Archive for January 2019

January 31st, 2019 Home therapy - or doing with intention

By VisiblePersonInvisibleproblem | Published Thursday, January 31, 2019

I did some new things in vision therapy today, which meant my Anxiety was triggered. After therapy, I remembered that in the beginning I couldn't do Feldenkrais or VT at home, & then eventually, I could.

I also remembered my home therapy kind of skidded to a halt (I wrote a post on 11/16/18 Anxiety & Depression - Recognition & progress).

I didn't talk about home therapy in that piece... I've been telling myself that integrating skills from therapy into activities is what matters, but I have a hunch doing home therapy - doing a specific thing with intention - also matters.

Christina says flooding myself isn't the way to go... but there's a big difference between flooding, & skidding to a halt... Joyce gave me a routine in May of 2017, when I had my big setback, to help my sensory system regroup - part of the Masgutova method she's trained in - which I still do, & I've made progress with it.

So I need to talk to Ann & Joyce about little ways to bring back home therapy... thinking this immediately triggers Anxiety... UGH... I hate how hard this is - there's so many triggers - but I have to do this... the only way to know what I can handle outside of sessions - & what will help me - is by trying.

And I have to admit, there's this little voice struggling to be heard inside my head, saying "damn it, you can do it!"

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January 29th, 2019 Facing PTSD Anxiety's very hard

By VisiblePersonInvisibleproblem | Published Tuesday, January 29, 2019

My mom asked a basic Q - why is my vision therapy taking so long? I decided my answer was worth sharing, so here it is -

MAV - My vestibular migraine complicates my situation - Dr. Margolis was upfront about that right from the beginning.

Sensitivity - I think I rate pretty high on the sensitivity scale - this has, for example, been an issue for me re using prism glasses (fairly commonly used)... I've thus far not been able to do more than a short bit in VT of a low level prism, but this is certainly better than nothing, & something that does get re-visited periodically.

Neurological rehab is never easy, even without Anxiety.

I don't want ANYONE to think the work of facing Anxiety's easy - words are just words, & don't always adequately show the picture - the sign that I did for this piece is kind of how I feel about anxiety. The word "words" is the automatic thoughts that bombard me when my PTSD Anxiety's triggered.

PTSD Anxiety - it took a long time for me to figure out about, & be able to face dealing with my Anxiety - I say it with a capital "A" because it's not "garden variety, everybody gets this" anxiety. This is "I need meds, & the help of a professional to deal with this" Anxiety, & it's fucking hard work! The meds make it possible, but it's STILL really, really hard.

Avoidance - avoidance was a thing. I still fight avoidance. I don't like how I feel when my Anxiety's triggered, & Christina has pointed out that it's important not to flood myself - the goal is success, which comes gradually, over time. My psychiatrist, Dr. Mirsky, always says to me that I'm dealing with my Anxiety - the hard way (I think he means gradual exposure, etc.), because that's the way that works.

My Anxiety doesn't even want me to claim the progress I've made - it really messes with my mind - but I AM making progress, now that I AM dealing with my PTSD Anxiety.

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January 26th, 2019 why I share my story

By VisiblePersonInvisibleproblem | Published Saturday, January 26, 2019

I chose this picture not just because it's lovely - it's also winding, & there's lots of small steps... & balance

My CBT therapist, Christina, told me that trauma changes your brain & I believe her. I also believe that your brain tries to make sense of what's happening, & suspect that's what happened to me the night I got sick.

I like having answers - I think most people do - but I had no idea how long it would take me to get all of my answers. The final piece was a little over a year ago, when I realized I have PTSD anxiety - one of the changes to my brain (the other 2 being vestibular migraine, & convergence insufficiency - a vision disorder)... I was initially only diagnosed with benign paroxysmal positional vertigo - BPPV - which was finally successfully treated about 10 months after I got sick.

Why do I share about all of this in my blog? Why am I not private about it? While I don't share everything, I do share a good deal, & here's why -

1) it's exhausting, draining to keep secrets about what affects my life on a daily basis.

2) my writing helps me put the pieces together, & hopefully helps someone else - I know how hungry *I* was for info... I've shared Luis Carlos Montalvan's story on my FB page because it was from listening to his book that I realized *I* had developed PTSD anxiety as a result of my illness.

3) People talk about all sorts of medical conditions - why not also be comfortable talking about mine? I'm realizing more & more how my Anxiety impacts my perception, my thinking - I'm slowly learning how to respond. If you want to know about one of my disorders, ask me - if I'm not comfortable, or don't have an answer, I'll say so.

4) People need to respond with compassion & kindness, empathy (putting oneself in someone else's shoes) to those with invisible disorders/disabilities - & understanding hopefully makes that a bit easier.

5) I give you snapshots of my process, & a life worth living, with disabilities. I talk about my therapies - my neurological rehab - because they're a large part of my life.

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January 24th, 2019 Challenge but not overwhelm

By VisiblePersonInvisibleproblem | Published Thursday, January 24, 2019

I've been thinking about doing this sign, decided it was time...

Anxiety exposure = extreme weather

I can't control weather - accommodate is necessary, do the best I can

Anxiety exposure = exploring volunteer options

1 step at a time, it's a process

Challenging myself is hard, my Anxiety's telling me not to... but I remind myself that if I don't succeed, I won't be any worse off, & I can learn from ANY experience - good, bad, & in between... AND maybe I will have some success...

My goal can't be to avoid/eliminate ALL symptoms - including ALL Anxiety... I have to tolerate some discomfort... sucks, but true.

Recent months have shown me I CAN accommodate, & I CAN have some successes.

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January 23rd, 2019 Work up to volunteering

By VisiblePersonInvisibleproblem | Published Wednesday, January 23, 2019

Maisy (didn't e-mail her pic LOL)

I thought I'd share the e-mail I sent to the volunteer coordinator at Orphans of the Storm -

Hi Pam, I heard you were out sick today, & that I should try e-mailing you.

I spoke briefly with you about a week ago about being a greeter at orphans of the storm. I thought I'd give you a bit more info, & see what might work.

I've got some health limitations, & am trying to get back into volunteering. I would not be able to be in the cat room, & might need to take breaks, where I'd be able to sit down.

I've been a dog owner for nearly 12 yrs, & a cat owner (all 3 rescues, 2 from Orphans) for about 18 yrs. I've dealt with health problems with all of them.

If I could work up to an hour, would you be able to accommodate me as a Greeter, & socializing with the cats in the room where the cats are in crates/cages? Taking them out, & giving them attention? I don't know if I could eventually do two hours.

Please let me know - you can reach me at (gave home ph no.).

Thanks - Tamar Schwartz

I'm also going to go with Ron to check out the cat adoption center at PetSmart - I've never been there, & I'd like to see it, hopefully talk to someone, see if they're open to accommodating me.

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January 22nd, 2019 Truth about rumination, frustration, acceptance

By VisiblePersonInvisibleproblem | Published Tuesday, January 22, 2019

I'm going to call Orphans of the Storm 1 more time, & see if, given my needs, testing things out there is possible. I have to be prepared for disappointment.

I did a list today - not shown - re accommodations for someplace I might volunteer... I also wrote down my interests/what I'm good at... this was because Christina asked me if I was ruminating about this volunteering thing.

Truth - After I did the list, & thought some more, I realized "yup, ruminating.." & then I thought "why?"

I realized ruminating is Anxiety's way of saying "keep thinking about this - you'll come up with THE answer!"

Truth - Nope, actually I'll just drive myself crazy.

Truth - realization - I'm incredibly frustrated with my limitations, something I don't generally let myself register. I want to be the old me who could jump into volunteering where I wanted to... but that's no longer my reality.

I may not find something that takes the place of what music was for me... when you lose something you love, you deal with the loss, & figure out how to move on.

Truth - There IS no "The Answer" - there's working in rehab where the effort has pay-off, there's acceptance, & being able to say honestly to myself "I'm doing the best I can."

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January 19th, 2019 My 3 therapies... where I can improve

By VisiblePersonInvisibleproblem | Published Saturday, January 19, 2019

I don't know how far I can go with my 3 therapies, but I have a feeling I'm going to find out in 2019... Why? because I'm challenging myself more, trying more - that means finding out what works, & what doesn't work.

I have to deal with disappointment, as well as success - which actually is pretty much how life works, right?

My stamina is slowly building - I'm slowly getting stronger... my thinking is gaining clarity - I'm understanding my "flavor" of Anxiety more & more. It makes sense to me that I'm seeing improvement because it's only been the last year that I've had the tools to work on these.

My automatic thought is "why did it take me so long?" & then I think "because it was a process - give yourself credit that you kept looking, & DID reach out, & now you're doing this hard, important work with Christina."

Pre illness, I was on the other side of the volunteer fence - looking for reliable, caring, competent people... I've gathered a lot of info - I have a better idea of what's out there... Now I need someplace that is able to be accommodating to someone with disabilities.

Maybe I'll revisit this idea again, but right now is not the right time for me - I'm not ready... will I be able to do something more than the VeDA calls, & post sharing I do now? Will there be someplace that can accommodate, that's interesting for me, that I can handle?

I don't know... for now, I'll focus in my 3 therapies, finding - by trying - areas I can still improve.

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January 18th, 2019 gotta keep going...

By VisiblePersonInvisibleproblem | Published Friday, January 18, 2019

I left a message for this organization -

http://www.pawschicago.org/how-to-help/volunteer/volunteer-opportunities/volunteer-opportunities-by-location/volunteering-at-the-north-shore-adoption-center/

I called my local petSmart store, & this time was told I need to come in and fill out an application, which they give to the people at the cat adoption center - sounds like it operates completely separately from the store…

Feeling a bit discouraged - not optimistic that it's realistic that any of this volunteering with cats - or something else - is going to work, but at least I'm looking into it – better than saying I didn't even try -I never would have even checked it out once upon a time.

I also did something yesterday with Ann in VT which has to do with seeing things in 3-D, which still stubbornly does not work - I think my body's reacting to it a bit today, & maybe it's time to say that this piece just doesn't work…

So this is a day to remind myself of the things I'm doing that have worked, & it's not my fault that this happened to me - lousy yes, my fault no... Keep going… Keep going.

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January 17th, 2019 Sleep - reach out if you're having trouble!

By VisiblePersonInvisibleproblem | Published Thursday, January 17, 2019

Yes, SLEEP! In my quest to de-stigmatize, I wanted to share this - it's been 1 yr now that I've been taking a med that helps me sleep.

I use 2 weekly reminder holders for all my meds, similar to what's pictured.

Not surprisingly, my PTSD anxiety flares up at night because that's when I got sick, & insomnia was a thing... sleep - so fundamental to good health - is supposed to be this natural state we easily slip into, but for many it's anything but easy...

The med I take is NOT habit forming - & is also a good antidepressant. I started out micro-dosing because of my extreme sensitivity to side effects - I'm now on a normal dosage, & have been for a while.

I'm convinced that one reason I'm able to improve in a variety of ways, is that I get MUCH needed rest at night.

If you have trouble with sleep, talk to your doctor... discuss with a trusted family member or friend... It's worth it!

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January 15th, 2019 Investigating... it's all in the trying

By VisiblePersonInvisibleproblem | Published Tuesday, January 15, 2019

I did this "?" today because I'm in investigating mode - & I don't know what's going to work, or even IF something will - neither does Christina.

Julie Andrews came up today with Christina - we talked about the amazing voice she used to have, & how she managed to rebuild, re-create her life, how it must have been a process for her... I mentioned Michael J Fox, who didn't go public about his Parkinson's until 7 years after his diagnosis.

A lot of people write books once they've come out the other side of something major in their lives, & they have an ending of sorts... I'm sharing some of my process - I don't have the ending yet.

Here's my notes as I reviewed what I've done so far... not being a perfectionist, I decided to share my 1 and only draft -

Volunteering that for various reasons isn't a good fit, what I'm doing at home, & 2 possible ideas - one at our local shelter (I love cats & dogs), & one about neural rehab - specifically vision.

I'm fascinated with neurological rehab - something I knew NOTHING about prior to getting sick, & I remembered Dr. Margolis talking to me - probably at least 3 yrs ago - about some kind of interviewing... I said I was interested, but then my depression & anxiety got in the way.

So now I'm thinking "well, what about that? what about learning more about this vision thing?" I have no idea what I can do - I have to reach out to Ann about this, & Dr. Margolis.

I DON'T want to look back "X" number of yrs from now, & say "I didn't try"... there's lots of little ways I'm pushing myself now, challenging myself. It's frustrating when lots of stuff doesn't work, but I don't need LOTS of stuff to work - I just need 1 or 2.

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January 14th, 2019 Yes - it's hard, notice EVERY positive, keep going!

By VisiblePersonInvisibleproblem | Published Monday, January 14, 2019

I saw Joyce today - she pointed out some positives, encouraged me to keep trying... I also heard Christina's voice in my head sometimes... & so I did this sign today - I know Ann (vision therapy) will like it -

AND I said to myself "having to keep trying is hard, but it's what I have to do... & this is a GOOD sign... running the household MATTERS - it's part of what allows me and my hubby to still be living independently in our home - that's HUGE actually... I need to keep reaching out with phone calls - I can definitely handle those better than I used to... being creative is good, for a lot of reasons... and phone calls will help me feel connected"

AND in the end, I can allow myself to sometimes feel really down, but I've GOT to keep going... let myself register every single thing that's good, no matter how tiny.... FINALLY, remember there are others out there with their struggles... some of them maybe reading these words - we ALL have to keep going!"

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January 13th, 2019 one more year, still grieving, but still trying

By VisiblePersonInvisibleproblem | Published Sunday, January 13, 2019

Here's a picture of my beloved flute... truly, this beautiful instrument feels like a part of my body when I hold it, an extension of my arms, hands -

I wrote a piece a year ago "Speaking my truth, the depth of my loss," & it still resonates... I said at the end "I KNOW I need to create some kind of life... but I ALSO need to feel - even on meds, and CBT - the depth of my loss...".

These 2 ideas - creating some kind of life, & feeling the depth of my loss - will always be true... they're not mutually exclusive.

Sometimes the pain of my loss - how my life changed -is a deep, heavy ache inside of me... the loss I feel the most keenly is still about music... giving flute lessons, playing duets, trios, playing in a band... simply picking up my flute, taking out a favorite piece of music - & playing.

I also used to sing in our congregational choir - which I really enjoyed - but that's been taken away from me as well, by my illness. I can sing with Ron & my daughters for Chanukah, or sing Happy Birthday, but that's it. Better than nothing, absolutely, but a major loss.

I'm slowly coming to terms with the fact that this pain will never completely go away. It's the same as the loss of a loved one... hopefully over time, the pain, the grief will be less intense.

Part of that will come from talking about it. I learned to play flute when I was 9 yrs old, took my first flute lesson in high school. I first sang in a choir as a college student - & I'm now 57. Nowhere in my plans was it "get sick at age 50, a life-changing kind of sick."

But that's what happened. I'm one of many, many people with health conditions that change their lives forever. Forever isn't a word to be used lightly - just like the word "never" - but sometimes it applies.

And yet, if I'm honest, I'm still grateful to be alive, to be able to try... even though some days I don't really feel like trying, I feel like saying "the hell with it"... but on most days, I know I need to keep going, figuring out whatever I can.

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January 11th, 2019 Getting to know MY Anxiety, getting positive

By VisiblePersonInvisibleproblem | Published Friday, January 11, 2019

Lists are useful - To Do/reminders, grocery, etc., & I'm finding that focusing on the positive is really hard for me, BUT doing lists just doesn't do it for me, sooo, here's my latest drawing - it's a BIG "plus" sign with some of what I've done.

I always thought that having Anxiety meant FEELING anxious - & a lot of times it does... but inaccurate thinking - what are known as cognitive distortions - is ALSO Anxiety (it's how Anxiety works on your brain).

Here's a couple links - 1 for an article, & 1 for Wikipedia -

https://healthypsych.com/psychology-tools-what-are-cognitive-distortions/

https://en.wikipedia.org/wiki/Cognitive_distortion

Here's the messed up thinking I think I get into most frequently -

1) minimizing the positive - the opposite of paying attention, giving my/yourself credit

2) avoidance - anxiety makes my/you want to avoid

3) catastrophizing - jumping to worst case scenario "Something bad's gonna happen," which tends to go with "what if?"

4) personalizing - it's my fault - i.e. because of my illness, as opposed to "I didn't choose this, & it just IS, & I'm doing the best I can"

January 9th, 2019 Feldenkrais - neurological rehab is powerful

By VisiblePersonInvisibleproblem | Published Wednesday, January 9, 2019

My Feldenkrais work with Joyce, is important, & I'm constantly learning from it, so I thought I'd share some of what I've learned -

the fundamental idea of Feldenkrais is that improved movement - flow as opposed to rigidity, stiffness- allows for improved balance

if movement hurts, do less, & build up gradually

if your symptoms (headache, dizziness, etc.) were too much, do less of the activity, but still try - something I need to keep reminding myself. Still might not work, but try,

everything is connected, so try moving something close to what's not moving, &/or hurts - I recently did a pelvic exercise & it helped my head

one side learns from the other side... do something with the arm, leg, hand, etc. that's moving more easily - neurologically, your brain will transfer the info to the other side

think really small movements - it's easier to notice subtle differences, & when it comes to balance, subtle matters

do things in a neutral position, that gets you out of your habit - try lying down... I've noticed what muscles move when I do something as simple as putting on hand lotion, when I do it lying down...

You can experiment with movements when lying down, because it lessens the vestibular load

if you're sitting, improve your posture by sitting up from your lower back/pelvis - your shoulders will naturally follow, as will your head, & your gaze, & your breathing (opens your chest slightly) - & breathing is SO important!

Some of these concepts apply to vision and cognitive behavioral therapy as well.

Neurologically everything is connected!

If you think Feldenkrais would be helpful for you, give it a shot.

My friend Leora, who first told me about Joyce, told me something that has stayed with me "even if it doesn't feel like she's doing much, she is - this stuff is powerful..." words to live by for ANY neurological rehab.

This is a link to Norman Doidge's fascinating book, which has a great chapter on Feldenkrais -

https://www.amazon.com/Brains-Way-Healing-Discoveries-Neuroplasticity/dp/B00RC527CU/ref=sr_1_1?ie=UTF8&qid=1547075819&sr=1-1&keywords=norman+doidge

a link to the paperback version of Doidge's book - https://www.amazon.com/Brains-Way-Healing-Discoveries-Neuroplasticity/dp/014312837X/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1547075819&sr=1-1

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January 8th, 2019 Past "hijack/Anxiety" mode, to the living, thinking human...

By VisiblePersonInvisibleproblem | Published Tuesday, January 8, 2019

Being frustrated, sad, angry about what happened to me is not just OK, it makes sense... but putting down roots in anger, etc. isn't healthy.

So, I did this sign - a BIG sign, with LOTS of colors, because I don't really want to say "OK, this is enough..." it's tempting, because trying is hard, scary.

The PTSD Anxiety's not going to disappear, but Christina gave this analogy -

my automatic response/thought now is Anxiety hijacking my brain - "oh my God, something bad's gonna happen!" just like when you call a big company & get the automated system.

My goal is to respond "OK, yeah, there's Anxiety again, but I'm gonna keep going," get past "hijack" mode, past the automated response, to talk to the live human - to think, reframe my response.

I take everything I know about my vision & vestibular disorders, & PTSD Anxiety, & say "OK, what's something within my reach to try?"... I remind myself that when I'm actually in a situation that requires accommodation, I generally figure it out - do the best I can.

It takes time to make anything of real value, of importance, to learn how to do something really well... I got sick 7+ yrs ago, but counting ALL my diagnoses, & everything I need in order to make progress, I've only been at this for a year... & I've only been doing exposure as part of my CBT work with Christina for about 6 months... so baby steps... keep going... keep trying.

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January 6th, 2019 neurological change - it IS possible

By VisiblePersonInvisibleproblem | Published Sunday, January 6, 2019

Real, lasting neurological change (a brooaad category - I mean, we're talking about your brain, nervous systems) is really hard work - & is frequently complicated... but it's possible if -

1) you're motivated - you have to REALLY want it, because it's hard, can take a long time, and you'll want to give up sometimes

2) you own the process - YOU have to want it, not just your health care team, and you have to communicate - what's working, what's not, what's having a positive impact on your life outside of rehab,

3) it's done gradually - being overwhelmed doesn't work - your body/brain needs to process what's happening,

4) you have a support system, and finances are part of this,

5) you get it that progress won't be in a straight line

6) you're not aiming for perfection, because then you'll never feel like you're "there,"

7) you have/acquire the necessary tools (& I don't mean a screwdriver or hammer LOL) - therapies, meds, special diet, etc.

8) you're prepared to work hard, and get the rest you need - which might be a lot,

9) you're prepared to be patient, & persevere...

After 6 1/2 years of vision therapy, I no longer have the diagnosis of Convergence Insufficiency. I have more work to do to integrate my visual system with my vestibular system.... so yes, Perseverance!

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January 4th, 2019 be my own cheerleader

By VisiblePersonInvisibleproblem | Published Friday, January 4, 2019

I've got a big outing challenge tomorrow, so I did this... I realized it's okay - even good - to cheer myself on, as I try to DO, with my invisible disorders :-)

I have to be my own cheerleader - believing in myself is even more important than others believing in me... I've had these cray pas for months, & finally used them... Different feel than pencils, but I like them - you can make a really BOLD statement... so I did :-)

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January 3rd, 2019 My sneaky, stealthy buddy - Anxiety

By VisiblePersonInvisibleproblem | Published Thursday, January 3, 2019

My Anxiety's just as real as my vision & vestibular disorders, & just as invisible.

here's my latest sign -

I had vision therapy today... Ann & I agreed that while 2017 was a lousy year, 2018 was much better, I'm making progress, integrating all my therapies into my life... afterwards, I thought about how my anxiety works - sometimes I don't FEEL really anxious, but then I realize I'm going inward - the way Anxiety tricks my mind is so tricky - stealthy - I'm still in the process of understanding.

So, going back to my goals of flexibility & stamina - what are some ways to build these, & not feel like I'm letting Anxiety win?

1) I've done 4 days of going out in a row... could I try for 5?

2) could I go out the day after VT? This is a definite anxiety trigger, but I'm tired of making choices based on Anxiety - on what MAY happen

3) could I eventually go out more than once in a day? I actually DO do that - I go someplace, & then walk with Ron. Doing 2 outings plus the walk is BIG - but maybe something to work for.

4) keep on building my activities at home, what I do on a therapy day - remember that everything counts!

My anxiety's trying to get in my way - thinking about what I can handle. There's a balance between acknowledging my disabilities, & trying my best to live a full life, & my Anxiety tells me to be very, very cautious. But the only way for me to know for SURE is to try - not with a 10 on the Exposure Richter scale, but still try.

The more I realize about how Anxiety works, the better - I can have more awareness... talking with Joyce (Feldenkrais) about goals is valid - reviewing what I'm doing at home, as well as with her, so I can keep moving forward.

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January 2nd, 2019 Being present & planning can co-exist, or "what's in my future?"

By VisiblePersonInvisibleproblem | Published Wednesday, January 2, 2019

I'm sharing this piece because I thought that it might be helpful for others - not just myself - to see my thought process. That said, neurological rehab is very individual -something I remind myself of frequently.

Part of what makes my life full right now is my therapies, but I've also said that therapy is a means to an end, not an end in itself... therapy shouldn't become something I do because I'm used to it.

As 2019 begins, I'm thinking that being present, & thinking about the future are not mutually exclusive... I can't look into a crystal ball & know for sure how my life will unfold, but that doesn't mean make NO plans at all.

Volunteering - yup, still thinking about that - I used to think that volunteering had to be "out there," but maybe not, right now. My main goal really is to do something that feels valuable. I don't want to do anything that's on a tight schedule - definitely not ready for that.

I'll remind Cassey at VeDA about sending me new member calls. www.vestibular.org

Maybe I could do something for a local organization - like our local Shelter (Orphans of the Storm - very close to our house. Fleece blankets for cats & dogs?

Therapy - it feels like talking with Ann & Joyce about parameters of my treatment makes sense.

Joyce, my OT/Feldenkrais practitioner was the first person who provided the beginning of my road to recovery, & working with her is not only for balance, but also sensory work - she's also trained in the Masgutova method (https://masgutovamethod.com/).

Vestibular & sensory issues are complex, but it's relevant & valuable for me to think about what & when I transition to in my work with her. I don't know what kind of support I will need long-term - given my vertiginous migraine disorder - I'll only find out by experimenting.

Ann - vision therapy - vision is a multilayered, complex system involving so much... but again, what are the parameters of my treatment at this point, and what kind of support will I need long-term?

Working with Christina - cognitive behavioral therapy - will at some point moving to support, but I don't think it's time for a discussion about that yet - I'm still in my first year of treatment.

I'm fully aware that I'm extremely fortunate to be able to think about having long-term support. I truly wish everyone was in this position, especially because it can take a long time to pull all the pieces of a successful treatment plan together.

thanks to my friend Marla for the above quote

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