The Conference: Part 1 of 3

I was one of the lucky ones who got to attend the first-ever Northeast PANDAS/PANS Conference in Providence, Rhode Island. I had an exhausting blast. It was spectacular to hang out with new and old friends, and to be in an atmosphere in which everyone spoke the same language*. It was also overwhelming. So much scientific information, so many emotions. And my own Lyme-induced fatigue crept up on me every afternoon. That didn't stop me from going with friends to see WaterFire for Veteran's Day in Providence Saturday night. I needed to get out of the hotel and BREATHE. 

I did promise to take notes. Fortunately, some of the presenters posted their PowerPoint presentations on the Northeast PANS/PANDAS website and you can find it here.

I wrote as quickly as I could. I nearly filled a 60 page composition book with all the notes I took, but I have to admit, I did NOT understand everything I wrote. I still jotted it down, hoping to look up words and ideas later, and supposing that another scientist might remark on it. So, I have included many one-liners here, with a couple of pauses for my thoughts.

The dedicated doctors and scientists impressed me and I am incredibly grateful for them. It was wonderful to see Dr. Charles Ray Jones, our Lyme Disease pediatrician and fighter, there, along with his friend and wonderful neuropsychologist, Dr. Judy Leventhal. Dr. Trifiletti gave an amazing presentation and could have spoken more about his genetic research. There were many other attendees and presenters who have done so much to help our children.

There were also a couple of surprises. Dr. Latimer and Dr. Cunningham advocated vaccines to a stunned, silent audience. Plasmapheresis (PEX) was advised, although many of our children recieve IVIG first. I wondered about hidden agendas. No longer do I take the word of one doctor without consulting with another doctor whom I trust. 

So, following this is a long list of information. Think for yourself. Check out the facts. Doctors and scientists don't necessarily agree on every item, and parents who have fought in the trenches, vehemently disagree with some of the following. But there is much good information here, so use it wisely. And when I get through the rest of my parent/teacher conferences and teaching pretty healthy fifth graders outside of my home, I'll post the rest.

*For a great blog about speaking PANDAS, click here.

Conference Notes:

Dr. Susan Swedo, Chief Pediatrics & Developmental Neuroscience Branch at the NIMH: Post-infectious inflammatory response 

Swedo:  15 years of negative information that this doesn’t exist. Call it PANS/CANS. This is “controversial”—that’s what we need to deal with. Almost like AIDS in the 1980s.

Swedo: confront the controversy head-on.  Debate with AAP was successful. One district at a time (Leckman)  Unified approach when educating—share approved information.

Dr. Susan Swedo:  “It’s been 25 years and parents are still being blamed for their kids’ illness.”

 “Freud himself described OCD as a biological/neurological illness."

Swedo:  PANS is  a misdirected immune response and not an autoimmune illness.

If you can’t remember the exact day and time your child changed, it might not be PANDAS. ????? (

I found this to be controversial and Dr. Trifiletti would come up with a different theory the following day. I can't recall the exact day and hour, and there were insidious symptoms all along that we never caught. Yet four different doctors have diagnosed my chid. I'm not in agreement with this.)

Comorbidity with ADHD, OCD, tics, depression, etc. short-term memory problems, urinary urgencies.

Titers—don’t chase titers. It’s only a rise in titers that indicates a child has an infection. Once high, titers can stay there.

65-70% of children will have strep during the school year.

Strep carriers are common.

There were negative studies trying to prove PANDAS doesn’t exist. But they were looking at the wrong subjects at the wrong time in the wrong place.

PITANDS: they knew from the beginning that strep wasn’t the only strep (chicken pox, influenza, especially H1N1, mycoplasma, Lyme, etc. can all be triggers.)

PANS vs. CANS:  Pediatric is an appropriate term because it goes up to age 24/25. PANS is pediatric. CANS means Childhood.

There are people deeply invested in this NOT getting respect.

Criteria for PANS includes a foudroyant (lightning-like) onset.

Eating disorders are often the result of restricted eating, fear of vomiting, having difficulty swallowing, and eventually, body dysmorphia.

Only 3% of the population is susceptible to rheumatic fever. Perhaps 3% is susceptible to PANS?

Or maybe more people. The incidence of PANS might actually be quite high and it’s only the unlucky ones who end  up with severe issues.

Keep kids on antibiotics throughout college. Do kids with PANDAS outgrow susceptibility after adolescence?

Psychotropic drugs: Start low and go slow

Plasmapheresis has fewer risks but is a bigger ordeal.

Volume of the caudate in the brain changes after PEX treatment. Before treatment, a caudate showed a 20% enlargement. IVIG can also normalize the parts of the brain that are inflamed.

Dr. Ditran Agallio, UC Irvine, Development and Cell Biology

There’s a lot of swelling in the basal ganglia.

The blood brain barrier is an important gatekeeper to the brain.

It limits the entry of pathogens, immune cells and drugs.

Glucose is essential to the function of the brain.

How is the BBB invaded? Hypothesis: the destruction of tight junctions between endothelial cells.

Selective interaction of antibodies with endothelial cells; these are transported to the brain.

Repetitive GAS Infection: characteristics of immune cells change

Takes several infections for this to occur

This is a normal immune response

The body needs to balance

Hypothesis:  dysregulated Th17 Immune Response to GAS infections

Immune cells enter the brain after repeated intranasal GAS infections

Where are these immune cells found in the blood?

Olfactory bulb (region of brain)—there are a lot of t-cells there, crawling along the nerve

Once in the brain, within 48 hours, there is a shift in migration to the posterior parts of the brain.

If a child is prone to autoimmune disease, the response it going to be higher

These parts of the brain are affected: Lateral hypothalamus (has to do with eating) and the amygdala (processes fear)

The BBB is leaking.

Some of the antibodies entering the brain use another transport mechanism.

There are resident immune cells.

And increase number of activated microglia in mice suggest that the brain is in a state of inflammation. This occurred after strep was introduced only to the nose, and not to the brain.

How long will T-cells stay in the brain? 58 days after recurrent infections (in mouse.) Which, for a mouse, is a very long time, considering that mice only live a couple of years.

Strep: specific T cells will remain in the brain for a long time and be re-activated with another infection.

How do T cells get into olfactory bulb? They crawl along nerves and enter the brain. Strep-specific T cells can enter the brain. Immune cells can invade the central nervous system.

There are specialized gateways in the spinal cord and brain for T cell entry (found in autoimmune cases of central nervous system.)

What are the long-term effects of BBB breakdown for neuropsych disorders? Fahr syndrome was mentioned.

Certain areas of the brain are much more susceptible.

Dr. Beth Latimer (neurologist):

One size does not fit all. PANDAS is a tragedy because of the lack of recognition and because it’s a life-threatening condition and should be treated as such.

Why do we treat strep when it will go away by itself in 3-4 days? We treat to prevent autoimmune diseases.

They are using plasmapheresis in extreme cases and it’s working.

When children with PANDAS are sent to psychiatric facility, it triggers separation anxiety and they children are worse than ever.

Psych facilities don’t treat medically and medical facility don’t treat if there are psych symptoms. Big problem.

As the brain changes and evolves, the symptoms change and evolve.

Reading takes 4 years if you start at age 2 and 4 seeks if you start at age 6.

The younger the age, the more dysregulated the symptoms.

Autism is no 1/88 but another recent survey claims 1/50. It’s more prevalent than ever before. It is autoimmune encephalitis?

Low Vitamin D is associated with autoimmune infections.

IL-17/ TH1:  big marker for MS

Thought to open the BBB

This is also implicated in asthma

TH1 -  kills?

Why is there an increase in autoimmune disorders in children? Is PANDAS new?

Could it be possible that Flonase supresseds the immune system in the nasopharynxz?

Also, aspirin is no longer used much due to fear of Reyes (this is not a suggestion to use aspirin.)

Rarely does she see African American children with this disorder. Genetic?

Is there something different about the gut flora in these kids? They can better tolerate high antibiotics for extended amounts of time than can the general population.

Kids can reactivate even when they’re on antibiotics.

If other kids are getting FluMist and your kids are I school, they’re getting the FluMist (shedding.)

Getting vaccines to prevent infections is very important (Note: the room was silent at this news. Many parents of children with these diseases have been advised to withhold vaccines, especially if the children are immune-deficient. Many people wondered if there’s another agenda…appeasing the AAP? Because there are associations with NIH?)

Bleach baths are suggested to help get rid of strep on skin, etc. Bath entire body except head. ½ cup of bleach to 40 gallon of water; soak 5-10 minutes.

Rifampin works great for strep but use it quickly; it can cause liver damage. Use clindamyacin, followed by rifampin.

How do we get T cells out of the brain? IVIG will shut off you own production of antiobodies.

Children’s immune systems forget…as children grow. That’s why we have to re-vaccinate. 

There are zero complications to plasmapheresis.

IVIG takes 2-3 weeks to work. Plasmapheresis can be much quicker.

Augmentin is an anti-inflammatory.

Planquenil is also anti-inflammatory.

If you’re on antibiotics and you have flares, ride it out for a week or take a 5-day burst of steroids (NOTE:  Children who have LYME Disease CANNOT take steroids.)

For H1N1: sometimes 2 days of tamiflu.

Dr. Kyle Williams/Yale (psychiatrist)

 There is strep A-F

“All kids get strep throat,” people will say. Group A Strep is one of the most prevalent diseases in childhood.

 Strep is associated with a wide variety of autoimmune disorders, moreso than any other diseases:  Sydenham’s Chorea, rheumatic fever, etc.  Sydenham’s Chorea looks really similar to PANDAS and is treated prophylactically with antibiotics.

PANDAS vs. Sydenham’s

In PANDAS, there is no cardiac pathology, but there is usually some type  of cardiac pathology in Sydenham’s Chorea.

Why do some people get PANDAS instead of rheumatic carditis or Sydenham’s?

There is a dysfunction of the basal ganglia. OCD and Tourette’s are both mediated by this dysfunction.

There is no genetic test for OCD right now.

Only a clinical presentation will show difference between childhood OCD and PANDAS.

Serum from patients with both SC and PANDAS reacts with proteins expressed to the basal ganglia. Antibodies also cross-react with an extra-cellular strep protein.

Hypothesis:  Find target (basal ganglia) following infection.  An MRI can show evidence of a basal ganglia infection (my question—what kind of MRI, since my son has had 2 and we’ve never seen anything?)

There is increased volume to parts of the brain:

8% caudate

7% pallidal

5% putaminal

Post-treatment saw a 30% decrease of the caudate volume and a 35% decrease of the putamen volume

Inflammation: through treatment, the parts of the brain that are inflamed, decrease in size.

What cells are responsible for this change in volume?

Treatment:

With anti-autoimmune therapies

In psychiatry, placebo responses can be VERY strong.

IVIG is highly purified IgG

The infection rate is astronomically low

PEX: 1 month later there is a 49% decrease in tic severity

IVIG vs. PEX

Scientists have “no idea” how the IVIG really works

Letter to PANDAS Grandparents

Dear Grandma and Grandpa,

If you're like most grandparents, you truly care about your grandchild. Maybe you're wondering what's going on with the kid? Is it behavioral? Is it the fault of your child-in-law? Could this be some genetic defect from the OTHER side of the family?

And why aren't your kids doing more to help their child? They tell you he has some unusual disease--PANDAS or PANS. But you wonder if their child is acting up for attention. He seems OK to you, most of the time, especially if you're watching him. It's when his parents come home that he starts acting up. 

You have good questions and you deserve explanations. You play such an important role in the lives of your children and grandchildren. They have never needed you more. So it's integral that you know the difference between fact and fiction.

Myths and Realities:

1. The child acts up only for her own parents.

Actually, you are lucky if the child can hold it all together when she's with you. These children are medically ill. They have a disregulated immune system. When exposed to germs, their body makes antibodies that then attack their brains. They often have tics, OCD, separation anxiety. If they seem OK with you, they are either in a healthy place or expending energy to make it seem that way. The safer they feel with you, the more they will allow you into their medically ill world.

2. It's just strep throat.

Actually, PANS (Pediatric Neuropsychiatric Acute-onset Syndrome) can also be triggered by Coxsackie Virus, flu, pneumonia, and more. Lyme Disease seems to play a large role. Lyme Disease in often accompanied by other tick-borne coinfections like bartonella and babesia. Some of our children are now immune-deficient and any tiny germ can set off a flare.

3. The kid had his tonsils out. How can he still be sick?

Read the above. Also, strep can hide out in other parts of the body. That's why more and more parents are giving their child supplements to help treat the "gut."

4. This kid isn't getting better.

Unfortunately, there are very few doctors who understand PANDAS/PANS and treat it. Every child is different; there is no one cookie-cutter way of treating PANDAS. There are so many factors involved. Some children can be healed completely, some immediately, and others can take years. There are adults walking around with PANDAS. But children ARE getting better. Perhaps they will never be completely rid of this disease. Perhaps they will. It's too soon to know.

5. The parents let the child get away with a lot. In fact, the child is back in the parents' bed!

Ahhh. This is part of the separation anxiety. I've read of 16 year olds who are sleeping on mattresses in their parents' rooms. It's almost non-negotiable. If the family wants to sleep, it must take care of the very ill child who experiences increased anxiety at night. Stress exacerbates symptoms. Parents have to learn to choose their "battles." These kids might not be able to handle chores. Or showers. They often have sensation issues that they never before had.

6. The child needs to go to a hospital.

I wish! Unfortunately, with a few exceptions, there are almost no hospitals that treat PANDAS/PANS. There are no hospitals to my knowledge that treat chronic Lyme Disease. In most cases, children who are acting in a way deemed to be psychiatric are placed into psychiatric wards. Some of these children are removed from their parents' custody. For more information, google Elizabeth Wray. Her parents and grandparents supported her fully, moving her from one hospital to another in search of a wonderful doctor who could help her. Alas, they ended up at the reknowned Boston Children's Hospital and then their nightmare began. BCH removed custody from her parents. A gag order was placed over the family. I attended a rally to support the Wrays. 

7. There's nothing I can do.

Yes, there is! If possible, watch the children for a couple of hours so that the parents can get out together. It's hard to keep a marriage together when there is so much trauma. Help financially. Many of the best doctors don't take insurance. Medicines, supplements and IVIGs cost a great deal of money. Often, one parent must stay home to care for the sick child. Families suffer financially. Offer hugs. Offer emotional support. Listen. Don't minimalize the experience that your child and in-law are experiencing with their own kid. Assume you don't see the worst. They do, and they're keeping their family together. It takes a lot of strength to do this. Show your respect.

8. My doctor said PANDAS is over-diagnosed.

Doctors can be wrong. They're people just like you and me and if they haven't experienced anything like this before, they just don't know. Furthermore, the American Pediatric Association is just starting to recognize PANDAS. There is not enough awareness yet. Not enough research. Help to educate your doctors. You might save the life of another child.

9. My grandchild is on way too much medicine.

This hurts, doesn't it? Looking at all those pills. Visiting when the little guy goes for a plasma infusion. No parent would do this unless absolutely necessary. Have faith in your children's decisions. It is breaking their hearts to do all this. They have probably already been to at least a dozen doctors.

10. The child doesn't eat/is a picky eater. The parents insist on a dairy-free, gluten-free, sugar and soy-free diet. It's ridiculous.

Many of our children are on gluten-free diets. Gluten can be inflammatory. Some of these kids have shown sensitivities to different foods: gluten, yeast, dairy, sugar. It's important that we support the parents in keeping to these strict diets. Why? Because when the child is overloaded with stressors, including food, the medical symptoms increase. My own son had OCD-induced anorexia. Ironically, now that he is on a strict diet that eliminates the foods that can result in more antibodies, he is eating better. If you're able to cook foods that he enjoys while keeping to his restrictions, you'll be a hero. Believe me. My mother-in-law came to the house with gluten-free, yeast-free, dairy-free, peanut-free brownies. My son was in heaven.

Want to know more? You can read about PANDAS here: http://www.panslife.com/whats-pandas/. Also, PANDAS Network has an excellent site. You can also donate there to support more research and awareness.

We need you on our team. It's a nightmare for many of our families. The things is...if this disease is caught really early, it can be treated much more effectively and possibly eliminated. Someday, the medical community will know as much as you do. That's right. If you're a grandparent of a child with PANS or PANDAS, you know more than many doctors. 

Thanks for being here,

PANSlife

Times, They Are a'Changin'

Just a rambling ride...this journey into PANDAS and Lyme. And that's what this blog post promises to be. 

Ticks are out in full force. Yesterday, friends of ours went hiking and had to sweep many off of themselves and their dog. Another friend in Rhode Island found an adult tick crawling on her arm. Watch out. These buggers are insidious and dangerous.

Lyme plays a big component in PANDAS. It's possible that not every child with PANDAS may have Lyme (or coinfections,) but many do. And often, it's untreated, unknown. Heck, I would NEVER had known that I have Lyme, or that my daughter does, if my son hadn't been diagnosed first. And he was treated for PANDAS for about 9 months before we discovered the Lyme.

Yesterday, my husband and I left our kids at home with my son in charge while he and I went bicycling for his birthday. It was a warm autumn November 2 day, with golden highlights streaming through the leafed trees and the smell of burnt and decaying leaves. My nose didn't appreciate the allergens. My eyes reveled in the colors.

A year ago, this would never have happened. We would not have been able to leave our children together, even with a babysitter. But life is better, for today.

Last night, my daughter played drums in an "Evening of Drummers" recital. It was rock-and-roll heaven for some, but flashing lights and lots of loud noise for others. My inlaws came; my husband had brought earplugs for them just in case. I felt like I had gone to Hogwarts for the night to experience wizardry, except that each of these wizards had two magical wands. I loved it. 

But I kept an eye on my son. How would he do, with his PANDAS sensation issues? He's again having a little trouble with the sensations that showering brings.

He was great! He not only survived, but he was able to stay for the second half of the show. The constant drumming--which was exceptional--did not bother him. He admitted that the lights increased his tics, and that he couldn't eat with the large crowd there (OCD,) but he survived. Happily.

As PANDAS parents, we are different from normal parents. We scoped out the room and got him a seat to the side where he wouldn't be so exposed to germs. I brought his own food so that he wouldn't eat from the buffet (germy.) He went outside for part of the intermission. After 4 days of him flaring earlier this week, I was a little nervous--how would he fare? My husband thought that perhaps we should bring two cars just in case. My own Lyme acted up and I felt so fatigued that I didn't want to drive. It was all OK. Everything worked out.

I'm joining a book club for the first time in years. Last year at this time, I could not get out at night, could not leave my son for a minute. And, next week, I'm going to the first-ever Northeast PANDAS conference! 

I'm so excited! Yippee! Freedom! I'm trying to prepare the kids for my absence. I have to instruct my husband as to the medications each take. But since he's the one mostly at home with our son, he has the food restrictions totally under control. I let my kids know that they cannot text me to tell me they need me. I don't need guilt trips while I'm away. Last spring, when I was away for a day, my son texted me non-stop that he needed me but never let his dad know that he needed help. Am I nervous? You betcha. I've actually never been away from my kids for two days before!

But I'm also thrilled. PANDAS awareness is building. I intend to post as much information as I can about the conference but I must beg for time...I will return to mounds of laundry and parent/teacher conferences at school. And I intend to have too much fun with fellow PANDAS moms at night to work on transcribing my notes. This is my time...and we all need to find quality time for ourselves so that we can be there for those who need us.

Ironic how my quality time revolves around a PANDAS weekend, huh? No bike rides for me next weekend. Just pray for a flare-free week. 

Happiness = PANDAS getaway. 

Believe

What do you do when your world is out of control?

Eat chocolate. Gluten-free, dairy-free chocolate. 

What do you do when you can't button your jeans?

Go for a bike ride or two or twenty seven. Take the dog for a walk. Ask a friend to accompany you.

What do you do when your child is is suddenly not doing well?

Call a friend. Connect with your computer. Find a support group. 

Know you're not alone.

But that's not enough. 

Find a GREAT team of doctors.

But that's not enough. Results can take months. Years.

What do you do when you're running out of money because of all the health bills? When your family's in turmoil? When you can't do a damn thing about it? When today you cannot save your child from this sickness?

Go for a bike ride. Go for a run. Sweat it out. 

What do you do when you can't even get out of the safe den of your bed?

Read.

Escape into fiction. 

Stories that end happily. Mysteries that are solved.

Listen to music.

Oh, baby, baby, it's a wild world.

Hide my head, I want to drown my sorrow.

If you think you've had too much of this life, well hang on....

Take a pill.

But the pill made me gain ten pounds. And crave chocolate.

Hug a sweetheart.

Hug a pet.

Watch a movie. One with a happy ending. One that makes you laugh. Watch Big Bang Theory. Or There's Something About Mary.

Bake brownies.

Give them all away.

Accept hugs.

Email a friend who is happy to hear from you just because you're you.

Clean out your closet.

Scrub your kitchen.

Bake. 

Research. Google every PubMed article there is. 

Cry. In the car, alone, on the way to buying tissues. Or chocolate.

Believe.

Somewhere out there, someone can help us find an answer, a solution, an end to the intensity of this upset.

Force yourself to believe

that one year from now, five years from now, ten years from now, all will be better, safe, secure, happy.

You're not alone. Where you are struggling, others have also struggled. 

Where you are searching for solutions, others have found solutions.

If you're reading this, you're not living in a cardboard hut with dysentary and no running water. 

And you have at least one friend. 

Me.

For some of us, life is a gray, windswept land. Only the howl of the clouds surrounds us.

There is a huge stone mountain if we keep walking. 

On the other side are surf and sundrops.

And although we weren't born mountain climbers, we need  to get around or over that mountain and to the other side.

Holding hands, we can do it.

While eating chocolate.

A friend got in touch with me. You read my blog, looking for inspiration. I am afraid that perhaps my last few blog entries don't offer much inspiration. This one's for you. I needed to read this also. With love.

Where are the Doctors?

Alone time and I could be loving it, but I'm dealing with bills and insurance papers. Major yuck.

I'm contemplative, perhaps overly so. Sometimes, life seems incredibly challenging. Now that our son is doing better, I should be rejoicing. But I'm not. Our bills are gastronomical. 

Yes, I meant that word. The bills are so astronomical that they're stomach-unsettling. We just can't get ahead. Just can't catch up. I feel guilty going to the dentist for a cleaning or buying new clothes for work. It all goes on credit. This is not how I pictured myself at this age, at this stage. And quite frankly, at this age, it takes a little more to keep me looking a little younger.

I read FB posts in the parent support groups less frequently than I once did. I have found some wonderful friends--PANDAS and Lyme moms--and we commiserate, make each other laugh, provide emotional hugs. But when I do check the support groups, I see the same fears, the same questions that I have had. 

PANDAS/PANS is still out there, kicking loudly. Thanks to the efforts of many, many parents, 18 states, 4 cities and one country honored PANDAS with its first Awareness Day. 

But--where are the doctors? Other than a few doctors who have thrown their names in the PANS hat (and maybe themselves into the ancient Roman Colloseum,) many doctors still deny that PANDAS even exists. And others don't know enough about it to treat it adequately. 

In the four years that I've been dealing with this, my family has seen at least 25 medical and mental health professionals for my son alone. Twenty-five! No wonder I'm tired! That doesn't even include doctors, etc. in hospitals we visited. That doesn't include the dentist. Or the doctors my daughter or husband or I have seen.

It got to a point where I just didn't trust doctors that much anymore. I'm sorry, but our beloved doctors just don't know much. I had to research, read, learn, and when I finally came upon PANDAS, it fit. Like Cinderella, the slipper fit. Unfortunately, there is no "one" cure for this disease. Unfortunately, educational institutions don't understand it. Unfortunately, even the pediatricians in my children's practice will say it's "over-diagnosed." Unfortunately, some of our friends and family just couldn't hold on for our wild, tumultous ride over PANDAS mountain.

Fortunately, we know who really cares. Fortunately, my husband and I survived, and together. And fortunately, I was then able to find: not one, not two, but four different doctors who confirmed the diagnosis. Then, we discovered Lyme as well. It mixed up into one citrusy,  not-so-cutesy cocktail and set this kid on a rampage.

Well, he's not rampaging anymore, thanks to doctors. I'm aware that puberty can throw him off. I know that a bee sting can throw him off, for goodness sake. Or the cold that we floated through the house this week. But we're managing for today. He's a happy, kinda normal kid. He's bright and a pain in the butt to his younger sister at times. 

And me? If I had more money, I'd do more for myself. Go get my hair straightened. Do some shopping therapy. Go away for a weekend or week. I AM going to the first-ever Northeast PANDAS conference in Providence, R.I. And while I'm thrilled to hear the speakers, I'm even more excited to see my fellow PANDAS parents. And to get away overnight! Yeah, this is what I do for fun now-a-days.

So, here I am, going through bills, submitting to insurance, trying to get reimbursement (or insurance to cover the bill for $3,239 that should never have come to us from LabCorp.) Stress? Hell, yeah, but a different kind of stress.

Alone time? Not the kind I wish for. But I remind myself that things are better than they've been in years. I never thought it would be like this. And if it can happen for us, it can happen for you, too.