Today is Rare Disease Day

The National Organization for Rare Disorders (NORD) is celebrating Rare Disease Day today.  To help promote increased awareness, I am asking for your help.  It will take less than five minutes, but your involvement could make a difference.

NORD has an electronic messaging service on their website (link is shown below) that allows you to email the president and other elected officials of your choice to tell them you care and why they should also care about rare diseases such as Kennedy’s Disease.  The first portion of the email is ‘canned’, but there is a section near the bottom that allows you to personalize your message (for example, why it is important to you and your family).

NORD’s message to all of us is shown below:

“Tell President Obama, Members of Congress and other elected officials that you care about rare diseases. Follow this link and submit your letter now. Then post the link on  your Facebook, Twitter, blog, website etc. and encourage your friends and family to submit their letters, too.”


Please, take a couple of minutes and let our elected officials know you care.  Thank you.

Two Important Kennedy’s Disease Studies Revisited

Back in 2010 I wrote articles on two important Kennedy’s Disease studies. For my newer readers, these two studies are still important reads to help understand Kennedy’s Disease and its effect on anyone with the mutated gene.

The Natural History of Kennedy’s Disease

I believe this is one of the most complete studies on what happens when it happens to a patient with Kennedy’s Disease. I summarized the report in my original article:

"Fortunately, this study is well written … meaning I could understand it.  This is the only study that I am aware of that focuses in on what happens and when does it occur.  It is based upon data provided for up to twenty years of a patient’s life.  This study is different than most, because of the number of patients.  So often the patient base is substantially smaller.  I would recommend reading the article if you want to learn more about the onset and progression of Kennedy’s Disease.  Little time is given to the cause of Kennedy’s Disease or current research if that is your interest."

Below are the links to my articles on this report:
http://kennedysdisease.blogspot.com/2010/05/natural-history-of-kennedys-disease.html
http://kennedysdisease.blogspot.com/2010/05/being-53-is-not-excuse.html
http://kennedysdisease.blogspot.com/2011/04/natural-history-of-kennedys-disease.html


The key findings in this study were:

1. The greater the size of the CAG-repeat expansion (CAG count), the earlier the onset.  The study used nine ADL’s (activities of daily living*) for milestones in this study
2. The rate of disease progression was not dependent upon the number of CAG-repeats. 
3. The researchers commented that the most striking observation was that the CAG-repeat length did not affect the interval periods between the individual ADL milestones.  In other words, the progression of the disease is not influenced by the CAG count. 
4. The most common cause of death was pneumonia due to aspiration and dysphagia.  Even though these two bulbar symptoms were relatively mild when first manifested, they were serious issues in the later phases of the disease. 
5. Creatine kinase (CK) averaged 863 in these patients with a range from 31 to 4955. The normal range for CK is 45 to 245.
6. Serum testosterone levels were relatively high even with older patients, although the levels did decrease with age.

Clinical Features of Spinal and Bulbar Muscular Atrophy

The other recent study goes in a somewhat different direction, but is also very helpful in understanding the disease. I summarized the report in my original article:

“In October of last year, a paper was published on the findings of 57 patients with Kennedy's Disease here in the United States. It is somewhat different in scope than the "Natural History of SBMA" report I discussed in May. The information provided in this report was obtained during the last NIH clinical trial. The title of this report is "Clinical Features of Spinal and Bulbar Muscular Atrophy." In today's article I will highlight certain findings that I found interesting. I would recommend that if you are interested, please follow the link above and read the entire paper.”

Below is the link to my article on this report:
http://kennedysdisease.blogspot.com/2010/06/clinical-features-of-kennedys-disease.html

"This report concluded that the longer the CAG repeat length (number), the earlier the onset. It also commented that the longer the CAG repeat length, the greater the abnormalities in motor and sensory nerve conduction. 94-to-100% of the patients had some sensory problems. They reported that there was a significant difference in the MUNE (motor unit number estimation) between SBMA subjects and the control (healthy) group. This sensory nerve issue (nerve conduction) has been one that has bothered many of us with Kennedy's Disease for some time. The tingling or numbness in the feet, hands or other parts of the body has been frustrating, because it had not been reported as a symptom until recently."

If you haven’t visited these articles or read the actual reports, I would recommend that you take the time to do so.

Personal Update

Several readers have written to ask how I am doing. I reported a few weeks ago that my arm strength and my neck weakness and pain were concerns.
 

Arms-Hands-Shoulders

Fortunately, about a week ago my arm strength returned. I believe I am close to 100% back. Whew! I was really beginning to wonder what happened. I woke up on February 17 and noticed the difference immediately. What happened this time was different than what I call ‘the slide’.
 

Neck

And, since I changed my hours sitting in front of my PC, my neck has recovered. It is about 80% of what it was last fall, but that is a lot better than just a month ago. I now only spend an hour at a time in the office and then I take a break. It has made all the difference in the world. I also have added a couple more neck exercises to my daily routine. As long as I continue to be ‘smart’ I should be all right.
 

Other Thoughts

My leg strength continues to be good and that is a blessing. And fortunately, I have not had any joint pain in many months.

My exercise program is going well now that my arm strength has returned. I average 90 minutes every other day and 15-20 minutes on the in between days.

Thanks for your concerns, advice and support.

What does the DNA blood test tell us?

At least a couple of times a year someone will write and question the accuracy of the DNA blood test for Kennedy’s Disease. This normally happens because a man has identified many of the symptoms he has are also related to Kennedy’s Disease (KD).

It is my understanding that the DNA test is 99+% accurate. Yes, that still leaves less than one percent available for error. Of course, there is the possibility that a person is ‘borderline’ KD. That means his CAG repeats are 34-39. It is also my understanding that borderline cases can exhibit some of the symptoms, but not all of them. The progression is also not as evident.

The two DNA tests that I had showed a scale similar to the following:

• 0-33 = Normal
• 34-39 = Borderline
• 40 and above = Kennedy’s Disease (Spinal Bulbar Muscular Atrophy or SBMA)

So, borderline could be diagnosed as normal by some doctors and also explain why a patient experiences some of the symptoms.

In a study conducted a few years ago, it was reported that the higher the CAG repeat count the earlier the onset meaning the progression is also more apparent over time. I happen to be on the higher end with a 53. I have known others with counts in the low 40s that did not exhibit any noticeable symptoms until the late 50s or 60s. (Boy would that have been nice)

_______________________________

Wikipedia defines these type disorders as Trinucleotide repeat disorders (also known as trinucleotide repeat expansion disorders, triplet repeat expansion disorders or codon reiteration disorders) are a set of genetic disorders caused by trinucleotide repeat expansion, a kind of mutation where trinucleotide repeats in certain genes exceeding the normal, stable, threshold, which differs per gene. The mutation is a subset of unstable microsatellite repeats that occur throughout all genomic sequences. If the repeat is present in a healthy gene, adynamic mutation may increase the repeat count and result in a defective gene.


Wikipedia also explains Kennedy’s Disease as: SBMA is caused by expansion of a CAG repeat in the first exon of the androgen receptor gene (trinucleotide repeats). The CAG repeat encodes a polyglutamine tract in the androgen receptor protein. The greater the expansion of the CAG repeat, the earlier the disease onset and more severe the disease manifestations.

How to listen and how something is made

Goodlife Zen, one of my favorite websites had a good article recently about ‘listening to the nudges of your heart’.  I felt the three steps discussed by Christopher Foster could apply to many things in life … especially for those of us who find that life can be unpredictable at times.  Below is an excerpt from the article.

Listen to our own inner wisdom

As our lives become increasingly busy and the world wobbles in alarming ways there is one thing, I have learned, upon which I can always depend. Listening to the little nudges of my own heart. I don’t catch them all but I sure do my best. Three steps that are essential in my experience are these.

Three essential steps

1. Stop:  Slow down. Sometimes, faced with an emergency, we simply act spontaneously as the situation demands. But most of the time, with a difficult decision to make, or a priority to choose, we have time to be still for a moment and step back from the situation.
2. Listen: Life is very clever. Sometimes it only needs that moment of silence for the answer to a problem to appear. Sometimes it happens when we give up. But as you make a habit of listening to that still small voice within yourself will find something quite magical happens. You realize that stillness is not empty. All the wisdom of the universe is there.
3. Trust:  The last step is trust. … trust your inner voice.
It is not wisdom that comes from far away, it is our own grace and it loves us. It will never leave us. But we have to do our bit and listen.

Several times in my life I found that the answer to some problem I am experiencing is already known.  Once I disengaged from the process of trying to do or remember something and believed the answer would come to me, it usually did.

Stop, Listen and Trust

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How a major league baseball is made

Occasionally I post something that has nothing to do with Kennedy’s Disease or research or self-help or my personal life.  Today is one of those days.

A friend sent me a link to a short video on how major league baseballs are made.  According to the narrator, this is the first time they have been able to show some of the machines involved in the making of a baseball.  I found it interesting how much of the process is still labor intensive.  The workers that do the stitching of the covers still have the toughest job in my opinion.

For anyone who played baseball, played catch with your father or son, or has been to a game and caught a foul or homerun ball, the look and feel of a baseball in something that you never forget.

I hope you take the time to watch the video, I found it fascinating.
http://www.reliableplant.com/view/25724/how-baseballs-are-manufactured

Global Rare Diseases Registry (GRDR)

The Kennedy’s Disease Association received an email from the National Institute of Health (NIH) regarding a pilot program they are trying to establish. The concept is interesting and the opportunities it represents for rare diseases like Kennedy’s Disease makes it something worth looking into further. There is a lot of information available on the website and the program is only in the exploratory stage, but I felt it is worth bringing to my readers’ attention.  [Note:  I have highlighted some key points]  I would be interested in your thoughts on whether this appears to be an opportunity.

About the program

The Office of Rare Diseases Research (ORDR) within the National Institute of Health has launched a pilot program to establish the Global Rare Diseases Patient Registry and Data Repository (GRDR). The goal is to enable analyses of data across many rare diseases and to facilitate clinical trials and other studies.

Patient organizations are invited to participate by collecting patient clinical information. The platform being developed can be used by any patient group to establish a registry or to contribute de-identified patient data to the GRDR.

Why Rare Disease Registries

Rare diseases comprise a clinically heterogeneous group of approximately 6,500 disorders each occurring in fewer than 200,000 persons in the USA. They are commonly diagnosed during childhood, frequently genetic in origin, and can have deleterious effects on long-term health and well-being. Although any given condition is rare, their cumulative public health burden is significant with an estimated 6-8% of individuals experiencing a rare disease at some point during their lives.


Because these disorders are so uncommon, no single institution, and in many cases no single country, has sufficient numbers of patients to conduct generalizable clinical and translational research. Geographic dispersion of patients has been a major impediment to patient recruitment into clinical trials. Most rare diseases do not have a specific International Classification of Diseases (ICD) code, which hampers research using existing administrative databases.

Best estimates are that fewer than 20% of rare diseases have registries, and most are operated by patients’ organizations or academic researchers. Although most registries are country-specific, there are a small number of international efforts—e.g., in Cystic Fibrosis and Neuromuscular Diseases—that are demonstrating the benefits of combining data across international boundaries.

Identifying patients and gathering genetic test results and clinical status parameters for many rare diseases is laborious and expensive. The Global Rare Diseases Patient Registry and Data Repository (GRDR) allows any rare disease population, regardless of size, to collect patient data that can identify clinical trial candidates and fuel research. By assembling many small patient registries into a common data repository, economies of scale can be realized and researchers will have the ability to look beyond a single gene/indication which may reveal non-obvious associations between genes and diseases.

How Do Registries Work?

A registry is a systematic collection of standardized data on a group of patients. The starting point of a registry is to develop a list of patients. Once patient group is defined, a variety of data types can be added. Data can be entered into a registry by patients, clinicians, researchers, or directly imported from electronic health records. Scientists and pharmaceutical companies are more likely to conduct research on a given rare disease if they find a patient registry in place. By defining a population of patients, registries enable the formation of various types of research, educational, and outcomes improvement infrastructures.


In the GRDR patient registry model, patients register themselves on the registry website, answer a questionnaire regarding their medical history and attach electronic versions of testing results to their account. A registry may have a coordinator who verifies the patient submitted information. In this model, information is tracked longitudinally and email reminders are sent to participants missing testing results or with out-of-date accounts.

How Can Registry Data Be Used?

Registries support various types of research, education, and outcomes improvement initiatives, including:

• Learn among the community
• Knowledge dissemination
• Encourage research and plan trials
• Recruit patients
• Understand the disease
• Evaluate effectiveness
• Safety monitoring
• Quality and outcomes improvement – treatment, practice, surveillance/monitoring
• Genotype/phenotype associations
• Hub to link other registries, repositories and data sources

These varied uses of registry data are made possible by the infrastructure available to the GRDR registry which supports unlimited ‘roles’ of users. Researchers and clinical investigators may register on the site for access to de-identified data, best practices and other information generated as part of this program. Patients may register as participants to contribute their data and learn from others. Protecting privacy of participants is of the upmost importance to the GRDR registry program. No identifying patient information is released outside the registry without the stated permission of the participant.

Dutasteride – One year update

I can hardly believe it has been a year since I started taking dutasteride. I reviewed my dutasteride journal this week and summarized my findings by quarter.

1^st Quarter

• I was flying high because there was an immediate improvement in strength.
• Improvement in leg strength was the most noticeable.
• I felt stronger and had very little pain.
• Many of my muscles felt alive again … tightness after exercising.
• Exercised seven days a week.
• Continued to add exercises and weight until my longer program was two hours long.
• No apparent side effects.

2^nd Quarter

• Stabilized at the new stronger level.
• Didn’t notice quite the same level of high (strength) that I experienced in the first quarter.
• For a week in May I had a significant amount of neck pain.
• Continued to exercise for 120 minutes every other day and 15-20 minutes on the off days.
• No apparent side effects.

3^rd Quarter

• Exercised for 115-120 minutes every other day and 15-20 minutes on the off days.
• No apparent change in strength. Continue to feel I am stronger than I was six months ago.
• No apparent side effects.

4^th Quarter

• I felt that I was over-training and was no longer enjoying my long exercise program.
• I reduced my long program to 90-95 minutes and it seemed to help.
• I began to experience neck weakness and cramping, often severe.
• In the 11^th month I noticed a slight weakness in the arms.
• In the 12^th month my right arm was weaker
• No apparent side effects.

Final Thoughts:

This has been an interesting twelve month ride. I believe that dutasteride helped initially and that I ended up being stronger than I would have been without it. Over the last three months I have experienced neck pain as well as arm and neck weakness that I had not experienced earlier. What these means for my future only time will tell.

Conclusion:

I am glad I tried dutasteride and will continue to take it for the foreseeable future.

An essential part of living a healthy life

I read the short article below the other day and thought it needed to be shared. I strongly believe that a positive mental attitude (PMA) and positive self-feedback (PSF) are important aspects of anyone’s health. I have seen and experienced how being positive can make a difference in how you feel and how you look forward to the day ahead. Yes, it is easy to become frustrated, angry, depressed and anxious especially when you are dealing with an incurable progressive disorder, but that doesn’t mean we have to wander through life feeling that way.

For example, it seems that when you are down and tell yourself how tired (or weak, or sick, or bummed out) you are, the rest of the day goes downhill. And, anything else that goes wrong you attribute to how you felt earlier ... just a continuation of a bad day. At times like this it is easy to begin a negative dialogue (I should have stayed in bed, why did I ever start this anyway, I think I’ll just sit here and do nothing). How do you feel after that? Worse, right?

Positive Affirmations Work

On the other hand, if you are down and begin feeding yourself some positive affirmations (I am feeling better already, I’ll feel better after breakfast, I can’t wait to start XXX, after I exercise I know I will feel better, etc.), it always amazes me how your outlook changes. Also, if you engage in some productive work to take your mind off how you are feeling, you often start feeling better.

I like the comment below that “thinking positively is exercise for the mind.” My brother, who also has Kennedy’s Disease, is twelve years older than me. I swear you will not meet a more positive person. Even if things are going poorly, he always seems to look on the bright side and usually ends up saying something like, “It could be a lot worse.”

I need a laugh
From my personal experience, if I am feeling down (or sick), I watch “Blazing Saddles” or “Young Frankenstein”. It is amazing how laughing for a couple of hours changes my outlook on life.

________________________________

 

How Positive Thinking Keeps You Healthy

Orion Jones - BigThink

What's the Latest Development?

It is no coincidence that you feel more energetic and relaxed when you are thinking positively, or that you feel lazy and tired if you are thinking negatively. Hormones secreted by the body, which are then carried into the blood stream, greatly affect how we feel. The sensations of impatience and pressure which accompany anger are caused by stress hormones like cortisol and norepinephrine. And it is the brain which controls the release of such hormones, influencing heart rate, blood pressure and breathing patterns.

What's the Big Idea?

Thinking positively is exercise for the mind. Even though it may not come easily, it remains an essential part of living a healthy life. In anecdotal cases, some medical patients have beaten odds stacked highly against them by refusing to believe a negative prognosis, instead surrounding them with family, friends and comedy films. Norman Cousins, former editor of theSunday Review, was one such case. He outlived his doctor's expectations by 26 years after being diagnosed with ankylosing spondylitis, a painful and degenerative spine disease.

Pay-it-forward

Last week I sent out the Kennedy’s Disease Association’s 2011 annual report. As in past years, it always amazes me how much can be accomplished by an all-volunteer non-profit in one year. At the same time I consider how much more could be done with more volunteers.

I have never been a proponent of hiring an office staff or paying a commission to telephone solicitors. I hate those ‘canned’ phone calls and all the mailings that include small giveaways in hopes of enticing you to give.

Yet, it would be nice to have more ‘feet on the ground’ that are focused on the KDA’s work. We do so much good with so few resources. It still amazes me that 90¢ of every dollar spent by the KDA goes to Kennedy’s Disease research (80¢) and Kennedy’s Disease education (10¢).

When I review the financial reports of some of the larger non-profits, I cannot believe how much is spent on salaries, overhead and fund raising. On the other hand, most of these larger non-profits seem to be quite effective in raising needed funds.

I don’t know how much longer I will serve as president of the KDA, but I do know that these last seven years have been some of the most rewarding years of my life. I have made many friends and shared many stories. I have helped some people and have been helped by so many more. In some ways it reminds me of the concept “pay-it-forward.”

Today’s article is a long-winded way of saying “THANK YOU” to all of your who have donated your time and/or money to make the Kennedy’s Disease Association so effective. Without you there would be no KDA.

Loneliness and Guilt

The KDA website’s home page has this statement: “You are not alone.” I believe most everyone who learns they have an incurable disease feels ‘alone’ at some point as they go through their own acceptance process.
 

Reasons for feeling alone

• You have no one to talk to that understands what you are going through.
• Many times your doctor is not even a resource for information on your condition.
• There is little information available on the disease.
• You are uncertain what this could mean to your future employment. (How long will I be able to work, can I still do my job, etc.)
• You are afraid and often angry, but don’t feel you can share these feelings without appearing weak.
• You want to protect your loved ones, so you refuse to share your feelings and concerns with them.
• You don’t know what to do or who to turn to for help.

About thirty-five years ago I started going through this acceptance process. At times it wasn’t too bad and then there were times where I was not a ‘happy camper’. Fortunately, I have a wonderful wife who is very supportive and understands that I am not always going to be ‘Mr. Personality’. She knew when I just wanted someone to listen and when I needed comfort. We got through it then and continue to go through it today as the disease progresses. In my humble opinion, ‘acceptance’ is a personal journey; not a destination state.
 

What could be worse?

In my opinion, there is only one thing worse than the feeling of being alone in this world. That is the guilt you feel because you have burdened your significant other/spouse with having to care for you. I call it the ‘martyrdom phase’ because you begin to think your loved one would be better off without you. You already see the progression and the loss of certain abilities, but even worse, you cannot imagine how your spouse/significant other could continue to love you for the burden you have given her/him as caregiver.
 

Just another stage ...

Fortunately, both loneliness and guilt are just phases in the acceptance process. If we understand that these are just phases, we know that ‘these too will pass’. Once we recognize that these feelings are just our ego being challenged; it becomes easier to look for positive ways to reinforce relationships, share feelings, ask questions, and move on to the next phase. Reading about it is one thing; living through it is something else. It is not easy, but it is a necessary part of growing and living with your disease.

And, always remember,

YOU ARE NOT ALONE!

Follow this link to read more about the nine stages of the acceptance process.

This and That ...

Neck?

Several have asked about my neck weakness. It seems to be better, but I have also been more mindful of the time I spend at the computer. I also spend an hour or so every afternoon in the recliner with a bog-bone pillow for my neck. It seems to stretch out the muscles and provide some needed support.

It is still easy to get caught up with KDA stuff and spend too many hours at the computer. I just need to be more mindful and the price I pay when that happens.
 

Contacting old friends

Last week’s article about ‘Regrets’ took an interesting spin yesterday. I received a call last night from someone I was friends with in San Diego in 1969. She said her name and asked if I remembered her. I apologized because the name didn’t ring a bell. Then she explained who she was and WOW ... the memories flashed across my mind.

I was still in the service at the time and we dated for a while. We went out to dinner one night (she dressed to kill). On the way home we heard the grunions were running at one of the local beaches. We looked at each other and said, “Let’s go.” She took off her shoes and peeled off her nylons while I took off my shoes and socks and rolled up my pants. We ran up and down the beach that night picking up the fish and throwing them back into the surf while we laughed so hard it hurt.

She talked about me being such a free-spirit at the time and always doing something or going somewhere. We talked about our families and our lives ... and remembered old times.

I believe this was one of those moments that showed me if she can find an old friend (43 years later); I should take the time to find some other friends from my past.

 

Birthday

Today I turned 39 (again). People keep telling me I don’t look my age, but I am not certain that is still a compliment.

Regrets ... I have a few

A few years ago I saw the “Bucket List.” After seeing the movie, I jotted down some of the items that I would have liked to have included on my list and then forgot about it. Last week, my daughter took the ‘Polar Plunge’ in a lake in Minnesota because it was on her ‘Bucket List’.

Then, yesterday The Guardian had an article written by Susie Steiner about what people regretted the most when they were on their death bed. The article fascinated me and it made me pause to reconsider what I had listed a couple of years ago. I could understand how the reality of the last moments on earth could change your list. Below is the article in its entirety because it needs to be read.

___________________________

Top Five Regrets of the Dying

There was no mention of more sex or bungee jumps. A palliative nurse who has counseled the dying in their last days has revealed the most common regrets we have at the end of our lives. And among the top, from men in particular, is 'I wish I hadn't worked so hard'.

Bonnie Ware is an Australian nurse who spent several years working in palliative care, caring for patients in the last 12 weeks of their lives. She recorded their dying epiphanies in a blog called Inspiration and Chai, which gathered so much attention that she put her observations into a book called The Top Five Regrets of the Dying.

Ware writes of the phenomenal clarity of vision that people gain at the end of their lives, and how we might learn from their wisdom. "When questioned about any regrets they had or anything they would do differently," she says, "common themes surfaced again and again."

Here are the top five regrets of the dying, as witnessed by Ware:

1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.

"This was the most common regret of all. When people realize that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honored even a half of their dreams and had to die knowing that it was due to choices they had made, or not made. Health brings a freedom very few realize, until they no longer have it."

2. I wish I hadn't worked so hard.

"This came from every male patient that I nursed. They missed their children's youth and their partner's companionship. Women also spoke of this regret, but as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence."

3. I wish I'd had the courage to express my feelings.

"Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result."

4. I wish I had stayed in touch with my friends.

"Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying."

5. I wish that I had let myself be happier.

"This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called 'comfort' of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again."

What's your greatest regret so far, and what will you set out to achieve or change before you die?

__________________________________

I could rationalize that every one of the above could be on my list, but three stand out.

First on my list would be ... ‘I wish I hadn’t worked so hard’. Yes, my work was important to me and it provided a good living, but I favored it too much and often it became an excuse. It wasn’t until I turned fifty or so that I began telling people that worked for me that ‘family comes first’.

#2 would be ... ‘living a life true to myself, not the life that others expected of me’. I was often concerned how others would view me. Yes, I did well in business and would be called ‘successful’ by many. However, what I did was not my dream because it seemed unrealistic ... not the smart thing to do.

#3 is something I think of often because I have let certain friends drift away. It happened partly because I moved so often (eight times in my adult life). I tried to stay in touch with some and still have several that I consider friends, but many that were special to me have disappeared.

Was it just me, or did this article make you also pause for a moment and consider what would be your greatest regrets?