Faith Under Stress

Faith Under Stress

To say yesterday afternoon was stressful is an understatement. Dean and I were looking forward to my much anticipated consultation appointment with the cardiologist Dr. Carroll at the University of Denver Hospital.  Traveling from Cheyenne, we made a list of the questions I had regarding the procedure and recovery. We stopped for lunch at Chipotle, even eating outside as it was 70 degrees!

Once we found a parking spot on the gigantic hospital campus, we walked to the Anshutz Inpatient Pavilion.  After winding our way through many long hallways, we finally found the cardiology and vascular wing on the 3rd floor.  Here we checked in and waited.

Once all the basics including vitals were taken care of, I was finally put into a room and was able to meet Dr. Carroll's nurse and nurse practitioner.  Finally, he arrived.  

Needless to say, the appointment didn't go as I had envisioned.

First, the disc that I picked up from Sage West the day before, did not contain the content that the team needed.  We had requested my transthoracic echocardiogram (TTE).  The disk instead contained a CT scan.  This was not even of me. Second, I learned that Dr. Carroll had not even received nor was aware that I had had shunt study completed in Casper in early December.  Third and most shocking, Dr. Carroll explained that as of then, he did not have the objective information needed to justify the closure of my holes.

"WHAT?"  I though.  I had a pretty hard time hiding my surprise.  All I could think was, "Why are we here then?  What is the alternative? AND How can I continue to feel like this the rest of my life?"  I couldn't even fathom being limited to brisk walks for the rest of my life.  I am 35 years old!  Am I just going to wait for a stroke or heart attack to occur?  I should not be feeling this crappy. I should not breathe hard during a brisk walk.  Needless to say, I am pretty proud of myself for not bursting into to tears that minute.

So, the plan was to have another TTE and bubble study and repeat all lab work.  Also, the nurses were to take me for a walk and measure my oxygen levels to check if there was a change from sitting to light exercise.  Dr. Carroll needed an objective measure that the holes in my heart where not an incidental finding and are actually causing problems in the function of the heart.  He stated, if the right ventricle is enlarged, it will mean extra stress is being placed on the heart and this will warrant closure.  

I had been told by the cardiologist in Casper the right atrium is enlarged, but nothing about the right ventricle.  I got very nervous that we wouldn't find what we needed to find in order to keep the procedure scheduled.  Most of all I was worried that I would not be feeling better any time soon.

"Ok," I said, "but what if we can't find a reason to need to close these holes?  What then?"  Dr. Carroll said that then we will need to continue to investigate what is causing my symptoms.

So I began praying.  Almost the entire time I lay on the bed during the TTE, I prayed.  I asked God to reveal what they needed to see in order to help me become well again.  I asked him to only do this if the closure was truly what would help me to feel better soon.  (I do not want to have a procedure that will not help with my current symptoms.)  I kept repeating, "Please let everything turn out ok," as I wiped tears from the corners of my eyes several times.

Thank goodness my rock Dean was right there with me the entire time.  It is amazing how long 45 min-1 hour can feel when you are stressed.

Soon after we returned to the room, Dr. Carroll returned.  He came back shut the door with authority and said, "We will absolutely move ahead with closure on Thursday morning."  

"Thank God!"  I said my shoulders dropping several inches.

He explained that the TTE showed that my right ventricle is enlarged and also that I have bilateral shunting.  This would explain why I feel so terrible.  He said my oxygenated blood and deoxygenated blood are mixing together. He used the words aneurysmal and fenestrated.

Later Dean explained to me in normal people language that basically my septum is like a thin piece of swiss cheese.  It has several holes and is a thin flap. (The exact number of holes will be determined on Thursday.  The Dr. thinks at least 3.)  He described it as plastic blowing in the wind.....  

Seriously, I still can't believe it.  But I did see it flapping around on the screen with my own eyes.  I also saw the bubbles go right through right to left instead of left to right like they are supposed to do.  

Editor's Note (Written by Dean):  A bubble study is where bubbles are injected into the veins which are delivered to the right atrium where they are supposed to go to the right ventricle and then the lungs.  In a normal system, the bubbles are filtered by the lungs and do not return to the heart.  If there are bubbles on the left side of the heart, it means something is wrong.  

The bubble study wasn't just "positive", it was shocking.  When you can impress the cardiologist (who has done 600+ of these procedures) you know that there's something really wrong. 

Most shunting (blood flow through the leaky heart wall) will go from left to right as the left side of the heart is higher pressure than the right side.  This causes the right side of the heart to have to process some blood twice, effectively increasing its workload and causing the heart muscle to get bigger and stronger due to the stress. Ann's shunting is the opposite of what is expected, her deoxygenated blood has been passing through the holes in the atrial septum and then being pumped directly out to the body, effectively skipping the lungs and their required oxygen.  Even though the majority of the flow is right to left, there was still enough left to right shunting to cause increase in the size of the right side chambers of the heart.  Whether or not blood is going right to left or left to right is dependent upon what Ann happens to be doing and the position that she's in at any given time. (end Dean) All of this apparently makes for me feeling pretty cruddy.

Needless to say, I am relieved that we are going to go ahead with the procedure.  Dr. Carroll did say there is a 5% chance that when he gets in, he won't be able to close the holes percutaneously.  In that case, I would need open heart surgery. 

 I have continued to pray all day today that all goes well, and I will not be that 5%.  Either way, I know with faith, all things will be okay.  Thank you all for your continued love and support.  

Isn't It Ironic

Isn't It Ironic?

Irony: On September 11, 2011, I finished Harvest Moon Half Ironman Triathlon in Aurora, CO.  I am sure that I had a view of the University of Colorado Hospital from my hotel room and didn't even give it a second thought.  Fast forward; a little over 3 years later, I will be visiting that very same hospital this week to have my ASD and PFO repaired via a cardiac catheter procedure in which two patches will be placed over the holes.  I have been told this procedure will take anywhere from 4-6 hours.  I finished the Half Ironan in 5:36:05.  Irony.

Taking the irony one step further, I listened to the book, Unbroken, during my 6+ hour drive to the race as was recommended by a friend and neighbor.  What an inspirational story.  The movie came out last month.  Dean and I have been putting off seeing it in hopes of catching it while in Denver. This to be a "restful" outing on the day between my appointment and procedure. I don't even think I need to explain the irony in the title.

It amazes me how so many things in life end up coming full circle. Past experiences prepare you for future battles.

I admit it. I have been struggling to face the unknown.  However, this morning while sitting in Mass a sudden realization hit me. Going into this week, I have felt exactly how I feel one week before a big race.  Nervous; Excited; Scared; Unsettled; I think I have even noticed some adrenaline..... Sound familiar?  Then, a wise, little voice whispered,  "Use what you know.  You have faced so many physical challenges successfully.  You can do this, too. Be strong." SO TRUE!  I can do this. I will come out of this experience a stronger person.

In many ways, the challenge I am facing at 8 AM on Thursday morning is not much different than what I face at any start line in any race.  Most of life's challenges come down to what is between our ears; MENTAL.  Our bodies are capable of so much if we just let go and trust that they will carry us through.  When racing, I am putting trust in all the hard work and training that I have done in the months prior knowing my body is strong and can handle it. Although this is a different challenge, my body is still strong and can handle the task at hand.  In fact, it will very likely come out stronger in the end.  

Now, I know what I must do.  This week, I have to put trust in the training of my cardiologist.  This part is much harder for me, because I do not have control over this aspect.  Once I am put under anesthesia, most of the outcome is in the control of the doctor and his team.  I HATE NOT BEING IN CONTROL. Everyone who knows me knows this.  

Therefore, today, I am choosing to control the things I can and try to trust in the things I can't.  I will trust that I have chosen a fantastic doctor at a good hospital.  Someone (I wish I remember who) told me a few weeks ago, "Remember these doctors do these procedures like moms change diapers."  That has stuck with me and comforts me. So, I will make my lists. Grandma Brenda, will then know my girls schedule and important phone numbers, while she is here taking care of them.  I will leave good lesson plans for my substitute teacher, to ensure that my classroom runs smoothly in my absence.  I will pack my bags with all the items I will need this week.  

Tomorrow at 4:30 PM, I will give my girls the biggest hugs and kisses ever. I will bravely get in the car with Dean and leave everything here in good hands.  I can do this.  One step at a time. One foot in front of the other. I CAN DO THIS.

Balance

Balance

According to the Oxford Dictionary the definition of the word balance is: "An even distribution of weight enabling someone or something to remain upright and steady;  Stability of one’s mind or feelings."  We all try to maintain balance in our lives.  It is a never ending juggling act to divide our energy and attention between our children, spouse, other family members, friends, career, exercise, and leisure, all while maintaining emotional stability.  As most of us see it, far too much time is spent on the things that we "need" to do and not enough time is left over for the things we "want" to do. Often, there is not even close to enough time to do the things we need to do well.

This week was an especially hard week in my own personal balancing act.  After a particularly rough day, I came across this article which really spoke to me. When All the Spinning Plates Crash (You are required to read this before proceeding.) 

I have spent most of my life trying to keep all my spinning plates from crashing.  Most of the time I am successful.  However, there are numerous times when they come crashing down, and when this happens, no one is harder on me than me.  Lately, it has been much harder for me to keep my plates spinning. It is a much harder task when you simply don't feel well and don't have the energy to do yet one more thing.  More often than not, I feel as though I am coming up short in many aspects of my life.

This week, I have spent a lot of time preparing both my home and classroom for my absence.  True to my nature, I want to make sure that all bases are covered, and of course, no one can do it like I would. 

It is hard for me to ask for help.  It always has been (probably always will be).  This has caused me a lot of problems.  On Friday, at a meeting at school, a co-worker, bless her heart, made me promise that once I have left for my procedure in Denver, I leave school behind.  She stated, "This place can run without out you.  Take care of yourself first."  

Easier said than done.  Moms take care of everyone else first.  That is just what we do.  In fact, this morning, I began cleaning my house and doing laundry before I remembered to feed myself breakfast (everyone else had eaten).  

Late this morning, I received a FedEx overnight package labeled "open immediately, medical device enclosed".  The package contained an event monitor for my heart, which I will be wearing for approximately the next 2 weeks leading up to my procedure. This allows the doctors to monitor my heart via real time in order to gather more information. Big Brother is watching my heart! Four electrodes are connected to my chest along with wires that all lead to a monitoring device.  This transmits information to a cell phone which then transmits the information. Now, this whole thing seems REAL, making this week much more difficult emotionally and adding another plate to juggle.     

So, if you see me, and I seem a bit frazzled, know that I am just trying to keep my plates from crashing to the floor.  I am working on putting one foot in front of the other while planning to be gone for at least a week, and I am exhausted and a bit nervous.  

I can't even imagine how hard it would be to keep up with this balancing act if it were not for all the wonderful friends, family, and co-workers, I have surrounding me and lifting me up through this process.  Thank you all for the little pep talks this week and just for asking me how I am doing.  I know you all have plates you are trying to keep spinning as well. 

Eleven more days to go until the procedure to fix these holes in my heart.  I am excited and anxious to begin the road to recovery and continuing on the journey towards embracing more balance in my life. I am looking forward to this eventually becoming easier when this plate is eliminated from the mix.

New Year

New Years always signals the time of year when I along with athletes of all types begin planning our upcoming racing season as well as setting new personal goals.  This year it has been a more difficult task then in the past. I think it is because I went through December with too many unanswered questions to think much about the new year ahead.  So here I am, 1 week late working on my New Year's Resolutions.  

This week my resolution was simple.  Finish my New Year's Resolutions and survive the first week back to school.

So, I started by reading A LOT.   While this actually started out as procrastination, it turns out I read some excellent articles, which helped me finalize some goals for 2015.  Here are links to a few of the best ones I read and highly recommend to others.

15 Damaging Myths About Life We Should All Stop Believing

This is What Brave Means
Modern Moms Looking for Perfection in All the Wrong Places
Why Being a Mom is Enough
5 Mom-Shaming Trends that Need to Stop Now
The One Thing Christians Should Stop Saying

Brene Brown

Here are a few realizations I had as I read...... 

1. There is no such thing as "perfect".  Striving for the unattainable will just leave you feeling frustrated and "not good enough".

2. We are only truly happy if we accept ourselves as we are and then try to be the best version of ourselves. In a nutshell, stop comparing ourselves to others.  Be your own measuring stick.

3. Going against the grain might be what is best for us.

My Beautiful Family Christmas 2014

4. There is not one definition of a good parent. There are actually many ways in which you can be a good parent.  Loving your children (and showing them you love them) and making the best decisions you can is what is most important.

5. Happiness should be the ultimate goal in our lives and worrying about "shoulds" and "what ifs" does not equate to happiness.

6. Focusing on the Negative does not allow room to cultivate and grow the Positive.

7. Use the opportunities set before you to make a difference.

8. It is hard work that results in good fortune.

9. Forgive more.

10. Find enjoyment in the simple things.

 I used the basis of what I learned from above to form my goals for 2015. I reserve the right to add to or revise in February when I am more informed regarding my road to recovery.....

Goals for 2015

1. Write down at least 1 gratitude for each day of the year.

2. Practice patience each day. Along with the gratitude for each day, write down 1 way in which I was patient.

3. Be truly present when spending time with my children. No FB or texting between 4:30 and 7:30 PM.

4. Go to at least 1 country music concert before 2016 maybe more than 1.  Music makes me happy.

5. Plan a trip for my family to Disney (Land or World) in December 2015. We have been putting this off for 2 years.  It is time to go. Family quality time in December instead of buying thing, purchase experiences.

6. Ride Little Red 100 miles on June 6, 2015. A great way to give back to the fight for women's cancer research.  This will be somewhat up to the lottery process.  Hoping to ride with Dean's mom, Brenda and Aunt, Julie.  If not this road cycling event, find another in which to participate.

7. Run a 5K by the 4th of July (if not on).

8. Do a sprint triathlon in August (Lander?).

9. Ride in the Jurassic Classic in September.

10. Revisit my list of realizations and goal list above at least once a week (more realistically once a month).

Although these are not the grandiose goals I had envisioned several months ago, if I can accomplish them, I think I will truly be through one of the hardest years I have ever experienced in my 35 years.  Between having rhabdo and discovering the two holes in my heart in 2014, I have definitely learned NOT to take health, friends, or family for granted.  
If all goes well, I hope to be back on track to work towards Xterra National qualification in triathlon in 2016 (originally my 2014 goal). 

NEWS!

As of last night, I wasn't planning to have an update so soon.  Isn't it funny how you receive news when you least expect it?  

The first thing this morning, I received a phone call. On the other end of the line was the Denver cardiologist's nurse.  As it turns out, Dr. Carroll did have a chance to look at my file yesterday.  The nurse explained that she did not have a chance to call me, because she was home with a sick kiddo.  "Hallelujah!"  resounded in my mind, "I finally have answers!" 

Not only did I have answers, but she told me that Dr. Carroll would be able to repair my holes through the percutaneous (closed) method.  It will involve two patches, but it can be done.  Better yet, I was able to make an appointment for a consult with the Dr. himself on January 27 and the procedure will be completed on January 29, 2015. 

"Is this soon enough for you?" she asked.
"Absolutely!" I replied finding it hard to contain my excitement, as we continued our conversation.  

I soon found out that following the procedure, I will only have to be hospitalized for 24 hours, and then I will be able to go home.  I can return to work early the following week.  

I still have many questions for the doctor including how sure he is that this method will work for me and when I will be able to return to the activities I enjoy.  Those will have to wait another few weeks until he returns from Taiwan.  This procedure will also need to be preapproved through my health insurance company. I hope this won't hold up being able to have my heart repaired, as I have read horror stories of others who are still waiting for procedures due to insurance snags.  

Right now, I am going to enjoy this wonderful news, but wanted to share it with you all.  I am so thankful to have a problem that looks like it can be repaired.

Thanks to each and every one of you for following my story and your continued support and prayers.  I have received so many kind messages from my many friends and family old and new, near and far.  I wouldn't be able to "hold it all together" if it were not for you all.  I will continue to update this blog as there is new information and ups and downs.

Waiting

I wrote this yesterday......working on an update......

This is my new mantra.  I am failing miserably.  Waiting..... NO ONE would describe me as a patient person.  In fact, my dad told me, "There is not a picture of you in the dictionary next to the word patience." 

Exercise has ALWAYS been my coping mechanism for stressful situations. Does this not qualify as stressful?  Now, the most I am allowed to do is take a brisk walk?!  

Today, marks 2 weeks since my TEE when I was told that I have a PFO and an ASD. I marked this day on my calendar with a large red X, because the cardiologist in Casper said I will have information regarding how these two holes will need to be repaired in 1-2 weeks.  

He explained that they may be able to be repaired through a closed procedure in which a catheter inserted through my groin would be used to place a patch over the holes.  The other possibility would be open heart surgery.  Because there are 2 holes with very little tissue between, the later would more likely.  However, we will know for sure after he sends the TEE and shunt test to a cardiologist in Denver who specializes in the closed procedure.  "Ok," I thought, no big deal, we will know soon. Sedation has a way of making a person more patient.....

"BIG DEAL!" The first week wasn't so bad.  I was busy with the end of the first semester at school and getting ready for Christmas. The time off from exercise gave me some much needed extra time and some energy to get the "extra things" completed.  

Week 2 well that is another story..... Christmas is over, the kids are bouncing off the walls, and I want to go skiing, to Cross Fit, ice skating, sledding, and swimming.  My house is a mess, and did I mention we got a boat load of snow on Christmas day and a little more each day every since????  I also got a kidney infection for Christmas.  Talk about adding insult to injury.  This morning, I joked with my doctor that I am just going to move into the clinic.  

I still have almost a whole week off from school and still no answers.  I feel like I am getting the run around.  On Friday, I was told, you should definitely have answers on Monday. The cardiologist has been off because of the holidays.  Today, the nurse said, the doctors in Denver and Casper have not talked yet. The cardiologist in Denver is going to Taiwan tomorrow and the cardiologist in Casper is off this whole week. Still no information......Ugh!  I don't know how much longer I can wait! I know that doctors are very hard working people just like everyone else and everyone needs a break, but why does it need to be when I am waiting for information!

My poor husband and best friends, Shelli and Josie, and my sister, Ellie (via phone) got the brunt of my breakdown tonight.  I am so lucky to have such wonderful people in my life supporting me and lifting me up. Thanks to you all being there for me no matter what.

So, I made an appointment with a different cardiologist in Denver. The earliest I can get in is January 14, 2015.  Another 2 weeks to wait for answers...... that is the plan for now.  In the meantime, maybe the cardiologist in Denver will call..... I guess I am just not the type of girl who will sit and wait for the phone to ring forever.  

In the meantime, I need to figure out how to not go crazy. Once this infection clears up, I will settle for skiing behind the girls, very easy swimming, and my "brisk walks"..... I will find joy in more Lego projects with the girls and my new found a crochet hobby.  I may even do a few body weight squats, push ups, yoga, or anything else I can do at a brisk walk pace. Who knows, maybe I will stop and smell some roses along the way.... metaphorically speaking of course since tomorrow the high is supposed to be -2.

Diagnosis Shock

Bear Lake Brawl Swim to Bike Transition

On Monday, December 15, 2014, I found myself at Wyoming Medical Center. A feeling of irony overcame me as I was walked to the outpatient wing by a very, elderly, woman volunteer.  She looked frail and much closer to death than myself.  "Why am I here?" resounded through my mind numerous times as we wound through the long hallways. 

I was there for a  TEE to find out more information about the possible hole(s) in my heart. Following the test, the doctor reported that there are 2 holes in my heart, both in the wall between my atrium.  One is an ASD and one a PFO, and they are both large enough to need to be repaired.  These holes are congenital.  My immediate thoughts were......."You mean I have had these MY WHOLE LIFE?  Are you kidding me?  How on earth have I been able to do all that I have done physically including having two children through natural childbirth and not had a stoke?  I was in labor with Eva for 37 hours!"  Needless, to say I was in shock.  I think I still am in shock.  
The other crazy thing, is my mom had a hole in the wall between her atrium repaired 42 years ago when she was 17.  The doctors were well aware of this when my sisters and I were all born.  They were on the lookout for this genetic defect.... I have never had a murmur and still do not have a murmur! 

Cross Fit Open 14.2 2014 Chest to Bar Pull Ups

Jurassic Classic 2014

These are  just a few of the athletic activities I love and used to do daily.  Ever since I can remember, if there was a new physical challenge, I was ready to sign up.  From figure skating and piano lessons to marathons, triathlons, and endurance cycling events, I am not known to sit still for very long.  For my first 30 years of life, I really DID NOT have any indication that anything could possibly be wrong with my heart.

Looking back, my first symptom was likely after my 2nd daughter was born in the Spring of 2009.  I started to notice that my heart was skipping beats, otherwise known as palpitations.  I had an EKG and wore a holter monitor for 24 hours. Nothing real alarming showed up.  My doctor said it might just be the stress of having babies 23 months apart and the strain of pregnancy and nursing on my body.  I should rest.  So I did (as much as a mom of a newborn and 2 yr old can) for a few months.  The symptoms seemed to disappear. 

In the meantime, I began competing again in the summer of 2010. I participated in several half marathons and triathlons, 2 marathons in 2012, and became more active in mountain biking including the Dakota 5-0 in the fall of 2013.  This is also when I I joined the local Cross Fit "box" and competed in my first CF competition and the CF Open.  Also, did I mention, I became a certified personal trainer during this time and was a co-founder of the local sprint triathlon?

The winter of 2013, I returned to classroom teaching after 5 years of being a stay at home mom and part-time personal trainer.  My husband and I also hit a pretty rough period in our marriage.  The symptoms returned.  I was experiencing the palpitations again. However, I also was not sleeping and was super STRESSED.  An EKG showed PVCs and the results of the holter monitor showed occasional palpitations, but again "nothing to worry about". I even ran a hard 5K with it on.  My heart rate remained at a level 140 the entire time.  I have always had very low blood pressure and a very low resting heart.  I am an athlete. The symptoms were once again likely related to stress. I experienced rahbdomylosis that spring twice (the specifics of this are part of another story...).

Therefore, I took the 2014 season off from racing (other than the 4th of July 5K and the Jurassic Classic mtn bike race - 8 miles), despite having just gotten a new mountain bike and having had previous goals of qualifying for Xterra National Championships.  I was taking a break to recover fully from the rahbdo.  I was being really careful with both volume and intensity.  I did keep up with exercise 4-6 times per week. I had trouble off an on throughout the summer with my health and going into fall things seemed to get worse and worse.  My stress at school was way less than the year before and my life stress had mostly disappeared. This time, I knew it WAS NOT STRESS causing these symptoms.  Something was WRONG.  I felt terrible, I was tiring easily throughout the day, and was EXHAUSTED by the end of the school week.  I went back to the doctor several times.  We tried a few different things. I had labs done, but we were really not finding an answer.  I still felt terrible, and the palpitations kept getting worse. 

One Friday morning on December 5, 2014, I was preparing for the day in my classroom.  I was feeling extreme fatigue and nausea. I checked my pulse, and I was having 3-4 palpitations in a minute.   I also had the school nurse check my pulse and blood pressure.  After walking down to her office from my classroom, my blood pressure was 102 over 62, my pulse was 70, and I was still skipping 3-4 beats a minute. Immediately, I made an appointment to see the doctor that afternoon.  I was unable to see my regular doctor, so I went to his PA.  As a result of my appointment that day, I was referred for an echo cardiogram the following Tuesday.  

I followed up with the echo, and while I was having the test done, the tech ordered a bubble test.  At the time, I had no idea what was going on or why.  That Thursday, I found out why, when my doctor called me while I was Christmas shopping.  He told me that I had a hole in my heart.  At least one, but he couldn't rule out the possibility of more than one.  He explained that the bubble test was used to test where the blood was flowing in my heart.  It was supposed to go from my lft atrium to my lungs.  If this was happening, the bubbles would disappear into my lungs.  However, the bubbles were not doing this.  They were passing directly from my lft atrium to my rt atrium quickly and in a large volume.  Since, I live in a small mountain town in Wyoming, I was lucky enough to have a cardiologist in town to look at my bubble test. He recommended I go directly to Casper for a TEE.  I was scheduled for the test that next Monday.

So here, I am sitting, waiting, patiently, as patiently as a person who almost NEVER sits to find out what my next steps will be.  It is Christmas Break.  I want to be at the CrossFit "box" with my friends.  I want to have enough energy to play with my kids.  I want to know that when this is all figured out, I will be able to do everything I could do before.  I am told that I will probably be even better in the end.  Right now, it is not in my hands, so I am trying to leave it in God's hands.  This is not easy for a "control freak" who schedules everything at least a month ahead of time.  Hopefully, it will be a matter of a few days, and I will know if I will have an open or closed procedure to repair the holes.  Right now, they are being filled by love and support from friends and family.  Thank you all, you don't know how much this means to me.  I the days and weeks to come, I will continue to use this blog to keep friends and family near and far update.  It is also therapeutic to me to think out loud in writing.