digestive disease. Probiotics are also recommended to be taken following the use of  antibiotics in order to help replenish the good gut bacteria that is stripped away by antibiotics. To understand the importance of probiotics, it helps to have an awareness of the effects of microbiota on the body and interaction with the immune system.

Our immune system is made to protect us against threats that are not considered "self". Typically, immune responses are elicited from viruses, bacteria, and parasites that cause infectious diseases but can also be prompted by our own cells that look different than expected, such as cancerous cells. Immune responses are aggressive and must be controlled as the immune system has the capability to kill the identified organism, or person, itself.

The human microbiota is a combination of microorganisms that includes bacteria, fungi and archaea. Some microbiota found within humans are beneficial to the body whereas others may be harmful. There is a delicate balance required for human microbiota and its essential role for a healthy immune system and various neurobiological functions.

The Human Microbiome Project found that there are thousands of bacterial types found within an individual and different body sites have their own distinctive bacterial communities. The specific bacterial makeup for a given body site varies from person to person by type and abundance. Due to each part of the body having a different microbial arrangement, different probiotics will target different areas. Not every probiotic will be helpful to every part therefore this needs consideration when selecting food and medications specifically for their probiotic benefits.

It's estimated that 500 to 1,000 species of bacteria live in the human gut. Gut flora has the largest numbers of bacteria and the greatest number of bacteria species in comparison to other parts of the body. These gut bacteria are predominately Firmicutes and Bacteroidetes but others present also include Proteobacteria, Verrumicrobia, Actinobacteria, Fusobacteria, and Cyanobacteria. The gut flora is established within one to two years after birth which is enough time to allow for the intestinal epithelium and mucosal barrier to support the gut flora and provide a barrier to pathogenic organisms. Probiotics help protect the mucosal surface barrier from inflammation. When this barrier weakens due to inflammation, resistance to malignancy is reduced and cancer and inflammatory disorders may occur. With weakening of the barriers, we risk microbiota leakage or absorption in between cells where we do not want absorption. The brain receives every nutrient introduced to the body and probiotics activate the vagus nerve that reaches from the abdomen to the brain. The blood brain barrier allows nutrients to reach the brain while limiting harmful substances reaching the brain. However, with weakening of the barriers due to inflammation, harmful substances may pass through the blood brain barrier.

Depending on our food choices, certain foods can help keep good microbiota alive and bad microbiota down and vica versa. Fiber and oils promote the good whereas sugar and fats promote the bad. You may notice this when constipation occurs as bad microbiota likes constipation. Once the diet falls apart, so does the immune system. Diet also influences the type of microbiota present. A healthy diet promotes healthy microbioata whereas unhealthy foods promote harmful microbiota. Nutrients are vital for efficiency of the immune system.


Typical and Unusual Types of Probiotic Bacteria for Healthy Gut Flora

Foods that naturally contain probiotic bacteria include:

Fermented cruciferous vegetables, fermented root vegetables and legumes, and sour milk products such as:

• Yogurt, recommended to be plain yogurt with no added sugar and labeled with live and active cultures. To sweeten, add fruit. Avoid adding sugar, artificial sweetners, or honey
• Kefir
• Icelandic skyr
• Swedish filmjolk
• Buttermilk
• Acidophilus milk
• Crème fraiche etc.

Non-dairy foods:

• Kombucha
• Kimchi
• Sauerkraut
• Green olives
• Tempeh
• Szechwan vegetable
• Indian pickle
• Mixed pickle

Another method for delivery of healthy probiotic bacteria is the Fecal Microbiota Transplant (Stool Transplant) to aid in restoring healthy colonic microflora by introducing healthy bacterial flora from the stool of a healthy donor by means of an enema, orogastric tube, or an oral capsule. This has been shown to be effective for C. Diff infections and is being used experimentally for treatment of other GI diseases including colitis, constipation, IBS and neurological conditions.

For the growth and activity of probiotics, prebiotics are necessary. Prebiotics are typically non-digestible fiber compounds in foods such as chicory root, Jerusalem artichoke, dandelion greens, garlic, leeks, asparagus, wheat bran, whole wheat flour, and bananas. There is not a broad consensus on an ideal daily serving of prebiotics but recommendations typically range from 4 to 8 grams for general digestive health and up to 15 grams for an individual with a digestive disorder.

There are diseases and syndromes linked to bacterial imbalance and immune dysfunction. These imbalances can occur in various parts of the body where the microbiota has deranged. In such instances, the normally dominating bacteria species become underrepresented and the normally outcompeted or contained species increase to fill the void. This dysbiosis, or microbial imbalance, is most commonly reported as a condition of the GI tract, particularly when there is an overgrowth in the small intestine of bacteria or fungi. This has been reported to be associated with illnesses such as periodontal disease, IBD, chronic fatigue syndrome, cancer, and colitis. It may be important to note that patients treated with PPIs to reduce stomach acid tend to have a higher frequency of small intestine bacterial overgrowth.

Microbes within a tumor can affect cancer growth and spread. Microbes and microbiota affect cancer formation by altering the balance of tumor cell life and death, immune system function regulation, and influencing the metabolism of foods and pharmaceuticals.
Mucosal surface barriers within the body require rapid repair, once these barriers are breached then microbes can elicit pro-inflammatory or immunosuppressive programs thereby allowing cancer and inflammatory disorders to occur. Probiotics can help protect the mucosal surface barriers against inflammation.

Inflammation is a biological response of body tissues to harmful stimuli and a protective response. Inflammation functions to eliminate the initial cause of cell injury, remove necrotic cells and tissues damaged from the original insult and start tissue repair. The typical signs of inflammation include heat, pain, redness, swelling, and loss of function. Inflammation may be acute or chronic. Prolonged inflammation can lead to a progressive shift in the type of cells present at the inflamed area. Inflammation can cause disease related genes to be expressed and is linked to most chronic diseases including arthritis, cancers, cardiovascular diseases, IBD, and diabetes.

Of the dietary components tested thus far on the Dietary Inflammatory Index (DII) for pro-inflammatory and anti-inflammatory properties, the top anti-inflammatory components include Turmeric, Omega 3 Fatty Acids, Fiber, Genisten (protein found in soybeans), Tea - the leaves are best, Alcohol - wine berries, and Magnesium. Turmeric should be taken with fresh ground black pepper in 10 parts turmeric to 1 part pepper for optimal absorption. the DII has a long way to go still as only a handful of dietary components have been tested for their pro and anti inflammatory properties.

When thinking of maintaining a healthy immune system, we must take in consideration not only the foods we ingest but also our exposure to environmental factors. With the advance of technology, we are now exposed to chemical compounds that were not naturally occurring on the planet previously and we are now exposed to chemicals normally hidden within the ground that are now exposed through mining and manufacturing. Heavy metals exposure causes significant alterations to the immune system by increasing the body's pro-inflammatory and decreasing anti-inflammatory responses. Air pollutants, pesticides, phthalates, PCBs, and perfluoralkyl substances exposure are also associated with medical conditions.

To help reduce one's susceptibility to immune dysfunction associated with such environmental influences, it's recommended to choose phthalate free personal care products, fresh foods rather than processed foods, and reduce exposure to pesticides, heavy metals, and air pollutants as much as possible.

To help lower inflammation and maintain a healthy microbiota balance, it is recommended to eat healthy, fresh foods, ingest probiotics, obtain adequate sleep , exercise regularly, and reduce stress. Exercise secretes proteins that are anti-inflammatory and remaining in the stressful fight or flight crisis response mode increases inflammation.