Soap Dope

Oh, man. Ready for another dopey Julia moment?

I was helping to stuff envelopes yesterday at church. As usual, I had soda, water, and coffee cups scattered around my workspace, and so also was beating a regular path to the office restroom.

During one visit to the bathroom, I looked around and noticed several large plastic bags filled with a clear liquid stacked on a shelf. They had prominent white plastic connectors and black printing on the clear plastic bags.

I looked at them with shock of recognition. Gosh, I thought.

As I returned to the workroom, I grabbed Terese and asked her in a hushed whisper, WHO is having to do peritoneal dialysis here??

Terese looked at me as if I had sprouted a second head. "What?"

Peritoneal dialysis! The bags are in the bathroom.

(I should probably explain here that peritoneal dialysis is one treatment choice for patients with kidney failure. AND that it is a procedure that some patients choose to do in privacy in their workplace. If you're curious, you can read more here.)

She steered me back down the hallway. "Show me."

I pointed - Look! Those are PD bags!

"Julia. Do you mean the refill bags for the SOAP DISPENSER??"

Yikes. I took a closer look, and sure enough, clearly printed in black were the words antimicrobial hand soap.

Ladies and gentlemen of the jury in the court for doofus behavior, I give you these two images in my defense:

Image of peritoneal dialysate bag found here.

Image of antiseptic soap refill found here.

I rest my case.

I don't want to know what the verdict is. I already know....

Gobbledygook Day

Woo! I made it to post number 30 in the WEGO health blog prompt challenge. The very last assignment: Make up a word. What does it mean? Use it in a sentence.

Before I unveil my very own weirdo word, I'd like to comment a bit on the experience of writing thirty posts in a row on topics dictated by someone else.

We all know about my control issues.

So, yes, even though I routinely post here daily, my post topics have always been determined by me and me alone. Until the challenge.

I've had mixed feelings about these new terms. I did agree to do this. Nobody has twisted my arm to get me to consent. But it just didn't seem to be that big of a deal.....until I got started. You want me to write what? About what? When? Where? In what form? It didn't take very long before the hairs on my neck began to rise and I could feel my contrary nature struggling to take control. Of everything.

But I take my commitments seriously in spite of writing in a very un-serious manner, so I chugged out post after post. And, I'm happy to say that I have actually learned a few things after this experience.

First, I've learned that even though someone else dictates the subject matter or writing form, the work that I put out there is still mine. Undeniably.

Secondly, I've learned that I'm just not comfortable with serious introspection. Some of the assignments turned my attention inward, and though my posts fell far short of baring my soul, the exercise in focusing on the non-silly part of my nature was a good thing.

And third, I had the chance to read other bloggers response to the same assignments. Thanks also to the Reasonably Well readers who also chimed in! Each response was enlightening and very enjoyable to read.

So finally, I come to the very last assignment, and my fabricated word is.......drum roll, please.....I'MGLADTHATIDIDITBUTI'MGLADTHATIT'S OVER.

There. A word. AND a sentence.

Health Cliches

WEGO blog prompt day 29: Write about a health cliche that really bugs you.

Ah. Health cliches. There's so many to choose from:
No pain - no gain
This too shall pass
Early to bed and early to rise makes a (wo)man healthy wealthy and wise

I only wish that by exercising until my muscles scream, waiting for my disease to go away, and going to bed early would cure everything...

But as annoying as those tidbits are, lately the one that I find most annoying goes something like this: Just say no. Carve out a place in your schedule for YOU. Be sure to take time for yourself.

Sigh.

Like all health cliches, this one has definite wisdom to offer - if you're a healthy, normal, burning the candles at both ends kind of person.

But for me at this point in my disease, all I have is time. Which made me think of a post that I published a few years ago and is focused on the NO cliche:

I was sitting in my weight loss group the other day (and don’t ask me how that’s going because it’s not good), when the topic of self-care came up. The leader began by asking, “How many of you find that you are caring for everyone else in your family besides yourself? How many of you carve time out in your schedule that is just for YOU?”

Well. Ever since I had to quit work, I have been doing nothing BUT focusing on myself. My entire day is booked almost completely with the word ME in every time slot. There was a time when I would have thought that this would be a perfect existence. Several of my friends have commented that they would love to change places with me. But let me tell you honestly, focusing entirely upon yourself stinks. Especially when you are a chubby 50 something with a strange hairdo, painful joints, and a disease that saps your energy when you least expect or want it to. 

I am just not interesting enough to warrant attention 24/7. 

If I allow myself to become uber focused on my body and it’s symptoms, I become very strange and hard to live with. Every pimple, ache, or pain seems to be magnified 200% simply because, in the absence of anything else to focus on, that pimple turns into a monstrous problem. I become anxious and fretful, and even crankier than usual. It’s not pretty. 

Instead, I have found that saying YES to a few things has rescued me from myself. Granted, the things that I have agreed to do are very limited commitments. But when I spend a few hours answering phones for one of our church’s non-profits, I am blissfully focused on something and someone else.

All kidding aside, I do know that many women’s lives are packed above and beyond what is reasonable for any person, and I admire the women that can keep all those plates spinning. My sisters are really good examples of this.

Too bad there isn’t a way for us all to average these lifestyles so that everyone is happy. 

What cliche annoys you most?

It's Happening Again

Well, as usual, it's time for the routine "After The Holiday Whineybutt Session In Which I Confess All The Stupid High Calorie Stuff That I Have Been Eating".

Yes. I know I do this after every holiday, and I always promise NOT to A: Begin chowing down on everything bad for me as soon as the guests enter the door, and B: Make a boring confession about it all. And, of course, A happened immediately and now here comes B.

Sorry, folks. This thing is bigger than the two of us....I can't hold back.

Just deal with it.

But I will be kind this year and spare y'all the details of the mmmm mmmm GOOOD stuff that I stuffed down my gullet. *smacks lips* The annual Easter Ham-O-Rama was attended by twenty eight friends and family this year and between the yummy ham that John and Greg and our son presented to us, and the delectable contributions from our other guests, the tables were groaning with all sorts of delicious foods.

Alleluia! For lots and lots of reasons!

What made this Easter's chow-down particularly impressive was the fact that I did indeed consume a large amount of candy and goodies in spite of the fact that THE CALORIE POLICE CAME TO DINNER. (Read this if you need a CP reminder.)

Yes. Yes, they did. Three of them. All looking disgustingly svelte and all CARRYING TASERS.

Just like this one. Except they were paper. But could have been dangerous, who knows.

And would anyone care to guess who embodied these calorie police people? Hmmm?? Anyone??

It was none other than my traitor friend, TERESE and two of her relatives.

Turncoat. Terese was supposed to be driving my getaway car!! Saving me from the Calorie Police! And heading to Krispy Kreme!

Instead, she and her cohorts were sitting docilely at MY DINING ROOM TABLE eating disgustingly healthily with TASERS STICKING OUT OF THEIR POCKETS.

Ah, but it takes more than brute intimidation to keep me away from my Peeps, by golly. And my mayfair chocolate egg. And my Nerd jelly beans. And my lemon meringue pie. And my Dairy Queen ice cream cake. And my....oops, sorry. I promised not to give a rundown on the gruesome details.

Yeah. I showed THEM. Paper tasers. Pshaw.

Ahhhh....I'm so lucky to be gifted with such weird friends. Must be because opposites attract.....

I Used To Be.....

WEGO blog prompt day 28: Write a five line poem in this form: I used to be.............but now I'm not.

I used to be frightened, but now I'm not.
I used to be alone with my disease, but now I'm not.
I used to be without good medical care, but now I'm not.
I used to doubt my ability to go on with life, but now I'm not.
I used to be without hope, but now I'm not.

With thanks to Jennifer Pettit, author of Understanding Invisible Illnesses - for lots and lots of reasons.

Hope

Day 27 WEGO blog prompt: Write about a quote that inspires you.

Several years ago, my sister gave me this lovely glass paperweight. When I look directly into it, I see this quote by Mother Theresa: "You are greater than you know."

I love this.

It makes me feel......hopeful. Comforted. I feel as though there is someone out there that has taken stock of me and my potential, and that somehow I have met their expectations.

That I have the ability to be a better person, a better wife, a better mother, a better human being. That even though I am '50 something years old and struggling with a disabling disease, I still am capable of creating something better within and of myself.

That I can still learn more, love more, and be more.

Say It Isn't Over...

.....yet. Easter weekend was a riot, and like all good things, I really didn't want it to end. Lulu and I came up with a way to prolong the holiday festivities, though.

One of our favorite schnauzer blog sites posted pictures of two dogs nuzzling their way through a container of bouncy balls in search of a treat.

Hm....This gave us both an idea.

Lulu loved her Easter basket filled with empty plastic eggs and several small treats thrown in the mix. It kept her occupied for longer than I would have thought.

Meanwhile, I was occupied searching through the kids' empty Easter baskets looking for a lost jellybean here, a discarded Peep there. And I have to say that a few stuck-on strands of plastic grass doesn't diminish the yumminess of a Cadbury egg at all. Slightly chewy - but not bad.

Don't judge me because I'm pathetic....

Spongey Spirits

WEGO blog prompt day 26: Give you or your condition a spirit animal.

Guys. You're KILLING me here. A spirit animal? For me to write something like this without becoming completely silly is almost impossible. Sigh. OK, ok......

Well, I think that if I had to assign Sjogren's syndrome an animal, it should be a sea sponge, or Poriphera. Here's why: like all animals, sponges depend heavily on water, but like Sjoggie animals, water is especially important:

....most rely on maintaining a constant water flow through their bodies to obtain food and oxygen and to remove wastes, and the shapes of their bodies are adapted to maximize the efficiency of the water flow.

You can read more about sea sponges and see the above image here.

We who have Sjogren's syndrome depend on a constant water flow, too -- especially those of us who are dealing with decreased saliva and tear production. As a matter of fact, I would even say that like sea sponges, our bodies are changed in response to water flow as well. My parotid glands swell and attempt to work harder to produce as much saliva as their compromised cells can. I am planning to adapt the lacrimal punctae in my eyelids by having them cauterized to make my tears remain in my eyes longer and work more efficiently.

Hm. What else....ah, yes. I wouldn't describe a sponge as being particularly mobile or active. It's an easy comparison with sjoggies and autoimmune fatigue.

However - sea sponges are tough little animals. They are able to adapt, to modify, and to evolve their bodies to make the best use of their environment. And I would have to say most of us dealing with autoimmune disease are required to tap into those skills, too.

For us, like a sponge, life without water is beyond difficult. But we don't give up easily. Sjoggies are tough little critters, too.

Take Two: My Tongue Is Blue

WEGO blog prompt Day 25: Find an old post of yours and revise it.

It's always interesting for me to look at my blog statistics. One piece of info which is particularly important are the google search words used which cause a reader to arrive on Reasonably Well. Most searches are predictable: dry mouth, Sjogren's syndrome, autoimmune disease. But it's always surprising to me to see how many people enter the words blue tongue and end up reading my post entitled, Doctor, My Tongue Is Blue:

I'm a real sucker for any new product that has the words dry mouth on it's label, so when I spotted a new mouth wash type product that promised to re-hydrate my mouth, I grabbed the biggest bottle that was available. 

Mmmm. Minty fresh, yet soothing. A magically moist mouth didn't materialize, but then I'll take relief for oral dryness even if is for just minutes at a time. I found myself swishing then spitting several times a day. 

This morning, as I looked in the mirror, yawning and bleary-eyed, I did a double take. Something looked very strange. A blue tongue? Yes, a bright blue tongue!  Since my brain was still asleep, it did not occur to me for a full two minutes of panic that my newest oral hygiene product was the culprit. 

I can only imagine Dr. S's reaction if I would have frantically e-mailed her before my morning cup of coffee kicked in: 

Dear Dr. S:

I am very concerned about my tongue. It has turned a strange shade of blue. I have reviewed my anatomy and physiology books from nursing school, granted they were printed in 1975 but anatomy is anatomy, after all. I am certain that a blue tongue is not normal. In spite of feeling otherwise fine, I believe that this is definitely a pathological symptom that requires immediate treatment. Should I proceed to the nearest emergency room for what appears to be hypoxia of the oral cavity? Or should I simply call 911?

Julia

Dr. S. is fortunate that my laptop takes a few minutes to fire up. That delay, along with a jolt of caffeine, saved her from reading an email from an idiot. I would deserve this response:

Dear Julia,

The fact that you are able to turn on your computer and type indicates to me that your condition is not critical at this time. 

As far as I know, the only creature capable of producing a blue glossopharyngeal surface is the Australian blue-tongue lizard. Unless you have developed a taste for fungi, insects, and slugs, it would appear that this unique symptom is a result of something not life-threatening. 

Dr. S.

Thank goodness for Folgers. 

When I wrote this post, I hadn't thought about the fact that there actually are several potentially serious causes for a blue tongue, all of which deserve a much less silly answer than the one above, and may include:

• disruption in the normal oxygen/carbon dioxide ratio in the body caused by heart disease resulting in a blue (cyanotic) tinge to tissues 
• an infection in the mouth and tongue tissues
• oral cancers

Bottom line - if you notice a consistent change in the color of the lining of your mouth and tongue, a sore that doesn't heal, or a growth, pay careful attention and speak to your doctor. It could be a condition which requires further examination by a physician.

Great Weekend!

Check out Godson's duck above. I absolutely love that thing. If you pick it up by it's ears, it says, "WAAAAAAACCCCKKK! Put me down! Put me down! WAWAWAWAWAAAAAAA!" I had to gift wrap it just so that I would quit wearing the batteries down before I was able to give it to him.

It also will sing and dance in a Donald Duck kind of way if you push his foot. But if I were Godson, I'd drag him around by the ears. Constantly. Just to hear him squawk.

Two of the couples attending this year's Ham - O - Rama made the exciting announcements that each of the couples were expecting a baby!

AND.....my son and his girlfriend are ENGAGED!

*happy happy dance*

So many wonderful things to look forward to!!

Happy Easter, Everyone!

Happy Easter! Happy spring!

Remember the reason for the day......and always eat your chocolate bunny ears first.

Dr. Seuss Day

WEGO writing prompt day twenty three:

It's Dr. Seuss day! Write a post using as many rhymes as you can.

On a bright spring morning -
a beautiful day -
Julia the sjoggie
went outside to play.

She rushed out the door
and didn't stop to think
that she should do a few things
that took just a wink.

She didn't wear her sunscreen.
She didn't wear her hat.
She didn't put in eye drops.
The next day she was lying flat.

Oh, poor me! she cried.
Whenever will I learn?
I'm so stinkin' tired!
And I've got a sunburn!

The moral, my sjoggies,
of the story is this:
Wear your hat and some sunscreen,
so your spring will be bliss.

Image found here. 

Sjogren's and the Social Security Administration

This from the April update for the Sjogren's Syndrome Foundation:

Sjogren's Testifies in Front of the 
Social Security Administration

"On behalf of the SSF, Baltimore Support Group Leader Eva Plude recently testified in front of the Social Security Administration's Compassionate Allowances Outreach Hearing on Autoimmune Diseases.

Eva did a wonderful job detailing her struggle to be diagnosed, the difficulties of living with Sjogren's, as well as how disabling the disease can be.

Her written testimony also was submitted to the SSA as part of their extensive consideration of autoimmune diseases needing "Compassionate Allowances" for social security disability, and the SSA copied and distributed her testimony to attendees at the hearing.

Other Sjogren's volunteers were in attendance and we are excited for the opportunity to once again talk with the government about just how debillitating Sjogren's can be."

You can read Eva's excellent written testimony here.

Take This And Don't Call Me In The Morning

Blog Prompt Day Twenty Two: Your doctor writes a wacky prescription for you. What is it?


Dr. K. pushed his glasses up on his nose as he thoughtfully reached for a pen.

"Julia, I just don't know what to do with you anymore. You're such a non - compliant patient." He put up his hand to silence my retort. "Look. You've simply got to lose some weight. You know it. I know it. Your schnauzers know it. Everyone knows it. Weight loss would help ease your arthritis symptoms, and we could give you less medication if your BMI was a lower number."

I glared at him but didn't say a word. Because I knew he was right.

"Drastic times call for drastic actions." He tapped the pen on his desk. "I hate to do it, but I'm going to write a prescription for a year's worth of calorie police monitoring."

What??!

"Yes. The calorie police. It's a squad of dedicated individuals that will follow your every move for every day for one year."

You're kidding me.

"No. Not at all. I've only had to write this prescription once before....and I didn't think I would have to again. But you leave me no choice." He peered over the top of his glasses and pushed a red button on the wall. "There's no escaping the CP, so don't even try."

Immediately, three svelte, grey uniformed women marched into the exam room. They wore skin tight spandex neck to toe leotards and black boots. Each had her hair pulled back into a tight chignon and carried a small yellow taser stun gun. They stood silently in a line in front of the door with arms crossed and met my astonished gaze with stoic determination.

Dr. K. cleared his throat. "Look, don't mess around with these ladies. Their instructions are to monitor every morsel that goes into your mouth. Once your 1200 calorie allotment is consumed for the day, any attempt to ingest anything aside from water and non-caloric beverages with be met with a serious deterrent." He looked meaningfully at the stun guns held in each of the women's hands. "They will leave this appointment with you and will remain by your side for a year. They will also accompany you to your exercise outings and will provide...ahem...motivation if you choose not to cooperate."

I opened my mouth to protest but once again he held up his hand. "I've spoken to your husband and he's agreed to this. I'll see you again in three months. We'll weigh you then. I expect to see considerable progress. Good-bye."

I didn't know what to say or do, but sat slack jawed in disbelief. The nearest calorie policewoman gave me a nudge with her taser. "Julia. It's time to go."

As we headed out of the exam room, my mind was whirling. This couldn't be possible. It couldn't be legal. And John approved of this? I shook my head. Well, Dr. K. was right about one thing, I thought. Drastic times DO call for drastic action. I surreptitiously slid my hand into my purse and felt for my cell phone, then palmed it into my pants pocket.

"Ladies," I said as authoritatively as I could. "You aren't really going to follow me everywhere, are you?"

Silence. Determined stares.

"Even the bathroom??"

The tallest of the CP spoke. "Of course not. I'm assuming you don't store food in there, do you?"

Duh. NO!

"Then that would be an appropriate time for us to step away from your side."

Ah. Well, girls, I really have to go to the bathroom now. Mind if we stop off before leaving the clinic?

"This would be acceptable. But you must allow us to search your purse first for food products."

Good grief. I handed my purse over and they gathered around it as they examined every item. As they handed it back, I headed into the ladies room. Once inside, I hit the speed dial for Terese.

"Hello?" Thank God she was at her phone.

I spoke quietly but urgently. Girl! Where are you? It's an emergency!!

"What did you do now?" Nothing surprises Terese anymore.

I'll explain later but you have to pick me up at the clinic. The BACK door of this clinic. You know where that is?

"Sure. I'm actually at the grocery store not far from there. Why?"

You won't believe it until you see it. Just get here asap. Park near the back side of the building and give a little toot on your car horn when you get here. Keep the motor running and watch for me.

I took my time, flushing the toilet repeatedly and then washing my hands and running the electric hand driers several times.

Be right out, ladies! I shouted at the door. I could hear them shuffling their boots on the tile floor. After what seemed like forever, I heard the sound of a car just outside the bathroom window.

Beep. Beep.

Yes! I tentatively cracked the bathroom door and peeked into the hallway. All three CP were leaning against the wall studying their fingernails in boredom.

I closed the door quietly and turned to study the size of the bathroom window thoughtfully. Yes, yes. This just might work. I carefully raised the window as quietly as I could, while hitting the hand drier with my foot.

*WHIRRRRRRRRR*

Just before the drier automatically shut off, I pushed the screen out and leapt through the window, landing on the rhododendron below. Terese stared at me in disbelief as I plucked the bright red flowers from my hair and threw myself into her SUV.

Go, woman, GO!! I shouted. She hit the gas and we screamed out of the parking lot, tires squealing. The girl can drive.

"Where to?" she asked.

Krispy Kreme!! And step on it!!!

Image found here.

Day Twenty One

WEGO blogging prompt day twenty one: Write about someone that you admire.

One of the grocery stores that I frequent for the last fifteen years employs a cashier that I've always liked. She's a slim blonde woman that I'm guessing is age 60 or so.

I've always liked paying for my groceries in her line. She's remarkably adept at her job, scanning and bagging effortlessly, and knows the price of everything. EVERYTHING. Her smile is sincere - when she asks how my day is going, she genuinely seems to care about my answer.We never have had a lengthy conversation since she always has my purchases rung up and is handing me the receipt in a remarkably short period of time, but she seems to be the kind of person that I would like to know better. After all these years, she smiles in recognition when she sees me and we exchange small talk and pleasantries.

Over the past month, she's become even more thin. And though her hands still move quickly and her smile is still genuine, her skin has taken on a different quality - more pale and almost translucent. She's now wearing a cotton bonnet that I recognize as being a chemotherapy hat.

I chose to write about this woman today not because she is continuing to work through an illness, but because from what I've observed, the qualities that make her a genuinely nice person have not been changed by that illness. She continues to be who she is in spite of what seem to be significant medical challenges. She's persevering not only in her job, but in the preservation of her identity and character.

The next time I see her, I'm going to talk to her. Really talk to her. And even though there may be others in line behind me, I want to tell her that I appreciate the person that she is.

Say Cheese

Ah, Facebook.

My profile photo on Facebook has been the same for EVER. But I like it. Mostly because it's just a giant head and a teensy weensy little body. It's my Mii from my Wii Fit game.

But one of my friends, who shall remain anonymous but her name begins with  B and ends with EVERLY, has commented several times that she thinks I should put a real pic of myself up there. I grudgingly agreed, thinking that it shouldn't be too hard to just look into my laptop computer's camera and just take the stinkin' picture.

Of course it was hard. I dragged this stupid laptop all over the house trying to find a spot that had the right lighting and didn't have weirdo stuff in the background.

This was the best I could do and of course it was the first one that I took without even combing my hair and my wrinkles sharply illuminated by the laptop screen. But I thought if Bev wanted the real me - here it is - where I usually spend most of my time, plunked down at my little white desk and futzing around on the computer.

I may or may not choose to make this my Facebook pic, but thought I'd post it here today with a bit of a warning:

When you read Reasonably Well, here I am - looking back at you. So behave yourselves. Don't make me come over there.

The Best of The Worst

Thanks to a tweet yesterday by @EssentiallyAli, I had a chance to read this really great conversation thread found on the Sjogren's World Forums. The topic? Five least favorite Sjogren's syndrome symptoms.

What symptoms would top your list?

Sunshine and Springtime and Sjogren's Syndrome

Ahh. It's that time again. Spring is tiptoeing into the Pacific Northwest, even though I'd rather it was sprinting full speed ahead.

Still, I'm glad for those sporadic days filled with sunshine, the gradually warming temperatures, and the irresistible urge to frolic around short - sleeved and bare - headed.

Bad Julia. Bad, bad Julia. For lots of reasons. First, and foremost, no one in our neighborhood should be subjected to the sight of a pale, plus sized, jiggly - armed woman frolicking.

Eww.

Then there's the whole sunshine/UV issue. I need to grit my teeth and slather on sunscreen, strap on my hat, and cover my arms, not just this spring but all summer long.

I haven't tolerated direct sunlight for many years. It's not unusual for sjoggies to have issues with UV rays, as do most people with various autoimmune diseases. You can learn more about sunshine and sjoggies on a previous post here, but here's a snippet:

This very good article from the Arthritis Today online magazine describes the mechanism: 

"..it turns out the sun’s dangers are more than skin deep. The sun’s rays – particularly deep-penetrating ultraviolet-A (UVA) rays – can damage the DNA within the nuclei of the body’s cells, inhibiting their ability to control how and when cells grow and divide....Problems can range from an immediate redness, burning and stinging of the skin to a systemic flare of the disease, characterized by inflammation of the joints, blood vessels and internal organs."

Sometimes the medications used in treatment of Sjogren's and other autoimmune disorders can also be the culprit in causing sun-related problems:

"Several medications that people take for those and other inflammatory diseases, including rheumatoid arthritis (RA), can also cause sun sensitivity and lead to problems such as skin rash or rapid burning. Some of the most common culprits are nonsteroidal anti-inflammatory drugs (NSAIDs) and some disease-modifying antirheumatic drugs (DMARDs), including hydroxychloroquine (Plaquenil), methotrexate and sulfasalazine (Azulfidine). Tetracycline antibiotics, some antidepressants and diuretics can cause sun sensitivity too." 

My sun sensitivity will be heightened this year with the addition of methotrexate and cyclosporine to my medication list, so it will be especially important for me to remain vigilant. This will be hard. It always is, but especially when those first sunshine-filled days arrive, and my garden begins to bloom.

We have blossoms on our pear, peach, cherry and magnolia trees:

And tucked away in our little greenhouse, a few strawberries are just beginning to set fruit. Mmmmm.

Sunscreen is my friend. Sunscreen is my friend. Sunscreen is my friend. Sunscreen is my friend....

MmmHmmmm. Sure.

WEGO blog prompt day eighteen: Write your daily routine in detail.

Well, now. Um. I'm imagining writing down
EVERYTHING......ick. Sorry, folks. Really - you don't want to know this. REALLY.

But - there's a better way! Let's play the opposite game, OK? You remember the opposite game, don't you? Whatever I say, you imagine just the opposite! This was a very very cool thing to do in junior high.

I'm much more comfortable playing the opposite game, so here goes:

Julia awakes at dawn, one arm draped gracefully over her softly tousled hair. She opens her eyes with a gentle smile on her face, stretches her arms overhead with the elegance of a ballerina, and slips her dainty feet into high heel slippers placed neatly under the bed. Her seafoam colored chiffon neglige swirls around her ankles as she glides down the stairs, while tying her matching delicate green bathrobe around her slender waist. 

"Good morning!" she trills in harmony with the birds singing merrily outside the kitchen window. "Good morning, darling birds!" 

A bluebird flutters to the windowsill, and eagerly hops onto Julia's outstretched perfectly manicured finger. She smiles and sets it free, watching it soar effortlessly away through the perfect blue morning sky.

Minutes later, she makes her way back upstairs to the bedroom balancing a bed tray lined with crisp white linen and laden with artfully arranged china, fresh steaming coffee, warm home baked cinnamon rolls, and a perfectly segmented grapefruit topped with a maraschino cherry half.

"My darling..." she coos. John awakens and sits up, as Julia plumps a pillow behind his back and sets his breakfast before him.

"Ah." he says. "It just wouldn't be morning without breakfast in bed. I simply don't know how you do it every day, my dear."

OK. CAN'T DO THIS ANYMORE, PEOPLE. JUST REMEMBER THAT THIS IS THE OPPOSITE GAME.

'Nuff said.

Image found here.

Phone Fogginess

I am sorry to have to do this to y'all, but I need to begin this week with a confession.

It IS holy week, after all.

Friday was one of those days. John should have just taken me by the hand and led me around for the entire day and duct taped my mouth shut. I was so foggy that it seemed that I couldn't remember anything. I began the day by calling to make an appointment with my dermatologist, and needed to leave my request on an answering machine.

*We're not in the office right now, but your message is important to us! Please leave your name, health record number and return telephone number at the tone. BEEEEEEEEP*

"Hello. This is Julia. And my medical record number is.....um.....gosh. Is it 234... no it's 4417 something.... no that's not right....Well, isn't that just....I need to call back! Click."

Can't you jut see the appointment secretary's face as she listened to THAT one.

Good grief. Like most sjoggies, my medical record number is one of the few things that is usually permanently burned into my brain. I scoured my purse for the insurance card and waited a few minutes before sheepishly calling back. I considered trying to disguise my voice but realized that the caller ID number would be the same as my previous call. This would only add to the weirdness of my attempt to make an appointment.

I bumbled my way through the rest of the day. Running into walls, aimlessly wandering from room to room trying to remember what I had forgotten to do that took me into that room, getting crankier by the minute. I took a nap and awoke crankier than before.

Up until this point my day, while annoying, was nothing particularly unusual for my foggy days.

Until.

I was listening to my voice mail messages, specifically one from my mom. I love my mom's messages, since she speaks to the answering service the same way that she would have a conversation with me. Her messages go on for at least three minutes and when she's finished, I feel as though we've had quite the conversation.

So I was standing there, listening, and somewhere into the message about thirty seconds or so, I forgot that this was a recorded message from my mother.

I began to try to speak to her.

"Mom..."

blah blah blah blah blah...

"Oh, Mom?"

blah blah blah blah blah blah blah....

"MOM! Can't you hear me?!"

blah blah blah blah blah blah blah blah....

"MOM!! WHY WON'T YOU LISTEN TO ME? ARE YOU OK? HELLOOOOO? MOTHER? MOOOOOOOOOOM!!!"

Well, it's been nice talking to you honey, talk to you later, ok? Ok! Click.

I blinked in astonishment. Did my mother just HANG UP ON ME? We never hang up on each other. I was furious.

Greg had stopped by for a Friday night game of darts with John, and unfortunately was witness to the whole thing. I could see his eyes widen with surprise as I began yelling into the telephone. At my MOTHER.

I stormed into the living room and flopped down on the couch, fuming. As I sat there stewing away, it gradually dawned on me that I was having an argument with Verizon's automated message service. Oh, brother.

Should I 'fess up to Greg about my total brain absenteeism? Which would be worse - to have him think that I was mindless or completely rude to my sweet mom?

Hm. The answer was obvious, even to foggy me. Greg knows all about my foggy days. I think his first real experience with foggy Julia was the day that I walked face first into a glass patio door. Which was closed. And he was on the other side.

They still talk about that one.

On the other hand, Mom and I haven't really argued since I was a bratty thirteen year old. Well, not a yelling kind of disagreement, anyway... I wouldn't want him to think that I would really be that disrespectful.

So I had to haul myself out onto the front porch where Greg and John had retreated and admit my seriously foggy lapse in judgment. Yikes.

I knew there was only one cure for this sort of thing, and it involved hopping into my snuggly bed and shutting the old brain down for an eight hour re-boot.

So I did. I decided just before I fell asleep that the fault was not mine - it was those stupid answering machines. Yes. Yes, they're the culprit, for sure. Couldn't be me.

The end. I feel so much better now.

Too Funny To Use

Oh, my gosh. When I saw these cocktail napkins I just HAD to have them. Someone sketched this picture of John and I without us knowing it.....

I think I may have to frame one of them. 

Drink Up

WEGO post prompt day sixteen: Write a news report presenting an invention or cure for your condition.

Portland, OR, April 16th, 2011:

What was once considered a party novelty or a football stadium must is now a therapeutic tool for sufferers of Sjogren's syndrome mouth dryness.

Yes, sjoggies, your days of lugging around liquid refreshments are over. With the Sjoggie Soda Hat, just place the chilled beverage of your choice into the handy can carriers located conveniently near the brim of this attractive pink chapeau. Viola! Your hands are free to carry other vital sjoggie supplies such as sunscreen, eye drops, and the occasional Krispy Kreme donut box.

You can buy your very own Sjoggie Soda Hat here.

I'm So Lucky That This Is True

WEGO post prompt day fifteen: Tell a story in two sentences.

"Oh, husband," she cried, "what's become of our lives; to think of what I've become just gives me the hives, for I'm sick and not able to put food on the table; I'm weary and grubby and puffy and tubby, how can you remain with me lifelong as my hubby?"

"Oh, wife," he exclaimed as he gave her an embrace, "though you're tired and achey I will always love your face; I care not that your cheeks have become rosy and round, that the dust on the table now weighs about a pound; and though I do miss your spectacular pie, I find joy in your smile and the twinkle in your eye; all those years ago that we said I DO, well that means honey, I will always cherish you!"

Yup. That's one of my fave wedding pics, a zillion years ago.

A Schnauzer Solution

Poor Lulu and Maggie have been somewhat deprived of their walks since my hands have become inflamed and sore from the arrival of psoriatic arthritis. I used to strap on their gentle leaders, then click on their leather leashes. Without fail, I'd have to manipulate the leashes by pulling on them or winding them around my fingers. And since these two woogies are not particularly well-behaved, I was winding and yanking a lot.

Owie.

I was excited when I spotted a potential solution at my local pet store. Once again I have to admit that I'm hopelessly gadget uneducated, but finally noticed one of those retractable leash thingies that seem to be everywhere these days. It can handle the weight of both of the girls, plus it has a cushioned hand grasp. I grabbed a doohickie that lets me attach both schnauzers, and presto!

So far it's working great.

I think schnauzer butts are so danged cute. Now I need to get MY lazybutt out there to walk them regularly. I have no more excuses.

Lies, Lies, Lies

Image found here. 

WEGO writing challenge day fourteen:
Write a poem in which every line is a lie or misconception about your illness.

It's nothing to worry about.
It's only dry eyes.
It's only a dry mouth.
Just drink more water.
Nothing else will change.
This is what happens when women get old.
Get more exercise. That will take care of everything.
Lose weight. That will take care of everything.
Wear crystals. That will take care of everything.
Read this book. Then you'll know that your negative thoughts caused everything.
It's nothing to worry about.

Methotrexate And Me

Well. There they are. My Tuesday challenge. Three small yellow methotrexate pills.

They look deceptively innocent, don't they?

Over the past month, these little guys have given me no end of grief, BUT I'm happy to report that this week is going a bit better. Thanks to my newly-favorite health professional, my pharmacist, I've tweaked the way I take this med a bit and although it seems that I won't completely avoid the day after nausea and dopiness, it's less. Definitely much less.

Hey! Whaddya mean, it's hard to tell if I'm less dopey??

Every Part Of The Body Is An Expressive Instrument Of The Soul

Day 13 of the WEGO writing challenge: Pick up a book and open it. Use the first sentence that you read as the title of today's blog post.

"Every part of the body is an expressive instrument of the soul."  - Signs of Life by Scott Hahn.

Everyone speaks without using their voice.

I remember from my days as a nurse educator that only 10 percent of our communication is verbal. The other 90 percent is information relayed by our posture, our expression, our movements, and our proximity to others. We all intuitively know this to some degree. Sometimes this 90 percent of communication is called "body language".

While working as a staff educator in an Alzheimer's community, becoming fluent in speaking the language of the body was a vital skill. Many times body language was the only means of effective communication that those in advanced dementia states were able to use. I recall one conversation in particular with a client named Dick. Dick was very hard of hearing and refused to wear his hearing aids. in addition, he had severely limited speech ability at that point in his Alzheimer's disease, so our conversation utilized very few words. It went something like this:

Dick approached me with brow furrowed, cradling his left arm with his right hand, and a pained expression in his eyes.

I stood directly in front of him and smiled. He gave me a nod of recognition, and rubbed his arm, which had a gauze bandage wrapped around his forearm. The skin encircling the bandage was bruised.

I pointed at his bandage with a quizzical look in my eyes.

"Oh," Dick said. "Fell."

I gave him a gentle pat on the shoulder, then looked at him with a question in my eyes.

"Hurts." he said.

A medication nurse was standing about ten feet away in front of her med cart, busily dispensing medications to other patients. I pointed down the hallway in her direction, and looked back at Dick.

"Nurse?" he asked.

I nodded and patted his arm gently. I began to walk in the nurse's direction, and Dick took my hand. He shuffled slowly down the hallway with me.

He stopped halfway there. "Pills?" he asked.

I turned to face him and smiled. I nodded my head, then looked at him with eyebrows raised.

I could see him deciding whether he needed to take something for the pain. "OK." he said.

We made our way together to the med cart, and Dick looked expectantly at me. He clearly was asking me to do the talking.

"Hi Janet," I said. "Dick would like me to tell you that his arm hurts." I looked to him for affirmation and he nodded. I left him in Janet's capable hands, but as I turned to leave, I could see Dick's expression change from pained to relieved. I felt the same way.

As I walked back to my office, it occurred to me that I hadn't actually said one word to Dick, but we had communicated pretty well.

The Financial Burden of Autoimmune Disease

The American Autoimmune Related Diseases Association and the American Coalition of Patients Groups recently released a white paper which explores the fiscal impact of ADs on patients and U.S. healthcare spending - The Cost Burden of Autoimmune Disease: The Latest Front in the War on Healthcare Spending. Bolding and parenthetical statements mine. 

The summary states:

Autoimmune disease as a category affects 50 million Americans. It is one of the top ten causes of death in women under the age of 651, is the second highest cause of chronic illness, and is the top cause of morbidity in women in the United States. Additionally, autoimmune diseases have been reported to be on the rise in the U.S. and around the world, making this poorly understood category of disease a public health crisis at levels comparable to heart disease and cancer. Because of a severe lack of awareness amongst the general public and medical practitioners and unequal allocation of research funding and focus at the National Institutes of Health (NIH), plus a lack of coordinated care and standardized diagnostic tests, the associated cost of autoimmune diseases has become a significant portion of the rising cost of healthcare in the U.S. Addressing the pressing concerns surrounding autoimmune diseases should be a major priority of the United States Congress as a means of reducing healthcare spending while ensuring improved public health.

Of particular interest was data showing the annual indirect and direct cost of Sjögren’s syndrome and rheumatoid arthritis (RA) against a control group:

This data was published by the Sjögren’s Syndrome Foundation and was produced by two independent UK studies16. The studies found that indirect costs totaled $21,369 per patient per year. These included time lost from current work, inability to work at all, or to work full-time, as well as costs associated with the necessity to hire outside help within the home to assist with tasks no longer possible due to disease progression, such as housework and yard work. With four million patients suffering from Sjögren’s syndrome in the U.S. today, this adds billions more to the already staggering financial burden faced by patients, your constituents, in the U.S. today.

According to the paper's authors, much of the blame of the staggering cost of autoimmune disease is placed squarely on the current health care provider system:

Innate problems exist for autoimmune patients regarding getting a diagnosis and onset of treatment which add unnecessarily to the cost of having these illnesses. According to an AARDA study, on average patients spend upwards of four years seeking an effective diagnosis. Visits to more than four physicians are typically needed; and because of poor physician training and education in this category, the AARDA study found that 46 percent of patients were told that they are constant complainers or too concerned with their health. The cost ramification of this is that the illness continues to progress throughout this process, extending the time to which patients begin to obtain proper treatment and care for their illness. Disease progression, unchecked with treatment, has major consequences, such as organ damage and physical disability that often lead to earnings losses and financial distress due to high out-of-pocket costs. Ultimately, after becoming unable to work and support themselves and their families, patients are forced to apply and obtain disability payments.

The paper went on to address ways in which our current health care system could be adapted to ensure better care for AI patients and in doing so, reduce the cost burden of these diseases to both patients and the current health care system providers:

• Streamlining the diagnostic process. 
• Coordinated care through community-based triage center. I was intrigued by their suggestion to create a new physician specialty - the autoimmunologist. This new specialist would serve as the head of a multi-disciplinary team of physicians within autoimmune triage centers, providing not only more cost-effective care but also increasing the quality of care for these patients. 
• Focus on research funding: knowledge limits waste. "Ultimately, better autoimmune disease costs and epidemiological studies are necessary to improve assessment of the prevalence of all 100+ autoimmune diseases so that the U.S. can allocate, in fairness, resources in funds for research and drug development, focus on research and medical training, and provide accurate information for developing public health policy."
• Increasing awareness. "....adding to a severe awareness gap are physicians. Many are poorly trained in this area and typically do not ask about a family history of autoimmune diseases on patient intake forms. It has been scientifically proven that these diseases are genetically linked; therefore, family history plays a major role. If the patient doesn’t know to tell the physician of a family history of autoimmune disease and the physician doesn’t know to ask, patients are destined for years of misdiagnosis or no diagnosis; and billions of dollars are spent that could have been saved with an increase in awareness."

The authors conclude:

Autoimmune diseases will continue to be a mounting public health concern in the U.S. and around the world for the foreseeable future. The cost associated with these diseases, while difficult to pin down accurately for all 100+ diseases, has clearly been illustrated to be a major component in the healthcare spending picture, adding perhaps hundreds of billions of dollars to healthcare spending through cost to individual patients and Medicare/Medicaid, as well as loss of productivity in the U.S. workforce. It is imperative that autoimmune diseases become a public health priority that is recognized throughout NIH institutes as well as amongst the congressional representatives who must represent the pressing needs of this growing constituency of Americans who live with autoimmune diseases.

Amen! Take the time to read this excellent white paper. 

An Ocean Ekphrasis

I needed to turn to google to clarify day twelve's writing challenge prompt - to find an image and free-write about it. Interesting. Do you need to refresh your knowledge of literary terms, too?

Ekphrasis: One particular kind of visual description is also the oldest type of writing about art in the West.  Called ekphrasis, it was created by the Greeks.  The goal of this literary form is to make the reader envision the thing described as if it were physically present.

I took this picture a few years ago out at the Oregon coast.

Lick your lips. Taste the salt riding the invigorating cool ocean wind that has found your face. Stretch out your arms. Feel that? Close your eyes and let your muscles strain against  the powerful gusts that could lift you into the air like a kite. Imagine bobbing and soaring high above the sand, tethered only by a slim cotton string. Listen. The ocean is shouting; it's words unintelligible, lost in it's own roar. Squint as bright sunshine makes it's way past high feathery clouds and warms your hair. Sigh in contentment with the knowledge that all those that you love most are standing on the warm sand next to you.

Wiki Sjogren's

WEGO Writer's Challenge Day 11: Revise your condition's Wikipedia page.

I dutifully typed Sjogren's syndrome into Wikipedia today, and found an entry that was well-researched and surprisingly extensive. Since I couldn't think of a thing to add or correct in the existing entry, I moved on to other Sjogren's entries on Wikipedia. Who knew there were so many other things besides Sjogren's syndrome that were named so similarly?

Of course there's a long list of accomplished people who have the surname Sjogren. But then there's also several other diseases and conditions which use the name Sjogren in their title - none of which were discovered by our own Dr. Henrik Sjogren of Sjogren's syndrome fame, BTW.

And then there's the Sjogren shotgun. Really - a 12 gauge semi-automatic shotgun designed by the Swedish inventor Carl Axel Theodor Sjögren, manufactured in Denmark by Haandvaabenverksäderna in 1909. It used an inertia system later revived by the Italian firm Benelli and today widely used in shotguns.

Aw. Makes me all misty-eyed for the days of my youth when my parents actually gave ME a .22 rifle and then turned me loose with it. Good thing all of the wildlife around our farm were better runners and fliers than I was a shooter....but boy howdy, watch out if you were a tin can, by golly.

I need to get myself one of these. I could designate myself as the official sheriff of the autoimmune disease community. I need some spurs and a rifle holster so that I could jingle (JINGLE, people. Not jiggle.) menacingly as I stride down some main street in the virtual Sjogren's syndrome world.

Howdy. *spit* Thar's a new sheriff in town, folks. *scratch* Yessirree, don't mess with Sheriff Julia, the meanest rootin' tootin' sjoggie this side of....um....anywhere. I can take out one of them thar lymphocytes that's been cripplin' any saliva gland with one shot. Yep. Me and Lucky, here, mah trusty 12 gauge loaded up with DMARDs. *snort* Whuuut? Think yeh can take us?? 

High noon. Take cover. We'll be thar.

Understanding Invisible Illnesses - On Air

Sjoggies - we have a celebrity among us. Head over to Optimal Health Seekers' Radio to hear an awesome thirty minute interview with Jennifer Pettit, founder of Understanding Invisible Illnesses.

Jen speaks eloquently yet clearly about her own personal experience with Sjogren's syndrome and other autoimmune illnesses. While working full-time as an auditor in a major metropolitan city, Jennifer also works tirelessly to increase awareness of invisible illnesses both in her workplace as well as for her community at large.

Go. Listen. Be inspired.

It's Not A Secret

Today's Day 10 writing assignment:

You know the beloved Post Secret community? Write down a secret that really isn't a secret. Hint: A misconception about your condition, something people would think you'd be shy to disclose (but will!), or just something you want to shout from the rooftops!

Ah. It just so happens that this morning, I spotted a beautiful blue heron perched on my neighbor's rooftop. My postcard secret would read:

I wish that I could fly!

Just like my gorgeous blue buddy. I could see myself shouting Wheeeeeee!! while perched on my neighbor's rooftop....

A Hitch In My Giddy-Up from MTX/Cyclosporine

I've been taking a new drug cocktail for the past two weeks now - methotrexate and cyclosporine. I have to be honest here and say that although my fingers are greatly improved.....

So much better!

.....the side effects of this drug combination may be problematic.

I've taken methotrexate many years ago, and although I tolerated it with absolutely no problems, it didn't seem to help my overall Sjs symptoms, so we discontinued using it and moved on to other meeds.

Fast forward to two weeks ago, when my rheumy elected to begin a methotrexate/cyclosporine combination therapy to bring my raging psoriatic arthritis under control. As usual, he had excellent rationale for his choice:

Psoriatic arthritis (PsA) is a chronic, progressive, and debilitating disorder. When monotherapy fails, combination therapy is necessary for the long-term management of these patients.......The combination of cyclosporine and methotrexate reduces the dosages and also the side effects of each agent, allowing better disease control with less toxicity.

I began taking these meds with the mindset that I would tolerate them perfectly well since there are very very few medications that give me grief. So I took my MTX with a full evening meal once a week, and took the cyclosporine exactly twelve hours apart every day, also with a meal - breakfast and dinner. I supplemented with folic acid on non-methotrexate days, as prescribed.

I marveled as the inflammation in my hands began to subside. What a relief! But I also noticed immediately that this particular drug combination would be difficult for me to take. Puzzling.

After taking the methotrexate (and cyclosporine) with Tuesday night's dinner, I'd go to bed feeling perfectly fine. But I'd wake up on Wednesday feeling just dreadful. Dizzy, nauseous, and stuporous. These weirdo symptoms slowly taper away until Friday.

Wah wah wah wah.....I know, I'm a whiney-butt. But I don't like this one bit. You'd think that all this intestinal stuff would make staying on my Weight Watchers diet pretty easy, but actually one of the foods that is most soothing to my tummy is ice cream. Hm.

I discussed my symptoms with my pharmacist yesterday. He acknowledged that all of these are possible with this drug combination, but also told me that if after taking next Tuesday's dose that the same symptoms occur in the same or worse intensity, that I should call my rheumy. Will do. He also advised me to take my Tuesday dose of methotrexate at lunch so that I can avoid taking both methotrexate and cyclosporine in one gulp together.

I WILL make this work. I WILL make this work....

You can read more about methotrexate's side effects here, and cyclosporine here.

What's That?

Write a poem where every line is a health question.

Interesting. Although I am beginning to feel as though I am back in high school wading through my English class assignments. My English teacher was my Auntie Kay, and instead of giving her niece any preferential treatment, I think she expected more, not less, from me. Not that that's such a bad thing, Auntie Kay. Not complaining. Nope. Um....see you at the family reunion, Auntie Kay?

Back to today's poem.

I've asked more than my share of health questions since my diagnosis. And after beginning to write Reasonably Well, I've been asked many health questions as well. So here goes:

How do you spell that? (S-J-O-G-R-I-N-S)

How do you say that? ("show"-"grins")

Why do I have that? (Nobody knows for sure.)

How will my body change because of that? (Oh, girl. In lots and lots of ways.)

Can I get rid of that? (No. Never.)

Can I have a life with that? (Yes. Yes, you can. It won't be the same life that you had before, but you can fashion a satisfying, loving, and meaningful life while dealing with that.)

*An addition*

I would be interested in YOUR responses to the WEGO writing challenge. How about it? Post a response here with your interpretation of that day's assignment. I promise not to yoink your ideas and take credit for them. And no, my fingers are not crossed behind my back. Tsk. Such skeptics.

Voice Mail

Day Seven: Leave your HEALTH a text or voice mail.

*Riiiiiinnnnngggg...riiinnnngggggg.....riiinnnnngggg....click. You have reached the home of Julia's health. Leave a large slice of Rose's Deli carrot cake on my doorstep. Or leave a message after the beep. Thanks. BEEEEEEEEEEEEEP*

OK, I know you're in there screening your calls. Pick up. PICK UP!

Sigh.

OK. Be that way, missy. This - as I'm sure you know - is Julia. Just wanted to leave a FYI. I have joined Weight Watchers. I have joined the community center and am swimming twice a week. Dr. K and I have changed my meds. So I want you to get on board here and change for the better. I want to see a noticeable, appreciable change. Got that?

Don't make me come over there.

*BEEEEEEEEEEEEEEEP*

Some Things Never Change

Day Six: Finish this sentence: I write about my health condition because.....

......I can.

Even if I'm flat in bed, I can still plop my laptop on my belly and peck away at the keyboard. I can read and cut and paste and cite and link to my heart's content. Sure beats twiddling my thumbs in boredom waiting for my energy batteries to recharge.

My vocal cords don't produce the same voice that they used to since Sjogren's syndrome arrived and it's dryness definitely added a seriously croak-y quality. I can't sing in our church choir or even carry on long conversations anymore without my voice dropping off to a hoarse whisper. But my virtual voice is completely unchanged. I can blab and ramble and occasionally make no sense whatsoever in what I'm trying to say. Just like I always have.

Woo! Thanks to the written word, life goes on.

And Now For Something Completely Different

We like working on jigsaw puzzles.

Lately I try to buy ones that are seasonal pictures. I choose the puzzle, break open the box, and just scatter the pieces on the formal dining room table. It's a great place to work on the puzzle because it's a generously sized table and a quiet room. Well, usually..... except for Ham-o-rama days and of course Christmas and Thanksgiving.

So my most recent puzzle was a print of Davinci's Last Supper. It was a challenge, but then that's half the fun. We finished it last week.

Looks great, doesn't it?

Look carefully. Yeah - looks great except for one little chewed up puzzle piece.

Wonder who did that?

Lulu says it didn't taste as good as the piece that she chewed up from the Santa Claus puzzle.

We boxed it up and donated it to Goodwill after writing this on the cover: This puzzle has all the pieces. One is slightly puppy-chewed. Sorry.