National Eating Disorders Awareness Week

The majority of this post was originally written in August 2018 and has been sitting in limbo, mostly unchanged since that time.  There were too many excuses not to post it... but it's time.  Because someone else may benefit.  Someone else may learn they're not alone with what they're going through.  Someone else may need a place to look for help.  And I have nothing to be ashamed of.  I have nothing to lose.  And it's National Eating Disorders Awareness Week.  And I'm home in Connecticut with my family right now.  And I've run out of excuses not to post it. And because of the treatment I've been going through, none of my pants fit.  So... let's have some awareness about Eating Disorders, RIGHT NOW, and then take a moment to love ourselves. Come as you are.

Maybe I'm wrong, but as an East Coaster, I feel like there is a stigma against seeing a therapist. Not a physical therapist like me... we're totally cool on both coasts... a mental health therapist...a psychiatrist or psychologist... a shrink.  The vibe just isn't the same from coast to coast. The only people in Connecticut who ever mention seeing a therapist (to me) were working through marital issues or recently had a significant trauma, and even then it was a hush-hush conversation. I still can't identify a single friend seeing a therapist at home. That doesn't mean it isn't happening, we're just not talking about it.  I can easily identify several friends who have experienced things they probably should see a therapist for... but after my own experiences, I realize that it only works if you're ready to face your own issues.

Things in Seattle are different.  Not only is therapy a common activity, but people talk about it freely!  I'd text a friend asking to grab dinner and they'd say, can we go at 7PM after my therapy appointment?  And then we'd meet up and sometimes discuss what happened at their session: new revelations, techniques to try this week, weird questions they were asked that were surprisingly thought provoking. It's amazing how removing the stigma makes it comfortable and so much less of a big deal.  Pretty much all of my favorite people in Seattle have seen a therapist at some time - and none have been shy with talking about their experiences.  

If you know me beyond this blog, you know I'm 100% extrovert.  At best, I tolerate solitude. I thrive on social interactions.  I'm jealous of friends who say they need alone time to recharge their batteries because I just don't operate that way.  I talk to people all day long at work and then want to keep being around other people because it's like a constant energy flow... or a way to avoid whatever is going on inside my own head.  So when I first moved to Seattle and didn't know anybody, I spent several months, night after night, and all my days off, alone without anyone to talk to over dinner or to go for a walk with and sit and watch TV together.  I was alone.  I was missing my family and friends who were insanely hard to reach due to the time difference and my work schedule.  All that time alone could have been an opportunity to learn about myself or find some hobbies, but what I learned was that I couldn't tolerate being alone, and instead turned to food for comfort.

Interesting how moving 3,000 miles across the country doesn't make binge eating go away. I didn't know before moving that I fit the criteria for an eating disorder diagnosis... I just thought I had poor self control.  I was living alone after spending three years with two amazing roommates who had delicious snacks around the house.  I stole their food and would replace it without their knowing... only to steal it again later on.  One time, one of them had taken a single bite out of a Snicker's bar and put the rest into the kitchen cupboard for later... I finished it, drove to 7-11, bought another one, took a bite out of the new one, and put it back in the spot I had taken it from.  I did it 3 nights in a row, finishing the partially started one and replacing it later on... she never knew.  When I told her about it, we laughed.  Then I cried.  Then I asked if she had half of a candy bar around for us to share.  Neither of them knew the kinds of things I did eating their food. I'm that good at hiding it.  So when I moved, I figured if I didn't buy the snacks and they weren't in my house, the problem would just go away. I was wrong.

It took almost a month for all of my stuff to arrive in Seattle from Connecticut.  I slept on a blow up mattress in an apartment with no furniture, enough clothing for one week, no dishes, eating rotisserie chicken with plastic cutlery standing over the kitchen sink.  I borrowed the money to move, so I didn't have much to spend.... but then I would find myself in Dollar Tree searching for cheap binge foods.  Trigger alert: Did you know they sell whole bags of mini Mr. Goodbars? And pints of ice cream?  And weird brands of chips?  And actual M&M's? Each for a dollar?!  I still cant make it out of the dollar store without buying foods I used to binge on... but now I can manage to only buy one instead of before where I would have bought a lot more.

I knew I did this for years in Connecticut... but it took me far too long to realize how much of a problem I was experiencing. I didn't know that it wasn't normal.  Other people don't buy a whole box of Cheez-Its and eat them in their car and then throw away the box so nobody knows it happened?  Nobody else walks to 7-11 with a spoon in their pocket so they can eat the whole pint of Ben and Jerry's and it never even enters the house?  Nobody else sees a coworker bring in a box of donuts and politely declines them all day long only to have the last three at the end of the day when the office has left and you've stuck around until the coast was clear? Anybody else feel like they've blacked out while they're eating only to realize the box of whatever you're eating is now empty... and not remember eating past the third bite?  Just me?  I was in the dark for a long time about what's going on in my head and what I've been doing to my own body.  Not any more.  It isn't just me.  

So I was alone in Seattle, no local friends, living alone, and starting a brand new career in a city I didn't know.  I'm working with a lot of youth athletes as well as with professional women's basketball players who are incredibly fit, strong, powerful, beautiful, and intelligent. I'm working in my dream job in the WNBA while morbidly obese.  How can I possibly survive this career promoting health, fitness, and exercise while I look like I do?  Who would choose a fat healthcare provider when they could have a fit one who looked like a healthy person?  I convinced myself on multiple occasions that any job I was not hired for that I applied to was because of how I looked.  Not because I'm a bit loud in personality.  Not because I was a new grad physical therapist.  I was certain it was because I was fat.  I tried to lose weight for the zillionth time in my life doing the Whole 30... but when I would reintroduce foods back into my diet, not only did I gain back the weight I had lost, but the binges got bad. Really bad. I go through cycles.  Out-of-control eating followed by a strict restrictive diet for a few months, lose weight, feel good about myself, and forget there's anything wrong only to lighten up a little on my eating restrictions and have it blow up in my face.  I'm not sure if anyone knew about my bingeing... certainly nobody confronted me or offered help.  I don't remember ever being caught.  I did it in private.  Correction: I do it in private.

I really wanted to fix this problem on my own, without ever discussing it or telling anyone else.  I was ashamed.  I'm still ashamed.  Though I'm starting to learn that there's no reason to be ashamed.  The Whole 30 was my last attempt at trying to go it alone before seeking help.  I didn't know what I was looking for.  For years I had told myself that I just needed to learn self control... restrict eating sugar, go on yo-yo diet episodes.  My best friend told me in college that I was happiest when I was on a strict diet. (She also told me I could make friends with a squirrel... isn't she the greatest?!)  But she's right.  Somehow, when I diet, I don't binge... until I stop the diet, and the binges take over. So I started googling online tests like "How do I know if I have an Eating Disorder."  I took about 7 of them.  (Here's one you can try if you're questioning this for yourself). They all said I did.  Every test said to get help.  They all recommended treatment. And then the creepy Facebook ads that read your mind started recommending the Emily Program.

So in February 2015, six months into living in Seattle, finally having made a few friends who all loved their therapists, I went to the Emily Program, a facility that evaluates and treats people with eating disorders.  They, too, have an online quiz you can take to see if you might need treatment on their homepage.  My intake paperwork took over an hour to complete with boatloads of tests asking me questions about eating habits, body image perspective, weighing myself, tracking my food, exercise routines... it was extensive and thorough.  I cried the whole time.  Not just tears streaming down my face... actual sobbing. I was so thankful I was in a room, alone, at a desk that was facing the wall.  I remember thinking... how does this place not have tissues? And why did this take me so long?  Not the paperwork... getting myself into an office where I could get some help.  

The intake specialist whose name I don't recall and whose face I could not pick out of a line-up diagnosed me with binge eating disorder that day. (Click the link and read about it.  This is National Eating Disorders Awareness Week, after all!). She told me I was not testing to extremes which meant I was unlikely to hurt myself beyond the damage of excessive caloric intake in short periods of time, and recommended some counseling.  I didn't need hospitalization or medication but was given a phone number to call in case I started considering self harm. So I set up some appointments with a therapist.... you know... one of those people we East Coasters despise...And I went.  And there was a couch in the room but I didn't lie down on it.  And I hated it.  Despised it. So I stopped going. 

I told my family.  I told a few friends. A few Seattle friends were recommending their therapists to try - maybe it had just been a bad fit.  But I was dead set against therapy and refused to do anything more than I had already done. Now I had an excuse.  I'd binge and then say - well, I have an eating disorder, so this is just going to happen. Then I'd do another round of the Whole 30 and lose the weight.

That was my cycle for the past three years.  A Whole 30, I'd feel amazing and lose weight, and then I'd have binge rages.  Despite the definition of insanity being "trying the same thing with expectations for different outcomes," I kept doing the Whole 30 because it made the binges stop, even if just for a month.  And I felt really, really good while I was restricting my diet.  I also read a book on mindfulness, a few about nutrition.  I tried the HeadSpace app for meditation... that one I really despised.  I started doing yoga - which I wrote about here - and which was the only thing I tried that I actually enjoyed and helped me channel my energy in a new way, but it wasn't changing my eating. 

All this to lead up to the fact that I had my annual physical in 2018 and my primary care doctor flat out told me to go see another therapist. For a lot of reasons.  She told me that I shouldn't feel like I needed to figure it all out on my own. And that's where this blog post came to be.  I'm sitting in the waiting area for my intake session with my new therapist, freaking out, and for some reason, I started writing what was going on around me to distract me from the fact that this couldn't possibly go well.

I had to fill out paperwork asking me questions about how frequently I'm sad or anxious or can't get out of bed or don't feel joy the way I think other people do, and what brought me to treatment and, as is typical for me, I was way too early, so I got stuck sitting in the waiting room feeling like I was running down a hallway naked. I'm holding a book on my lap but I can't possibly read it.  I'm wondering ALL THE THINGS. Can you talk to others in the waiting room of a therapist's office? (I wouldn't at the dentist... why would I think of that here?) I need to go to the bathroom, but don’t know where it is, and the lady that's also sitting here seems comfortable here, unlike myself.  I need to go before my session... oh she smiled at me I guess it’s OK to maybe ask. Thank you, kind stranger also working on your mental health for pointing to a door.  Walking around aimlessly didn't seem like the right approach...

Back from the bathroom... are there any men here? I've been here 20 minutes and have only seen a few women.  Otherwise this place is too quiet and there aren't enough pictures on the walls.  Why is the music playing so loudly?  How was my previous sentence that the room is too quiet while also feeling like the music is too loud?  Awesome, they have coffee... oh wait, I don't drink coffee.  Oh... the other side has tea.  And that lady just stole 2 tea bags and put them in her coat pocket!  Seriously? Maybe one of the therapists here treats kleptomaniacs... should I admit that I'm a pen stealer?  Yes! A man! Oh, he works here. Figures.  Men never have problems.  Wow my sarcasm level is elevated sitting here.  I'm starting to sweat.

Checked the time on my phone. She's running late. I never run late. I already said that. I also don’t generally feel like I’m a nervous person.  When was the last time I was nervous?  Oh yeah - that was when when I had my work annual review.  My boss is my favorite person on the planet for 364 days of the year and 365 on a leap year... but then all of a sudden she’s a Dementor because we have to discuss my performance. I normally wear scrubs and a light shirt to work, but for that first review I chose to wear khakis and a long sleeve work jacket because I'm getting reviewed and maybe I should look a little bit professional... And then I was sweating and my heart was racing.  Yep... I can remember exactly one occasion where I was considerably nervous in the past year... until right this second.  I'm not sure which is worse.  Actually, that's not true.  I'd rather be sitting with my boss.  She already knows I'm crazy... this therapist does not yet know.

And then she brought me into her office. Of course she would also be thin and gorgeous...how can she possibly know anything about being fat? That's not going to make this easy.  I can't possibly like this therapist woman who looks like she's the same age as me and if we met at the bar, we'd probably get along just great. With my own new patients, I start with "What brings you into Physical Therapy today?" and then follow with "Have you ever had physical therapy before?" which, if they have, I ask, "how did it go - what worked and what didn't work for you?"  I didn't even give this therapist a chance to ask her usual questions, I just blurted out the answers to those from the very start in a stream of consciousness - kind of like this blog post has come pouring out of me:

"I come from a place where there is a stigma against therapy and that makes it hard for me to buy into this process. I know the impact of buy-in on outcomes and am willing to try to overcome this barrier. I never connected with my previous therapist because she was constantly saying 'I'm curious about...' and I would count how many times she said 'curious' in each session which was insanely distracting. I really need you to be receptive to what I'm saying until we get comfortable with one another and I need you to not be curious.  I know that if this relationship doesn't work out, there's no chance I would try this again with a third therapist, so basically you're my last hope. I don't want to do this... but I need to do this." Yes I sounded that desperate.  No I didn't cry.  She asked me to commit to six sessions and that we would re-assess then.  I'm certain now that she's the second best decision I've made living in Seattle... the first was working at Seattle Children's, which I celebrated two years at yesterday.  Thank goodness they somehow didn't notice that they were hiring a fat physical therapist... or if they did, it wasn't a barrier for them.  They do list Diversity and Inclusion as one of their workforce values... I'm not sure if obesity fits into that, but I'm happy to make the office photo look a little bit different.  To be honest, with some of the kids we see, it may be the best thing for them.

So now I'm telling all of you.... many months later.  Because making excuses means I can't move on. Because if I say it isn't that big of a deal that I see a therapist or that I have an eating disorder... then it can stop being such a big deal. Because I work with kids, particularly teenagers, and I sometimes suspect that they're experiencing similar issues to what I'm experiencing and they don't know what to do... so here's one more piece of noise on the internet that maybe they'll come across and ask someone for help.  Because I have a teenage niece and nephew who are surrounded by the pressures of middle school who I hope will grow to love themselves and be able to express themselves better than I am able to.  Because when I tell my therapist that something she's doing is bothering me - she stops doing it.  Just like I do with my own patients. And because of this, I now trust her.  Because I've been working on improving my "situation" - which is, I'm told, a disease - even though, until I knew I had it, I don't know that I realized how sick I really felt.  But truly, a lot of the time, I actually feel quite sick.

I'm learning a lot about myself and can see things changing, particularly my mood, which has actually gotten considerably calmer without so many extreme sugar-insulin spikes - but other things as well. Things got a lot worse before they got better.  They might get worse again... never know what that sneaky therapist might uncover. I haven't been on a diet in eight months.  Before that, the longest I think I've gone was three months without dieting for the past 20 years. I am out of my comfort zone.  No diet = weight gain = a lot of inner struggle.  I want to be on a diet.  I want to be off sugar.  I want my pants to fit. But I'm learning that I can't do that because in the end, it makes things worse.  So I'm going to try trusting the process and realizing that I have a crew of people lined up to help me now... there's a dietitian in the mix... is there a stigma against that, too?  And so what if my old pants don't fit... I can just buy some new ones.  Or wear scrubs.  They have an elastic waist band.

Come as you are.

The Battle Against Fat Continues

Let's kick of some 2023 blogging with a controversial topic, shall we?  The Battle Against Fat continues.  If you've never met me in person, you may not know that I am fat.  I don't say that in a derogatory or negative way.  It is simply a descriptor of my body.  I'm not really short or tall - average in height.  But I am apple-shaped and thus, fat is an accurate adjective to describe me. I don't choose to be fat. In fact, I spent my first 30 years yo-yo dieting in an effort to make myself smaller, having great successes followed by even greater reversals. With support from a therapist and a dietician, I've learned to accept that this is the body that I've got and overall it does it's job pretty well, even if it isn't the socially approved size. That doesn't mean I don't wish I was smaller - it just means I'm no longer torturing myself to try to achieve that and instead strive to live healthily. 

cartwheel

I've previously written a few posts about my own experience with binge eating disorder and recognize that this impacts my beliefs about weight loss and body size. I have endured plenty of weight stigma and fat shaming both personally and professionally. My body size has come up in conversation as a healthcare provider during hiring processes and I've received derogatory comments from colleagues.  

In Physical Therapy World, there are physical therapists who think we need to be thin, fit, and muscular to do the job we do... but the way I look is not an indicator of my level of fitness and it certainly has no relationship with how smart I am or how much I care about my patients.  Imagine if we had to be capable of performing all the things our patients and clients do?  I wish I could shoot a basketball as well as some of the basketball players I've been fortunate enough to work with. I treat dozens of gymnasts and have never been able to do a cartwheel... I don't think that's because I'm fat. It's because I'm terrified of landing flat on my face.

I have also been a patient with doctors telling me that losing weight would fix whatever problem I was in for. Problems which also occur in people whose body weight is in the normal range on the (horrible) Body Mass Index Scale. There are numerous articles about how bad the BMI scale is, including this one. It was NEVER intended to be used in the way that it is. I went to have a sleep study a few months ago and the physician kindly explained to me that the findings would not be as accurate if I did a home study because the equipment used at home can't accommodate higher BMI as well as the equipment in the hospital does.  I asked my doctor, "If I was skinny, which test would you have me do?"  He said "the home test," so that's what we did. I respected him for presenting the data around the differences and for placing the blame on the equipment rather than on my body, and for ultimately treating me the same way he would treat a smaller person. 

Often ignored in this conversation are the kids I work with who also have higher body weight who whisper that they're so glad they don't have to work with the skinny PTs because it makes them uncomfortable.  The ones who have cried because a previous medical provider blamed their pain on their body, or that they hate their own bodies and are self-harming or thinking about it.  In some ways, my body size has made several teens comfortable enough to tell me there was an issue for which I got them help. In the clinic, it crushes my soul when I'm working with pediatric patients whose parents call their own kids lazy or fat rather than encouraging them to be active and work towards health. Or that time I told a little girl that she was strong and she looked me dead in the eye and said "only boys can be strong, not girls."  Or the kids who come into the clinic and walk on the treadmill only to be excited by how many calories they're burning. Are we even teaching them the right things? Where does this messaging come from?! 

I have been asked numerous times from parents how to help their kids lose weight, and when I point out all the things their body is capable of doing as it currently exists, it's like I have a third eyeball. Follow that up with asking about nutrition at family meals or physically active habits the family shares and you would think I'm suggesting families should be surviving on raw broccoli and running marathons together.  The American Physical Therapy Association has a Position Statement indicating that it is within PT scope of practice to "screen for and provide information on diet and nutritional issues" in collaboration with a registered dietician. The problem with this is that there are conflicting views about weight and what "proper nutrition" is in the United States. If all the doctors are skinny, the fat patients will never be heard or given medical care. We have a serious problem, but I don't think we're fighting the right battle. Instead of the Battle Against Fat, we should be fighting The Battle Against Too Expensive Nutritious Foods, The Battle Against Unsafe Play Areas For Kids, The Battle Against Decreasing Recess and PE in Schools, The Battle Against Unaffordable Child Care and Housing, and so many other battles.  Instead, our healthcare system is again doubling down on the Battle Against Fat, but now they're doing it against children. 

On January 9, 2023, the American Academy of Pediatrics published a new "Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity." I really didn't want to share the link to the paper because it's downright awful, but I also think people should have the chance to read it and make their own conclusions about the contents, so here it is. It's really long.  It's hard to include clips of the guideline here, so I've only selected this one clip about Parental Obesity which is considered a strong predictor of pediatric obesity.  And yet we're targeting these interventions on the children. 

The goal of these Guidelines is to streamline clinical practice for kids who are fat.  There are numerous recommendations made, and perhaps they may have done the right thing in suggesting that more kids get screened for metabolic disorders, but all the recommendations are based on use of the BMI Scale, which was created by a mathematician studying white men to find averages - never intended for use in children or even to be applied at the Individual level. The Guideline even hints at this, mentioning that BMI is not the Gold Standard to assess body composition, but it is easy to use. 

To be very clear, I believe that this guideline will be harmful and do not support the recommendations, and I am fully aware that this goes beyond my scope of practice as a PT, but not beyond my understanding as a human. Two particular recommendations worry me above the rest. Depending on BMI, recommendation #11 indicates weight loss medications should be provided for kids over age 12 and recommendation #12 directs bariatric surgery for kids over age 13.  Teenage girls who haven't yet started menstruating and will undergo considerable body development over the subsequent several years should not be having surgical interventions to change their digestive systems. I'm shaking with disbelief typing these thoughts. I know I am not a researcher.  I know that I am not a surgeon who could conduct surgeries like this on kids, and I don't know which surgical methods they would even use. Nor am I a pharmacist who would be prescribing kids drugs which could be needed for their entire lives rather than focusing on so many alternative options. I'm constantly seeing teens in the clinic with body dysmorphia, body dysphoria, eating disorders or disordered eating, and low self esteem and there is already data indicating the severity of depression in teens.  How much worse can it get as we start to prioritize weight loss even more?

I've finally finished reading the Guideline in all of it's terror, but before I could finish, I helped facilitate discussions at an event through the University of Washington on January 19, 2023 on a similar topic.  The event was part of the University of Washington Center for Health Sciences Interprofessional Education Program where students work to increase engagement with different medical disciplines. Thirteen programs including nursing, dentistry, public health, pharmacy, and physical therapy require their students to select from a variety of topics for interdisciplinary discussions and there were about 100 students at this event discussing Weight Stigma in Clinical Care. 

Participants received two articles prior to the talk, which was led by Dr. Lisa Erlanger, a Family Medicine Physician in Seattle, and Dr. Erin Harrop, a Licensed Clinical Social Worker and Professor at the University of Denver. First, "Everything You Know About Obesity Is Wrong," a publication from The Huffington Post written by Michael Hobbs that exposed some really eye opening patient testimonials about the harms of healthcare providers participating in weight stigma practices.  The article begins by demonstrating the delay between science finding solutions and medicine implementing them: The story of sailors dying from scurvy, easily cured by eating citrus fruits, but that fruit wasn't provided as different (more cost effective) options were tried instead, resulting in more death. Startling statistics were included that try to paint the picture of how unlikely it is to maintain considerable weight loss.  How many children will need to be medicated in order for one child to achieve and maintain normal weight?  I don't think this type of study has been done yet.

The other article, "How and Why Weight Stigma Drives the Obesity 'Epidemic' and Harms Health," by Tomiyama et al, an opinion piece from BMC. When will physicians catch up to the studies that show that weight cycling is bad for health and that weight stigma is even worse!  It's like this quote from the movie Mean Girls, "I don't hate you because you're fat, you're fat because I hate you." (Also - that movie is somehow 19 years old!)

So the session began with didactic education including review of the statistics and memorable anecdotes from these articles and additional research, followed by discussions of case studies.  Students elected to participate in this discussion for a variety of reasons which they shared - concerns about their families, wanting to learn how to challenge fat bias, growing up overweight as a child and experiencing weight stigma, wanting to learn how to talk to patients or friends battling weight-related challenges, and more. 

Even as a facilitator, I learned new things.  For example, "fat" as a word is a descriptor of having adipose tissue, however the moral judgement applied to using the word has created a negative connotation. More recently, "fat" has been re-claimed by those who live in larger bodies in a similar way to how "queer" was reclaimed by the LGBTQ+ community and the associated attitude towards these words are evolving.  Previously considered as a slur, "fat" has been  reclaimed as an identifier and we need to move forward to increase awareness and reduce stigma. 

"Headless Fatty"

Diet culture was discussed. An overarching set of societal beliefs that confuses health with weight, healthcare providers contribute to diet culture and weight stigma constantly and in harmful ways.  Diet culture encourages weight loss and correlates this with improved health, but it wrongly accuses fat as the cause for other conditions. It also moralizes things like: healthy food vs unhealthy, standing vs sitting, good movement vs bad.  It perpetuates a weight normative approach with a focus on BMI and having an "ideal" body weight. Health-ism occurs, as well, where providers may be accepting of higher weight AS LONG AS there are no metabolic health concerns. A common representation of diet culture was also mentioned: The "Headless Fatty" - showing pictures of large bodies without a face, a common, dehumanizing weight stigmatizing behavior. 

How does diet culture show up in healthcare?  The most common scenarios I've come head to head with are surgery being denied due to higher BMI and inadequate equipment availability. Orthopedic surgeons are frequent flyers in weight stigma, opting to avoid surgeries because there may be higher risk of infection in larger body sizes or predicted outcomes being less than desirable, sometimes including required weight loss prior to intervention. It's a frequent occurrence that poorly fitting blood pressure cuffs are used on larger bodied patients, which elicits inaccurate readings.  Waiting rooms at clinics may not have chairs that can accommodate a larger bodied person. Sometimes tests have limitations so they're not conducted on patients, thus increasing their risk of illness due to equipment and lack of training.  I already mentioned my own experience with sleep testing at home.

The discussion at UW did touch on the new Clinical Practice Guidelines, which was timely.  There were some resources shared including a blog from Ragen Chastain who writes about why the guidelines are harmful here. She included mention of unlisted conflicts of interest for many of the authors for the Guideline, as well as the American Academy of Pediatrics, with financial incentive from the pharmaceutical company that makes weight loss medications. I just feel icky reading this, but agree with her that while the authors may have good intentions to improve pediatric health, they may also be misguided and lacked input from eating disorder specialists and mental health providers who could have helped improve the guidelines to make them safer. 

Healthcare providers - if you congratulate your patients for weight loss without asking them about the behaviors around their weight change, you could miss serious diagnoses.  Like cancer, or an eating disorder, or celiac disease, irritable bowel syndrome, heart failure, diabetes, or thyroid problems.  You may have good intentions, but plenty of people lose weight and do not gain health - or even feel poorly.  The underlying goal should be health - not small bodies. Think about how you define health?  I've previously written a blog post about the different types of health, but I think that we, as healthcare providers, often exert our own beliefs of health onto our patients rather than hearing what they find important.  Usually people defining health choose functional answers, like ability to do certain activities.  The common medical definition of health is "Freedom from disease," but if this is the case, most of us will have periods of episodic or constant non-healthy time.  I used to think health was a thin body, but at my smallest, my mental health was poor and I was restricting so many foods, I couldn't maintain that lifestyle.  My smallest was bigger than many people will ever be, and it didn't bring me any happiness because I was in a constant brain fog from hunger and distracted by constantly wanting my next meal.  My biggest size didn't necessarily make me feel good, either, but at least then, I was able to eat and focus on my work and the challenges I faced were different.  Regardless, I have been the same person at every size I've been.

I'm sure I could continue discussing this topic ad nauseum, but I think I'll stop here.  Here's to hoping the kids stay healthy and safe. And good on you, University of Washington, for finding a place for these more challenging conversations in your medical programs' curriculums.

It Takes a Village

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© Sgame

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Happy Thursday, blog followers!

Warning: In this week's blog post, I'm being selfish.  I'm making a situation that has nothing to do with me, entirely about me.  But it's OK to do that if you admit it up front, right?

This past week, I received some terrible news. The instructor of my weekly Turbo Kick class, Meg, informed our class that she is moving away.  I’m sure she’s making all the right decisions for her family, but to me, this was crushing, devastating, drop me to my knees in tears while unnecessarily over-reacting, punch me in the gut, painful news. I didn’t see this coming. I’m not prepared.  Do I have enough time to get used to the idea of a new instructor coming in?  It took me SO LONG to psych myself up into attending her class in the first place! And it just can't be the same with another instructor.  Say it ain't so!

So, this week I'm writing about the village of people I've assembled to help me get my health in order as well as the positive impact of attending group exercise classes. This was a great reminder that you might be changing someone else's life without knowing it.  Sometimes I forget this when I'm working with my patients.  I have no clue how I've impacted people other than with their physical therapy, but I hope I've helped others the way Meg has helped me.

I joined the YMCA in August 2018 as part of my elaborate and carefully plotted plan to combat my eating disorder and body image issues, which I first discussed here.  I had been in severe denial about what was going on in my life, blissfully ignorant to reality, and had started seeing my therapist at the same time.  I decided to create a small village of people to help me with my journey: a therapist, a dietitian, someone to revamp my physical fitness - who ultimately became Meg - along with some family and close friends. I was entirely unmotivated to move my body - which I was currently hating - and I was sick of my training routine. I wasn't looking for group classes when I joined, hoping could manage my physical health myself, but considerd I might need another person in my village to oversee that, too.

I was initially opposed to group classes because I experienced a particularly uncomfortable CrossFit situation when the instructor told me that "a girl of my size should be lifting a lot more weight." To some extent he was correct - I could squat and deadlift a lot more than I was using there.  But at that time I hadn't been training much and knew the planned workouts included high repetitions and the volume was too much for me to load up the barbell as they recommended.  They pushed me to lift more, I pushed back saying I wasn't ready, and it was ultimately an embarrassing and painful situation.  It is specifically why I treat my own patients meeting them where they are - not where I want them to be.  So I had that experience, plus, I hate the idea of people seeing my body moving.

2008 CT Sun Yoga Class

Those reasons led to apprehension for group classes with the exception of yoga. In 2008 I went to a group yoga class with the Connecticut Sun and have been able to continue with yoga intermittently since then. I wrote about my recent return to yoga here, but, as I previously wrote, I only do hot yoga where I get high (or delirious) from oxygen deprivation that I basically can't tell anyone else is in the room.  Group exercise class?  For sure the others would notice that I'm fat, that I can't jump, that I will get tired, that I sweat a lot and breathe heavy, and that I'm not very coordinated.  Now, many months later, I'm here to tell you none of this occurred.  It was all in my head!

In October 2018, after walking by Meg's class on several preceding Mondays, I finally talked myself into trying her class.  I told myself that I knew the music was good and that I had to complete the class but that if I absolutely hated it, I would try one different class before swearing off group classes for the rest of eternity.  Dramatic much? Thankfully, Meg ran up to me that first day, super spunky and upbeat, introduced herself saying that her class was super fun and that it didn't matter if I knew any of the steps, just keep moving however I wanted to. I've been hooked ever since.

Here’s why Meg’s departure hit me like a ton of bricks.  I was in a deep dark hole of emotions and confusion when I started this journey and quickly learned that I needed to ask for a lot of help. I built my village including three smart, beautiful, strong women to help me pick myself up off the floor and put my pieces back together.  My therapist and dietitian knew each other, use similar approaches for treatment, and know all about my issues. I don’t think they intend to be sympathetic towards me, but sometimes they are, and sympathy isn't what I want or need.

But Meg is different.  She's not sympathetic towards me because she has no reason to be. She doesn't know why I'm in her class or what I'm dealing with. She barely knows anything about me, really, and that's just how I liked it. She's empowering and motivating because that's in her nature. And yes, it's her job, but there are other instructors in there with totally different vibes. I've walked by their classes a bit, too, wondering if I should add to my routine. Choosing her class was not a mistake. She welcomed me in, kick started most of my Mondays since October with high energy, a positive attitude, motivation, and joy. I purposefully attend her class right before going to see my therapist because turbo kick is basically a class where you can punch and kick your problems in the gut and my G-d I needed that.  It also lets out a lot of energy, which calms me and helps me organize my thoughts before saying them out loud.  When I started pairing turbo kick with therapy, I was really struggling to see my therapist because it was so vulnerable. Dance fighting with a room full of strangers is vulnerable, too, but way more fun than one on on conversations in a room with a couch and too many boxes of tissues.  I can’t actually tell which “treatment” has helped me more over the past six months, but I can tell you what this class did for me.

First- a group class has other people working towards their own goals- but the goals can be kept private as you work towards them together. I don’t know if people in the class are trying to lose weight, get stronger, let off some anger issues, or hear some current music. I don't know if they secretly wish to be a performer on a stage - but instead work as an accountant because they need to pay their bills. I don't know if they want to learn ways to protect themself if they were attacked, because truthfully, I would definitely use the moves I've learned there if someone came at me. I don’t actually care why they’re there. It doesn’t matter. We’re all going to do the same moves and at the end be disgustingly sweaty and high five each other with a sense of accomplishment towards our own goals.  I can go deadlift and have an awesome lift on my own, but there won't be anyone to high five me when I'm done. And because people start recognizing each other, it really does start to feel like community. Like if you missed a week, someone might ask if you were OK, or if you went on a nice vacation. Sometimes you just need that!

Second- all my concerns about other people watching me were entirely unfounded.  Nobody else is looking at what I'm doing in this class. They don't care. Once we get started, I barely even notice there are other people in the room, except to watch out for kicking my neighbor and to follow Meg instructing the moves.  Everyone is trying to get the steps right for themselves.  The rule is to keep moving even if you don't know the steps... but sometimes I know the steps and choose to do something different. For example, I CAN do burpees... but I hate them... so when there’s a burpee in the routine, I do jumping jacks or squats or whatever I want. Because for me, the whole point is to move. Not get better at burpees. Once I stopped exercising to lose weight and started doing it because it made me feel good, things in my life started to get a whole lot better. It’s still a struggle to make myself move regularly, so I attend a weekly dance party with some uppercuts and roundhouses thrown in and I actually feel like I’m prepared to conquer the week - whatever it may throw at me.

Third- and probably most important for my personal journey- the room is lined with a wall of mirrors. For the first several weeks, it disgusted me to see myself in the mirror. I was sure others could see how gross my body was. When I was diagnosed with my eating disorder, my testing suggested that I didn't have any body image issues. This was apparently very wrong. I've learned it was/is a huge problem. Prior to facing my issues, I didn't realize I was avoiding mirrors.  We have them at work, too, and I didn't even notice how much I put my back to them.  If I lifted at the gym, I didn’t want to see myself doing it. I don’t have a full length mirror at home and have never had one since I moved to Seattle.  I didn't actually realize how much I had been avoiding looking at myself until one class I caught myself in the mirror while doing a punching move and realized holy crap! That's me!  That's my body! It's doing all these things.  It's working hard and feeling pretty good. I’m actually able to tolerate looking in the mirror and smile at myself a little now.  That may not sound big... but for someone who went from not knowing what their body looked like at all and hating her own skin to tolerating her body and appreciating the things it’s capable of, I think it's huge. I’m sure somewhere down the road, there will be a time when I might like my body- and maybe even love it. That's not where I'm at right now, but I’m sure that the road started with the mirror in turbo kick.

And so, while I am sad to know my village is evolving, I’m eternally grateful for the role Meg played in it at the beginning.  Can't wait for the next Turbo Kick class.

2019 in Review

Reflecting...

This is my third "Year in Review" blog post since starting "Abby's World" in 2017.  (If you wish to read my previous versions, 2018 is here and 2017 is here.)  When reflecting on this blog, I feel gratitude to those who have read posts - one or many, I cherish the experiences that I've been able to document here, I acknowledge that I still don't know my target audience and I've embraced that.  I like that I chose a name that allows me write about random topics, though I wish I had come up with something more creative.  My mind wanders a lot... my blog topics only tend to wander occasionally. For the most part, I've stuck to Physical Therapy/Health and WNBA Basketball/Women's Sports, but I've thrown in some odd topics along the way, too, like this post which had weird photos of my eyelids.

In summary, since starting the blog, I've written 110 posts with a collective total of over 25,000 readers. I've had two posts eclipse 1,000 hits (this one about Physical Therapist Board Certification and this one about sport specialization), and I'm sure they're not my mom reading the same post 1,000 times. I posted less in 2019 than in 2108, but I also traveled and read a lot more. I like this pace and expect it will be similar in 2020.  Here are a few of the highlights from 2019, both personal and professional, and a look forward to what's coming in 2020. 

The beginning of 2019 was insanely busy.  From January through early April I supervised my first PT student who I wrote about here. In March, I presented advanced anatomy and biomechanics of the shoulder at a Youth Upper Extremity Injuries conference, which I wrote about here, and which showed me that I really enjoy teaching, though I would miss clinical work way too much to dive into that full time. At least for now. And then a week later was the Sports Certified Specialist PT Exam which I wrote about here.  Taking a student really opens up your time to focus on other things, at least when they're as good as mine was. I took full advantage of that opportunity. 

In 2019, I "came out" about my eating disorder with this blog post and shared some mental health struggles.  It's amazing how much better things can get when you 1) learn there is, in fact, a problem and 2) do something about it.  I faced these issues with a much bigger support system than I had anticipated, along with an army of healthcare providers, which made things so much better.  I spent many hours and even more dollars between my Therapist's office and my Dietician's office along with visits to my Naturopath and Gastroenterologist because adding foods back into my diet that I had been previously binging or restricting ultimately made me pretty sick. Like bent over in pain, leaving work early, and carrying extra clothing around in case something horrific happened sick. Unbelievable how much damage you can do to yourself but also how resilient the body is!  It could be that some of those foods made me start restricting in the first place, but we'll probably never know that. I'm certain that we need to continue working to de-stigmatize mental healthcare in the US. Too many people need help but are ashamed to get it, and it can make a huge difference in your quality of life.  

Justin Timberlake!

Despite having a persisting gut ache, I also traveled more in 2019 than ever before.  It started with a day trip to Vancouver, BC, on Valentine's Day to see Justin Timberlake in concert. Amazing.  So Amazing.  In March, an East Coast visit with the family and Climb to the Top of Rockefeller Center for Multiple Sclerosis for the fifth time (which I've previously written about here). I won't be climbing in 2020 but if you'd like to donate and support the cause, please let me know and I'll connect you to fundraisers! In May a trip to the Olympic Peninsula to check out Dungeness Spit and learn about that type of land formation. In June I headed East twice more for weddings, once with family in Ohio and then in New Hampshire two weekends later.  

World Travels

In August I enjoyed a life-changing opportunity to volunteer in Tanzania, Africa, for two weeks which I wrote about here, and which was has captivated my thoughts and prayers since. In September the AASPT Traveling Fellowship brought me to Ohio and Minnesota, which I wrote about here, and which impacted my learning and career goals in several ways. In October there was a quick snowy vacation weekend to Denver followed by a Thanksgiving trip to Connecticut to see the family, which I wrote a bit about here.  The year will wrap up with my birthday celebration in Portland, OR for some Trailblazers vs Lakers basketball.  Basically, I was all over the map and spent a lot of time reading and writing in airports.  Shockingly I have zero travel plans for 2020 right now, but I'm sure that will change. 

I read a lot of books in 2019, both fiction and non-fiction, thanks to audio books for the commute and OverDrive on my phone for while I was on the road.  Four books were listed in the syllabus for The Level Up Initiative, which I wrote about here, all of which were really awesome. My favorite reads of 2019 were "The Moment of Lift How Empowering Women Changes the World" by Melinda Gates, "Yale Needs Women" by Anne Gardiner Perkins, "Educated" by Tara Westover, and "Hunger: A Memoir of (My) Body" by Roxanne Gay.  I also listened to some podcasts and binge watched "The Handmaid's Tale" on Hulu... can't wait until the next season comes out!

There was continuing education, kayaking, basketball, and time with family and friends.  I didn't spend nearly enough time with my family, but hopefully that will change next year.  My biggest goal for 2020 is to purchase a house, so perhaps I'll write about that experience.  My student loans are finally under $80,000, so it only seems appropriate to acquire more debt, right?

As the sun sets on 2019, I'm wishing everyone a safe holiday season and look forward to writing more in the new year.  

Random Things I've Learned at Work

This past week, the new North Clinic of Seattle Children's opened for patient care! The facility is beautiful, a lot more space than the previous location, a whole crew of new staff that I've been having a great time getting to know along with all of my previous favorite coworkers making the transition.  It certainly doesn't hurt that there is a basketball court fully stocked with Seattle Storm basketballs and a fellow physical therapist who keeps beating me at knock out... eventually my shot will begin to fall!  (We're keeping score - he's up 9 to 3 in knock out wins... there is hope!) So after a few days of orientation, learning important things like where the AED is kept and how to badge into the parking garage, we're back to our usual routine of patient care and I'm up to my typical shenanigans - making silly jokes and setting up my desk with photos and toys like my Breanna Stewart bobblehead.  

Having just completed a pretty lengthy continuing education course about the knee which I wrote about here, I'm taking a short hiatus from my continuing education to read "The Princess Bride" (SO GOOD!) and catch up with friends while watching the WNBA playoffs get into full swing... so no PT talk this week! For the pasta few months, I've kept track of some of the random things I’ve learned at work, and now I’m going to share them with you. Watch out trivia- if we ever group together and compete, we’ve got all the major categories covered. It really helps that I spend every day surrounded by unique, intelligent people who have varied interests and experiences. This might be a simple way of saying my coworkers are awesome.

Random fact number one - learning about the NBA.  Today is Kobe Bryant's 40th birthday! I mistakenly thought he had made it to playing in the NBA until he was in his 40's because I also wrongly thought he had made it more than 20 years in the league.  While I knew he had gone into the NBA right after high school, I hadn't realized that he was only 17 years old coming in... too young to sign his own contract, which his parents had to co-sign.  While Kobe is not my all time favorite NBA player, what I love about him is that he played his whole career with the Los Angeles Lakers.  As a Boston Red Sox Fan, the only positive thing I've ever said about Derek Jeter is that he played all of his career with the New York Yankees.  Diana Taurasi and Sue Bird, both still playing in the WNBA but having spent more than a decade with their teams, are well on their way to doing the same thing.  Something about that loyalty and your relationship with fans in your community is really special... it makes me wonder what it would be like if I had the same job for 10 years.  I'm about to hit two years at Seattle Children's and hope they'll keep me for eight more!

Now, sometimes it isn't up to an athlete to stay put on the same team - other times it is their choice.  Someone who didn't stay with the same team for their whole career is LeBron James.  Interesting fact about LeBron is that he is 33 years old, (born December 30th, 1984, two days after I was born).  His older son is about to start 8th grade, which means that based on the current NBA rules, his son could be eligible to play in the NBA in 6 years.. making him 39 years old, about 2 years older than Kobe was when he retired.  I would argue, based on personal observation of health science used in the NBA, that LeBron has managed to stay healthier and keep his body in better physical condition to make it that far... and how insane would it be if LeBron could be playing in the NBA while his son was?  I searched - and could only find this article that describes fathers/sons playing/coaching in the major sports.  In the NBA it only has fathers that coached their sons or against them, but never were they both playing at the same time.  I'm rooting for this to occur, now. 

Second random fact: Do you or someone you know chew on ice? This could be a sign of a psychological (eating) disorder called pica characterized by craving or consuming non-nutritional items such as ice, paint, clay, glass, or paper.  This often corresponds to people with a nutritional deficiency such as anemia or celiac disease.  I learned about this with a patient who chews ice who also happens to be anemic.  So it might warrant some medical evaluation if you're experiencing this, because there may be a nutritional deficit occurring.  This is not to be confused with oral fixations like chewing on pens or gum or smoking that relate to Freud's psychosexual theories, which, according to this non-scientific article, occurs due to issues in infancy such as with breastfeeding and may not include consumption, but rather stimulation of the mouth. 

Third, I don't remember the context of the conversation in which I recently learned about stinging nettles, but, there is a plant that grows all over the world including in the United States, particularly in areas that rain a lot (yes, it rains a lot in Seattle), which has leaves with tiny hairs that when touched, basically turn into needles stabbing you all over your body!  (Too dramatic?)  It reminds me a bit of poison ivy, because that's what I encountered as a kid, but apparently it was shocking that I was unaware of this type of plant and have now read all about it.  Fortunately, I have not encountered this beast.

Are you having as much fun reading this as I am writing this?  Let's talk about wasps.  One of my coworkers is in a constant battle with his yard.  Several conversations about weed whackers, soil, lawn mowers, tilling... every time I'm grateful that I don't own a house yet.  Anyways, he was working on his yard and came upon a mud wasp nest.  Say what??? I did not realize how many types of wasps there were, but basically you can break it down into social wasps that make the typical paper nests I was picturing, more like a bee hive (though they're not the same) hanging from a tree or generally above the ground - or solitary wasps that make mud nests, more typically on the ground.  I'm never walking barefoot outside again.  I'm not sure how I haven't come across wasps while reading The Origin of Species... better get back to reading that so I can learn more!

Lastly - a little Physical Therapy related fun fact for my favorite type of patient: post operative Anterior Cruciate Ligament (ACL) Reconstruction.  If someone tears their ACL and has it reconstructed, the piece that is used to replace the torn one is called a graft.  Grafts can either come from the person who was injured - in which case they can use a portion of the hamstring, a portion of the patella tendon, a portion of the iliotibial band, or a portion of the quad tendon.  Sometimes, however, the graft is taken from a cadaver, and in this case, they may use the patella tendon, Achilles tendon, or the tibialis anterior.  I found this interesting because they have more choices coming from the ankle than from the knee when taken from a cadaver - and I also did not know that they used different sources for the graft, before now!

Anybody have some random thoughts to share?  Now's your chance!

Words My Mom Doesn't Want Me To Use

Many Words of Mental Health

This post is long overdue.  So are many, many others that are similar that I've half-written but are not completed and haven't published because I hate dealing with my own vulnerabilities and weaknesses. That's right.  Hate.  A word my mother banned me from using as a kid because it is so intense.  I remember her telling me that if you use the word hate regarding another person, you mean that you want them dead.  I'm sure I probably had used it towards my twin brother for hitting me... and ultimately I got in trouble for using a bad word rather than him getting in trouble for physical violence.  Of course I didn't want him dead... just to quit it with the wet willies. So hate is an intense word and I don't take that lightly. But it's appropriate right now.  The alternative would be saying that I can't do it... I'm unable... but that portrays weakness... and I'm perfect so I won't use that word.

Perhaps you've heard of the author Brene Brown.  I may have mentioned her in a past post, but honestly I can't remember.  She has written several books on various topics including, according to her website, "courage, vulnerability, shame, and empathy."  She has this quote on her home page: "I believe that you have to walk through vulnerability to get to courage, therefore...embrace the suck."  Ha! Suck is another word my mom wouldn't let us use as kids... funny how both of those words came up and a blog post was born.  I hate facing my own vulnerability so much that I was incapable of reading Brene Brown's book, Daring Greatly.  I tried. Multiple times.  I checked it out of the library, read the first chapter over and over again because I couldn't process it, and when I got the notice that it was due, I returned it.  My roommate really liked it and others by this author, and usually I agree with her taste in books, so I watched her Ted Talk on YouTube - which was OK... or tolerable - and checked the book out again.  Couldn't read it.  Physically incapable.  So I returned it and tried the audio book, but I never made it past her discussions of vulnerability.  It's dangerous to black out while you're driving but I felt like I tuned out the book and the whole world.  Specifically regarding Daring Greatly... and a few blog posts.... I can't walk through my vulnerability to get to the courage.  I'm a coward. Maybe I'll try to Dare Greatly again in 2019.

I've been writing this blog for many reasons... all of them selfish.  I'm not writing for you... I'm writing for me.  While I'm glad others are reading it, I don't actually care when a post only has 20 readers versus the more popular ones that have hundreds of views.  Oh!  There's another phrase I drove my mom crazy with as a kid... "I don't care."  She'd ask what I wanted for dinner... this was probably around 7th grade... and I'd say I didn't care.  But that's when I was trying to stop eating red meat so when meatballs or lamb chops showed up on my plate... I absolutely did care!  So many life lessons... thanks, mom!

Mom

Selfish or not - I'm hopeful that something I say helps other people.  I'm hoping some young physical therapists check out some of the continuing education courses I'm doing or some PT students learn from the mistakes I made earlier in my career. It would be awesome if suggestions I make help decrease some injuries in youth athletes or help people cope with their chronic pain.  When those more vulnerable posts do finally sneak onto the published side of the blog, I absolutely hope someone benefits from them... but I'm getting out what I'm putting in.  I won't pretend I'm doing this to be generous.  This blog has a much bigger purpose that has not yet reached full transparency.  Yet.

So why today's blog post?  A friend is in pain. Maybe not the physical pain that I treat in the clinic or chronic pain that I've written about so many times on this blog.  I'm not sure.   But there is suffering.  Sadness.  Emotion.  I got a phone call today and was told that they had decided to self-admit for inpatient mental health services a few days ago.  Only a very small number of people know and for some reason, I'm on the short list.  They wanted to know what I thought.  Talk about vulnerability.  Courage.  Strength. 

I think that others may be struggling who might need to hear this too. To be honest... when I'm having a down day... I need to hear these things myself.  Despite all my jokes, laughter, and smiles... I do have down days.  So here's what I think, and also some of what I told my friend.  And I'm sharing with whoever reads this... because it's the start of facing my own vulnerabilities.

1) Mental Health, per dictionary.com, is a) psychological well-being and satisfactory adjustment to society and to the ordinary demands of life; b) the field of medicine concerned with the maintenance or achievement of such well-being and adjustment.  Wikipedia says it's the absence of mental illness.  EVERYONE has a mental health status. And it isn't some concrete place that you're always going to be in. It's a fluid construct. There are times in life that are more stressful or more sad or overwhelmingly happy...  and your psychological well-being changes during those times. That doesn't make it pathological - or mental health illness.  But just by looking at someone - you really can't tell if a person has a pathological mental health or not.  Just like you can't tell I'm Jewish by looking at me... there's no sign on my forehead telling you these things you can't see.

Remember Robbin Williams?  He was a comedian and all around funny dude... and all you ever saw publicly as a fan of his movies was happy, jovial, doing voices Mrs. Doubtfire or Genie from Aladdin.  But underneath the skin was a dark place that most people couldn't have known about.  I refuse to believe he was sad all the time on the inside while happy all the time on the outside.  But I have no way of knowing.  And so - everyone has a mental health status - but more importantly - you never know what's going on with other people under the surface unless you ASK.

2) They are not alone.  I don't know what specific mental health circumstances my friend is going through. It's none of my business if they don't want to tell me.  I can be a supportive friend without details. Maybe other people react differently? What I do know from recent reading about mental health illnesses is that there are a long list of them - potentially including: anxiety, mood disorders, depression, body dysmorphia, PTSD, eating disorders, personality traits, social anxiety, diagnoses like schizophrenia or bipolar disorder, gender and sexuality issues... and TONS of people experience these problems. Unfortunately, this friend isn't the only person I know having some struggles right now.  The people I love are hurting... which hurts me, too. And so I told my friend about my own recent mental health journey and we couldn't understand why neither of us had discussed these things before now. Well... actually I don't talk about it because of that V word I talked about above... you know the one. Maybe that happens for a lot of people?

3) There's a lot of darkness going on in the world right now.  The news is sad. You can't go on social media without seeing really big issues - global warming, separation of children at the border, economic policy, gun control, starving countries, natural disasters.  All those big issues can make an individual feel pretty small and less important. But less important is NOT unimportant.  The holidays are coming up.  I'm personally looking forward to seeing more photos of children looking at Christmas Trees and Menorahs, families having meals together, and drowning out some of the bigger stuff.  Let's bring it all a little smaller, find ourselves a little bit, take a deep breath, and focus on the positives and things we can control.  Even if it's just for the month of December.

I can promise there will be more where this came from.  If you feel there is a negative tone to this post, you should know that in my head there is only optimism.  hope.  healing.  and love.