Monthly Archives: March 2010

Just Talkin’ Tuesday 03.30.10: Symbols of Recovery

“Cool ring,” she said, catching me completely off-guard.

I managed to mumble a thank you once I realized it wasn’t my plain gold band about which she was talking.

On my left hand, I wear a silver butterfly ring. It’s a symbol of how far I have come. I know in my heart I’m recovered. But it’s nice to have a symbol.

I also have an African Violet plant in my kitchen given to me by my brother and sister in law on the Mother’s Day shortly before my hospitalization. Back then I did not really want to take care of it, much like I did not want to take care of myself, my family, anything. But now? Now we are all thriving and it is too. I recently replanted it, actually. The thing is monstrous!

Much like holidays have their own symbolism, each one of us may have a symbol we have come to associate with recovery or our journey toward wellness.

What’s yours? What are you holding on to when nothing else seems to help? Is there a story behind it? Share it with us.

Two years ago today

I wrecked my Mazda.

Without insurance, I went to the hospital on a backboard.

My fingers and toes were numb. Tingly but mostly numb.

I was scared.

It got worse.

After what seemed like an eternity in the hospital, I was released.

Into the custody of a Police Officer.

For not having auto insurance.

Because my husband was addicted to marijuana and had not been paying our bills because he had been too busy paying his habit.

All of this after surviving two episodes of Postpartum Depression.

Giving birth to a third child and FINALLY experiencing bliss. What it was SUPPOSED to be like. Heart Soaring Heaven.

Two years later from that night  – tonight –

I am in my living room.

My husband is sitting in his chair.

We love each other more than ever. We talk more than ever.

We.are.still.married.

WE are strong.

Still not perfect but hey, who really is?

God had to tear us down first and whooo… did he tear us down.

But it was worth it. Oh so very worth it.

Marriage is for better. For Worse. We’ve been  both places.

Better is well, better. But Worse is survivable.

And I am grateful.

SO grateful He chose me all over again.

Today is his 2 year sober anniversary. And our two year brand new marriage anniversary.

Happy anniversary, honey.

I love you more than I can ever ever tell you with words.

Postpartum Depression formal screening not worth the cost, BMJ study says

According to a recently published study in the British Medical Journal (BMJ), Postpartum Depression Screening is not…. brace yourselves. Worth the cost.

That’s right.

NOT.WORTH.THE.COST.

In their cost effective analysis, the researchers used “A hypothetical population of women assessed for postnatal depression either via routine care only or supplemented by use of formal identification methods six weeks postnatally, as recommended in recent guidelines.”

The conclusion was that overall not using a formal screening method was much more cost effective as it eliminated false positives.

So the mental health of a woman which will then affect her child, her family, her community, the world at large, are just not worth it to the National Health System of the UK. The EPDS scored out at about $67,000 per quality adjusted life years while no screening method scored at a price tag of just $20 – $30,000. No value for the money was found to exist when using the formal identification methods.

Did these researchers not read Murray & Cooper’s Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression which explores the effects of postpartum depression treatments on children?

There is SO much more at stake here than the dollar value to the National Health System.

There’s the potential for broken families. The potential for children growing into their own mental health issues, the potential for continued need for mental health treatment due to an undiagnosed episode of postpartum depression, potential for increased incarcerations due to untreated mental illness, continued sadness, the continued stigma, continued and perpetuated lack of education on the part of physicians in regards to Postpartum Mood Disorders.

The most interesting aspect of this study is that it focused on screening for Postpartum Depression in the Primary Care setting. Primary care physicians are not always comfortable or knowledgeable in screening for mental health issues. If a patient were to screen positive, that physician is then morally responsible for referring them to a specialist. Often times, at least here in the states, a Primary Care physician is unaware of where to refer a patient for help with a Postpartum Depression Disorder. Therefore, they become afraid of screening because they fear what will happen if a positive were to occur. What would they do with the patient? Where would they send them? How would they respond? Are they familiar enough with Postpartum Mood Disorders to recognize a false positive?

I think the key to the results of this study is not so much in blaming the high percentage of false positives but in urging that Primary Care physicians receive more training to enable them to recognize a false positive through more in depth questions after a positive is scored via the Edinburgh Postnatal Depression Scale.

original photo/graphic "Hand holding necklace" by K.Sawyer @flickr

A stronger safety net involving a stronger communication between midwives, Obstetricians, Pediatricians, and General Practitioners is so desperately needed to keep women from falling through the very big cracks which currently exist in the system.

Let’s think about this for a moment, shall we?

A woman gets pregnant. She sees a medical physician to get the pregnancy confirmed. Most mothers seek OB or midwife care for their entire pregnancy. Unless they’re depressed – depressed and mentally ill mothers are less likely to take good care of themselves during a pregnancy, making specialized care even more important even when baby is still in utero. Once mothers give birth, they are then shuttled off to the pediatrician’s office for the bulk of their medical contact. One six week or eight week visit to the midwife or OB to ensure mom is healing properly then an annual PAP visit unless something arises in between. Many Pediatricians focus on babies and not mother. But the tide is changing as more and more Pediatricians are taking into account the family lifestyle and well-being. My own Pediatrician does this and I absolutely adore her for it.

But overall, there is typically no continuity of care, no communication between physicians throughout the birth process. There should be. There needs to be. A woman deserves a team of support. She deserves to thrive. So do her children.

No matter what the cost.

Because once you fail woman and her children, you fail society.

Fail society and we fail to exist.

If we fail to exist….

Friday Soother: 03.26.10

coffee cup

"Coffee Cup Reflection" by Jason Tavares @flickr.com.

Mourning Coffee

(by Steve Krupnik)


– Ask for help when you need it.

– Take it one day or one moment at a time.

– It is ok to say no when you are not ready to do something.

– Be patient with people who may not understand.

– It is ok to not want to do your normal daily routine.

– Don’t be upset when others tell you how to feel.

– Learn to not isolate yourself for long periods.

– Understand people are trying to help, don’t fault them for trying.

– Talking will help you bring out your feelings and emotions.

– Find meaning in your loss and reach out to others.

– Just because someone is gone doesn’t mean they are not with you.

– Eventually people will stop calling, don’t let this surprise you.


Just when things seem to settle down, grief will visit again.

Learn to accept and embrace it.


Inspire Someone.


Enriching postpartum therapy through at-home activities

In addition to the different types of therapy we discussed yesterday, there are some at home activities you can do (provided your therapist has approved them) to enrich your professional care and journey toward wellness.

First, start a gratitude journal. But I don’t journal. I hate writing! Don’t worry – this isn’t having to write an entire page every day. It’s a simple two entries a day. In the morning, when you first wake up, grab your pen and journal. Write down three things for which you are grateful, no matter how small that thing may be. As your day progresses, focus on what has made you laugh or smile. Once you have retired to bed each night (even if it’s for two hours), write down at least three things which made you smile or laugh during the day. At the beginning, even just barely cracking a smile counts. This activity is two-fold. First, it forces your brain to refocus on the positive things in your life. Second, it provides physical evidence of the positive influences in your life you can look through on the particularly tough days.

Second, write down all five senses on a sheet of paper. Taste, touch, smell, sounds, and sight. Write down five of your favorite things for each sense. Chocolate, silk, a favorite perfume, a cd or song that makes you smile, favorite color or flower or art. Post the list on the fridge. Treat yourself to at least one thing from EACH SENSE every week. Rotate them out. Putting the list on the fridge helps family members and friends to know what to help keep around the house as well. (Sneaky, I know)

Third, take time for yourself. Schedule it if you have to. One thing I love to do is to dress up my lunch. It’s my quiet time of day and I have been known to make a frozen pizza and a coke look like it belongs on a table prepped by Gordon Ramsey. Lean Cuisine never looked so haute. I’ll also treat myself to the routine of making tea. The key is finding one thing you love and making sure you do it at least once a day. Without interruption.

Some other moms will put positive post-its throughout the house and even in the car to help give them a boost when they need it most.

A successful recovery relies heavily on your active participation. If you’re not participating, you’re not getting better. YOU are the most important quotient in the equation when it comes to journeying toward mental health wellness!

How did you actively participate in your recovery? Have any tips for currently struggling moms? We’d love to hear them!


Be sure to stop back tomorrow for the triumphant return of the Friday Soother, my weekly gift to you!

Switching from Feedburner to WordPress Email Subscription

Little bit of house cleaning here, readers.

As of Sunday, March 28th, 2010, I will no longer be offering email subscriptions via Feedburner.

I’ve realized over the past week that Feedburner doesn’t put the posts out there as soon as they are published. The delay is simply not acceptable for me as I want you to be able to get fresh content as soon as it hits the blog, not 24 hours later. Stale content isn’t good for anyone.

WordPress recently introduced their own email subscription program. I subscribed and have to say that I am a huge fan.

You can opt to receive emails immediately, on a daily basis or only once a week. And no, you shouldn’t have to join WordPress to receive your email subscriptions from my blog.

I’ll be moving the widget to the top of the sidebar this evening and would encourage you to visit the blog to switch your email subscription over.

Thanks for reading and I look forward to continuing to provide great topics and up to date Postpartum news for you!

Therapy Choices for the Postpartum Woman

Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies  used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as $10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!

Just Talkin’ Tuesday 03.23.10: How did you find your therapist?

Original photo: "Everyday Use Items: a couch" by @foka_kytutr @ flickr.com

Congratulations!

You have broken through the fear to make the call for help.

But now what?

Unless you have a therapist tucked away with the burp cloths or shoved in a random diaper bag pocket, chances are you’ll be scrambling to find one after diagnosis with Postpartum Mood Disorder.

There are a lot of questions to be considered when searching for a therapist. Some are financial, some regarding training, and others regarding how experienced the therapist is with your specific diagnosis.

Just as you wouldn’t see an Oncologist for a Pulmonary Embolism, you wouldn’t visit a Substance abuse therapist for a Postpartum Mood Disorder.

But when you are in the throes of Postpartum Mood Disorder, you don’t necessarily have the wherewithal to be going down a checklist of requirements for a Therapist. (That is, unless you get lucky like me and develop Postpartum OCD. Then lists and keeping certain things in a very particular order becomes very very important to you.)

So how can you tell your therapist is going to be a good match or is trained in dealing with Postpartum Mood Disorders?

The first thing you need to know is what degrees to look for when ensuring the therapist you are considering is professionally and properly trained. A therapist will primarily hold a Masters level degree and be either a Licensed Social Worker or Counselor/Therapist depending on your state’s licensing office. A solid counselor should not hesitate to provide evidence of his/her training and current license status if requested. You may also see a Psychologist, who will hold either a Ph.D (research) or a Psy.D (Professional) for therapy.

The second thing to consider is specialized training in Postpartum Mood Disorders. If the therapist is truly focused/familiar with Postpartum Mood Disorder patients, he or she will be aware of Postpartum Support International, Karen Kleiman’s Clinician Training at the Postpartum Stress Center, or Pec Indman’s two day training via Postpartum Support International. If your therapist claims to be intimately involved with treating Postpartum Mood Disorder clients yet has no earthly idea who these people or organizations are, be wary. Ask what specialized training they have completed in the area of Postpartum Mood Disorders (if any) and how long they’ve been treating patients with similar diagnoses to yours.

Third, while your therapist is not meant to be your best friend, you should feel somewhat at ease during the appointment. If you feel uncomfortable or on edge during therapy, you’ll be less likely to disclose as much and therefore hinder your own journey toward wellness. It’s worth the search to find a therapist with philosophies similar to yours.

Do not be afraid to ask what their policy is on admitting to Intrusive thoughts. Many many women worry that if they admit they have thoughts of doing horrible things to their children, the children will be taken away from them. I faced this very same issue and asked my therapist this question before I admitted some pretty dark thoughts to her. Her response was that yes, she was required to report situations which indicated imminent harm to oneself or others but that she understood intrusive thoughts and their involvement in my particular diagnosis. This particular concern goes back to finding out what experience the therapist you are considering has with Postpartum Mood Disorders.

Dr. John Grohol over at PsychCentral has some good advice on how to tell a good therapist from a bad one. I would highly recommend you read it and keep these tips in mind.

Another great link to keep tucked away is “Tips for talking with your doctor” by Karen Kleiman over at the Postpartum Stress Center. She suggests starting with the doctor you feel most at ease with even if it’s your primary care physician. He or she can always refer you to specialists once a consensus is made that further help is indeed needed.

I now hand this post over to you, the reader.

What did you do to find your Postpartum Therapist? Any tips? Suggestions? What to look for? What to avoid?

Let’s get to just talking here!

(Tomorrow we’ll be discussing different types of therapy available for the Postpartum Woman. Stay tuned!)


The reprehensible spammification of Postpartum Mood Disorders

Something is afoot.

Something strange, disturbing, and downright irresponsible.

Sadly, I am not surprised at this recent development given what a hot topic Postpartum Mood Disorders has become of late in relation to recently (passed!) legislation and the courage of more and more mothers speaking out about their own difficult experiences after the birth of a child.

More and more, I have been receiving very odd links in my Google Alerts for several Postpartum Mood Disorder related search terms. These links lead to websites that have absolutely nothing to do with anything maternal, postpartum, baby, family, or any other related topics. And the information included therein is anything but accurate or reliable.

Even worse, I’ve been seeing a lot of new websites crop up with blanket promises of “Curing” postpartum depression for one low price. (One website even includes a friends and family “coupon” which cuts the price in half just for you!)

My stomach has been churning at the very thought of at-risk women and well-meaning family members finding these sites.

Oh yes, ladies and gentleman, I’m talking about the spammification of Postpartum Mood Disorders.

I can tell the difference between a reliable website and an unreliable website.

Women who blog with me, survivors, experts, and others intimately familiar with the topic can tell the difference.

But what about women and families currently being tossed about on the big nasty Postpartum Sea? Can THEY tell the difference or will they fall prey to these deceptive tactics masquerading as effective life preservers in a hopelessly churlish sea?

Spamming is a disgusting and contemptuous act which has been going on for years. Many of our in-boxes sit full of spam. Some of it makes it through from the spam folder into our in-box making it seem even more reliable. And if one of these links were to make it into the in-box of an at-risk woman or a well-meaning but uninformed family member of a woman struggling with a Postpartum Mood Disorder, the results may prove ghastly.

So what are we to do?

How do we get educated and knowledgeable when it comes to dissecting the authority and reliability of a website?

There are a few steps you can take.

First, is the site’s URL address directly related to the topic you’ve researched?

Chances are that if you’ve researched Postpartum Mood Disorders or Depression and end up on a website for air conditioners, furniture, auto repair, or turf builder, you’re not at a reputable website.

Second, let’s say that the website you’re at DOES correlate to the topic you’ve researched and the word postpartum is in the URL address. That’s gotta be good, right? Well, yes, and no.

Does this website link to known organizations specializing in helping women with this issue? (Think Postpartum Support International) What’s their google page rank? Are they HON Code certified? (Think Postpartum Progress) What’s the story behind the person who put the website together? Are they clear about their training? Do they let you know they’re a Mom/peer supporter, a doctor, provide confirmable evidence of education/degrees/certifications? Can you find anything about them elsewhere? Have other bloggers or websites linked to them and endorsed them or mentioned them? Or are they only published at their specific website and other unreliable websites? (I don’t have a high Google Page Rank or an HONcode certification but I am working to improve my page rank and also toward an HONcode certification as well. I also over-research everything I put up here which is why sometimes I’m a little behind on posting about a hot topic. I’d rather get it right than have it up as soon as it happens)

Third – is the website trying to sell you something? Does the website promise a cure? Are they dismissive of an entire approach to treating Postpartum Mood Disorders?

If the website is really trying to get you to buy something without describing in detail what it is, you need to be wary. There is no one size fits all treatment. There is NO overnight cure for Postpartum Mood Disorders. Just as with all women, all pregnancies, and all deliveries, there are many different types of Postpartum Mood Disorders and they are rooted in different issues dependent on the history of the woman, the type of birth she experienced, her thyroid levels, anemia levels, etc. There are SO many different layers to uncover when it comes to a Postpartum Mood Disorder. It is dangerous to buy into a one size fits all approach. Just as labor is a fluid process subject to change at any moment given any circumstances, so is postpartum recovery. We all approach life with our own individualized chemistry and baggage. Matching sets don’t commonly occur out here in the real world.

The practice of Quackery has been around for eons and will unfortunately continue to exist as long as people are willing to grasp at any answers that may save them from their current condition. That being said, there are legitimate complementary treatments and alternative approaches available for treating postpartum mood disorders. Anyone worth their salt in dedication to helping women with Postpartum Mood Disorder will be open to supporting whatever path you choose to take toward wellness regardless of what type of methods you choose. In the same vein, anyone worth their salt will also strongly encourage you to work with medical professionals as you work toward wellness. Anyone worth their salt will also openly share their training, education, and base of knowledge with you as well. There should be no hidden cloak, no Wizard of Oz mumbo jumbo going on during your journey to wellness with a good provider.

Here are a couple additional links that may help you navigate your way through the 102,000 results you’ll get via Google in .20 seconds for Postpartum Mood Disorders:

Tips on Identifying Reliable Health Information on the Internet

Quackwatch.org

What can you do if you fall victim to one of these websites? First, you can file with the FTC. And if you’ve lost money and care to pursue legal action, you are entitled to do so under something called the Lanham Act. You can also contact the Better Business Bureau’s Online department by clicking here. You can also click here for seven tips on how to keep your email address from getting added to the growing number of spam lists out there.

As more and more voices speak up about their experience with Postpartum Depression, more and more Snake Oil salesmen will crop up to take advantage of the growing searches occurring on the Internet for information. It’s sad and blasphemously tragic but such has been the way for ages with many medical conditions.

Bottom line: If in doubt, throw it OUT. That phrase is handy in the restaurant industry and certainly handy here too. If a link promises too much too fast or reeks of a foul distrusting odor, throw it out.

Tread carefully. Think it through. Talk to a professional. Take care of you.

Tomorrow we’ll be sharing tips on how to tell a good doctor/therapist from a bad doctor/therapist.

Have any tips or insights to share on this? Email me at ppdacceptance(@)gmail.com.

Be sure to check back to see if your tips/experiences were included!

Happy Survivor Day to me!

Today, four years ago, at 2:20pm, I gave birth to a beautiful little girl.

She was three and a half weeks early after 42 hours of labor and not quite complete.

Her palate it seemed had not quite made the journey.

But she was eager to join us and had lessons to teach.

Oh, the lessons she had to teach were difficult to learn. But beyond priceless.

Lessons in love, patience, joy, understanding, beauty, laughter, faith, discipline, coping, and discovery of strength we did not know we possessed.

FOUR years ago today my trip down a spiral staircase began at a rapid pace.

But here I sit, four years later, the mother of three beautiful children.

I laugh, I cry, I parent.

But I am here. And here I sit as I sigh and smile, grateful deep down for all the time we have had and the time to come.

The mother of a child who, four years ago, needed a feeding tube to grow. Who needed round the clock care for the first month of her life.

The mother of a child who needed 6 surgeries in the first 5 months of her life.

And now – now she laughs. She talks. She eats without help. Without fear. Without a feeding tube.

She can say “Bobby” and blow up balloons.

Bubbles? Not a problem for this princess anymore!

She can say her ABC’s and sing a tune.

A good book is often found clutched in her sticky hands.

She.is.HEALTHY.

And I am happy.

I can understand 85% of everything she says to me. (Less than a year ago I couldn’t understand 50% of what she was saying)

She hugs. She loves to be tickled.

She can tell a very funny (and original) joke.

She is absolutely uncompromising on more occasions than I care to admit but I still love her with all my heart.

She says “I Love You, Mommy and I mean it!” which melts my heart more and more every time.

Four years later.

We’re closer than ever.

Happy Birthday to her.

Happy Survivor’s Day to Me.