Back in That Roller Coaster: 2 Month Post-op Echo

... And I don't even like roller coasters. I guess God knows that, so He wants me to face my fears by continuously putting me on one!

I got my 2 month post-op echo done last week. The results were posted online, where I could read them earlier this week, and I had a feeling things were not "kosher", but today my cardiologist called me and confirmed. 

I have had low diastolic blood pressure since I left the hospital. Normally, they kept asking me if I am lightheaded and until about 2 weeks ago, I was not. However, since I started Phase 3 in rehab, and I have been pushing myself to do more, and last more on the treadmill, up my speed, etc, my blood pressure keeps staying low (average 100/30-something) and I have felt dizzy and light headed when I exercise. 

The echo shows aortic insufficiency, which basically means my new On-X valve is leaking. It's leaking enough, to maybe cause left ventricular insufficiency, perhaps (unless that's still left over from my heart attack while I was in the hospital healing from surgery), and could also cause low diastolic pressure, with the symptoms that I have when I work out. The echo shows left ventricular insufficiency as well as slight left atrium enlargement, as well as trivial mitral and tricuspid regurgitation. These last 2 are not of immediate concern to the cardiologist - just something to watch, but with my aortic valve history, they don't sit too well with me. 

The next step is to completely eliminate my beta blocker for a couple of weeks to see if the blood pressure comes back. If yes, that's what's causing the low BP. If no, then the aortic insufficiency is to blame. Right now, we have too many variables and we don't really know what's causing the symptoms.

In the meantime, I am not to push myself too hard. The cardiologist said to definitely keep active and move, but not to run or cause my heart to speed up. He wants to see if my diastolic pressure will come up in more normal ranges, of 50-60's and stop being in the 30's and 40's. 

I have an appointment with him in 2 weeks and then a repeat echo in another week from that. 

I am completely bummed because I was supposed to start working in 3 weeks, but with these many questions still in the air, I am not sure what will follow. 

I am of course VERY bummed that my aortic valve is still regurgitating, even after its replacement. Sure, it went from severe to mild regurgitation, but still enough to maybe cause havoc in the functioning of my "pump" (my left ventricle which pumps the blood out to the whole body). 

He did say that with this type of valve he often sees aortic regurgitation in the very beginning, which clears up after a while. He sometimes sees it not clearing up which will require re-surgery. 

My ejection fraction went way down from 70 pre-op to 55 now, but I did have an MI (myocardial infraction) on my left ventricle. Like I said: too many variables, right now. 

I can't even think about "the worst", because I feel like I don't know everything to even be there yet. The area of the aortic valve is definitely improved, so are the speeds through the valve. So, there are some pluses. However, the thickening of the atrium and ventricular insufficiency scare me, and the symptoms I feel when I exercise do too. 

I can only think of "what's next" and for now, I quit the beta blocker, take it easy and go about my days  calmly. The whole time since surgery has been somewhat stressful on a personal level, so that could have contributed to my heart not healing properly, as well. 

One day at a time, and never ever take any second for granted. 

Much health to all of you.  

10 Weeks Out from OHS and 1 Week of Praluent

Although I have been walking this OHS journey now for 10 weeks myself, I am still coming up against new things that my body is going through. I am amazed that symptoms are still coming up and I feel and experience new things. The doctors' appointments and lab visits are still a weekly necessity.This is kind of what this post is about as well as a short follow up on my Praluent side effects. 

Today was my follow up echo, the first one after the release from the hospital. As far as the tech could tell, it all looks good, but the official reading from the cardiologist has not come in yet. 

After that, I went to have my INR checked (my weekly appointment for now), and it's under the range. Again. Today was 1.9, which is just 0.1 lower than the lowest margin. Argh! For the fifth week now, I am under the lower limit. Somewhat unsettling. The only silver lining is that I have an ON-X valve, which should require less Coumadin, and accept a lower INR. 

My husband and I went to Home Depot for some spring shopping after my appointments, and although I was not pushing a cart, nor was I lifting anything at all, I got REALLY lightheaded for the first time almost since I left the hospital. I just felt like my knees were jell-o and they would just not support me. I had to sit down on a shelf right away, as I felt I was going to go down otherwise. After 5 minutes or so, I gained my balance again, but I felt drained. Just like all the energy depleted me. 

After lunch at home and a nap, I felt better. My chest hurt a lot today, too, but I blame my rehab stretches on that - they REALLY are engaging my torso. My blood pressure was low, again (100 over 40), today, but it's been low before, with no dizziness, so ... no idea what this was, but it came and went, so far. Just something to keep an eye on and see if it should happen as a norm. 

I took it easy this afternoon - everything I did was sitting down. I am still surprised that some of this "weirdness" kind of comes and goes even to this day, even after this many weeks. This makes me nervous, of course, especially with the starting of work looming ahead. 

Now, about the Praluent. My arm hurt for about 4 days after they gave me my shot last Wednesday, but only when I massaged my injection spot. The night I got the injection, I had a panic attack. I felt like my heart was pounding hard, and I felt just like I feel before a job interview, but multiplied by 20. I got cold sweats followed by really hot, dripping sweats. I didn't take anything for it, I seemed to sleep it off, in an agitated night sleep, and I was better by the morning. 

I also, for some reason, have a hoarse voice. I know that nasopharyngitis is a major side effect of Praluent, but I don't have congestion in my nose/ head, or flu-like symptoms, etc, but I have a very hoarse voice and I sneeze a lot. I think the jury is still out whether this is from Praluent, or just the pollen season being upon us. I will keep watching it and continue to report back on what else weird is happening. 

Much health to all of you, and I hope you have a beautiful spring to enjoy, like we do, here in The Rockies. 

Huge Milestone for Me: Cardiologist Visit and New Drug Therapy

Hard to believe that it's been two months since my heart surgery already (two days ago), but time is not asking us to pass. It takes its own liberty to do so.

Although I have seen tremendous progress for which I am immensely grateful, my body is still trying to adjust after getting hit by that proverbial truck, a name a lot of us, members of the cracked chest club, call OHS. Aside the progress I see in moving more freely and having less and less pain every day, the biggest benefit from this is that I feel that my heart is stronger. Even with the occasional palpitations and low blood pressure, I seldom run out of breath when I do my walks, or walk up the stairs – which was a constant in my previous life. So, so grateful for this!!

There are still a few things I am not able to do. Definitely the biggest complaints are the consistent pain, and the daily, hourly fatigue. I max out on energy after about 3 hours of any activity– which does not make me be in any position to restart work, not even part time. I wish my disability insurance would get this – I have been fighting with them for the past three weeks to make them understand that my body is not ready to return to work. My HR folks get it, but not my insurance. Go figure!

Apart from pain and tiredness, and the consistent numbness in my left arm, leg and left hand side of my chest, there are random “weird” things like seeing stars or dark patches sometimes, occasional, very loud ringing in my ears, dizziness – things that worry me if I were to drive on my own, with no one else in the car, like I would, for work.

I am also still anemic – with a low hemoglobin and still taking iron supplements. I am also still at 95 lbs, 10 lbs less than before the surgery – pounds I did not need to lose, but I can't seem to gain back, no matter what I eat.

I am told by all the medical staff that all this is normal, and all this is temporary. I am told that time will heal all this, and not to worry about the temporary discomfort. So, we wait.

Today was my 2 month follow up with my cardiologist. He tweaked more drugs, and made another laundry list of follow up and specialist appointments, too. In other words: the normal, for me.

Some drug changes: he half-ed my daily dose of beta-blocker, to try to stop my blood pressure from being so low (my diastolic pressure has been in the upper 30's, 40's and low 50's since the surgery). He is keeping me on zetia, too (more samples of that, since it's so insanely expensive, with everything else I take). He is adding a brand new drug, Praluent, to my anti-lipid cocktail (more about it below). 

This was the content of my bag after my appointment today. Got drugs, anyone?! 

In referral/ follow-up appointments area, he wants me to start seeing a vascular surgeon, for my blocked carotids – maybe I need surgical intervention there, too?! He also ordered my 2 month follow up heart echo for next week, to see the state of my valves and aorta. As you might remember, my mitral valve has trivial regurgitation now and a calcified leaflet. So in addition to keeping an eye on what has been fixed (ascending aorta, aortic valve/ root, the four bypasses), we need to continue to keep an eye on what's adjacent and has not been fixed (aortic arch, mitral valve, etc).

As I mentioned above, I have accepted (finally, some might say) to take the new drug for cholesterol, the PCSK9 inhibitor, Praluent. I have known about the research for this drug since around 2008-2009. I have been asked to be in the research for it since then, but I continued to be skeptical (still am), since little is known about its side effects. It was approved by the FDA only last year (July 2015), and here I am, not even a year later taking the bi-weekly shot. I am scared and nervous, but I do want to get those cholesterol numbers down to a normal range.

My cardiologist has been the head doctor for the research on Praluent since 2011 (5 years this year) for our state, so I feel in pretty good hands with him administering this to me and checking my progress.

After never having a normal reading of cholesterol ever, in my life, and after seeing the damage it has done to my heart in 41 years, I am willing and ready to try what is next, to avoid another OHS, or a stroke, or a stent in my carotids or elsewhere, you name it. So, here I am adding to my cocktail in hope that we can put a dent in the numbers for the very first time ever. (my latest numbers are here: http://livingwithfh.blogspot.com/2016/03/new-numbers-under-duress-sort-of.html).

It's like this at this point: although by living with FH you have heard all your life that that truck will hit you, now, in the post-OHS era of your life, you're actually conscious about it, so you see the emergency in trying to grasp at whatever options you have to avoid the collision. I am not oblivious to the risks, but I have seen first hand what the high numbers will do to your body. And a sudden death not to mention a miserable life from those is something I want to avoid going forward. I will still read, inform myself and research on my own as before, and I will continue to stay involved and ask the right questions from my doctor, as before. I am just opening up a new door to my healing, that is all.

As I explained before (here: http://livingwithfh.blogspot.com/2016/03/not-bicuspid-valve-after-all.html) the sole reason for my heart surgery was FH. The sole reason was living with this disease and allowing the cholesterol to muck up my valve, my aorta, my carotids, and God knows what other arteries in my whole body. The only measure we have at how bad the damage will be/ can be in our arteries is by looking at cholesterol numbers which are high, for me. The Praluent is a promise to keep those numbers low, and in consequence, allow for the damage to the arteries to be either delayed (some will still happen with aging), or non-existent. This is a personal choice, and in no way is this a recommendation to any one out there, reading this. This realization will have to come on your own, with the help of your medical team. This is where I am today, in my healing process.

I know, I am drinking the kool-aid, according to some, and trust me, I am very, very scared. I hope that my body will alert me before something does go terribly, irreversibly wrong in my system as a result of taking these new, potent drugs.

The drug is a shot, and it comes in a pen format – you give it to yourself every two weeks. It is very expensive (tens of a thousands for a year) and most insurances don't cover it, but talk with your doctor, and they have payment plans and samples they can help you with, if you can't pay for it yourself.

It is also important to know that they won't approve this unless nothing else worked before, pharmaceutically, to bring the numbers down. I have been on all the statins for 18 years now. None of them work, except for lipitor, which works partially, for me. Even being on lipitor, and with a number of other drugs added to it (niacin, zetia, cholestyramine to name a few) my numbers have never been normal.

My cardiologist believes we should see the numbers drop after 2 shots, even. I will definitely report here what the result was. So far, from taking my first shot today, it is not a big deal – the needle is very small and you can't even see it – it's like a blood sugar check needle, only the “pen” part is longer and thicker than that. I have seen reports of patients feeling soreness and swelling from the injection site, but so far (2 hours after the shot), I feel/ see neither one.

From having the very involved surgery I had recently (http://livingwithfh.blogspot.com/2016/02/open-heart-surgery-day-1-to-8.html) you learn a lot about self preservation and being proactive. I feel like I have always tried to be proactive in my life, but I have always been scared of the new therapies. Well, I guess that is over for me, as I am now embarking on this new journey. Hoping for only smooth sailing ahead, as I hope for every one of us.

Much health, all!

Update on Recovering

Today, I am roughly at a month and 2 weeks from my heart surgery. In some ways, I am looking back and I cannot believe how far I have come (I am not in a hospital bed, wired and attached to machines with everyone doing everything for me), and in some ways, I cannot believe I am still recovering and re-learning to do the easiest things daily (like putting on my socks and shoes).

A month and two weeks is hardly enough to get back to who you were before – I have learned this every day since then. One of the Rehab Center techs told me my body “was assaulted like never before” during this surgery, and trust me – this is exactly how it feels.

I still go through the pictures of all the scars and wounds and bruises I left the hospital with, just to remind myself what I am pulling myself from and to encourage me that change is happening and I am doing better. Some days, the hard ones, it is hard to remember this.

I have found a routine for my recovering weeks, and it usually goes like this:

• during the week, I wake up and after shower and breakfast, I go to rehab in the early morning – my husband is still driving me, because I am nervous to be on the highway with my upper body hurting from steering and with the seat belt not in the right place - I wear it under my left arm, because it hurts my chest;
• I come home and I snack – those exercises take away all my breakfast;
• Sometimes, I take a light nap or I catch up on email or the news;
• Then, I either read, or do some sitting down work/ crafts (mostly something I can do with my right hand) or I do house chores; I can't do strenuous ones (like vacuuming and cooking pots of food, or taking the trash out), but I put (small) dishes away, I dust, I put away clothes that have been washed, or clean up the cat's corner, etc;
• In the afternoon, after lunch, I either walk on my treadmill, or walk around the neighborhood, or lately, I have been going to a store and walking around there with my mom and my husband; my mom has gone back home now, so it will be harder to find excuses to go to the store often in the afternoon;
• Then, it's dinner time, and watching some tv;
• I try to stretch and do breathing and arm strengthening exercises all throughout the day; I am weak everywhere, but my arms feel it the most.

I have not been able to cook much yet. I made some hashbrowns in the oven the other day, and I reheat a lot of stuff, but I cannot peel a potato, or lift a pot of water of more than 1 qt from the sink.

I drove just around the neighborhood pretty much today, for the first time, and I was out of breath by the time I got to WalMart which is like 3 minutes away from my house. The steering wheel feels like it has no power steering at all, and it hurts my chest with every move. Plus, the “adjustment” I made to my seat belt does not hurt less, it just hurts in a different place – my left arm, instead, which is numb to begin with. I am definitely in no shape to start driving to work, which is at least 30 minutes away with no traffic, one way, all highway driving. I am not venturing on the highway yet.

Other than my weekly INR checking appointments, I have not had any other appointments lately. I am also blessed and every so grateful that I have not landed in ER or any other “unexpected” appointment yet.

The INR is a slippery, tricky beast, though, in itself. My target for now is 2-3. I have been fine … till last week when I decided to introduce leafy greens and broccoli to my diet, and boom! It tanked at 1.8. So, now, they increased a dose a little, only one day a week. I have no idea how it all works for them to decide which days to have 2 mg of Coumadin on and which days to have 1.5 mg, but this is what they do... They alternate the dose and spread the higher ones out through the week. It's OK for now to have the INR all over the place, because I am still learning what to eat, what affects it and how to be consistent about eating it, so I can balance the INR. Until then, weekly checks is what's needed.

I have gotten a phone call from my disability insurance to interview me and check whether “I am still sick”, basically. As much improvement as I have seen since leaving the hospital, I still cannot tell you that I have the stamina, and the strength in my body to resume work yet.

I am tired most of the time, even with a slightly easy schedule (above). I cannot muster more than 2 hours tops out of this house, and after that I must sleep and lay down for the rest of the day. I don't go out of breath from showering anymore, or washing my hair, but I still am completely done for the day after rehab in the morning (an hour or so) and a similar workout in the evening. And I don't trust myself to drive yet – which is a big part of my working life.

Another big part of my work life is typing – and with my numb and painful left hand, this is a challenge. I correct my misspellings all the time, because my typing is poor with my left hand.

My left arm is completely numb and very painful. All. The. Time. I can carry my purse, which is about 3 lbs, but I would not be able to even lift my work bag, which has my laptop in it, and my entire contents of my purse, not just the “abbreviated” ones I have now. I am thinking because of my upper body strength being so weak still, my back still hurting, my ribs, too, and because I am not gaining weight at all, I will have to use a dolly to carry my work bag and my lunch bag, when I do go back to work, for a long, long time.

I know you are wondering what can be so heavy to lift in a 2 qt pot and a 15 lbs (or maybe more?!) computer bag?! But I weigh 95 lbs right now. 15 lbs is more than 10% of my body weight, so to me, with no muscle mass to speak of, and just bones, and with the arms depending on the still cracked and healing sternum for support, this is a huge deal.

My incision is almost all healed, except for two spots which are still scabby. I still have a huge scab in the bend of my left knee, where they harvested the vein from. The left leg is numb but not as painful as my left arm.

I am getting there, albeit slowly. I am still paranoid about catching the flu or pink eye or something from the huge children population of my state, so I keep my visits to public places limited. I do have people visiting me, though, and I eat out maybe once a week – although I choose my restaurant carefully (cleaner, less kids, perhaps?!).

I am still uncomfortable sleeping – I don't see this changing any time soon. I am still learning a lot about Coumadin and my new life with it.

My blood pressure has been very low lately! Even with exercise, the last two times I went to rehab, it's been around the 108/35 range. Even after 40 minute 2.8 miles/ hour walk (I have small feet and short legs, so this is like running to me!), the blood pressure sits stubbornly at 110/45 or something crazy like this. I asked the rehab nurse and my cardiology nurse whether this is a problem, maybe my beta-blocker dose needs to be lowered, now that I have a “different” heart, but they insisted that if I am not lightheaded, then it's OK. So, I am keeping the 100 mg dose of atenolol that I have taken for 15+ years now.

I also asked about why being so tired all the time and why not assimilating anything I eat to gain some weight – they said all this is normal post-surgery fatigue, it will go away with time and patience and they said all that I am eating now goes to healing my body, and not to increasing my weight.

I am back on my vegan diet, because the animal protein I was trying to eat to increase my hemoglobin and address my anemia has made me sick (hives and GI issues). I am sticking just with fish (tuna and salmon mainly) and vegan meals. I do eat and the taste for food is mostly back, but for some reason assimilation of all I eat is the problem.

And that's what's new in the heart surgery recovery corner. Spring is slowly coming and I hope to move most of my exercise outdoors, whether I'll prune my roses or walk in the neighborhood to peek at neighbor's yard improvements. My sister and older nephew are coming to stay with us for a week, and I hope to take him to parks, to the aquarium, to a mall (not all of them in the same day, mind you!), so that will give me a reason to walk, too. One day at a time and one foot in front of the other is all I know, right now.

The short disability insurance person asked me how long do I think I will need before being completely ready for work – it's really just like asking someone how long do you think you're going to live. There is no telling. Days are sometimes good and some are really bad. Some days, I wake up in the middle of the night grabbing for a Tylenol, but wishing it was a Percocet, and some nights I can grind my teeth and end up just sleeping through the pain. I wish I knew what my body decides to do every minute, but it's like a crystal ball.

A Light One, for a Change

I haven't posted one of these in a while. Open heart surgery gets you distracted like that!

I wanted to share a 100% vegan and so surprisingly yummy dinner combo I made up tonight. Everything is soy free, as well. 

I buy these vegan Marsala burgers at Trader Joe's which are super good, and not too bad for you (0.5 sat fat and 0 trans fat and cholesterol). So I warmed one of those up, then I made a side of cheesy grits with just half a teaspoon of vegan "butter" and half of a teaspoon of vegan cheese, salt and pepper, and then my mom made what I call Romanian coleslaw - it's chopped cabbage and just balsamic vinegar, salt and pepper. 

I was dubious of the combo but it turned out like a complete meal and very delicious to top that. 

The finished meal 

Not a Bicuspid Valve, After All

So, here’s the story: about 6 years ago I lived in North Carolina. I had seen this cardiologist for about 10 years at that point and I absolutely worshiped him. He took good care of me, and, to my knowledge, he took good care of my heart. He did all the right tests, kept me on the right meds, sent me to a doctor in pharmacy to manage my nutrition and drug regimen, the works. 
But he never ever said once (after doing an echo of my heart almost every year) that I had a bicuspid aortic valve (which should be there since you were born). 

About 6 years ago, I moved to Utah. I had to get a new cardiologist. About the second year I saw him, he said for sure I have a bicuspid aortic valve that is shrinking and at some point I’d need surgery. I started doubting my long time worshiped North Carolina cardiologist, because how in the world did he ever not see my congenitally modified and bad valve?! He did tell me about the heart murmur, and bruits in my carotid arteries, but never about this anomaly of my valve. Why?! How could he miss it for 10 years?! He went to Harvard, for crying out loud?! 

In the past 6 years, my so called bicuspid aortic valve continued to get bad, until this year, when you know what happened (http://livingwithfh.blogspot.com/2015/12/and-now-we-wait.html). 
Fast forward a few months later, till yesterday when I met with my heart surgeon, after a month from surgery. 

My pushy and annoying curiosity kept asking the surgeon very specific questions about my surgery - just tactical, specific ones. So, he finally printed my entire operative report and gave it to me, to easily answer my morbid curiosity. 

And to my huge surprise, it’s written quite clearly all over it that what the surgeon replaced inside my heart was a “tricuspid aortic valve with two leaflets joined together with severe calcification”. He writes there how only one leaflet was working, and the other two were glued together and immobile. 

So many things and questions came through my head:
First off, my North Carolina doc was not wrong - probably, at that time, my valve was visible as a tricuspid valve (which is normal), so no reason to alert me of anything
Then, how can so many echos done here in Utah, for 5 years now been wrong? They did MRIs and CT scans and even an angiogram. Not ONE of them could show the difference between a bicuspid valve and a atherosclerotic tricuspid one? 
How can these very advanced tests that we trust so much not be able to tell the difference? 
Well they didn’t. 

Sure, the final outcome was good - we got the valve repaired (regardless of the reason of how we got there), along with everything else, but the final diagnosis was just: CAD caused by FH. All the damage, whether in my valve, my aorta, or three of the coronary arteries were all caused by what I knew since I was 6 that it’s killing me slowly: cholesterol.  

You know, almost 35 years after being diagnosed with FH, there is not one year without surprises in this disease. Either good ones, or bad - they’re all there. You’re always on your toes and always learning something new about your body. 

The 'Cannot Do' List, after a Month and a Bit from OHS

A lot of people have sent me many messages saying things like “I am so happy you’re this advanced/ progressing so well/ this far into your recovery so successfully”, etc. I REALLY appreciate this, I really do. But, honestly, I still feel like I am lagging many, many weeks behind, and I am slow as a sloth, compared to my “before” self. 

Also, some people with my condition facing surgery ahead are wondering how fast the recovery goes. I cannot speak in general, of course (who can?!), but I can speak for myself. 

For these reasons, I thought of putting together a quick list of what I cannot do by myself yet, at a couple of days after my one month anniversary: 

-I cannot tie up my shoes
-I can’t very much bend to the floor, for some reason, so I can’t do anything like picking stuff up, or feeding my cat 
-I cannot open heavy glass doors (especially sliders), or sometimes freezer or fridge doors
-I can’t chop, cut meat, or anything heavier than bread
-I can’t wash plates, pots, anything in the sink, nor can I lift pots full of food; my husband and my mom do all the cooking because of these reasons
-I cannot change the toilet paper in the holder - those springs are so tight for me
-They tell you “you can lift up to 8 lbs” after surgery, but I think this is a myth: this should be in accordance with your body weight. If the 8 lbs is a generic number, and you are a 300 lbs man, my number should be “slightly” lower at 97 lbs. Anywhoo, I cannot lift my purse without pain in my chest, any it’s about 4 lbs heavy if that. 
-I can’t drive - and I won’t be cleared for it till I do some upper body strength training at the cardiac rehab center, and I have not been cleared to start that yet. 
-I misspell words that require letters typed with my left hand; I have to go back and correct them often. My left arm is completely numb.
-I tire easily - I can walk for about 45 minutes max, slowly, and then I am done for the day. If I wash my hair in the shower, I am done for about 6 hours. It exhausts me! 
-I sleep poorly and eat poorly, too. I cannot sleep on my side, still. 
-Outside my arm and leg which are totally numb, I still have a very “burned” back - the skin on my back feels cigarette paper thin and hot, which makes it extra hard to sleep solely on the back. It’s like sleeping on timbers. 
-As far as scars go, I have thick, painful scabs still on several scars: on my incision (6.5 inches), my two insertion points on my left leg where they harvested my vein for my bypasses, and a couple on my stomach where my drainage tubes went in. 
-Days are uneven: I took 2 painkillers yesterday, all day, but I’ll probably take at least twice as much today, and that’s just to numb the pain, not to make it completely gone. 
-I can’t work screw caps and lids.

I am grateful that I can walk about the house and I am not bedridden, and that my mind is back to being clear, so I can read and keep up with friends and family and keep my medicines straight myself. Most than anything I am grateful I am ticking, still. 
I am grateful for all the small things I can do by myself, too. But there is a long way to go, still, till I feel like a full person again. With patience and time, I hope to get there one day soon.