Saturday, July 14, 2018

Neurology - medicine - Autism - THE LOT


BORN EQUAL ACCORDING TO THE CONSTITUTION

I am BACK!

writing blogs were the last thing on my mind in recent months.
BEFORE 'ILLNESS' I WORKED AS AN EQUAL CITIZEN, PAID THE SAME WAGE AS EQUAL FOR A JOB WELL DONE.

I COULD CREATE EQUALLY WITH THE MOST CREATIVE.  I PAID RENT AS EQUAL TO OTHER ARTISTS AND I HAD A QUALITY OF LIFE EQUAL TO ALL. 
THIS IS MY STUDIO I LOVED BEFORE I BECAME ILL.

I EQUALLY HELD EXHIBITIONS AND SOLD WELL.
THE ONLY INEQUALITY DUE TO 'DIFFERENCE' BEING, I WAS ISOLATED, LONELY AND HAD ASPERGER SYNDROME.  IT DID NOT PREVENT EQUALITY IN CREATIVITY AND ABILITY.

SHY AND RETIRING I DID NOT 'COURT' AN AUDIENCE AND PETRIFIED IN THIS SITUATION.
dealing with healthcare consumed me to such a degree I really felt as if I was drowning.
I came to the veritable 'full stop.'

Breaking a wrist did not help.
Doing my back in compounded my sense of despair.
Fighting a large organisation for basic medical and auxilliary care and supports had now become a 24/7 nightmare and a hell on earth.

My life as it once was had passed by ten full years - I want it back - I still want it back.

NOTHING PREPARED ME FOR THE MEDICAL DISREGARD.  I BECAME ILL AND SENT HOME - LEAVING ME LIKE THIS FOR TWO YEARS IS NEGLECT.  I MANAGED TO GET TO UK AND DIAGNOSED FIRST WITH SJOGRENS SYNDROME AND MUSCLE MYOPATHY

VERY SICK - ABANDONED BY ALL
AN IMAGE SNAPPED BEFORE CROHNS SURGERY IN 2002, VISIBLE SLASH MARKS ARE EVIDENT.  THIS DID NOT HELP IN MY PHYSICAL HEALTHCARE AVAILABILITY.  I DID OVERCOME THIS, BUT THE RIGHTS OF EQUAL TREATMENT NEVER MATCHED MY ABILITY TO BE EQUAL.

CIRCA 2009 I WAS VISIBLY SICK.   STUDIO NOW GONE - THERE WAS NO MEDICAL CARE AND NO UNDERSTANDING

THE HSE DECLARED MY SOCIAL HOUSING UNIT 'A FIRE HAZARD' AND SUGGESTED I ASK FOR REHOUSING - EVENTUALLY PERSUADED NOTHING PREPARED ME FOR FALL OUT.

RESULT - MEDICAL MISMANAGEMENT AND HSE DYSFUNCTION - RESULT - FALLOUT ON A MAJOR LASTING SCALE.

YOU SHOULD NEVER PUT SICK AND VULNERABLE PEOPLE IN VIOLENT SITUATIONS WITH ALCOHOLICS WHERE SHE WAS IN DANGER

HOW THEY TREATED ME PRODUCED THIS IMAGE.
HOW I REACTED IN STRESS DEFINED ME TO THEM IN TERMS I NEVER IMAGINED

TEAM MEETING - HSE VERY AWARE OF HOUSING DANGERS - BUT IN THE END THEY CLOSED THIS FILE ON A VERY SICK INDIVIDUAL.

A PICTURE PAINTS A THOUSAND WORDS.  WE SOLD OUR ONLY ASSET, TWIN WITH PARKINSONS DISEASE SLEPT ON MY TINY SOFA FOR EIGHT MONTHS - WE FLED THE COUNTY DUE TO FINANCIAL CONSTRAINTS.  THE HSE ONCE SEEKING QUALITY OF LIFE FOR ME ABANDONED ME.

I THINK IMAGERY SAYS IT ALL.
THE SUFFERING THAT ENSUED.
I dream of the time I can paint and write.
That tapping out distress, tapping out begging emails and letters ceases and that harmony will prevail.  The care I receive will end with quality input from medicine and quality output at what i am best with - my creativity.

Lets look at where I am at.

Regarding engaging with the HSE, its as dreadful as ever.
To me thoughts around
'Who do they think i am,' 
springs to mind as i have spent long hours looking through community healthcare files.

WHO THEY THINK YOU ARE is actually more important to them than:


  • WHAT IS WRONG WITH HER
  • WHAT IS HER DISEASE PROCESS
  • HOW DO WE ACCOMMODATE THIS
  • HOW DO WE STREAMLINE HER CARE
  • HOW DO WE 'ENABLE' RATHER THAN DISABLE.
  • HOW CAN WE RELEASE HER TO BE AN ACTIVE CITIZEN AGAIN
  • HOW CAN WE SUPPORT HER IN HER END YEARS.


but actually the predominant features of the Healthcare system as I see it today is far from lived reality.

It severely rebukes the disabled and chronic sick individual.

Healthcare in Ireland is based primarily on loving, liking and behaving.

You actually have to be a certain person.
You cannot be anything other than 'perfect'.

the model for a viable patient and disabled person runs something like this:


  • ENGAGING
  • COMPLIANT
  • WILLING
  • NON CONFRONTATIVE
  • LIKEABLE
  • AGREEABLE
  • NON DEFENSIVE.
  • NON ARGUMENTATIVE
  • A PERSON WHO NEVER OBJECTS, or SAYS 'NO,' 

BUT MOST IMPORTANTLY IT IS THE PERSON THAT NEVER:

  • SCREAMS
  • SHOUTSUSES NASTY WORDS
  • NEGATIVE
  • DEPRESSED
  • DISTRESSED
  • CRYING
  • BAWLING
  • YOWLING


Personality presentation COUNTS.
It is fine for many if the road is less hard and easily travelled.

It is terrible if the road was never easy, if it was fraught with lifelong difficulties in general communication, and integration. Ones ability and issues around stress in engagement, skilled communication compromised over that of a person who was always able to be a party animal and had many friends.

These types usually find a middle ground to negotiate difficult times.

So here is the personality the HSE are failing to understand within this client.
It is actually important to know!

For starters - no where in the files has it been noted that i have had frontal lobe brain damage from a young age.
This therefore is a profound medical omission.  it distorts the medical definitions and overview of this patient and client

It has not been noted that i have brain lesions too from birth issues around being born with Congenital Rubella Syndrome.
this being omitted from medical and community files or only briefly stated without qualified explanations is medically denying a reality for this patient.  It denies the person a right to the full patient profiling.

it has never been understood that i have only 20% hearing.
Lack of medical comprehension to these things is inexcusable, modern science, understand of deafness and impact has grown in the past decade and is understood and weighted as having 5 times disabling effects than ever once considered (World Health Organisation has upgraded its disadvantage)

this is a massive deficit.
you usually do not classify in percentage terms, but its easier to understand it in those terms.

you cannot tell a person because you have great fluency, a nice accent and no issue with actual pronunciation that she is anything other than deaf.    

Deafness began around seven years of age, so i had 'understood' language until then and the decline though significant in the early years became worsened in later years with 'menieres' onset and 'mastoiditis.'

So personality is further complicated with a very late diagnosis of Asperger Syndrome, this term now has been melted into the Autism pot as part of Autism and being on the Spectrum.

but denial of both brain damage, deafness and autism is pervasive on community files.
Denying the medical evidence is medical neglect and abuse of power.  It twarts the picture. It does not represent the patient. It effectively wipes a reality of complexity, medically defined, therefore files are incomplete. 'Weight of disease/complex issues,' is not reflective for the person nor for consultant or community care professional.

It is never written down in community team notes as being 'important to note' which i think it is!

The understand of 'wholeness' of complete observation of persons with chronic illness and disability cannot be found either, within the medical field.

When clashing dynamic of how a patient 'operates' in the 'functional' way of 'communication abilities' we inevitably have a disharmony.

You are not going to ever get a patient with such complexity to match your ideal.

Society has to be observant of 'difference'
it has to adjust to facts.  HARD FACTS being, disability is what it says on the tin, it pours out with the communication skills which are appropriate to these deficits.

You cannot ever make an autistic person into a neurotypical.
You cannot put brain matter back when its atrophied.
You cannot remove brain lesions.
You cannot give renewed hearing when it has died, and is effectively - dead.

When a patient therefore becomes sick, we have disharmony and only one person suffers in this.
The patient.

People like myself and of course many others have their own ideas of how to care for any individual.
There is a golden norm we wish to aspire to and its called: 

Best clinical practise for all

I personally have my idea of how i should be cared for. I am not without intelligence and I am very practical, sensitive, and knowledgeable.
That has not been damaged by the deficits i presently have.

i believe in Morality and Ethics. 
'Difference' should not bring in its wake inferior medical care and inferior community supports.

I am now 65yrs and this too can come badly against you as you are expected to go home and die off, irregardless of how unwell or disabled you are.
Again, i cite any country as a Morally Bankrupt society if it inflicts such suffering on the most needy as care should increase not decease for our older citizens of this state.

i don't intend to allow this happen and will demand equal treatment for equal illness as the rest of the youthful citizens.

Treatment of those with 'difference' has meant an inferior care system for us.

It is blatant, obvious and painful.

It crushingly defeats the strongest of us.
It attempts to deny and anihiliate the personality of spirit, spunk, genuine good intentions and the care for the greater good of the individual.

Arguing for best practise in a badly communicated way is considered consistently as - 'she is aggressive, abusive' and a character/personality is defined from professionals meeting this as:
 'here we have a disagreeable person'.

It says nothing of how that person deals with stress.
But then if you do not put on the files medical evidence the person deals badly with stress and distress we are not heading for a winner here, ever.  
This, I consider medically screwing the evidence for the benefit of the professional rather than the patient.
  
It is medical malpractise to obliterate the diagnosis

the black and white picture is very black for the consumer in Irish Healthcare.

Try going to a consultant (alone) with a diagnosis of Autism, Severe/Profound Deafness, and issues around communication, deprivation of social inabilities due to a life of isolation when you withdrew from the world for decades.

Try carrying on an equal discourse on disease, care and diagnosis with this set of 'communication difference'.

It is impossible.

you are not meeting my sisters here.

You are meeting a 'born with disability' person with newly acquired disability and chronic diseases of considerable complexity.

Missing this point entirely because I am articulate, forthright, intelligent and speak proper, misses the deficit marks entirely.

I speak sir and equally.
I am sir, different.
You will not applaud my screaming when so distressed its unbearable.
You will not applaud my meltdowns when you rubbish my illness and presentations.
You will not applaud my loud snide remarks, abusive phrases when you have brought me to the end of my personal rope and i am beginning to loathe every fibre of your being.
Denegrating me as a person who intrinsically never wanted this discourse or disease and who is pissed to the eye balls with the reticence and the rejections and the put downs will cause a reactive response every time.  You caused it, Sir!

You will not appreciate me telling you that for too long you have insulted me, defamed me, anihilated me.
You will not appreciate it when I attempt to tell you that although I scream and shout, I would not consider myself who you have decided to label me as.

YOU decided that without my input.
YOU decided that because it is convenient.
YOU have decided that without looking at 'cause and effect.'
YOU have made this judgement without looking at well observed, tested and diagnosed issues you have failed to note on the files with medical correctness that files should be complete and give the full picture.

There is no warning that difference will present in this individual from the start.

No doctor or community care officer has ever written such words of these as part of 'history' for this patient.

This woman in senior years presents with chronic disease and with a complex neuromuscular disorder of unknown aetiology.
Her social history has been peppered with disadvantage, isolation, exclusion and sadness.
She has rarely engaged with the general community on a level expected of a citizen who is accomplished in communication.

She is intrinsically vulnerable and has experiences not many encounter on a consistent basis.  She has a history of sexual abuse, further impacting on trust levels especially with men.

This woman has an autism spectrum disorder, is severely deafened and shy and has a communication fitting her ability.

We must therefore at all times remember her lived experience we may never understand or have experienced.

Best practise demands the following dialogue:

  • She comes to me today nervous, terrified, with little trust but expects as is her right to be treated well and fairly.
  • we have a duty of care to respect her, do all we can to 'enable' her have a quality of life as all life is sacred.
  • we will endeavour to give her back her dignity and quality by enablement not denigration of body, soul and spirit.
  • we treat her with a preciousness because she is special and requires a sensitivity from us she may never be able to equally give in return.
  • we must never abandon her or make her feel pain due to her communication disabilities.
  • we must never make it worse for her than it already is.


Alas my friends they, the medical professionals and the community care teams, have made this person's life HELL ON EARTH
Labelling has been so defamous that its shocking.
Denigration is the order of the day.
Abuse, torture and neglect comes on a power that many who can fight back would have been able to stem long ago.

HOW THE CARING PROFESSIONS SEE ME
To me today as a person thus described above, my lived experience of those who should be better able to enable has been profoundly traumatising.
It has cut me down to worm status. Given me a level of despair and depression I never thought possible.
It has halted me in my tracks and stunned me as if shot with a stun gun.
i have been very heavily beaten and thrashed.
Denial of healthcare has been the result.
Many know that part of the story.
How many know why it has happened?

Ignorance.
Plainly I see this all as inability to deal with 'difference' and inability to accept that people are different.
The ability to need a person to be a certain way before you can treat them is profound here in Ireland.
It does lead for an easier life if a person is a 'yes man/woman' and pliable and grovelling and compliant.
It is not easy to meet an intelligent woman with high standards, expectancy but who has a different way of engaging in a conversation she finds almost beyond her ability.
What happens then is anger, really on both sides as one trashes a person trying to be heard on a consistent basis resulting in a person who has had enough of the abuse and lash out.
That part should make perfect sense.
You cannot have it any other way.

Anyone abused should react!

Do I respect those who abuse me?
No,  I do not.
You will never make a saint out of a person who is harmed.
You will never make me act saintly in the face of abusive practises.
You will never make me accept your perception of me and you cannot expect me to be in your terms 'normal' when its abundantly clear what we are dealing with here.

It is MY personal situation from hell.   The anihilation is real.  It happens because of the expected response from a disadvantaged person with so many health issues.  You cannot ever conceive such a heavy disease burden.

Two consultants to date has named this as it is.
one said in writing 'she carries a heavy disease burden.'
The other considered me amazing and said to me as he wheels me away from a colonoscopy room, 'you have such a lot to deal with.'

Tears dribble down from the corner of my eyes.
Will you look into my eyes and observe my distress of this 'heavy disease burden' and unrealistic expectations of the healthy and powerful over one single person who is doing her best.

The added problem is, I have now reached 65yrs of age.
I am expected now to go home and die and go home with even less service than I ever managed to garnish for myself.

YOU DEFINITELY FEEL IT!
So we have inequality here being played out on a grand scale.
I DID NOT GO THROUGH SO MUCH TO LIE DOWN AND DIE NOW.
I AM NOT GOING AWAY WITHOUT MY FIGHT TO MY LIFE, QUALITY OF LIFE AND EQUALITY OF HEALTHCARE AND SERVICES.
This person will not accept this.
I demand equality, despite all.
You are not allowed discriminate on the grounds of age.
You are not allowed discriminate on the grounds of disability.
       route it out where ever it occurs.

Ten years of denying the therapies and treatments mandated by the medical consultants who mapped a plan for me has been denied me and my identical twin sister, i hasten to say.
I have yet to have anything implemented and now aged 65 it will be harder.
I want all to understand this - I will fight on, in truth and justice.
i will face this with my inability of communication but I will intellectually be able to tell you that it is against the law to abuse your power, to defame and to cause harm.
All of which you have done to me.

it is morally and ethically wrong
but more importantly - it is acknowledged as a dynamic as being against the law.

May i ask all the community care professionals as i end this discourse -

WHERE HAVE YOU HIDDEN THE MEDICAL EVIDENCE I GAVE INTO YOU WHICH NOW SHOULD BE ON MY MEDICAL FILES, BUILDING A PICTURE TO ENABLE YOU TO CARE FOR ME AS A DIRECT RESPONSE TO THE REALITY OF DISEASE, FUNCTION AND DISABILITY -

THEY SHOULD BE ON FILE, THEY ARE NOT.
WHY?
IT IS NOT POSSIBLE TO KILL OVER A 'STRONG SPIRIT WOMAN' DESPITE HER DIFFERENCE AND INABILITY THROUGH DISABILITY, I AM INTRINSICALLY SOUND!

I DID NOT GO THROUGH SO MUCH TO LIE DOWN AND DIE NOW.
I AM NOT GOING AWAY WITHOUT MY FIGHT TO MY LIFE, QUALITY OF LIFE AND EQUALITY OF HEALTHCARE AND SERVICES.









































Monday, April 16, 2018

When Quality of Life reaches the lowest 20% of population

Suffering isn't enjoyable.
Suffering is exactly what it says on the tin.
the story of lives played out in spectacle never expected
Torture too is abhorred the world over in all its guises.
Any fight worth the fight damages you
when you are very unwell.
Remember there are many faces to that  Torture.
it can be at the worst end of tragic and cruel wars, to the lowly silent killers of domestic abuse.
It can be anywhere in the middle.
It can be from the State and from the Public Services.

Countries can have a 'reputation' or 'suspicion' of being unsavoury, unpleasant, and undemocratic in its attitude to its own.

Countries can have a reputation for being a great 'crack,'  a 'fun loving nation' a country can be the best place to live, and yet lurking in the recess is the cesspit of abuse and torture.

Gift wrapping away issues of abuse and torture is held in the best hands at the commercial counters of 'sell us well' stores.
Gift wrapping is an Art form in some countries, especially if it is needy of world attention and affection due to size, economic wobbliness and poor management.

All these reasons, do not make torture in any shape or form, excusable.

I do not accept it in any form whatsoever.

WHEN IT HITS TO YOUR DOORSTEP AND THAT OF YOUR LOVED ONE, YOU WILL RISE UP AND DEFEND THIS INDEFENSIBLE ATTACK, which i now am trying to do and have done for a solid ten years of grim endurance.

I am tired, bone tired of fighting systems of abuse,systems of anihilation and systems who actually believe far more in defending the indefensible than in those they were constituted to uphold and honour.

I am tired of our healthcare system, our denegration of the citizen to the lowest of the low.
I am fighting weary of the suffering across Ireland,  for the elderly, the young, the very sick the disabled.
it was not a 'good life' but it was MY LIFE,
all i was given.
I am tired and angered that the people we elect do this to us and hold themselves up to be some wonderful species facing the modern world with modernity.

"we are a modern country"  states Enda Kenny in his office of An Taoiseach, with indignant stance against the Roman Catholic Church not so long ago in history.

Say that to the trolley watchers, the nurses, the patients and the ones that have laid on hard rock trolleys for 40hrs at the age of 80 and more.

When abuse hits home I guess that is where it hurts the most.
It has been a grim decade and we are in decline.
not for the first time booted out of A'E and ending in another hospital very sick
My twin returned to Ireland after an incredibly valuable career and contribution second to none towards the less able.  she gave to women who were victims of clerical sexual abuse, but she earned her crust showing a better way to treat children with disability and protecting them from abusive practises in care management systems.
you never get use to Irish healthcare systems
Nothing prepared herself nor I, given our decline through severe illness and disability for what was metted out to us for the past ten years.
we all felt betrayed with the denial of our rights under the Optional Protocol which the government of the Day rejected when ratifying the UN convention on the rights of those with disabilities.
WE FELT BETRAYED
WE ARE TRAPPED IN THIS ABUSIVE VICE
IT ALLOWS NO WAYS TO SPEAK THE PAIN
REAL CHOICES FOR REAL LIVES IS NOT THERE FOR MANY
WE NEVER PROTESTED WILLINGLY
PROTESTS COME ABOUT WHEN INJUSTICE OCCURS FIRST


'taking this on'
was not by choice
Driving wedges into our quality of life with reports now claiming we suffer severe PTSD and the reports also claim our quality of life rests at the bottom sector of society within the mass of 20% who has the worst quality of life within the citizen base.
 recent images
says it all
This was caused and there was purposeful intent to smash our resistance to the mite of the HSE, an institution of huge proportions within this state.

The HSE, the mechanisms of the HSE are recognised within the world of the sick, the disabled, the poor and the needy as being a very harsh and cruel force against the people who are vulnerable and needy.

The way it operates is understood by all, it may be a secret underground, undercurrent, but it is well understood.

it is morally and ethically wrong to be cruel and uncaring if your role is in the caring professions.

it is a bankrupcy worse than the financial sort.
its soul bankrupcy.  It kills body and soul. It kills to torture sick and elderly in this manner, hoping that if you keep it up long enough the sick will turn away and not bother to ask for more.

Or ask for rights based care and consideration.
Those who fight for their lives are literally fighting for that quality of life which left them, spirited by pain and suffering and abuse, spirited away from all they had once known that brought joy of being alive.

We face a desperate end of anihilation by this state.
We have fought a battle for ten years now.

Most across the globe recognise this, and stand by us, many may do so in the silent manner of the Irish.   We are not a very demonstrative nation when it comes to healthcare, at all.
Yet recognition is there and we are grateful we know it is.

I want to see closure from this situation. We have lost a decade of living and our lives put have been put on hold.
We have lost the ability to sense the joy in the juice of love and life.
We have lost the ability to look past this ghastly suffering as it still continues.

We want our lives back in total.

Today this is more about pleading, a pleading that sense will prevail.

It does no one any real favours defending the indefensible here.
The closure is for all.
Movement into a more positive vein is a worthwhile road to take.
Movement away from such intense involvement in our lives is worthwhile.   All involvement requires committment of time,money and paper trails.
No one likes to be hated to the core, as we do, due to injustice set upon us and our being, our character and our lives.
learning is the way forward.  when wheelchairs were seen to be a problem, Margaret did a post graduate course in 'wheelchair & postural seating' course with Limerick University.
Learning is a way to tackle issues more than procrastination
No one wants to sit in the office and know they have to tackle the same tedious odious job of sorting out for another day the procrastination game demanded of them, wearing them down and giving no job satisfaction.
No one wants to be an abuser.
But they are, and there are too many out there.  They get paid for that!

What better way for closure in an Irish psyche is a handshake with a smile?

Both parties divide, walk away from the table 'a peace process' in train, a sorting of a veritable mess achieved.

Back at the office the hands can be clasped to the gods above, "thank god that is done"
and we can go home and hug each other and say, "let our life begin twino."

Please pray with us that tomorrow that this is the last sort of,  trench warfare battle scene, where there are two victorious sides.
'Them and us.'
It would be a good feeling and a good day and a great outcome.

Remember the world does watch Ireland, we may be small and seem inconsequential, but i know the world watches this.
many are too terrified to go 'public' on state abuse.  the suffering is huge, fallout massive and there are consequences for action taken, it takes its toll.
The reputation in our healthcare services has reached far and wide by now.
Many are spreading their pain worldwide,  not only the twins.
Many say it as it is, and the face of the inhumane treatment is heard.
Ireland does work silently in these veins of communication.

Its not the enviable situation to be in to hear another country claim us as 'third world' in healthcare approach.
Far too often this is being said, to many not to a few.
London underground
on the way to meet a neuromuscular specialist.
we look great!
we feel absolutely awful!
Looks mean everything in an country that doesn't fully understand complex diseases.
Let us begin the beginning of an end to this.
Tomorrow we sit around the table,two 65yr olds going on 30yrs, who want life over the bed pan.
Sick yes, but needing our life.

Tomorrow we sit and hope that sense will prevail.
ALL VOICES COUNT TO TALK THE STORY OF NEED
Tomorrow we hope that the cruelty will end for us, we have endured enough.
Margaret waiting to give an impassioned talk to the Transport committe at Dail Eireann
Age Action, Friends of the Elderly, People before Profit, Simon Harris TD Minister for Health, Finian McGrath TD  Minister with special responsiblity for Disability, Deirdre Clune MEP,  Roisin Shorthall TD,  Gino, John Brady, Caoimhghin O'Caolin TD, Thomas Pringle, Pat Casey TD, Independent Living foundation, AT Networks, Centre for Independent living, Neurological Alliance of Ireland, IPPOSI and far more have heard our story.

Many international organisations of note heard our story - Amnesty International, International Mito Patients, Researchers, clinicians, Patient Focus, Advocacy groups, Disability advocacy groups, and charities.
CEO's of large organisations have been appalled at our plight, and stated such.
saying it as it is, is never 'Pretty'
So too has RTE, Joe Duffy, Joe Little, Primetime, Newstalk, East Coast Radio, the Irish Examiner, the Irish Independent, the Irish Times, Twitter and Blogs,  all carried features, video clips,  news snippets and paper spreads on this case.
we may have angered the HSE
we are very damaged by this system
Tomorrow 17th April 2018 is the day the war ends - or will it?

I would welcome a strong force of support in any guise it is to be activated, people power works, but it strengthens our resolve and should galvanise those to realise a Fight worth fighting is the Fight worth that fight.

Please be on our side tomorrow, in any way you chose, demonstrate the committment we have felt and seen for a full decade of our pain.  We have been in chronic pain during this journey.