Women Who Run With...Chihuahuas?

     There was a great book written in the 1990’s by Dr. Clarissa Pinkola Estes, a Jungian psychologist, called, “Women Who Run With Wolves”.  The preface of the book was about strong women in our society, specifically of the archetype of the “Wild Woman”, the female in touch with her primitive side and able to rely on gut feelings to make choices.  It was a wonderful book, which hit the stands during the boom of the self-help era and pointed the way for all of us women to let loose and run with the wolves, so to speak.

     I thought it was a great book then and I still do now.  But I’ve had to scale down my own expectations of myself lately in relationship to my inner Wild Woman.  MS is a teacher of this scaling down process and if you don’t learn it the first time around, it will just keep picking away at you until you get it!

     If I were to write a similar book about my life and my viewpoints now, I’d have to call it, “Women Who Run With Chihuahuas”.  I’m not gung ho about the whole running with wolves thing these days…I like the idea of just being able to keep up with the little dogs.  I’m no longer greatly invested in eviscerating or getting in touch with my “primitive side”. 

     I’m not poo pooing this process for all you wolf pup women out there.  I’m just saying for me, I’ve grown into a wise, old canine and I rather like hanging out with those energetic and loveable lap dogs…they’re not nearly as hard to keep up with and they keep me young.  They also take more naps than wolves.

     I believe these days I may rely on my “gut feelings” more than ever when I am making choices…I rely on my gut and my experience.  I simply don’t have the time or the energy to ponder much (nor the memory to recall what it IS I’ve been pondering!).  I don’t want to be bogged down with the uncertainty of making choices…I just want to “know” and then to choose. 

     I think my Wild Woman is still inside me somewhere…she’s just growing into a more even-tempered Crone…a Wise Woman who makes decisive choices based on her own needs and not necessarily the needs of the “pack”.  I suppose that’s not really wolf-like at all nor is it necessarily Chihuahua-like.  It’s probably closer in nature to a cat!

     Women Who Run With Felines…nope, it just won’t work as a book title…

I Have The Best Friends and Coworkers In The World...

     I was sitting at work this evening, after yet another long and tiring tour of duty, when two of my coworkers (who I am also thankful to call friends) mentioned to me they have enjoyed and continue to read "Brain Cheese".  I have to say, I was a bit shocked by this revelation because I was quite certain the novelty of my ramblings had surely worn off by now!

     My favorite male buddy, who I'll call Roger (because that's his name), says to me, "No, I read it because it's kind of like a check in.  I wonder what's happening in your world today."  Now those may not have been his exact words, but I have memory problems so they're close enough.

     Then my dearest friend, T, (I don't call her by her full name, so "T" is who she will be known as) the woman who's social life I live through vicariously because she HAS a social life, says to me, "Yeah I read it too, every night when I get home from work."  I was double shocked.

     There are so many things in my life I take for granted on a daily basis...so many physical things and comforts I have grown used to...so many niceties and daily expectations I have built my life around.  I am slowly realizing many of the things I once thought were a "given" aren't and many of the things I thought I had to struggle to obtain come much more easily if I cease to struggle.  It is easy for me to become so wrapped up in my MS, my job, and my personal fears that I become oblivious to the things that really matter most in my life.

     If Multiple Sclerosis has taught me anything, it has been the importance and value of friends...MY friends in particular.  Without my friends, I would be lost on open waters, sailing without a course.  It only takes little moments like tonight to remind me where my support comes from and how my friends are the "rudder" for my ship...always there, steering me quietly underwater, and asking little in return.

     So today's blog is a salute to "all y'all"...my sweet, silly, serious, cantankerous, intelligent, caring, dramatic, sarcastic, wonderful and dear friends!  And YOU know who you are, so names are not important here...thank you for all you bring to my life, my work, and my soul.  I would surely be lost without you...

In Another Galaxy...

Science experts say space is one of the last frontiers yet to explore.  I beg to differ…NASA hasn’t called me yet to take a look inside MY brain and there seems to be a lot of unexplored “space” in there!

     I’ve been wracking my brain (full pun intended) for the past several days, trying to figure out how such tiny, little lesions in all that white matter mass of my brain could be causing such pain and problems in my life right now.  By comparison, you’d think half my brain was nonfunctional, given the extent of the pain I have been feeling in my left shoulder and arm.  But the majority of my brain remains intact…apart from a few inflamed areas seen on my MRI (yes, these pictures ARE of my brain…for several thousand dollars, you TOO, can have your own set!).

     There is still so much we do not know about the human brain or even why it works in the first place.  And since most of us only use a small percentage of all that spiral mass inside our skulls, it’s a wonder we even know as much as we DO about our central nervous systems.  We know the “brain” keeps us alive and regulates all of our bodily functions.  We know if our brains are injured, we may likely see a vast variety of changes in how we perceive and interact with the world.  But what we don’t know is why some people can injure their brains and show little effect, while others (in the case of Multiple Sclerosis) experience devastating disability from tiny, little dots of inflammation…it’s just one of life’s many mysteries. 

     They say it is our higher functioning brains, giving us the ability to reason, which separates us from other animals.  But what we still do not understand is what part of our brains and logic constitute “who” we are…who we believe ourselves to be and what provides us with our understanding of concepts like mind vs. emotion and spirit/soul vs. body.

     There is STILL so much to explore and know…and I don’t believe NASA can really assist us in this process.  We may never “know” so many important answers, but we will always know the questions.  We will always search for meaning and understanding in our quest to discover what truly establishes our essence of life.

     In the meantime, I’m still perusing over these MRI pictures and trying desperately to locate my ears and eyes…I think they’re in there somewhere!

Hell Hath No Fury Like A Hormonal Woman...

     I’ve decided it’s about time someone open up the floor for a discussion about menstrual cycles and Multiple Sclerosis.  After all, nobody else seems to be talking about it that much, so why not?  And, as for you men out there who might be reading this, get over it!  We have to suffer through YOUR commercials on erectile dysfunction (or the catch word phrase, “ED”) every night on the television…I imagine you can make it through a blog about menses just this one time!

     This morning I awoke to find myself in a pool of blood, looking something like Sissy Spacek in the movie, “Carrie”…only it wasn’t pig’s blood covering me, but my own menstrual blood!  At first, I thought I’d either been shot in my sleep or hemorrhaging from my aorta.  Yes, my thinking does get quite dramatic in times of stress or disorientation!

     The next thing that crept into my mind was, “Great.  Now I’ve ruined a nice set of 600 count Egyptian cotton sheets!”  I crawled out of bed and carefully made my way into the bathroom, wondering why this gush was happening to me now?  After all, I haven’t had this type of period flow since I was a hormonally distraught teenager.  Why now?

     As I sat soaking my body and my ruined set of sheets in a warm tub, my mind hazily drifted from thoughts about peri-menopause, Multiple Sclerosis, hormone replacement therapies, steroid use and action on menses, and a host of other topics specifically related to the female body.  I realized I knew nor had I read very little about thesetopics and decided this morning was a good time to do a bit of research to educate myself.  Perhaps with a little knowledge, I might be able to avoid another menstrual lahar and spare myself some sleep and early morning drama in the future!

     I assumed there would be quite a bit of material to peruse on the Internet about this topic…after all, more women than men are affected with Multiple Sclerosis and we ALL have menstrual cycles at one time or another in our female lives.  I thought surely there have been many studies and abstracts written on this subject to enlighten me.  Girl, was I wrong!

     Every brief abstract and reference I found on the subject of MS and Menses all acknowledged there was little information about the topic and MORE STUDY WAS NEEDED.  I began to wonder why if every scientist out there was shouting more study is needed, why on earth “more study” is not being done?  I certainly have ideas about why we lack research on this topic, but I won’t bore you with my political/feminist/male-dominated world/Eve as temptress/”the curse” ideas…you get the picture already anyway!

     Most all MS scientists and doctors accept there IS some correlation between hormonal fluctuations in women and the role these hormones play in influencing symptomology in women with Multiple Sclerosis.  Doctors know pregnant women often see a remission of MS symptoms during pregnancy, but there is a higher potential “rebound” of those symptoms to reoccur just months after child birth.  Most all women with MS know and/or experience a worsening of symptoms during their premenstrual phase, whether this is “scientifically” substantiated or not.

     Having been someone who has never had a predictable and “normal” menstrual cycle in my life, MS has given me some crude ability to now predict my periods with a fairly accurate measure…I GET AN INCREASE IN MY MS SYMPTOMS 3-5 DAYS BEFORE MY PERIOD.  I experience an increase in fatigue, pain, weakness, sometimes difficulty walking, and spasticity in my calves.  It’s my signal I’m either headed for a major relapse or about to experience a menstrual period…I always “hope” for the period, actually!  This has happened like clockwork every time I experience a hormonal shift, monthly or not.  When I was a teen, I suffered horrible PMS…now I just have the other “MS” with my periods… 

     This isn’t rocket science, folks…so why ISN’T more “science” focusing on these matters, especially topics such as menstruation and Multiple Sclerosis?  Why can’t we seem to get past our insecurities and embarrassments in this society and do some meaningful research in areas that affect purely the female gender?  How long must we as women suffer at the hands of the biblical Genesis and take a back row seat to male fertility and “ED”?  Who among us really gives a crap if “he” can get it up when we’re bleeding like a sieve from our peri-menopausal periods or completely disinterested in sex because of our MS???

     In an effort to share with you what small morsels of information are available about hormones, menses, and MS, I am including a few links and plagiarized information from various sites to assist you in your own information gathering.  Since no one seems to be too interested in this topic, I’m nottoo worried my cut and paste plagiarism will attract much attention…

    

FROM THE NATIONAL MULTIPLE SCLEROIS SOCIETY SOURCEBOOK:

 http://www.nationalmssociety.org/Sourcebook-Menstrual.asp

MS is a disease that is more prevalent in premenopausal women than in other groups. While it is not entirely clear what effects hormonal changes have on neurologic symptoms in MS, it has long been observed that certain other disorders such as epilepsy or migraine headaches are worse just before and during the menses.

Many Report Symptoms Worsen Within a Week of Menses
To see if there is, in fact, a correlation between neurologic symptoms in women with MS and the menstrual cycle, researchers at an MS clinic distributed a questionnaire to female patients. Of the 149 women with MS who answered the questionnaire, 70% reported that their MS symptoms seemed to change at a regular time in their cycle. Most of those who reported a change indicated that the change, usually involving a worsening of their symptoms, occurred within one week of onset of menses. Weakness, imbalance, fatigue and depression were the symptoms most frequently reported to worsen. Other self report studies have replicated these data. More recently, MRI studies done in women at different times of the menstrual cycle indicate that disease activity as measured on MRI may vary according to differing hormonal environment.

These findings have all come from small, uncontrolled studies, and much more research is needed to characterize the relationship between MS and the menstrual cycle.

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http://www.mscare.org/cmsc/images/pdf/07Houtchens%20.pdf

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The Premenstrual Period and Exacerbations in Multiple Sclerosis
Anneke Zorgdrager, Jacques De Keyser

Department of Neurology, University Hospital Groningen, The Netherlands

Address of Corresponding Author

European Neurology 2002;48:204-206 (DOI: 10.1159/000066166)

Abstract

The aim of this study was to assess whether an association exists between the premenstrual period and exacerbations of multiple sclerosis (MS). The subjects were 56 premenopausal patients with relapsing MS and a regular menstrual cycle. Data over the previous 2 years were gathered from a structured MS database and a comprehensive questionnaire. 42% had exacerbations starting in the premenstrual phase. Within this group the proportion of premenstrual exacerbations was significantly higher than in the remaining period of the menstrual cycle, and in 45% all exacerbations had started during the premenstrual phase. There was no relationship with the premenstrual syndrome, and there was no protective effect of oral contraceptives. Our results suggest that the premenstrual period triggers exacerbations in a subgroup of females with MS.

********************

ASK THE EXPERT
Questions answered by
Ronald Barentsen, MD, PhD, Netherlands
Chairman of the OBGYN.net Menopause Advisory Board

Question: Can you provide me with any information or known contraindications for a lady with multiple sclerosis prescribed hormone replacement therapy?

Answer:

There is an extreme shortage of literature on this topic; but the current concept is that MS is no contraindication for HRT. The only relevant abstract in Medline comes here:
Author: Sandyk R.
Institution: NeuroCommunication Research Laboratories, Danbury, CT 06811, USA.
Title: Estrogen's impact on cognitive functions in multiple sclerosis.
Source: International Journal of Neuroscience. 86(1-2):23-31, 1996 Jul.
Abstract:It has long been suspected that hormonal factors contribute directly and indirectly to the etiology and pathogenesis of multiple sclerosis (MS). The susceptibility of MS is higher in women than in men and women are even more susceptible to hormonal influences when onset occurs at an early or delayed age. Pregnancy has a short-term favorable effect on the course of the disease but there is an increased rate of relapse during the post-partum period. In addition, women often report premenstrual exacerbation of their symptoms with remission during menses. These findings suggest that in women estrogens may exert a stabilizing effect on the clinical manifestations of MS. The role of estrogens is supported also by observations of a higher incidence of cognitive impairment in women than men with MS. A 50 year old man with a remitting progressive MS experienced profound deterioration in cognitive functions during withdrawal from estrogen therapy which was initiated for the treatment of amenorrhea. Improvement in cognitive functions occurred shortly after she restarted therapy with an estrogen/progesterone preparation and was maintained during long term therapy. Serotonin (5-HT) mechanisms have been implicated in memory functions and estrogens modulate these functions through an interaction with 5-HT2 receptors in the cerebral cortex and limbic system. It is suggested that estrogen withdrawal induces impairment in cognitive functions through dysregulation of 5-HT2 receptor activity and 5-HT neurotransmission. These findings suggest that estrogens have a beneficial influence on cognitive functions in MS patients and that hormonal supplementation might be advised in menopausal and postmenopausal MS patients for the prevention of cognitive deterioration.

It's a Heat Wave!

     Break out the fans and blend me a Margarita!  It’s supposed to hit record highs here in the Pacific Northwest/Seattle Metropolitan area and it is ONLY May!  And “The Bush” says there’s no proof of global warming…

    

     Living in an area of the USA where no one has air-conditioning in there home because it isn’t needed, can pose a difficult task in staying cool when temperatures soar.  Summers in the Pac Northwest are generally mild, ranging in temperatures from the mid 60’s to 80’s.  It’s just usually not HOT here, except for a few weeks in July and August.  And hunkering down in a movie theater in the summer is the best place I have found to suck up semi-free air-conditioning and entertainment at the same time!

    

     When my personal body temperature rises, I find several of my underlying MS symptoms become more predominant.  For instance, my fatigue increases, I tend to get a blurring of my vision, and I have muscle weakness in my left arm and leg.  These symptoms will usually decrease or go away completely if I can cool off and relax a bit. 

    

     The technical term for a worsening of MS symptoms causes by increased body temperature is “Pseudo Symptoms” because the symptoms mimic those one might begin to see in a real relapse.  The difference is once the body temperature is lowered, the symptoms will spontaneously remit/go away, whereas in a true relapse, the symptoms will stay even if the body temperature is decreased.

    

     So for those of you just learning about the wonders of Multiple Sclerosis, you may be asking, “Why does heat/increased body temperature affect MS symptoms?”  This a good question and there are only theories why this happens.  I’ve done a bit of research into the matter and will share some of what I found with you now:

 

 

    Heat adversely affects nerve transmission and makes MS symptoms worse.  Here's why.  Signal transmission in the nervous system is helped, up to a point, with an increase in temperature, approximately up to our normal 98.6 degrees (degrees Centigrade). Push your temperature any higher than normal and nerve transmission slows. That is one reason why you feel fatigued in the heat or with a fever. It has been found that in axons that lack myelin as in MS, this temperature transmission curve is pushed to the right a bit, that is, conduction velocity is optimal actually a little shy of 98.6 or 37 degrees Centigrade and at above normal temperatures, conduction drops off even more precipitously.

 

     So what does that mean?  In simple terms, it means if you heat up the insulation around your nerves, the signals won’t go as fast as they usually do to the places they usually go to make things happen or the signal gets interrupted altogether.  And if your nerves are running slower, YOU are going to run slower because the nervous system is the part responsible for conducting the current from your main fuse box to your light switches and so on.  

    

     Weather and the seasons can adversely affect daily living in many people with multiple sclerosis also. The greatest number of relapses or flare-ups occurs in the coldest months (January and February) as well as in the warmest months (July and August). This is because both the extreme cold of winter and the extreme heat and humidity of summer can worsen existing symptoms as well as produce new symptoms of MS.

    

     The adverse response to temperature changes is called thermosensitivity. In highly thermosensitive people, it only takes a temperature change of a few degrees to affect MS symptoms.
    

     Sometimes a temperature change may produce a temporary improvement in one symptom and, at the same time, a temporary worsening in another symptom. For example, in one person with MS, a hot bath resulted in the improvement of numbness and walking, but caused a temporary blurring of vision in the left eye. This is called a "dual response" to temperature. In another kind of "dual response", heat and cold may produce worsening of existing symptoms as well as the development of new symptoms.

    

     There have been several studies over the past few years and decade that have looked into the effects of temperature changes and cooling in people dealing with Multiple Sclerosis.  Here is a list of several research studies and summary quotes:

 

Effect of Cooling on Physical Performance in Multiple Sclerosis

Dr. George Kraft, principal investigator, and Alan Alquist, research scientist, University of Washington MS Clinical & Research Center, Seattle, Washington (completed in 1996).

Summary Quote:

“Subjectively and objectively, we noticed remarkable gains [for those with] heat-sensitive MS [in their] ability to perform repetitive activities. We believe this may be an important finding for MS patients for it is repetitive motor tasks that elicit extreme local and central fatigue in MS patients.”

Enhancement of Cognitive Processing by Multiple Sclerosis Patients Using Liquid Cooling Technology: A Case Study

L.D. Montgomery, R.W. Montgomery, Y.E. Ku, Lockheed Martin Engineering & Sciences Company; and NASA Ames Research Center, Moffett Field, California (completed in 1997).

Summary Quote:

“This case study indicates that ‘cooling therapy’ may be used to temporarily improve the cognitive processing of MS patients.”

Temporary Improvement of Motor Function in Patients with Multiple Sclerosis after Treatment with a Cooling Suit

Jergen Kinnman, MD, PhD; Ulf Anderson, MD, PhD; Ylva Kinnman, MD; and Lil Wetterqvist; Department of Neurology, Länssjukhuset, Halmstead, Sweden, Journal Neuro Rehab, 1997, 11, pp. 109-114.

Summary Quote:

“After cooling, ten out of fourteen ambulatory patients and all six wheelchair patients were improved in at least one motor test.”

Cooling Garment Treatment in MS: Clinical Improvement and Decrease in Leukocyte Nitric Oxide (NO) Production

E.A.C. Beenakker, MD; T.I. Oparina, PhD; A. Hartgring, MS; A. Teelken, PhD; A.V. Arutjunyan, PhD; Dsci; and J. De Keyser, MD, PhD; Academisch Ziekenhuis Groningen, The Netherlands, Neurology, 2001, 157, pp. 892-894.

Summary Quote:

“Active cooling was associated with a decrease in mean leukocyte nitric oxide (NO) concentration by 41%... NO is a diffusible gas that can enter the CNS and block conduction in demyelinated axons through a mechanism that is not completely understood... Although several other mechanisms may be responsible for the beneficial effect of cooling in MS, results raise the intriguing possibility that a lowering of leukocyte NO production may play an important role.”

This study was supported by a grant from MSAA’s affiliated organization, Multiple Sclerose Internationaal, Amsterdam, The Netherlands.

A Randomized Controlled Study of the Acute and Chronic Effects of Cooling Therapy for MS

S.R. Schwid, MD; M.D. Petrie, RN (University of Rochester, Rochester, New York); R. Murray, MD, Jennifer Leitch, RN (Rocky Mountain MS Center, Englewood, Colorado); J. Bowen, MD, A. Alquist, PhD (University of Washington, Seattle, Washington);
R.G. Pellegrino, MD, PhD, Maria Dawn Milan, RN (Institute for Neurology and Neuroscience Research, Hot Springs, Arkansas);
Adam Roberts, Judith Harper-Bennie (Multiple Sclerosis Association of America); R. Guisado, MD (Center for Neurodiagnostic Research, San Jose, California); B. Luna, MS, Leslie Montgomery, PhD, Richard Lamparter, MS, Yu-Tsuan Ku, MS, Hank Lee, BS, Danielle Goldwater, MD (NASA Ames Research Center, Moffett Field, California); G. Cutter, PhD (AMC Cancer Research Center, Denver, Colorado, independent biostatistician); Bruce Webbon, PhD (NASA program manager and principal investigator), Neurology, 2003, 60, pp. 1955-1960.

Summary Quote:

“Although other studies have demonstrated that continuous cooling can promote improvement in neurologic signs over several days, no other study has systematically assessed the long-term benefits of daily cooling, as patients would typically use it. We found no evidence that cooling effects changed over time. Given the lack of side effects observed in this study, modest improvements demonstrated using objective measures of motor and visual function, and persistent subjective benefits, cooling therapy could be considered as a potential adjunct to other symptomatic and disease-modifying treatments for patients with MS.”

      So, as I watch the mercury rise on the thermometer outside today (rather a joke because mercury isn’t USED anymore in thermometers due to it’s toxicity), I’m going to sip some icy beverage and perhaps frighten my neighbors with my pasty, white legs in shorts.  It’s not about fashion, people…it’s about STAYING COOL!

 

IV Steroids...How Do I Love Thee? Let Me Count The Ways...

     The sun seems brighter, the flowers are brilliant, and I awoke this morning with NO pain!  Ah...the wonders of IV steroids!

     Except for an awful taste in my mouth, not sleeping all night due to insomnia, a bit of fatigue in my left leg and arm, headache, and of course AGITATION, I must say I feel GREAT!  Even if it only lasts for today, I am so thankful to have a moment of reprieve from the MS pain I have had for over two months.  It is odd to me now how I have been able to simply adapt to it...having the pain gone for the day, I am having difficulty understanding HOW I adapted to it!  I almost feel "normal", whatever that is.

     It is amazing how we MSers DO adapt to the constant changes and disabilities life throws us because of our disease.  Until today, I had forgotten the many processes I encountered the past two months LEARNING to live with the constant pain.  I changed how I walked, how I sat and for how long, my handwriting, carrying objects with weight, and learned to use (and over use...remember the Tennis Elbow debacle!) my right hand and arm.  I did this because I HAD to in an effort to continue status quo.  We ALL adapt to these bodily changes...or we stop functioning.

     Just for today, I am enjoying a pain free moment and it feels soooo wonderful!  I can relax my tense facial muscles and my body as a whole and hopefully be less irritable and kinder this Mother's Day.  I may even sit outside and enjoy the spring flowers...thank you, thank you to the inventor of IV Solumedrol!

     Happy Mother's Day dear friends...

Steroids At Club Med...

     Ok, I really wasn't at a beach today getting my IV infusion of Solumedrol.  And there were no martinis or Corona beer served, no spa massage, and no water front eye candy to gawk at.  BUT...I have to say I have never been treated kinder than I am when I go to my local hospital infusion lab (this time in the outpatient cancer center) for steroid infusions!

     Over the years of working in the healthcare industry and becoming a chronic patient of it's services, I have become apathetic about the type of patient care being delivered these days.  I have grown to expect long waits, inaccurate information, harried and curt staff, medication errors, and a sundry of other negative problems that have cropped up since healthcare became more focused on business and less on the art of compassion.  I am frankly quite "shocked" when I am NOT treated with some level of disregard when seeking services and I always try to write a letter of thanks to those who go above and beyond average to treat me with kindness.  Today was again, one of those "above and beyond" days at my infusion appointment.

     Since I changed to my new neurologist this year, I also had to change hospitals where I get other services.  Other than the major faux pas of FORGETTING to scan my brain while in MRI a few weeks ago, I have been quite pleased with the care I have receive at Club Med (and I can't hold one lame diagnostic technician accountable for my overall rating of services hospital-wide!). 

     I returned today to the Cancer Institute to get my IV steroid "blast" (as my neurologist so gently called it) in the infusion lab, a specialized unit in Club Med (if I revealed the true identity of the hospital in question, you'd ALL be lining up to go there and I might no longer be considered "special"!).  My dear friend, EB, met me at the Institute to keep me company while I infused.  We did wait a bit of time to be taken back to the infusion lab, but once there, my Steroid Party commenced.

     My infusion nurse (I am under gag order not to mention her by name) settled me into a private room, which looked more like a combination living room and treatment room.  I was seated in a comfy arm chair and asked several health history questions.  She actually seemed interested in my answers!  Then she started my IV, but not the usual "poke and dig" method I have been subjected to at other times...she used a tiny bit of local anesthesia to numb my delicate arm before surgically striking my vein with precision.  EB could not watch this part, hid behind the curtain, and threatened to vomit if she had to watch...this was highly entertaining!

     Once the "blast" was begun and running liquid gold into my arm, Miss Nurse asked me what kind of sandwich I wanted for my lunch?  I politely told her I would only be there for an hour and thought even I could wait to eat a bite later (it was only 11:30AM at this point).  She assured me if I didn't accept the sack lunch, Club Med would just end up throwing it out and, "Wouldn't you LIKE a sandwich to help take the taste of the steroids out of your mouth?"

     I looked at EB.  She's quite thin and looked as if she could use a few carbs or protein, so "we" settled on a turkey sandwich bag.  Miss Nurse then asked if I was comfortable and, "Would you like a pillow or anything?"

     I advised her there was no need for a pillow because, once again, I'd only be gracing their service for about an hour.  I then told her she may want to consider stopping the comfort measure offers or I might choose NOT to leave once the hour was up...this could prove to be a problem for her if I got too comfortable!

     She asked if I would like anything to drink with my sandwich (I was beginning to sense where all my insurance money was being funneled to and, frankly, I liked it!), and I replied, "Water will be just fine."

     "Ice or no ice?" she asked,and then looked at EB who was sucking down an iced coffee for the thrill of caffeine, and asked HER if she would like anything.  Who KNEW the service I could get at Club Med?!?

     I have already planned a vacation to Texas in October to spend time on the beach.  Perhaps I may want to reconsider my options and spend theweek at my local Club Med?  Sure, there's no beach, but the service is excellent!  I wonder if my insurance would let me book a week there in advance?...