Let’s talk about PTEN

… said almost no one except us. Ever.

That’s why it was intriguing and exciting when Kristin Anothony from the PTEN Foundation contacted me last spring and asked me to share my story on a podcast. Kristin and I have been in touch since before she started the foundation that now represents all of us.

We met Kristin in person in 2018 when she flew to New York for a dinner where Meghan was being honored

We were interviewed for episode 2 of a 5 part podcast. The link is here…

I am constantly humbled by the number of people who interface with this blog. It is mind-blowing to me that people either stumble across this or come here on purpose to learn what our PTEN journey has been.

Back when we were diagnosed in 2011 the internet had sparse mentions of PTEN mutations or anything related to it. But, since I was a mom on a mission my first goal was to create a survival network of others who knew this journey. I connected with Australia, Virginia, California, Colorado, and Alabama. I later found others in places across the globe. And, even though we were all too far for gatherings, in many ways they became my closest confidants.

People dismiss social media, and as a teacher and a mom, I have seen the damage it can do. However, as a rare disease patient, I literally cannot imagine my life without it.

When a diagnosis that is new, scary, and uncertain comes your way, you need hope. You need success stories. You need to know that although it is hard, so hard that sometimes it seems impossible, you are not alone. Like so many other things in life, when used properly, it is good for us. When used in the spirit it was intended social media can be our lifeline, giving us the connections that we so desperately need.

And sometimes if you are lucky, one of your internet lifelines travels to New York from Virginia and you get to hug her in person…

Margaret and I in November 2021

And if you are not that lucky, well, you still are. Because we have an entire team right now, climbing Mt. Kilimanjaro in Africa to raise awareness for us, and to raise awareness of PTEN mutations across the globe.

The rest of the podcasts are linked here. The content is amazing, from Kristin, the founder, and president of the PTEN Foundation, to Ashley and Keegan, a PTEN mom and son who amaze us every day, to Dr. MacFarland and Dr. Frazier, much-needed and appreciated medical professionals helping us navigate this wild ride.

As we head into World Rare Disease Day this week, I encourage you to share your story. Share it here in the comments, or share it wherever you feel heard. It matters. You matter.

#beatingcowdens

…in the basket of the shredder

The primary care, a title he earned through the path of least resistance, abruptly left the practice in December. There was no notice, and I found out quite by accident. But, none of that surprised me. Very little surprises me anymore.

After 12 years of a formal diagnosis, and a whole lot more than that at too many doctors all the time I just shake my head.

Don’t let it define you they say. Except it takes so much time. All the time.

We need someone to check the boxes. In theory anyway. We need someone with a license to order the diagnostics so we can avoid a few specialists. This PTEN team is often left without a captain. I sometimes feel like I am playing all nine positions at once, and the irony that I cannot throw or catch is not lost on me.

I’ve been on the phone for 2.5 hours trying to get a refill on a medication that my college-age, currently out-of-state girl has been taking for years.

The pharmacy can’t fill it without a doctor. I get it. I called the office (HIPAA on file is my lead in… all the time) and they can’t fill it until she sees someone. The last refill was in November. She’s not due home until the 7th of March. I offered to make the appointment and asked them to review her chart and authorize it in good faith.

No. And that was a hard no. A conversation ending block from a medical assistant who undoubtedly is following rules. But the rules are made for situations that fit in boxes. We pretty much live in the basket of the shredder. There are no definable boxes anywhere in our lives.

So, I made the appointment for March 7th for the two of us. Her medication will have lapsed by then. And when it is called in I will end up paying an extra $30 to expedite it. It’s not about the money really. It is that that fee is for people who wait until the last minute. I don’t.

We will go on March 7th together. I already met this doctor at my husband’s appointment to transfer primary care. I asked her if she was willing to take on two patients with PTEN. She looked a bit like a deer in headlights but reluctantly agreed.

I was online this morning trying to print out a guide for physicians who have no idea what our disorder is while trying not to be frustrated that we are once again caught up in the red tape of a system that requires the two of us to see ANOTHER MD who has NO IDEA what we need, so we can tell them what we need, so they can make us jump through more hoops to get it.

I’m grumpy.

I get that the rules have to exist, for the 90 percent of us without rare diseases. And, somewhere I understand why the other 10 percent of us have to suffer.

But, just because I understand it doesn’t mean I like it.

There has to be a better way.

And when I searched I found this site… https://www.ptenresearch.org/for-families-living-with-phts/additional-resources-and-information/useful-links/ Which ironically includes a link back to this blog. Which is both flattering and mind-blowing to me. I can’t do anything besides commiserate!

Fortunately, the PTEN Foundation came through again and I found this on their website.

pten-brochure-2023.pdf-2Download

But I am definitely suffering from fatigue while

#beatingcowdens

Dark Days/Finding the Light

I am a March-August kind of girl. I love warm weather and lots of sunlight. Long walks are my favorite. There is nothing that soothes me more than putting on a pair of sneakers, putting my music on, and just going.

I find the fall stressful. Maybe it’s years of being a teacher. There is hopeful anticipation about school in September, but the organization and logistics take forever, and the fall germs are just… a lot.

Before I have time to look up, the days are getting shorter, the leaves are falling, and it is time to pull out the sweaters.

I go through the motions dutifully, cleaning and organizing, but I lack the excited anticipation people have when they smell pumpkin spice and start to see their breath. I just don’t get it.

I think I was always this way, but in fairness, so many emotional events in the fall and winter may have given me the final shove into my aversion for those seasons and bolstered my affinity for my spring allergies.

Given all that, it might seem contrary to say that we decorate early for Christmas, but we do.

Remember, I love the light.

Our tree is up by Thanksgiving, and the lights around the house are on every possible second. I love buying and wrapping gifts. I take comfort in our advent calendar and the excitement of the impending arrival of the baby Jesus.

My faith anchors me through the tumultuous turns life tends to take. It keeps me grounded and focused on the fact that this life is merely a stopping point on a journey to forever.

I grew up in a church. I spent so much of my life there as a child, and a teen that I could navigate the building with my eyes closed. I stayed at that same church after my husband and I met, and it was there that we married and had our daughter baptized.

And as ironic as it is, it is the place I had to walk away from when our worlds got turned upside down with all things PTEN and Cowdens Syndrome. I had to walk away from the place to continue to nurture my faith.

When you grow up in a community of faith, it is hard to accept that reality. I miss weekly services, Angel Trees, and Christmas shows. And sometimes that disconnect can make the dark days extra hard. Yet, in the apparent contradiction that is often reality, my faith has continued to grow through the years.

So, this morning my new normal involved my air pods, my iPad, and my orchids.

Today I “went” to church in Buffalo and in Sarasota, and I never left my house. I sang and prayed and smiled and pondered through Western New York Church Unleashed, and Faith Lutheran Church in Sarasota, Florida. The pastors are comforting and familiar, especially Eric, my brother-in-law in Florida, and also Roger, Jeremiah, and Steve in Western New York whom I have never met. The same internet which often isolates us from each other, keeps me connected to my faith through Advent and beyond.

I took some time with my orchids. My beautiful, perfectly imperfect orchids, that I feel a strong kinship with. Somehow, despite the odds, and without any traditional interventions, they blossom and grow in the most amazing ways.

I spend too much time alone and find it easy to be lost in, and overwhelmed by my own thoughts. Cowden Syndrome is ever present in our minds and bodies, even when the medical drama is on “pause.” The anxiety and anticipation of a lifetime of justifiable worry can make so many things, just hard.

Today I was reminded to give thanks in all circumstances. I was reminded to pray without ceasing, and I was told that you can have joy in your heart, even when you are not happy. 

Life is a contradiction. Emotions yield guilt way too often. But, I have learned that feeling all the feelings is the only way I will survive and thrive in this crazy life.

I do not like the winter. I will never enjoy the darkness. I love the lights of Christmas and I eagerly await the birth of the baby Jesus.

I promise to stop and smell the “orchids” while anxiously waiting for the first sneezes of spring.

Wishing you and yours peace throughout this season.

#beatingcowdens

Ella, Buddy, and Jax bring us so much joy…

Dragon Scales

Art on Instagram@vic.ink_

A dragon?

That’s what I thought to myself when she first told me. That, along with a million other mom thoughts that happen when your 20-year-old declares that a new tattoo is coming.

However, she and I have developed quite a solid, trusting relationship through the years.

We are at a place where she can know that I’d rather she didn’t, but I can still be happy for her when it turns out exactly as she needed it to.

She understands herself, and that is a life goal many never achieve.

When I asked her to put the reasons behind the dragon, she sent me this…

I’ve been poked, prodded, and cut open my entire life, and I’ve never wanted any of it. I needed to do it to survive.

I am 20 and covered in scars that bring those memories back every day. So, I decided I needed to pick what happened to my skin for once, and that’s how my love for tattoos began.

It became a way for me to tell my story and show people what I was about when they saw me. I got to define myself and what I wanted to see on me as well as what I wanted others to see.

This time I picked a medieval dragon design, and I am over the moon with my artist and how it came out.

I spent a lot of my youth feeling weak, broken, and frustrated I couldn’t protect myself, all while reading through fantasy books faster than most could think. So, I got a dragon done because it was always my favorite creature and it was the epitome of strength, with impenetrable scales, and fire breath that meant no one could mess with it. I want to be that, and it’s my everyday reminder to work to a place where I have scales strong enough that no one can mess with me and fire breathe that allows me to take care of myself and keep my mind and body safe.

Oh, and the three stars are for our family of three…

It is impossible not to be proud of her, and grateful for the relationship we have.

Cowden Syndrome can be very cruel. But, my warrior kid is out there every day…

#beatingcowdens

Happy Thanksgiving from our family to yours.

Dirty Little Secret

Remember that killer headache you had last week? Or the time you fell off your bike? Or the day you slammed your finger in the door? What about the time you had a gallbladder attack and you ended up in surgery? Remember your most painful experience. Think about how it consumed you, and how hard it was to get through. Think about the people who cared for you and how glad you were when you were past it.

Remember the support you received after your injury/ surgery/ accident. Remember those people checking in on you and encouraging you. I bet if you think about it, one of the things that carried you through was knowing it would pass. No matter how dark it got, you knew that one day, with rest and medication and therapy and support you would feel better again.

But what if the pain never went away? What if there was always a residual pain, just present enough to occupy precious space in your mind 24/7/365?

I was, yesterday years old when my almost 20-year-old said something I don’t think I had ever really given much thought to. She said some people have no pain. I think I struggled to process what she was saying. So she said it again. To be honest the thought of having no pain was kind of mind-blowing to me. She and I both deal with pain, pretty much all the time. I think maybe it has been easier for me to deal with because I never realized or gave much thought to the fact that this is not the same for everyone.

Chronic pain is treated like a dirty little secret. You can’t talk too much about it. It is a buzz kill. It makes a room heavy. It makes people uncomfortable because even the most well-intentioned people do not know what to say or do. And if your chronic pain lasts, well, forever, talking about it is frowned upon. Talking about it can also generate unsolicited advice, “cures,” and shame. Many people cannot imagine that some bodies hurt. All the time. No matter what you do. So they resort to blaming the person who hurts. It must be their fault. They must be lazy, stressed, overweight, have poor eating habits, lack exercise, or they should just “relax.” It must somehow be their fault.

Blaming the sick person is a protection we use. I have done it. I think we all have. We often do it because we are glad it is not us who is sick or in pain. We want some concrete intellectual assurance that it can’t/ won’t be us. So, when you have chronic migraines, and someone asks you why you haven’t found your triggers yet, or when you have joint pain, and you get told to stretch and strengthen, or when your stomach pain is met with “calm down, it’s just stress…” someone is trying to make sense of what you are feeling. In this society, we want a pill or a medication or an easy repair. They are trying to “fix” it, but in doing so often the person in pain is now left also feeling like a failure.

And that patient blaming is not limited to colleagues, friends, and family. Patient blaming is on fire in the medical community. While some practitioners understand that most people do NOT want to spend their whole lives at the doctor, there are others who will find every reason in the world to make you believe you are a depressed, pill-seeking fool.

So those who endure/ survive/ function with chronic pain start to feel like they have a dirty little secret. They feel the pain is their fault and they have something to hide. They feel burdened by this pain that is involved in every single thought and every single move. All day. Every day.

Imagine a song you hate so much. Now imagine that song playing in your ear. All the time. When you try to sleep – it’s there. Taking a shower – it’s there. At work – still there. Out to dinner – yep, still there. The volume button broke. The song is stuck in a loop. It is just enough to keep you distracted but not loud enough for anyone else to hear.

The first few times, you tell someone it’s there. It’s loud. It is annoying. It is hard to concentrate. At some point people tire of hearing this, and tell you to get it fixed, or get over it. They can not even hear the song, but the thought of you mentioning it gets them twisted. So, you stop talking about it. But it NEVER STOPS PLAYING.

So, being aware that you need to do herculean things in a body that has the strength of a sloth, you press on.

You go to school. You meet up with friends. You go to work. You make polite small talk. You pursue career goals. Because you know that we only get one chance at this life and you don’t want to miss it.

And you bargain with yourself. You make little deals along the way with this body that has this terrible song playing so loud that a chunk of your focus is off, and everything you do is just harder than it should be.

You try so many things to get better. But you don’t talk about them. Because hearing someone tell you what should have made you better by now, or listening to the stigma of many alternative treatments has you wiped out and on the defensive. You don’t need to explain. You don’t want to be scammed, or judged. You just want to feel better.

While you are pressing forward, using every ounce of strength that you have to complete daily tasks, it is easy to pull away, even from those closest to you.

It can be so hard to be appropriately sympathetic to a skinned knee when the thought of amputating your most troublesome appendage crosses your mind at least every few days. Your rational mind knows the skinned knee in fact does hurt. Somewhere in the chasm between “I wish someone understood me” and “I want to be a generally decent and kind human” you find the words to say that you hope that skinned knee heals quickly.

Hope. It is the most powerful weapon we have. And sometimes we have to dig it up and polish it off and look at it for a long time. Sometimes we are afraid to dare to hope because we have been disappointed so many times before. But, hope. Hope is everything.

So what can you do if you love someone with chronic pain? How can you relieve some of the burden of this dirty little secret?

Some tips? Remember that it is there. All the time.

Be available for a hug if they want it.

Be encouraging but not patronizing. Use empathy over sympathy. And nudge them forward.

Don’t try to fix it. You can’t. If you could they would have already done it.

Sometimes quiet proximity is the best thing in the world. Being “alone together” can be reassuring.

Believe that they will do all they can when they can.

Don’t stop making plans, but be flexible whenever you can. Pain levels are not on a schedule.

It is hard to be in pain. It can be torture to watch the person you love in pain. By the way, they know how tough it is on you. It is why they worry so much. They have been abandoned before for being “too much” and they don’t want you to go too.

Show your person you want to stay. Show them that despite the dark times, their light is something spectacular you want in your life forever.

It is ok to remind them sometimes that they are a total badass. It’s not a title they were seeking, but it is well-earned all the same.

Cowden Syndrome in and of itself does not cause chronic pain. But, the ramifications of living a life of it, well that can. In our house, we stay active. We stay healthy. We go to work. We go to school. We pray and laugh and love each other. Together. In this house, we know that great things are possible even in the midst of relentless physical pain.

We have goals and we will succeed. So if you see us sitting on the bench, don’t count us out.

We remain….

…#beatingcowdens

This topic has been on our minds this summer. Send us your thoughts on chronic pain. We’re especially interested in the best and worst things people have said to you or a loved one in pain.

Meghan and I on our best days will always choose ‘Joy!’

My (Unsolicited) Advice…

I remember sitting at my computer in early 2004, sensing that things were not right with my then 4-month-old. A tumultuous birth was followed by months of colic. I was sure I was doing everything wrong. There were formula changes and pediatrician changes. Then in February of 2004, she was hospitalized with a cellulitis infection on her face. Ultimately we were released from the hospital, but I knew I would never rest too easily again.

We searched and searched as illnesses lumped on top of each other and bled into surgeries of odd growths. We started early intervention for Speech, OT, and PT. There was gall bladder surgery for “milk of calcium,” tonsils and adenoids, and so on. This slid right into an arteriovenous malformation in her knee, and the list just kept growing. We saw so many doctors I could not keep up. It was a giant game of “whack a mole” and there was no end in sight.

I buried myself in the internet, trying to find anything to help me understand why my girl was just not healthy. The internet in 2004 had a fraction of what is available in 2023, but it was a start. I learned to find credible sources and to look up words as I read the vocabulary in complex medical journals.

Although nothing could have prepared me for the diagnosis that came late in 2011 after our PT and angel Dr. Jill sent us to genetics because, well, “something isn’t adding up.” Dr. Jill was right, and it took the geneticist about 45 minutes of skillful conversation, some sneaky analysis of her motor skills, and a tape measure to declare, “I believe I know what she has, and I think you have it too, Mom.”

6 weeks later a genetic test confirmed a mutation on her PTEN (tumor suppressor) gene, and 4 weeks after that mine was confirmed as well.

And suddenly, at 8 and 38 we were members of a very tiny community that seems to be experiencing exponential growth these days. The numbers we got were 1 in 200,000, and the inheritance was “autosomal dominant” although we can not see evidence of it on either side of my family besides me. There were a lot of answers to a surgically rich history of my own that came with the diagnosis.

A good deal of our journey is chronicled in this blog which began in May 2012, and things I have learned along the way are peppered through the posts. But, as my girl turns 20 this summer I have a chance to look at things as the mom of an adult child with a PTEN mutation.

I’ll share this (unsolicited) advice with you:

1. You ARE an expert on your child and you ARE a valuable member of their team. Go ahead, read that again. The team should be filled with brilliant and well-researched doctors. Who you choose to be the CEO of that team is up to you, as long as the parent, or the child as they age, are a part of the team as well. It is my opinion that a doctor who lacks confidence in their own ability is the one threatened by well-intentioned questions from those on the front lines-the family. If a doctor is upset by your internet searches, do not promise to stand down, ask for guidance as to how to seek reputable sites and worthy information. Most of them have searched your condition soon after they met you, or right before your first appointment. I have even found practitioners searching Google in the ER before seeing us. I do not fault them for not knowing everything. No one can learn about every rare disease in medical school. However, if they make you feel foolish or less than for seeking answers – FIRE THEM. A solid medical professional knows your disease well enough to ask the right questions and is comfortable learning for you and alongside you. You are parenting a zebra, a beautiful, perfect, rainbow unicorn zebra. They should be treated as such. Do not let a doctor who is uncomfortable learning new things, or thinking outside the box intimidate you.
2. Your child knows something is up. Trust me. No matter their age, their IQ, their ability to verbalize, or their personality, they KNOW. They may not know the details but they know you are worried. Think about how many hours you are spending trying to find answers/ juggle appointments/ balance a job/ fit in additional costs/ care for their siblings, etc. There is no shame in your struggle. You endure what would level most and you push through on all cylinders from the depth of the love a parent has for their child. Just never assume you’re hiding it all. You never want them to interpret your quest for their health as a result of something they did wrong.
3. Control the narrative when you can. I had an endocrinologist soon after diagnosis plow right through my wishes and explain the cancer risks in depth to my 8-year-old. In hindsight, I should have at the very least fired him on the spot. I did not because I was at “the best” facility. I was intimidated. We do not use that facility anymore.
4. Tell the truth. I know this seems to go against what I said above, but the trick is simple. Answer the questions they ask you, honestly. I mean everything from, “Yes, the needle for the bloodwork will probably hurt when it goes in. Then, when it comes out and we, (insert something fun here) you will feel better.” Use as few words as possible. Do not restate or belabor the point. When they’re done listening you will know. But, if you are honest and basic with your answers, they will trust you and come back for more when they are ready.
5. Nobody has all the answers. Take good notes. Bring another set of ears when you can. Establish ways your specialists can be reached if there are follow-up questions. If your specialist does not listen or value you as a critical source of information, fire them. Respect them for what they know. Keep them if they are looking to learn more. If not, move on.
6. THERAPY. Start early. Search for quality. Hold on until you find quality. Then step away. Let your child have a safe place to work through the physical, mental, and emotional ramifications of this mess. They say they are fine. They seem fine. They are probably struggling. That is not your fault, and you can not fix it all. Truly some kids are just mean and by being different your kid is a solid target. This internet/ social media world is ruthless. They need to be able to say things that are on their mind without worrying about what you will think/ say/ do. And, if you lack a healthy outlet, consider therapy for you too. They are watching. Your ability to handle their diagnosis, and yours if you also are positive, will be something they are observing even when you don’t think they are. Make your own mental health a priority as well.
7. Make the boring and stressful things as much fun as you can. Quirky selfies, a favorite lunch spot, a special trinket, and some of the best conversations you will ever have may happen on those trips to the doctor. Instead of waiting for the “storm to pass” choose to “dance in the rain.” You are making memories, just not exactly where you had hoped.
8. Do not underestimate your child. With the right balance of love, acceptance, medical screening, therapy, and time for child-like joy, they will be the absolutely amazing human they were meant to be.

That is not an all-inclusive list by any means. Feel free to drop a comment here or on our FB page about the things you have learned about parenting a child with a PTEN mutation.

I remember in my earliest days after diagnosis there were a few kind souls who pulled me forward. I hope this blog, and knowing you are not alone provides you some comfort.

#beatingcowdens

Normalize This!$%#*!

Two hospitals, two IVs, two legs, four paws, and a tail. That is the short version of the last 2 weeks.

On the morning of May 15th, a few days after a week of intense finals, I drove Meghan to the hospital so her interventional radiologist could have another go at the vascular tumor buried deep in her right thigh. This ridiculous, relentless beast has situated itself adjacent to her sciatic nerve, and it’s nestled way too deep for removal. This incredible interventional radiologist is truly a class act. He is wise, compassionate, and empathetic. He is patient-focused and his passion for his field of work is evident as his desire is to help. All the time.

This same doctor worked on this tumor in May 2022. That was a layered procedure chronicled in detail here https://beatingcowdens.com/2022/05/ And while his work was helpful, the pain returned this spring with a vengeance and it was time to go at it again.

While we waited for the procedure, we passed the time as we always do. We shared some random conversations and made small talk with anyone who could help us place our nervous energy anywhere but on each other. We have been in the pre-op staging area so many times that every crevice and every sound are more familiar than you ever want to know, and we have a healthy respect for the emotions it evokes. Without those types of experiences people might think our photo ops are utterly bizarre, yet like so many things in life; if you know, you know.

On that day we were exceedingly grateful that the doctor’s daughter who was due with his third grandchild on 5/20 had not gone into early labor. The little things are the big/ huge things, and truth be told, his fervent love for his own family is infectious, and no doubt makes him a better doctor, at least from where we stand. His desire to communicate with Meghan, 1:1, by directly texting her has elevated him to near saint status in my eyes. A doctor who cares as much about his patients as is humanly possible undoubtedly generates the most positive outcomes possible. By the time he came in for consent, it was a mere formality as they had hashed out all the potential risks and benefits multiple times.

When they left for the procedure room, Ella and I grabbed a seat in the waiting room where I would pretend to play solitaire and candy crush for the next few hours. When the doctor called to let me know he was finished and that it went, “as well as I could have hoped from my end,” we headed to recovery. Her arrival in the recovery room was delayed by an hour due to severe pain when she woke. By the time she arrived in the recovery room, she had been knocked out with pain medicine.

The recovery room dance is one we have perfected and I know she’s awake when she asks for her glasses. It takes a few hours of monitoring, post-anesthesia coherence, some ginger ale, her GF bread, and a strategy for pain management before they consider a release. And as we were getting her situated in the car for the 90-minute ride home I sighed again with the ridiculous things this disease has forced us to normalize.

It was more than a decade ago when we stopped both taking the day off work on surgery days. Years ago our budget could just not afford it, as my husband is paid hourly and only when he goes to work, but now, when we could swing it financially, it just makes little practical sense. That sounds terrible even as I type, but the reality is we have normalized surgery. And we know it makes more sense to alternate days in case she needs post-op care.

Except, she really doesn’t. She also has normalized things to a point where she can get her own basic necessities pretty early in the recovery process. The first 72 hours are always the worst. It is in that window that her body is clearing the anesthesia and figuring out the new sensations. Once that dust settles and the swelling starts to subside we get a better idea of what the recovery timeline is.

Although my girl, a young woman now, understands 21 surgeries in that recovery goals must also allow “real life” to continue. And the harsh reality, and an incredibly ironic situation in my opinion, is that she needs to work to get “patient care hours” to apply to PA school. I believe the purpose of those hours has a great deal of value. Medical professionals need to be able to speak to patients in ways that are not demeaning or judgmental. They need to be able to listen to and respond appropriately to the people they treat. Except, this girl had BEEN the patient her whole life and is literally pursuing medicine to listen to and HEAR her patients. But, that is irrelevant because the criteria must be uniform.

So, dealing with swelling, residual pain, as well as numbness, nerve pain, and altered sensation in most of her leg, my girl said goodbye to her boyfriend who had been keeping her company for the week and prepped herself to begin her new job as a medical assistant the following Monday, May 22.

The day was challenging in so many ways. It was also painful and draining. I was most concerned with her when I came home from work at 3:45 that day. I saw her unwinding with Ella, sharing some tears with her BFF and I headed off to acupuncture, in my newest search to overcome the residual pain from my 2019 foot injury. In my haste, I forgot my phone. I called home from the office and told them I would be home in about an hour.

That was DEFINITELY the last time I will forget my phone anywhere for quite a while. I am used to 3 tails and 12 paws greeting me at the door. There were none. Ella was laying on the bed in Meghan’s arms and Jax and Buddy were trying to offer comfort to their sister in distress. My husband gave me a look that I knew meant swift and decisive were my only moves. So when Ella did not even thump a tail for me and choked on a small piece of food, (Ella is the girl we sometimes love to hate with the appetite of a linebacker and the waist of a supermodel) I knew we had to move.

We called the vet from the car letting them know we were coming. Within an hour they had an IV drip in her and her temperature had come down from a mid-106 to a low 103. She had a little bit of a wag when she came in to see us after that IV, but she was not being discharged. She stayed in the vet for 48 insanely grueling hours. She had virtually no white blood cells, which equates to precious few platelets and neutrophils, and little ability to handle an infection or a scuffle with her brothers. She was started on two antibiotics.

Two days later her WBC had increased 20-fold, and she was released. We still do not have a reason, and Ella’s follow-up visit is Thursday. She is still taking those antibiotics but has returned to her antics and last night wiped out both of her furry brothers with her pouncing and running in the yard.

Meghan’s pain is still significant, but we hold a bit of cautious optimism as it is “different” than the tumor-meets-sciatic-nerve hell that she was enduring pre-operatively. Ella is back by her side and it is more evident than ever that these two were made for each other. The bond they have is beautiful and indescribable.

This weekend the sun is shining where we live. People are out and about, socializing and enjoying the start of summer. We have already been to urgent care to treat Meghan’s sinus infection (allergies clashed with 4 weeks straight of untenable stress). We opened the pool and picked up some groceries. We have not really left the house at all.

That is the story of two hospitals, two IVs, two legs, four paws, and a tail. This insanely crazy medical life has left us pretty blissfully content to do absolutely nothing when we can.

…today #beatingcowdens looks like this.

The Future of Healthcare

I could write for days and never fully tell all that is spoken through those eyes. I could detail wars, physical, mental, and emotional that would have decimated those who think they understand strength. And I may, but not today.

Today I will tell you to pay attention. Look closely. This right here is the future of healthcare. This is the face of hope. This is the face of grit and determination that comes only after you have dug yourself out of the trenches over and over again and refused to allow yourself anything less than success. This is the smile that says, “I will go the distance for you. I will not quit. You deserve better.”

You deserve better. YOU. The sick. The frustrated. The marginalized. The dismissed. Those of you on the very edges of that “bell curve” of medicine, in the places no one ever looks or understands. The Zebras in a world of horses. You deserve compassion. You deserve to be treated by someone who believes you can feel the best your body is capable of feeling.

It took a long time to see that smile. It may in fact have been the first time in close to two decades that I ever saw THAT smile. But, let me tell you, now that it surfaced, there is no stopping it.

This young lady told me many years ago she was going into healthcare to “do better.” And every single time we hug, my certainty grows. She will “do better” because she understands. She has felt it, lived it, and clawed her way through the depths of it.

Rare Disease Day is this month, a day when we try to raise awareness of rare diseases across the globe. As patients of one of those diseases, whose estimated occurrence rate in the United States translates into about 1,700 patients nationwide we feel this every minute of every day. We understand the urgency in ways that are impossible to articulate. We need to be seen. We need to be heard. We need healthcare professionals who will fight for US.

You don’t see the unsteady footing over there in lane 1, from two distinctly different-sized feet, and a leg still weaker than we’d like from a tumor buried just deep enough to make things extra hard. But, you see that focus? You see those eyes looking forward to the wall? You can almost hear the goals in her mind as she prepares to start the race. You have no way of knowing what it took for her to get there, on the block of this championship college swim meet. But, you don’t need to. You just know she belongs right there. She fought like hell to get there, and she will not be taken off course.

That race she is about to swim, it is 66 laps. A full mile of nothing but raw determination, and the ultimate head game. This kid is long game. She is not a sprinter. She never backs down from a grueling battle and she never gives up. She is the future of healthcare we need.

This kid. She is butterfly. Exhausting, like life. It can suck the wind right out of you. And yet, she has learned to breathe through it and sometimes make it look flat-out basic. This is the future of healthcare. We need to step into the room and tell our hard stories and tell them to professionals who can breathe through to the end. We need to ones who will not stop fighting the challenging races with us and for us.

This kid, she is not only a lone wolf. She knows that being part of a solid team is utterly essential to success. She will not miss the handoff, and she will fight like hell so that she and her teammates get where they need to be. This is the future of healthcare, where egos are less important than results, and when we work together EVERYONE is better.

These are smiles that say we don’t have to be on the top of the podium to get the job done. These are smiles that say, sometimes it takes a village and if we all do our part every single time we ARE better. THIS is what the future of healthcare looks like.

This swim meet last weekend was not all about swimming. It was about character, drive, and determination. It was about using what we have as a tool to get where we need to be, not as an excuse to stay behind.

This was about knowing that sometimes, you will hit a personal best every single time you go off the block.

It was about celebration, and accomplishment, not as an end, but as a means to press forward always.

It was about taking the time to cherish the successes because no one stays at the top of their game all the time. It was about remembering what it feels like to soar so that you can always dig back and remember you have more.

It is not always about getting a medal. But this weekend it was about that too. She wears that medal as a symbol that we are stronger than almost anyone realizes. She wears it to remind herself that the next time she is at the very bottom of the heap, wondering if she has the strength to get back up – she does. We all do.

We hugged for a long time in the hotel room that night. We talked about the others we “know” with Cowden Syndrome. We talked about how even in our small community there is such a wide berth of challenges. We took a moment to honor all of our “sisters and brothers” and dedicated that medal to all of them. Because a win for one of us, is a win for all of us.

And we talked about Ashton, our sister in Australia, gone far too soon. A bright light whose “you do you” mantra is one we speak with reverent smiles.

Sometimes you are on top of your game. Sometimes you can barely get off the couch. Sometimes you win. Other times you don’t. But every day we wake, work, fight and honor, and strive to be our best selves.

Remember this face folks. The future of healthcare is here. This young woman will be a Physician Assistant who makes a difference. She will make the world better for all of us one step at a time.

In solidarity with all of you, we remain

#beatingcowdens

And, if you have a minute, unite us with RARE DISEASE warriors around the globe by leaving a comment here?

Unanswered Prayers

Sometimes my unanswered prayers end up being what I am most grateful for.

Sometimes what happens is not what’s “right.”

Sometimes we can fight to change it.

Sometimes we have to stop fighting and move on.

Sometimes we have to consider that there might be a bigger picture we can’t see yet.

There are a handful of songs that have shaped me as a person. Among them is “The Gambler” by Kenny Rogers. Somehow the chorus has come into my mind at some of the most challenging times in my life.

“You got to know when to hold ’em,
Know when to fold ’em,
Know when to walk away,
And know when to run.
You never count your money
When you’re sittin’ at the table.
There’ll be time enough for countin’
When the dealing’s done.”

My life, sometimes my very existence, feels like it has been one fight after another.

I don’t mean aggressive battles among peers or friends. I mean battling “the system.” Whether it was fighting the limousine company that tried to change the contract 5 days before our wedding in 2000, (yes we walked away, got to the wedding in another limo, sued them, and won,) or health insurance companies that don’t want to pay for tests, procedures, scans, and surgeries Meghan and I have had, or doctors themselves who sometimes just don’t listen, the list of fights goes on and on.

I have a stellar record in this never-ending stream of confrontations.

But at what cost?

I sometimes worry my memory is failing. There are so many things I can not recall. I am sometimes comforted by the movie “Inside Out” and the notion of my brain making room for the things that matter.

The last decade has definitely been among the most formative of my life. Mom always said you do more changing in your 20s than in your teens. I’m not sure where that leaves your 40s!

Sometimes I shake my head in amazement at the journey that included removing a few organs between us, attacking a few tumors, hospitalizations, appointments, graduations, celebrations, and loss. Sometimes the loss hurts maybe more than it should.

I was lucky enough to arrive in my 40s with grandparents. Not many people can say that, and yet not a day goes by when I wouldn’t gratefully accept another one with them.

My father died in 2013, soon after I turned 40, and the ache from that loss, after we had so recently found each other is constant.

And that brings me back to “The Gambler.”

“You got to know when to hold ’em,
Know when to fold ’em,
Know when to walk away,
And know when to run…”

I’m not sure anyone knows Dad referenced that chorus in December 2013 in his VA hospital room when I was tasked with telling him his kidneys were shutting down in response to a cancerous tumor in his pancreas. He was so calm. I wanted him to fight so badly. I wanted to keep him with me. I wanted to scream. But he simply told me it was time. He had fought plenty in his life. And he had overcome. But, this time he knew…

School was not ever Dad’s strong suit, but he was a student of life. He knew the numbers, the stats, and the odds. He knew the reality of how his situation was going to end.

Unanswered prayers. Maybe they prevented things he never would have wanted. Maybe they were what we all needed. I am not sure, and I look forward to hugging him tightly again one day. But for now, the lesson of the value of those unanswered prayers is something he left behind, that I can call upon right now when I need it most.

I fell in January of 2019 in my classroom. I was teaching and a chair moved as a restless student changed position ever so slightly as I circulated the room. My feet did not anticipate it, I could not have seen it, and my left foot stayed on that chair while the rest of me hit the ground. Hard. It was one of those moments where I just knew things would never be the same.

I filled out all the accident reports before leaving for x-rays and MRIs. And, as so often seems to be the case, things got complicated.

My injury wasn’t properly diagnosed until March of that year, much later than I needed that diagnosis, as the damage done walking on a partial Lisfranc tear during those first 8 weeks proved irreparable.

I have fought for that foot on repeat since 2019. Surgery in 2020 did nothing to make things better. As a matter of fact, the addition of 3 screws, well, let’s just say the foot is unimpressed by their presence. And, the rock/ hardplace scenario continues as the surgeon told me removing them will make things worse.

A year of remote teaching did nothing for my foot, although that year, unanswered prayers brought me closer to some amazing colleagues, students, and families.

Teaching in person seems to accelerate things in the wrong direction.

I applied for accident-related disability retirement in 2021 and again in 2022. The denial that came this time, which follows a transcript of me being berated by a doctor who has never been in a classroom, shook me to tears on more than one occasion. The decision actually reads that the fall was not an accident.

I am pretty sure it is the textbook definition of an accident.

I was chastised for going to work. No one could explain how I should treat this injury if I stopped working and lost my medical coverage.

My foot is in never-ending pain. My left hip aches. My right knee is wearing from a constant subtle limp. Complex Regional Pain Syndrome is quite real if you ever wondered. Sleep is often more of a goal than a reality.

I should fight. I should appeal again. I should write a letter of complaint for the way this doctor handled me. I should. But, I am not going to.

I can’t fight this one.

And as many times as I have modeled for my daughter on repeat that she should fight with all her might, I am going to model this time, that sometimes you need to “… know when to walk away, know when to run…”

“If it costs you your peace; it’s too expensive,” and this fight is way over budget.

I spent a few years pulling back. The world has gone mad. The battle of #beatingcowdens alone is typically enough to keep me busy. In this post-pandemic and politically divisive country, I could not continue to be the additional heaviness in every conversation – so I stopped having them. I missed a lot in other people’s lives I am sure. But I think pausing to reflect on my own unanswered prayers, has put me in a better place than I was before.

People can judge all day about my new desire for some global and systemic ignorance. I know all too well that “knowing” is subjective and often solves nothing.

Unanswered prayers – well, maybe they are answered, just not on my terms. Maybe I just need to pause and think and shift perspective, no matter how hard it is.

And as a 49-year-old mom of one amazing young woman, wife to a seriously incredible human, a rare disease patient, and a cancer survivor, I have decided this battle for my foot has to get set free.

Who knows, maybe the answer came in forcing me to slow my roll and look around with more feeling and sincerity than ever before? The only speed I ever knew before was fast. I did not even know there were lower settings on the dial of life.

I have prayed a lot for the healing of my foot. I prayed a great deal that the medical review board would be compassionate and see the facts of my case. Both were not answered as I asked, but maybe they were answered in a way that was better or necessary.

In just the past few years I have spent a week on my knees as my husband, the healthy one, endured that week in the hospital battling Covid pneumonia. He came back to us, and our relationship, our central triangle has never been stronger.

I have prayed to have my child delivered back to me safely from more operating rooms than I care to count. I prayed fervently for Ella, Meghan’s faithful service dog, to arrive in time for her to transition to college. At college, both Meghan and Ella now flourish.

I have prayed extensively for things that I was blessed to see.

I have prayed for things that did not come to be.

I have prayed for peace, clarity, and understanding when things did not go as I hoped.

I have prayed for patience and wisdom, especially for things I can not comprehend.

And I find, on repeat, that when I sit still and really listen, I can find blessings pretty much anywhere.

I have come to wonder if maybe my unanswered prayers are just answered prayers I don’t quite comprehend…yet.

So, I am looking to take this life one day at a time. I am trying my best to make the world a tiny bit better and find joy in the little things. I am moving much slower. I am noticing things I never saw before.

And, remarkably, I am finding peace in this slow-paced gratitude.

Trying each day to be a better human, we remain…

#beatingcowdens

Romans 5:3-5

This is 49!

Some days I look in the mirror and wonder who that lady is. Some days I hop on a scale chasing numbers that were there 30 years ago. Some days I am self-conscious about the gray hair and crows feet that stare back at me from the mirror. Some days I work extra hard to cover the age spots taking over my once fair, plain skin. Some days I am harder on myself than anyone else would be.

Today I looked at this photo from yesterday. I cringed a bit. I scrutinized as only the subject of a photo can.

Then I stopped.

Because the truth is, I am not the me of 30 years ago. Or 10 years. Or 5. Or even 1.

That is where it goes wrong sometimes.

It is so easy to tell my daughter to be present. To forgive herself. To not worry about how she thinks she compares to the standards of a flawed world. To not sweat the small stuff. But, sometimes I am a giant hypocrite.

Today I forced my own hand.

You see, this is 49. There is no living in this moment again. I can be miserable, or I can be content. In reality, if I have learned anything, I have learned that is one of the choices that changes everything. And it really is a choice.

Everyone you meet fights battles you know nothing about. And even when you think you share those battles, you only know what they choose to share with you.

Life is heavy. We can’t talk about our fears, our worries, and our sadness all the time. We can’t ask for others to fully absorb the weight of what we carry into each day. We can’t compare levels of difficulty. And we can not ask the world to adjust for us. Some of us are exhausted before the alarm goes off. But we still need to show up and make it happen.

So what can we do? I think we have to acknowledge where we are, and where we have come from. I think we have to offer gratitude to the higher powers in this universe. I think we have to carry a bucket of grace wherever we go, drinking from it when we are thirsty, sharing it when others have none, and allowing our own to be refilled by others.

But who am I? I am no more or less than you.

I am stream of consciousness writing,

I am 49.

I am wrinkles and declining vision.

I am scars and cellulite.

I am always prepared with a bottle of hair dye.

I am always hungry for chocolate and thirsty for caffeine.

I am sneakers and jeans and T-shirts.

I am quiet until I am not.

I am a long history of medical drama.

I am a professional at surgical recovery.

I am an athlete inside of a body that doesn’t know it yet.

I am a daughter, a sister, a granddaughter, a niece, a cousin, and a friend.

I am a wife.

I am a mother.

I am an absolutely ferocious beast at protecting my girl, her health, her rights, and her heart.

I am a sentimental fool.

I am a forgetful mess.

I am a nervous wreck.

I am an advocate.

I am a rare disease patient.

I am a medical biller on the side.

I am a teacher.

I am a life-long student of life.

I am one who loves deeply.

I am loved.

I am a believer in angels.

I am sure our loved ones never leave us.

I am ok with sloppy dog kisses, as I try not to overthink joy.

I am not 19, or 29, or 39, and I’m glad.

I am confident that lessons learned make me a stronger version of myself.

I am 49.

And I promise to work every day to be my best self.

#beatingcowdens