Anne

@anne78 | contributor
Navigating a life that has been turned upside down by illness. Going through the exhausting process of trying to get a diagnosis for my own chronic symptoms, and a caregiver to my mother with cancer. These experiences have changed my life and the way I view illness, disability and advocacy and now I hope to be part of a community where I can share these perspectives and learn from others.
Anne
Anne @anne78
contributor

Should I Use the Word 'Cancer' When Asking About Someone's Diagnosis?

I don’t blame anyone for not wanting to say certain words or steer clear of certain topics. These are my personal feelings about talking about illness — which also change periodically depending on my own ability to cope. The other day, someone wrote to me about a scene in a TV show and mentioned that it was about “you know… the… you know… can*er.” They tried to censor uncomfortable words sometimes to prevent me from getting upset. But first of all, that wasn’t really censoring because I know exactly what they mean — if I was going to be triggered, that would have the same effect as using the word “cancer.” Secondly, after years of being in the cancer world as a caregiver multiple times as well as being a person with other illnesses myself, I am not scared of words anymore. On the contrary, I often want to scream them loudly to anyone who will listen. In fact, I wish that my own family had not been so scared of certain words because then they might have been able to have more effective conversations with me that would have helped me prepare for life and not feel shame about my illnesses. I personally find that using full, uncensored words for illnesses and not beating around the bush makes things a lot simpler. This has not always been well received, though. When I tell people who ask me how I’m doing, “We’re doing all right, but things are hard with my mother’s cancer at the moment,” they are often taken aback and don’t know how to respond. I don’t mind that. Sometimes when people say something a little scary to me, I also need a few moments to process and figure out something appropriate to say back. What I do mind a little bit, though, is that people may be scared to continue talking to me or possibly to even keep in touch because they might be scared to talk about cancer or may worry that I mention it too much. They may not want to say the word “cancer,” so they often timidly ask, “Is your mom… you know… still not feeling well?” or “Your mom is feeling OK now, right?” Honestly, sometimes I want to respond “No, she has cancer, and she will always have cancer. But hopefully next week, she will feel a little better than she did this week”. I don’t want to skirt around the word “cancer” — I want to say it until it doesn’t bother me or the people around me anymore. Not using the word “cancer” makes me feel like I’m lying and it gives it so much more power than it needs to have. I always think of this in terms of Voldemort from “Harry Potter:” “He Who Must Not Be Named.” Sometimes in conversations, I feel like the other person might be about to mention the illness — but then may remember that it “must not be named” because it is so “bad.” Then find another way to say “cancer.” However, in “Harry Potter,” the characters realized that not naming Voldemort gave him more power. I feel like it’s the exact same way with not naming my mother’s cancer. “Cancer” can be an extremely loaded term. It can have so many emotions attached to it for each person it touches — and it is kind of like Voldemort in some ways. Until cancer suddenly affected almost my whole family, I wouldn’t know how to respond to the word “cancer” either, but now I see that this skittishness contributed to my overall anxiety. I felt like I had to stop saying “cancer” and keep my mother’s illness a secret. I am still triggered by the word “cancer.” If I see a video or a post or a scene in a movie, and there is a cancer storyline, I will have a breakdown and need to turn it off more often than not. But I’m not angry at anyone for saying “cancer” out loud — I am glad they do. Those are just my reactions, and I am aware of them and do not dismiss them. I’d rather have to go and hide for a few hours than not have any cancer storylines at all. It’s not just cancer, though. Many physical and mental health conditions are still spoken about in hushed terms. I still can’t talk openly and honestly about most of my illnesses with family or friends. I hope I will be able to one day, and people won’t feel the need to censor medical terms anymore. Telling the truth and explaining conditions using science and medical language is empowering. I want to tell people they don’t need to be scared of condition names. They are just words — important words. They can help us communicate how we feel and why we feel it. I feel like saying health condition names is necessary. I will always respect someone who tells me they do not want to talk about a certain illness because it’s triggering. I understand that, and if that’s what makes you feel comfortable, please let me know. But when someone talks to me or wants to know how I’m doing, I’d love for them to just say the word “cancer” and let me say it out loud too.

Anne
Anne @anne78
contributor

Why It Bothers Me When Doctors Assume I Have Time

The other day I was at an appointment, and when we were trying to find a day after my bloodwork to go over the results, the doctor said, “You don’t have a job, do you?” I am a full-time student so I said no, not at the moment. Apparently, she didn’t catch the full-time student part, and then said, “Right, then you can come in this day at this time, no problem.” She had made the appointment before I had a chance to respond. This might sound silly, but this exchange played on my mind for a long time afterward. Just because I am not employed right now does not mean I am not busy. Just because I do not have a 9-5 job does not mean that I should not be asked about what time might suit me best. Perhaps I was taking my sick mother to her appointment that day or visiting a friend or attending a lecture or having a different appointment. The list goes on. There are a lot of reasons why this disturbed me. First of all, being chronically ill can most definitely count as a full-time job, in my opinion. I have many different doctors and appointments and it’s a struggle to make it all fit, especially when they all have this similar attitude when scheduling. Secondly, in that type of rushed and dismissive interaction, the doctor demonstrates to me that they do not see my time as valuable. They don’t ask whether I have the time or whether I am able to come at that time. In fact, it might be just as well because with the pressure on the system, it might be the only appointment available for a long time. This brings me to my third point: that we as patients are treated in a way that forces us to be uber grateful for any appointment we are lucky enough to get. There have been other times like this one where I have said I really cannot make that time, and they kind of shrug and say, “Well then you’re going to suffer more because the next available time is three weeks off. You really should take what I’m offering.” This then leads me to panic. Should I take the appointment that I really can’t go to and thank the doctor profusely because I don’t have to wait in agony for three weeks? Then I will proceed to attempt to cancel whatever plans I had for the time of the coveted appointment. If I’m being very harsh, the doctor should actually be thanking me for my flexibility and/or even apologizing for the backup at the practice rather than making me feel guilty for taking up another slot in their schedule. I have seen a lot of doctors and they have made a lot of wrong assumptions about me. Some are dangerous to my health, but some, like this one, are just insensitive and make me feel like I’m not valued as a person or a patient. Assuming they can see what my life looks like based on the fact that I do not or cannot work and thus assuming that I have nothing more in my life than following the schedule of appointments that suits them best makes me feel like they are not hearing me or understanding me. I understand that healthcare systems everywhere are under extreme pressure at the moment. I know that appointment scheduling is really an art. But I would still very much appreciate the extra 30 seconds to confirm with me that I really can make that appointment, or even to ask what my daily life looks like, rather than make assumptions about it and in the process insult me by implying that I have an empty life.

Anne
Anne @anne78
contributor

Why It Bothers Me When Doctors Assume I Have Time

The other day I was at an appointment, and when we were trying to find a day after my bloodwork to go over the results, the doctor said, “You don’t have a job, do you?” I am a full-time student so I said no, not at the moment. Apparently, she didn’t catch the full-time student part, and then said, “Right, then you can come in this day at this time, no problem.” She had made the appointment before I had a chance to respond. This might sound silly, but this exchange played on my mind for a long time afterward. Just because I am not employed right now does not mean I am not busy. Just because I do not have a 9-5 job does not mean that I should not be asked about what time might suit me best. Perhaps I was taking my sick mother to her appointment that day or visiting a friend or attending a lecture or having a different appointment. The list goes on. There are a lot of reasons why this disturbed me. First of all, being chronically ill can most definitely count as a full-time job, in my opinion. I have many different doctors and appointments and it’s a struggle to make it all fit, especially when they all have this similar attitude when scheduling. Secondly, in that type of rushed and dismissive interaction, the doctor demonstrates to me that they do not see my time as valuable. They don’t ask whether I have the time or whether I am able to come at that time. In fact, it might be just as well because with the pressure on the system, it might be the only appointment available for a long time. This brings me to my third point: that we as patients are treated in a way that forces us to be uber grateful for any appointment we are lucky enough to get. There have been other times like this one where I have said I really cannot make that time, and they kind of shrug and say, “Well then you’re going to suffer more because the next available time is three weeks off. You really should take what I’m offering.” This then leads me to panic. Should I take the appointment that I really can’t go to and thank the doctor profusely because I don’t have to wait in agony for three weeks? Then I will proceed to attempt to cancel whatever plans I had for the time of the coveted appointment. If I’m being very harsh, the doctor should actually be thanking me for my flexibility and/or even apologizing for the backup at the practice rather than making me feel guilty for taking up another slot in their schedule. I have seen a lot of doctors and they have made a lot of wrong assumptions about me. Some are dangerous to my health, but some, like this one, are just insensitive and make me feel like I’m not valued as a person or a patient. Assuming they can see what my life looks like based on the fact that I do not or cannot work and thus assuming that I have nothing more in my life than following the schedule of appointments that suits them best makes me feel like they are not hearing me or understanding me. I understand that healthcare systems everywhere are under extreme pressure at the moment. I know that appointment scheduling is really an art. But I would still very much appreciate the extra 30 seconds to confirm with me that I really can make that appointment, or even to ask what my daily life looks like, rather than make assumptions about it and in the process insult me by implying that I have an empty life.

Anne
Anne @anne78
contributor

Why It Bothers Me When Doctors Assume I Have Time

The other day I was at an appointment, and when we were trying to find a day after my bloodwork to go over the results, the doctor said, “You don’t have a job, do you?” I am a full-time student so I said no, not at the moment. Apparently, she didn’t catch the full-time student part, and then said, “Right, then you can come in this day at this time, no problem.” She had made the appointment before I had a chance to respond. This might sound silly, but this exchange played on my mind for a long time afterward. Just because I am not employed right now does not mean I am not busy. Just because I do not have a 9-5 job does not mean that I should not be asked about what time might suit me best. Perhaps I was taking my sick mother to her appointment that day or visiting a friend or attending a lecture or having a different appointment. The list goes on. There are a lot of reasons why this disturbed me. First of all, being chronically ill can most definitely count as a full-time job, in my opinion. I have many different doctors and appointments and it’s a struggle to make it all fit, especially when they all have this similar attitude when scheduling. Secondly, in that type of rushed and dismissive interaction, the doctor demonstrates to me that they do not see my time as valuable. They don’t ask whether I have the time or whether I am able to come at that time. In fact, it might be just as well because with the pressure on the system, it might be the only appointment available for a long time. This brings me to my third point: that we as patients are treated in a way that forces us to be uber grateful for any appointment we are lucky enough to get. There have been other times like this one where I have said I really cannot make that time, and they kind of shrug and say, “Well then you’re going to suffer more because the next available time is three weeks off. You really should take what I’m offering.” This then leads me to panic. Should I take the appointment that I really can’t go to and thank the doctor profusely because I don’t have to wait in agony for three weeks? Then I will proceed to attempt to cancel whatever plans I had for the time of the coveted appointment. If I’m being very harsh, the doctor should actually be thanking me for my flexibility and/or even apologizing for the backup at the practice rather than making me feel guilty for taking up another slot in their schedule. I have seen a lot of doctors and they have made a lot of wrong assumptions about me. Some are dangerous to my health, but some, like this one, are just insensitive and make me feel like I’m not valued as a person or a patient. Assuming they can see what my life looks like based on the fact that I do not or cannot work and thus assuming that I have nothing more in my life than following the schedule of appointments that suits them best makes me feel like they are not hearing me or understanding me. I understand that healthcare systems everywhere are under extreme pressure at the moment. I know that appointment scheduling is really an art. But I would still very much appreciate the extra 30 seconds to confirm with me that I really can make that appointment, or even to ask what my daily life looks like, rather than make assumptions about it and in the process insult me by implying that I have an empty life.

Anne
Anne @anne78
contributor

Why It Bothers Me When Doctors Assume I Have Time

The other day I was at an appointment, and when we were trying to find a day after my bloodwork to go over the results, the doctor said, “You don’t have a job, do you?” I am a full-time student so I said no, not at the moment. Apparently, she didn’t catch the full-time student part, and then said, “Right, then you can come in this day at this time, no problem.” She had made the appointment before I had a chance to respond. This might sound silly, but this exchange played on my mind for a long time afterward. Just because I am not employed right now does not mean I am not busy. Just because I do not have a 9-5 job does not mean that I should not be asked about what time might suit me best. Perhaps I was taking my sick mother to her appointment that day or visiting a friend or attending a lecture or having a different appointment. The list goes on. There are a lot of reasons why this disturbed me. First of all, being chronically ill can most definitely count as a full-time job, in my opinion. I have many different doctors and appointments and it’s a struggle to make it all fit, especially when they all have this similar attitude when scheduling. Secondly, in that type of rushed and dismissive interaction, the doctor demonstrates to me that they do not see my time as valuable. They don’t ask whether I have the time or whether I am able to come at that time. In fact, it might be just as well because with the pressure on the system, it might be the only appointment available for a long time. This brings me to my third point: that we as patients are treated in a way that forces us to be uber grateful for any appointment we are lucky enough to get. There have been other times like this one where I have said I really cannot make that time, and they kind of shrug and say, “Well then you’re going to suffer more because the next available time is three weeks off. You really should take what I’m offering.” This then leads me to panic. Should I take the appointment that I really can’t go to and thank the doctor profusely because I don’t have to wait in agony for three weeks? Then I will proceed to attempt to cancel whatever plans I had for the time of the coveted appointment. If I’m being very harsh, the doctor should actually be thanking me for my flexibility and/or even apologizing for the backup at the practice rather than making me feel guilty for taking up another slot in their schedule. I have seen a lot of doctors and they have made a lot of wrong assumptions about me. Some are dangerous to my health, but some, like this one, are just insensitive and make me feel like I’m not valued as a person or a patient. Assuming they can see what my life looks like based on the fact that I do not or cannot work and thus assuming that I have nothing more in my life than following the schedule of appointments that suits them best makes me feel like they are not hearing me or understanding me. I understand that healthcare systems everywhere are under extreme pressure at the moment. I know that appointment scheduling is really an art. But I would still very much appreciate the extra 30 seconds to confirm with me that I really can make that appointment, or even to ask what my daily life looks like, rather than make assumptions about it and in the process insult me by implying that I have an empty life.

Community Voices
Anne

Looking for anyone with PAO surgery experience

Hi, I was diagnosed with hip dysplasia a year ago now. I’m still in the process of figuring out the best treatment, but they recommend PAO surgery. I’ve heard some bad things about it though. Any advice or experiences are appreciated! Thanks!
#HipDysplasia #ChronicPain

Anne
Anne @anne78
contributor

Why It Bothers Me When Doctors Assume I Have Time

The other day I was at an appointment, and when we were trying to find a day after my bloodwork to go over the results, the doctor said, “You don’t have a job, do you?” I am a full-time student so I said no, not at the moment. Apparently, she didn’t catch the full-time student part, and then said, “Right, then you can come in this day at this time, no problem.” She had made the appointment before I had a chance to respond. This might sound silly, but this exchange played on my mind for a long time afterward. Just because I am not employed right now does not mean I am not busy. Just because I do not have a 9-5 job does not mean that I should not be asked about what time might suit me best. Perhaps I was taking my sick mother to her appointment that day or visiting a friend or attending a lecture or having a different appointment. The list goes on. There are a lot of reasons why this disturbed me. First of all, being chronically ill can most definitely count as a full-time job, in my opinion. I have many different doctors and appointments and it’s a struggle to make it all fit, especially when they all have this similar attitude when scheduling. Secondly, in that type of rushed and dismissive interaction, the doctor demonstrates to me that they do not see my time as valuable. They don’t ask whether I have the time or whether I am able to come at that time. In fact, it might be just as well because with the pressure on the system, it might be the only appointment available for a long time. This brings me to my third point: that we as patients are treated in a way that forces us to be uber grateful for any appointment we are lucky enough to get. There have been other times like this one where I have said I really cannot make that time, and they kind of shrug and say, “Well then you’re going to suffer more because the next available time is three weeks off. You really should take what I’m offering.” This then leads me to panic. Should I take the appointment that I really can’t go to and thank the doctor profusely because I don’t have to wait in agony for three weeks? Then I will proceed to attempt to cancel whatever plans I had for the time of the coveted appointment. If I’m being very harsh, the doctor should actually be thanking me for my flexibility and/or even apologizing for the backup at the practice rather than making me feel guilty for taking up another slot in their schedule. I have seen a lot of doctors and they have made a lot of wrong assumptions about me. Some are dangerous to my health, but some, like this one, are just insensitive and make me feel like I’m not valued as a person or a patient. Assuming they can see what my life looks like based on the fact that I do not or cannot work and thus assuming that I have nothing more in my life than following the schedule of appointments that suits them best makes me feel like they are not hearing me or understanding me. I understand that healthcare systems everywhere are under extreme pressure at the moment. I know that appointment scheduling is really an art. But I would still very much appreciate the extra 30 seconds to confirm with me that I really can make that appointment, or even to ask what my daily life looks like, rather than make assumptions about it and in the process insult me by implying that I have an empty life.

Anne
Anne @anne78
contributor

How Pandemic Isolation Allowed Me to Better Understand My Autism

My official diagnosis came late, at 20. But for all my life I had known that I was different. I was not surprised in the slightest. It came at a hard time, though. It was during the spring of the first wave of the pandemic. 2020. At this point, we had been pretty isolated for a couple of months already, and to be honest, I wasn’t too bothered by that. I had come home from college where I had had a semester of disaster and struggle which can now be attributed to my undiagnosed autism. I was happy to be in my room alone, minding my business and watching YouTube to my heart’s content. I said I wasn’t surprised by the diagnosis. It just made my childhood and school struggles make a lot more sense. But now I didn’t have those anymore. I was alone and I took this chance to explore this part of myself that I had just been made aware of. I took an online course all about ASD, taught by a woman with autism. In her, and her descriptions of herself I saw myself. I cried because I knew that I wasn’t the only one who had felt this way my whole life. I also explored other online autism communities, such as the one here on The Mighty, and learned a lot more about autism presentation in girls and women and lots of other things that are often not part of the public dialogue about the spectrum. I was lucky because I had the time and space to investigate all of this on my own terms and I had a complete break from the neurotypical world. On top of external research, I began to want to understand myself more. Because I was alone for months on end I finally allowed myself not to stop my stims and other behaviors. I could listen to my music for hours and sway back and forth or bounce lightly up and down. I could sit on my bed and rock and no one would see. I could clap my hands finally, which you are told out in the world not to do without a very specific reason. Finally, I could do all these things that had been waiting to get out, that I had had to stop myself from doing for more than 20 years. And because I now had an understanding of ASD I didn’t feel ashamed. Well, maybe a little bit because I still am not able to be myself when I’m out in the world. I still mask a lot. But that’s for another story. The bad thing about the timing of my diagnosis was that there was no therapy available to me at that time. Most places were closed down and were waiting to open back up, and even then their waiting lists would have increased tremendously during the lockdowns. Over two years later, I am still on various waiting lists and have not been able to get the professional help that I do actually want. The isolation of the pandemic did become more challenging as the months wore on. Being in a vulnerable family, we were very careful. Even though I had more than enough time to myself to engage in all my stims and special interests, I worried more and more that socially I would regress. I lost out on the rest of my college years and meeting people my own age that would come with those years. I have not yet had the chance to try dating or other social things that people in their 20s do. Now, when I do have to go out, I can feel that I am a lot more anxious than before the pandemic, but I’m pretty sure that’s true for nearly everyone, ASD or not. Despite the incredible challenges and everlasting pain that was brought by the pandemic and the lockdowns, getting the space to understand and accept myself for who I’ve always been was an unexpected gift.

Having Support at Medical Appointments Is Your Right Under the ADA

It’s 2021 and my yearly echocardiogram and stress test appointment for my heart is coming up. The nurses call me and tell me what to expect at the appointment. When they tell me I can’t bring anyone in with me during any of my appointments, I freeze. I explain that I need a family member in the appointment with me. They tell me that it’s the rule and they will not allow anyone with me. After the call, I start to have a panic attack. As an autistic adult with medical PTSD and OCD, I need someone with me at appointments. I have trouble communicating and understanding everything that is going on during doctor appointments and tests. So I’ve always had a family advocate with me to help me during appointments. My family member often will help communicate to doctors what is going on with my health. When it comes to tests, it can be hard as I get very anxious due to my autism and previous medical trauma. Many doctors and technicians don’t always empathize or understand why I freeze up, which can cause frustration on both sides. Due to my disability, I’ve spent my whole life in and out of the hospital, seeing doctors, and having tests done. Medical trauma has made me extremely anxious during tests. I’ve had instances where the technician didn’t know my particular heart condition and had trouble doing the echo because of it. One of the times I was in the hospital, my family had left just for a bit and a tech came in to do my echo and proceeded to push really hard on my chest to the point where I had a couple of bruises. During these times, I tend to shut down. It’s like the voice I use to advocate for so many people becomes silent, stuck in my throat, and I lose the ability to talk. I’ve had doctors gaslight me and tell me that everything is fine when I was dying. My family provides clear communication and can explain my medical past as well as share the concerns I have talked about. They are the second set of eyes and ears and can remember more about appointments and keep notes when the doctor is talking too fast for me. That night I get on a video call with my therapist, telling her about my cardiologist appointment and how they are saying I have to be by myself. I explain to her that I can’t go to my appointments without someone with me. She nods her head in agreement and we form a plan. She suggests that she writes a letter explaining that I need to have a family advocate with me during appointments and tests. In the letter, my therapist explains my diagnoses and how they affect me in medical situations. Her letter states that per the Americans With Disabilities Act, I need an advocate with me during medical exams and tests to help me. The next day, I called my doctors and informed them that I had a letter from my therapist explaining my need for a family member to be with me at the appointment. They suggested that I make sure I had the letter with me when I got to the appointment and they would then put it in my file. Although most doctor appointments and hospitals are allowing people to have a guest or someone with them now, I still run into appointments where they tell me I can’t have someone with me. My most recent was a pelvic ultrasound for my endometriosis. My mum was with me at the time and showed the technicians my letter. Once they finally let my mum come back with me, she asked why she wasn’t allowed with me. They told her that it was to prevent a patient and their person from saying that the doctor did anything inappropriate — that is why they have the technician and a nurse present. My mum told them that seemed wrong as then they have two people against the patient so it’s the patient’s word against two people? These are the instances when it’s so important to have someone with me. Having the letter has profoundly helped me out. Doctors take their time explaining a bit more and they recognize my family members as a part of my team.

Anne
Anne @anne78
contributor

Why Cancer Caregiving Is Hard Even After Treatment Ends

When I realized that I was now going to be responsible for another person’s care, I knew it would be difficult. I would have to give a lot more of myself physically and emotionally. Be available to that person whenever they needed me, whether it be to help them eat or move around or comfort them. The task didn’t disappoint — it was difficult. But it was the months after the immediate crisis that surprised me the most. My mother has finished active cancer treatment for now. She has gone through three major surgeries in the last two years that had long and taxing recoveries. She did a year of chemo and radiation that left her weak, and during that year I was on-hand 24/7 (the pandemic helped a lot in that I literally had nowhere else I could be). During those times my caregiving had a clear purpose. There were clear tasks. Making porridge for breakfast, helping her eat it, watching TV with her, getting her meds, and making sure she took them, etc.  I knew the extent of what I could do to make her more comfortable or to distract her. Even though it was painful to know there was a limit to what I could do to make her feel better, it was a limit I had to accept. By this I mean accepting that nothing I could do from home would ever cure her or take all the pain away. During surgery recoveries, it was again very physical work that took up most of my time. During all of this, the message about the pandemic was ringing clear: it was dangerous for her (and by extension me) to venture out. The risk of getting severe COVID was high and not worth taking for anything other than hospital appointments. Then, things started to change. Surgeries and chemo were over for now. She was able to eat better, move around well for the most part and had more energy. At the same time the state of pandemic became muddled and we doubted everything. What was safe now? Was she still immunocompromised? Was COVID even still dangerous? Why are people wanting her to go back to work? Why don’t people want to wear masks anymore? Was I expected to return to my pre-pandemic college life and stop being a caregiver now? And the list of questions goes on and on. This confusion in turn led to some serious, serious anxiety. Because nobody could answer any of these questions with any degree of certainty, they spun around in my head on a loop. I began having nightmares about our health. Nightmares not only about what had happened but also about what was going to happen. The nightmare of the recurrence is the worst one. The nightmare of the recurrence combined with us wanting to go out to eat and coming back on a ventilator is at a close second. I don’t know what my specific tasks are anymore. My mother still needs me for emotional support and still tires easily. But she has also begun to hint that it might be time for me to go out in the world again. And I am incapable of making these decisions. The fear that has been instilled in me about both cancer and COVID keeps me awake at night. The strange superstitious idea that if I move from my caregiver position now she will suddenly go back to being very sick haunts me constantly. I’m in a space where I can’t tell what I am anymore or what is the right thing to do. Caregiving went from being a daily physical and emotional challenge to being a confusing and complex fog of emotions, doubt, and fear. Each stage comes with its own difficulties and lessons, which even though they are hard to swallow now, will serve me well later.