Weighing the factors when choosing LLMD, Flickr, Some Rights Reserved

Either you have a list of LLMDs, or you think you’ve found one.  Wait . . . before you make your decision, you need to consider a few factors.

• Where is your LLMD?  Since I reside in the South, my experience has proven that Chronic Lyme Disease, and sometimes even acute Lyme, is given very little credence here.  When I was in New England, however, I saw signs everywhere warning about Lyme Disease and its hazards.  I also learned that several prominent New York medical schools, including University of Columbia, support Chronic Lyme research.   The truth is, both you, and the political status of your LLMD, are better accepted in certain areas:   Namely, New England, major cities like Washington DC or Seattle (or in states like New York and CT, where legislation protects its LLMDs from prosecution).  Rhode Island has recently passed legislation that health insurances must cover Chronic Lyme Disease.  But, the further south you go (unfortunately), the less likely other people and doctors will believe you and your LLMD.  North Carolina is particularly notorious (although it has some excellent LLMDs) because of a certain physician/LLMD who, though well-respected for his pioneering work with AIDS, lost his license due to his later work with Chronic Lyme patients.  After the NC Medical Board withdrew his medical license, the BCBS insurance company sued him.  Unfortunately, many doctors still think Lyme Disease only exists in New England.

• Is your LLMD well-respected, and what are his credentials?  Many people and doctors think LLMDs are–basically–quacks.  One of my doctors said he did believe in Chronic Lyme, but he didn’t believe in all the Lyme clinics that jump to conclusions and diagnose Chronic Lyme Disease too fast.  Don’t get mad, because the thing is, he may be right!  In any field, whether doctors or homeopaths, there are bonafide professionals with credentials, as well as people who pretend to be what they’re not.  But what’s REALLY important, is that YOU are more likely to be believed and respected by others if your doctor has good credentials and is well-known.  Why does it matter?  What if you’re applying for Disability?  What if you’re appealing a decision your health insurance made?  What about convincing your general practitioner?  And your family and supporters?–they may not believe you either.  Finally, you need to make sure your LLMD is very thorough in her workup and testing.  She needs to rule out ANYTHING else.  Again, LLMDs who come to conclusions very carefully are much more likely to be believed.  When I hired my lawyer to help me get Disability, she pooh poohed Lyme (at first).  Then eventually she acknowledged that my LLMD was indeed very thorough.  It also helps if  your LLMD is affiliated with a major university, like Columbia University Medical Center.  Don’t forget:  Credentials, believability, thoroughness!

• What about distance?  Obviously, it helps if your LLMD is close by.  But in places like, North Carolina, South Carolina, or Georgia, you may not find the LLMD that will best fit your needs.  And yes, some people do move to be closer to their LLMD.   Some folks also move temporarily, or get a temporary apartment.  Why?  Well, what if you need an IV twice a week for a year?  Now, there are alternatives to the IV problem (to be covered in future post), but you should be prepared to travel.  For me, all it takes is a one to two-hour plane ride once a year.  The rest of the year I have phone appointments, something almost all LLMDs agree to do.

• Cost?  All I can say is, “Yikes.”  Sell your house if you need to.  It’s worth it.  Here’s the thing:  LLMDs are very similar in cost, and they all opt out of Medicare.  Unfortunately, most insurances don’t pay for anything related to Lyme, sometimes even acute Lyme.  Remember to appeal, appeal, appeal, especially if your LLMD is in a state that protects him by law.  Also, many insurance companies do cover medication, as long as they don’t know what it’s for!!!  Finally, foundations like Limelight can help you with the cost.

So, here are some facts about the LLMD I chose.  He conducts his testing (eg blood tests and brain scans) at major university medical schools.  He is affliated with Lyme researchers at those universities.  He took 12 tubes of my blood, and then I waited two months to receive a diagnosis, while he reviewed all the facts.  I felt frustrated, but it was worth it.  He is one of the best-respected LLMDs in the country, yet he charges about the same as the others.  His state protects him from prosecution.  Finally, I’m willing to fly one to two hours once a year to see him in person.  So remember to check:  Location, credentials, distance, and cost.

frustrated, flickr, jonwatson, some rights reserved

You’re sitting in front of your computer, completely overwhelmed, besides which, you feel like the Russian Army just trampled over you.  Your doctor  told you that Lyme disease only exists in New England, and that chronic Lyme doesn’t exist at all.  Your brain isn’t working, and the last thing you want to do is fill out a form, or join another forum.  It would be so much easier just to type “LLMD” into the daggone computer and find one.  It’s not as hard as you think:

1. Sometimes you can find LLMDs via friends or word of mouth.  If you know anyone–or have heard of anyone–who has Lyme disease, he might be your best resource.  Or, if there’s a Lyme organization in your state, contact that organization, and see if you can talk to someone directly.  That’s how I found my LLMD.  My experience shows that even in remote areas, you’re likely to find other people who suffer from Lyme.
2. Usually, it’s not that hard to sign up for a forum.  Some of the ones I’m acquainted with include www.ProHealth.com, www.MDJunction, and www.lymedisease.org   The latter is one of the best-known organizations in the country, and it hosts a forum for each of all 50 states:  Open the website, and click “resources,” then go to “online support.”   The site will guide you through the rest.  Another significant site is Lymeinfo.net; it provides a list of the most important lyme websites and forums.  Go to www.lymeinfo.net/directory.html  Click on ”regional support group websites,” and you’ll find a state-by-state listing of online support groups.  Note that  members of most forums can’t list the names of LLMDs on their sites, but most members who know of LLMDs will be happy to oblige by providing their private emails, where you can get the name.
3. Numerous websites give doctor referrals, but you usually have to fill out a form, either online, or through the mail.  Once again, go to www.lymeinfo.net/directory.html ; it provides a list of prominent  lyme websites.  Once you choose a website, you’re likely to find a link that will guide you to forums and doctor referrals.  For example, go to www.lymedisease.org, click on “resources,” then ”doctor referrals,” and the site will guide you through the rest.  Here’s another example:  Go to www.lymediseaseassociation.org, click on “doctor referral,” then on the “online doctor referral.”  Many other websites have doctor referrals.  Realize that Lyme websites sometimes require you to join so that they may protect LLMDs.

A few doctors are Lyme friendly, but chances are, they won’t know enough about Lyme to give you the best of care.  It’s much more prudent for you to consult an LLMD.  Once you’ve found someone, you’ll still need to do a little research about that doctor, to make sure she is the best choice for you (see Part 3).

When I first became ill, I saw what seemed like hundreds of doctors.  Like many of us, I was diagnosed with Fibromyalgia and CFS.  Yet, my illness seemed even more intense.  I started bumping into walls.  I’d get so tired, my lips would be rubbery, and I could barely speak.  I forgot words for common objects.  I even forgot my brother-in-law’s name.  The words and names would come back, but I thought I was losing my mind or getting early Alzheimer’s.  I saw even more doctors, who diagnosed me with everything from MS to the “it’s all in your head” syndrome.  I began searching the internet, and realized that my symptoms resembled those of chronic Lyme.  I read about the whole Lyme controversy, and I that’s when I discovered “LLMDs.”

People with Chronic Lyme Disease struggle for years to find the proper diagnosis.  This happens because most doctors don’t know much about Lyme disease.  They may treat acute Lyme disease with short-term antibiotics, but only if they see the bull’s-eye rash–a red circular rash with a white bull’s-eye in the middle.  Doctors also shy away from the diagnosis of Chronic Lyme Disease–either because they don’t believe in it, they know it’s controversial, or they’re afraid of being sued or of losing their licenses.

Just as there are many specialists, doctors like dermatologists, urologists, and so on, there are also specialists for Lyme disease:  LLMDs or Lyme-Literate Medical Doctors.  LLMDs practice in secrecy to avoid legal hassles and prosecution.  Generally, you cannot find the name of an LLMD on the internet just by searching for “LLMD.”  You have to know the LLMD’s name beforehand to get results on the internet.  If you suspect you may have chronic Lyme, you will have to fill out a form before a Lyme Disease organization can send you a list of LLMDs in your state.

In addition, some states like Connecticut protect their LLMDs, which means (hopefully) that such doctors won’t be prosecuted.  If you live in such a state,  your insurance is more likely to pay for your treatment.

LLMDs know much more than most doctors about both acute and chronic Lyme.  Medical schools tend not to teach much about lesser-known diseases like Lyme.  One doctor told me that medical students get about fifteen minutes of training in diseases like Fibromyalgia or Lyme.  He may have exagerrated, but not much.  Also, most med. schools go by the IDSA guidelines (Infectious Disease Association), even though a number of researchers, patients, and LLMDs, as well as a few regular doctors, don’t believe in these guidelines.  LLMDs spend years studying about forms of Lyme and its co-infections (other diseases that are also carried by ticks).  They often work closely with researchers, or they do the research themselves.  Some work closely with medical schools that are Lyme friendly, like the Columbia University School of Medicine.

If you think you need an LLMD, read further, and I will explain how you can find one.

On Tuesday, July 17, the House Committee on Foreign Affairs will hold a hearing on “Global Challenges in Diagnosing and Managing Lyme Disease–Closing Knowledge Gaps.” 

Remember, this hearing impacts you, so if you live in the DC area, make sure you attend.  The hearing starts at 2 pm in Room 2712 of the Rayburn House Office Building.  Arrive 45 minutes early so you can clear security.  The more people who attend, the greater impact they will make.

There will be a webcast of the event, so if you can’t attend, make sure you watch the webcast.  The committee will be counting people who watch the webcast as well.

For more information, go to Lymedisease.org, click on “News, Events, and Blogs,” and scroll down to July 14.  That should give you all the information you will need.

Sorry about the late notice, but I only found out about this new development last night.

Dr. Phil, courtesy Gregg O'Connell

This is huge:  Dr. Phil will be talking about Lyme disease tomorrow, April 13.  See  http://www.drphil.com/shows/listing/    After you have selected your state, check the listings for the channel and air times.  To see a preview, click on http://lymedisease.org/news/lyme_disease_views/dr-phil-lyme-preview.html

On February 29th of 2012, Diane Rehm of the Diane Rehms Show (WAMU 88.5–NPR) featured comprehensive coverage of Lyme by interviewing researchers and doctors from leading universities.  See http://www.thedianerehmshow.org/shows/2012-02-29/diagnosing-and-treating-lyme-disease

Don’t forget to sign the petition to remove outdated IDSA guidelines from the National Guidelines Clearinghouse.  See my February 2, 2012 post to sign.

Turn the Corner Foundation has joined the Tick-Borne Disease Initiative to create a strong new organization called the Tick-Borne Disease Alliance (TBDA).  Together, they will dedicate themselves to awareness, advocacy, and promotion of research.  See www.TBDAlliance.org

On a last note:  Be a Lyme advocate.  Join other patients; tell your story!

Worry, Daryl Cauchi, Flickr, Some Rights Reserved

“Most of my worries never came true.”

My great-grandfather

Here’s the Thing:  When you worry, you’re not in real time.  Most of the time, you’re either thinking about the future or the past.  You’re not living in the present moment!  Your worries have nothing to do with what’s actually going on around you.  What that means is that you’re thinking about something hypothetical, something that may not even be true or may not exist!

Read this scenario:  My friend MC and I were on vacation at Glacier National Park. The scenery is some of the most spectacular in the world.   MC left her sick husband behind, but he was in good hands.  Meanwhile, a hurricane was forecast in New England.  Ok, that sounds bad.  She had a house in Connecticut, but her friend AR was going to check on the house.

Yet, when we were driving through amazing scenery, MC hardly looked at it.  She spent almost her whole time worrying about her husband, the hurricane, and so on.  She was so worried, that even though she was only in Glacier for a week, she was ready to go home two or three days early.  She kept checking the hotel’s front desk  to make sure she had the checkout details right. The desk clerk even laughed that she was ready to jump on the plane.  To her, the vacation must have gone by in a blur.  Yet, when she got home, her husband was about the same, and her CT house only sustained minor damage from flooding in the basement.  If she had enjoyed her vacation, she would have lived in the present, instead of in the future.   So . . .

1.  Worry is like an imaginary place that doesn’t really exist.  You have to learn to live in the moment.    Whether you’re criticizing yourself or worrying about a car accident, the worry is only a thought and doesn’t exist in the present moment.  You have no idea what others really think of you, and the car accident is in your imagination.  However,  worry tends to perpetuate itself, like an endless cycle, until you’ve driven yourself crazy.  Worry also makes what you’re worrying more likely to come true.  If you tell yourself,  “I will not have a car accident!”,  it’s like saying, “Don’t think about elephants!”  What happens?  You think about elephants.  So if you say, “I will not,” the probability is more likely that you will.  My point is:  Instead of worrying about car accidents, slow down and enjoy the ride.  You know the cliché:  Think about the journey, not the destination (or the possible accident).  And for God’s sake, stop honking your horn and flipping the bird!    Just be here!

2.  Live within your envelope.  Instead of thinking  about what you don’t have, experience what you do have.  Now it’s hard not to worry when you’re chronically ill.  You have to deal with doctors, bills, health insurance, and a feeling of isolation, or of feeling misunderstood.  That’s why you need to do what you can to enjoy the moment, but within your limits. Don’t disappoint yourself with unrealistic expectations.   I had an online friend who was bedridden.  On days she could walk, she enjoyed going into her backyard, and just sitting on a small patch of dirt!  When she was in bed, she enjoyed knitting.  Her children visited, and her husband gave her a lot of support.  She got enjoyment out of life even though she could barely walk across the room to turn off the light.

3.  Ask yourself:  What’s the worst thing that can happen?  My friend J gave me this tip.  So if you’re late for work, the worst that can happen is that you’ll be a little embarrassed.  A year from now, it won’t even matter.  Now think again.  If you’re not in the moment, and you’re rushing to be on time, the worst that can happen is a car accident.  So it’s better to slow down, stop rushing, and live in the moment.  Crashing your car is worse than being a bit embarrassed.  Go ahead and be late, and learn from your mistake.  Then let it go.

Now here’s a novel idea:  When you’re seriously ill, the worst that can happen is bad pain, or even death.  When my mother was terminally ill, my cousin told me, “Life is a terminal illness.”  At first I thought he was being insensitive, yet I thought about what he  said for years to come.  Most people feel severe pain at some point, and everybody dies.  No exceptions.  So instead of thinking about death, live your life while you still can.

4.  GET OUT OF YOUR HEAD AND LIVE IN YOUR BODY, AND IN YOUR SURROUNDINGS.  I wrote this in all caps, because it can help you so much.    How do you do this?    Listen to what your body has to say to you, and follow its promptings.  It’s as simple as, if you’re hungry, eat. If you feel pain, get a hot pack.  This is very helpful with sleep, because if you can’t fall asleep, get out of your head/mind, and pay attention to the fatigue and the other sensations in your body.  You’re much more likely to fall asleep when you listen to your breathing, and feel how tired you are, then when your mind is racing.

More importantly, be mindful of everything that you’re doing, and all of your surroundings.  Use your senses:  smell, vision, touch, and taste.  Enjoy what you’re eating.  Literally smell the roses!  Leo Babauta, author of the Zen Habits blog (www.zenhabits.com)  talks about being mindful when you sweep the floor or do the dishes.  Take walks and pet the dogs.  If you absolutely can’t get your worries out of your mind, make a list to “get rid” of your worries, then act on the list later, by doing things to solve your problems.

5.  Learn meditation or relaxation techniques to help yourself live in the present.  Meditation is all about living in the present, and being aware of what is going on.  Relaxation techniques help you feel the different parts of your body as you relax your muscles, follow your breathing, and so on.  Go outside, and do Zen meditation with your eyes open, so you can really be part of your environment.

6.  But don’t confuse worry with depression.  Before I started taking antibiotics, I was in a dark hole, and I was panicking.  I was slurring my speech, I couldn’t remember words, I couldn’t drive, and I–with a graduate degree in English–couldn’t read!  I wasn’t illiterate, but I couldn’t focus at all.  That was the time to get professional help.  Thanks to other people with Chronic Lyme disease, I was able to find resources, an LLMD, and medication that helped me make it through dark times.  I still feel shaky, but I also feel the miracles of being able to read a book all the way through, walk the dogs, and even clean my house!  I can’t summit a high mountain, but if I climbed the mountain just to get to the summit, what would be the point?

Time for Change!! istock

Would you rather stay with anything that’s old-fashioned, stick-in-the-mud, traditional?  You might as well pretend that the world is still flat, and that Columbus will sail over the edge of the ocean.  I suppose the good ole’ boys in Columbus’s time refused to endorse peer-reviewed scientific research from outside their own (small) organization.

So, here’s the point:  The Infectious Disease Society of America (IDSA) controls any treatment that any of us with Lyme undergo (not to mention whether the insurance companies boot us).  The IDSA follows outdated guidelines.

According to lymedisease.org, “All treatment guidelines are listed by the National Guidelines Clearinghouse (NGC).  The NGC requires that guidelines be updated every five years.”   Well guess what?  The IDSA hasn’t revised its guidelines in well over five years, and the NGC let this go.  Sign this petition to remove the outmoded IDSA guidelines from the NGC.  8,000 have already signed the petition; think what would happen if 10,000 or 15,000 also sign?  Might we go the way of change?  Please ask all your friends and relatives to sign as well!

Go to  www.lymedisease.org/petitionscript/index.php  to sign.  It’s easy.

Ok, so I’m late with my “Dear Friends Christmas Letter.”  Aren’t we always a little late with our Christmas letters and cards?  Anyway, the point here is to tell you about my notorious year with my talented “progeny,” my two dogs, Sophie and Molly.  Tell me what you think, and be impressed, or laugh a little while you can.

Dear Friends,

This has been a very eventful year.  So eventful, in fact, that I felt someone had placed a Voodoo curse on me.

I don’t have any progeny to speak of, except for my canine companions.  The most amazing accomplishment my dog Molly can boast of was leaping a fence in a single bound and herding a very astonished group of otherwise complacent, cud-chewing cows (picture not available).  My other dog, Sophie, boasts of having one blue eye and one brown eye.  We call her brown eye the “good eye,” and her blue eye the “evil eye,” as she has a knack for being loveable, as well as jumping on dinner guests, play biting, and mercilessly hounding Molly, who now has arthritis.  Oh, and perhaps Sophie’s most amazing accomplishment of all is humping other dogs, even though she is a she.  At least, they keep me company, which is more than some people can say of their more real amazing progeny.  And it’s certainly more than I can say of most of the important persons in my life.

Sophie (all rights reserved)

In late Spring, I noticed–when I took my pulse–that my heart was beating at the record-breaking rate of 150 beats a minute, even though all I had been doing was folding clothes.  I told my then boyfriend L., “Umm, I think I need to go to the ER.”  L. gave a casual look of concern, and said, “Oh, they won’t do anything for you in the ER.  You’ll have to wait for hours, and the doctors who work there are really inexperienced.  They’ll just send you home.”  I continued folding clothes until I noticed I was having trouble breathing.  I drove myself to the ER.  Funny thing is, I didn’t have to wait a minute.  The nurse took one look at me, and said, “Triage!”  The long and short of it was that my thyroid levels were way out-of-bounds.  I was dutifully medicated, hooked up to the IV and the heart monitor, and I stayed overnight.  The ER doc. said I needed to see my family physician the next day.

The catch is, my family doc. didn’t have any appointments the next day, as the receptionist gleefully announced.  Or the next, or the next, or the next.  He told me to get a blood test in two weeks.  During those two weeks, I realized I couldn’t even do the simplest of things, like climbing stairs.  I began falling over like a rag doll.  I continued to go about my daily life, and went for a swim in the river, only to realize I couldn’t climb back up the bank (well, ok, it was a steep bank, but there were stairs).  My then boyfriend threw me a small inner tube, and I had to float downstream with my trustworthy dog, until I could find a “flat” place, but at that point, I could only crawl out.  At least L. came to meet me in the car.

After the blood test, the results of which didn’t come back for yet another two weeks (making the entire wait time a month), I became well acquainted with the porcelain bowl.  My stomach churned with a peculiar strength, kind of like one of those dryers to which you become a voyeuristic spectator.  I went to my trustworthy physician, who said maybe it was the fish I had eaten the week before.  Finally, the blood tests came back.  My otherwise calm physician was strangely alarmed.  This time, he wanted me to come by that very afternoon.  He then announced that I was in a “Thyroid Storm,” which is life threatening.  Oh well.

It was determined that I should have surgery to remove my thyroid, with its two accompanying tumors, which were also producing thyroid hormone.  Shortly thereafter, my father had a stroke.  The stroke was serious, so even though my surgery was scheduled on Monday, I left on Friday to fly to Miami.  I packed in a record ten minutes and broke speed limit records to get to the airport.  I also paid a record plane fare.  I returned for my surgery, which only took about six hours.  This time, my usually unconcerned boyfriend paced the waiting room.  The next day, as I lay in my hospital bed, thankfully full of Morphine, my sister called to announce that my father had died.  At least the Morphine served a purpose.  And hey, the tumors were benign!

That was the beginning of my long, slow regression.  I felt I was entering the negative zone of the number line (as in integers).  What is the opposite of accomplishment?  Deflation, as in a deflating balloon, that whizzes aimlessly around the room as it gives out its last hopeless squeak?  Of course, at that point, I didn’t realize that I was going to have another eventful year (by the way, the described events actually took place in 2008) on my downward slide toward Chronic Lyme Disease, which virtually no one believes in, except doctors who have dissected the cadavers of unlucky Chronic Lyme Disease victims, only to find the remains squirming with spirochetes, which are what cause the damned disease.

I lost my job, due to supposed budget cuts, although my cheerful boss quickly added, “Well, you were on thin ice.” Oh, and despite the budget cuts, she hired someone to replace me.  After that, I began to feel that I had been cursed.  Maybe an angry relative had taken a little doll effigy of myself and stuck it full of pins?

 Voodoo Doll, Vincent Ma’s photostream, Flickr, Some rights reserved.

Readers, I hope you at least got a laugh, if nothing else.  Also, realize that accomplishment is not always desired, especially when it is a farce, as in the boasting of most Dear Friends Christmas Letters, ie, “My son graduated Magna Cum Laude (sounds like a volcano)  from such and such high school.” Who gives a crap?  Ok, I’m sorry if you write Dear F. Xmas Letters.  At any rate, sometimes you learn more from devolving than from evolving, as in (from being sick as opposed to well, successful, etc.).

By the way, I do feel better since 2008.  And the point is, take your circumstances, and make lemonade out of the annoying lemons.  And laugh, laugh, laugh!  That is better than boasting, by far.

Is That You? Flickr, Some Rights Reserved, Cali.org

Do you have a pile of paperwork that looks like the leaning tower of Pisa?  Is your paperwork eating you alive?

When you’re sick, the tendency is to let housework and paperwork go, especially when your batteries have run dead.  The problem with that is that (1) your paper will collect like dustballs in every corner and on every countertop or table in your house; and (2) your bills won’t get paid, your taxes won’t get done, and you won’t know where anything is.  Paper will literally snowball, until the problem has become uncontrollable, and you’ll end up with even more to do.  Eventually, you’ll just give up the ghost, and the people surrounding you really won’t understand.  They’ll think you’re really lost.

You can actually take some relatively simple steps to deal with the paper monster.  Ok, you’ll need to take at least one day off to deal with the initial paper decluttering.

1. First, get all the paper you can find in your house (you can do filing cabinets another time), clean your dining room table, and dump it all indiscriminately on the table.  It might look intimidating, but once you get THIS STEP out of the work, I’ll give you some easy methods to keep up with your paperwork.
2. Get thee your recycling container and the trash bag.  Remember, you can’t recycle the shiny, plasticky looking stuff.  It goes in the trash, as do envelopes with windows.
3. Find some manilla folders.
4. SORT:  Put you paper in as few piles as you can.  Label your manilla folders.  Try not to use too many categories, and be careful with the “miscellaneous” category, as that one tends to get out of control.
5. THROW AWAY OR RECYCLE AS MUCH AS YOU POSSIBLY CAN!!  The fewer papers the better.  That means throw away all junk mail, sweepstakes, old greeting cards, four-year-old tax returns, etc. etc.  Just pretend you’re a paperwork anorexic.  You want to be lean in the paperwork department.
6. Pay all bills immediately.  No waiting around.  Have envelopes, stamps, and checkbook handy.
7. Put your (hopefully) small piles in their respective folders, for example:  health insurance, Social Security disability, health and medications, etc.  You had better not have more than ten folders!

NOW, how do you deal with incoming mail?

• As soon as you get your mail, sprint inside, and take care of it immediately.  If you have an appointment, you can do it later in the day, but DO it that day.
• All you have to do are three simple things:  Throw crap away, pay bills, and file.
• When your files get too big to store in  ONE DRAWER, rifle quickly through some of the folders and get rid of stuff that no longer applies.
• When you get pamphlets or announcements in the mail, write down or key in the appointments (with a brief description) in your calendar, then throw the pamphlet away.
• If the pamphlet doesn’t include a specific date,  get a notecard, and write down the info. (ie horseback riding lessons in Laurel Springs).  You can also write down websites.  Tape the notecard to your bathroom mirror, or in the front cover of your catalog.  Either that, or call the horseback riding outfit and make a date for your first lesson (if you feel well enough!!)

Just do these things everyday, and the papers will disappear.  Now you can deal with real dustballs or dog hair.

The good thing about paperwork is that it’s relatively sedentary, and you can do it sitting down.  If you’re having a flare, just set your timer for ten minutes, and do the paperwork in small increments.

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