There are 2 kinds of surgery: PLANNED and EMERGENCY surgery

Planned surgery, while medically necessary, is surgery that is scheduled in advance because it does not involve a medical emergency and does not need to be performed immediately. Examples of planned surgery include: exploratory or diagnostic surgery, cardiovascular surgery, some orthopedic surgeries such as a hip, knee, or shoulder replacement or reconstructive surgery, removal of a malignancy, inguinal hernia surgery, cataract surgery, gallbladder removal, some hysterectomies, cosmetic surgery and more.

Unplanned surgery arises from an accident or other medical emergency. It is surgery that cannot be delayed and must be performed immediately, or within a day or two. Examples include: trauma, appendicitis, aneurysm, aortic dissection, internal bleeding, subdural hematoma (from a head injury), orthopedic emergencies, such as a bone badly broken in a fall, extensive burns, twisted ovarian cyst, ruptured fallopian tube, amputations and more.

   Unplanned or emergency surgery—or plain ol’ unplanned emergencies—occur every day. Sometimes stuff just happens. These emergencies can provide some of the most challenging and scary moments in our lives. If this describes the situation you find yourself in, the first thing to know is,

You and the human spirit possess infinite strength—you can do this!

Knowing this, the most important thing to do immediately is,

Call is to someone you trust to have your back, to advocate for and support you.

Having someone you trust by your side is crucial. While there may be a lot to consider, the short- and long-term, it is simply too much to undertake alone. You will need someone to help you sort through the priorities and help you come up with a workable plan. You need an advocate!

Due to their nature—emergent—things may happen at an accelerated pace which can feel out of control. You may not have the luxury to make some choices; in fact, depending on your unique situation, there may be a lot of stuff you don’t have control over. For example, if you go to the doctor for hip pain and they recommend a hip replacement you may have time to do research on the surgery, the surgeon, the recovery, etc. However, if you fall and break your hip you will likely need to undergo emergency surgery where you don’t have the liberty of choosing your orthopedic surgeon or hospital, or plan the timing. Depending on the gravity of a situation, it could mean immediate surgery performed by the surgeon on-call. With an emergency you may have to roll with it. Saving your life comes first.

What do I need to know right now?

• Know you can do this!
• Pick up the phone and call someone who can come to the hospital—right now—and help you. (If you can’t call yourself, give the person’s name and number to a nurse and ask them to make the call for you—right now.)
• Take a deep breath and let go. Not everything is going to get resolved right now.
• Take it one step at a time. There may be a lot to consider, both right now and in the day(s) to come. An advocate present can help with all this. For some, having an advocate present will allow a patient to relax, knowing someone is watching over them. 

What about after things have calmed down, then what? Once stabilized and out of danger:

• Make sure you understand what’s going on and taking place and what the healing and recovery process look like. 
• Ask for help generating this plan for the future—for your hospital stay and release. Include plans for stays in a rehabilitation facility and the transition home. 
• Ask a trusted family member or friend to help you organize and prepare your home for your return. If a patient is incapacitated, someone simply taking the initiative and doing this would be incredibly helpful.

 

57M American's are having surgery every year and 25% of American's live alone!

As many of you may know, I am in the process of completing a "how to" book designed to help anyone going through the surgical process, this includes caregivers and advocates. It will be available in the next 30 days (give or take a day), so keep an eye peeled. It has been an incredible experience and boy, do I have a ton of great stuff to share!
Recently I came across two mind blowing statistics:

• 57M - that's 57,000,000 - American's are having some kind of surgery or surgical procedure every year. Nearly 35M out-patient surgeries and 22M in-patient surgeries.

• More than 27.4% of American's, or 32M American's, live alone (according to a 2013 U.S. Census Bureau report).

Those are big numbers. They indicate to me that there are a lot of people who could benefit from some help and support when facing medical crises. I'll hurry up with the book. In the meantime, here's something to get you started:

And check back. This blog is about all things surgery related – preparation through recovery. If you have any questions, send them along.

To your vibrant health!

Ask questions; lots of questions!

I just found this article on CNN.com about a hospital with a very suspicious track record on heart surgeries for infants. (You can check it out here: http://www.cnn.com/2013/08/03/health/kentucky-hearts-hospital/index.html?hpt=hp_t2)

It just further illustrated to me that patients, caregivers and advocates must be diligent and courageous!

Sometimes asking questions is scary and daunting and doctors can be arrogant and pretentious. Don't let this ever stop you from questioning any and everything you want. If you or someone you love is in the hospital the only thing that matters is that and how you feel about the situation. Doctors and nurses should be happy to explain any decisions they make to your complete understanding and satisfaction. It's your right as a patient to ask why they are doing something or making a particular recommendation and their job to assist you in understanding what is going on and why.

While there are lovely doctors out there who are patient and great communicators, the opposite also exists. It can be hard, but stick your ground!! Your health and safety are worth it and frankly, all that matter. Doctor bullies, be gone!

Have a great day.

I'm back to work finishing my book! It's soooo close!  :O))

The inequivocabile value of REAL sleep for healing!

On June 21, 2013, CNN.com posted a fascinating article by Alan Duke that delves into a story that illustrates how crucial real, solid, deep, restorative, level four REM sleep is! 

Sleep is a POWERFUL healer and, sadly, we are really sleep deprived in this country, even resistant to getting a good nights sleep. 

Michael Jackson. Went 60 nights without REM sleep. :O((

In the Michael Jackson case, Harvard Medical School sleep expert, Dr. Charles Czeisler, sleep consultant to NASA, the CIA and the Rolling Stones and NBA basketball teams said that the "drug-induced coma" induced by propofol (anesthesia) leaves a patient with the same refreshed feeling of a good sleep but without the benefits that genuine sleep delivers in repairing brain cells and the body. 

Propofol knocks the body out, but does not allow the brain to get the deep REM (rapid eye movement) sleep required for true rest.

Dr. Czeisler, testified that propofol deprives patients of vital REM sleep and that lab rats die after five weeks of no REM sleep. Michael Jackson was given the drug propofol for sixty straight nights. That's 60 nights withOUT real sleep!

Dr. Charles Czeisler, "Your brain needs sleep to repair..."

Michael Jackson may be the only human ever to go two months without REM -- rapid eye movement -- sleep, which is vital to keep the brain and body alive. 

In fact, in the weeks leading up to Michael Jackson's death, he exhibited textbook signs and symptoms of someone lacking REM sleep, which were identified and documented by many around him, but went unacknowledged and untreated, resulting in or contributing to his death.

Inability to do standard dances or remember words to songs he sang for decades, paranoia, talking to himself and hearing voices, and severe weight loss, cold to the touch in spite of warm temperatures, having trouble "grasping the work" at rehearsals and needed psychiatric help, all symptoms. "I believe that that constellation of symptoms was more probably than not induced by total sleep deprivation over a chronic period," testified Dr. Czeisler.

"Depriving someone of REM sleep for a long period of time makes them paranoid, anxiety-filled, depressed, unable to learn, distracted and sloppy. They lose their balance and appetite while their physical reflexes get 10 times slower and their emotional responses 10 times stronger," said Dr. Czeisler.

Dr. Czeisler continued with an explanation of circadian rhythm: the internal clock in the brain that controls the timing of when we sleep and wake and the timing of the release of hormones, "That's why we sleep at night and are awake in the day," he said. "Your brain needs sleep to repair and maintain its neurons every night. Blood cells cycle out every few weeks, but brain cells are for a lifetime. Like a computer, the brain has to go offline to maintain cells that we keep for life, since we don't make more, Sleep is the repair and maintenance of the brain cells."

According to experts, "adults should get 7-8 hours of sleep each night to allow for enough sleep cycles, he said. When you sleep, you "prune out" unimportant neuron connections and consolidate important ones during your "slow-eyed sleep" each night, he said. Those connections -- which is the information you have acquired during the day -- are consolidated by the REM sleep cycle. Your eyes actually dart back and forth rapidly during REM sleep.

"In REM, we are integrating the memories that we have stored during slow-eyed sleep, integrating memories with previous life experiences. We are able to make sense of things that we may not have understood while awake."

"Learning and memory happen when you are asleep, he said. A laboratory mouse rehearses a path through a maze to get to a piece of cheese while asleep. The area of a basketball player's brain that is used to shoot a ball will have much greater slow-eyed sleep period since there is more for it to store, he said. Players shoot better after sleep. The Portland Trailblazers consulted with him after they lost a series of East Coast basketball games, he said. He was able to give their players strategies for being sharper when traveling across time zones.

He's worked with the Rolling Stones on their sleep problem. Musicians are vulnerable since they are often traveling across time zones and usually "all keyed up" to perform at night, he said.

Czeisler developed a program for NASA to help astronauts deal with sleep issues in orbit, where they have a sunrise and sunset every 90 minutes. Other clients include major industries that are concerned about night shift workers falling asleep on the job, the CIA, the Secret Service and the U.S. Air Force, he said.

CONCLUSION:  Sleep is just as important to you when your body is healing, especially when the body or mind are under stress, such as following surgery.

The whole point of this blog, it to get your attention!! Sleeping and resting are to CRUCIAL elements that you must allow yourself following surgery if you are to have success.

:O))

Why, Why, Why? Please Tell Me Why!

Why? Short, simple question, but ultimately profound. Why this? Why that? Why? Why not?

Good things to ask, especially when embarking on the journey of preparing for surgery – or any other major life event for that matter.

But staying focused on surgery and healthCARE, as you go to doctors, they will inevitably give you opinions, recommendations and directions. Great. Listen and take notes, but also be sure to ask questions.

Question everything.

While doctors have been through special, even specialized, training, that doesn’t make them all the same or infallible. This is true about diagnosing and true about communciations. Some doctors are simply better than others. Asking questions is how you understand what is going on and get clear for yourself. It is your right and for your benefit.

So keep your power. Don’t give your power away by blindly doing what someone, a doctor, for example, says. Take responsibility for your experience and ask questions; learn why a doctor is making a certain recommendation. Find out why doing what doctors say is important and how it's going to impact your experience or recovery.

Remember, there are no small or stupid questions when it comes to your care, your health and your well-being. In the end, what matters is you and whether or not you feel comfortable and safe with a course of action. You should know everything about it, it's your body and your right.

  

Big and small "whys" can empower and enroll you.

Here are a few specific examples to get you thinking about questions and whys.

Be sure and tell your doctor everything (medicines, over-the-counter drugs, herbs, supplements and vitamins, even recreational drugs like marijuana, ecstasy, mushrooms, etc.) you’re taking before surgery. Okay, but why? 

Because it may be important to discontinue some medicines, herbs, supplements and vitamins prior to surgery. Things like over-the-counter aspirin, ibuprofen and naproxen, Alka-Seltzer^® products, Pepto-Bismol^®, the herb ginseng, vitamin E, non-steroidal anti-inflammatories and/or other agents can cause bleeding problems or other complications during or after surgery. For an optimal, safe outcome it’s best to disclose everything and follow your doctors directions on their use prior to and following surgery.

Don’t eat or drink the night before surgery. Ok, but why is that really important? 

Because if there is any food or liquid in your stomach during surgery, anesthesia can cause nausea and vomiting, which can aspirate to the lungs and cause serious complications, or even death in extreme cases. Thus, to be as cautious as possible, don’t eat or drink anything 10 – 12 hours prior to any surgery, or as directed by your anesthesiologist.

Stop smoking. Okay, but why? 

In short, because it can cause complications, delay healing and interfere with the actions of certain drugs. The most common complications related to smoking are (1) delayed or impaired wound and tissue healing, (2) greater scarring, (3) wound infection, (4) cardiopulmonary complications (smokers are at greater risk for requiring the ventilator for longer periods of time), and (5) possible interference with the actions of certain drugs. Not smoking will allow lungs to work better and which will in turn cause blood flow to improve, which keeps circulation moving, which sweeps debris away from the incision site, helping you to heal more quickly.

Be sure and get extra sleep. Okay, why? 

Because, among other benefits, the restorative growth hormone required for healing the body is only released when you hit level 4 sleep. This is just one reason why it’s important to sleep, and sleep well, prior to and following surgery or any other kind of illness or trauma.

 

Keep asking why until you are completely satisfied.

 
Remember, ask your doctor why he/she is making certain recommendations. Often doctors fail to communicate why what they say or recommend is so important, especially about "routine" recommendations like "don't eat or drink the night before surgery." This may be an awesome recommendation, but for me, knowing the “why” behind the “what” is really important! Among other things, knowing why enrolls me in following through on a doctors recommendation(s). Following directions is easy, but if I know “why” I’m doing something and how it’s affecting or impacting me, then I’m more motivated and invested and likelier to do it.

How do I get my questions answered?

Read my upcoming book. :D And, do your homework. Use the library, bookstore and

Internet. Get a 2nd opinion (I think this is very important). Keep looking, researching and asking questions until you feel absolutely satisfied with the answer, until you feel "yes" in every cell in your body. 

Don’t take mine or anyone else's word on anything; get clear for yourself. Get clear and comfortable with the answer(s) for you and your body. After all, this process is all about you.

Ask For Help: Create & Structure Support

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WE NEED EACH OTHER! Especially when facing challenging situations, like preparing for, going through and recovering from surgery.

Me with special friends!

My experience (and belief) is that as social beings we need each other. We are inter-connected and need each other to grow and to thrive in all we do and undertake in life.

How are we inter-connected? Pick one: family, friends, school, team, spiritual affiliation, community, business, neighborhood, city, state, country. You are a part of and connected to something; something that doesn’t work without each of the other parts. When supported, parts can move forward. When unsupported, nothing moves.

With any kind of healthcare situation, planned or emergent, it is important to intentionally build in support throughout the entire process, from the planing phase through recovery; asking for help and support is paramount for success.

Asking for help – support –

may be one of the single most important things we do for ourselves,

yet, we do it very infrequently.

Support is important no matter who we are or what we’re going through. Support is the thing that allows us to make solid, sound, well thought out decisions and to thrive. With busy, full lives, pushed and pulled by work, family, friends, the Internet, T.V., cell phones, smart phones and all the rest, sometimes we forget that we still need each other. There is no substitute for person-to-person contact and support. As independent and self-sufficient as we think we are (and may appear), we still need each other. Doing it all ourselves is a myth that we've come to believe.

Consider this, depending on the procedure you have, you may be unable to perform even simple, basic, typical daily tasks or routines, especially simple household chores, that require bending, lifting, twisting, or standing for an extended period of time. Now is the time to ask for help and support. Intentionally - strategically - set the foundation and create structure from which will can be successful. 

Sometimes we don’t ask for help because we don’t know what to ask for and sometimes we don’t ask for help because we are afraid to ask. When faced with the need to ask for help, I’ve learned to ask myself, “What’s the worst thing that could happen?” The answer is always the same, “nothing”, which is what will happen if I never ask. The great possibility, however, is that if I ask, I will get what I ask for, like help and support during a time I need it.

What does support look like? Feel like? Include?

Support has many faces. For example, I live in Salt Lake City, Utah and my mother and

Me 'n' Bert with Ann & Rocky! Thanks Ann!

father both live in Southern California. After my head injury I needed a great deal more support and structure than I had living alone in Utah, so I had to move back to California where first I lived with my brother and then a friend. In this case, support looked like living with someone who could assist me with some daily activities and encourage me as I healed - it was a scary time.

Many years earlier, when I had reconstructive knee surgery and had been completely unprepared and caught off guard with the healing and recovery process, support looked like my father getting on a plane and flying from California to Utah

Thanks dad!

and staying with me in my apartment for close to a month doing all the shopping, cookingand cleaning, including ferrying me back and forth to physical therapy and doctor appointments, all while sleeping on my futon. Thanks dad! I don’t know what I’d have done without you.

For my back surgery a couple of years ago I was more prepared and asked my mother – before I had surgery – if she would stay with me after my surgery. She accepted and in addition to staying with me following surgery, she became my greatest advocate before surgery, going to doctors appointments with me and patiently listening to me when I would have the occasional meltdown. And how grateful I

Thanks mom!

was after surgery for her patience as she checked my surgical site, helped me with ice packs, did all the cooking, errands, laundry, getting the mail, feeding and walking Bert the dog, all while I rested and healed, so I could rest and heal.

I have also had the opportunity to view recovery and support from the vantage point of a caregiver. On one assignment as a hired caregiver, I provided support to a 65-year old woman, who was recovering from lumbar spinal fusion surgery. The hospital discharge instructions from the surgeon were: 
(1) that she should lay flat on her back (knees up to take stress off the lower back) and rest so that the fusion process could take place, 
(2) to follow up in the surgeons the office in two weeks to have the surgical staples removed; and 
(3) to then follow up again in the office in six weeks to see how the fusion was progressing. 

Since following her 10-day hospital stay, her daughter and son-in-law, who lived with her, had to be out of town for several weeks, I was hired to live-in, check her incision, assist her in being comfortable, taking medications on schedule, prepare meals, do shopping and errands, manage the home health nursing aids that came to check her temperature, blood pressure and help her shower, clean the house, do laundry and care for, feed and clean up after her cats. During this period I was also her sounding board and voice when necessary. Going from a busy, strong, independent woman to having to lay flat on her back for several weeks was a big challenge for her, but having support allowed her to let go of the day-to-day and simply rest and focus on healing.

So, ask for help as you prepare for surgery. 

Reach out, call family members and friends and 

start laying the foundation for your process, for your success.

When asking others for help and support, I learned that seemingly large, overwhelming-feeling projects can be easier to manage and accomplish when broken down into smaller, one-step tasks. Large projects broken down into manageable tasks can easily be assigned to a family member, friend or other support person for help. Single tasks with clear objectives are quick and easy for people to understand and carry out correctly.

Your list of tasks will be particularly handy when someone says “Let me know if you need anything.” Ahhh, now you know how to take them up on their generous offer. Keep a list handy and ask for specific help. Being specific also allows for not overwhelming any one person with too much. A neighbor’s teenager can easily drag the garbage to the street and back once a week!

Here are some examples:

• “I need a ride each Tuesday at 10:00A to physical therapy (or to radiation, or, or …)"
• “My garbage cans need to be taken to the curb each Monday night and then returned to the garage Tuesday afternoon.” 
• A friend can easily grab you some groceries when they are at the store if you tell them what you need, “A dozen eggs, a pint of low-fat cottage cheese, two bananas and a yellow onion.”

What I know now is that life for me could have been easier 

if I’d asked for help and support.

Start creating a list of things you could use help and support with. A great tool to begin with is getting and using a simple, dedicated, spiral notebook (or even phone app) to track everything.

As you prepare it's helpful to write things down as you think of them. Notes are crucial for me! I keep refining my system for taking and keeping notes. Right now I use Evernote on my computer and the Calendar and Reminders features on my iPhone.

Arrange for help and support BEFORE surgery.

The time before surgery can be stressful, overwhelming and scary. Preparing ahead of time with a family member or friend can ease any feelings of burden and eliminate feelings of having to do it all alone. Sometimes even the simplest of tasks can feel overwhelming and like too much. These are normal feelings and they are indicators that it is time to ask for help.

Recruit and enroll your spouse, parent(s), siblings, relatives, friends, neighbors and co-workers to help and support you before and after surgery – for as long as you need it! My experience has been that generally, people want to help, but usually don’t know how, or what to do, so asking them for specific help and giving them specific tasks is really helpful.

Below are suggestions of tasks and projects that friends and family can assist you with prior to surgery. This list may look overwhelming, but hang in there, it’s broken into small, easy to accomplish tasks. These are just suggestions, so keep breathing, read on and see if it resonates for you. There are infinite ways to slice a pie, this is just one. 

Ask for help before surgery with:

• Brainstorming things that need to get accomplished prior to surgery.
• Organizing your thoughts, priorities and “to do’s.”
• Creating lists of things you’d like to remember, make notes of, get done, ask your doctor about, etc.
• Organizing your home – bedroom, bathroom, kitchen, living room – for safety, ease and mobility. (See Chapter 3 for lists of ideas on preparing and organizing everything from medical files to your living space.)
• Setting up a phone tree so that with one phone call your family and friends can get updated on your condition, or are ready in an instant in the event you need something right away.
• Setting up support and structure following the surgery. 
• Grocery shopping and food preparation.
• Mundane errands. Everything’s always funner and easier with a friend. 
• Going to doctor’s visits.
• Pre-arrange rides to and from the surgical center or hospital from a reliable adult. Patients must have a ride from the hospital/surgical center and will not be permitted to drive themselves. Driving yourself after any kind of anesthesia – or while on pain medication – is unsafe (and against the law) as anesthesia and pain medication can impair your ability to focus, make decisions, react or respond in the event of an emergency.
       Note: Reliable is important. I asked a boyfriend to pick me up after knee surgery once and he “forgot.” (Yes, super lame :O((.) Luckily, my friend Lisa was around and happily came and got me and stayed the night to make sure I was ok. “Note to self: ‘Reliable’, very important!”
• Pre-arrange rides physical therapy, or other appointments.
       Note: Following surgery, patients are often restricted from driving for potentially extended periods of time. This is especially true for patients who have had abdominal or thoracic surgery. Check with your doctor regarding possible driving restrictions and plan accordingly. (See pages 33–34 for more about driving after surgery.)
• Ask a family member or friend to stay with you for at least the first 24 hours following surgery. This is an IMPORTANT SAFTEY precaution, in the event of an unforeseen complication or emergency. This person is there “just in case” cause complications don’t happen on a schedule.
       If possible ask that person to stay with you longer than 24 hours. Best case scenario: someone is willing to stay with you for as long as it takes, which could look like someone spending the night in your guest room for a week or longer depending on the procedure you’ve had performed and how you are feeling.
       Note: Oral surgery (i.e., having a tooth or teeth pulled, etc.) and cataract surgery count as surgery! They are surgery and they require rides to and from and someone be with you for at least 24 full hours following the procedure. I confess that even my own mother needed a reminder on this one. She recently had cataract surgery and didn’t bother calling anyone to stay with her until the morning of. Oh mom.
       If it isn’t possible for someone to stay longer than 24 hours, then arrange to have someone drop by on a regular schedule to check on you and handle any little tasks you may need assistance with.
       For example, depending on the procedure and projected recovery, it could look like someone stopping by every day or every other day for 1–2 hours to straighten and tidy, pick things up off the floor, do some food preparation, assist with a seated shower, wash and blow-dry your hair, move heavy objects, take out the trash, change the cat litter box, do a load of laundry, get the mail, etc.     Create this schedule ahead of time with a reliable family member, friend or combination thereof.

Arranging for help AFTER surgery is equally important.

After surgery you may require more assistance than usual. That’s normal. Planning for extra help and support after surgery is smart. Too much help is a better problem to have than too little. Plan ahead.

Here are some examples of where physical support comes in handy:

• Taking or applying medications. For example, my friend’s mother is blind in one eye and required surgery on her good eye. Following surgery she needed to put an ointment in the surgical eye three times a day, but how do you do that – apply ointment into a “good”, but injured eye – when the other eye is blind? It requires help.
• Getting or adjusting ice or pillows for comfort.
• Getting in or out of bed or a chair.
• Walking up or down stairs, even with the use of a supportive rail and/or cane.
• Getting to the toilet including sitting down on to the toilet and/or getting up off the toilet.
• Bending or reaching to get a roll of toilet paper out of a low or high cupboard.
• Showering or bathing.
• Bending over the bathroom sink to brush your teeth and rinse.
• Placing items in or taking items out of the oven, refrigerator, or dishwasher.
• Picking up groceries AND putting them away.
• Getting prescriptions refilled.
• Preparing meals AND washing, drying and putting away pots, pans and dishes.
• Picking something up off the floor.
• Getting the mail.
• Taking out the trash.
• Taking trashcans out to the curb on trash day.
• Helping with children – taking/picking them up from school, etc.
• Watering plants, which means lifting and carrying watering cans, and bending down or reaching up to water plants.
• Doing laundry, which includes: bending and lifting laundry from the laundry basket into the washer, lifting heavy detergent bottles, then lifting wet laundry into the dryer, then bending to get clothes out of the dryer. Laundry also entails standing for long periods of time folding clean clothes and carrying stacks of clothes to be putting away, which can again require bending or reaching.
• Housekeeping and chores. Regular household tasks require standing, bending, lifting and even twisting. These may be contra-indicated activities for a while.
• Pet care. Feeding, changing water, walking, cleaning up after them.  If it’s a dog(s), letting them in or out of the house. It might be important to implement some pet management too. Pets that normally jump on the bed can be a problem (startling someone resting or landing on an incision – ouch). Pets that have a tendency to jump up can cause you to loose your balance and possibly fall.
• Rides to/from work when you’re ready to return to work.

It’s important to know who can help when. Some people can only help on the weekends while others can help during the week. For example, I sometimes work nights, so am available and flexible during the day. Other friends work during regular business hours and are only available in the evenings or on weekends. Create a reference list or schedule of available friends you can call and their availability. This is a handy list to have as a reminder.

As you prep, better too much help than too little. It’s easier to send someone home, than to feel anxious because something is falling through the cracks.

Stay tuned for information on my book release announcement.  ;0))

In the meantime,  

Remember, YOU CAN TOTALLY DO THIS!