Well, today was Jim's 2nd ALS Clinic appointment. For those not familiar - it is a "round robin" visit where patients rotate through PT, OT, Speech Therapist, Nutritionist, social worker and neurologist.
All in all it was a very good day. Jim was having a good day both physically and mentally. He has some increased stiffness (which is obvious) which is from the muscles shortening. He has been shown more stretches to do - trick is to get him to do them!! He was also given some stretching exercises for his wrists. His grip was actually a lot stronger then it was in January (probably due to good day & meds helping the muscle spasms.)
His breathing is still good and weight is stable - the "thinness" we are seeing in his legs, chest and legs is most likely muscle atrophy. (Again something we pretty much guessed.)
I wasn't overly impressed with the neurologist - don't get me wrong he was nice and all - but like the other 2 better. He does think we should pursue the consult with the FTD specialist (scheduled for August.)
After getting out of the appointments early I asked Jim what he would like to do - he wanted to see Eclipse. So yes I have seen it 2x on opening day!! (nerd) Jim also applied for his golden buckeye card (lol).
I offically feel old 4+ hours in the clinic, lunch with our 2 for 1 coupon, matinee movie and a buckeye card. Now we just need to be in bed before dark.
**** I REALLY have to thank my cousin Gretchen for watching our girls!!! It was so nice to not have to worry about them and know they're having lots of fun!!!*****
Wednesday, June 30, 2010
Sunday, June 20, 2010
A whole lotta nothing...
I can't believe more then a month has gone by - so much has gone on. Mikayla graduated kindergarten and had her dance recital. I have opened the pool (successfully I may add.) Besides that - a whole lot of nothing new.
Jim had almost 2 very good weeks we it almost felt like the "old Jim" was back. He was right on with his humor and very helpful around the house and with the kids. Was a lot of fun. Well this weekend the aggitation seems to be really coming back as well as the (what I call ADD) behaviours. He's been really distracted and kinda distant yet real focused on what is important to him (like trips for icecream and miscellaneous household things.) Some days he is pushing himself to get the most irrelevant tasks done.
Though his FTD symptoms seem to have let up these couple weeks the ALS has seemed to "flare up." He has almost no upper body strength. We are finding he can't turn a screw driver and really isn't lifting things like he used to. He can no longer carry Ruthie to bed (Mikayla was out awhile ago.) He is having more noticable fasiculations (spasms) in his arms. They are not painful - but he says he can really feel them and you can see the muscles moving.
Also increased are his "night tremors." The doctors recentally increased his medication for these from 40 to 60mg - but they are breaking through again. They seem to bother me more then him so we are waiting to bring it up again at the ALS clinic on 6/30.
We recieved "offical" word that his FTD neurologist has retired so we were referred to another Clinic neurologist. I am waiting to get the ALS doctor's opinion on the new doctor. Our old neurologist thinks that the ALS doctor should be able to handle most of the FTD symptoms also.
Not that I lack faith in the new guy - I have scheduled an appointment with a University Hospital neurologist who specializes in FTD. Just want to see what he has to say. I have heard nothing but positive things about this doctor and he is supposed to really understand FTD. Of course the first opening for this doctor isn't until mid-August.
Well, I think that about covers it - not very exciting - just a lot of busy work!
Jim had almost 2 very good weeks we it almost felt like the "old Jim" was back. He was right on with his humor and very helpful around the house and with the kids. Was a lot of fun. Well this weekend the aggitation seems to be really coming back as well as the (what I call ADD) behaviours. He's been really distracted and kinda distant yet real focused on what is important to him (like trips for icecream and miscellaneous household things.) Some days he is pushing himself to get the most irrelevant tasks done.
Though his FTD symptoms seem to have let up these couple weeks the ALS has seemed to "flare up." He has almost no upper body strength. We are finding he can't turn a screw driver and really isn't lifting things like he used to. He can no longer carry Ruthie to bed (Mikayla was out awhile ago.) He is having more noticable fasiculations (spasms) in his arms. They are not painful - but he says he can really feel them and you can see the muscles moving.
Also increased are his "night tremors." The doctors recentally increased his medication for these from 40 to 60mg - but they are breaking through again. They seem to bother me more then him so we are waiting to bring it up again at the ALS clinic on 6/30.
We recieved "offical" word that his FTD neurologist has retired so we were referred to another Clinic neurologist. I am waiting to get the ALS doctor's opinion on the new doctor. Our old neurologist thinks that the ALS doctor should be able to handle most of the FTD symptoms also.
Not that I lack faith in the new guy - I have scheduled an appointment with a University Hospital neurologist who specializes in FTD. Just want to see what he has to say. I have heard nothing but positive things about this doctor and he is supposed to really understand FTD. Of course the first opening for this doctor isn't until mid-August.
Well, I think that about covers it - not very exciting - just a lot of busy work!
Sunday, May 16, 2010
Elvis??? Really???
Well, Wednesday Jim's lip start doing its best Elvis impersonation. The muscle on right side of his mouth (above the corner of his lip)started "fasiculating" or spasming. This really scared him - plus he was dizzy. So off to the doctor we went. Of course our regular doctor and our "backup" doctor were already booked - so we got to meet ANOTHER new doc. This one was actually very nice and took time to really read Jim's records before doing anything (novel - huh?)
He came in and introduced himself - asked Jim what was going on - and Jim of course looks to me to answer. I look at the doctor and explained the new symptoms. The doctor literally just stared at me - then apologized "I'm sorry I am just trying to absorb this. It is a very unusual diagnosis" At least he was honest!! In addition to the face spasms his night "tremors" have started to break through his medication again. (FYI - Difference between spasm and tremor - got me. Neither of these are the "right" term - just what I named them as they showed up in the beginning. The correct term is fasiculation.)
Anyhow, this doctor increased the medication to controll the spasms from 40mg to 50 and okayed him to take another 10mg if needed. He has taken 60 everyday since. If he doesn't take the extra before bed he gets up to take on in the middle of the night. He is noticing the muscle movements now - something he never used to. Part of the reason I think is because he can't help but feel and see them in his arms and face.
I called the ALS neuro's office assitant on Wednesday and left a message. Friday I called again and got no response - turns out the physician assistant is not there anymore. Thank goodness for the FTD Physician assitant for solving that puzzle. But now I wasted Wed-Fri waiting for a call that never came. So Monday I will start at square one with the ALS neuro's office. I hate wasting time!! Will keep you posted!!
Also, on Wednesday Jim's Grandpa was admitted to ICU with a blood sugar level over 1,000. Luckily he seems to be doing better, he is out of ICU but still in the hospital as of this post. An extra prayer is appreciated.....THANKS
He came in and introduced himself - asked Jim what was going on - and Jim of course looks to me to answer. I look at the doctor and explained the new symptoms. The doctor literally just stared at me - then apologized "I'm sorry I am just trying to absorb this. It is a very unusual diagnosis" At least he was honest!! In addition to the face spasms his night "tremors" have started to break through his medication again. (FYI - Difference between spasm and tremor - got me. Neither of these are the "right" term - just what I named them as they showed up in the beginning. The correct term is fasiculation.)
Anyhow, this doctor increased the medication to controll the spasms from 40mg to 50 and okayed him to take another 10mg if needed. He has taken 60 everyday since. If he doesn't take the extra before bed he gets up to take on in the middle of the night. He is noticing the muscle movements now - something he never used to. Part of the reason I think is because he can't help but feel and see them in his arms and face.
I called the ALS neuro's office assitant on Wednesday and left a message. Friday I called again and got no response - turns out the physician assistant is not there anymore. Thank goodness for the FTD Physician assitant for solving that puzzle. But now I wasted Wed-Fri waiting for a call that never came. So Monday I will start at square one with the ALS neuro's office. I hate wasting time!! Will keep you posted!!
Also, on Wednesday Jim's Grandpa was admitted to ICU with a blood sugar level over 1,000. Luckily he seems to be doing better, he is out of ICU but still in the hospital as of this post. An extra prayer is appreciated.....THANKS
Thursday, May 6, 2010
Another Update
This is an extension of my last post. A few people had questions and I realized I ha a lot in there that people didn't quite understand. Seeing how it came up a few times here is a further explanation:
In short, Jim has 2 neurologists. The current head of the Cleveland Clinic Neuro Dept is managing the FTD (dementia) - that was who his appointment was with. This Dr. is currently opening the Cleveland Clinic's Alzheimer's Clinic in Las Vegas - so he only sees his "hard cases" when he returns to Cleveland every few months. Well he is retiring - so we will get the new head of neurology to replace this doctor.
Jim looks a lot thinner then he did in December - his collar bones kinda stick out and his legs look a lot thinner. A year ago Jim wore a 34" waist, by Christmas he was in a 32" and now those look saggy too. However he remains a constant 165 pounds - no weight loss.
His bicep muscles spasm (or tremble) under the skin. This was not there in December. His calves have done this since at least July. He has night tremors (twitching) at night that he manages to sleep through - (I do not). In December they increased his anti-spasm meds which has controlled it until this last week. Right now the break-through tremors are mild so they will reevalute them in June and possibly raise the dosage again.
He is having left side pain (just under the ribs) that he rates 11 on a scale of 1-10. When it really flares up his pain meds don't touch it. This is new since last week. His 1st symptom (now almost 2 yrs ago) was the same pain on the right. Dr is not sure what this is - may be muscle degeneration from the ALS. But ALS doesn't typically effect these muscles.
A major symptom of this type of dementia is changes in behavior, empathy and decision making skills. Before his diagnosis I did not understand his thinking/actions and it would drive me crazy. Now I understand when I ask him a question (for instance) and he answers something strange - it is not him - it IS the disease. (An example I use is: Jim what color is the sky? He answers - not purple. In the FTD mind the answer is right. Instead I now ask "is the sky red or blue?" - then I get the right answer. This is a simplified explanation obviously.)
The dementia is causing increased aggitation in his behavior - so they subscribed a "calming" medication for this.
As for the ALS (Lou Gerhig's) - he has an ALS Clinic day every 6 months. It is a full day where you rotate through appointments with the neurologist, nutritionist, social worker and physical, occupational and speech therapy. It is a 6 hour day. They track his progression, meds, etc. This is run by a 2nd neurologist - he actually wrote the Doctor's textbook on ALS (literally).
Jim also has an in-home physical therapy (lower body) and occupational therapist (upper body) who come to work on stretching his muscles and work on reducing his overall stiffness.
A lot of Jim's ALS symptoms mimic Parkinson's disease (like the way he walks) which is also atypical. His ALS progression has been rapid - but could be much much worse. We thought he was loosing strength in his upper body - but he really is not. He has trouble lifting things, cannot pick up the kids and has trouble with fine motor skills. It is not his strength declining but something with his muscles. (A technical term I don't remember. )
In short (I know - too late) most patients with this combination of these diseases survive 18 - 36 mos. Given Jim's "abnormal" ALS symptoms his progression seems slower - hopefully giving him 3- 7years. Most patients in his case should be falling or wheelchair bound by now. His breathing is good - many are on a ventilator. God willing it will be a long time until we face that.
I have a blog for Jim: shaggymetz.blogspot.com I keep this updated with information. There is more info on both diseases including a FTD piece Channel 3 did "starring" a friend from my support group. Feel free to ask me anything. My role in this is to raise awareness and support.
In short, Jim has 2 neurologists. The current head of the Cleveland Clinic Neuro Dept is managing the FTD (dementia) - that was who his appointment was with. This Dr. is currently opening the Cleveland Clinic's Alzheimer's Clinic in Las Vegas - so he only sees his "hard cases" when he returns to Cleveland every few months. Well he is retiring - so we will get the new head of neurology to replace this doctor.
Jim looks a lot thinner then he did in December - his collar bones kinda stick out and his legs look a lot thinner. A year ago Jim wore a 34" waist, by Christmas he was in a 32" and now those look saggy too. However he remains a constant 165 pounds - no weight loss.
His bicep muscles spasm (or tremble) under the skin. This was not there in December. His calves have done this since at least July. He has night tremors (twitching) at night that he manages to sleep through - (I do not). In December they increased his anti-spasm meds which has controlled it until this last week. Right now the break-through tremors are mild so they will reevalute them in June and possibly raise the dosage again.
He is having left side pain (just under the ribs) that he rates 11 on a scale of 1-10. When it really flares up his pain meds don't touch it. This is new since last week. His 1st symptom (now almost 2 yrs ago) was the same pain on the right. Dr is not sure what this is - may be muscle degeneration from the ALS. But ALS doesn't typically effect these muscles.
A major symptom of this type of dementia is changes in behavior, empathy and decision making skills. Before his diagnosis I did not understand his thinking/actions and it would drive me crazy. Now I understand when I ask him a question (for instance) and he answers something strange - it is not him - it IS the disease. (An example I use is: Jim what color is the sky? He answers - not purple. In the FTD mind the answer is right. Instead I now ask "is the sky red or blue?" - then I get the right answer. This is a simplified explanation obviously.)
The dementia is causing increased aggitation in his behavior - so they subscribed a "calming" medication for this.
As for the ALS (Lou Gerhig's) - he has an ALS Clinic day every 6 months. It is a full day where you rotate through appointments with the neurologist, nutritionist, social worker and physical, occupational and speech therapy. It is a 6 hour day. They track his progression, meds, etc. This is run by a 2nd neurologist - he actually wrote the Doctor's textbook on ALS (literally).
Jim also has an in-home physical therapy (lower body) and occupational therapist (upper body) who come to work on stretching his muscles and work on reducing his overall stiffness.
A lot of Jim's ALS symptoms mimic Parkinson's disease (like the way he walks) which is also atypical. His ALS progression has been rapid - but could be much much worse. We thought he was loosing strength in his upper body - but he really is not. He has trouble lifting things, cannot pick up the kids and has trouble with fine motor skills. It is not his strength declining but something with his muscles. (A technical term I don't remember. )
In short (I know - too late) most patients with this combination of these diseases survive 18 - 36 mos. Given Jim's "abnormal" ALS symptoms his progression seems slower - hopefully giving him 3- 7years. Most patients in his case should be falling or wheelchair bound by now. His breathing is good - many are on a ventilator. God willing it will be a long time until we face that.
I have a blog for Jim: shaggymetz.blogspot.com I keep this updated with information. There is more info on both diseases including a FTD piece Channel 3 did "starring" a friend from my support group. Feel free to ask me anything. My role in this is to raise awareness and support.
Wednesday, May 5, 2010
Jim Update
Well, we had his appt yesterday. The FTD neuro is retiring and will refer us over to the new head of the department. However, he thinks much could be handled by the ALS neuro. His physcian's assitant promises us we will not fall through the cracks.
His next ALS clinic is scheduled for June 30.
The neuro says he thinks we are handling this well because I am accepting that Jim is the way he is mentally because of the disease and not because he is trying to be a jack a$$. Says that is a big hurdle for families to get over.
He says he can't believe that Jim hasn't lost weight - he to notices changes in his legs and shoulders. I told him that I bought him pants that were 2" smaller at Christmas and they already look big - he agreed. But his weight is stable - actually a little higher then a year ago. Again something else that doesn't make sense.
He is having intense pain on his left side (kinda like what he used to have on his right.) Jim says it's an 11 on a scale of 1 - 10. Neuro says this stumps him. ALS shouldn't affect those muscles - but then again Jim's ALS isn't typical.
Right now he is just continuing to treat this with pain medication. We also have in home physical and occupational therapy coming in a few times a week.
The doctor also noticed fasiculations (muscle spasms) in his biceps - this is new but I had a problem seeing them. He said it is not loss of strength in his upper body - but something else (can't remember the term he used.) Some kind of Parkinsons-like symptom.
Good news(???!!!) is that since Jim is not typical in his ALS progression so his prognosis is a little better. "Standard" ALS/FTD is 18mos - 3yrs.
Jim's prognosis is 3-7 years.
Hate to put all this info in an email/post - but don't think I can handle repeating it in detail over and over in phone calls. Any other questions please ask.
Prayers are always accepted! In the meantime enjoy life!!
His next ALS clinic is scheduled for June 30.
The neuro says he thinks we are handling this well because I am accepting that Jim is the way he is mentally because of the disease and not because he is trying to be a jack a$$. Says that is a big hurdle for families to get over.
He says he can't believe that Jim hasn't lost weight - he to notices changes in his legs and shoulders. I told him that I bought him pants that were 2" smaller at Christmas and they already look big - he agreed. But his weight is stable - actually a little higher then a year ago. Again something else that doesn't make sense.
He is having intense pain on his left side (kinda like what he used to have on his right.) Jim says it's an 11 on a scale of 1 - 10. Neuro says this stumps him. ALS shouldn't affect those muscles - but then again Jim's ALS isn't typical.
Right now he is just continuing to treat this with pain medication. We also have in home physical and occupational therapy coming in a few times a week.
The doctor also noticed fasiculations (muscle spasms) in his biceps - this is new but I had a problem seeing them. He said it is not loss of strength in his upper body - but something else (can't remember the term he used.) Some kind of Parkinsons-like symptom.
Good news(???!!!) is that since Jim is not typical in his ALS progression so his prognosis is a little better. "Standard" ALS/FTD is 18mos - 3yrs.
Jim's prognosis is 3-7 years.
Hate to put all this info in an email/post - but don't think I can handle repeating it in detail over and over in phone calls. Any other questions please ask.
Prayers are always accepted! In the meantime enjoy life!!
Friday, April 23, 2010
Avoiding the cracks...
Despite what is sometimes my best effort Jim nearly fell through "the cracks" in the medical system.
With the evidence of progression I contacted the physican assistant (PA) for the FTD neurologist. Though I don't think it is urgent to get him in we had no follow-up setup. Thank goodness I called - the neuro is currently working in Las Vegas opening the Cleveland Clinic's Alzheimer's Clinic. He will be in town the first week of May for 1 day of patient appointments and 1 day of meetings. Though his schedule is full they squeezed us in since Jim is a "special" case. The neuro only sees his "difficult" cases while here (his words - not mine.)
During the conversation with the PA she asked when the ALS follow-up was. Well... that wasn't scheduled yet. Apparently we should have already been scheduled for July. However, the ALS clinic neuro we saw in January will be on maternity leave. Therefore, there are no ALS clinics in July. Good news is we got an appointment with the "main" ALS neuro.
In a discussion with the ALSA support group I decided to try to get a referral for in home physical therapy. Jim is really stiffening up - especially his upper body. So we saw our family doctor for that and pain management.
This was an enlightening appointment. The last time he saw this doc was in April 2009 when he was given the referral to the neurologist. That was the start of this journey. Anyhow, the doc comes in and asks what's new. I start to answer - the doc stops me wanting Jim to answer. (He is also my doc so he knows the whole story.)
Jim answers - "well I've seen lots of doctors"
Dr - "and..." Jim: "I became the human pin cushion" Dr: "and what have they told you you have?" Jim sat there for a minute then "they keep telling me but I keep forgetting." Broke my heart.
Well... the first PT appointment went well. They called to schedule the 2nd and Jim told them no... we wouldn't be home. OK - called the office back and reminded them NOT to try to schedule with the dementia patient!! Sad thing is I didn't learn this until much later!! Oh well, live and learn.
With the evidence of progression I contacted the physican assistant (PA) for the FTD neurologist. Though I don't think it is urgent to get him in we had no follow-up setup. Thank goodness I called - the neuro is currently working in Las Vegas opening the Cleveland Clinic's Alzheimer's Clinic. He will be in town the first week of May for 1 day of patient appointments and 1 day of meetings. Though his schedule is full they squeezed us in since Jim is a "special" case. The neuro only sees his "difficult" cases while here (his words - not mine.)
During the conversation with the PA she asked when the ALS follow-up was. Well... that wasn't scheduled yet. Apparently we should have already been scheduled for July. However, the ALS clinic neuro we saw in January will be on maternity leave. Therefore, there are no ALS clinics in July. Good news is we got an appointment with the "main" ALS neuro.
In a discussion with the ALSA support group I decided to try to get a referral for in home physical therapy. Jim is really stiffening up - especially his upper body. So we saw our family doctor for that and pain management.
This was an enlightening appointment. The last time he saw this doc was in April 2009 when he was given the referral to the neurologist. That was the start of this journey. Anyhow, the doc comes in and asks what's new. I start to answer - the doc stops me wanting Jim to answer. (He is also my doc so he knows the whole story.)
Jim answers - "well I've seen lots of doctors"
Dr - "and..." Jim: "I became the human pin cushion" Dr: "and what have they told you you have?" Jim sat there for a minute then "they keep telling me but I keep forgetting." Broke my heart.
Well... the first PT appointment went well. They called to schedule the 2nd and Jim told them no... we wouldn't be home. OK - called the office back and reminded them NOT to try to schedule with the dementia patient!! Sad thing is I didn't learn this until much later!! Oh well, live and learn.
Monday, April 12, 2010
Running a little behind....
Not sure if I have just been that busy or plain out putting off this update.
This has been a busy few weeks. Of course Easter and Ruthie turned 3 on Friday. She is very excited over her Zhu Zhu pets, new wardrobe and the bike Grandma and Grandpa got her. Mikayla returns to school today - though she INSISTS she's not going. Ruthie told Grandma that Daddy was being mean making 'Kayla go to school.
Ok - now Jim.
Symptoms have certainly been showing up this month. He is showing a lot of increased aggitation this last month. Some of this has caused irrational responses or behaviors. I have found that it is best to redirect his attention when this happens if at all possible. (this is an FTD symptom)
Another reminder of the FTD is his continued lack of self awareness. We find him "wandering" across the street and parking lots with out looking. Even Mikayla has warned him on this one.
I have taken greater control over his medications, especially the ones on an "as needed" basis. He has difficulty figuring out how much he can take and how often.
He continues to show increased stiffness or rigidness especially in his upper body. We have an appointment on Wednesday to get a referral for physical therapy to come to our house. He was given stretching exercises to follow at the ALS clinic in January but hasn't managed to do so. After some discussion we think that having someone showing him these in house may help.
He has had an increase in his drop foot (or feet in this case?) This causes almost a constant shuffle in his walk. His hands are more unsteady and he is experiencing an increase in pain especially when active. This will also be addressed at Wednesday's appointment. I am trying to convince him not to over exert himself but sitting around drives him crazy.
He is on the waiting list for a loaner wheelchair. Though he does not "need" it now I am trying to convince him to use one so he does not fatigue himself while walking at places like the mall. I am trying to get ahead of the game on this one.
Perhaps his biggest change - and the most significant - is Jim is no longer staying home alone or with the kids. This has been a big adjustment for us all. Trying to get someone to watch your kids and husband has been a little difficult. Mom has been a tremendous help in this area. She has been playing chauffer while I am at work and hosting sleepovers for Jim, the kids and the dogs. She is also spending a few nights at our house to help out. Jim IS aware of this change, even joking about having a babysitter. I have explained the safety aspect to him and he seems to accept it.
Now we are just praying for another plateau in the progression. We have had enough changes for now - time to adjust again.
PLEASE PRAY - IT IS THE BIGGEST THING YOU CAN DO FOR HIM.
This has been a busy few weeks. Of course Easter and Ruthie turned 3 on Friday. She is very excited over her Zhu Zhu pets, new wardrobe and the bike Grandma and Grandpa got her. Mikayla returns to school today - though she INSISTS she's not going. Ruthie told Grandma that Daddy was being mean making 'Kayla go to school.
Ok - now Jim.
Symptoms have certainly been showing up this month. He is showing a lot of increased aggitation this last month. Some of this has caused irrational responses or behaviors. I have found that it is best to redirect his attention when this happens if at all possible. (this is an FTD symptom)
Another reminder of the FTD is his continued lack of self awareness. We find him "wandering" across the street and parking lots with out looking. Even Mikayla has warned him on this one.
I have taken greater control over his medications, especially the ones on an "as needed" basis. He has difficulty figuring out how much he can take and how often.
He continues to show increased stiffness or rigidness especially in his upper body. We have an appointment on Wednesday to get a referral for physical therapy to come to our house. He was given stretching exercises to follow at the ALS clinic in January but hasn't managed to do so. After some discussion we think that having someone showing him these in house may help.
He has had an increase in his drop foot (or feet in this case?) This causes almost a constant shuffle in his walk. His hands are more unsteady and he is experiencing an increase in pain especially when active. This will also be addressed at Wednesday's appointment. I am trying to convince him not to over exert himself but sitting around drives him crazy.
He is on the waiting list for a loaner wheelchair. Though he does not "need" it now I am trying to convince him to use one so he does not fatigue himself while walking at places like the mall. I am trying to get ahead of the game on this one.
Perhaps his biggest change - and the most significant - is Jim is no longer staying home alone or with the kids. This has been a big adjustment for us all. Trying to get someone to watch your kids and husband has been a little difficult. Mom has been a tremendous help in this area. She has been playing chauffer while I am at work and hosting sleepovers for Jim, the kids and the dogs. She is also spending a few nights at our house to help out. Jim IS aware of this change, even joking about having a babysitter. I have explained the safety aspect to him and he seems to accept it.
Now we are just praying for another plateau in the progression. We have had enough changes for now - time to adjust again.
PLEASE PRAY - IT IS THE BIGGEST THING YOU CAN DO FOR HIM.
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