Specialists, Specialists Everywhere, But for the Little Things, Not a Doc to Spare

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The last time I had any sort of primary care doctor was when I was in first grade, up until the pediatrician who referred me as a baby to the ENT and immunology doctors handed me off to them altogether. It appeared I wasn’t exactly an ideal candidate for generalized care. Considering the strep that sent most little kids to the doctor’s office for a quick swab test and some meds ended up spewing from my ears and lodged in my knees, I can’t really argue with his logic.

For most of my childhood and young adulthood, I rotated among specialists for a confounding array of ailments: an asthma/allergy doctor for my lungs (and we all know how well that went); an immunologist for my IGg deficiency disease, an ENT doc for the ever-present (and sometimes life-threatening) infections and surgeries, a rheumatologist for the joint inflammation that began in my lower back at age 10. There was also the orthopedic surgeon who fixed my ankles and diagnosed my knee problems, the specialist who dealt with my enlarged liver and spleen, the urologist, the endocrinologist, and many others.

No wonder my genial suburban pediatrician looked at me and secretly wanted to run in the opposite direction. (And can you just picture what it was like when I was asked to supply copies of my entire medical record? I think upwards of six hospitals had a piece of me.)

It was (and is) a precarious position to be in, and I cannot help but think of the overused analogy of the quarterback: I had lots and lots of team players responsible for different things, but I had no one coordinating all the moving parts.

I still don’t. I have my lung doctor, who is amazing. I actually have to suppress the urge to tell him he’s a rock star when we communicate via e-mail because I do not want to sound like a crazed fan or something. I have a scarily smart rheumatologist who oversees various infusions and inflammations and serves as my de facto primary care doc, but her office is busy and isn’t made to handle acute (but minor) things that aren’t technically related to rheumatology. I still have a handful of other specialists who deal with isolated problems and body systems, and I see them and undergo their suggested tests.

I am not arguing against specialized medicine. I would be foolish to do so. If it weren’t for advanced, sub-specialized care, I never would have received diagnoses for rare respiratory diseases, diagnoses that have changed my life. I depend on the cutting-edge research into ridiculously niche problems my specialists conduct to maintain my quality of life and hopefully change the future outcomes of progressive diseases like mine.

That’s no small order.

But whom do I turn to when I have a nagging headache that persists for weeks? I know (because after 20 surgeries, you just know these things) it isn’t sinus related, and my eye prescription is current. What about the fleeting dizzy spells and intermittent fog that is different from the chronic fatigue or adrenal depletion? Do I start with the ENT doc and move outwards after that? Call up the rheumatologist and see if she’ll take a crack at it?

And what about all the normal things other people get checked for during physicals? I can’t remember the last time I had a physical. I know that many, many important things in my body are monitored regularly, but for all the sophisticated tests and labs I have, are there smaller routine things no one is checking because everyone is looking at something different?

I’ll figure it out, I know. I have a lot of weird issues that necessitate a lot of doctors and I can’t argue against that.

But when niggling things manifest, I’m not sure any of them are appropriate people for me to bother. I’m thinking of taking the plunge and getting a certified primary care doc. I hear they’re something of an endangered species, and I fear people like me are largely responsible for that. But if they’ll have me, I just might like one of them….

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Radio Debut…

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I’m branching out a bit: To my surprise and pleasure, I was contacted this week by the co-host of Get Real Girls, a popular weekend radio show that airs in Minneapolis on FM107.1 and online at EatBetterAmerica.com. The show is devoted to helping women live their lives with intention and purpose. This weekend, they are focusing on letting go of guilt, and after reading an essay I wrote that appeared on Chronic Babe, they selected me as the Get Real Girl of the Week.

The interview will air this Saturday and can be found on 107.1.com, where they also have a brief feature on me.

I promise I will try not to talk too fast. This is no small promise.

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September Lessons

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I’ve always loved fall. Some of my reasons are more typical ones: I love the vibrant colors of the leaves, the smell of burning leaves, the cool days where I can wear a sweater and not be too hot or too cold, the abundance of root-vegetable inspired dishes. I love the way the nutmeg and cinnamon-scented candles I use to replace the flowery smells of summer fill my living room, and the way the smoky aroma of grilled meat at football tailgates lingers in the air.

Plus, I am huge dork. Fall has always been synonymous with “Back to School,” and for dorks like me, this is a big event. When I was little, I would start planning my back to school shopping in July—not the clothes, mind you, because I wore a uniform from first grade through high school. No, much to my brothers’ horror, I was focused on such weighty issues as Trapper Keeper versus regular folders, erasable pen versus regular pens, and whether I wanted standard or college-rule lined paper.

And summer reading? I’d have finished it all within the first couple of weeks of summer and would count on the diligent notes I’d taken to refresh my memory in late August.

Obviously the older I got the less critical things like Trapper Keepers and erasable pens became, but fall (and September in particular) continue to have meaning for me, and my reasons for this are less typical.

For starters, the simple act of breathing is easier. True, my temperamental lungs never handle the change in seasons too well, but once we’re firmly entrenched in fall weather and I can say goodbye to the humidity that suffocates me, I am happy. I don’t mind the infections as much if in between them I can actually inhale and exhale without feeling like I will never get enough soupy air.

But beyond pragmatic changes like the weather and going back to school, for as long as I can remember fall has also been synonymous with this thought: “Maybe this year will be my year.” The clean slate I’ve been waiting for, the fresh start every student gets, the year no major calamities occur.

When I was little, “my year” would have looked something like this: No surgeries to accompany almost every holiday and long weekend. No weeks’ long absences. No streams of blood gushing from my ears, ruining my pillowcases and making me hesitant to sleepover friends’ houses. No missing birthday parties and ballet recitals and skating shows because I was too sick. No broken bones and casts with classmates’ signatures, no missing the bus because I needed another nebulizer treatment. No sitting on the sidelines at Field Day every May, watching everyone else run and compete.

In college, “my year” would have looked something like this: No missing weeks of classes each semester due to hospitalizations. No needing my friends to take me to the hospital or visit me during my longer stays. No needing to ask to borrow notes or make up more essays, no needing to conference call the campus newspaper from my hospital bed, oxygen mask and all. No needing to worry my parents with late night calls from the ICU, no getting worse and worse despite the more medication I took. No more feeling like all I did was put my life on hold for illness, and no more feeling like however much I gave up for illness, it would never be enough to make me feel better.

It was a vicious cycle of disappointment I set up for myself. Obviously I never got a year like that, and the more I wished for one and counted on that fresh, clean slate to feel normal, the harder it was when it never happened.

I still get excited for September, and I still get anxious to go back to school. I enjoy my writing students and their work, and I like the structure and routine of semesters. But I no longer count on each September to herald in “my year” and I am much happier because of that.

Don’t get me wrong, it is not that I have become resigned to crises and medical issues, or that I have given up hope that an uncomplicated medical life exists somewhere out there, and I am happy to say that the crises aren’t as pronounced as they used to be. But I’ve stopped setting up expectations that are counterproductive. It’s not about starting over each September with a clean slate or getting back to normal (whatever that normal is); it is about accepting that where I am, disruptions and all, is what is important.

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So What About the Healthy One?

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I started a line of thought in my most recent post that warrants its own entry: the reason no illness is ever truly invisible is because the people who love us can decipher the many signs and symptoms of illness no one else can. I think it’s important to explore what it’s like for our partners or spouses when a shared illness is invisible, because it isn’t easy. It isn’t fun, or glamorous, or fleeting.

And it certainly isn’t fair.

I mentioned previously that my husband can tell from the single word “hello” if I am having a bad day. The reason he is so attuned to me is because he has spent our entire relationship doing things for me and because of me that no one ever sees:

Performing my chest PT when I need an extra treatment. Racing to hook up my nebulizer when I can’t get it myself. Picking up my prescriptions and accompanying me to doctor appointments when I am too weak to get there on my own. Eating outlandish food that does not contain wheat, poring over recipe books to make my limited diet more interesting. Wiping my forward when I am clammy, holding my hand when I have palpitations. Taking me to the ER and spending nights wide awake next to my hospital bed. Rubbing my back when I cannot stop coughing and knowing when to thrust the spit cup under my mouth. Staying nonplussed when steroids make me moody and unpredictable, carrying things for me and doing all the shopping and housework and lugging when I cannot help him at all. Understanding when we have to cancel long-awaited plans, miss outings and trips, or have to leave early because I am not feeling well.

(Loving me when I am at my lowest, loving me when I cannot recognize myself.)

And these are just the physical things, the actions and reactions precipitated by symptoms and medications and infections. I cannot leave out all the other realities of his life with me: The enormous medical expenses that will never go away. The financial ramifications of the career choices I have made in the interest of my health. The fact that in some ways, we are limited by my illnesses in ways that have nothing to do with stamina, oxygen stats, or infection rates. The fact that no matter what, progressive diseases mean things will never be uncomplicated and there will always be nagging fear.

“You’re sure you know what you’re getting into, right?” I asked him during our engagement, only half-kidding. But the man who was not scared by IV bruises the night we met, who did not mind spending part of our honeymoon scouting out a Walgreens and playing Scrabble while I used my neb, does not seem daunted.

(He’s crazy, I think to myself. And I’m lucky.)

Acquaintances are surprised if they find out I am sick, and friends who do know often do not realize it is in any way life-defining. This is because I look healthy when we split bottles of wine and pore over appetizers; this is because they do not see me on any sort of day other than a good one (and lucky for both of us, there are so many more good days than there used to be). So aside from my immediate family, I do not think many people realize the cost of invisible illness for him, for anyone who chooses to spend their lives with people who will have good days but will never be healthy.

I do not think my husband spends much time thinking about this, or wishing people understood the pressure and responsibility of illness. But from my perspective, I think it would be hard for anyone in his position. Because for as many people there are who ask me how I am doing and how I am feeling, far fewer stop to ask him how he’s doing with all of this, how he’s feeling. I am the patient, so I am afforded the empathy and the queries.

And so in the background stands the person most responsible for all the days when I can safely tuck my illness away underneath invisibility, and no matter what I can hide from outside eyes, it will always be visible to him.

(Even when I wish it wasn’t.)

Individual symptoms and diseases are less important than the fact that whatever is wrong with someone directly influences the people in his or her life. With that in mind, and all the other healthy people involved in relationships with patients of any chronic illness, I want to point out that the Well Spouse Association’s 19th Annual Conference is happening this October. For more information, click here.

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Seeing the Scope of Invisible Illness

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Today kicks off National Invisible Chronic Illness Awareness Week, making it the perfect time to tackle the realities of living with illnesses that aren’t obvious to the naked eye. This year’s theme is “Living with an Invisible Illness Feels Like a Roller Coaster—Help a Friend Hold On!”

As someone with many different invisible illnesses, I find this theme compelling. On the one hand, it implies that this kind of life can be difficult and that patients need support and understanding—very true. Yet it isn’t as simple as that. The roller coaster metaphor immediately conjures of memories of white-knuckled ascents up steep hills and the rush of relief that follows. These highs and lows, the white-knuckled anxiety and the carefree moments, they are all part of invisible illness.

But You Don’t Look Sick
You knew I was going to start here, didn’t you? That’s because of all the issues tangled up in this discussion, this is the most obvious and probably most relevant. Why even bother having a National Invisible Illness Awareness Week? Because when you’re sick and there are valid reasons why you can’t do something the way you want to or are worn out or need help and you look otherwise healthy, that disconnect can cause big problems.

If I don’t look sick, then I must not be sick. If I don’t look sick, then I shouldn’t need to take the elevator when I am carrying a heavy bag and four flights of stairs seems like it would take way more oxygen than I can get. If I don’t look sick, then I shouldn’t have to re-arrange plans to accommodate chest PT sessions, or quietly leave the dinner table so I can cough without making a scene.

Duh.

Similarly, people with serious illnesses who do not “look” disabled shouldn’t need handicapped parking placards, or people who are young and dress well and wear make-up couldn’t possibly have a life-threatening or life-altering disease because truly sick people are only found in hospital beds, wearing faded johnnies and cracking wan smiles, and they certainly don’t look like normal people. I know enough people with enough invisible illnesses to know that this kind of thinking happens all the time.

This is the frustrating, anger-inducing part of the roller coaster metaphor, the one that quickens my pulse and flushes my face. I’m not asking for or expecting understanding from these people. I don’t really need it, and I’m not expecting miracles here. But there are times when I just want them to keep their preconceived notions of what sick looks like and their judgmental indignation to themselves.

Escape, Sweet Escape
I’ll be honest, there are lots of times when I am glad that whatever is wrong with me is largely undetectable on the outside. Sure, it can be isolating to feel like crap and slog through the day, trying to be “normal” and feeling so far from that. But there is a very real upside to this isolation: Escape.

Remember that rush of relief when the stomach-churning drop is over? That’s what I’m talking about. “Carefree” is not often a word associated with illness, but I’d say “caring much less” is a big part of it.

If no one knows anything is wrong with me, then for a little while, whether it’s at work or out with friends or riding the train, I can suspend reality. Having chronic illnesses is only one part of who I am, but sometimes necessity dictates that it seeps over into the other roles I take on, too. I don’t want to always think about, talk about it, make decisions based on it, or be associated with it.

And luckily, I don’t have to. The public, non-patient persona is really important to me—and, I’d argue, anyone with any type of condition—because, quite simply, it allows me to define myself in so many ways that have nothing to do with illness. Illness is always there, obviously, but it’s in a back-seat role.

And Lastly, the Invisible Made Visible
There’s something else to uncover in this discussion, something that perhaps isn’t as obvious a theme as the first two: To the people who really matter (and the people whose opinions likewise really matter), there is no such thing as “invisible” illness.

My mother can tell just from looking at my eyes (Are they glassy and flat?) if I am having bad day. My husband knows from the tone in my voice from one single word—“hello”—if I am not doing well. Even at a distance, my father can tell from watching me take two steps how I’m feeling. My friends know the subtle difference between the “just me being me” cough and the “hmm, something’s brewing” cough, even if I’m not even coughing all that much or that loudly.

I know how important having that inner sanctum familiarity is. I can see the same signposts in the sick people I am closest to: the slackened gait of exhaustion, the subtle grimace of joint pain, the tempered tone of tiredness. To the people who know us best, there are always telltale signs, ones that no one else would notice. As long as we have people who can see beyond what’s seemingly invisible, we have what counts, and the ride seems so much more manageable.

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Medicine and Social Networking: An Inevitable Pairing?

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Last week, I read with great interest this post from Hospital Impact about technology, health care, and the Facebook generation. The points raised are compelling ones, namely: Is social networking is a better vehicle to foster community and spread awareness of health care innovations? Does it successfully integrate health care into daily life? Would health care providers benefit from social networking, and would viral marketing benefit practitioners and patients alike?

While I was pondering these questions, Healia.com, a consumer health search engine, launched its first Facebook application, the Healia Health Challenge. I use Facebook (albeit somewhat sparingly). I’ve used Helia. What would it be like to combine the two? Intrigued, I tried it out. (More specifics on the application follow below).

Of course, a whole new set of questions sprang to mind. Does the tech-savvy consumer/patient have emerging needs that depart from what more traditional Web forums, online communities, or list-servs can satisfy? Is this technological shift inevitable?

Between the great post at Hospital Impact and Amy’s query at Diabetes Mine, it’s clear the medblogging community has a lot to say about what it wants from health sites. As a corollary to all of this, I interviewed Jonathan Shaw, a marketing associate at Healia.com, to what he had to say about healthcare and social networking. Here’s some of our discussion:

Q: Let’s talk about social networking and healthcare innovation. What made you reach out to Facebook as compared to, say, exclusively health-related online communities?
A: When Facebook opened up its API to developers to build their own applications, we immediately realized we had a great opportunity here. We saw that we could create an application that’s both fun and educational, and can raise awareness about our search engine in a rapidly-growing medium. We do follow the health-related online communities closely, but we haven’t seen this sort of opportunity anywhere else yet – certainly not with the sort of exposure to a wide audience that Facebook provides.

Q: The Facebook application is a health quiz where top-scorers are designated “Chief of Medicine.” What factors went into creating this type of quiz? The style and content cover a broad spectrum of health issues but at the same time, they speak to a particular type of healthcare consumer. Does the “Facebook generation” have different needs than other healthcare consumers?
A: We wanted our application to be fun but also stoke young people’s curiosity about health issues. Many of the questions in the quiz were sparked by lunchtime conversations in which we bantered about health-related issues with uncertain facts. One of us had heard that carbonated water is supposed to be bad for you; others hadn’t heard that. Who was right? We used Healia to get to the bottom of these mysteries and we wrote our answers based on what we found. Through this process, we learned about common health myths and included these in some of the questions. From what we’ve heard so far, people are sometimes surprised by what they learn through the Healia Health Challenge.

(Editor’s note: Despite an embarrassing mix-up between HDL and LDL cholesterol and a misstep here or there regarding things like caffeine’s ability to help a hangover, I rocked the Healia Health Challenge. That’s right, you can call me “Chief of Medicine.” It was fun, especially since I am a medical dork and am oddly competitive about objective tests I take by myself.)

Q: Do you have any other plans/developments in store in terms of Facebook and the Healia Health Challenge?
A: We definitely want to keep this application interesting for Facebook users who’ve installed it, so we’re currently working on a new set of questions. This is a fun, creative process and if you’ve got any ideas for questions we should cover, please send them to our Marketing Manager, Tassie DeMoney: tassie@healia.com.

At the end of the day, I’ve proven that I know a lot about topical health care issues and now have an application on my Facebook page that tells people this, allows them to test themselves, and introduces them to a useful online resource. But is this first step the start of a new technological revolution for the health care consumer? You tell me.

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So Speak Up Already

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An interesting article in Monday’s Boston Globe called “Patient, Protect Thyself” covered ways hospital staff and patients alike can combat a serious and often preventable problem: infectious disease in hospitals. From making sure everyone who enters a patient room washes his or her hands to maintaining vigilance over the amount of time tubes are left in the body, there are all sorts of ways to reduce the threat of infections.

Questions of communicable agents and preventative practices aside, the article touched on a larger theme that resonates with me, the idea that patients not only have the right to question their health care providers but that such queries are an essential part of optimal care.

Perhaps the meaning of “Patient, Protect Thyself” is really “Patient, Assert Thyself.”

This semantic difference isn’t what really concerns me, though. I’m much more interested in why it can be so hard to do that, especially considering it is our health at stake. Maybe some of you aren’t ever plagued with momentary meekness, but I’ve definitely had encounters where I’ve had to double check or question something and before the words are out of my mouth my face is flushing a bit.

I don’t want to be annoying. Or condescending. They are the ones with medical training, not me.

(And do I really want to annoy someone who’s coming at me with a needle?)

I trip over my own words with “I don’t mean to be a pain” and “I just have a quick question” and “I’m not sure, but I think…” when of course, I am pretty sure. I’ve been through the revolving door of hospitals and doctors’ offices my entire life. I’ve learned some things along the way, like where the best veins for IV lines are, how many nebulizer treatments I need to have before they actually start to help, or that one medicine in particular is the only one that stops my nausea after anesthesia.

There are the obvious times when it’s easy to be assertive, like the time I was sent for the wrong test on the wrong body part with the wrong patient ID number (hello, HIPAA!), or the time my doctor ordered chest PT three times a day while I was an inpatient and I hadn’t gotten any. But the less egregious encounters are the awkward ones…which is weird, right? I mean, I don’t have a problem sending back the wrong coffee order, or double-checking that the security tags have been removed from newly purchased clothes, or repeating the take-order over the phone when I sense the person on the other end may have missed something.

Surely looking out for my body is more important than latte orders, security tags, or garden salad versus spinach salad?

And that’s exactly the problem—it is so much more important. One could argue that part of the problem is the leftover vestige of the patient-practitioner hierarchy where the patient’s job is to sit still and defer all authority, but I don’t think that explains it. I think deep down it’s a question of vulnerability, too. Despite how much we know and the wisdom we’ve accumulated, in these situations we still need to rely on someone else to do what we need done to feel better. Once you’ve crossed over that very real physical boundary and let someone in, it’s not always easy to admit a lack of confidence in what they’re doing.

* * *

On another note, Grand Rounds is up at Rickety Contrivances of Doing Good, where my post on the role narrative plays in the doctor-patient relationship is featured as the first post. Susan did a great job with a really compelling theme, so be sure to check out the posts.

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Apparently, There’s Some Thinking Going On…

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Many thanks to Jenni Prokopy at ChronicBabe for giving A Chronic Dose its second Thinking Blogger Award, and congratulations on her own much-deserved recognition.

UPDATE: Before you delve into the blogs listed below, I wanted to update you with news regarding my friend Jenni at ChronicBabe, whose home was destroyed last week during the heavy storms that struck Chicago. To read more and see how you can help, visit ChronicBabe.

Now it’s my turn to select five blogs that make me think, make me question, and otherwise enlighten or inspire me. There’s a lot of great writing out there, so this isn’t an easy task. With no further ado…

Susan Palwick at Rickety Contrivances of Doing Good is an acclaimed sci-fi writer, an English professor, and a volunteer ER chaplain— a dynamic mix indeed. She’s a thoughtful, engaging writer with a perspective well worth reading.

Tiffany at Sick Girl Speaks has quite the long medical history under her belt, but her mission is much simpler: to be a patient advocate to the healthy world. No one’s seen more of the medical institution than Tiffany, and her insights are both spot-on and unflinchingly frank.

After the MFA starts by posing the question that makes all MFAs cringe a bit: So, now, all of a sudden you’re a writer? For anyone thinking about getting an MFA, working towards one, or anyone has one and has no clue what to do with it, check out this site. It’s informative, witty, and doesn’t sugarcoat.

Tracey at More Than a Minivan Mom has lots to say on all sorts of topics, and her opinions are as interesting as they are honest. Plus, she’s about to embark on a career that’s especially close to my heart: working with pediatric patients (specifically, kids with cancer).

Michelle Richmond at Sans Serif is a best-selling author and her thoughts on writing, reading, and “bookly ephemera” are compelling.

Here are the rules for winners. If you choose to participate, please make sure to pass the rules on to the next Thinking Blogs you tag!:
1. If, and only if, you get tagged, write a post with links to five blogs that make you think.

2. Link to this post so people can easily find the exact origin of the meme.

3. Optional: Proudly display the “Thinking Blogger Award” with a link to the post that you wrote.

* This award was started by Ilker Yoldas at The Thinking Blog

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An Open Letter to Non-Coughers

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This advice column in Salon—“There’s a cougher in the office and it’s driving me mad!” gave me a lot of pause, especially since the academic year is about to begin and I will soon be sharing a very small office with several colleagues and in front of classrooms of students.

As you’ll see, the letter-writer seems to think his co-worker’s cough is due to some sort of neurosis, not a physical condition. I can’t say whether that’s fair or accurate (somehow it seems unlikely), but I can say that for people like me, persistent public coughing is as much a nuisance for us as it is for everyone else.

You see, coughing is an occupational hazard of being me.

I am famous (infamous, really) for my cough. When it is juicy and tight, people in doctors’ offices grimace at the sickening sound of congestion churning around and politely ask if I’m getting over something. Some offer thoughtful but useless cups of water, others un-subtly move seats. “I’m not contagious, I’m just being me,” I’ll say, and I’m met with confused stares. I get lots of turned heads and cool stares in movie theatres and on the subway, in stores and restaurants. I blush, knowing people inch away from me thinking I am contagious and knowing this is not unreasonable of them.

When the cough is spasmodic and choking enough to land me in the emergency room, people in the waiting room practically trip over one another trying to move away from me, something I’ve dubbed the “ER Duck-and-Run.” Someone will quickly slide a facemask over me and wheel me past the triage bays and right into the ward, and I can still feel people’s eyes on me and their apprehension enveloping me as I am wheeled away. I’m torn between wanting to reassure them I don’t have SARS or something and wanting to say “I can’t help it, stop staring at me!”

But can I really blame them?

When my cough is dry, it is a hoarse bark, the kind of nail-splitting sound that ricochets off of walls and echoes obtrusively through quiet corridors. That cough is the one people remember most. It is the cough nurses hear long before they come through the ER doors and actually see me, the cough that makes hospital roommates discretely ask for a room transfer, the cough whose grating tenor disturbs family members visiting loved ones several rooms away. It is the cough that makes me excuse myself from my writing workshops and wander through deserted hallways until I find a place far enough away to absorb its sound. It is an almost shameful fame I have acquired by proxy of this cough of mine because I do not have the power to change what is so obviously uncomfortable for other people. I do not like that feeling.

So believe me, non-coughers of the world, people like me try to hold it in. We try to stifle it until we can duck into a bathroom, we make sure our mouths are covered, we are just as put out by the constant hacking and the rib-aching choking. We don’t mean to interrupt or irritate you, and we certainly don’t mean to be such a distraction. Coughing is our survival mechanism, the process we need to move the gunk in our lungs around, so while we hate it and it often hurts and we cannot help it, we also know we need to do it.

Thank you for the cups of water, for the smiles of understanding, for not moving your seat or shooting me a look. I promise I’ll try to keep it down, okay?

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Don’t go without your Chronic Dose!

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I know you’re out there, loyal readers. I have a simple request of you: the time has come for me to do a better job managing my site traffic, so I’m changing things up a bit. Bear with me. I’ve added a handy-dandy e-mail subscription service–located at the top of the sidebar info on the right–and I’m hoping you’ll take a couple of seconds and subsribe to my posts that way. Thanks so much!

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