Another Post About Pain - Actually, Losing It (Temporarily, I Mean)

I've got this great massage therapist, named Peter, who I've been training for a while now, and it appears he has finally graduated. Now, I should probably, in the spirit of full disclosure, tell you he is already licensed, so the training I refer to here is regarding my particular feet. I've probably been to a hundred or so massage therapists in my life, and only one other "took" to the training I offered. The rest merely got this condescending look that said "who are you to tell me how to do massage, bub?" And then went and did whatever they wanted to do. Even when I screamed in pain. Funny, huh?

So, Peter. Guy really knows how to open up the old sinus tarsi, if you know what I mean (nudge, nudge, wink, wink.) (Extra points if you know the episode that comes from.) He stretches the joints rather than trying to push his fingers through the joint and out the other side. And holds that stretch for juuust the right amount of time. Aaaaahhhhhh. What can I say - he just "gets" me.

By the time he finishes with me, I can get sometimes as much as two full days without the extreme pain, and often gets it down to about a 2-3 on that scally thing for pain, which is really quite wonderful. Pete's a keeper, for sure.

But it occurred to me that it would be an interesting thing to approach one of the local massage schools to offer a specialty class for doing massage with people with disabilities. As the musculo-skeletal system is often not "exactly" the same as so-called "normals," the approach to a body with a disability also needs to be different. This would apply as well to those with arthritis. The motions and techniques that work with a non-disabled body may, and often do, cause a painful reaction in other types of bodies.

The thing about stretching, rather than applying direct pressure, is that many joints hurt because of their position, loss or lack of cartilage, poor opposition (meaning one group of muscles is weaker than their opposing group of muscles, and thus not as able to maintain a good joint position.) The act of slowly stretching, and holding at stretch, a particular joint, allows several things to occur. For one thing, it tells you where the need for further work is needed. It also helps slowly overcome any soft-tissue spasms, allowing a more full and normal range of motion for that joint. This is especially helpful around our more complex joints - shoulders, hip, subtalar. Such joints have a greater number of soft tissue connections and interactions, and thus, a greater likelihood of poor opposition setting in.

So, for those of you out there making regular use of a massage therapist, I urge you to educate them on what really works for you, especially with your feet. Oh, and a good physical therapist helps, too. They will be able to help you discover the sites with the greatest need, which you can use to further educate your massage therapist.

All this talk of massage makes me want to call Peter right now, to set up my next appointment. Where'd I put his number?

That Bottomless Pit

Depression. I suspect few clubbies have ever NOT experienced it. And like chronic physical pain, depression can become self-reinforcing, and not surprisingly, it is then called chronic depression. It can seem as though you are at the bottom of a very deep pit from which there seems to be no escape. And hen you have chronic pain, well, chronic depression can seem like its fully supported by the facts.

But that isn't really true. There are many people with chronic pain who somehow manage their depression, both with and without medications, and/or therapy. And while it may seem one has very good reasons to be depressed, there is always a large part of that notion that is NOT driven by any facts at all. The longer one remains depressed, the higher the likelihood their brain chemistry will alter to deepen the depression by that means alone. This is when medications are truly necessary - when the problem is fueled by these changes in brain chemistry. And only a professional can evaluate and treat this issue properly.

Now, I would be a fool (oh, yes, i sometimes actually am one,) if I tried to tell you that any medication would wipe away all the factors that lead to, and continue, a person's depression. But what it will do is stop the constant downward slide, the sense that one will never get out of the depths. It won't suddenly make you happy, but it will stop you from believing you will never be happy again. And that will at least make it possible for you to attend to the facts of your situation, rather than the beliefs those facts have come to dominate your thoughts.

The dimensions of all the facts accompanying post-club feet are many, and varied. there is no one element, perhaps other than pain, that all clubbies share completely. But I have come to believe that, not just us clubbies, but nearly everyone who lives with chronic pain, are susceptible to depression, and the damage it can do if left untreated. So I urge all my fellow clubbies, if they have yet to do so, to take a serious look at this aspect, this specific dimension, of the post-club feet syndrome. Its hard enough our feet drag us down - but as much as we have limits on what physical response will be truly effective for changing our condition, we can at least have greater control over the issue of depression. Its real, but its workable. You just have to make it as much a priority as anything else you are trying to do to improve the picture of your life.

Does This Blog Have Value To You?

You might consider this my first popularity poll. Or, more accurately, a value poll. I think it is important that a blog of this type periodically poll users to find out if they still see a value in the content and tone of a blog, to learn whether you, the reader, find something of value each time you visit. And if not, to learn what would make this blog of better value, from your perspective. So, for the next few weeks, I will be putting up a poll feature, with different questions each day, to get a better sense of what changes need to be made to make this blog serve you, the reader, better.

The poll will be over there, in the sidebar. I urge you, dear readers all, to help me make this blog a place where you can get the support, information, and necessary outrage (when appropriate) to impove your life as a clubby, in this world where clubbies are often not allowed in the Big Club.

Thank you for your participation,

Notumbo

The Damage Done - Old Neil Young Had It Right

I'm going to go out on a limb here, and venture into some rather difficult territory. This is indeed associated with club feet, but only as one of many disabilities, deformities, etc. And I am certain some out there will take exception to what follows, but that's pretty much a given, these days, especially on these here interwebs, as some have taken to calling it.

We live in an increasingly toxic environment (and I'm not just talking red state/blue state here,) and this environment is having an increasing impact on our specie's genetics. Mercury, lead, arsenic, air pollutants, radiation, food pathogens, etc., etc., etc., all have and will continue to impact the incidence and severity of birth defects. Include in this mix poorly tested pharmaceuticals (can anyone say thalidomide?) And biochemicals - herbicides, pesticides, food additives. It's pretty much a chemical soup we live in these days, so it should come as no shock to anyone that there will be mutagenic impacts.

In some ways, this goes back a long time. Industrial manufacturing unleashed a holy hell of toxic products into the human environment (not to even mention the animal environment.) But it was the real acceleration of these processes in the mid-20th Century that made this issue come to the fore, with the impacts of DDT, thalidomide, and many other issues, such as the massive mercury disaster in Japan, the Minimata Disaster in the 1950s, and then later, the Bhopal Disaster of December, 1984.

And, lest we forget, the entire nuclear arms race, starting with the first above-ground tests in New Mexico, and then the hells of Hiroshima and Nagasaki. It seems pertinent to mention these last two today, this being the 65th anniversary of Hiroshima's bombing with a nuclear device.

There are no easy-to-find statistics to support any correlation, but I have often wondered what the incidence rate of club feet and other birth defects were in the fifty years after Hiroshima, compared to a similar demographic study of a similar population in the fifty years preceding that same event. Of course, if anyone out there actually has real data on this, I'd love to put it here for all to see. But barring that, we can make at least some estimation of this specific issue by looking at a similar demographic, that of the incidence of specific cancers over similarly comparable time frames. Since the increase of cancer-causing mechanisms fairly well parallels the same rise in mutagenic mechanisms, this is not that difficult a comparison to make. In this article,

Genetic Causes of Adult-Onset Disorders

By: Kira Zhaurova © 2008 Nature Education 

Citation: Zhaurova, K. (2008) Genetic causes of adult-onset disorders. Nature Education 1(1)

 

we see at least one such study to assist in making this point. I am certain there are many others that reach similar conclusions.

And we know now that club feet, at least some percentage, have a clear genetic mutation that is implicated causally. See this article for more info. So it does seem reasonable to ask the question - was the incidence of club feet as a percentage of the birthrate greater before, or after, mid-20th Century?

If anyone has data they'd like to share, to either support or refute this theory, please feel free to Comment, but please provide citations to support your response.

An All-Too Familiar Story

Over there at www.clubfeet.net, there are a bunch of truly moving personal stories, of both parents of children with club feet, and of adults like me and you with post-club feet, and the struggles we deal with. But one of those stories, recently posted, really got my attention. Tom (http://www.clubfeet.net/story/981/) tells his story of long time pain, personal frustration, and being seldom understood by those without c/f. His story echoed my own in many ways, and I wanted to bring it to your attention.

It truly illustrates why it is so critical we shake up the orthopedic and podiatric establishments on the subject of post-club feet. I have been researching this topic many years now, and have yet to locate a specialist whose focus is on treatment for adults with post-club feet. We have all been subject to pediatric surgeries and treatments, been told we were now "normal," then cast into the world with no idea of how bad it could become, and no resources on how to effectively deal with what was clearly inevitable. Many practitioners who have dealt with some of our issues do so from a "one-off" perspective. That is, they look at the problem we present with as an isolated issue, unique to only us individually, and never as a broad-spread syndrome deserving further focused study, and a focused search for solutions.

I have said before, and will say again - as long as the pediatric doctors don't talk to the adult focused practitioners, there will never be sufficient progress into our issues. A phenomenon not seen is a non-existent phenomenon. But we live with these issues every day. They affect our physical and psychological well-being, the very experience of our daily lives. We cannot only be offered fusions, and addictive medications, or weak and poorly-informed attempts to apply orthotics without seeing post-club feet as a different issue than plain vanilla over-pronation, as one example. Post-club feet are both the same person-to-person, and different, at the same time. Without a focused effort to research this syndrome, and a clear acknowledgment that this syndrome even exists, it looks to many of us like we are on our own. This is especially hard to shake when considered against the backdrop of people with post-club feet who talk of amputation, or spending the rest of their lives in wheel chairs.

Not to mention a near-vacuum of response from the medical community. Maybe its time I yelled a little louder. And Tom? Get in touch, OK?

Old News is Interesting News

I've been doing research for some time into locating my old medical records, or at least information on the doctor and clinic where I was treated. Well, I have a couple of things to report to you, my dear readers. First, I have made contact with a doctor who was a colleague and who trained with my doctor, Dr. Day, and who also worked at the Detroit Orthopedic Clinic. It turns out the records are almost certainly kaput, after fifty-plus years (no surprise there,) and the clinic is now renamed. And I've learned the clinic was originally started by a sorority! Cool, huh?

Anyway, I'll be filling this story in further in a later post, but for now, I will also share that I've learned Dr. Day's full name, after all these years - get ready - Dr. Andrew Jackson Day. Totally cool!

Stay tuned, more to come!

You're Disabled - NO! I'm Not! Nyuh-huh! Uh-uh! Nyuh-hah, too!

Its a pretty conundrum we clubbies have - we aren't really "disabled," right? Unless we are. I'm having a bad day. I don't know if you can tell - cyberspace is pretty poor at expressing emotions, emoticons notwithstanding. And it's also a place where anything you say can be held against you in the court of public, er, opinion? Or, perhaps, attitude explosion? Yeah, that's it.

We were most of us I'd venture to guess raised to "keep the secret," about being disabled - after all, the doctors, and by proxy, our parents, assured us we were "just like anybody else." Sweet. But then one day we wake up and our feet scream at us, Whoa, there, just a minute, not so fast - you ain't steppin' on ME today, bub! And that's the beginning of doubt, the start of a small but irritating picture in our minds that, well, we been flim-flammed on the jim-jam, as some famous cartoon figure of the distant past used to say. But we won't use that word, nosiree! Not on your life. 'Cuz we're just like everybody else, yep, no doubt, none at all. Uh-uh.

Yeeaahhhhh, wrong. Sorry to break it to me and you like this, but we are - disabled, that is. Doesn't mean we can't do as much as we are willing to try to do, but we just don't have the same range, the same endurance, the same absence of pain that all those "normal" people do. We are "differently-abled," if that makes you better able to stomach this major change of focus. But the sooner we come to terms with this, the better we will be at doing what we need to do.

I got my wake up call on this issue a few years back. I was working on a certificate in training and human resource development, and in one of my classes, the instructor invited each student to run their own five-minute training for the rest of the class. One man began by having the class stand along one side of the room. He then would ask everyone to respond to various types of self-identified groups we all might consider ourselves part of. As he would announce a specific group, or affiliation, people who so identified would go to the other side of the room. It got to where there were only three people on the original side, and I was one of them. the other two finally responded to something or other, leaving only me. Not unlike being the last one to be picked for a team in baseball when neither wants you.

And then he said, "disabled, or handicapped."  At first, I didn't really hear the words. But suddenly, it was like a big hand pushed me from behind, and I stumbled forward. I must have looked pretty shocked, because the instructor suddenly came toward me, and then, I fainted. Yep. No kidding. I have never fainted in my life, not before, nor since.

It has taken me many years, now, to process this event, as well as this acknowledgment of my situation. I believe I was so adamant that I was "normal," or not disabled, that I was simply not prepared to deal with the response my body had to that word, that idea. Even today, I fight against the concept, firmly believing I can, should be able to do whatever I want to do. Which, by now, you'd think I was too intelligent to be so self-deluded. Apparently not.

Today I was in a great deal of pain. Every step was an effort. I couldn't take the dogs for their walk, which made them cynical and deeply disappointed, and, well, mainly concerned. They aren't cynical, sorry, but I sure as hell am. And it occurs once more that this cynicism is built on a foundation of denial of my true situation. If I am NOT disabled, then this pain is a failure of what - my will? My manhood? My belief in this long-held and well-cemented lie? Yep. that one will do. I am in pain because my feet just don't have the strength to deal with relatively mild, and by most people's estimation, normal demands of getting through one's day. So, I get in a pissy mood, or go in for some really rock-em-sock-em self-abuse, and get to feel even worse. Oh, lucky me.

But this afternoon, at the height of my miserable, rotten day, I went to an event, as part of my job, actually, that really punched me in the nose. It was held at the main branch of the library, in their big auditorium. It was The 2010 Superfest International Disability Film Festival. Now, I was there because I needed to interview someone about, well, I just needed to interview this person, can't really go into specifics, sorry. But there I was, surrounded by a flash from my past, just like the orthopedic clinic I attended throughout my childhood. Wheelchairs, walkers, prosthetic limbs, the works. Disabled people being proud of themselves as people first, disability second, while never once denying who they were, and the nature of their situation on this planet. And me. Mr. Not Disabled. With a cane. And a limp. And two screaming puppies hollering to sit down right now, dammit! Oh what fools these mortals be!


If you are born without an arm, lets say, there is never a moment where someone tells you, hey, guess what, you are NORMAL. Or with dwarfism, or Down's Syndrome. But clubbies? Hell, normal as an Iowa cornfield. Right? Man, I could just slap myself sometimes. Wake up, fella, that little voice of rationality and logic screams. And I just go walking along, in pain, and supremely in denial. But these films, they offered a portrait of life with disabilities, and great, sometimes insurmountable difficulty, and the people so affected, bless everyone of them, just keep on bulling through all the obstacles, even if it means getting their heads bruised in the process. Because, while they might be disabled, they are first and foremost free, autonomous human beings who have as much aspiration and desire as any so-called "normal" person. Which, if you think about it, makes them all, well, normal.


Truth? 

I am freakin' disabled. Get over it. And get on with it.

The Sub-Talar Joint - A Real Neighborhood Dive

You've heard me mention the sub-talar joint many times, and probably think I go to bars with weird names, but seriously - I do. I just have a preference for this particular joint, where all the tunes on the juke box are variations on the Twist. (Boy, am I dating myself. Which is a good thing, because no one else will - bah-da-boom.)

Actually, this is the first in a series on basic biomechanics. The intent of this series is to help other clubbies better understand their own particular feet better, and to make it easier to understand the strange foreign language of doctors, which is nearly as indecipherable as their handwriting (did you know that the last course a doctor takes before graduating is medical penmanship? If the professor can actually read your test answers, you flunk.) So today's lesson, cats and kitties, is the subtalar joint. Hop up on a bar stool, place your order with the bartender, and let's get started.


First of, without the subtalar joint, we would all walk like a cartoon figure, throwing one leg forward, planting it fully, then swinging the other forward. We most likely would not have evolved the ability to run, which means the saber tooth would have gotten more of us, as would the mountain lions, tigers, bears, tax collectors, etc., which by extension means we wouldn't be a very crowded planet, and probably no internet, and thus, no blog. And that would be a bummer, wouldn't it? Because without a subtalar joint, the leg cannot rotate over the foot while the foot is planted fully on the ground. Go ahead - try it. Try to twist your foot against the ground while your leg is directly over it, then keep doing that every step. It's OK, I'll wait.....

So? How was that? Pretty difficult, and I'm sure, very tiring. And if you did that all day, your knees and hips would be killing you tomorrow, trust me on that. The subtalar joint is the only joint in the body that operates in all three "cardinal planes." What, you are asking, as if I could hear you, is a cardinal plane? No, its not the one used by that team from St. Louis. A cardinal plane refers to the three planes we move in, and consist of the frontal plane (or coronal plane), the sagittal plane, and the transverse (or horizontal) plane. Here is an excellent and easy to understand explanation. And here is a video showing all three planes, with other motion-related terms for easy understanding. Most joint operate within only two planes, because there is no need for rotational motion to be transferred. While the hip and the shoulder joints move in three planes, they don't of themselves transfer motion. The subtalar joint allows the rotational motion of the leg as it passes over the ground to take place without making the knee and ankle joints provide the same motion, which they are not designed to do - the knee is a hinge joint, and the ankle, as well, and neither is capable of moving through all three planes of motion.

There are many views of the subtalar joint that can be found on the Web, but here is one simple one:

The talus is the bone over which sits the two bones of the lower leg - the tibia, and the fibula. The talus, in turn, sits on, or more properly, articulates with, the calcaneus, what we often refer to as the heel bone. It is this articulation, between talus and calcaneus, that we call the subtalar joint. It is the shapes of the "articular surfaces," or, the intersection of the two bones, that determines the motion that can occur between them, more properly, the motion of that joint. The talus and the calcaneus, in turn, articulate with other bones, and through that motion transfer motion from the ankle, to the mid-foot. You might liken the subtalar joint to a universal joint, that translates vertical motion to horizontal.

But with talipes equino-varus, the talus is dis-articulated from the ankle "mortise," and also from the calcaneus. A major part of the re-forming of the post-natal club foot is designed to get the talus and the calcaneus back under the ankle and in proper articular positions. Hence all the stretching, casting, and bracing, not to mention the surgical interventions. Yes, there are other joint-alignment issues, as well, but this - the subtalar and ankle alignments, are the most critical.

But we post-clubbies know, if not by word, at least by function, that we have less subtalar motion, and more subtalar pain, than non-clubbies. Most of that pain occurs in the space between the talus and the calcaneus. Because of the shapes of the joint surfaces of both bones, there is a sort of cave between those two bones, properly termed a "sinus," the sinus tarsi, to be exact. It is in the sinus tarsi where most of our degenerative joint changes are going on. You can test this quite easily. Grab your foot (any foot- your choice) and stretch it back toward it's original clubbed position. You should feel immediate reduction of the pain. This is because you are, in effect, opening the sinus tarsi, thus relieving the compression of the joint, which is what you are doing all the time you are on your feet. So finding ways to open that joint up are the key to reducing pain in that area. Unfortunately, the solution of fusion of the subtalar, while it will in fact (temporarily) reduce that pain, it will simply force the ankle and knee joints to produce motion they are not designed for.

So the key is to find ways, such as massage and stretches, properly designed orthotics, and proper fitting footwear, to keep that joint even a little more opened up, instead of staying at its end of range of motion continuously. Wikipedia has an excellent explanation of the concept of range of motion here.

If you want even more on the subtalar joint, its quite easy to find way too much on the Web. I recommend shaken rather than stirred, but that's just me. Next time, we'll go down the street to the mid-tarsal joint.  They have lots of micro-brews. tell 'em Lenny sent ya.

Do You Have A Favorite Shoemaker?

Well, kinda blows the column, doesn't it? The title, I mean - pretty stand-alone, right? But you know me, always ready to talk a spell.

I have asked, and will continue to ask you, dear readers all, to share your resources with others here, and I am doing so once again (I suppose you should expect a pitch every month or so, just in case you missed the last one:-) But today, I am especially looking for shoemakers and shoe modifiers. Yes, there is a difference. A shoemaker makes shoes from scratch, or in Britain, bespoke. Whereas a shoe modifier, who may be a pedorthist, or even a very skilled shoe repair/cobbler person, takes existing footwear and makes modifications - lifts, wedges, rocker soles, inserts, orthotics, etc. For some of us clubbies, the later folks will do the job just fine. But for some of us, modification is not enough. We need truly custom footwear.

The problem is, there aren't a whole lot of these elusive creatures left in the wild. There are very few younger people who want to learn the craft, because well, its hard - to learn and do - and pays less than a software engineer. Or most other fields, for that matter. And many of the old timers are getting, well, too old to continue much longer.

You probably didn't know that, prior to 1890's, there were more than10,000 shoemakers in this country alone. But as the industrial revolution and mass production came into greater prominence, most of these shoemakers were absorbed, and eventually, segregated by the parts of the operation - last making, pattern making, mounting, "making" (sewing the uppers,) soling, finishing. The result was fewer true shoemakers, who are really capable of making the entire shoe as well as the last (for those unaware, the last is the first - step, that is. It is the form upon which the shoe upper is stretched, or "mounted" that gives the shoe its shape and size.) Hence the great decline in practitioners. Even today, at shoe-making operations doing custom work, the work is often segmented by parts, for greater efficiency and cost savings - it is not cheap to make a shoe, especially today. Few people bring their own hides into the shoemaker as part of the payment for the shoes, and yes, people actually did that at one time in this country.

It is no surprise, really, that most people don't get their shoes custom made anymore - it is far more expensive than the local big-box store sells mass-produced shoes for. But then, they don't exactly make many claims about fit, do they? But many clubbies tend to have wide feet. There are only a few mass-produced shoe lines that make 3,4,5 E width shoes anymore - New Balance, Alden, PW Minor, and a couple others, and no one can accuse any of those companies as making sexy shoes. But hey! They fit many of us.

Custom shoes, however, do more than fit (if made well, of course.) They allow for better incorporation of custom orthotics, hiding a necessary lift, better incorporation of a rocker sole, and because most shoemakers tend to use high-grade materials, they almost always last far longer than a factory-made product. My shoes last, on average, eight to ten years, and require resoling every two to three years. The fact is, the better the shoe is balanced, the more it works with your particular biomechanics, the longer it will last. Just sayin'.

So, who's your shoemaker, or pedorthist, or cobbler? Have you had to shop around before finding the one you currently used? What is it about their work that you can best recommend to others. Come on, folks, put it out there for your fellow clubbies! Because by recommending your shoemaker to others, the shoemaker is likely to remain in business longer, be able to find an apprentice one day, and thus ensure you with a steady source of footwear for the indefinite future. Imagine trying to find shoes that work for those sore doggies at the bottom of your legs at, what - Shoe Gazillion?

Coping With What It Is

I was recently made painfully aware, as those gentle readers who've been reading here for a while know, about how some people find themselves unable to cope with what might seem to some like a trivial, or at least not insoluble problem. And while suicide is certainly the most extreme manifestation of an inability to gain perspective, it is not by any means the only such manifestation. Chronic depression, drug addiction, alcoholism, inappropriate ways of dealing with inner rage, even obsessive-compulsive disorder, all can be outlets, self-destructive though they may be, for our own individual inability to manage the things, large or small, that overwhelm our coping skills.

Chronic pain, especially pain that interferes with our daily activities, the kind in fact that we see everyone else doing around us with no apparent stress, can push our coping skills to their outer limits at times. I would venture a guess that most clubbies, after ten, fifteen, twenty years of daily bouts with the feet demons, can understand this with little difficulty. We all know, many of us from childhood, that useless and unanswerable question - why? Why me can be a mantra, but one without any reasonable answers, which only adds to the dimensions of the pain, layering frustration, anger, resentment, depression, even resignation, upon the pure physicality of daily reminders of the condition we find ourselves bound to.

Now, I'm not a psychologist, nor a particularly insightful guru, or anything remotely resembling a person with answers. All I can do is share my own process and journey through this landscape I have to negotiate daily, and hope others find some resonance of their own experiences. And of course hope you, gentle readers, will likewise share with other clubbies your own story, your own search for respite from the pain. And I can share knowledge, information, resources that may be of use to you, as well.

But it does seem to me there is some insight possible with respect to our situation. Not rationalizations, mind you - I am after all seeking to upset some long-held falsehoods regarding club feet, and post-club feet, even at the risk of ticking a few folks off. No, not quite right - even at the possibility of doing so - its not really a risk. But I suppose you could call it a mission.

One such insight pertains to radical and poorly thought out "solutions" with the thought they will end the pain. I refer, as just one example, of the notion (one which I've expressed and thought of seriously myself, though not for many years now) that amputation and resorting to prosthesis would finally end the pain. Of course, this seems reasonable, from several points of view, I suppose. But it is in fact merely "trading up," replacing one type and location of pain for another, maybe not immediately, but sooner than you'd like.

Truth is, its important to be skeptical about any idea whose very radicality causes others to jump back in surprise when its put forward - that reaction is a pretty good clue that you might want to do a considerable amount of research before making a decision that cannot be reversed. Just saying.

Post-club feet, not unlike many forms of disability, are far more than a physical set of symptoms and pains. It encompasses deep and complex psychological elements, social stigma, sense of isolation, limits on life choices, etc. And for that reason alone, we need the input and kind ear of others as we each attempt to navigate through our not-so-simple lives. If my young friend, no matter what her internal demons caused her to believe, had reached out to even one other person before moving on her idea of ending her pain in such a permanent manner, she may have, at minimum, started her journey toward a solution. Maybe not the solution she believed she needed, but almost certainly one that would enable her to at least continue her search. Now, sadly, that option has no further value for her.

The value that we clubbies stand to gain, I believe, in building relationships across many states and countries, is a vastly larger set of possible solutions to put on, try out, that may indeed provide many others with solutions we may not believe we want, but cannot be sure if we don't even know they exist. They might in fact be solutions that change someone's life.

But we cannot know if we don't enter the conversation. What are you waiting for? Come on in, and let talk.