Perhaps a better word for modern doctors is diagnosticians.
When my car is broken, I take it to a mechanic. She or he runs tests to diagnose the problem and prescribe a fix. Sometimes the problem can't be found, or the symptom (that knocking noise) doesn't happen while the patient (car) is at the repair man and I'm told to bring it back at the moment it is happening if I can.
I take my car to the mechanic because I don't have the expertise to diagnose the problem and I don't want to take the time to read a manual and figure it out.
I do the same when I go to anyone of expertise, including medical doctors. That is what I am paying for - their knowledge and expertise.
I know doctors don't know everything. I don't expect that. But neither do I expect that I will have to do in-depth research on my own to try and figure out my diagnosis. Plus, when one is ill, one's energy is used up in just functioning every day - going to work, eating, dressing, bathing. Fatigue makes researching one's ailments difficult, to say the least.
In July, 2011, when I was given a diagnosis of serum sickness for my bizarre symptoms, I put all my symptoms in the serum sickness basket. I read and read and read about serum sickness. Everytime I had a flare up over the course of the following 18 months, I figured it was something to do with what had happened in my plasma due to serum sickness. But, having the same symptoms almost 2 years later and knowing what I know about serum sickness, I think the premise was wrong.
I think the diagnostician (doctor) made a diagnostic error.
I understand that and I don't blame the diagnostician. But neither should the diagnostician blame me for trusting the initial diagnosis and then later, still suffering with the same symptoms that should have cleared and for which no one still has an answer, researching to try to self diagnose.
Last week, I sat with a friend catching up, sharing our stories from the past few months. After I shared what I've been through physically, he responded, "So, you are back at square one."
"No," I replied. "There has been learning. So I'm not back at square one."
I paused and thought a moment and said, "I'm stepping outside the square."
Two days later, and after more reading and searching, I had a light bulb thought: I may never have had serum sickness. Rather this may be a straight forward side effect to terbinafine (the drug to which I responded with symptoms that were diagnosed as a serum sickness like response to oral terbinafine).
If I am reading information on a link correctly, the FDA has 31 reported cases of peripheral neuropathy to terbinafine, not much among the tens or hundreds of thousands of people who ingest terbinafine. But, how many cases may be misdiagnosed or undiagnosed or ignored, writing the patient off as exaggerating or suffering from some type of hysteria? How many cases go unreported? (My "serum sickness" case to terbinafine was not reported. I asked, "Shouldn't we report this so it's on file?" I was given the answer that there may be somewhere I can find to report it. It was left up to me to find out where and how.)
I'm pretty dang sure that I have my diagnosis figured out. It's not serum sickness or allergies, but small fiber peripheral neuropathy brought on by a toxic substance. Now I need to figure out how to present it intelligently and respectfully to a new diagnostician to get the proper tests. I'll be open to being wrong, once I am proven wrong.
Remember Carol when you were diagnosed with a herniated disc confirmed with the right test, an MRI? You presented your doctor with a route to try while presenting your doctor with Dr. Sarno's book and research you found online. The doc listened, read the book, and agreed to give the approach a try...and it worked.
I can do this. My very quality of life and future may depend on it.
Have confidence Carol, not arrogance...but confidence.
*************
April 28, 2013
April 26, 2013
I shall rise... two, too, to...
I am fed up with American medical hoop jumping.
I combed my mind this past week:
What is it Carol? What are you doing incorrectly that has you feeling beaten by the system? Where did you veer off the course of self-empowerment? What are you afraid of?
I've not been an advocate for me. I have given too much authority and power to the American medical system without listening to my own heart and body.
As I sat in my chiropractor's office on Wednesday, I stated: "They aren't practicing medicine or healing. They are practicing technology."
I've been passed from one test to another. All tests are for the most part "normal," except I am now developing carpal tunnel in my left wrist.
But, but, but....here I sit with the same symptoms in all my limbs for two years with no answers.
As of 1-1/2 weeks ago, my primary care doctor has denied the one medication I know that helps curb the symptoms to give me respite for the next leg of this struggle. That medication is low dose prednisone; I know it well and I know the side effects well...so does my body. All I asked for was relief so I could continue to search for answers.
Instead, the doctor prescribed Xanax so I can sleep. It gives no relief to my physical symptoms which are at the core of every other symptom I am now experiencing.
As I examined what I have done incorrectly that has left me feeling mired within American medical politics passing me off from one doc to the next, from one test to the next, I realized that the system's opinions are based mostly on tests. If the test states, "you don't have this problem" ... then the test trumps. The patient has been reduced to numbers on a sheet.
I call bullshit.
Example:
In the summer of 2011 when I could barely walk or use any of my limbs or hands, an ultrasound was ordered for my abdomen. Why? If memory serves me correctly, it was ordered because all other tests were coming back normal; I was healthy. Except that I was lame.
The results of the ultrasound? Gallbladder disease.
But, I had no gall bladder symptoms.
That didn't matter.
The GP's office set an appointment for me with a gallbladder doctor.
A few weeks later I get a phone call from Dr. Gallbladder's office confirming my upcoming appointment.
The conversation went something like this:
Dr. G: "Hi Mrs. Welch. This is Dr. Gallbladder's office confirming your upcoming appointment."
Me: "Yes, I have it on my calendar."
Pause
Me: "I have a question. What exactly will be done at this appointment?"
Dr. G: "Well it is a pre-op appointment to have your gallbladder removed."
Me: "What?!?"
Dr. G: "Your GP's office made the appointment because you show signs of gallbladder disease."
Me: "No. A test showed I have signs of gallbladder disease. I have no symptoms."
Dr. G: "You have not symptoms?!?"
Me: "Correct. None."
Dr. G: "Well, you don't need this appointment then. We'll just cancel it."
Me: "Thank you."
I brought this scenario up later with my GP. Her response was that the test shows I have this problem and that she wouldn't want me out on the trail and my gall bladder all of sudden gives me trouble. I responded that I'd cross that bridge if it ever happens.
To this day, two years later, I still have no symptoms of gallbladder disease.
Perhaps my gallbladder is riddled with poison and will explode any day, but I'll opt to wait it out.
I do have symptoms of peripheral neuropathy (PN), but all the tests (so far) say I'm healthy. I'm learning that I'm not unusual in that category; others have been down a similar path. And there are tests I haven't had yet.
After googling PN and terbinafine (the drug that has caused all this suffering) I found that the FDA has at least 32 cases on file of terbinafine causing PN.
I now think I never had serum sickness. I think I was misdiagnosed. I should have gone to a neurologist from the beginning. Medications are one of the main causes of PN.
Could I be wrong? Sure. But, until someone can give me evidence and a clear diagnosis, I think I am correct. I don't blame the docs for the misdiagnosis. I do blame the system. (Actually I don't solely "blame the system." The system is partly driven by the public. I am part of that public. There is plenty of blame to go around. Pointing out blame doesn't help; taking responsibility is what helps. In the scenario in which I currently find myself, I think my biggest error was that I was not bold enough regarding what I know about my own body. I am responsible to speak up and even to agree to disagree and find another practitioner if necessary.)
I saw an acupuncturist on April 24. I'm hopeful that I see results. I googled drug-induced PN and acupuncture. Some have gotten relief and have even gotten better. Maybe, just maybe.
This all reminds me of Audubon's quote, something like: "When the bird and the book disagree, believe the bird."
The Phoenix is a bird. I too shall rise.
****
ADDED NOTE, 4/28/13: Since writing this blog piece on 4/26, I have collected hard copies of tests results from 2011. The ultrasound result from July, 2011, regarding my gallbladder states: cholelithiasis. Translated to lay terms: gallstones. It may be that my GP's office told me this at the time and I looked up gallstones; I cannot recall now and in July, 2011, I was exhausted and simply trying to function every day. Surgery is not recommended for "silent gallstones." Had I opted to see the gallbladder surgeon, I imagine (and hope) the gallbladder surgeon would have concluded that surgery was not necessary.
****
I combed my mind this past week:
What is it Carol? What are you doing incorrectly that has you feeling beaten by the system? Where did you veer off the course of self-empowerment? What are you afraid of?
I've not been an advocate for me. I have given too much authority and power to the American medical system without listening to my own heart and body.
As I sat in my chiropractor's office on Wednesday, I stated: "They aren't practicing medicine or healing. They are practicing technology."
I've been passed from one test to another. All tests are for the most part "normal," except I am now developing carpal tunnel in my left wrist.
But, but, but....here I sit with the same symptoms in all my limbs for two years with no answers.
As of 1-1/2 weeks ago, my primary care doctor has denied the one medication I know that helps curb the symptoms to give me respite for the next leg of this struggle. That medication is low dose prednisone; I know it well and I know the side effects well...so does my body. All I asked for was relief so I could continue to search for answers.
Instead, the doctor prescribed Xanax so I can sleep. It gives no relief to my physical symptoms which are at the core of every other symptom I am now experiencing.
As I examined what I have done incorrectly that has left me feeling mired within American medical politics passing me off from one doc to the next, from one test to the next, I realized that the system's opinions are based mostly on tests. If the test states, "you don't have this problem" ... then the test trumps. The patient has been reduced to numbers on a sheet.
I call bullshit.
Example:
In the summer of 2011 when I could barely walk or use any of my limbs or hands, an ultrasound was ordered for my abdomen. Why? If memory serves me correctly, it was ordered because all other tests were coming back normal; I was healthy. Except that I was lame.
The results of the ultrasound? Gallbladder disease.
But, I had no gall bladder symptoms.
That didn't matter.
The GP's office set an appointment for me with a gallbladder doctor.
A few weeks later I get a phone call from Dr. Gallbladder's office confirming my upcoming appointment.
The conversation went something like this:
Dr. G: "Hi Mrs. Welch. This is Dr. Gallbladder's office confirming your upcoming appointment."
Me: "Yes, I have it on my calendar."
Pause
Me: "I have a question. What exactly will be done at this appointment?"
Dr. G: "Well it is a pre-op appointment to have your gallbladder removed."
Me: "What?!?"
Dr. G: "Your GP's office made the appointment because you show signs of gallbladder disease."
Me: "No. A test showed I have signs of gallbladder disease. I have no symptoms."
Dr. G: "You have not symptoms?!?"
Me: "Correct. None."
Dr. G: "Well, you don't need this appointment then. We'll just cancel it."
Me: "Thank you."
I brought this scenario up later with my GP. Her response was that the test shows I have this problem and that she wouldn't want me out on the trail and my gall bladder all of sudden gives me trouble. I responded that I'd cross that bridge if it ever happens.
To this day, two years later, I still have no symptoms of gallbladder disease.
Perhaps my gallbladder is riddled with poison and will explode any day, but I'll opt to wait it out.
I do have symptoms of peripheral neuropathy (PN), but all the tests (so far) say I'm healthy. I'm learning that I'm not unusual in that category; others have been down a similar path. And there are tests I haven't had yet.
After googling PN and terbinafine (the drug that has caused all this suffering) I found that the FDA has at least 32 cases on file of terbinafine causing PN.
I now think I never had serum sickness. I think I was misdiagnosed. I should have gone to a neurologist from the beginning. Medications are one of the main causes of PN.
Could I be wrong? Sure. But, until someone can give me evidence and a clear diagnosis, I think I am correct. I don't blame the docs for the misdiagnosis. I do blame the system. (Actually I don't solely "blame the system." The system is partly driven by the public. I am part of that public. There is plenty of blame to go around. Pointing out blame doesn't help; taking responsibility is what helps. In the scenario in which I currently find myself, I think my biggest error was that I was not bold enough regarding what I know about my own body. I am responsible to speak up and even to agree to disagree and find another practitioner if necessary.)
I saw an acupuncturist on April 24. I'm hopeful that I see results. I googled drug-induced PN and acupuncture. Some have gotten relief and have even gotten better. Maybe, just maybe.
This all reminds me of Audubon's quote, something like: "When the bird and the book disagree, believe the bird."
The Phoenix is a bird. I too shall rise.
****
ADDED NOTE, 4/28/13: Since writing this blog piece on 4/26, I have collected hard copies of tests results from 2011. The ultrasound result from July, 2011, regarding my gallbladder states: cholelithiasis. Translated to lay terms: gallstones. It may be that my GP's office told me this at the time and I looked up gallstones; I cannot recall now and in July, 2011, I was exhausted and simply trying to function every day. Surgery is not recommended for "silent gallstones." Had I opted to see the gallbladder surgeon, I imagine (and hope) the gallbladder surgeon would have concluded that surgery was not necessary.
****
April 18, 2013
I shall rise....
I'm not sure what to write.
As of a couple hours ago, I knew at least the direction I wanted to write.
But then, I discovered I'd received a voice mail. It was from my General Practitioner's office letting me know that I have an appointment at 8:00 AM in the morning with a rheumatology/immunology specialist at the local university hospital.
I was stunned. I had no idea it would be that quick.
I returned the phone call to my GP's office. Typically I get a voice mail and have to leave a message, but not this time. Crystal answered.
"I got your message. I can't go tomorrow morning. I had no idea I'd get in so fast."
"Carol, you have to go. You are meant to have this appointment. Otherwise you are looking at 3 months. They had a cancellation. This appointment is meant for you."
"How about the neurologist? Is there an appointment yet?"
"Right now we are looking at July."
"July?!?"
"Yes, July. But, I am putting together a 60-page fax and sending it to the triage nurse with neurology at Wake to hopefully get you in quicker."
My stomach had butterflies. I was in a state of shock. One would think I'd be thrilled by the news that I could get in as quickly as I could with the one doctor.
"That's why you have to be there tomorrow morning. It is meant to be. It really is like miracle. This never happens."
"Okay, I'll make it work."
I hung up and started dialing Son's number to line up a schedule change so he could cover my early AM business appointment for me. As I was getting ready to dial, he texted me. "Do I still have Hilde in the AM?"
I called Son and got his voice mail. I hung up without leaving a message, our typical phone communication. He'd see on his phone roster that I had called and eventually call back.
I began composing a text in response to Son: "No, not Hilde. But I need your help with something else. Can you..."
My phone rang before I got the text finished. It was Son. Yes, he can cover my morning business appointment.
Yesterday, Wednesday, was a day from emotional hell. It began at 9:30 at a neurologist office for more tests.
All I could do from the time I awoke and through the appointment was cry.
I felt so embarrassed.
I felt desperate.
We finished the test.
"Well, your nerve connectivity tests are normal for the most part. And all you blood work is normal."
I started balling.
"I can't go on like this. I need relief."
I went into my whole reasoning as to why I need to go up on prednisone and then taper down again...just so I can get relief. So I can sleep. So I can move and get some exercise to start building up muscle again. So I don't arise with dread and then dread the night time when I will be awoken with pain. So I can turn a key without it feeling like I have just performed an incredible feat. So I don't have 24/7 pain. I needed a respite and the only thing I knew that could help was prednisone.
"I can't help with that," he replied. "I'm not the prescribing physician for that prescription for you."
Between sniffs and rolling tears, I thanked him.
He released me.
I called my GP's office tears flooding down my cheeks.
She was working Wednesday, but had no openings.
"I have to be worked in today. I cannot continue this way. Is there anyway I can get in?"
"Hold on."
Someone else picked up the phone.
"Can you be here at 1:45?"
"Yes."
We hung up and I called Hubby.
"Do you need me to come with you?" he asked.
"You can do that?"
"Yes," he replied.
I went home to wait for Hubby and count how much prednisone I had.
I started on prednisone in July or August, 2011, after the diagnosis of an idiosyncratic serum-sickness-like response to oral terbinafine. I know prednisone risks well; pred and I are well acquainted and have a love-hate relationship. But, I've been a low dose since August, 2011. Side effects are supposedly less at a low dose. Since December, 2012, I'd been on 2.5 mg per day. But it wasn't doing the trick. At 5 mg or 7 mg, I could function reasonably well. But not at 2.5.
I knew my GP would say no to me going up to 15 mg and tapering down. But maybe she'd agree...just so I could get a break until we knew what to do next. Even if she didn't, maybe I had enough to get me through a month.
While at home I roughly counted how many prednisone pills I had.
Enough to start at 15 mg on Wednesday and then work down to 5 mg or less over the next month.
My appointment an hourish later with my GP was exasperating. At one point I got up angrily with tears streaming down my face to walk out. I could not understand the logic of the risk of steroids for respite compared to what I had been going through: lack of sleep, depression, pain 24/7, inability to function, hopelessness, no clear diagnosis for anyone to treat, inflammation and tenderness in all my limbs and hands and feet.
She had to understand that I could not, in any way shape or form, continue. I had to have a respite from this suffering. Damn it!!!
She acknowledged my pain. She has been all along.
I apologized for my emotional eruptions.
Somewhere in the midst of our discussion or maybe it'd be better described as argument, she brought up tertiary care which we had discussed as a possible plan of action if nothing panned out with a local neurologist, which it hadn't.
She had spoken with the local neurologist from my morning visit. He had suggested acupuncture, which of course I am willing to try. My GP stated I could start the acupuncture. In the meantime, she would get me in with two university doctors, either at Duke or Wake. One appointment with a rheumatologist and another appointment with a neurologist. They could consult with their thoughts and results. It'd probably be a few days before Crystal would be back with me regarding an appointment. They would do their best to get me in ASAP.
I had already made an appointment earlier that day with an integrative doctor. She agreed with my decision on that. The integrative doctor has an opening mid-May.
And now, here I sit staring down a rabbit hole I never, ever, ever, ever wanted to go down again. A Carousel of Physicians.
Since May 2011 with the onset of serum sickness: General Practitioner. Rheumatologist. Neurologist. Hand surgeon. Chiropractor.
On the agenda now: Research rheumatologist. Acupuncturist. Research neurologist. Integrative MD.
Carol, maybe it won't be a rabbit hole or a carousel. Maybe you won't have to get on the merry-go-round. Calm your heart. Address and clarify your fears. Let the doctor know your fears. You have more wisdom now, about maneuvering the medical politics, about your body, about your say. Remember that, Carol. Stay calm.
I started the 15 mg on Wednesday.
Placebo effect or not, I'm already feeling relief.
I looked up information on the web about the research doctor I see tomorrow.
He looks nice.
His reputation is good.
His knowledge appears impressive and open to new ideas.
He's got a few decades of research and healing.
He better be a good listener.
Still, I cry.
***********
As of a couple hours ago, I knew at least the direction I wanted to write.
But then, I discovered I'd received a voice mail. It was from my General Practitioner's office letting me know that I have an appointment at 8:00 AM in the morning with a rheumatology/immunology specialist at the local university hospital.
I was stunned. I had no idea it would be that quick.
I returned the phone call to my GP's office. Typically I get a voice mail and have to leave a message, but not this time. Crystal answered.
"I got your message. I can't go tomorrow morning. I had no idea I'd get in so fast."
"Carol, you have to go. You are meant to have this appointment. Otherwise you are looking at 3 months. They had a cancellation. This appointment is meant for you."
"How about the neurologist? Is there an appointment yet?"
"Right now we are looking at July."
"July?!?"
"Yes, July. But, I am putting together a 60-page fax and sending it to the triage nurse with neurology at Wake to hopefully get you in quicker."
My stomach had butterflies. I was in a state of shock. One would think I'd be thrilled by the news that I could get in as quickly as I could with the one doctor.
"That's why you have to be there tomorrow morning. It is meant to be. It really is like miracle. This never happens."
"Okay, I'll make it work."
I hung up and started dialing Son's number to line up a schedule change so he could cover my early AM business appointment for me. As I was getting ready to dial, he texted me. "Do I still have Hilde in the AM?"
I called Son and got his voice mail. I hung up without leaving a message, our typical phone communication. He'd see on his phone roster that I had called and eventually call back.
I began composing a text in response to Son: "No, not Hilde. But I need your help with something else. Can you..."
My phone rang before I got the text finished. It was Son. Yes, he can cover my morning business appointment.
Yesterday, Wednesday, was a day from emotional hell. It began at 9:30 at a neurologist office for more tests.
All I could do from the time I awoke and through the appointment was cry.
I felt so embarrassed.
I felt desperate.
We finished the test.
"Well, your nerve connectivity tests are normal for the most part. And all you blood work is normal."
I started balling.
"I can't go on like this. I need relief."
I went into my whole reasoning as to why I need to go up on prednisone and then taper down again...just so I can get relief. So I can sleep. So I can move and get some exercise to start building up muscle again. So I don't arise with dread and then dread the night time when I will be awoken with pain. So I can turn a key without it feeling like I have just performed an incredible feat. So I don't have 24/7 pain. I needed a respite and the only thing I knew that could help was prednisone.
"I can't help with that," he replied. "I'm not the prescribing physician for that prescription for you."
Between sniffs and rolling tears, I thanked him.
He released me.
I called my GP's office tears flooding down my cheeks.
She was working Wednesday, but had no openings.
"I have to be worked in today. I cannot continue this way. Is there anyway I can get in?"
"Hold on."
Someone else picked up the phone.
"Can you be here at 1:45?"
"Yes."
We hung up and I called Hubby.
"Do you need me to come with you?" he asked.
"You can do that?"
"Yes," he replied.
I went home to wait for Hubby and count how much prednisone I had.
I started on prednisone in July or August, 2011, after the diagnosis of an idiosyncratic serum-sickness-like response to oral terbinafine. I know prednisone risks well; pred and I are well acquainted and have a love-hate relationship. But, I've been a low dose since August, 2011. Side effects are supposedly less at a low dose. Since December, 2012, I'd been on 2.5 mg per day. But it wasn't doing the trick. At 5 mg or 7 mg, I could function reasonably well. But not at 2.5.
I knew my GP would say no to me going up to 15 mg and tapering down. But maybe she'd agree...just so I could get a break until we knew what to do next. Even if she didn't, maybe I had enough to get me through a month.
While at home I roughly counted how many prednisone pills I had.
Enough to start at 15 mg on Wednesday and then work down to 5 mg or less over the next month.
My appointment an hourish later with my GP was exasperating. At one point I got up angrily with tears streaming down my face to walk out. I could not understand the logic of the risk of steroids for respite compared to what I had been going through: lack of sleep, depression, pain 24/7, inability to function, hopelessness, no clear diagnosis for anyone to treat, inflammation and tenderness in all my limbs and hands and feet.
She had to understand that I could not, in any way shape or form, continue. I had to have a respite from this suffering. Damn it!!!
She acknowledged my pain. She has been all along.
I apologized for my emotional eruptions.
Somewhere in the midst of our discussion or maybe it'd be better described as argument, she brought up tertiary care which we had discussed as a possible plan of action if nothing panned out with a local neurologist, which it hadn't.
She had spoken with the local neurologist from my morning visit. He had suggested acupuncture, which of course I am willing to try. My GP stated I could start the acupuncture. In the meantime, she would get me in with two university doctors, either at Duke or Wake. One appointment with a rheumatologist and another appointment with a neurologist. They could consult with their thoughts and results. It'd probably be a few days before Crystal would be back with me regarding an appointment. They would do their best to get me in ASAP.
I had already made an appointment earlier that day with an integrative doctor. She agreed with my decision on that. The integrative doctor has an opening mid-May.
And now, here I sit staring down a rabbit hole I never, ever, ever, ever wanted to go down again. A Carousel of Physicians.
Since May 2011 with the onset of serum sickness: General Practitioner. Rheumatologist. Neurologist. Hand surgeon. Chiropractor.
On the agenda now: Research rheumatologist. Acupuncturist. Research neurologist. Integrative MD.
Carol, maybe it won't be a rabbit hole or a carousel. Maybe you won't have to get on the merry-go-round. Calm your heart. Address and clarify your fears. Let the doctor know your fears. You have more wisdom now, about maneuvering the medical politics, about your body, about your say. Remember that, Carol. Stay calm.
I started the 15 mg on Wednesday.
Placebo effect or not, I'm already feeling relief.
I looked up information on the web about the research doctor I see tomorrow.
He looks nice.
His reputation is good.
His knowledge appears impressive and open to new ideas.
He's got a few decades of research and healing.
He better be a good listener.
Still, I cry.
***********
April 9, 2013
Grief...
Today I feel grief.
At least I recognize the emotional pain and can state what it is.
I am trying to not suppress the grief.
At the same time, I am endeavoring to be grateful for all the good in life.
After the grief today, I felt anger and determination.
I told myself, "I will not allow this illness to steal my dreams."
But, at the same time, I must somehow accept the reality that this may never go away and will always be.
My father lived as a quadriplegic for 13 years due to a car wreck.
He lived a full life those 13 years, in spite of his disability
I can adapt and live a full life too, even if I need to change some of my dreams.
***
At least I recognize the emotional pain and can state what it is.
I am trying to not suppress the grief.
At the same time, I am endeavoring to be grateful for all the good in life.
After the grief today, I felt anger and determination.
I told myself, "I will not allow this illness to steal my dreams."
But, at the same time, I must somehow accept the reality that this may never go away and will always be.
My father lived as a quadriplegic for 13 years due to a car wreck.
He lived a full life those 13 years, in spite of his disability
I can adapt and live a full life too, even if I need to change some of my dreams.
***