I wrote this open letter, following a series of very difficult visits with my Hepatitis C nurse; during which sessions, I felt misinformed and spoken to in a very unhelpful way. Not good for keeping treatment on track (in terms of good health information0 or for general morale. The idea and format for this letter was inspired by a letter originally written by Bek Oberin. If you want to read that original letter - please visit support forum Hep C Nomads. (HepCNomads.co.uk) search Letter to People Without Hep C - by Bek Oberin. This version: letter to my Hep C nurse, is intended either as an encouragement, in itself, to patients, especially those who have had difficult sessions with medics; or as a letter to be printed and handed to health care professionals, as needed. good health to you all. xxx eva
BEFORE I CAME TO SEE YOU FOR MY FIRST APPOINTMENT, I HAD ALREADY BEEN ILL FOR A LONG TIME..... I WAS TIRED, AND ACHING, AND NAUSEAUS – AND WITH NUMEROUS UNEXPLAINED SYMPTOMS. I DIDN’T KNOW I HAD HEPATITIS C. I DIDN’T EVEN KNOW WHAT IT WAS. BUT IT HAD CHANGED MY WORLD – ERODED MY QUALITY OF LIFE IN SO MANY WAYS. AND I NEED YOU TO UNDERSTAND THAT THROUGH ALL THAT TIME, WHEN I HAD BEEN STRUGGLING SO MUCH WITH MY HEALTH, I HAD ALREADY SEEN MANY DIFFERENT DOCTORS AND HEALTH PRACTITIONERS. MANY OF WHOM HAD SENT ME AWAY, TELLING ME IN EFFECT THERE WAS NOTHING WRONG WITH ME ... OR IT WOULD PASS... OR PERHAPS, THAT I WAS NEUROTIC.
SO I HAVEN’T ARRIVED TODAY WITH A BLANK CANVAS. I AM ALREADY FEELING ANXIOUS, AND YES, A LITTLE LACKING IN CONFIDENCE OF MY OVERALL HEALTH CARE.
PLEASE UNDERSTAND, THOUGH, THAT I CARE ABOUT MY LIFE AND MY HEALTH. I WANT TO GET WELL: FOR ME, FOR MY FAMILY AND FRIENDS, MY WORK, AND ALL THE THINGS THAT MAKE FOR A FULL AND ACTIVE LIFE. SO WHEN I ASK YOU QUESTIONS, IT IS BECAUSE I WANT TO LEARN AND TO KNOW HOW TO MANAGE MY TREATMENT – WITH YOUR HELP – SO THAT I CAN MAXIMISE MY CHANCE OF CLEARING THIS HORRIBLE VIRUS.
PLEASE REALISE THAT I DON’T HAVE A NOTEBOOK IN ORDER TO READ FROM A CHECK-LIST INTENDED TO CHALLENGE YOU AND YOUR EXPERIENCE. MY CHECKLIST IS TO HELP ME GATHER MY THOUGHTS – AND TO ENABLE BOTH OF US TO WORK WELL TOGETHER AND BE SURE WE HAVE CLARIFIED ESSENTIALS. I AM JUST FINDING OUT ABOUT HEPATITIS C.AND I NEED YOU TO KNOW THERE'S BEEN A PERIOD OF A LOT OF ADJUSTMENTS AND A HUGE LEARNING CURVE. THROUGHOUT MY TREATMENT, BECAUSE I AM SICK, AND MY CONCENTRATION IS AFFECTED, I ASK YOU TO BEAR WITH ME, IF I SOMETIMES NEED TO REINFORCE THE FACTS OR ASK FOR FURTHER EXPLANATIONS.
I REALISE FROM YOUR RESPONSES THAT SOMETIMES, YOU MIGHT THINK THAT I AM TRYING TO PIECE TOGETHER TOO MUCH SPECIALISED KNOWLEDGE. SOMETIMES, WITH VARIOUS MEDICS, IT SEEMS AS IF IT’S REGARDED AS INAPPROPRIATE,EVEN ODD BEHAVIOUR, WHEN I WANT TO ASK ABOUT AND PROPERLY UNDERSTAND MY OWN BODY, MY BLOOD, MY TREATMENT. I ASK THAT EVEN IF I SOMETIMES MISUNDERSTAND CERTAIN THINGS – YOU WILL PLEASE BE PATIENT, AND LISTEN AS I PIECE THINGS TOGETHER. IN WHAT I SAY, THERE MAY BE NEW LEARNING AND MATERIAL WHICH IS USEFUL TO YOUR PRACTICE, BOTH IN WORKING WITH ME AND FOR YOUR OTHER PATIENTS TOO.
I WOULD LIKE YOU TO KNOW THAT WHEN I RESEARCH MATERIAL, THROUGH SUPPORT GROUPS, AND ORGANISATIONS OR THE WEB AND INTERNET FORUMS, I AM NOT OBSSESSIVE OR UNSTABLE. I AM LINKING UP WITH OTHER PATIENTS WHO INCREASINGLY UNDERSTAND WHAT A POSITIVE AND REAL DIFFERENCE IT CAN MAKE TO SHARE EXPERIENCE AND INFORMATION. WE ARE BEING PROACTIVE AND HELPING OURSELVES AND EACH OTHER – AND HOPING TO ENCOURAGE GREATER UNDERSTANDING OF THIS DISEASE. BOTH FOR OURSELVES AND ONE ANOTHER, THE GENERAL PUBLIC AND THE HEALTH SERVICE. PLEASE DON’T ASSUME THAT I AM SO NAIVE AND UNAWARE THAT I AM GOING TO SOAK UP ANYTHING I AM FED, VIA THESE OTHER SOURCES, WITHOUT DISCUSSION OR DISCRIMINATION. I AM SENSIBLE ENOUGH TO COME AND ASK QUESTIONS AND CROSS-REFERENCE. AND YET I STILL DO APPRECIATE IT IF YOU GIVE ME FURTHER GUIDELINES OR EXPLANATIONS.
AND WHEN YOU DON’T KNOW THE ANSWER, I APPRECIATE IT WHEN YOU TELL ME SO, AND OFFER TO CHECK IT OUT FOR ME – OR POINT ME IN THE RIGHT DIRECTION. IF YOU LISTEN AND BE PATIENT WHEN I STUMBLE – BECAUSE, AGAIN, REMEMBER, HEPATITIS C AND TREATMENT ERRATICALLY AFFECTS MY CONCENTRATION – SOMETIMES, I MAY HAVE DISCOVERED KEY FACTS ABOUT NEW RESEARCH, OR TREATMENT MANAGEMENT, WHICH COULD BE HELPFUL TO YOU AND YOUR CLINIC.
OF COURSE I RECOGNISE HOW MUCH YOU KNOW ABOUT HEPATIS C AND I REALISE YOU HAVE EXPERIENCE, AND GUIDELINES TO FOLLOW. I HOPE YOU CAN RESPECT ME, TOO, AND REMEMBER THAT I AM NOT THE SAME AS EVERY OTHER HCV PATIENT WHO YOU SEE. I NEED YOU TO KNOW A LITTLE BIT ABOUT MY PERSONAL CIRCUMSTANCES, MY REAL LIFE AND DAY-TO-DAY SITUATION AND HOW IT IS AFFECTED. ALSO HOW MY CIRCUMSTANCES MAY AFFECT MY TREATMENT. IT MAKES A DIFFERENCE WHEN YOU USE MY NAME, AND REMEMBER SOME SMALL, PERSONAL DETAILS ABOUT MY LIFE, WHICH I HAVE TOLD YOU.
PLEASE ASK ME HOW I AM AND WHO CARES FOR ME. I NEED YOU TO KNOW WHAT IS MY SUPPORT NETWORK – OR LACK OF ONE. AND TO HAVE SOME PICTURE OR HOW MUCH I AM STRUGGLING TO CONTINUE WORK, OR COPE WITH THE DISAPPOINTMENT OF STOPPPING WORK. DO YOU KNOW IF I AM BECOMING ISOLATED? IF MY FAMILY ARE STRUGGLING TO COPE WITH THE TREATMENT AND IT’S EFFECT ON ME? PERHAPS I HAVE NOT KNOWN HOW TO EXPLAIN THE LEVEL OF DEPRESSION OR MOOD SWINGS THAT ARE AFFECTING ME – OR JUST HOW HARD IT IS TO FEEL AFRAID TO TELL CERTAIN PEOPLE IN MY LIFE ABOUT THIS DISEASE
AND ESPECIALLY, WHILE I GO THROUGH TREATMENT, I NEED YOU TO BE SOMEONE I CAN TALK TO AND CAN TRUST. SOMEONE WHO UNDERSTANDS THAT I DO THIS DAY BY DAY AND WEEK BY WEEK AND SOME DAYS ARE TOUGHER THAN OTHERS. THAT SOMETIMES I FEEL AFRAID, ANGRY, DISCOURAGED OR FRUSTRATED - AND JUST VERY, VERY TIRED.
I NEED TO FEEL COMFORTABLE WHEN I COME AND SEE YOU – NOT WARY AND WORRIED. COMFORTABLE THAT YOU ARE AN ALLY AND WILL HELP MAKE THE JOURNEY AS SMOOTH AS POSSIBLE FOR ME. PLEASE RECOGNISE THAT I AM FINDING THE SIGNPOSTS AND THE TRAVELLING COMPANIONS ALONG THE WAY – AS WELL AS DOING THE LONELY STRETCHES WITH AS MUCH COURAGE AND DETERMINATION AS I CAN. WHEN YOU HELP MAKE THE ROAD AHEAD MORE CLEAR – WE CAN BOTH KNOW THAT IT IS ME THAT HAS TO TAKE EACH STEP. THANKYOU.
(written by eva day.)
Friday, 30 April 2010
Sunday, 18 April 2010
The Red Pill - or the Purple Pill?
No, this is nothing to do with a variation on The Matrix! The title comes from a debate over the colour of the pills I want to write about. My daughter says - they are red. I say that they are a kind of purplish-red; and that therefore, I can write about them as The Purple Pills, for the sake of alliteration. She urges accuracy. You take your pick!
In any case, they feature prominently in my day, after I discovered them last night, in the bottom of my hospital overnight bag.
Wednesday, I did my interferon jab in the morning, and went off to the hospital for a minor operation, expecting to be home that evening. But the last time I had day surgery, there were slight complications afterwards, and they ended up keeping me in overnight. Of course,then, I didn't have any personal items with me, and it was a bit annoying. So, via the perverse laws of Sod, I figured that if I did have an overnight bag with me this time, then all would go well, and of course, I wouldn't need it. This worked - ha! Sod was foiled! I came home, was hellish to be around for about an hour, apparently, and then settled down back on the sofa again, to rest up and recover. Spare toiletries, pajamas, etc, have remained in the bag, unpacked for the last few days. Shocking, isn't it?! You would be appalled at how shoddy I am being just now.
Yesterday evening (Saturday) after being miserable and at odds with myself and the world for much of the day, while my daughter zoned out on mobile phone games, I was sprawling pathetically on the sofa feeling thouroughly sorry for myself. I finally decided to rally and set a few small goals, to arrive at some sense of achievement and to haul myself out of the pits of a foul mood. A little bit of pottering and clearing up was a start; whatever could be done one-handed, as left hand is in splint and sling.
Time to put away bits and pieces that were still in the hospital bag, which was dumped on top of a pile of un-sorted laundry. Emptying the bag, I found, at the bottom, a packet of pills. They are called Lofepramine, and are a sort of reddish-purple colour, as mother and daughter discussed. They are my anti-depressants. I took them down to the kitchen, to put away with the rest of my extensive pharmacy stock. Realising it wass nearly time to take my evening medications anyway - only 20 minutes off regular time - I decided to have a banana and a bit of toast, and take them early.
So I grabbed my pill box (all very well organised) and noticed that in each compartment, marked for the days of the week, am and pm, there were the familiar assortment; tiny, white tablets, fat, round yellow ones, small green capsules, and the very important oval pinkish coloured Ribavirin tablets. It all looks a bit like a pick 'n' mix. No reddish-purple ones, though. Moment of realisation! It seems I hadn't loaded my anti-depressants in, along with the others, on Weds morning before doing my injection and going off for my op. The normal routine for me is to do my jab and Wednesday mornings, and re-stock my pill box. But clearly, something had gone pear-shaped with my well-executed (or so I thought) preparations before going to hospital. I had taken some extra meds in my bag just in case - but I hadn't re-stocked the pill box properly. So, of course, though unaware of this, I hadn't been taking my anti-depressants for the last few days. Ok, I think, bloody typical; if I was going to omit a pill - it had to be the damned AD's, didn't it? (Blood pressure, anti-histamines, all the various supplements, they are all there.) Then I think; well, thank god it wasn't the riba; fortuntely I am right on track with them.
I had, before that, found myself wondering about the fact that I had been feeling fogged, weepy, angry; and curiously, both full of self-pity yet strangely determined to put on a cheerful head - tell myself and everyone that "I am fine, absolutely fine." Surely not still the anaesthetic, after a few days? And this is more intense, I am sure, than my usual post-jab response. Perhaps it's also because I am missing my husband, who is abroad for a couple of weeks? And now I am also thinking; well there is another key ingredient also; I haven't been taking my anti-depressants for the last few days.
On a practical level, apart from missing his presence, I recognise that had my husband been here, he would have done most (ok - all!) of the basic chores, and I would have concentrated, and sorted my pills properly, instead of wondering around in pointless circles, thinking I was being efficient.
The morals of the story are: a pill box is a wonderful thing, if (like any system) you actually use it properly. A good husband is worth his weight in tablets as well as gold. And some of us on treatment are beyond all sense, without our anti-depressants.
May all your tablets be taken, your capsules consumed and your pills be popped!
I missed a couple of days ADs once before, by mistake. Either we live and learn, or we repeat the same mistakes, again. And sometimes - again! A lot depends on circumstances. And brain fog, of course.
xx eva
In any case, they feature prominently in my day, after I discovered them last night, in the bottom of my hospital overnight bag.
Wednesday, I did my interferon jab in the morning, and went off to the hospital for a minor operation, expecting to be home that evening. But the last time I had day surgery, there were slight complications afterwards, and they ended up keeping me in overnight. Of course,then, I didn't have any personal items with me, and it was a bit annoying. So, via the perverse laws of Sod, I figured that if I did have an overnight bag with me this time, then all would go well, and of course, I wouldn't need it. This worked - ha! Sod was foiled! I came home, was hellish to be around for about an hour, apparently, and then settled down back on the sofa again, to rest up and recover. Spare toiletries, pajamas, etc, have remained in the bag, unpacked for the last few days. Shocking, isn't it?! You would be appalled at how shoddy I am being just now.
Yesterday evening (Saturday) after being miserable and at odds with myself and the world for much of the day, while my daughter zoned out on mobile phone games, I was sprawling pathetically on the sofa feeling thouroughly sorry for myself. I finally decided to rally and set a few small goals, to arrive at some sense of achievement and to haul myself out of the pits of a foul mood. A little bit of pottering and clearing up was a start; whatever could be done one-handed, as left hand is in splint and sling.
Time to put away bits and pieces that were still in the hospital bag, which was dumped on top of a pile of un-sorted laundry. Emptying the bag, I found, at the bottom, a packet of pills. They are called Lofepramine, and are a sort of reddish-purple colour, as mother and daughter discussed. They are my anti-depressants. I took them down to the kitchen, to put away with the rest of my extensive pharmacy stock. Realising it wass nearly time to take my evening medications anyway - only 20 minutes off regular time - I decided to have a banana and a bit of toast, and take them early.
So I grabbed my pill box (all very well organised) and noticed that in each compartment, marked for the days of the week, am and pm, there were the familiar assortment; tiny, white tablets, fat, round yellow ones, small green capsules, and the very important oval pinkish coloured Ribavirin tablets. It all looks a bit like a pick 'n' mix. No reddish-purple ones, though. Moment of realisation! It seems I hadn't loaded my anti-depressants in, along with the others, on Weds morning before doing my injection and going off for my op. The normal routine for me is to do my jab and Wednesday mornings, and re-stock my pill box. But clearly, something had gone pear-shaped with my well-executed (or so I thought) preparations before going to hospital. I had taken some extra meds in my bag just in case - but I hadn't re-stocked the pill box properly. So, of course, though unaware of this, I hadn't been taking my anti-depressants for the last few days. Ok, I think, bloody typical; if I was going to omit a pill - it had to be the damned AD's, didn't it? (Blood pressure, anti-histamines, all the various supplements, they are all there.) Then I think; well, thank god it wasn't the riba; fortuntely I am right on track with them.
I had, before that, found myself wondering about the fact that I had been feeling fogged, weepy, angry; and curiously, both full of self-pity yet strangely determined to put on a cheerful head - tell myself and everyone that "I am fine, absolutely fine." Surely not still the anaesthetic, after a few days? And this is more intense, I am sure, than my usual post-jab response. Perhaps it's also because I am missing my husband, who is abroad for a couple of weeks? And now I am also thinking; well there is another key ingredient also; I haven't been taking my anti-depressants for the last few days.
On a practical level, apart from missing his presence, I recognise that had my husband been here, he would have done most (ok - all!) of the basic chores, and I would have concentrated, and sorted my pills properly, instead of wondering around in pointless circles, thinking I was being efficient.
The morals of the story are: a pill box is a wonderful thing, if (like any system) you actually use it properly. A good husband is worth his weight in tablets as well as gold. And some of us on treatment are beyond all sense, without our anti-depressants.
May all your tablets be taken, your capsules consumed and your pills be popped!
I missed a couple of days ADs once before, by mistake. Either we live and learn, or we repeat the same mistakes, again. And sometimes - again! A lot depends on circumstances. And brain fog, of course.
xx eva
Monday, 5 April 2010
emotional well-being on treatment. PART 2
MANAGING EMOTIONAL SIDE EFFECTS ON HCV TREATMENT:
PART TWO. PATIENTS EXPERIENCES.
for broader over-view, please read Part One first. (There you will also find links to more background information and to support options) Many patients will experience at least some occassional milder mood changes; having a realistic understanding of wha to expect during treatment does help.* Some people will have more intense reactions or go through periods when they do; these articles are to help understanding for them as well as their family or friends. .
PERSONAL EXPERIENCES
Individuals stories, and thought to hold on to if ever you do “loose the plot” and wonder what the heck is going on with you. I did say “weird and vacant.” Vacant was how I felt when i was: volatile, anxious, confused, angry, neurotic and tearful. I add this note as a direct description of my own experience - and a sort of anchor, to help you remember; No blame, no shame: remember it’s the meds and chemical reactions, as well as normal human responses to illness and struggle. Hold on to humour and as many routines as you can, to stabilise and normalise your days. You will emerge, stronger, wiser and more resilient than ever ..... and I hope: virus –free. Here is what some other patients said when asked "what were the most difficult side effects of treatment?" (many patients have only mild reactions in this area: others experience it more, as did these people.)
"The mind stuff is certainly the worst. The feeling of being absolutely useless at everything I once took for granted; like being able to process information. This and the insomnia which makes it 100x worse.“bugs”
(note: due to secondary health issues, at one point this person had to choose whether to cease or to continue treatment, when chances of successful outcome were looking like they were seriously reduced. Despite having suffered the “Weird” effects, this person chose to continue: stronger than ever before and determined to fight the disease.)
"I have done two treatments, one without Ad’s and one with. I thought I was fine with the 1st treatment, but in fact I was not. The interferon had bought and booked me onto the crazy train - and I was not even aware I was going for the ride. The 2nd treatment, with Anti-Depressants, was still challenging- emotionally and mentally. ut at least I had a footing and base to keep things together.
Some folks do just fine without the Ad’s (but in my opinion ) they could be on the train and just don’t realize it. I have yet to come across anyone in all my time in Hep C circles, that wasn’t affected by the Interferon in some way mentally. For some these are just subtle changes; but for some these changes are drastic. Again this is just my opinion but I believe they are a very important component to treatment and should be started before Tx begins to get the full affect. I’m also of the mind that the pre-treatment stress and anxiety calls for anti-depressants, for some folks as a norm. (M. G.)"
(this patient did not clear the virus, but continues to support others through effective management of treatment, to maximise chances of full recovery.)
"The worst side effect is the mood swings caused by Interferon Alpha.Some experience full-on depression, but with me it was full-on anger and impatience .This manifestation didn't much hurt me, but everyone around me , like my family (my immediate one), who had to endure hell for the weeks when I denied I had an anger and impatience problem on treatment. .For the whole of my 2nd treatment , I managed the brain chemistry changes with Citalopram, and fluctuated between 20-40mg per day.However, my 1st treatment was different, on this treatment, I held-out until week 24 without an SSRI and my wife (carer) and daughter suffered horrifically. It was at week 24 that I was frog marched to the GP, by my wife, for some SSRI's , apparently I was a puppy-dog within 48 hrs of taking them .So why is uncontrollable anger and impatience the worst side effect of HCV Combined Therapy?Because, if left to go untreated (unmanaged) , it can destroy a long-term marriage, relationship between partners and destroy a parental relationship .In my case, it did not result in this terrible outcome to treatment. But I've heard enough patient stories to now realise that it happens very frequently" .Ross xxx
(note: 1st treatment did not succeed for this patient. Despite his experiences of mood reactions described, he chose to undergo treatment a 2nd time, in a commitment to clearing the virus. On 2nd round, happily he won the battle. For info re anti-depressants, please see links in Part One)
"Depression, Anger, Anxiety and generally being out of my mind. I got so emotionally unhinged at the end that I looked like and acted like those weird crazy people you avoid if seen in public. I knew it, but could not stop it. I just had to roll with it because I was not going to stop tx. This was with taking anti-d's. I shudder to think how horrid I would have been without, as I was horrid enough with them." Peek.
(note; this patient has done treatment twice and has elsewhere stated that had she not cleared the virus; would do treatment again, if she had to...Fortunately she is now post-treatment, virus free and recovering well. )
An overview of outcomes for people I have known through support forum and internet connection: Of those who have completed treatment and cleared the virus .... despite the more unpleasant aspects of mental or emotional sides .... none has said that they regret undergoing treatment.
Of those who unfortunately did not clear the virus, many have continued and done treatment a second time, even those who found emotional reactions challenging: they were prepared to ride these side effects through again in order to beat the disease.
Even where outcome of clearing virus completely was not successful; viral load and liver damage, as well as other Hep C symptoms, are likely to be greatly reduced in any event; thus minimising health problems and improving potential quality of life and longevity.
For those patients who did not clear, although there will have been initial feelings of anger and resentment at the experience of treatment; but the longer-term outcome, once they have recovered from intitial shock, is eventual acceptance. And recognition of the alleviation they will have achieved. And so, generally , without regret; but, instead, glad that they had undertaken treatment - and often waiting for an opportunity for re-treatment or new trials, in determination to be clear of HCV. I have read a comment by one person who was an exception to this trend; sadly this person had experienced other very complicated personal circumstance during and just after treatment.
This closing thought is offered as those making the choice to begin treatment, and to those experiencing he more difficult periods. Keep fighting ... HCV can be a very serious disease and so the battle is worth it. Wishing you peace, courage, as smooth a ride as possible, good support; and good health, good living!
xxx eva day
* please see separate article (to be posted soon) re studies showing how realistic expectations of treatment, before commencing, can make a great difference to successful management of treatment.
** also, to be posted in future; notes specifically discussing experiences of temporarily reduced concentration, general thinking skills and recovery of cognition, post treatment.
Sunday, 4 April 2010
managing emotional well-being on treatment
Why do I feel Weird and Vacant?
This is a basic over-view of emotional and mental reactions Hep C patients might experience, while on treatment. . For explanation of medical causes, and for further information, please follow links given at end of article.
I’m calling it the weird experience because during treatment, general perception of day to day reality can feel very surreal.
I use the word “weird” as an anacronym and in a lightly humorous way. This is about getting past concerns of there being something “wrong” with us when we experience these emotional reactions on treatment. So, with a little gentle laughter and relief from fear: weird stands for
Withdrawn, Emotive; Irritable; Reactive; Depressed. ......
Ok; sounds pretty unpleasant?! These sides vary, amongst different patients, from minimal and transitory – to more extreme. In general, for sure, treatment is no picnic. Even if you do remain fairly level most of the time ...... there are likely to be moments....
My own take is that treatment is a commitment, and can be tough: but worth it with the end goal in sight. Clearing the virus.
. Having a clear and realistic sense of what treatment entails is one of the best foundations for managing it well and successful outcome. Some people do find the mental effects worse than some of the physical side effects. But, with the right medical and social support, they are manageable and it is doable. So here are some of the more common experiences;
Withdrawn. Fatigue, discomfort and irritability may make you tend to absent or isolate yourself. . Some retreat may be part of the process of diverting energy into fighting the virus. Too much disconnect, though, will exacerbate depression. Try to step out of the bubble and interact, even briefly, as regularly as possible, without becoming exhausted.
Emotive. Emotions and perceptions may become heightened. For example; anxiety; feeling weepy; sudden and intense changes of mood or odd thoughts, paranoia. etc. . without always knowing what is the trigger. Keep an eye on your sleeping patterns. Insomnia can make this more severe.
Irritability. Pretty common: from irritation at things that wouldn’t normally bother you, to full-blown fury .(Often referred to as “Riba Rage”, named for the Ribaviran.) -Hopefully, friends and family will understand some edginess and and ride out even the occasional more extreme reactions. It may be reasonably containable: but , if it reaches the level of aggression, or potential abuse; get help. . (see quote by “Ross” and others, below in Part Two.)
Reactive.
Your thoughts and your interactions with others – can be magnified –at times you may be hyper-sensitive: a minor concern, suddenly becomes a compelling fixation or a slight disappointment suddenly is hugely unfair .... and others seem insensitive to not understand your feelings, but later, it may seem no big deal. Some people get a bit paranoid or generally anxious. . Try to remember it’s not you, it’s not real .... it;s the meds. Used post-its, stuck around the house, as reminders of this.
Depression. there are complex physiological and emotional processes involved. Symptoms can include: *a low, heavy, miserable feeling *general loss of pleasure in things that used to be enjoyable – often including sexuality and intimacy. * reduced concentration. * hopeless and bleak thoughts. . Some of these reactions are natural responses to chonic illness. But a lot of it may be chemically induced by the treatment meds you’re taking. Remind yourself what the fight is for – to eradicate the virus and regain your health, natural enthusiasm and quality of life. Please follow and read links on managing depression.
PLEASE SEEK IMMEDIATE HELP IF DEPRESSION REACHES POINT OF THOUGHTS OF SUICIDE OR SELF-HARM . THERE IS A WAY THROUGH. ALSO, SEEK SUPPORT IF OTHER FEELINGS, EG ANGER, OR ANXIETY BEGIN TO BE OVERWHELMING - TALK TO HEALTH CARE PROVIDER & FRIENDS / FAMILY. CONSIDER ALSO THE ROLE OF ANTI-DEPRESSANTS IN MANAGING TREATMENT. SEE LINKS BELOW FOR HELPFUL INFO
General notes on emotional well-being and understanding / treating depression. http://helpguide.org/mental/depression_signs_types_diagnosis_treatment.htm
http://www.helpguide.org/mental/mental_emotional_health.htm
http://www.mind.org.uk/help/medical_and_alternative_care/making_sense_of_antidepressants
http://www.counselling-directory.org.uk/bacpcharity.html
http://www.mind.org.uk/help/medical_and_alternative_care/making_sense_of_counselling
http://www.sane.org.uk/SANEline
(telephone helpline for mental health issues)
The following links access information on emotional and mental health specifically related to Hepatitis C and Hep C treatment.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/MH%20depression%20overview.pdf
http://www.hepatitis-central.com/mt/archives/2009/01/why_depression.html
http://nchsr.arts.unsw.edu.au/media/File/HepCtreatment.pdf
http://www.hepctrust.org.uk/news/2010/January/Management+of+Depression+During+Hepatitis+C+Treatment+with+Interfero+-based+Therapy
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Treatment_Side_effect_Guide.pdf
(see section 8 – mental and psychiatric symptoms)
IN A SEPARATE POST, PART TWO OF THIS ARTICLE DESCRIBES SOME PATIENTS PERSONAL EXPERIENCES AND DISCUSSES OUTCOMES OF TREATMENT CHOICES AND COMMITMENT
This is a basic over-view of emotional and mental reactions Hep C patients might experience, while on treatment. . For explanation of medical causes, and for further information, please follow links given at end of article.
I’m calling it the weird experience because during treatment, general perception of day to day reality can feel very surreal.
I use the word “weird” as an anacronym and in a lightly humorous way. This is about getting past concerns of there being something “wrong” with us when we experience these emotional reactions on treatment. So, with a little gentle laughter and relief from fear: weird stands for
Withdrawn, Emotive; Irritable; Reactive; Depressed. ......
Ok; sounds pretty unpleasant?! These sides vary, amongst different patients, from minimal and transitory – to more extreme. In general, for sure, treatment is no picnic. Even if you do remain fairly level most of the time ...... there are likely to be moments....
My own take is that treatment is a commitment, and can be tough: but worth it with the end goal in sight. Clearing the virus.
. Having a clear and realistic sense of what treatment entails is one of the best foundations for managing it well and successful outcome. Some people do find the mental effects worse than some of the physical side effects. But, with the right medical and social support, they are manageable and it is doable. So here are some of the more common experiences;
Withdrawn. Fatigue, discomfort and irritability may make you tend to absent or isolate yourself. . Some retreat may be part of the process of diverting energy into fighting the virus. Too much disconnect, though, will exacerbate depression. Try to step out of the bubble and interact, even briefly, as regularly as possible, without becoming exhausted.
Emotive. Emotions and perceptions may become heightened. For example; anxiety; feeling weepy; sudden and intense changes of mood or odd thoughts, paranoia. etc. . without always knowing what is the trigger. Keep an eye on your sleeping patterns. Insomnia can make this more severe.
Irritability. Pretty common: from irritation at things that wouldn’t normally bother you, to full-blown fury .(Often referred to as “Riba Rage”, named for the Ribaviran.) -Hopefully, friends and family will understand some edginess and and ride out even the occasional more extreme reactions. It may be reasonably containable: but , if it reaches the level of aggression, or potential abuse; get help. . (see quote by “Ross” and others, below in Part Two.)
Reactive.
Your thoughts and your interactions with others – can be magnified –at times you may be hyper-sensitive: a minor concern, suddenly becomes a compelling fixation or a slight disappointment suddenly is hugely unfair .... and others seem insensitive to not understand your feelings, but later, it may seem no big deal. Some people get a bit paranoid or generally anxious. . Try to remember it’s not you, it’s not real .... it;s the meds. Used post-its, stuck around the house, as reminders of this.
Depression. there are complex physiological and emotional processes involved. Symptoms can include: *a low, heavy, miserable feeling *general loss of pleasure in things that used to be enjoyable – often including sexuality and intimacy. * reduced concentration. * hopeless and bleak thoughts. . Some of these reactions are natural responses to chonic illness. But a lot of it may be chemically induced by the treatment meds you’re taking. Remind yourself what the fight is for – to eradicate the virus and regain your health, natural enthusiasm and quality of life. Please follow and read links on managing depression.
PLEASE SEEK IMMEDIATE HELP IF DEPRESSION REACHES POINT OF THOUGHTS OF SUICIDE OR SELF-HARM . THERE IS A WAY THROUGH. ALSO, SEEK SUPPORT IF OTHER FEELINGS, EG ANGER, OR ANXIETY BEGIN TO BE OVERWHELMING - TALK TO HEALTH CARE PROVIDER & FRIENDS / FAMILY. CONSIDER ALSO THE ROLE OF ANTI-DEPRESSANTS IN MANAGING TREATMENT. SEE LINKS BELOW FOR HELPFUL INFO
General notes on emotional well-being and understanding / treating depression. http://helpguide.org/mental/depression_signs_types_diagnosis_treatment.htm
http://www.helpguide.org/mental/mental_emotional_health.htm
http://www.mind.org.uk/help/medical_and_alternative_care/making_sense_of_antidepressants
http://www.counselling-directory.org.uk/bacpcharity.html
http://www.mind.org.uk/help/medical_and_alternative_care/making_sense_of_counselling
http://www.sane.org.uk/SANEline
(telephone helpline for mental health issues)
The following links access information on emotional and mental health specifically related to Hepatitis C and Hep C treatment.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/MH%20depression%20overview.pdf
http://www.hepatitis-central.com/mt/archives/2009/01/why_depression.html
http://nchsr.arts.unsw.edu.au/media/File/HepCtreatment.pdf
http://www.hepctrust.org.uk/news/2010/January/Management+of+Depression+During+Hepatitis+C+Treatment+with+Interfero+-based+Therapy
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Treatment_Side_effect_Guide.pdf
(see section 8 – mental and psychiatric symptoms)
IN A SEPARATE POST, PART TWO OF THIS ARTICLE DESCRIBES SOME PATIENTS PERSONAL EXPERIENCES AND DISCUSSES OUTCOMES OF TREATMENT CHOICES AND COMMITMENT
Tuesday, 30 March 2010
"GET TESTED; WHO AND WHY!" I WROTE THIS PIECE SHORTLY AFTER JOINING A HEP C SUPPORT FORUM* AND LEARNING MORE ABOUT THE DISEASE. (PRE- DIAGNOSIS, I KNEW NOTHING ABOUT IT) I HAVE LEFT IT AS ORIGINALLY WRITTEN, AND JUST ADD THE NOTE THAT I AM NOT INTENDING TO PORTRAY HEP C AS A LIFESTYLE DISEASE. SEE LINK AT BOTTOM OF POST FOR ACCESS TO FURTHER INFO ON HOW HEP C MAY BE CONTRACTED, AND ON GETTING TESTED..
all you wild child, gypsy nomads, party poppers & risk takers (back then in the past or still living it out now, on the edge from time to time or too much but you just can't help yourself) when we were innocent (and younger) we thought we could get away with it all . ........ further down the line we sometimes discover there may be a price to be paid for all that reckless abandon and experimentation! that's life, kiddo. I do NOT agree with people I've read elsewhere saying stuff about "well, it's karma." that's almost like: serves you right for not being a good girl / good boy. some of us broke out and messed around - and got the riches and the journey as well as the possible dangers of that, is all I'm saying..........so if you ever:
*jacked up a few times and ran out of clean spikes and thought just this once, splash it in boiling water, it's only my buddy, we'll be fine (in other words, you shared a needle: once, just once, is all it could take. )
*backpacked off to some exotic destination and got yourself a tattoo from someone who set up a little shack on the beach somewhere, whittled their own bamboo ..... well, you were off your face, and it was a personal slogan written in thai . hindu/ make it up script, whatever ...... maybe it wasn't totally sterile?........
*similarly, you were drunk, everyone was wasted, your mate did a DIY tattoo when you were all hanging out in some club / pub/ squat/ you were so gone you never felt a thing. it did get a bit scabby.. no one meant any harm, it was kinda funny ..... but .... maybe it wasnt sterile etc etc back then we didn't know that the Hep C virus was catching a ride from one mate to another ......
*someone practiced acupuncture on you and they tried but maybe ...... it wasn't sterile? you get the picture ......
* and for those of you who didn't even get to have the fun of all the wild times: you have ever had extensive surgery / dentistry / a blood transfusion especially pre 1991 and sorry - we didn't know; some health workers were unkowing carriers - some blood batches were infected.
* whoops factor 1. you might have accidentally used someone's toothbrush (it happens) who maybe was a carrier. and they / you had bleeding gums and: well, you heard news of them recently - sure, they're fine. but they could be a carrier or not manifesting yet.
*whoops factor number 2. remember that time you cut yourself, your mate had a cut too, you guys were rock climbing or whatever - he helped patch you up ...... wonder if there was any blood to blood contact? remember, this is a blood bourne virus.
none of this is to make you paranoid. just that early diagnosis is of course best. and it's realistic; this is a fast growing world wide epidemic. (google up AM I NUMBER 12?) so don't be anxious, just get tested. and if you know someone who you think may have been at risk - are you able to gently suggest this to them? most especially if you know someone who always seems to be sick and tired - struggling with unexplained symptoms.
much love; carrying on doing your thing and if you're a natural risk taker (some of us are, and I get it) ok, that's your nature; just take a safety / reality check now and then. no blame and don't oversimplify the very subtle concept of karma. karma is just ... your path
much love Eva
written by eva day: Nov 2009.
for further info, access http://www.hepctrust.org.uk/
all you wild child, gypsy nomads, party poppers & risk takers (back then in the past or still living it out now, on the edge from time to time or too much but you just can't help yourself) when we were innocent (and younger) we thought we could get away with it all . ........ further down the line we sometimes discover there may be a price to be paid for all that reckless abandon and experimentation! that's life, kiddo. I do NOT agree with people I've read elsewhere saying stuff about "well, it's karma." that's almost like: serves you right for not being a good girl / good boy. some of us broke out and messed around - and got the riches and the journey as well as the possible dangers of that, is all I'm saying..........so if you ever:
*jacked up a few times and ran out of clean spikes and thought just this once, splash it in boiling water, it's only my buddy, we'll be fine (in other words, you shared a needle: once, just once, is all it could take. )
*backpacked off to some exotic destination and got yourself a tattoo from someone who set up a little shack on the beach somewhere, whittled their own bamboo ..... well, you were off your face, and it was a personal slogan written in thai . hindu/ make it up script, whatever ...... maybe it wasn't totally sterile?........
*similarly, you were drunk, everyone was wasted, your mate did a DIY tattoo when you were all hanging out in some club / pub/ squat/ you were so gone you never felt a thing. it did get a bit scabby.. no one meant any harm, it was kinda funny ..... but .... maybe it wasnt sterile etc etc back then we didn't know that the Hep C virus was catching a ride from one mate to another ......
*someone practiced acupuncture on you and they tried but maybe ...... it wasn't sterile? you get the picture ......
* and for those of you who didn't even get to have the fun of all the wild times: you have ever had extensive surgery / dentistry / a blood transfusion especially pre 1991 and sorry - we didn't know; some health workers were unkowing carriers - some blood batches were infected.
* whoops factor 1. you might have accidentally used someone's toothbrush (it happens) who maybe was a carrier. and they / you had bleeding gums and: well, you heard news of them recently - sure, they're fine. but they could be a carrier or not manifesting yet.
*whoops factor number 2. remember that time you cut yourself, your mate had a cut too, you guys were rock climbing or whatever - he helped patch you up ...... wonder if there was any blood to blood contact? remember, this is a blood bourne virus.
none of this is to make you paranoid. just that early diagnosis is of course best. and it's realistic; this is a fast growing world wide epidemic. (google up AM I NUMBER 12?) so don't be anxious, just get tested. and if you know someone who you think may have been at risk - are you able to gently suggest this to them? most especially if you know someone who always seems to be sick and tired - struggling with unexplained symptoms.
much love; carrying on doing your thing and if you're a natural risk taker (some of us are, and I get it) ok, that's your nature; just take a safety / reality check now and then. no blame and don't oversimplify the very subtle concept of karma. karma is just ... your path
much love Eva
written by eva day: Nov 2009.
for further info, access http://www.hepctrust.org.uk/
Monday, 29 March 2010
Note For friends / family / colleagues of a patient on treatment for Hep C.
SHORT NOTE FOR FRIENDS/ FAMILY / COLLEAGUES OF A HEP C PATIENT
This person is on treatment to fight to eliminate the Hepatitis C Virus with which they have been infected. They have a certain percentage of chance for success and have to maximise this by following very particular treatment procedures. They understand the basic facts of this disease and are not putting you at risk of contracting it in any way: please be assured of that. As time goes on, they will learn more about the disease and how to manage treatment; it requires a big commitment over a long period of time. Hepatitis C can be a very serious disease, so they have taken a very positive step in committing to treatment. They may often look and seem fine..... and be wanting to be as cheerful, active and positive as possible. But the virus is a tough one and so treatment is quite radical. Treatment can cause be a lot of side effects. Various changes in bloods, and chemicals they take, will cause fatigue. They are often: sore, very weak and tired, generally uncomfortable, maybe having to suffer sleep or mood disturbances. For some, not all, there can be depression and loss of normal concentration levels. Your friend will tell you if that is the case if they feel they need to. They may also have various strange, uncomfortable sensations, painful joints and muscles, itching, headaches, nauseau, heightened sensitivites to a lot of activity, noise, even foods, taste and smells. ALL THIS IS DUE TO THE VIRUS A& THE MEDS THEY ARE TAKING . For you to read this and understand a bit of what they are experiencing will certainly help them so thank you.
by eva day
p.s. click on this link to access very good Hep C forum - good information and support for patients and their family and friends http://hepcnomads.co.uk/phpBB3/index.php
I HAVE WRITTEN - AND WILL PUBLISH - SOME ARTICLES WHICH I AM HAPPY TO SHARE FOR GENERAL USE - THESE CAN BE PRINTED, PASSED ON ETC; WHERE THIS IS FINE, I MAKE A CLEAR NOTE OF THAT. I DO ASK THAT YOU LEAVE MY NAME AS AUTHOR. THIS IS MY ANCHOR OF MAKING SOME CONTRIBUTION IN THE WORLD, WHILE I AM AT HOME AND SICK. (ALSO AS THE DAUGHTER OF TWO JOURNALISTS, IT IS INGRAINED IN ME THAT ACKNOWLEDGEMENT OF AUTHORSHIP IS RESPECTED AND PLAGARIASM IS TO BE AVOIDED) THANK YOU. EVA. XX
THIS IS WRITTEN AS A SHORT "FLASH CARD" STYLE CRIB SHEET TO SHOW TO COLLEAGUES, FRIENDS, FAMILY, TUTORS, BOSSES ETC., TO HELP EXPLAIN HEP C TREATMENT. PLEASE PRINT AND USE IT IF IT'S HELPFUL.
THIS IS WRITTEN AS A SHORT "FLASH CARD" STYLE CRIB SHEET TO SHOW TO COLLEAGUES, FRIENDS, FAMILY, TUTORS, BOSSES ETC., TO HELP EXPLAIN HEP C TREATMENT. PLEASE PRINT AND USE IT IF IT'S HELPFUL.
SHORT NOTE FOR FRIENDS/ FAMILY / COLLEAGUES OF A HEP C PATIENT
This person is on treatment to fight to eliminate the Hepatitis C Virus with which they have been infected. They have a certain percentage of chance for success and have to maximise this by following very particular treatment procedures. They understand the basic facts of this disease and are not putting you at risk of contracting it in any way: please be assured of that. As time goes on, they will learn more about the disease and how to manage treatment; it requires a big commitment over a long period of time. Hepatitis C can be a very serious disease, so they have taken a very positive step in committing to treatment. They may often look and seem fine..... and be wanting to be as cheerful, active and positive as possible. But the virus is a tough one and so treatment is quite radical. Treatment can cause be a lot of side effects. Various changes in bloods, and chemicals they take, will cause fatigue. They are often: sore, very weak and tired, generally uncomfortable, maybe having to suffer sleep or mood disturbances. For some, not all, there can be depression and loss of normal concentration levels. Your friend will tell you if that is the case if they feel they need to. They may also have various strange, uncomfortable sensations, painful joints and muscles, itching, headaches, nauseau, heightened sensitivites to a lot of activity, noise, even foods, taste and smells. ALL THIS IS DUE TO THE VIRUS A& THE MEDS THEY ARE TAKING . For you to read this and understand a bit of what they are experiencing will certainly help them so thank you.
by eva day
p.s. click on this link to access very good Hep C forum - good information and support for patients and their family and friends http://hepcnomads.co.uk/phpBB3/index.php
Friday, 26 March 2010
THE THREE C'S AND "WHAT KATY DID."
the KatyI 'm talking about was the lively girl, tomboy heroine from a favourite childhood book of mine. sorry blokey blokes - you probably didn't read it, but those of us who were girl children might remember? Katy was feisty and fun, full of energy, often awkward and in a pickle and with a quick temper but warm heart. numerous siblings, aunties .... and then a cousin who arrived at the family home, sick, saintly and dying. or gently declining? I believe she was called Cousin Helen: and I refuse to check my references (or to be corrected) as this is how I am happy to remember it.
Cousing Helen had some mysterious ailment from which she was gradually fading away; she lay on a day couch. in a lovely room next to an open window, fresh flowers by her bed each day, smiling sweetly, welcoming in the various boisterous children, dispensing kindness, words of guidance, kissing the hurts better, patching up disagreements .... and never once complained of pain, discomfort, loss. This was my childhood myth of illness, and I knew that if ever I had to face it my life, this is who I would be; pale and interesting, angelically embroidering samplers with little home truths on them, to give as gifts, reading the classics, and gathering loved ones around me, singing and playing piano until everyone quietly tiptoed on as I gently drifted off to sleep. Probably after an occassional dose of some lollipop-flavoured laudinum and a dash of brandy, dispensed by a kindly old doctor who delivered me at birth.
What a load of old bollocks. I was convinced that something magical happened once you were ill .... there was pain, yes, but somehow angels surrounded you in a bubble of oblivion, so that pain became remote, you floated gently, poignantly in a mist of tranquil detachment from the world of ordinary trivia, and a sort of wisdom and peacefulness descended on you.
I recently looked up books about illness, for children, to help them understand a parents experience through chronic illness. Haven't looked at much of the content yet but sure hope it's a little more real than the images I grew up with. If not I shall write one: and call it "The year My Mum was Crumpled, Collapsed and Crabby." ( a child's eye view of Hepatitis C)
I believe there was also a sequel to Katy's story: she fell of a swing and damaged her legs and spine and became, herself, confined to the couch for a year. At first she was cross and crotchety...... but with Cousin Helens inspiration, also transformed into the angel on the sick bed.
As for me .... with various health problems running up to the Hep C diagnoses, I have now been largely inactive and unwell for three years, and pretty much housebound for two. Crumpled, Collapsed and Crabby pretty much describes at least several moments during the average day. I do have moments of ... well, lets not go so far as to say sweetness and light, but of being reasonably pleasant and not unbearable. They may not last ......
Probably lucky for the majority of people in my life that I am living at some distance from previous social circles. They don't have to put up with me. My husband does ... and chooses to. And still enjoys my company and remains calm, level, understanding.
Obviously, in this household, it is the carer and not the patient, who has the saintly disposition.
(thank you darling!) I have often read, from post-treatment heppers, that the disease and experience has made them a better person. I will put my faith in that experience, since that is how they tell it .......
but would like to ask, at what point does this transformation of self-improvement and growth become manifest? I am three months into treatment and no sign of it yet!!
Will certainly let you know, when it shows up, and am willing to share a little of it, too!
meanwhile, I remain collapsed, crumpled and crabby - and I am sure my daughter would agree.
xxx eva
the KatyI 'm talking about was the lively girl, tomboy heroine from a favourite childhood book of mine. sorry blokey blokes - you probably didn't read it, but those of us who were girl children might remember? Katy was feisty and fun, full of energy, often awkward and in a pickle and with a quick temper but warm heart. numerous siblings, aunties .... and then a cousin who arrived at the family home, sick, saintly and dying. or gently declining? I believe she was called Cousin Helen: and I refuse to check my references (or to be corrected) as this is how I am happy to remember it.
Cousing Helen had some mysterious ailment from which she was gradually fading away; she lay on a day couch. in a lovely room next to an open window, fresh flowers by her bed each day, smiling sweetly, welcoming in the various boisterous children, dispensing kindness, words of guidance, kissing the hurts better, patching up disagreements .... and never once complained of pain, discomfort, loss. This was my childhood myth of illness, and I knew that if ever I had to face it my life, this is who I would be; pale and interesting, angelically embroidering samplers with little home truths on them, to give as gifts, reading the classics, and gathering loved ones around me, singing and playing piano until everyone quietly tiptoed on as I gently drifted off to sleep. Probably after an occassional dose of some lollipop-flavoured laudinum and a dash of brandy, dispensed by a kindly old doctor who delivered me at birth.
What a load of old bollocks. I was convinced that something magical happened once you were ill .... there was pain, yes, but somehow angels surrounded you in a bubble of oblivion, so that pain became remote, you floated gently, poignantly in a mist of tranquil detachment from the world of ordinary trivia, and a sort of wisdom and peacefulness descended on you.
I recently looked up books about illness, for children, to help them understand a parents experience through chronic illness. Haven't looked at much of the content yet but sure hope it's a little more real than the images I grew up with. If not I shall write one: and call it "The year My Mum was Crumpled, Collapsed and Crabby." ( a child's eye view of Hepatitis C)
I believe there was also a sequel to Katy's story: she fell of a swing and damaged her legs and spine and became, herself, confined to the couch for a year. At first she was cross and crotchety...... but with Cousin Helens inspiration, also transformed into the angel on the sick bed.
As for me .... with various health problems running up to the Hep C diagnoses, I have now been largely inactive and unwell for three years, and pretty much housebound for two. Crumpled, Collapsed and Crabby pretty much describes at least several moments during the average day. I do have moments of ... well, lets not go so far as to say sweetness and light, but of being reasonably pleasant and not unbearable. They may not last ......
Probably lucky for the majority of people in my life that I am living at some distance from previous social circles. They don't have to put up with me. My husband does ... and chooses to. And still enjoys my company and remains calm, level, understanding.
Obviously, in this household, it is the carer and not the patient, who has the saintly disposition.
(thank you darling!) I have often read, from post-treatment heppers, that the disease and experience has made them a better person. I will put my faith in that experience, since that is how they tell it .......
but would like to ask, at what point does this transformation of self-improvement and growth become manifest? I am three months into treatment and no sign of it yet!!
Will certainly let you know, when it shows up, and am willing to share a little of it, too!
meanwhile, I remain collapsed, crumpled and crabby - and I am sure my daughter would agree.
xxx eva
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