What Are You Doing New Year's?

As far as years go, this one's not been so bad. I managed to see no more than two emergency rooms and seven hospitals—and I didn't die. A good year indeed!

The first two hospitals came on the same day, as on Easter morning I suffered a gastric rupture. I was traveling with my mother for a story I was working on. The night prior my husband and I had a campfire in the backyard. As we'd gone to bed, I noticed my stomach hurt a bit, figured it was gas, took some Mylanta, and went to bed. Through Saturday I was just fine, but that night my mother and I had a large dinner out. Again that evening, I though the tweaks in my abdomen were nothing serious, took a chewable gas tablet, and went to bed. 

I woke up at 3 a.m. in pain and in a panic. I awoke my mom with the super flat, no nonsense tone our family reserves for only true emergencies, "Mom, I need you to wake up right now." As I paced in the hotel room, flapping my hands to shake off the increasing stabbing and burning going on under left ridge of my ribs, my mom called 9-1-1. We weren't able to describe our location well, and the road to where we were was less than ideal for an ambulance. Instead mom got directions to the hospital. I slid on some clothes, and we loaded into my car, which mom had never driven, in the pitch black dark, which mom doesn't like to drive in, and headed off toward the hospital, which neither of us knew exactly where was. Nonetheless, the town was small and the hospital easy enough to find, if one followed the signs. 

To make a long—and sordid—story short, hospital one treated me for gas, finally took an x-ray, and concluded, "You're really sick." There was talk of transporting me via helicopter or ambulance. They picked the bus, and the family converged on the region's larger hospital where I had emergency surgery. They cut me stem to stern. It was the second time my intestines were entirely removed from my body. They stapled my stomach shut, but only marginally closed my incision—a measure I think both aimed to allow the swelling to go down and to reduce infection. Four days after surgery, they stapled me shut in my hospital bed. Out of all that I've had done, I'd never had stitches or staples while awake. I was nervous to the point of tremors. The nurse loaded on four CCs of pain killer before beginning and kept two more on reserve. "So, um, those two CCs, yeah, is that for pain or to, like, keep me from freaking out?" I asked as cheerfully as possible, given the circumstances. "Both," the nurse replied with a tone both honestly direct and comforting. "Cool, cause, yeah, um, you might wanna push that," I said. 

I had three stitches and 37 staples down my middle when all was said and done. Recovery went well other than that I retained a bit of fluid in my incision, which consequently didn't close in two spots and began to gap open when my staples were removed. Though we'd been through much together, my husband had yet to actually see my insides—until then. As the physician's assistant measured the depth of my wound with a Q-tip, my own injury was less my concern as he went white and sweaty and reached for the chair. The wound would need to be packed twice a day. My husband would have to be the one to do it. With tweezers. He doesn't like to cook chicken. It took a month, but we got through the healing. My scar is stupendous and makes X only marginally shorter than my inseam. 

The third hospital visit was to see the surgeon who did my renal, celiac, and mesenteric bypass in 2005. At that time, we didn't have an official diagnosis for what caused my arterial stenosis. Takayasu's arteritis first was considered. Fibromuscular dysplasia was mentioned on the lab reports. My health was great until May 2008 when my I had a stroke, discovered my bypass had failed, and that I had four brain aneurysms. I lost my kidney as a result of the failed bypass. We concluded that my gastric rupture must play in as well. We agreed it was time to see a FMD specialist, so I headed to the Cleveland Clinic. My diagnosis came as a blessing and a curse. Knowing what I have is great. What I have is not great to have. 

In early November, I had to make another trip to the hospital for an outpatient procedure. Again, all went well, but again my husband ended up packing a wound—a much larger one this time. As we close in on the New Year, we're in the closing stages of wound care, but it's been a long two months. Shortly after the procedure, I was given the opportunity to be a speaker at the state's only support group for brain aneurysm patients, which meets at Duke Raleigh. I'd gone full circle from literally crawling in the emergency room door to commanding a Power Point about my disease in a hospital classroom. 

So I guess it's all to say that it could have been worse. I hope I can say it again next year. 

Terrible Twos-day: YouTube Edition

In bringing back Terrible Twos-day, it seemed appropriate to inject a bit of humor into the post-holiday lull as we wait for the new year to come about. That said, TANS turned to YouTube for inspiration, which of course means a cute cat video and other randomness that comes in twos. Enjoy!

The Two Talking Cats

The Napper's three cats are talkers, but usually don't talk to one another. 

Rob Base and DJ E Z Rock - It Takes Two

Oh, 1988... get down with your bad self. 

Between Two Ferns With Zach Galifianakis

Zach interviews Natalie Portman and her dog, Whiz.

Marcel the Shell With Shoes on, Two

His name is Marcel, and he's partially a shell, but he also has shoes and a face, and lots of other great qualities as well.

Joke of the Day: Two Atoms

Two atoms are walking down a road...

Shagged By a Rare Parrot - BBC Two
Stephen Fry and zoologist Mark Carwardine head to the ends of the earth in search of animals on the edge of extinction... and Carwardine gets more than he bargained for.

Happy Tuesday!

The Healing Hound

I'm sick. It seems to be nothing more than a run-of-the-mill Christmas cold; nonetheless, when I made it home yesterday afternoon, it was all I could do to strip down and crawl directly into bed. I slept until my husband got home from work and awoke only enough to request medication. Since I'm not allowed to take pseudoephedrine or ibuprofen—which puts most cold medicines off limits—there was nothing in the house to suit the situation. The hubs went out to procure both drugs and dinner, returned home to dope me up and dine, and really that's the last that I remember until about 5 a.m. As I rolled out of bed, my foot landed on something soft, warm, and hairy. Our hound dog, Bruce, who normally sleeps on his fluffy bed in the living room, had curled into a tiny ball on the floor by my side of the bed.

I didn’t mean to adopt a hound—at least not a barrel-chested, stick-legged, long-eared, musk-smelling hound. They told us he was a Norwegian Elkhound and Golden Lab mix. Golden Labs are reliable, if not overtly friendly dogs, and I’d known a Norwegian Elkhound at the horse stable where I rode as a teen. He was protective and fiercely loyal to those of us he saw on a regular basis. As I held that squishy double handful of puppy in my hands one late winter day, I was hooked.

My husband didn’t want a dog. He was fine with other people having dogs; he just didn’t want us to have a dog. I was persistent, or perhaps I was simply annoying, and in that our first year of marriage, my husband caved. As we filled out the adoption papers, our puppy lolled in a sweet sleeping puppy coma, exhausted from playing with his six other brothers and sisters. That would be our last moment of peace for the next year.

While my husband and I had both had dogs before, we had never been responsible for the raising of one. Bruce, as he was named, was more than we bargained for — even at rescue adoption prices. He never … ever … ever … ran out of energy. An hour at the dog park wasn’t enough. No amount of destroying stuffed toys was enough. Electrical cords were tasty treats. The three cats were horrified. Six living beings were too much for our little townhouse. There were tears shed and serious discussions as to whether or not we’d screwed up, whether we needed to find Bruce a new home. Even after we bought a new house with a fenced in yard, Bruce drew my husband’s ire by digging holes – a telltale sign of his then abundantly obvious hound traits. The breaking point was one night when Bruce chewed a hole through my husband’s Carhartt jacket. I made an online plea — “Save My Marriage, Adopt My Dog.”

But as much trouble as Bruce caused, I loved him. He and I had a bond, and that night as we sat on the sun porch steps with our heads pressed together, my husband saw us. With a sigh he said, “You don’t have to give away your dog.” So Bruce stayed, and tried harder to manage his energy through training. For all his faults, Bruce was never stupid. He knew no, sit, shake, down, stay, move, and my personal favorite leave it/take it in which he would lie on the kitchen floor and I would balance a treat on each paw, making him wait for my command, drool not withstanding, to gobble up the goods. “Leave it” also worked in regards to the cats, socks, and dropped non-food items.

By age two, Bruce showed the makings of a real dog. He also ate an entire bar of Dial soap and learned how to steal a full beer from a camp chair cupholder. By age three, we figured he had to mature sometime soon. Friends with hunting dogs pegged him as a Black Mouth Cur and Plott Hound mix. By age four, he played patiently with our six-year-old niece who spent the whole of Christmas taking his rawhide and hiding it another room.

Bruce turns five in January. He’s scared of our cat Penelope, fireworks, lightning, gunshots—both real and on TV—and the dark. He’s just the kind of hound that most hound owners wouldn’t want, but he’s just the right kind of hound for me.

AfternoonNapper's Fibromuscular Dysplasia

Just before Thanksgiving, I had the opportunity to speak to the state's only brain aneurysm support group, which is sponsored by the Joe Niekro Foundation and Duke Raleigh Hospital. Natalie Niekro founded the Joe Niekro Foundation in 2007 in honor her father who lost his life from a sudden cerebral brain aneurysm on October 27, 2006. Many remember Joe as a major league knuckleballer who the Cubs (my team) drafted in 1966 and who achieve his greatest fame with the Houston Astros. The foundation is based in Scottsdale, AZ; however, there are foundation affiliates across the country.

Speaking to the aneurysm support group was important to me because I have four aneurysms of my own. It was just about this time in 2009 that three of the four aneurysms were treated via a process known as coiling. Not all aneurysms are eligible for coiling. I was lucky. I was out of the hospital about 36 hours after I had arrived. All I needed was a little Vicodin for my headache, and otherwise, I was told just to take it easy for the next two weeks. Who knew that brain surgery would be one of the easiest surgeries I've had yet? 

Exactly why I developed aneurysms is unknown. There is evidence that they are side effects of my overall diagnosis of fibromuscular dysplasia. It's also been said that I may have an undiagnosed and unidentified connective tissue disease overlap that would lead to aneurysms. Speaking to the Niekro Foundation's group allowed me to talk about my aneurysms in the context of FMD and subsequently how social media has played a part in having a disease like FMD.

Please take the time to watch—and then share!

AfternoonNapper's Fibromuscular Dysplasia (Part 1)

AfternoonNapper's Fibromuscular Dysplasia (Part 2)

The Advocate As Caregiver

What beats you down? What breaks you? When that happens, where do you go? I've spent the past week living a bit more internally. I needed to step back. I needed a little perspective.

There are so many voices in this chorus of healthcare advocates that I worry if some singers even notice when others are too overwhelmed to continue carry the tune within their hearts and go silent. In the worst case scenario, a tired voice drops out and walks off stage, closes the curtains behind him or herself, and exits the building. No one stops to notice. No one says, "We need you." Some members of the chorus may even go so far as to think the tired singer was of no use, that the singer's voice was of a lesser quality, that the singer did not add value to the chorus, and therefore the singer will not be missed. Broken, the tired voice decides leaves singing behind altogether. The chorus is diminished both by the singer's absence and the absence of the singer's supporters. As the act plays out time and time again, what was once a chorus deteriorates into a solo. The effect of standing on stage alone depends on the singer left standing—either the soloist manipulates the spotlight or the song is silenced altogether. Neither outcome is preferred.

We can not be advocates alone. We must have the support of our fellow advocates, which comes in large part from supporting our fellow advocates. The same principles that we apply to teaching caregivers to care for themselves—allow for breaks, seek outside help, reward yourself—should be applied to the advocate community. What else is an advocate other than a caregiver who cares so intently as to try to affect change? Change is difficult to attain. It is made even more so, when the change that one is pushing for relates to a patient community that is, by its very nature, beleaguered by disease conditions. Such advocates themselves often are impacted by the disease they try so hard to support. When a member of the patient community suffers an event or is overwhelmed by symptoms, the community rallies around that patient. However, patient advocates may well find themselves reluctant to admit feeling the same things that the patient community experiences. This behavior is not uncommon in families. Mothers tirelessly provide for children but never confess to being run ragged and depressed. Fathers work ceaselessly yet never say they feel unappreciated and overlooked. Patient advocates may develop these same complicated relationships with the communities they are trying to serve, which begs the question—who advocates for the advocate?

Without resources in place to help advocates, I fear that our chorus will lose valuable members. During a recent TweetChat about healthcare leadership, the great @NateOsit said that a true leader enables others to become leaders. There is much to be learned from that statement. Today's advocate leaders have taught me so much about being an advocate, and I am making it a goal to in turn teach others about being an advocate. It is my hope that by doing so, no single advocate will feel overburdened by his or her responsibilities and that the overall community of advocates will grow and become stronger, which will mean more patients will have someone on whom they may rely. Healthcare professionals must remember that many advocates came into their roles for much the same reason as they were—a call to help and serve. Let us give those who have arisen to meet the need to help and serve the emotional and physical care to continue.

Engage With Grace

I have great respect for what Engage with Grace is working to accomplish with The One Slide Project. The concept is simple. Download this one image, share it whenever possible, and begin a dialogue. Connect with Engage with Grace on the organization's website, on Faceook, and on Twitter.

Express Yourself

In Irving Stone's biography of Vincent Van Gogh there is a line that reads, "Many times in your life you may think you are failing, but ultimately you will express yourself and that expression will justify your life." It was years ago that I first came across this maxim, and it immediately halted my reading and jolted my heart. There is no other quote that has resonated so deeply within me and continued to do so.

I've been lucky enough to be a writer in some form or fashion for the vast majority of my life. While I was in kindergarten, a local writing teacher worked with our class, and I wrote a story about a grasshopper. My mother, of course, saved the story in a box along with school photos, misshapen pieces of art class pottery, and report cards. The writing teacher had hailed my grasshopper story as very descriptive and encouraged me to keep writing. Several years later, the writing teacher—Kathryn Stripling Byer—was named the state's poet laureate. This summer, she featured my poetry on her blog. Life has a way of arching back on itself.

This Saturday, I was stirring a pat of not-quite-butter into a bowl of peas in preparation for dinner when it struck me that I am experiencing a similar arch. While in college, my news writing instructor required that each student write a variety of stories—crime, courts, etc.—as well as pick a beat about which an additional two stories would be written. I chose the medical beat. Throughout the class, my favorite story was one I wrote about the Amplatzer Septal Occluder. In a catheterization laboratory procedure, the device is run into the heart and through the defect (a.k.a. hole). It helps to picture the device as an Oreo. One wire mesh disk is deployed on one side of the hole (cookie), then a tiny wire mesh waist (creme filling) connects to a second mesh disk that is deployed on the other side of the hole (cookie). The two disks cover the defect completely and allow heart tissue to grow around the wire mesh structure. With the Amplatzer Septal Occluder, what was once open heart surgery became a procedure with a one- to two-day hospital stay for recovery.

At the time I wrote the story, Dr. Michael R. Mill, an associate investigator on a 1998 AGA Medical Corporation study about closure of atrial septal defects using the Amplatzer Septal Occluder, was the Chief of Cardiothoracic Surgery at UNC School of Medicine. Though a student, I was permitted to interview doctors performing the first surgeries at UNC using the septal occluder and the mother of an adolescent patient who had the device implanted. Fortunately, I made it through college before becoming the professional patient that I am today; nonetheless, the impact the Amplatzer Septal Occluder would make on medicine and on patients' lives was not lost on me. I found everything about the story fascinating from the technical details of how the device worked to connecting with a worried mother who, by agreeing for her son to undergo a relatively new procedure, had found a way to lessen her child's trauma.

I don't know what about stirring a pat of not-quite-butter into a bowl of peas has to do with remembering my love for my first medically-based story. I also don't know why I didn't realize that there was something larger at play and redirect myself and my studies to capitalize on my interest. It has taken the past 31 years of wrestling with my own health and using my love for writing to express what I have gone through to get me to this point—the point that I identify myself as an ePatient, a healthcare blogger, and a patient advocate. I wholeheartedly embrace my suffering and my diagnosis with an incurable rare disease because by sharing my story and using my skills I may help others. Everything has arched back in on itself and finally come together such that ultimately I am expressing myself, and that expression justifies my life.

Raising FMD Awareness In Style

Today I had the great pleasure of unveiling the new logo for the global peer-to-peer support group for fibromuscular dysplasia patients, FMD Chat. The indelible image brings together the symbolism of FMD's primary form — the ubiquitous string of beads — with the vascular system's complex web of arteries connecting heart and hand, which is seen as both giving and receiving, and represents the caring community created by FMD Chat's participants.

Our designer is none other than my dear friend Margaret Hester. Margaret is a graphic designer and photographer with a warm and fun personality. She knows how much FMD Chat means to me — I am fortunate to be a co-founder along with my cohort, Kari Ulrich, who has inspired me with her tireless dedication to patient advocacy. When I asked Margaret to design a logo for us, I was pleased when she sought to better understand fibromuscular dysplasia so as to best portray its characteristics. FMD is a rare disease, though recent studies indicate that it may not be as rare as it is simply underdiagnosed. FMD can masquerade as other vascular diseases and, in cases such as mine, present with gasterointestinal symptoms that throw doctors for a loop. There is no blood test for FMD—just as there is no real treatment and no cure. The gold standard for diagnosing FMD is via angiogram, which provides a detailed look at a patient's arteries and may reveal the tell-tale string of beads of the medial variety or narrowing that may at first look like traditional atherosclerosis or stenosis in my own intimal variety.

As FMD Chat continues to grow, we hope that FMD patients and family members, healthcare providers and caregivers, supporters and advocates may draw their own inspiration from the logo. We are patients, and therefore we understand what it means for patients to put their hope, faith, and effort into a support group—it is a matter of holding one another's hearts, it is a matter of trust, it is a matter of compassion, and it is a matter of patients doing unto others as they would have done to them. We thank all of those in the FMD community who have chosen to participate in FMD Chat—we couldn't do it with out you. 

To learn more about designer and photographer Margaret Hester, please visit her at pictographybymargaret.com, on Facebook, and on Etsy, where her work is available for purchase. Please connect with FMD Chat on Facebook and Twitter. 

Caring for Caregivers

Stacy Schaplow was 27 when she got married on Sept. 18, 2010. She was happy and healthy other than a strange soreness in her neck that she wrote off as stress; after all, she was in a dental hygiene program and studying for her state board exams while planning her wedding to financé John. The day of the wedding she took a few ibuprofen for the pain and walked down the aisle in a stunning white dress and carrying a bouquet of white roses and green orchids with eight bridesmaids in funky plum purple dresses and peep toe pumps by her side. The two exchanged vows in an outdoor ceremony, cut their four-tiered cake together, and a few days later left for their honeymoon in Maui. 

It was on the sixth day of the trip while on their way to go wake boarding that Stacy had a stroke. She was rushed to the hospital via ambulance. The doctors told John that Stacy's vertebral artery dissected, causing a blood clot. Stacy was within the three-hour window of time in which doctors could administer Tissue plasminogen activator (t-PA). The drug dissolves clots by thinning the blood, but poses serious bleeding risks. Stacy had become unresponsive in the time it had taken to get to the hospital, so it was left to John—her husband of six days—to decide whether to allow doctors to administer the drug, which could either save Stacy's life or kill her. 

John, for the second time in a week, said I do, consenting for doctors to give Stacy the drug. She lived, but began bleeding in her lungs. She was placed on a ventilator, and John was told that if the bleeding didn't stop, the worst case scenario would mean removing one of Stacy's lungs. It took six days, but the bleeding finally stopped. The question that remained was how much neurological damage Stacy had suffered. "Being on the ventilator and heavily sedated, I couldn't communicate," Stacy writes in her submission to Tiffany Burke Photography's online Love Story Contest for a second honeymoon. "I tried communicating with the nurses and was told that I pointed to my ring finger and they knew then that I wanted my husband. When he got to my room, I squeezed his hand and he knew everything was going to be alright." 

Recovery would be arduous, and Stacy asked her new husband a serious question—whether, given her condition, he still wanted to be married to her. John asked back, "What kind of man would I be if I left you when you needed me most?"

Stacy is among those who found true love and a love who would accept the role of caregiver. To become a caregiver for a loved one is no small task. Relationships are complicated enough without the dynamic of one person depending on another for his or her health and survival. In the most serious of situations, both patient and caregiver are saddled with the loss of independence and ability. What the patient can not do for him or herself the caregiver must do, and the time and effort caring for a patient takes reduces the caregiver's ability to care for him or herself. 

The importance of caring for caregivers can not be minimized. A caregiver is a person who has, by choice or by call of duty, given him or herself to helping another person—but that caregiver is still human. According to a 2009 report by the National Alliance for Caregiving, more than 65 million people provide care for a chronically ill, disabled, or aged family member of friend during any given year. On average, these caregivers spend 20 hours a week caring for their loved ones, while 13 percent of family caregivers spend 40 hours a week or more. Many of these caregivers do not have the luxury of making caregiving their job and so are working to bring in an income in addition to providing care—73 percent of those caring for someone over age 18 in fact. Reports state that the stress of caregiving translates into three-quarters of family caregivers not going to the doctor as often as they should, nearly half of working caregivers reporting that an increase in caregiving expenses has led to using up all to most of their savings, with 40 to 70 precent of family caregivers showing clinically significant symptoms of depression. 

I have not been in the position of being a caregiver; however, I have been—and will continue to be—a caregiving recipient. My experiences have taught me about the humanness of my caregivers. Like Stacy, I had a stroke. Mine was at age 28 after a year and seven months of marriage. One morning I was a reporter on deadline. The next morning I was unable to walk. After a week in the hospital, I had mobility using a walker, but would run into walls. I had double vision with Horner's syndrome on the left side of my face and the loss of pain and temperature on my right side. For several months, the neurological damage was too bad to very actively combat. My husband would get me in front of the TV—which I saw two of due to the double vision—make provision's for snacks and beverages and then have to go to work. Upon his return, he would find me exactly where he left me. He would make dinner, help me bathe, and then set about taking care of the routine responsibilities around the house—doing laundry, cleaning, caring for our pets, etc. 

Fortunately, we did not then (and do not now) have children. I lost my job, which added stress to my husband's already profound sense of duty. Fortunately, my parents are part of my caregiving team, and from time-to-time I would go and stay with them for a few days in order to give my husband a break. He would stay home, watch TV, drink a beer, and enjoy not having me around. There was nothing mean about our arrangement. It was simply honest. Caring for me took a lot of his energy. In addition to always being sure to vocalize my appreciation for all he was doing, what I could do to help him help me was to allow him time to rejuvenate, to give him space and time to be himself, to breathe, to not be so damned responsible. One day I searched online for information about caring for caregivers. A cancer site offered up words like bittersweet chocolates on a silver platter—grief, loss, frustration, anger, resentment. These were the words that my husband and I were choking down without acknowledging their existence—for him. He had not yet grieved the vibrant wife he lost. He was frustrated that he could not fix me. He was angry at the world. And at times, he resented me and all the care I required. Each emotion was at once horrible and a relief to acknowledge. Each emotion was valid and human. We stopped pretending everything was alright, and we cried tears of grief, loss, frustration, anger, and resentment together. 

Three and a half years later things are better. Our lives as individuals and our life together changed with the stroke and continued to change as my health became increasingly complicated. While I recovered most of my function, there are still deficits, and since the stroke, I have lost a kidney, had three of four brain aneurysms repaired, and experienced a gastric rupture. My husband has been my caregiver throughout it all. Like Stacy, I have offered my husband a chance to get out. Like John, my husband has never taken me up on it. 

Remember to vote for Stacy & John's Love Story!

Just Because I Have The Same Disease As You That Doesn't Mean I Like You—But That's OK

I enjoy playing mahjong. When I was a kid, I was a fan of Oregon Trail on the Apple IIe, but mahjong held my interest game after game. Sometimes I planned my moves. Sometimes I just tried to see how fast I could match tiles. I always liked that mahjong was a game that I could play by myself.

Only children like myself are used to doing things alone and often prefer it that way. Indeed there is an element of control that we relish. Doing things alone involves no compromise, no sharing, and complete autonomy in rigidly staying the course or wildly abandoning plans to do something else entirely. An only child left to her own devices may go from building elaborate Lego houses one moment to playing dress up the next to building Lego houses in dress up clothes because there is no one to please other than herself. The only child grows into an adult who may well prefer to work alone, stubbornly refusing to delegate lest a project be done differently than imagined. The only child may turn down help because she has learned that no one else can be depended upon. The only child is therefore self-reliant to a fault. 

Chronic patients mimic much of an only child's behavior. The chronic patient is used to no one understanding how she feels. The chronic patient may withdraw because it is easier to be alone than to try to keep up with everyone else. The chronic patient operates on a schedule much her own so as to move with the ebb and flow of her health, one day hosting a dinner party and the next day never leaving the bed. 

The chronic patient who is an only child is a creature who is both fiercely independent and profoundly lonely. I am that creature, and my loneliness is further compounded by the fact that I have a rare version of a rare disease. There's a saying often used in the medical field that if something looks like a horse, and walks like a horse, and sounds like a horse, it's probably not a zebra. As an only child who is a chronic patient with a rare version of a rare disease, I can't help but imagine myself as a sullen green unicorn sitting in the corner who no one will play with because even though I could be really nice and awesome, sullen green unicorns are just weird. Even zebras think so. 

That's the problem with diseases, rare or otherwise. Simply because one shares a diagnosis with another person, that doesn't mean the two will get along. Every patient who has cancer doesn't like every other patient who has cancer. Every patient who has lupus doesn't like every other patient who has lupus. Every patient who has psoriasis doesn't like every other patient who has psoriasis. Patients must have the ability to pick and choose their disease friends the same way they pick and chose their regular friends. Attempting to pigeon hole patients into disease specific groups may actually fragment the disease population more so than allowing patients to form their own unique sub-groups. Imagine "Libertarian Breast Cancer Survivors Who Love to Knit" or "Rheumatoid Arthritis Sufferers Who Enjoy Baking and Bowling." There might be only five group members across the entire nation, but the level of connectedness that those five members would feel among one another would be tremendous. Support need not even be disease specific. That may mean that a sullen green unicorn, a zebra, a couple of otters, and a cheetah all decide to hang out together. There have been stranger friendships. So long as the motley crew can support one another in the way one another needs, the group serves its function. 

I've had the pleasure of getting to know several fellow chronic patients via social media and my relationships with these patients are based on who we are as people. There's @HurtBlogger who has arthritis and with whom I shared late night tweets about headaches. There's @joltdude who has diabetes and with whom I've tackled patient care and end-of-life issues. These are people about whom I've come to care. There's @katherinekleon who experienced spontaneous coronary artery dissection and with whom I've talked about patient-driven research and who, when she learned of my upcoming surgery, wished me "a soft cotton hospital gown with a pretty print that wraps ALL around." That's what I call true patient support. 

As the health care industry continues on its quest for true Medicine 2.0, those who are organizing patient support groups would be well advised to remember that above all else, patients are people. If patients can not get the support they need from people they like, from people they trust, then patients will grow to feel even more alone, embittered and embattled, like sullen green unicorns wishing to hell that the rest of the animal kingdom would ask them to play. 

All Things #hcsm

Each Sunday at 9 p.m. EST medical social media Tweeps barrage the Twitter stream with tweets carrying the #hcsm tag. The tag stands for healthcare communications and social media, and those who follow it are involved discussions covering a wide range of topics (T1, T2, etc) from the role of technology in the exam room to patient support groups. The chat, created by Dana Lewis, moves at lightning speed because so many Tweeps are in on it and there's so much to be said in the hour's time. Even if one only "lurks" (reading without tweeting), the chat is educational, inspiring, thought provoking, and a great way to "meet" new people to follow. Throughout the rest of the week, the #hcsm tag pops up from time to time on individual tweets that are related to the overall topic of healthcare and social media, so at any time a search for the tag is sure to turn up something worth reading. In the spirit of the #hcsm chat, today's blog post covers a range of topics that, at least for me, are just as exciting. 

TI - Stanford & Medicine X

It is my great honor to have been selected to serve on Stanford University's Medicine X ePatient Advisory Panel. This panel will be responsible for helping ensure that the patient voice is part of the Medicine X conference that overall will address emerging technologies in healthcare. My fellow panelists are Sean Ahrens, Hugo Campos, Steve Wilkins, and Nick Dawson—each of whom I had the pleasure of meeting at Stanford for the Medicine 2.0 conference in September. To keep up with plans for the conference, a project of Stanford's own Anesthesia Informatics and Media Lab and directed by Dr. Larry Chu, visit medicinex.stanford.edu or follow @StanfordMedX and #medX on Twitter.

T2 - Doctors 2.0 & Paris

Continuing the healthcare and social media conference trend is the upcoming Doctors 2.0 & You conference to be held in Paris in May. The conference is a true international affair and an incredible opportunity to look beyond the American healthcare system for ideas. Previous speakers whose names ring (or should ring) a bell with those on this side of the sea include Brian Vartabedian of Texas Children's Hospital/Baylor College of Medicine and author of 33charts.com, Victor Montori, who has worked with the Mayo Clinic's Social Media Center, and Gilles Frydman, co-founder of the Society for Participatory Medicine. Denise Silber, conference organizer and president of Basil Strategies, has said that she'd love to have me there. Registration fees may be waived for international patients; however, travel to Paris is not covered. Like most patients, I am unable to afford a trip to Paris, regardless of purpose, and so am putting out the call for sponsorship—for myself and for fellow patients who hope to attend the conference. For now, Silber is the contact for patient travel sponsorship. Thanks to the suggestion of the ever creative ePatientDave, I am hoping to set up a Kickstarter.com page to help bring in donations, and if it is approved and goes live, I will be sure to let you know. My estimate is that the trip will cost approximately $2,500 for airfare and hotel. As an alternative, I also have set up a PayPal donations account. My involvement in healthcare, social media, disease awareness, and patient advocacy is all building up to a book, which I will begin writing in 2012. Should I exceed my sponsorship goal (a girl can dream!), then funds will be used for a planned writer's residency at Wellspring House and actually bringing the book from concept to fruition.

T3 - FMD Chat

Shortly after my diagnosis with intimal fibromuscular dysplasia, Kari and I stumbled across one another on a Mayo Clinic discussion board when we both responded to another patient's posting about having high blood pressure and gastrointestinal issues but having passed all GI screenings with flying colors. Kari had responded that the young female patient should consider having a vascular work up. I agreed with Kari 100 percent—the patient's symptoms and history so closely mirrored my own—and responded to the patient saying as much. Kari and I alerted on one another like two hound dogs on the trail of the hunt, which is to say we recognized ourselves in one another. Sure enough, we shared the FMD diagnosis. I can not impress what a life-altering moment it was to have not only unexpectedly stumbled across another FMD patient but my first fellow FMD patient. Kari and I instantly clicked and became fast friends. Every time I hear her Minnesota accent, I think of Frances McDormand, William H. Macy, and Steve Buscemi. She's a firecracker who, after already having a successful career as an RN, has made it her life's work to be a patient advocate for those with FMD,  is the vice-president of the Joe Neikro Foundation, which is dedicated to raising awareness of and researching aneurysms, and founded the Midwest Women's Vascular Advocates group. One night Kari and I had a conversation about how, as a patient, I had never had the experience of any kind of support group—for my bypass, for my stroke, for my aneurysms, for FMD. The next morning FMD Chat was born. The group's goal is to offer non-medical, peer-to-peer support to FMD patients around the world, and it is based on Facebook specifically so that it is open, accessible, and free. Since it's creation, FMD Chat has blown me away. There have been other online groups, but the pervasiveness of Facebook has allowed for more connection between patients than I had previously thought possible. There are so many patients who are frustrated and scared and who simply want to talk to another patient with their same disease so that they don't feel like such a freak. My fellow FMD patients move me with their stories and their compassion. I am so glad to be a co-founder with Kari because I know she is someone whose heart is in the right place and will always put patients first. 

T4 - Upcoming Gigs

I will be writing a guest blog post addressing talking about dying and advance directives for the Death with Dignity National Center this month. Learn more about end-of-life issues by participating in the weekly TweetChat on Wednesdays at 10 p.m. EST. Follow #EOLChat. On Jan. 11, 2012, I will be moderating the hospice and palliative medicine TweetChat, which is held each Wednesday at 9 p.m. EST. Follow #hpm. The absolutely fabulous Renee Berry and Christian Sinclair organize the chat. 

Output vs. Input

Hello? It is very quiet and still here tonight. 

It feels as though there has been too much output with too little input. 

There is a need for something fabulous to occur. *glitter* 

Instead, it is becoming winter. 

We turn inward. 

What will our frosty reflections bring about? 

Can hot chocolate soothe a soul to release its secrets? 

Everything I have told is too much, but it is not yet enough.

What if we all went silent? 

What if we refused to tell our stories? 

What if there were no stories to tell? 

We would cease to communicate.

We would stop being human. 

It would be so easy to fail to mark the passage of time with ceremony.

We could pass from one day to the next unfettered. 

Our sense of loss only comes in retrospect.

Like looking out on an empty driveway after company has gone.

We turn away.

How are we so alone yet all together?

Can we accept what we are given?

Everything I have told is too much, but it is not yet enough. 

(hat tip to Douglas Coupland, Microserfs, and the mind dump)

To Flow As Water Does

We are all going to die. Let me repeat that. We are all going to die. So get over it. Or at least do the best you can to get over it because you can't stop it from happening.

The problem is that as a culture we have grown to associate death with an end, with a loss, with grief, with pain. How would our relationship with death change if we could realign our perspective so that death is viewed simply a transition? Death is what is supposed to happen. It is natural. It is—depending on one's spiritual views—just another life event. If we talked about death more, would we be so scared of it?

There is a practice in psychology that involves addressing trauma by talking about it and by allowing the very feelings that one tries so hard to block out to be fully experienced. At first, the very idea of undergoing this process is terrifying and causes anxiety in a patient. A patient typically has spent great amounts of effort avoiding everything related to the trauma—sights, smells, sounds, textures, etc—that he or she has gone tremendously out of his or her way not to come into contact with the feelings originating from the trauma. I equate it to walking around the other side of a building that takes up a full city block in order to avoid a puddle. Patients most likely will not be successful in dealing with their trauma and its lingering emotions if they attempt to change their perspective by running headlong into the puddle. Rather it is a process. First, one must think about not walking around the other side of the building. That in an of itself is a challenge. Then one might decide to examine the puddle from afar. Next the puddle may be approached. Perhaps the patient throws a stone in the puddle. The patient might then sit next to the puddle. Each phase of the process is slow and dutiful, and at any time there may be regression so that the patient again must walk around the other side of the building in order to experience a bit of relief from the intense feelings that arise from dealing with one's puddle. 

This exercise allows the patient to address their fears and emotions with a certain degree of control. Control is the very thing that many trauma victims lost and what they try so vigilantly to maintain post-trauma as a method of coping. But trying to control everything that goes on around us is exhausting. Patients may seem stressed, hyper-critical, and unreasonable, but all they are really trying to do is protect themselves from being hurt again. Fear is the motivation. Fear is what must be quieted. 

Like trauma victims fear losing control and being subjected to reminders of their trauma or a subsequent trauma, we fear death because we can not control it. We try to. We hang on so tightly that we strangle our own lives, and when the time comes, deathbed wishes tend not to be that we were more punctual, or had the oil changed more often, or cleaned the bathroom tile grout more throughly. The regrets are that we did not live more, love more, laugh more. 

And so we must learn to let go. We must learn to control only that which we can control and which is worth controlling, and let the rest be as it will. We must relax, accept, and move with the fluidity of life like a leaf floating on the surface of a rushing stream. We will be swept along, we will reach eddies and be trapped by twigs, we will sink, and we will rise, yet we will still be a leaf. And when our leaf finally settles in its resting place, it's return to the earth will nourish new life, and so the cycle continues. 

As we accept our condition of impermanence and allow ourselves to move with the flow, we may still exercise good judgment to make preparations that will ease the lives of those around us at the time of our passing. Such is the role of advanced directives, which spell out an individual's wishes for end of life care in the event that the individual can not speak for him or herself. Rather than leave family members, friends, and caregivers wondering what one's wishes might be, one can have a say and help alleviate some of the doubt and stress of decision making. To issue an advance directive is to give the gift of peace of mind. For those who struggle with a desire to control life and death, writing advanced directives is the closest that one can come. Directives are not simply wills that divide personal belongings. Advance directives relate to all documents regarding the end of life. Directives allow one to say whether he or she desires life prolonging measures, whether measures should be taken for two weeks or two years, whether one wishes to donate organs, how one wishes to have his or her body put to rest, as well as how one wishes financial and property issues be handled. 

Those whose end of life wishes may be considered unique or those who already know that their wishes are not in line with their family's wishes are particularly encouraged to pursue advance directives. For example, I have determined that I want a green burial—one without embalming fluids that will allow me to decompose naturally in a green cemetery where coffins are made of natural materials or bodies are buried only in a shroud. My advance directive outlines this wish, as well as notes my desired cemetery, my casket of choice should one be required, my pall bearers, and my wishes for visitation and burial ceremonies—there will be punch and pie and pierogi. I update the document, which is a simple form that I keep on my computer, every year or so and have shared it with my husband and parents. My directive documents are not legal documents because I have discussed my desires with my family. My family is supportive of my decisions. Those who may not have this kind of support will want to ensure their documents are legally binding—not to sue from the grave, but for peace of mind. 

Evaluating one's own final wishes can be an extremely uncomfortable task. Consequently, my recommendation is to think about final wishes before one needs to think about final wishes. Although the questions often are deep and emotional ones, one is essentially writing an agreement—though is it easier for one to change his or her mind about whether to play Eric Clapton or B.B. King at the service than it is to get out of a cell phone contract. Families may wish to make writing advance directives a group effort to be approached with love and light and laughter. The fact of the matter is that the majority of people are afraid of the same things, which means that no one is actually alone in their fears. Like the trauma victim working through the therapeutic process, talking about fears takes away some of their power. 

Caring Connections, a program of the National Hospice and Palliative Care Engagement Organization, provides a wonderful set of resources for creating advance directives including state specific directives and information about starting a discussion with loved ones about advance directives and end of life issues. (To access these resources, visit this link.) Before beginning such a conversation, one should read Dr. Ann Becker Shutte's "Five Steps for More Compassionate Listening" to help facilitate a productive and caring dialogue. Shutte is a licensed counseling psychologist who also leads a weekly Twitter chat about end of life issues at 10 p.m. EST on Wednesdays. To participate, follow the #EOLchat tag. Make it a goal to have discussed matters with your loved ones—or better yet have written your own advance directives—by April 16, 2012, which is National Healthcare Decisions Day and allow yourself to spend your energy living instead of trying worrying about dying.  

Not Cool, Man... Not Cool

It is 2:42 a.m. I am awake because there is something wrong with my butt. I know exactly what is wrong; however, I do not yet know the extent. The problem—and I CAN'T BELIEVE I'm telling you this—is that I have a cyst.

I happen to sit down a lot. I sit down a lot because I'm tired a lot because I've had a whole boatload of other health problems. I spend a ridiculous amount of time on the computer, and that requires sitting down a lot. I sit in these weird smushed up, twisted up positions, which apparently isn't good for the skin back/down there. From all I can figure, I have traumatized the skin, which has led to the current situation. I also have a very shapely booty. Apparently, shapely booty-ism can be a contributing factor.

I am mortified. 

Also, I feel kind of crappy. Today was the third day of waking up feeling pukey and self-medicating with Pepto and Protonics. I think I might have a bit of a fever. My back hurts, and it's been hurting for so long that I can't remember it not hurting. At least some of my back pain originates from the fact that my L4 and L5 vertebrae are off kilter. Last month, I turned to a chiropractor out of sheer desperation when I could no longer put on my underwear without propping up against either the bed or the dresser and groaning onerously. The chiropractor has helped some, though I admit that I am always skeptical of the practice and that my ten minute appointments, marked by loudly banging drop tables and gentle prodding, often feel like eating rice cakes—unsatisfying. However, the pain in my back is a dull ache that spreads into my buttocks. I have convinced myself that my cyst has grown to epic proportions, and when I go to the doctor, he or she will tell me that I need to have the majority of my butt removed, which is what seems to be the classic treatment according to The Internet. 

That's the problem with The Internet. The Internet provides information, yet typically does not put that information into context and typically exudes an alarmist nature. If we all believed what we read on The Internet, we would all be about to die of some absolutely horrible disease. Forum contributors share horror stories on what seems like a 9 to 1 ratio, which makes sense in regards to human nature—because few ever feel compelled to write, "I had this thing. It was treated. No big deal. Now I'm fine." Instead there are postings replete with failures to administer adequate pain medication, slow healing, terrifying side effects, and sometimes even pictures of profound disfigurement. I know. I've been reading these posts for the past three hours—and that's just in relation to the current medical situation at hand. 

I've spent enumerable hours reading about my other conditions including stroke, brain aneurysm, fibromuscular dysplasia, and gastric rupture. I read and research not because I am a hypochondriac—I've got enough stuff that's actually wrong to worry about what "might" be wrong. I read and research because I am a person who functions better when I have lots of information. I like to understand the history of a disease, it's epidemiology, it's treatments. Understanding diseases from a scientific perspective helps me get a handle on them from an emotional perspective. The human body is a truly fascinating thing, and if patients can get beyond the fact that fascinating (and sometimes terrifying) things are happening to their own body, then an illness is a wonderful chance to engage the brain and learn something new. Since being diagnosed with intimal fibromuscular dysplasia and tested for overlapping connective tissue disorders, I have become very interested in the endothelial cell. Knowing more about the endothelial cell probably will never help me unless I'm on Jeopardy, but it helps me help myself. Science takes away feelings of having bad luck. Science explains disease processes for exactly what they biologically and chemically are. 

One need not be interested in science in order to seek out scientific information about disease. One need only be curious. Research has shown that patients turn to The Internet when they are sick; however, I am continually surprised by the number of patients with whom I interact who have not done any research at all. These such patients befuddle me. I do not understand them. I do not understand how they can so blindly and blithely go to see their doctors and fail to engage in their own healthcare. Nevertheless, an internet search of any given disease can and will turn up a plethora of information that ranges from extremely detailed medical research to full-on quackery. It can be difficult for patients who are not researchers by nature to differentiate what is real, sound medical information from that coming from Aunt Sally Jo's House of Cards and Ill-Advised Shams. Real medical information can be daunting. It's a bitch to read. Most of the words are terminology only used within the profession. However, patients can still learn from reading medical information, particularly if they take the time to look up terms and exercise their critical thinking skills. A good place to start one's journey into personal medical research is at healthfinder.gov, which includes an encyclopedia, free health tools, and more. Beyond that, patients should look toward sites that end with .org, .edu, or .gov. There are, of course, reputable sites with .com or .net endings; however, the big players at the medical table typically will be found in the .org, .edu, and .gov communities. Use some common sense. If one fears he or she has rabies and one finds a site recommending drinking three gallons of buttermilk and rubbing his or her skin with salt, one would do well to think that the deadly viral infection could use more aggressive and scientifically-based treatment. Homeopathic and alternative treatments absolutely have a role in medical care. I am a fan of aromatherapy—peppermint for nausea, lavender for stress—and have had great results with acupuncture. I turn to chamomile tea before I reach for chemical sleeping aids. I've found yoga and massage to help relieve muscle pain. But if I break my arm, I'm not about to go chew some tree bark and forget about it. 

My discovery of a small pit in my sacrum occurred a few weeks ago; however, I dismissed it as some sort of run-of-the-mill boo boo. The second time it made itself known, I had my duty-bound husband investigate the area. He found nothing much cause for alarm. This evening, discomfort led to another investigation, and carefully chosen Google terms quickly led to the cyst's diagnosis. It seems that the area needs to be incised at the very least, and at the worse... well, I'm not going to talk about the worst. The beauty of The Internet is that it is available 24/7, so my restless mind was able to pour over several sites' worth of information, including one truly wonderful patient driven site, consequently working itself in a real lather. Thankfully, 2:30 a.m. on the East Coast is only 10:30 p.m on the West Coast, and one of my doctor friends on Twitter was still awake and able to provide a bit of advice—go to a doctor but not urgent care; instead I need a surgeon. I am decidedly not thrilled about this entire scenario, but to find someone knowledgeable, who actually has had the same problem before, to provide a bit of comfort at 2:30 a.m. is wonderful. That's another bit of beauty about The Internet—it and everyone on it is there for you when there's something wrong with your butt.

Terrible Twos-day: Sinus Infection Edition

The Afternoon Napper has come down with the crud and apologizes for her blog absence. In lieu of the Napper's own words, please accept the following two blog entries from the blogosphere regarding sinus infections:

With props for the most accurate description of a sore throat ever to Carmel Lobello of death & taxes—"Without going into too many details, I have a sinus infection, which comes with a sore throat that makes me feel like I’m gulping wood splinters every time I swallow, a cough which has led me to pull a rib-muscle, and the kind of headache that makes you consider breaking your pinky toe with a hammer just to transfer the pain."

And one really angry guy who saw what patients would refer to as the doctor from hell—"For those who aren’t going to read, bottom line, I had a doctor who ignored her patient’s medical history and symptoms, berated me and treated me with such passive aggressive nonsense that I felt it necessary to write a 2,700 word blog post about it. In the end, I got the prescription I came for."

Waesuck Wednesday: Breast Cancer Edition

October is Breast Cancer Awareness Month. That's great. Breast cancer sucks, and it is prevalent. According to the National Cancer Institute, "based on current rates, 12.2 percent of women born in the United States today will develop breast cancer at some time in their lives." The American Cancer Institute says, "Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer."

Read that again—second leading cause. Do you have a clue when lung cancer awareness month is? Do you know what color ribbon to wear? "Lung cancer is one of the most common cancers. In 2007, lung cancer will account for approximately 15% of all cancer diagnoses and 28% of all cancer deaths. It is the second most diagnosed cancer in men and women (after prostate and breast, respectively), but it is the number one cause of death from cancer each year in both men and women," according to lungcancer.org, a program of CancerCare. The problem is that lung cancer has not had the marketing forces behind it to make awareness of it a global phenomenon. It's not as sexy. It's not pink. A recent USA Today/Gallup Poll revealed that "84% of all Americans including 95% of those ages 18 to 29 now 'shop for the cure,' buying pink products with a breast cancer tie-in." However, some of the pink pushers are coming under fire for how little of the proceeds from pink products actually go toward research—and how much goes toward overhead. This month Marie Claire published a pointed article examining the trend of pink washing and the ugly trend of "charity organizations" and pro-pink items not really supporting the cause. "The fact is, thousands of people earn a handsome living extending their proverbial pink tin cups, baiting their benefactors with the promise of a cure, as if one were realistically in sight," the article reads. More over, the author recommends the following: "Skip the pink-ribbon merchandise. Because no one really owns the rights to what has become the universal symbol of breast cancer (though Susan G. Komen for the Cure trademarked its own version), peddling the logo has become a massive racket, overrun by slick profiteers exploiting the public's naive assumption that all pink purchases help the cause."

Some breast cancer patients have become extremely aware of the effect that pink washing is having on research for the disease—capital gains vs. finding a cure—and the looming presence of breast cancer in the overall cancer picture. The USA Today/Gallup Poll showed that "one in three adults, and nearly half of women under 50, say the intense focus on breast cancer overshadows other worthy causes." Women who are part of the breast cancer social media movement on Twitter loudly echoed this sentiment during a TweetChat on Monday night. Gayle Sulik, a medical sociologist under the Twitter handle @pinkribbonblues and author of a book and blog by the same name, led much of the discussion about the role of pink in breast cancer awareness. "Saw the White House swathed in pink light tonight on Nightly News. Doubt it will be (purple?) for pancreatic cancer," she tweeted. Of the a handful of men participating in the chat—including the well known advocate Dave deBronkart a.k.a. @ePatientDave, registered nurse Andrew Lopez a.k.a @nursefriendly, and an IT/tech guy named John and tweeting as @joltdude—John was the first man to speak out in regard to other cancers, "Nothing 4 nothing, w/ all ths pink, other cancers seem 2 B left out of equation.. including us guys... we get cancer 2... All cancers need to be treated, resolved to the best of our ability. and by only focusing on one, we really do neglect everyone else." To further complicate the issue, awareness doesn't equate action, chat participants said. "People are aware, but many now think all BC is diagnosed early & curable," wrote Dr. Deanna Attai, a breast surgeon in L.A. Awareness of the disease has not made it any easier for those suffering from it. "I am sick of being told I got the good cancer. People are not aware. Not really," wrote blog author and patient Nancy Stordahl. "Sad thing is it's all about the marketing. That's why metastatic is invisible. What kind of lipstick goes with thrush?" asked Jackie Fox, breast cancer survivor and author of From Zero to Mastectomy: What I Learned & You Need to Know About Stage 0 Breast Cancer.

With all the organizations and all the pink and all the awareness, it has felt to me that breast cancer, among other prevalent diseases, gets more than its fair share of attention. For better or worse, we as a culture are fascinated with breasts and what they represent and slogans like "Save the Ta-Tas" is fun and catchy. "One must admit, 'Save the walnuts' doesn't have the same cachet," Dave deBronkard pointed out during the chat. Previously I blogged about having disease envy and particularly called out breast cancer patients for monopolizing pink; however, I found Monday's chat eye-opening and refreshing in its honesty. It had never occurred to me that those in the pink might be tired of all the pink and that the quantity of attention does not make up for the lack of quality attention to the subject. The chat served as one of what I'm sure will be many calls to action for improving and altogether evolving pink's message to one of overall breast health and cancer awareness as a whole. One idea for this is to lend pink to other diseases. Use the pre-established breast cancer networks—which due to the sheer number of those effected are a true community force—to call attention to other diseases by letting them go pink. The goal isn't to necessarily keep straight what pink represents each month or each week but to get people talking about their health. While pink may have well accomplished its goal of awareness of breast cancer, people are not as aware of so many other serious diseases such as my own disease—intimal fibromuscular dysplasia. In exchange, those of us who want to support those with breast cancer will do something real to help. We will push for research, but we will also be there to do with the stuff that no pretty color or twisted ribbon can really do—we'll listen, we'll let you talk about something else altogether, we'll hug, we'll let you be angry, we'll let you cry, we'll help you celebrate, we'll let you be tired, we'll drive to doctor appointments, we'll make something other than another damned casserole. No matter what the disease, no matter what the outcome, the experience is exquisitely human, which is what we all are.

Terrible Twos-day: Twitter Edition

I've been on Twitter too much lately. It's the result of neuroticism on one hand and inefficiency on the other. I want to know what's happening even though it doesn't involve me. I'm afraid I'll miss something important that does or does not involve me. I'm sure there are better ways to cull the information, but I haven't learned them yet, so for now I'm simply compiling a great big list of links to visit later, which I'll probably never visit or will visit six months from now when they'll be irrelevant. It's hard work this keeping up and staying in touch.

And while Twitter is a new fangled type of great communicator, it is also an old fashioned time waster. Remember how once upon a time boredom prompted Googling of random words just to see what popped up? Now that same concept can be applied to the Twittersphere. Search for a random hashtag or key word and see what other people have to say about it. There's always humor to be found. And so, the AfternoonNapper brings you this Terrible Twos-day: Twitter Edition, Keyword "Two" — Real Tweets from Real Tweeps.

Lucecannon_ Luce Cannon

#HeresTheBeef Two asians can't have a caucasian child... Because two Wongs dont make a White

DjMightyMi Milo Berger

Two things in life where you get what you paid for = toliet paper and car phone chargers
#SpendTheExtraDough

OloriSWANK Olori SWANK

Watchin two ppl play catch w. cement bricks while living in a glass house. ...wash yo hands before u start pointing them sticky fingers boy.

Andreezyxaf Andrew Izek Carrillo

About to buy two gold fish and name them Cosmo and Wanda.

StevenAmiri Steven Amiri

Babysitting my friend Derek's kids. Put season two of Breaking Bad on the TV and gave them soda. Derek's more of an acquaintance.

BobBrigham Bob Brigham

I'd normally be opposed to a remake of Footloose, but with two Mormons running for President, maybe we need a reminder.

mason bryan mason

Guess who has two thumbs and doesn't have to worry about making payroll for the first time in a decade? THIS GUY!!

wilshipley Wil Shipley

What has two lightsabers and is more machine than man? #sithguy

LilCutty Mr.SouthCarolina

The Octo-Mom got a twitter??? If so, tell her I'm trying to claim two of her kids on my taxes!

bulls_horns TJ Alley

Just popped two Viagra and depending on how long it takes this Ambien to kick in either my wife or my pillow is having an exciting evening.

PFTompkins Paul F. Tompkins

Everyone at my gym agrees: the best place for two people to have a conversation is in a doorway!

Stache16 george parros

two days in finland and I have yet to eat any form of reindeer...i am so disappointed in myself

Give What You Get

"If you're going to leave me, I'd rather you go ahead and do it now."

I was 24 when I told my then-boyfriend these words. Altogether, we had been a couple for nearly six years, having met through mutual friends, spent our college years together, then, after my graduation and subsequent move for a job five hours away, entered a year attempting a long-distance relationship that crumbled. There was a year apart. I moved for a different job, somehow managing to be five hours away from the old job and still five hours away from the guy. Nonetheless, we found ourselves back together in May 2004. We tried to overcome our past, but the fact of the matter was that while we had both changed, we had trouble recognizing that in each other, so it was no great surprise that by winter we were both looking for an easy way out. And then I got sick.

Really, I'd been sick for years, but things had finally come to a head when an incident at work convinced me that I had to get my high blood pressure under control. I'd been having several unilateral headaches on my left side, which I dismissed as stress and heredity. While at my computer one such headache suddenly turned into a dizziness and a numb left arm. The feeling passed, but it got my attention—if I didn't do something about my blood pressure, which had peaked at 220/110 and tended to hover around 190/105, I was going to have a stroke. Since I had recently graduated and moved and then moved again, I confess that I hadn't been as on top of my blood pressure as I should have been. My doctor at student health had taken me off a few meds and put me on a few others to no avail. A doctor I saw while working the out-of-state job did the same. My blood pressure didn't budge. So when I showed up in my new family practicioner's office he recommended something else, "There's something really strange I'd like to have you tested for." I went for an MRI and the strange thing was found—the artery to my left kidney was more than 90 percent stenosed, which meant that the kidney was not getting an adequate blood supply and therefore was emitting renin to raise my blood pressure to try to force blood to the little dying organ. What the MRI also found was that my celiac and mesenteric arteries were 100 percent occluded. We didn't know why, but suddenly the severe gastrointestinal problems I'd had for years on end suddenly came sharply into focus. The arterial blockages were killing my system, and if blood supply wasn't restored, I stood a great chance of a) losing my kidney b) suffering complications from high blood pressure including a weakened heart c) losing my bowel. I was referred and then referred again. There was talk of a vascular disease. There was talk of major surgery.

And finally, there was talk of breaking up. I knew two things: I needed to pay attention to myself and not a shoddy relationship, and if I was going to get out of a shoddy relationship, I wanted to do it before things go ugly, before things got to the surgery and recovery and scars part. It was shortly before Christmas that I said, "If you're going to leave me, I'd rather you go ahead and do it now." And so he did. My parents went to my doctors appointments with me. I spent most evenings at their house, only driving home at 11 p.m. to feed the cats and go to sleep. Bypass surgery was put on the docket for July 5.

I hadn't really had much of a mind for dating. My situation was serious, not the kind of thing to throw at a new relationship, but there was a guy, a friend at work, to whom I had become close. We hung out from time to time, going on "not dates." He had never ever tried to make a move on me. I never made a move on him. Instead, we were just friends—blushing, awkward friends. The night before I was to leave for surgery, I was nervous and alone. I called my "just friend." "Talk to me," I said. "I don't care what you talk about, just talk to me." Three or four hours in to the conversation, I couldn't take it any more. "Travis, why don't you ever hit on me?" There was a long pause. "Well, I will if you want me to," he replied.

Travis came to see me in the hospital, which was three hours away. The surgery had been eight hours long, and afterward, I spent a foggy two, maybe three, days in the ICU. When I finally got to a regular room on the vascular floor, I hadn't eaten in days, hadn't had solid foods in a week, was unshowered, unshaven, and generally looked like a meat marionette held up by IV lines. I think he got to stay for 45 minutes before my meds made me sick and I threw him out of the room.

After two weeks in the hospital, I headed back homeward, but was too weak to live alone. I stayed with my parents for nearly a month. In that time, Travis and I resumed our hours long phone conversations. He came over to my parents' house and took me out for dinner and a movie. And still, he was perfectly, annoyingly polite. Without going into great detail, I'll say that on Aug. 13 I took matters into my own hands. The relationship was everything I'd never had before. We were married just over a year later on Oct. 20, 2006—this month we celebrate our five year anniversary.

In that five year span, Travis and I have gone through a lot with my health. There was the stroke, and the nephrectomy, and the four brain aneurysms, and the gastric rupture. We've gone through a lot in life. I made him let me get a dog (in addition to our three cats), we sold my townhouse and bought a bigger house, I lost my job after the stroke, I went back to school, I started working again part-time. Throughout it all, he's been stoic. He's been by my side. He's sponge bathed and cut up food when the IV in my hand won't let me and changed bedsheets and packed wounds with gauze and driven me to appointments and filled prescriptions and brought chocolates and held me while I cry and nagged me to do my physical therapy and has never once showed any signs of leaving. I don't know how he does it. Sometimes, I don't know why he does it. It would be so much easier for him not to. It would be so much easier for him to close off and close up and want nothing to do with me and my sickness. I try to give him as much as he gives me, but I know that that is impossible.

A lesson that sickness has to teach us then is that in sickness we must not always focus on that which we lose; we must look to what we gain as well. I gained a husband who is my joy, my solace, my caregiver, and my love. I also have gained a community in which fellow patients serve as caregivers, supporters, and friends. I have gained insight into myself, what I want to accomplish in life, and what is truly important and worth fighting for. I have gained experience and knowledge. When there is so very much to be lost and so very much that has already been lost, searching for what one has gained may prove difficult, but it is what we gain that fuels the fire to carry on.