Intravenous Immunoglobulin (IVIG), Autoimmune disease, and they think they can fix me! (wait, what?!)

So in the ballpark of eight months ago, my GI sent me to cardio for POTS. This cardio clinic had a protocol for doing an echocardiogram on every new patient. I got the echo and my aorta was semi-enlarged. I was referred to genetics because of that and my hypermobility. Genetics sent me to pain management. Pain management did a ton of blood work and found some autoimmune markers (Gad65 and SSB). Sent me to neurology for consideration of IVIG.

While that massive backstory certainly wasn’t necessary, I still find it interesting how much the specialists bop around to other specialists before finding anything worth pursuing. I also use this sight to (sorta) record what’s happened, so anyway, now I’m verbosely explaining the explanation.

The real reason I’m writing this is because we think we may have possible treatment that could either really help or fix my problems! We met with the neurologist in early-mid August. She put me on a two week course of a bunch of prednisone. Prednisone helps with autoimmune diseases, so the idea was that it would show us a lot quicker and insanely cheaper if I may have improvement with IVIG. I took the two week course of the steroids and it helped significantly to tremendously with many of my symptoms. Because of this, we started the IVIG approval process.

Once it got approved I had my first treatment in early October. It was not easy. Because of MCAS, I had to do a really specific protocol to avoid serious side effects (namely aseptic meningitis) that made me take a ton of benadryl. So, obviously, I was exhausted. And a side effect of the treatment is exhaustion. And brain fog. And migraines (which I had for days). Of course, my school work didn’t let up, so that was stressful for me.

Apparently, my veins act veins act like an 80 year old’s. IV’s are difficult. They got an IV on poke #2 on day one and left it in until day three. With IVIG, they start it at a really low rate and work up to a higher rate. On day three, they were at the really low rate and my vein was hurting pretty significantly. The nurse decided to pull it and start a new one because that vein had been infused into for a while so it was probably leaking/’tired’. She managed to start the new one on poke #1, however, she dug around in my arm FOREVER. It worked well though.

I had a nasty (I think, don’t have much experience in the migraine department!) migraine on the days after the infusions.

Oh, I forgot to mention, they did it at home!! I preferred it so much to having to go to a hospital/infusion center. Home is much more comfortable.

So far, I have not seen too much of a change in symptoms. I do feel like POTS symptoms are a small amount better. However, it can take up to three months to take effect.

I am more writing this to document than anything else, it’s also late and I’m typing on my phone, so I hope it’s coherent!

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How I organize my medical supplies + post surgery update

So it’s been just over a month and a half since my surgery and I can officially say I am fully recovered. It went really well, but it was a tough recovery. They placed a low profile AMT G-Jet button, which was the absolutely best case scenario. They also did a salivary gland biopsy to check me for Sjogren’s. Fun fact: your lip is completely numb (like after a dental procedure) for up to two months after the biopsy. At least I don’t have to chew very much! Anyway, I have some pretty bad hospital anxiety after some traumatic experiences back in May, so that part was tough. Also, ‘oral’ (through my J tube) pain medications didn’t work very well in comparison to the IV ones. The one they normally do had no effect and the one that ended up working didn’t last for very long. The surgery was on a Tuesday and I was released on Thursday, so not too long of an admission, but longer than expected. I don’t have too many more details about right after the surgery, it’s all still a little hazy. I do know my stomach went into a bit of a worsened shut down afterwards. I went from being able to eat 600-700 liquid low fat low fiber calories a day to 100-200. I am working hard to get back to where I was, though. I am at 500-600 right now, so I am really proud of that.

I love going out in public and having no one stare at me. It’s kind of awesome. I used to (with my NJ that I had for 9 months) be used to having people just staring at me everywhere I went and asking the rudest questions. (I need to update my list!)

However, this new tube is taking some getting used to. I was used to NJ land: change tape every three days, flush through med port every six hours, pour food into bag, turn pump on. That’s basically all there was to it. And one of my NJs lasted over three months, so I WAS fastidious.

Now I have two extensions + cleaning and replacing extensions, meds through the tube (which is more work, but worth it), changing the dressing around the tube and cleaning it and skin around it, venting/draining, everything discussed above, daily taping, more syringes, basically more stuff, believe me, the list goes on!

I AM getting a system down, which leads perfectly into the second portion of this post!

I am going to talk at length with pictures about how I organize my medical supplies. This includes how I organize my time dealing with medical stuff because (and I forgot to mention this!) I started high school a bit over a month ago! I am doing an online public school and currently tackling seven credits including chemistry and biology. I’m working hard to not get behind.

First things first, I always push as much medical stuff as possible to the evenings or weekends. This is because I am so utterly exhausted by the evenings that I can’t do schoolwork well so I have to use as much of my mornings as I can. Here’s my to do list in the mornings:

  • Flush J tube
  • Disconnect J tube extension
  • Change sponge + clean around tube
  • Reconnect J tube and connect G tube (includes taping)
  • Take morning meds (I push as many as possible to the evening, I also pre measure my morning meds (there’s only 3) in the evenings to save time
  • Make tube food if necessary, otherwise get it out of the refrigerator
  • Fill bag, load with pump into backpack

That’s about all for the morning, and it takes under a half hour, which is really nice for optimizing my morning time! However, it does lead to a lengthy (over an hour and a half) nighttime list. Here’s what I do at night:

  • Flush G + J extension
  • Remove both extensions
  • Clean extensions thoroughly (my patented method (not) is rinsing with hot water, cleaning the outside with goo gone because they get tape residuals on them, rinsing with soap and hot water, flushing it with straight white vinegar and letting it sit for five mins, then w/ out cleaning the vinegar out flush multiple times with baking soda water. The chemical reaction is mild because the baking soda is diluted, but something about doing this cleans the residual gunk out really well)
  • Replace sponge and clean around tube
  • Reconnect G + J extensions (includes taping)
  • Clean syringes
  • Measure and take night meds
  • Measure morning meds
  • Count out calories for the day to calculate how much I have to run overnight
  • Make overnight mixture (this includes my regular tube food, green juice, coconut water, collagen powder, water, salt, and multiple meds that can’t be given in a bolus)
  • Make tube food for next day
  • Set up overnight mixture
  • Clean dishes, countertop, food scale, etc
  • Do all normal person stuff (brush teeth, etc.)
  • Clean up room and bathroom (they get incredibly messy in just a day with medical randomness and school)

Also, throughout the day, I vent air out of my stomach and that takes about 5-10 minutes each time. Every week I have to replace a whole litany of supplies. I always do it on Sunday. It is a lot easier to remember if there is only one replacement day.

I now have these systems memorized, but when I was developing them I would write everything I had to do down and arrange it in a good order. For example, it would be silly to remove the extensions and then need to take meds because it would require a lot more finagling.

The way I develop them is something I call ‘cleaning protocols’. They are incredibly simple. It has an area, for example, the medical area in my bathroom. It has different times (every morning, every night, every Sunday, every home health shipment) Then you write down everything you need to do on the appropriate field. I shared my morning and evening ones for my medical area above. I include deeper cleaning on the weekly and monthly (every home health shipment). This keeps everything super clean, organized, and on track pretty consistently. I laminate them and check things off with wet erase markers until I have them memorized. Here’s a picture of the cleaning protocols for my room:

 

I am going to move on from cleaning and medical tasks and show some pictures of my supply organization. It’s quite elaborate, if I do say so myself 😀

 

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This is my main storage area. It is a Pax from Ikea. It holds about 20 Kate Farms Peptide, my Cromolyn (it’s space consuming), sparkling water/green juice/coconut water, bags for food, farrell bags, extra syringes, extra sponges, alcohol wipes, adhesive remover, extra extension sets, extra clorox wipes, etc.

 

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This is my sink. I use the blue sponge for cleaning dishes and the yellow sponge to clean the sink itself and counters.

 

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This is my main supply area. It holds the things I use multiple times a day and need to grab quickly. From the bottom left: Adhesive remover and alcohol pads, syringes (side note in regards to syringes: I took a jar filled with marbles and stuck big straws in it. Put the main part of the syringe (not the plunger) on the straws and they dry a lot easier and tidier.), q-tips, syringe/tubing caps, extra partial meds, colored stickers, and sponges.

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This is a second supply area that’s a little less medical. I have a pencil cup with scissors, pencils, highlighters, etc. I also have some medical tape with some sharp scissors to cut it better and a dog hair roller because I’m allergic to the dog so if I get dander on my clothes I need to take it off…obviously. I’m not sure that needed an explanation.

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This is a vinegar rinse I use to keep things clean. It is a 1:3 ratio of vinegar to water and I change it weekly.

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Extension cleaning supplies. Vinegar and baking soda water.

These are my drying racks. The smaller one (left) holds things like my cup for flushed and medicine cups. The big one holds large/less used dishes. I use my drying rack to store the dishes because I only have enough dishes to not quite fill the racks and I don’t have enough storage space to put it all away. Plus, putting it away is time consuming!

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This is my medicine drawer. It holds medicine. Fun/useful hack: Take a pill minder you aren’t actively using and fill each day with one type of pill each. Then put a sticker on it and label it. This is easier because it consumes less space and you don’t have to open and close lids.

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Tape, tube clips, etc. I really like grip loks for holding my tubes up. I support them with paper tape (only tape tape one I’m not allergic to, but I used to like transpore). I don’t know why tegaderm is still in there, I’m allergic to it now.

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This is like my counter top. I have a brita water filter in the refrigerator that I fill the pitcher with. Hand sanitizer because sometimes I need to really quickly clean my hands. Using a scale is so much easier than using measuring cups/spoons. I just know how many mLs to put in and it’s more exact anyway. I use blender bottles to mix my tube food up with. I have to add a lot of salt and some meds and they have a little whisk that gets it really well incorporated. I also water it down because it is really thick and I don’t end up getting enough fluids with the densenesness. This is a largeish nightstand that is wood, so I put an Ikea plastic desktop cover on top (kinda like a placemat but it has grippy things on the base so it doesn’t slide around. It’s also quite large.).

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This is a towel holding rod (not sure what to call it!). I have paper towels on the rod (I think that’s the most creative idea I’ve come up with, it’s very convenient.), Clorox wipes, and a VERY multipurpose washcloth. I use it for spills (yes, the yellow stuff happens to be intestinal fluid. I change it daily.), wiping countertops down, etc.

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The trash area looks horrible but it’s really necessary. I put it in the weirdly large bathtub I never use. There is trash, compost, plastic recycling, and commingled recycling. They are all necessary, or otherwise I spend hours every week sorting trash. We believes strongly in recycling/composting (did you know you can compost paper towels?!?), so this is a good system for me, and I have tried MANY.

Last but not least, you have my awesome and tiny mini fridge. I actually LOVE it. It is down the hallway from me because I can spend an entire day hardly moving in my small spaces, so it forces me to walk around. It has the brita filter mentioned above, sparkling water, juice, tube food, meds, oral ‘foods’, etc.

 

If you made it all the way down here to the bottom of this long post, I want to say I’m impressed. I am a bit of a rambler sometimes.

 

I hope this post is to you what I needed nearly a year ago and first got my tube. I was desperately in need of some ideas so if this helps even one person, that would be awesome!

See? I rambled again.

12 invaluable tips and tricks for NJ tubes (and plans for surgery!)

I am saying goodbye to my NJ in one week after over EIGHT months with NJs. I will be getting a GJ tube on the 21st. I think I am excited. I mean, the recovery is going to be no fun, but the overall benefit is pretty high! I am going to take a minute to write a little list of upsides:

  • Gastric decompression
  • More discreet; less stares
  • Less frequent replacements
  • Not in my nose
  • Not as easy to displace
  • No tape on my face
  • Once healed, it’s easier to swim with (tangled in goggles, swim cap, hair; much worry about it getting caught)
  • Not so bad with colds

Because I have had a very long run with NJs, I thought I’d write about some tips and tricks I have to make the ‘nose hose’ more comfortable!

  • When you are getting it placed, always soak your nose with saline spray first and ask them to use the lubricant on the whole tube instead of just the tip. This helps massively!
  • After a few weeks, my ear was getting floppy and sore from always holding a heavy tube up. Now I always wear cloth headbands to hold the tube up. Before you connect the tubing, put the headband on. The tube should go behind the headband and then when you connect the bag’s tubing the headband will hold it up instead of your ear.
  • Always keep everything in the backpack. It is just so much easier! I have command hooks hung up everywhere to put my backpack on, and of course I can hang it on the IV pole. I spent the first month or two hauling an IV pole around everywhere I went. It was grueling.
  • The infinity pump is one hundred thousand times nicer than the kangaroo pump. Specifically request it right away. It is practically silent and it is incredibly lightweight.
  • There is a type of tape called mepitac and it is super soft. I almost always put it under my tube and I fully believe that is why all of my face skin hasn’t just fallen off. I also put tegaderm on top, and it works really well, though it is really annoying to remove. I have done some IV3000 and it is fine, just not waterproof. I don’t recommend transpore, because it is really itchy.
  • Never put durapore on your face.
  • Your nose and throat will hurt and be congested and make colds twice as miserable. Put antibiotic cream (neosporin, mupirocin) in your nose to prevent infection. Use nasal saline spray to keep it moist. If you are able, drink warm drinks (even warm water). This helps because you have mucus going down your throat because of the cold. It likes to stick to the tube and harden onto it. The warm drink helps it soften and come off. Cold liquids, ice, and popsicles help with throat pain a lot too.
  • If you have POTS, put your salt down the tube. It makes it so easy!
  • Get a routine. I always mix up my tube food in the same way, or otherwise I mess up. I always flush it at certain times (like after brushing my teeth) or otherwise I forget. It helps to write these routines down.
  • When people stare at you, stare at them right back. Hard. They then realize how rude they were being, get uncomfortable, and look away. After that, sometimes they say something weird about it. It’s kinda funny. You have to make the staring somewhat funny, because otherwise it makes you SO uncomfortable to be out in public.
  • Appreciate all that the tube does for you and be at peace with it. The first 3-4 months I hated it with a PASSION. Hating it just makes it harder to deal with. After I hated it, I developed a love-hate relationship with it and that wasn’t much easier. Now I am at peace with it, and it is so much easier to cope with. With that said, I am very excited for it to be off my face!
  • If you run stuff at night, you want the tubing parallel to your body, not perpendicular. When I first got the tube, I put the IV pole right by my head. I would frequently wake up with tubing wound around my neck from tossing and turning. If you put it near the foot of the bed, it can’t get wrapped around you.

#annoying, #calorie, #calories, #chronic, #chronic-illness, #enfit, #feeding-tube, #feedingtubeawareness, #gastroparesis, #mast-cells, #medical, #nj-tube, #pots, #rare-disease

I’m nervvvous…

  • I’m going to a different hospital three hours away.
  • It’s going to be a new doctor.
  • I’m going to be admitted.
  • There is anesthesia.
  • There is a new tube placement.
  • There is a manometer placement.
  • I will not be allowed to move for 24 hours.
  • I have to consume 400+ calories in less than 30 mins.
  • I am going to be given medicine that I showed an allergy to.
  • If it’s normal than they probably won’t have much to help me.
  • If it’s abnormal, they don’t have great solutions either.
  • All of this in less than 48 hours…

I am going to be getting antroduodenal manometry on Wednesday. I will try to remember to take some pictures of the whole thing and write a post afterwards. Here’s the schedule:

Monday: Clears all day and drive to a hotel near the hospital for the night.
Tuesday: Get endoscopic placement of the manometry tube. Spend the day waking up. Be admitted. Try to sleep that night.
Wednesday: Bright and early they start recording. At 10 am I have to eat the 400 cals. At noon they give me a motility stimulant. At two they give me a different one. The test is over at four. The doc should tell us the results. Then they attempt to put my NJ back in. Then I get discharged. Go to the hotel and sleep overnight.
Thursday: Drive home. Be done.

Random thoughts:

A friend gave me a reusable tourniquet for starting the IV. It is pretty cool! I think these are similar: https://www.amazon.com/Hooshion%C2%AE-Emergency-Tourniquet-Activities-Multi-color/dp/B016B5QN0I/ref=sr_1_2_a_it?ie=UTF8&qid=1526170835&sr=8-2&keywords=reusable%2Btourniquet&th=1

I plan to run an odd mixture of bone broth, collagen, coconut water, and saline through my tube on Monday for some protein and to keep my sodium and fluids up. Here’s my recipe:

3 C bone broth
4 T collagen powder
1 C coconut water
1.5 C water
1 t Himalayan pink salt

That will provide me with:

300 calories
51  grams of protein
2.5 gr sodium
44 ounces of water

…which is pretty good considering the fact that they are clears! (You can tell I spent a lot of time coming up with that recipe.)

 

 

 

I have a really awesome suitcase that I am using to hold my stuff: https://www.amazon.com/dp/B016IO9O9O/ref=twister_B0779B999Z?_encoding=UTF8&psc=1

 

 

 

Of course I will use another one of my awesome enfit tubes! https://www.vitalitymedical.com/corflo-ultra-lite-ng-with-enfit.html It’s the 8 FR. 43 Inch Length 3G wt w/ Stylet.

 

 

 

The long and short of it is that I am just incredibly nervous. I have anestesthia, radiology, new doctor, and admittance, all mixed in to just two days. The good news is, this test could bring me some answers I really need, and help find some treatment to have me feel better! (And then my nervous brain says ‘What if I get a false negative?!?’)

 

 

(That post had no spine and probably didn’t make incredibly much sense, but it was helpful to write down what I am nervous about)

#chronic, #chronic-illness, #cooking, #dairy-free, #enfit, #feeding-tube, #gastroparesis, #gluten-free, #manometry, #medical, #medical-testing, #nj-tube, #orthostatic-hypotension, #pots, #rare-disease

DO NOT call it ‘formula’ and my other tubie pet peeves

I have no idea why, but I hate it when people call my tube food formula. I guess it’s probably because it sounds like it’s for babies. I know the word formula simply means a formulation of food, but it still really upsets me! Also, I don’t like when people say you are ‘feeding’, because it sounds very animalistic. What do dislike people saying about your tube?

Current running list of what the tube itself has been called:

Line
Hose
Stick
Strap
Thingy
Yellow strip
Weird thing in your nose
String
Flotation device (no joke – I was in the pool and this older woman comes up to me and asks how it helps me float. I absolutely COULD NOT figure out what she was talking about until she finally said ‘the yellow cord on your face’. I explained to her that it doesn’t help me float, it’s not for swimming at all. She acted like she didn’t believe me.)

And my favorite:
Why do you have a pencil in your nose?

And some sweet little kid even told me:
That looks owy!

Some rude older lady asked me, “What is THAT?!” I kindly explained it is a feeding tube. Her response: “I guess you’ll be slender forever!” No, ignorant person. Just no. So many things wrong with that comment!

And then of course there is the stares…

#annoying, #chronic, #chronic-illness, #cool, #dairy-free, #enfit, #feeding-tube, #feedingtubeawareness, #gastroparesis, #gluten, #gluten-free, #mast-cells, #mcad, #mcas, #medical, #nj-tube, #orthostatic-hypotension, #pots, #rare-disease, #wheat

My crazy NJ month

So, about a month and a half ago, I passed out, and my NJ tube got caught on something and was pulled out of my intestine. We spent five days trying to push it back in, and it just Would. Not. Descend.

So I had to go to radiology to get it ‘fixed’. They couldn’t fit the wire in because it was too old of a tube, so they had to guide it without a wire. That didn’t work, of course, we had been doing that for five days! So I had to pull the tube all the way out, and they had me choose a new one. There was what I already had, and one other that didn’t have a medicine port (one of the banes of my existence), and it was ten cm. longer. So I chose that one. And let me mention that I was coming down with the flu that day, and I had a low grade fever, so my decision making might not have been the best. But anyway, this tube was PVC and super stiff. They guided it right into my intestine, which has never happened before!

The new tube worked great. (except for the fact that it was very uncomfortable)  But nine days after placement, the connector at the end popped off. We spent multiple days trying to find a replacement part to no avail. They literally do not fix nasal tubes.  So I pulled it out.

Before replacing it, we decided to research and find the best tube possible. We did. It is absolutely awesome. I have the CORFLO ULTRA Lite NG with ENFit 8 FR. 43 Inch Length 3G wt w/ Stylet. The part number is 40-7438. Getting ahold of this tube was a time consuming pain. First we asked my home health company to supply it. They said I needed a prescription so we wrote a prescription and got my doctor to sign it. They sent it to my home health company. My home health company had to order it. And… of course they sent the wrong tube. They sent the non enfit tube. I really didn’t like it. Home health informed us they can not get ahold of the tube requested. So my dad ordered it from vitality medical. They only sell TEN packs, so he ordered a ten pack. Unfortunately, we needed a prescription to buy it online as well. The prescription had to be changed, though, because we were ordering ten tubes. So the prescription had to be signed again. Then we waited for the tubes to come.

The day after they came, we went to radiology to get it put in under fluoroscopy. They absolutely could not get it into my intestine (because of my gastroparesis, nothing passes through my stomach without a fight), so they gave it some slack and asked me to come back the next day. The next day, it was still in my stomach (of course). They reinserted the wire and pushed it around a bunch. It finally went in, which was an unexpected surprise!

Later that SAME DAY, I went swimming. I dove into the pool (which I do all the time), and my goggles broke. They caught my tube and it got pulled about 5-8 cm. I didn’t get too worried, I thought it would definitely still be post pyloric, even if it wasn’t as far down. I pushed it back in and crossed my fingers.

When I got home and started using it, I started to get really full and nauseous, so I checked the placement by pulling some of the contents out of the tube and seeing what they were. I also did a whoosh test and a few very large water flushes. I concluded that it wasn’t fully where it needed to be, but that it was still post pyloric, just back flowing into my stomach a bit. I pushed it in another ten cm to help it get back down to my jejunum.

Now, after some research, I don’t think that was the best choice. If you have a tube in your duodenum, and you push on it, it hits a tight bend in the intestine. If you push it into this bend, the tube loops back around and goes into your stomach. I think this is what happened, but I can’t be sure. I now think the tube is fully in my stomach. So I am currently running tube feeds incredibly slowly into my it.

In normal circumstances, we would now go get it replaced AGAIN. But I am going to get antroduodenal manometry in less than a month, which entails pulling the tube out. It simply isn’t seeming worth the radiation/ anesthesia to have it only be used for 2-3 weeks.

And that brings you to where I am now. Crossing my fingers that it will descend into my intestine on its own (which it probably won’t, because it has never done that in the past.) Ug, it’s been a frustrating month!

#annoying, #chaotic, #chronic, #chronic-illness, #dairy-free, #enfit, #feeding-tube, #feedingtubeawareness, #gastroparesis, #gluten, #gluten-free, #mast-cells, #mcad, #mcas, #medical, #nj-tube, #rare-disease, #ug, #wheat

Some really good motivational quotes :)

I really like these quotes. They are especially relevant to illness, but they can relate to anyone.

 

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

Whether you think you can or you think you can’t, you’re right.

The best revenge is massive success.

People often say that motivation doesn’t last. Well, neither does bathing.  That’s why we recommend it daily.

Never let the things you cannot do prevent you from doing the things you can

You either get bitter or you get better. It’s that simple. You either take what has been dealt to you and allow it to make you a better person, or you allow it to tear you down.  The choice does not belong to fate, it belongs to you.

You are strong when you know your weaknesses. You are beautiful when you appreciate your flaws. You are wise when you learn from your mistakes.

Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.

We are stronger in the places we have been broken.

The reason why people give up so fast is because they tend to look at how far they still have to go, instead of how far they have gotten.

If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.

When you have exhausted all possibilities, remember this: you haven’t.

Maybe life isn’t about avoiding the bruises. Maybe it’s about collecting the scars to prove that we showed up for it.

Normality is a paved road. It’s comfortable to walk, but no flowers grow on it.

I can’t tell you when, but I can promise you it will get better, it will get easier, and it will all be worthwhile. Just promise me you won’t ever give up.

Live to inspire, and one day people will say, because of you, I didn’t give up.

Be soft. Do not let the world make you hard. Do not let pain make you hate. Do not let the bitterness steal sweetness. Take pride that even though the rest of the world may disagree, you still believe it to be a beautiful place.

She made broken look beautiful and strong look invincible. She walked with the universe on her shoulders and made it look like a pair of wings.

Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’

Regret for the things we have done will be tempered by time. It is regret for the things we did not do that is inconsolable.

Our greatest weakness lies in giving up. The most certain way to succeed is always to just try one more time.

It’s about the journey.

If you’re going through hell, keep going.

What doesn’t kill you makes you stronger.

You either get bitter or you get better. It’s that simple. You either take what has been dealt to you and allow it to make you a better person, or you allow it to tear you down. The choice does not belong to fate, it belongs to you.

The truth is we’re all a little bit broken. We must learn to love the broken pieces of ourselves – be gentle and empathetic with ourselves, and others.

Hope doesn’t require a massive chain where heavy links of logic hold it together. A thin wire will do…just strong enough to get us through the night until the winds die down.

Nothing is more beautiful than a real smile that has struggled through tears.

Don’t forget you’re human. It’s okay to have a meltdown, just don’t unpack and live there. Cry it out and then refocus on where you are headed.

Some days are better, some days are worse. Look for the blessing instead of the curse. Be positive, stay strong, and get enough rest. You can’t do it all, but you can do your best.

The strongest people I’ve met have not been given an easier life. They’ve learned to create strength and happiness from dark places.

We are stronger in the places we have been broken.

I don’t want my pain and struggle to make me a victim. I want my battle to make me someone else’s hero.

Maybe it’s not always about trying to fix something that is broken. Maybe it’s about starting over and creating something better.

Do not believe the things you tell yourself when you’re sad and alone.

If you stumble, make it part of the dance.

Never let the things you cannot do prevent you from doing the things you can.

Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.

A woman is like a tea bag: You never know how strong it is until it’s in hot water.”

She believed she could so she did.

The secret of life, though, is to fall seven times and to get up eight times.

Time is priceless, but it’s free. You can’t own it, you can use it. You can spend it. But you can’t keep it. Once you’ve lost it you can never get it back.

Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.

Look at a stone cutter hammering away at his rock, perhaps a hundred times without as much as a crack showing in it. Yet at the hundred-and-first blow it will split in two, and I know it was not the last blow that did it, but all that had gone before.

Nothing is more destined to create deep-seated anxieties in people than the false assumption that life should be free of anxieties.

The truth that many people never understand is that the more you try to avoid suffering, the more you suffer, because smaller and more insignificant things begin to torture you, in proportion to your fear of being hurt.

The world is more magical, less predictable, more autonomous, less controllable, more varied, less simple, more infinite, less knowable, more wonderfully troubling than we can ever imagine.

Many of life’s failures are people who did not realize how close they were to success when they gave up.

Courage is not having the strength to go on; it is going on when you don’t have the strength.

Something will grow from all you are going through and it will be you.

Success is not final, failure is not fatal: It is the courage to continue that counts.

You may be the only person left who believes in you, but it’s enough. It takes just one star to pierce a universe of darkness. Never give up.

Health is like a crown the healthy wear, but only the sick can see it.

It’s like swimming upstream every moment you are awake.

She was always fighting a battle but her smile would never tell you so.

And here you are, living despite it all.

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