Wednesday, July 12, 2017

Medication is Risk vs. Reward

At some point many special needs parents have to make the decision about whether or not to medicate their child for their condition.

This is never an easy decision.

I mean, there'a s lot of shit to take into consideration. Immediate side effects. Long term side effects (Thalidomide was a wonder drug for women suffering extreme morning sickness, until the babies started being born with phocomelia). Stigma. Costs (at one point, the cash cost of R's meds was $1000 per month). Other treatment options.

Recently, someone in an epilepsy parent support group on Facebook asked about the choice to medicate (or not). This is my answer:

Medication is risk vs. reward. 

Medication has been a positive experience for us. We went from hundreds of seizures per day to 2-3 per day now. Before we found a better med combination, he would be so disoriented after an absence seizure that he once almost walked into traffic. But our meds aren't perfect. They don't give us 100% control, and his current side effects include a tiny appetite (but better than the tremor and hair loss he experienced from previous meds). But it's better than him never being able to be more than a few feet from someone else because of worry that he would get hurt as a result of the disorientation. It's better
than us trying to find a way to make pool noodles stick to the corners of the walls because he would often run into them just walking to the bathroom. It's better than him missing 40-90% of what his teachers were saying. It's better than him starting the same sentence ten times because he's clustering so quickly he doesn't realize he's already said those words. It's better than him spending hours on my lap or laying with me on the couch because his brain is rebooting every 6-10 minutes from a seizure and it's scary to him to lose time like that. Today he's sitting in the living room while I'm in my bedroom, watching a show he loves on Netflix, after doing some typing exercises for Occupational Therapy, and his chores, which include putting away dishes. He'll make his own lunch soon (he's 11), which he couldn't do for awhile because he would forget what he was doing (the microwave died when he forgot to put his food in it before turning it on). After lunch, we'll do some reading/recall, again for Occupational Therapy, and if it cools off enough we'll go outside and play (which we still have to do together because he does still have some seizures and we don't have a fenced yard). He may need services for the rest of his life, but what we have today is 1000 times better than what we had a year ago, and that wouldn't be possible without meds.

I can promise you that I am most definitely a hippie mama. My house is fully stocked with medicinal teas, herbs, and essential oils. Just like you, I want the best for my children. When that means caring for a cold or muscle sprain, I most definitely go for the crunchy methods. But epilepsy? I'm not willing to risk the long term effects that could happen by playing with herbal remedies for that. No. 

There is a time and a place for crunchy cures, and there's a time and a place for medications. You'll have to make that decision for yourself. But for us, it was a no-brainer.

Friday, March 31, 2017

What is Essential Thrombocythemia (Essential Thrombocytosis)

I've mentioned a few times that my daughter suffers from Essential Thrombocythemia, also known was Essential Thrombocytosis. Every time I say or write those words, people look at me as if I'm speaking a foreign language. Even my spell check doesn't recognize either of those words.

The short version is that Essential Thrombocythemia, or Essential Thrombocytosis, is a condition in which your bone marrow produces too many platelets. Platelets are the components of your blood that make your blood clot when you cut yourself. They're the reason we don't bleed to death when we do something stupid like hold the bagel wrong while we're slicing it, or cut off the tip of our finger
Blood cells
when we're using a meat slicer. Clots are good!

However, clots can also be bad. Clots are what cause strokes, because blood clots form inside of veins and cut off oxygen to the brain. Clots can cause pulmonary embolus or can lodge in the heart or lungs.

My daughter, forever known here as A2 (because she's the second child with the first initial of "A") was given a diagnosis Essential Thrombocythemia when she was nine. We suspect she may have had it for longer. Here's her story:

A2 started having headaches that I thought were migraines when she was six. We have a family history of pediatric-onset migraines, so it really didn't strike me as strange, although there's no doubt that it sucked. We took her to the doctor, and we had an eye exam that showed no problems. Doc suggested that dehydration was probably contributing, and we moved on. They eased quite a bit once we started making sure that A2 got plenty of water every day.

When she was eight, they came back with a vengeance. We again took her to see a doctor who said she was probably deficient in magnesium. On her orders, we started treating her with a daily magnesium supplement and giving her Milk of Magnesia when she got a headache. While the MoM helped her headaches, the magnesium supplement did little to change the amount of headaches. We went back to the doctor and she suggested more magnesium and a B vitamin. By this time, I was a little pissed that we hadn't been referred to a neurologist and she hasn't done blood work; in short, she was guessing about the magnesium deficiency. Some weeks, A2 was having three headaches a week. We decided it was time to switch pediatricians.

While we were waiting for our new patient appointment, she got a headache so bad that we took her to the ER. The ER doc suggest caffeine in the mornings and daily ibuprofen until we could get in to see a neurologist. He put in a call to our new pediatrician, and was able to expedite our appointment. Our new pediatrician immediately ordered an MRI, did a blood draw, and gave us a referral to a neurologist. He called the next day and told us to stop the magnesium and B vitamin. Her levels of mag were high, and her levels of B were stable. His nurse called a few days later and told us that her platelet levels were high, and that they were referring us to another doctor. She gave me the number and told me to call to set up an appointment.

I was a little nervous. The nurse, who I've known since she was in junior high school, wanted us to be sure to call the new doc today. Said it was urgent that we get her seen as soon as possible, even though it meant driving over four hours to the specialist. I called the doctor's office and they answered the phone "Rocky Mountain Pediatric Hematology/Oncology Clinic." I almost dropped the phone. I scheduled the appointment. I remember thinking that my voice sounded funny. I debated calling my husband, and then decided that this was "in person" news, not phone news.

I can tell you, I've had some moments as a parent when I've been knocked for a loop. My oldest kid routinely ended up in the ER because she inherited my inherent gracefulness and managed to fall down or bump her head hard enough to knock herself out or some other goofiness several times during her late teen years. Seeing her in an ambulance was scary. Seeing my son having a convulsive seizure in my hallway was scary. But those are fear in the moment kind of things. You're scared and then things calm down and the fear eases somewhat.

But knowing that your child has an appointment with an oncologist? That shit doesn't ease. It sits there, marinating in the dark recesses of your brain, where every single ugly, negative scenario that you can imagine plays out in high definition slow motion agony. I called my BFF and confided in her, then tried to get my shit together to go pick up the kids from school. Once, when I was in high school, a cute boy said hi to me and I felt all of my marbles fall out of my brain. I couldn't think of a single reply. I just stood there, smiling, trying to remember what I was supposed to say to reply to him. Now, as an adult, I spent much of the afternoon of that phone call trying to find my marbles, but every time I found a few, they would scatter all over again.

I didn't actually recover all of my marbles until a few days later. I had to wait to tell my husband, because I wasn't yet emotionally able to offer the support I knew he would need. I barely had all of *my* marbles together; there was no way I could help him pick up his when they fell.

Essential thrombocythemia is generally diagnosed through elimination. First, we had to have another blood draw at the oncologists office. Often, high platelets are caused by something going on inside the body. This is known as reactive thrombocythemia or reactive thrombocytosis. Our doctor noticed that A2 had a low ferretin level, which both could cause the high platelets, and could cause her headaches. She immediately put us on an iron supplement, and scheduled us for another blood draw (we did most of our follow up blood draws locally, thank goodness).

In the meantime, she had an MRI, which came back clear. When we saw the neurologist, we gave him the CD of the MRI, and he said that she was young for pediatric onset migraines, but that it wasn't unheard of. He prescribed Maxalt and anti-nausea med, and told me to call him if anything changed. He told us we could stop the caffeine and the ibuprofen, but the oncologist had told us to keep taking the ibuprofen, because it makes platelets less sticky, so they are less likely to form a clot.

This continued on for several months. A2's platelet levels continued to climb. After four months, our doctor had us come back up to Denver where she did another exam and then did a blood draw for a genetic test. If A2 had indeed had reactive thrombocythemia, her platelet level should have returned to normal either with time, or with the iron supplement. Instead, her platelets had continued to go up. She told us it would take six weeks for the tests to come back. It took almost eight.

Finally, we had our diagnosis. Essential thrombocytosis, positive for JAK2 mutation. Our oncologist switched A2 from ibuprofen to aspirin, because aspirin does a better job of preventing clots than ibuprofen. Of course, we were hesitant about that choice, because aspirin causes Reye's Syndrome. So not only did I need to read about her new diagnosis, I needed to read about this as a possibility. Most people diagnosed with Essential Thrombocytosis are over 50; taking aspirin is no big deal for them.

We were about to learn just how rare A2's cancer is. I joined a Facebook group for Essential Thrombocythemia, and found only a handful of parents there. The vast majority of members in this group were in their 50s or older. The few parents in the group started chatting, and before long we formed a group for pediatric onset essential thrombocythemia. I learned that A2 is one in ten million, and most of the treatments available to her weren't proven; there were hardly any studies on life expectancy of children who developed this form of blood cancer, because there have been so few cases. Of the few parents in our Facebook group who are active, only a couple are from the United States. The rest are spread out throughout the rest of the world.

For the worries about Reye's Syndrome, we were cautioned that A2 should not get the flu or chicken pox. For the first time, we all got the flu shot in 2016. Chicken pox is no problem, since she's vaccinated for it. We put together a health plan with the nurse that explained to teachers that they needed to watch for signs of deep vein thrombosis or stroke. It's odd that I have a ten year old child who is at a much higher risk of stroke than most elderly people I know. Because of her aspirin therapy, we also have to make sure she doesn't get cut badly.

In November, A2 had a bone marrow biopsy and an ultrasound of her spleen. This was a relatively easy procedure (the bone marrow biopsy was done under general anesthesia) done at Rocky Mountain Hospital for Children. Everything went well. No scarring of her bone marrow and her spleen isn't enlarged. Her platelets continue to climb (as of this writing her platelets are 1,453,000; normal is around 350,000). We are considering obtaining a second opinion; it's not that we don't trust our oncologist, it's that this is so rare that we're concerned we may be missing a treatment option.

Mostly, we just keep going. Some days, she's really tired. She has random bone pain that is probably due to the Essential Thrombocythemia. We met with our local first responders to make sure they understand how critical her situation is; that way we don't worry about them thinking we're overreacting if we call 911 because she's having stroke symptoms. Because yes, our ten year old could actually have a stroke. We've changed our diet to be more healthy; less gluten, more whole grains, more raw vegetables, etc.

Whether you're the parent of a child who has a diagnosis of Essential Thrombocythemia (or Essential Thrombocytosis) or an adult who has that diagnosis, I've put together some links you may find helpful.

First, read my post about what to do if your child is given a shitty diagnosis.

This .pdf, from the Leukemia and Lymphoma Society, is a great starter information sheet for caregivers including school nurses and teachers.

This site gives a broad overview of ET.

This site has a pretty comprehensive FAQ about ET.

Voices of MPN is a great site put together by Incyte Corporation. They send you brochures, bracelets, and ribbons to help you build awareness.

National Cancer Institute has some good resources, too.

Facebook Essential Thrombocythemia Group

Facebook Pediatric Onset Essential Thrombocythemia Group

Friday, March 24, 2017

What to do when your child gets a scary diagnosis

You might be here because you were recently given a diagnosis that scared the shit out of you. You might feel pretty overwhelmed or like you don't know what to do next.

In 2016, my youngest son was diagnosed with epilepsy (and he had already been diagnosed with asthma and autism). It was scary and overwhelming and I was utterly filled with a mess of emotions that included fear and even rage. What the hell was going on? Why us? Could this be wrong?

Nine months later, my youngest daughter was diagnosed with a rare blood cancer called Essential Thrombocytosis (aka Essential Thrombocythemia). Not only is this a rare condition over all, but it's what our oncologist called an "old people's disease." It was one of the last things she tested my daughter for, because it's that rare. A2 is literally one in ten million.

So I know what you're feeling right now.

You're not sure what to do now that you have this shitty diagnosis.

First, you need to give yourself permission to feel however you feel. It doesn't matter *how* you feel. How ever you feel is the right way to feel, and you should never, ever let anyone tell you that your feelings are invalid. Cry. Rage. Go out into a field and scream. Break something. Just *do not* harm yourself or anyone else. Or break something that you might regret later, like Aunt Jane's precious vase or, you know, the car. Feel those feelings. It's okay.

Next, you need to put on your big girl panties (or big boy boxers, whichever you prefer), stand up, and take one step in the right direction. This seems like a small thing. Moving toward acceptance or positivity or action or wherever the right direction is for you seems like it's pretty easy, once you've given yourself a moment to feel your feelings. But I'm going to tell you that the first step is a bitch. You're going to think you've taken it, that you're moving forward, when all of the sudden you're knocked on your ass again and you are back at your starting point. The pain, the anger, the fear is real, my love, and the first step is really hard.

At some point, you're going to need to tell someone that's not your spouse (or your kiddo's other parent, no matter your living arrangement). Someone who can be supportive of you. This might be your best friend, or your parent, or your neighbor. Pick carefully. You need support right now, not questioning of your information or motives or choices. Because right now, you may be busy supporting your spouse or your sick kiddo. It's essential that you tell someone. You need support more than you know. Especially because it's gonna get a bit tougher for awhile. If you don't have anyone, start with me.

You will want to lock down your social media. R.'s second seizure was at school. People knew what was going on before we made it to the hospital. We left the hospital with our diagnosis and a lot of unanswered questions. Once we were home and had some time to process, I logged into Facebook to tell *my* person and I had a dozen friend requests from people affiliated with our school (either parents or staff). I thought "Wow, these people really care about my kid." But none of them ever actually said anything. Not even a "Hey, we're thinking about you." They just wanted to be nosy.

Be prepared for disappointment. We very quickly learned who are true friends were. We had countless messages in those early days, from people wanting to know how they could help. In the early days, we were too overwhelmed to know how to answer that question. But in the following weeks we began asking for help-and got a lot of silence in return. We were, and remain, grateful for every bit of help we got.

Be prepared for small things to overwhelm you. I went to our local grocery store and the cashier, who we've known for ten years or more, said "Oh, hang on, I have something for you." She walked us out, and grabbed an envelope out of her truck. It was a hand-written note from her elderly mother, letting her know that she was praying for us. I broke down sobbing right there on the sidewalk. In the midst of all of the looky-lous and the crickets resounding from those who had offered to help but backed out when we needed them, the gesture of offering prayer, and taking the time to write me a note, meant everything.

You may want to hide for awhile. For several weeks, we just kind of closed in on ourselves. It gave us time to deal with our feelings, to help the kids deal with theirs, and to find our new definitions of
normal, of ourselves, and of our friends. We made new rituals. Blood draws means ice cream. Emergency room visits mean you get dinner of your choice after release (or when doc clears you for a normal diet). Bone marrow biopsies mean you get a movie of your choice.

Become a dedicated student of your child's condition. I know more about epilepsy and essential thrombocythemia than I know about Star Wars, and that's saying something. I've read medical journals (Google is your friend when you're trying to figure out the definition of polycythemia vera or hypotonia), watched YouTube videos, and found parent support groups where I learned even more. While you have to trust your specialist, it's important that you have basic knowledge. No one will be a better advocate for your child than you will, and for that to happen, you have to know as much as you can.

Find a support group. For epilepsy, it was easy for us to locate our state support group. The only problem is that the closest meeting is about three hours away. So I found some online groups (Facebook is a great source) that gave me the opportunity to ask questions about meds, how to find a great doctor (we're on our third neurologist), and see if a side effect was a normal expected reaction or something I should be concerned about. For A2's blood cancer, the condition is so rare that online was my only option for finding support. Thank goodness we have the internet to allow us to have that kind of support.

Tell other people *as you're ready* to. People will come up to you and ask, and you only have to answer questions to your level of comfort. Let me say that again: you are under no obligation to tell anyone anything about your child's medical condition if you don't want to. Some folks ask about one of the kids, and I know they are actually showing support. I share more info with them. Those looky-lous and nosy folks get the bare minimum. I tell them the kids are doing well today and thank them for asking.

Be prepared for everyone to become an expert. I've had people tell me about remedies they were certain would work, second-guess our decision to medicate (or not), ask the kids' vaccination status, and ask if we had considered the possibility that one or both kids were possessed.

Learn your rights. When it comes to your child's education, your insurance coverage, your ability to have a service animal in your rental, and your ability to medicate your child how you see fit. There are various groups on Facebook that can help with many of these issues. Learn your insurance company's appeal process in case they turn down a medication or treatment. If your child will need help accessing their education, you may need an IEP (Individualized Education Plan). Work with your school nurse to develop a health plan.

Realize that even after you get past the initial shock, outrage, fear, and whatever else you may be feeling, that you will still have bad days. A health setback, curious questions, or even absolutely nothing can cause you to have an emotional day. And that is totally okay. This is where your support person is important. You will need them way more than you realize in the beginning. I can send my person a message that simply says "fuck epilepsy" and she will not judge or even ask what's up, because she knows if I need to tell her more, I will. Maybe I just needed to get that little bit off my chest. She has been the one to listen when I cried or yelled or just needed to vent. She was always there. She even came and picked us up once when we got released from the hospital a day earlier than we planned on. But also realize that your person may not be enough. My therapist says that many special needs parents suffer from PTSD. I also have anxiety, and take medication for it. That's okay, too.

Finally, you need to remember that you are stronger than you realize. I'm not going to give you that bullshit about how God only gives special children to special parents. I heard that so many times in the early days and I just wanted to throw up every time I heard it. It's an empty platitude to someone who is scared, mad, and second-guessing everything. But you are stronger than you realize. You're going to feel tested, bent, beaten and bruised many times in the next six to twelve months. But one day you're going to wake up and realize you're a little less pissed than you were yesterday. Or you're going to be able to find joy in something small. Or you're going to realize that you only cried in the shower once this week. Any of these are victories. Your backbone will strengthen and you will come to realize, at some point, that everything you dread may happen tomorrow, and that you're going to have to live through that, just as you lived through the diagnosis and the days that followed.

And you will live through these early days. They may feel dark and cold and lonely and so fucking painful. But you will live. Because you must. Because you are who your kiddo has to guide them through this thing that is also scary and confusing to them. You are that light shining through the darkness to them, even if you do have to go hide in your closet to sob for three minutes every afternoon.

Friday, March 17, 2017

What to Pack in a Hospital Bag

We've spent a bit of time in the hospital in the last year and a half. Several ER visits, one emergency surgery, two extended EEGs and one outpatient procedure. Not only did we put a shit ton of miles on our Suburban, but we logged a lot of hours sitting in hospital waiting rooms. In some cases, we were lucky to be in hospitals with great peds floors that not only took care of the patient, but of their siblings, too. But sometimes, you're stuck in hospitals where the waiting room is little more than some chairs parked in front of reruns of Judge Judy. In that case, you need to have a bag packed for hospital trips.

Each of our younger kids has a hospital bag. Any hospital trip, no matter who it's for, means that the hospital bags for both littles get thrown into the truck. We also have a general med bag that goes with us everywhere, but that's a post for another day.

The hospital bag for A2 includes the following:

  • Extra charger. Tablets may not be charged if we're off on an emergency trip. Because our specialists are four hours away, the charger comes in handy if we need to charge devices once we get to the hospital.
  • A soft green blanket. It's kind of cold in hospital rooms. Green is her favorite color, but it's not a favorite blanket. In fact, I picked it up for a couple of bucks at a thrift store. It's no big deal if it gets lost-or bled on, which is possible given her condition.
  • Apple juice and some snacks. If she's the one in the waiting room, she can have a little snack without us having to pay high hospital vending machine prices.
  • A book. Sometimes, it's not really practical to be using a device. Or we forgot to grab it on the way out the door. I pick up new books every single time we hit a thrift store, and some of them get stashed to be put in the hospital bag.
  • Headphones or earphones for her tablet.
  • Extra set of clothes.
  • Tissues, pain reliever, water bottle.
  • Complete medical list including diagnosis, meds, weight, and specialist names/numbers.

For R., the hospital bag is a little more detailed.

His bag includes everything that A2's does, plus:

  • Yellow sunglasses to help with florescent lights. R. gets headaches from these lights and the yellow sunglasses help if he's the one in the waiting room. We tend to extinguish or dim the lights if he's in an ER room.
  • A portable massager for deep tissue stimulation. In addition to epilepsy, R. has autism, and with that comes sensory issues. The portable massager helps to calm him down if he's bouncing off the walls.
  • Coloring book, crayons, and Rubik's cube. R. gets bored easier and has issues with sitting still.

We also have cash stashed for ER visits, too. If we're there longer than we anticipated or it gets late, we may need to grab some dinner, or, in a worst case scenario, we'll need gas money to get to a hotel or a friend's house. When our older daughter needed emergency surgery, the stash of cash meant that I wasn't hoping for leftover pudding or graham crackers in the hospital. While some hospitals provide an extra tray for the room on the peds floor, not all do, and the cost of eating in the hospital can add up. At some point, I may pack a grown up bag that includes drinks, snacks, and a change of clothes for me, my husband and our older daughter.

In my purse, I also have an extra charger, and a power bank. Without fail, every time we have been transported in an ambulance, my phone has been at 15%. It sucks trying to update family members but having to be careful about your battery use. I also carry pain meds. If you're worried, it won't take long before you develop a tension headache.

Do you have more suggestions for what should be in our hospital bags?

Friday, March 10, 2017

Shout out to Moms

I feel like I need to give a shout out to those of you moms who have missed half of your work days this week because of sick kiddos. For some moms, that's not really much of an issue. Your kid gets sick, you make a phone call, and work does without you for a few days. I had a job like that for
awhile and it was fucking glorious.

For me, missing half of my work week because of a sick kiddo means that I've had to squeeze in some work time at 4:30 this morning. It also means I'll probably be drinking coffee at 10 pm in an effort to deliver some other stuff on time.

It means I lost a client. When she asked to become my client I told her I wouldn't be available to answer emails every day, and she assured me that wouldn't be an issue. Until I wasn't, and it was.

For some moms, staying home with a sick kid means scrambling, often at the last minute (because who plans norovirus?), to find someone to cover your shift or you'll be written up.

For some moms, taking a few days off to take care of a sick kid means there's going to be some pretty creative juggling of the grocery menu because there's nowhere else the lost money can be made up.

For some working mothers, calling in to take care of a sick kid today means they were told not to come back. Or that, at some point within the next week, they will be called into HR and told that they are "too unreliable" to hold a job there.

I'll recover from my missed days, likely sometime in the middle of next week. Then I can start to recover from my missed sleep. But for some families, having sick kids means facing some pretty shitty consequences. And that needs to stop.

Have you ever faced the ultimate consequence from missing work to take care of a sick child?

Wednesday, December 28, 2016

Reflections on a Craptastic 2016

It's December 28, and everyone is posting their retrospectives about 2016. Heres mine: Fuck you, 2016. Continue on for the tl;dr version.

Sometime in 2015 I wrote this long essay about how the next year was going to be my year. The kids were getting older and my business was going well and I was going to be able to devote some time to writing and dammit, it was glorious. So glorious, in fact, that I should have known better. Because never in my life is shit that glorious.

And then 2016 actually arrived. The first few weeks puttered by, lulling me with a false sense of security. Decent weather, great clients, all in all a positive start to the year.

The third Sunday in January was a pretty normal Sunday for us. We had gone shopping. I made spaghetti for dinner. The little kids were in the hallway, watching videos on their tablets, sharing the only unused outlet in the house. I was walking into the kitchen to refill my water when I heard the youngest say "11! You just fell over!" This seemed a little odd to me, so I went to go check on them. I found 11 on his side on the floor, convulsing.

When you have five kids, you've spent a little bit of time in the emergency room. Usually, it's parental over-protectiveness. Once, 24 shut her finger in the car door and I was afraid it was broken. 18 got in a fight and got pushed and hit his head on the gym floor. 24 went to the ER several summers in a row
while working at a Boy Scout camp because she's clumsy and would hit her head...often. Each time, we were sent home within a few hours, fully recovered.

None of that prepares you for seeing your child laying on the floor having a tonic clonic seizure. It was, without question, the scariest moment in my life. I've been in car wrecks, been in fist fights, been in jail, walked in on someone having a "meeting" with a bunch of shady looking guys with guns at their waists, and never was I as scared as I was that Sunday night.

11's tonic clonic sent us on a long journey that isn't nearly over yet. He has, at this point, a diagnosis of Childhood Absence Epilepsy, but that may change, as his epileptologist thinks he has some damage to his left temporal lobe. He had an MRI last week. Since January, he's also gotten a diagnosis of asthma, and a confirmation of our suspicion that he has autism. He's failed five anti-seizure medications; if he fails this one we will start on combinations. It's been a year of skill regression, memory loss, side effects that included weight gain, weight loss, hair loss, tremors, and fear. He hasn't had a tonic clonic seizure since January (he had his second seizure two days after the first) but he has absence seizures every day.

As I was trying to find our new normal, and learn about how our lives would be changed with an epilepsy diagnosis, my middle daughter got an abcessed tooth that required emergency surgery. My stress level was through the roof and I went on medication for high blood pressure. After 15 began recovering from her surgery, my youngest daughter's (9) migraines began to worsen. Trying to find treatment for these led to a diagnosis of Essential Thrombocytosis, a rare blood cancer that usually happens to people over 60. In the middle of all of this, my uterus broke and I needed surgery, and my mother died.

Thankfully we had some good moments to balance out the bad. My oldest son graduated high school, valedictorian of his class of six. Yes, six.We live in a tiny rural town and my kids go to a tiny rural school with an enrollment of less than 200, pre-K through 12. 15 is growing out of that awkward early teen phase and becoming a smart, creative, opinionated person that I am proud of every day. 24 celebrated her first wedding anniversary.

And the littles? Despite having a craptastic year, they seem to be thriving, most of the time. I watched this morning as 11 had a cluster of absence seizures, but then he went back to what he was doing as if it hadn't phased him. 9 makes me laugh every day, in her smart, funny, confident way.

Fortunately, I'm able to take my cues from them. While 2016 has sucked big hairy donkey balls, my kids have given me the strength to move forward. Well, my kids and three different types of anxiety medicine. But seriously, if I hadn't have needed to remain strong for them, I would have long ago dissolved into a raging mass of goo.

So that's my 2016 retrospective. Just steps away from raging mass of goo status, but working towards solidifying in 2017.