Tuesday, June 12, 2018

Trust Thy Gut: Healing in the Age of the Microbiome

I was diagnosed with ulcerative colitis in May, 2002. On the day of my diagnosis, I refused my doctor's prognosis, as well as the drugs, and commenced a journey to heal—a twelve-month experiment, absent any conventional medical guidance whatsoever, that ended midway through my honeymoon, when my new wife admitted me to the ER.

For twelve months, I devoted my life to an obsessive and fastidious investigation. Hunched over my desk, I spent day after day Googling. For a phrase like “ulcerative colitis natural cure,” I'd click twenty pages deep, reading every word on every site—every blog, every forum. Certain opportune comments led to new searches in new windows, fresh rounds of clicking.

When I risked leaving the house, I’d visit the book store, where I’d scan the indexes of books, seeking the slightest reference to "colitis," or "autoimmune." Inevitably, though, turning from my screen, or trudging from the store briefly lifted by some tidbit, I’d come to think of the only definitive cure: death.

I do not believe my obsessive investigation, nor my despair, were unique. In my experience, most people who experience illness--from colds to colitis--engage in some form of this fanaticism. And many, discovering confusing or contradictory advice, have yielded to despair. My search led to life.

I've learned to heal my symptoms--without drugs.

And yet, each year for many years, around March or April, just as the weather warms, I would suffer a relapse, or "flair." The severity of these flairs varied--yet I knew how to recover.

In May 2013, however, I suffered a particularly bad flair. My go-to remedies--a horridly wine-free lifestyle, VSL#3, and Metagenics--seemed to fail. Worse, the severity of the symptoms transported me back in time, to 2002, when I felt my despair most acutely.

My wife, who witnessed my behavior over the years, acclimated herself to my eccentricities. But even she was startled, that year, when I walked into our infant daughter's nursery, and pointed to the dirty diaper laying on the changing table.

"Save that," I said.

"What?" she asked.

"Save that," I said, and to state the case plainly, I added, with conviction, "I'm doing a fecal transplant enema."

Nearly all DNA in our bodies belongs to microorganisms: they outnumber our cells nine to one.

- Burkhard Bilger, writing in The New Yorker 
Fecal Transplant Enemas: A Brief History

Although the provenance seems to be disputed--by this guy, for example--the fecal transplant enema is generally accepted (by the folks at Wikipedia, and elsewhere, at least) to have been first described in 1958, when the Chief of Surgery at Denver Hospital, Dr. Ben Eisman, reported in the Journal of Clinical Gastroenterology, on four patients who had been cured of pseudomembranous colitis (commonly known as C. difficile colitis or C. diff).

Eisman described a novel treatment: Enemas containing feces from healthy colons had been transplanted into the patient's colons, and had successfully replenished the patient's bacterial ecosystems, effectively curing the patients.

The next documented success occurred in the mid-1980s, when an Australian gastroenterologist, Dr. Thomas Borody, was faced with a particularly challenging case. A traveler, recently home from Fiji, had contracted an especially pernicious form of colitis. Searching the medical literature for a potential cure, Borody discovered Eisman's article, and decided to give it a try.

Writing in The Scientist, Cristina Luiggi explained Eisman's procedure quite candidly in her article "Same Poop, Different Gut":

"He collected stool from the woman's brother, and after screening it for known pathogens, he stuck it in a blender, added some brine, and filtered it to get rid of any undigested material. The stool, now turned into slush, was administered to the patient—who had her gastrointestinal tract previously flushed—via two enemas over the course of two days. The results were nothing short of surprising, Borody said. Within days her colitis was gone, never to return."

This is the method I'd considered in the spring of 2013. Obviously, like any reasonable human, I would've preferred to administer this treatment with a doctor.

Unfortunately, despite the mounting evidence of the treatment's success--including the first randomized control study--the FDA had made the procedure essentially untenable for any liability-minded doctor. Even though some doctors believed the regulations had become too strict., it was nearly impossible to find a reliable source of treatment.

(Happily, updated guidelines recommend the treatment for C. diff.)

Faced with this climate in 2013, but suffering acutely, I found myself standing in my daughter's room pointing at her diaper, envisioning my own guerrilla campaign.

All I'd need, I told my wife, was a "dedicated" blender and a little poop.

Michael Pollan's 2013 lead article for The New York Times Magazine, introduced the microbiome to many readers:  "To the extent that we are bearers of genetic information, " Pollan wrote, "more than 99 percent of it is microbial. And it appears increasingly likely that this 'second genome'...exerts an influence on our health as great and possibly even greater than the genes we inherit from our parents."

Sterility, Cleanliness, & Purity

I believe the FDA's regulations mirror a cultural obsession with sterility--and as Kathleen Barnes, a Johns Hopkins Medical School researcher, said in a Science Talk podcast on the "hygiene hypotheses," this obsession may be harming our health:

"The hypothesis is that as we make the shift from dirt to sterile that you are changing the direction of your immune response. And so in the context of asthma, and frankly in other autoimmune diseases and diseases of inflammation, it's this imbalance from that side of our immune response that we believe evolved to protect us against things like bacteria and viruses and malarial parasites to the other side of our immune system that, frankly, when it's revved up causes diseases like allergies and some of these other diseases of inflammation."

For me, this obsession with sterility--and by way of sterility, cleanliness and purity--touches the most intimate part of my life: my relationship with food.

For my entire adult life, I’ve been a staunch "health-food" enthusiast. At the age of twenty-one, while traveling in Italy, I became a vegetarian. But even before my trip to Italy, I'd experienced a lifetime of brown rice and Moosewood Cookbook recipes, organic broccoli and honey-sweetened treats. My mother raised me with a special attention to my diet; she also sent me to a school--the Waldorf school--that favored whole food cooking.

I lost touch with this impulse throughout my teenage years. Then, when I was twenty, in college, in the midst a dismal semester eating in the student cafeteria, I came across a surprising image in the cafeteria kitchen: a box of hamburger patties stamped Grade F, But Edible.

Within a week, I was a vegetarian.

For me, vegetarianism, and later veganism, morphed in my twenties into obsession with purity. When I experienced my first symptoms of autoimmune illness, my obsession evolved into what I now view as an eating disorder.

My early symptoms were vague: moving pain, crushing fatigue, listlessness, depression. Blaming certain foods, I refined my diet. For months, I refused to touch anything but organic greens, sprouted grains, wild salmon, brown rice, and tempeh. I drank green drinks. I refused wine. I did not eat one ounce of cheese or bread. I avoided all night-shade vegetables. I never, ever combined proteins and carbohydrates at the same meal.

By the time I received my ulcerative colitis diagnosis my diet was already remarkably limited. The new diagnosis, however, thrust me into a new realm.

At the time, my relationship with food, ritualistic and minutely precise, alienated me from others. When eating lunch, specifically, I simply could not bear company. I dined under strict conditions: on the zero or five, at say, 12:00, 12:05 12:10, and so on, exactly four hours after my last bite of food—a bite I might’ve detained in my mouth, for minutes, if the time did not match my zero/five requirement. For fifteen months, from my ulcerative colitis diagnosis to my wedding day, I never once finished eating on the one, two, three, or four.

For reasons I have yet to entirely fathom, this rigor did not survive dusk. Dinner absolved me—and Karen, from her patient allegiance to my eccentricities. We’d invite others to share the weirdness—to share our chilled Chianti and buttery Castelvetrano olives, our pan-roasted wild salmon and spice-grilled mini sweet potatoes. Easing into these dinners, I eased back to myself—my pre-illness self: the gallant host, the ecstatic narrator.

Today I live for dinner’s absolution, but I am still haunted by my daytime exactitude. My timing is more fluid, but I can only bear company to a point—as long as I’m free to sit in complete silence, and slurp my 1¼ cup seasonal soup, and dip each of my twelve tempeh squares into a tiny ramekin of portioned extra virgin olive oil, and eat my seasonal salad without once glancing to my left or right, but down, to the latest New Yorker.

My Lunch: Every Single Day
My obsession with purity nearly killed me. Refining my diet to an impossible degree, I distorted my relationship with my body and food and those around me. Worse, I'd tricked myself into believing that this diet was the only diet for my symptoms.

Even then, I felt shameful of my illness; shameful of the person I'd become, this ill person with this horridly embarrassing disease. Yet I felt powerless to change. I could hardly utter the word, "colitis," in private, let alone write about it on a public forum.

In a sense, I was guilty of "kitsch," as Milan Kundera defines it:

"The absolute denial of shit, in both the literal and figurative senses of the word; kitsch excludes everything from its purview which is essentially unacceptable in human existence."

My recovery was occasioned by the opposite: an embrace of the chaotic and messy in my life and writing, the literal ingestion of dirt, and an entirely new diet typified by my first bite of meat after eight years of vegetarianism: a juicy, blood red hunk of lamb, cooked rare.

I'd ordered the lamb, spontaneously, with the sort of nervous enthusiasm a person might reserve for a wedding proposal. It was this enthusiasm, this new sense of goofy caprice, that also typified the attitude that inspired me to walk into my infant daughter's room seeking poop.

Not to say that I hadn't researched the topic with my typical compulsive energy. I had.

By "goofy caprice," I simply mean to say that in learning to recover from illness, I've opened myself to change, and that in doing so, I've also learned to see humor in my vehemence.

For me, humor provides confidence even in the darkest hours. This is something I try to express in my writing. I often write about illness, about how I feel as if I’ve been slapped by life. In part, I want to express an honesty about my feelings of woundedness. However, I don’t want this sense to drive my writing into dour seriousness, but rather give me range to be, at times, slightly goofy, as all celebration is.

In the end, after a series of tedious conversations with my wife, I did not administer a fecal transplant enema. I'll spare you the details. Instead, as a compromise, I tried the probiotic enema suggested on the website Listen to Your Gut.

This video, specifically, convinced me as well as the raw testimony of the video's star, Crohns Boy:

"So to tell you the truth it sucked being sick for the last 2 weeks especially while I was in Hawaii. When I look back at it now I am almost grateful for being sick as it has taught me a lot in the process. I have learned that when I feel awesome and other people are doing shitty I really have to remember how I felt when I was in their shoes-feeling depressed, hopeless, insecure etc and I have to be able to communicate effectively that they will overcome this and that stuff will be lost in the process. I also realized life has a great way of humbling you from time to time even if it came in the form of a flare lol I realize you really have to soak up the GOOD TIMES and enjoy them!! Sunshine is always awesome and appreciated the day after the storm.....simply said."

"Gut bacteria may be the key to preventing or treating some diseases," says The Harvard Medical School, which recommends fermented foods or probiotics as a healthy option for "good bacteria." [Photo Source]

Fermented Foods and Probiotics

I am a passionate proselytizer of bugs--specifically the beneficial bacteria found in fermented foods. In my former position at Whole Foods Market, I spoke to hundreds of people over ten years who offered testimony after testimony to the effectiveness of probiotics. And finally, it seems, the idea of "beneficial" bacteria has entered the cultural conversation under the meme of "the microbiome."

Although the microbiome is meant to describe our entire bodies’ bacterial ecosystem, much of the current talk focuses on the gut, and the profound influence the gut has on our health. Many scientists studying the microbiome are hesitant to make recommendations. In his groundbreaking article, however, Michael Pollan teased enough information out of his sources to discover “the outlines of a new diet.”

Near the end of the article, Pollan writes, “one of the keys to good health may turn out to involve managing our internal fermentation.”

How is this done? If you’re interested in trying a probiotic, I suggest inner-ēco™ Coconut Kefir--a food-based probiotic that follows Pollan’s advice of tending to “internal fermentation.” Another option is eating small amounts of fermented foods, like miso, tempeh, or pickled vegetables.

Recently, I have also tried a relatively new product, Restore. I cannot recommend this product enough. The effects have astonished me. My digestion has improved appreciably, and I am sleeping better. This is a simple addition to any diet.

Five Years: Symptom Free

"I have learned that when I feel awesome and other people are doing shitty I really have to remember how I felt when I was in their shoes-feeling depressed, hopeless, insecure etc and I have to be able to communicate effectively that they will overcome this and that stuff will be lost in the process." Crohns Boy

By the time I'd read this quote from "Crohns Boy," in mid-April, 2013, I'd already suffered two months of symptoms. I'd been to my doctor three times, and had, for the first time in my life, considered taking the potent anti-inflammatory drugs. I'd lost ten pounds, and had acquired the paperwork to take a LOA from work. Inspired by Crohn's Boy, I tried the probiotic enema on a memorable date, April 15, 2013: the day of the Boston Marathon Bombings.

That was Monday. By Wednesday, I was completely symptom-free.

I've remained symptom-free since then. (Update: As of August, 2018-five years later, I am still symptom-free).

I understand that the very nature of my illness might ensure a relapse--perhaps maybe even next spring. With each flare, and each recovery, however, I do believe I've learned to become a bit more human.

For me this means, specifically, an acceptance of that which I cannot control.

Each year, I learn to cede a bit more control to life as it is: radically imprecise, often downright messy. Bacteria, and by extension, probiotics and poop, have become metaphors for my growth.

That I can now talk about this so openly seems to prove the point--for me at least. 

Monday, June 4, 2018

The Art of Eating

"Tell me what you eat," Brillat-Savarin wrote, "and I will tell you what you are."

You might know this quote from the Japanese Iron Chef, where it appears in the opening sequence of each episode, accompanied by a solemn overture from Hans Zimmer's "The Arsonist's Waltz," which quickly cuts to the show's brash theme song, another Hans Zimmer song, "Show Me Your Firetruck." Both songs originally appeared in the 1991 film, Backdraft--an odd choice for Iron Chef, if you ask me, but also complementary to the odd spirit of the show.

(If you're interested, here's an a cappella version of "Show Me Your Firetruck.")

After the opening bombast, any viewer of the Japanese Iron Chef will quickly see: the tone of the show is bombastic, too. The show's most famous image occurs at the end of the opening sequence, when the host, Chairman Kaga, bites a pepper. From his quizzical expression, it's hard to say, exactly, what Chairman Kaga is thinking or feeling. In any case, it's a distinctly Japanese moment: to a Westerner's sensibility, bizarre and inexplicable.

Although the Brillat-Savarin quote feels apt for the show, the opening sequence, with its bravado and flaming torches, does not offer an entirely accurate association for Brillat-Savarin, let alone the tone of his masterwork, The Physiology of Taste.

In fact, Brillat-Savarin's work is equal parts bravado and self-parody--a fitting combination, I think, for any discussion of food and eating.

Thursday, October 19, 2017

Ella Loves Kindergarten

Ella has no talent for evasion. She reveals her emotions without the slightest artifice. Her happiness is so obvious, so transparent. She smiles, laughs, and skips--actually skips--across the room. When she is angry, the emotion is no less obvious, and the source is unmistakable. Often, I catch her glaring, with hooded eyes, at Owen. When angry with her parents, she retreats to the corner and pouts, her anger determining our mood like a bad weather pattern.

Since starting Kindergarten, in September, she has revealed new emotions, most notably a strong sense of self-esteem, obvious in her posture, how she straightens her back and tilts her chin upward when speaking about her lessons: counting and writing and coloring in the lines--oh, the profound importance of coloring in the lines!

I love it. I love everything about her school. I love the principal, Mr. Mac, who visited our house in August to read Ella a story. I love her classroom, with its primary colors, the gleaming metal pegs where she hangs her backpack, the low chairs, the smell of crayons and pencil shavings and books. I love picking her up after school, at late care, when we walk the corridors, poking our heads into classrooms, or the library, or the gym, which smells of decades of sweat. (The school was built in 1969, the year my brother Scott was born).

Ella loves it, too, though she spent the entire summer dreading it. One night in late July, before Mr. Mac had come over and after we had watched Spider-Man 3, she woke around 5:00 AM and padded into our room, crying.

"Mommy," she said, half asleep, "I dreamt of Venom. It was almost as scary as the principal coming to our house!"
But he came. And she survived. And now whenever Mr. Mac sees her, he shouts out, "Ella!"

Recently, when I picked her up on a Friday, after Mr. Mac had shouted across a hallway crowded with kids, "Have a good weekend, Ella," I stopped in my tracks to stare at Ella. She was shaking her head and smiling as she tightened her backpack straps to her chest.

My God, I thought. She is so proud.

I loved it. I loved her. It felt like the best moment of my life.

She looked up at me. "Daddy," she said. "STOP."

She knew what I was thinking--for I have no talent for evasion. In the hallway, surrounded by children, she was embarrassed by her father. And I loved that, too.

Originally posted on Facebook.

Monday, July 3, 2017

Thirteen-years Married

Thirteen-years-ago I married my high school sweetheart. Unreliable online data suggests high school sweethearts account for only 2% of all marriages. And less than 2% of people who marry their high school sweetheart earn a college degree.

That last statistic is significant (to me) for a simple reason: After I graduated high school (a year before Karen), we survived a five-year long-distance relationship. I lived in Bloomsburg. Karen lived in D.C. In a box in our bedroom closet, we keep a testament to this time: hundreds of hand-written letters.

The most difficult period, by far, was our first separation, during the summer of 1995, when Karen traveled to Mexico for six weeks and I entered Bloomsburg's "summer freshman" program. I dormed with Anthony, a football player, a truly unintelligent person, who had yet to discover the bacchanalian freedom most summer freshmen had abused for entire high school careers. Making up for lost time, he boozed nightly and rarely slept. Sleepless and depressed, I abused Tylenol P.M. I drank too much bad beer. I found sleep, though not of the restorative sort. Even then, no torment equaled my summer-long paroxysm of lovesickness.

Jerry Garcia died that summer: August 9. That night, when Jerry’s noodling droned in countless iterations from a hundred dorm room windows, the sound was indistinguishable from the mountain-rich blur of bugs, yet I recall walking across campus, from Shroomin's room to my own, excited for my appointed call to Karen’s host family’s place, and catching a snippet of “Box of Rain.”

Oh, how I hated the Grateful Dead. My feeling was: Good, stay dead. But Karen loved "Box of Rain."

Hearing the snippet was enough: I burst into tears. On the phone, minutes later, we cried together, not for Jerry, but for ourselves, for the lonesomeness of our long-distance call—one of many despairing, lovesick calls which reduced both of us, on any number of humid summer nights, to sobbing.

And that was just the first summer. Anyways: Here's to high school sweethearts! This image was taken last week in New Orleans, at the back of a streetcar. We were on our way to the Garden District to get drunk and eat tacos.

Originally posted on Facebook.

Wednesday, May 3, 2017

On the GOP's New "Healthcare" Plan

Of my various pre-existing conditions, type-1 diabetes is the most cost-intensive. In the GOP's new plan, my state can either continue the Obama-era protections for pre-existing conditions or place me (and others like me) into a "high-risk pool," as a way to separate me from healthy people, who can then enjoy lower premiums.

Here's what Andrew Gurman, the president of the American Medical Association, has to say about high-risk pools:

"Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage -- if they are able to obtain coverage at all."

Without coverage, I will pay out-of-pocket at least $500 per month in insulin and testing supplies alone. With insurance, under the new plan, my costs may be--what?

Trump said on Monday: "It will be every bit as good on pre-existing conditions as Obamacare."

Yet nearly every publication I have read, with the exception of The Wall Street Journal, disputes this fact. The Journal's opinion, contrary to the president of the American Medical Association, is that "high-risk pools are a fairer and more equitable solution."

Yet The Journal's editorial misstates the amount of money available to states for these pools as a "$100 billion." The real number is $8 billion, which is woefully inadequate according to nearly every healthcare expert. (Please correct me if I'm misreading this).

Implicit (to me) in so much of the debate about healthcare is that there must be "winners and losers," as if the health of other human beings is a game.

Also implicit is the notion that sick people do not "deserve" to pay the same premiums as healthy people--after all, why are we sick? I've actually seen this argument made against people with diabetes. What can I say? If you know me, you know I fight every single day to be healthy. And yet, I have several chronic illnesses--so, inevitably, on any given day, I lose my fight. That is the nature of chronic illness.

So what do I deserve as human being who requires care? Do I deserve the label (and attendant costs) of "high risk"? Or do I deserve to pay the same premium as my "healthy" friends?

Health care is not political. We all deserve health care. When we create distinctions between the sick and the healthy, we fail to recognize each other's humanity.

And just to say: I am not posting this picture of my infant son and me to be gratuitous or attract undue attention to my post. The point of the picture, to me, is simple: Healthcare is about caring for those who need it. And some require more care than others.

Originally posted on Facebook.

Monday, January 23, 2017

Invisible Illness

I talk and write about illness often, so I'm hesitant to say--with the lingo--that I have an "invisible" illness. And frankly, I'm not one to hide my illness. I lance my finger in front of friends and colleagues. I jab a needle into my gut wherever: a restaurant, a crowded street.

What I do hide is my day-to-day symptoms. At any hour, on any day, I might feel vertigo, bewildering fatigue, pain. I often have a headache. I rarely feel balanced. My symptoms stand opposed to the person I want to be, so I try to appear healthy, for hours each day, until I return home, when Karen, just home herself after a long day, suffers the burden of my efforts. I can be silent, mean. She's receptive, but not sympathetic. After all, she too suffers an "invisible" illness.

So we have an implicit understanding. We move on, ignoring our symptoms for days, weeks, months. We attend all the events. We host countless dinners. We welcome the world to our home. We do this, we tell ourselves, for life, for our children. We go on and on—until life makes us stop.

Two weeks ago, I woke with a pain in my chest. I thought of Uncle Dean, whose own heart troubles began in a similar way: one morning, a pain in the chest. The feeling, and the thought, were impossible to ignore. I could not take a deep breath. I tried, but some mechanism blocked me.

Already anxious, it was impossible for me to respond reasonably. I plunged into the woes: frustration, sadness, worry. For a few hours on a Tuesday, I was dying. I now admit I was suffering an “anxiety attack,” as my doctor called it—a diagnosis I had, at first, denied. I was certain I was experiencing Dean’s illness. Over fifteen years, I had learned to manage my chronic illnesses, yet these symptoms felt acute, and somehow the opposite of “invisible.” As I went about my life, I thought everyone could see—or worse, feel—my anxiety.

Oh, I thought, this is not the person I want to be. But since everyone could see, I thought, I might as well speak. So I started talking to people—at the grocery store; at the Y. One morning, some self-interested impulse made me confess my anxiety on Twitter. Friends responded with encouraging words. One friend wrote in a message: “Seth, I have suffered anxiety for years. My suggestion: find a picture of Owen and Ella. Look at it until the darkness passes.” And so I did exactly that. Whenever I felt anxious, I looked at this picture of Owen and Ella.

What I learned from talking and sharing, I think, is that many people suffer from “invisible” woes—and many, like me, do not share for fear of seeming vulnerable or self-interested. Oh, but how sharing healed! Even the simplest of words helped me feel less desolate, less afraid. Since then, the pain has subsided, my breathing has calmed. The darkness has passed. Be well, friends. If you feel a need to share, I'm here with open ears.

Originally posted on Facebook

Thursday, November 17, 2016

This Too Shall Pass

Around the time Ella was born, I heard a similar sentiment from many older parents--parents of teens, twenty-somethings, even grandparents: "Enjoy it now. Before you know, she'll be thirteen."

I enjoyed Ella, when I could, but really I just lived life. Day after day: writing, working, cooking. Each morning, I stepped outside to the same world of air and sun and sky, all the old things. Each evening, I drove home under the same stars and moon, so ancient and familiar--and consequently, so unremarkable. When I was away from home, my longing for Ella and Karen drove me to tears. At home, though, thrust into my duties, I balked. Changing diapers. Washing dishes. On my hands and knees, scrubbing the floor. I was filled, at the worst possible moments, with resentment.

This is not my life, I thought. I longed to be writing. Of course, we filled our lives with friends and family, the routine of love and food that sustains me. And yes, I was stunned by the speedy pace. Days, months, and years lapsed without my consent. We moved into our first house. Owen was born. Ella became a little girl. Karen and I learned to forgive--and so, to love--in new ways.

When something terrible happens, we comfort ourselves by saying, "This too shall pass." To be honest with ourselves, though, we know the same applies to the best of life. The birth of a son. The elated, drunken spree. The summer's first ocean plunge. Each fall, Thanksgiving. The winter pleasure of a merino wool sweater. Each spring, the poppies. This, too. This, too.

So I try. At my best, I enjoy it now. I let my children's reverence for the moment, for simple old things, sweep me up into that joyful realm of irresponsibility and glee. "Look, Daddy," Ella says. "A rock! A leaf!" "It's just a rock," I say. "It's just a leaf." But when I pick her up from daycare, I notice her cubbie crammed with rocks, with leaves of different colors: orange, red, brown. There's something going on here, I think. Something important. So I help her gather her treasures in a bag.

Now, as I sit writing, the bag is next to me, at once a pile of refuse and my child's miracle. Friends, Thanksgiving is a week away. I hope you find the time--and space--to slow down. I've never been the type to extol wisdom, but to echo the old ones: "Enjoy it now." I know I'm going to try my hardest. I also know: This too shall pass. All of it.

Originally posted on Facebook.