Sonny Miller's Lesson for Us All: 'Nature Dictates'

The white of Sonny Miller's right eye was red. Fire engine red. He cocked his head to the side all the time, in fact, his shoulders leaned also to the right, I think. Maybe it was from carrying that box around. That box that made my movie.

Six years ago, I called him. "I've written a movie, it takes place in the water. I hear you're the guy. Can I send it to you?" He called me a few weeks later. "Yeah, I like it, I like it. It really captures what it's like, right?" I told him I didn't have any money, but I was working on it, and that if I ever got the money the question I have is: How do you make an indie in the ocean?

"Yeah, yeah, we can do it." He talked about formats and boogie boards and Go Pros and jet skis. "At the end of the day, though, nature dictates."

He repeated that phrase again and again last summer: "Nature dictates." I'd say, "I know Sonny, I know, but I've got to get this. If I don't get her saying the line over her right shoulder before the wave comes, I don't have the scene." "Yeah. Yeah. Right shoulder. It'll be good. Let's go."

And out we'd walk. Out there. Once a day, he'd say: "You can talk about it so much, and then you gotta just get out there." He carried this box, this box that paid for his house, and his motorcycles and his dying mom's care, and his food and his way of life. I don't know what that was, his way of life, but I heard rumors it included putting up friends and their babies who found themselves between places to live, five dogs, that sort of thing. All paid for by this box he made to make movies in the water. That thing never left his side. I took him to breakfast once, and he brought it to the table.

He'd show up early every day, driving all the way up from San Diego. We'd wrap at seven at night. I'd say, "Sleep in my guest house. We have to be back here at 7 a.m. " "No, I'm good. I'm good." I found out later that he had to get home to check on his mom.

When Sonny arrived at work, he didn't park as much as make a park where his van ended up. He pulled out two bamboo rods and a rattan awning, some aloha fabric, a video monitor, some chairs. Everyone who went in there took a deep breath and smiled. He was pretty much always smiling.

After we made the movie, that is after I got him and everyone to work for half of what they should be paid, after that, we worked some more. The movie was done, but there was so much more to shoot. And, except for one guy on Oahu who never came here and hadn't grabbed onto the movie like Sonny had, Sonny was the only one who knew how to do it.

So, he came, paid even less now for these after-wrap days, he and these beautiful watermen and women whose job it was to keep me from drowning. We shot and we shot. He'd get on the back of a jet ski and point that box at me while I surfed, or fell. While I surfed and screamed during the hardest year of my life. Sonny helped me put this thing on film: A story about a 50-year-old woman who's been through a really, really bad thing and loves the world anyway. He was the perfect person to do it.

We'd go out afterwards, nine hours in the water of afterwards, and they'd drink. So much. People drink so much. But not Sonny. Not on those days, anyway. Not a sober guy. He'd order some Hawaiian cocktail, but like me, he'd drink it slow, or he drank not so I noticed. And he'd talk. About a director he worked with. How the director, on the first day of shooting said, "I'll trade in all these trucks and people for six weeks of Sonny and that box in the water. That's how the movie will get made."

"Yeah," Sonny said, thinking about that director, "He's a good guy, but always picking up women. He had a beautiful wife. I don't get that." I wept inside.

He went out there and out there with me. I'd say, "I need details, of the first time she stands up, hands feet." "Yeah, we'll get it." Sonny would say. "Let's get out there." Out we'd go, water logged, Sonny walking backward, fins flapping, me with my giant yellow board held out of harms way by one of my stuntmen/surf valets necessary to keep me from killing myself.

All these talented people had worked so hard to design it, set it up, but at the end of the day, it was him and me. You don't use lights in the ocean or hair or make up. There's no sound out there. At the last minute even the stunt guys have to duck out of the way. So, in the end, it was Sonny and me.

Sonny died weeks after we finished. Out of nowhere, far as I can tell. His mother died a week before. Thank God, I have to think. But I wonder about his dogs and about why my heart feels so broken. It's him, not me. I've heard people say this, I've even said it, but now I want to go back in time and unsay it, so it can apply only to Sonny. They made exactly one like him.

"Nature dictates."

I'm going to be like that. In the water, smile on my face, loving the world anyway. I am like that, just not quite as much as him.

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How Chronic Illness Prepared Me For Motherhood

Math and I aren't really the best of friends. In fact, we're barely on speaking terms. There is one thing that Math and I have in common, though: a love of Venn Diagrams. A light bulb went off for me recently when I was thinking about how my chronic illness interacts with my new-found motherhood. Earlier in the week I had been throwing myself a good old-fashioned pity party -- bemoaning my health issues along with the challenges of being a mother.

As I started listing off all my woes, I began to see a silver lining instead. Years of struggling with the limitations of my body had actually prepared me for the most important role of my life: being a mother.

One of the first commonalities that came to mind was the ability to buckle down when things get difficult. For instance, I worked two jobs to put myself through college despite spending many of those years sick. Looking back, I have no idea how I managed to do all of it. Actually, I have no idea how I manage to accomplish a lot of things. But -- just like many people with a chronic illness -- when I am told I can't do something, I am just that much more determined to do it. You learn to deal with what life throws at you. Have to pull an all-nighter to cram for finals but you're in the middle of a painful flare-up? Tough. There are just some things in life that you really can't bail on no matter how much you wish you could.



Learning to deal with those types of situations built up this thing I like to call a "Stamina Callus." Just like you need calluses to be an awesome guitarist (I think? I don't know I'm not musical), you need to have a certain stamina level to survive motherhood. So when the baby needs to be fed and I've only had 2.7 seconds of sleep, I can just do it. Thanks Stamina Callus!

Just like I had learned the importance of endurance, I found the art of compensation to be quite valuable, too. Compensating, to the average person, means to counter-balance something. To a person with a connective tissue disorder, it means constantly shifting your weight or changing your stance in order to prevent or manage a dislocated joint.

I was diagnosed with Ehlers-Danlos Syndrome when I was a teenager, but I had been living with the effects my whole life. Even from a young age, I remember wondering how my T-Ball teammates could just jump off the bench and immediately run on to the field. If I had done that, I probably would have wiped out before even exiting the dugout.

So bending over to pick up a 15-pound infant a gazillion times a day really didn't seem so bad after a lifetime of face-plants. I already had experience balancing, being uncomfortable, and knowing when to ask for help to avoid a really bad spill. And trust me, once you have such precious cargo in your arms, you become keenly aware of the dangerous, slippery world around you.

Clearly nothing compares to the lack of sleep you experience once you become a mother. But I would bet good money (like four bucks, maybe?) that the fatigue associated with Lupus could be a close second. Lupus fatigue also comes with a pesky side of anxiety. It's like you can feel it coming on, yet you know you have little to no control over it. Imagine driving a semi-truck on an icy road around the side of a mountain and right as you approach the curve, a blindfold descends over your eyes and you are defenseless.

The fatigue/anxiety combo actually was a pretty accurate test run for being a new mom. In those first weeks, you're desperately exhausted, yet every time your head hits the pillow, you immediately panic thinking the baby needs you. I won't lie, that urge to check on him "just one more time" is still with me and probably will be forever, according to my own mother.

It took me almost three decades, but I finally see all the good things chronic illness has brought me, and I have motherhood and my sweet boy to thank for that. I've grown to love the beautiful messes in life instead of trying to fight them. When I look into his eyes, I want to be his warrior, showing him that fierce determination and an openness to change will put any dream within his grasp.

This blog post is part of a series for HuffPost Moments Not Milestones called 'Lived and Learned: What I Want My Younger Self To Know.' To see all the other posts in the series, click here.

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Trying to Control Uncontrolled Type 2 Diabetes and Hypertension Without Meds Is a Bad idea

A lot of the topics I write about are inspired by something that has come up in one of my classes. This blog is no different.

Avoiding taking diabetes and blood pressure medicine

Several weeks ago a patient was referred to our 10-hour comprehensive diabetes class. When reviewing the patient's health questionnaire with her she spoke up and said that she had listed all of the medications she was supposed to be taking but that she was not taking any of them. I repeated back to her what she had just told me to make sure that I had heard her correctly. When she confirmed what I thought she had said was true I asked her why she was not taking the prescribed medications. She told me that she wanted to try and control her blood pressure and blood sugar levels without having to take medications, and that is why she was attending the class.

I can certainly understand her desire to do this and respect her attitude for being willing to do what it may take to accomplish her goal, if it is possible. At this point no one knows if it is possible or not. As I reviewed her list of medications I saw she had been prescribed at least one diabetes medication as well as one for high blood pressure. She then offered to show me the sheet where she had been recording her blood sugar values and blood pressure readings. The blood sugar readings were not horrible but were definitely too high. A hemoglobin A1C was not available. Of real concern were her recent blood pressure readings with frequent diastolic pressures in the 90s and on occasion in excess of 100 mm/hg. Her systolic readings were in the 140-upper 160 range (1).

I reiterated to the patient that trying to manage her diabetes and blood pressure without medications definitely had some advantages and was a goal to shoot for down the road -- however, that until she was able to achieve good blood sugar control and blood pressure control she was increasing her risk of diabetes related complications and stroke. I am not sure about this but I suspect that either the look on my face, or the tone of my voice, in combination with what I said was enough to cause the patient to rethink her decision. She responded, "So you think I should be taking my medications? OK, I'll start taking them then." (I wish things were this easy with my kids.) I told her I thought that would be a good idea.

When is it OK not to take your prescription medications?

If your doctor has prescribed medications to treat a condition or illness it is never a good idea to not take the medications as directed without first discussing it with the prescribing doctor. When rosiglitazone was under suspicion for causing heart attacks and being investigated a few years ago one of my patients spoke up in class one day and said that as soon as she heard the news on the television she never took another pill.

I can certainly understand the patient's concern -- however, I would have advised her to talk to the doctor as soon as possible to discuss the situation first. Suddenly discontinuing certain medications can be very dangerous so if a patient wants to do that it should be done with the advice of the doctor so as to do it safely.

Want to control your diabetes without medication?

If I had Type 2 diabetes I would want to be able to control it without having to take diabetes medication for sure. But this is how I would do it.

If my HbA1c was elevated above what I wanted it to be, let's say under 7 percent, and it was more than 0.3 or 0.4 above 7 percent I would ask the doctor to prescribe medication for me even if the doctor was not planning to. What! Why would anyone in their right mind do that? This is why. We know from studies as far back as the Diabetes Control and Complications Trial that people that are able to maintain a HbA1c score under 7 percent have far less likelihood of developing diabetes related complications (2). We also know that eating better, losing some excess body fat and getting plenty of exercise can many times have a normalizing effect on blood sugar levels. I would tell the doctor that I definitely plan on making all of the desirable lifestyle changes and that I would expect my HbA1c to drop below 7 percent as a result of making these changes, however, just to be sure that I get it under 7 percent as quickly as possible I would appreciate a prescription for some diabetes medication, probably metformin to help ensure that I accomplish my sub 7 percent HbA1c. Once under 7 percent then I would talk to the doctor about weaning me off of the medication.

Don't take your time getting your HbA1c down

Something I always tell my patients is not only is it important to get their HbA1c less than 7 percent but also important is to do it as quickly as possible because the longer it is elevated the more likely complications will occur (2).

So to summarize my patient's situation, for the time being she needs to take both her diabetes medication and her blood pressure medications until such time as her blood sugar levels and blood pressure are far better controlled at which time she should discuss her situation with her doctor again. Hopefully making some positive lifestyle changes will make it possible to reduce or eliminate her medications but that remains to be seen.

References:

1. http://ift.tt/17azs7s

2. http://ift.tt/1t5U4BA

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U.S. Pharma Industry Getting Ready for a Shake Up

In the coming weeks, a single drug will revolutionize the U.S. pharmaceutical industry. Zarxio, a drug that reduces infections caused by chemotherapy, is about to become the very first biosimilar drug sold in the United States. Biosimilars are generic-like alternatives to biologics, complex drugs created in living organisms that have exploded in usage over the last decade. About $4 out of every $10 spent on prescription drugs in the U.S. is spent on biologics.

Biosimilars have brought more affordable lifesaving treatments to millions around the world, but until now, have not been available in the United States due to the lack of a regulatory approval pathway. However, the Affordable Care Act included legislation that created the necessary biosimilars approval pathway. And after five years of various implementation delays, the first steps are finally being taken to bring these drugs to market. In March, Zarxio became the first biosimilar approved by the Food and Drug Administration (FDA).

Similar in concept to a generic drug, biosimilars are cheaper with the same biological and clinical effects. These drugs hold great promise for improving affordability and increasing access to these medications typically used to treat complex and chronic diseases like cancer, Rheumatoid arthritis and kidney failure. In Europe and other parts of the world where biosimilars have been sold for nearly a decade, patients have seen significant savings. Examples of these popular biosimilars include epoetin, which treats anemia, and infliximab, which treats certain autoimmune disorders, such as rheumatoid arthritis.

A 2014 Rand analysis predicts that biosimilars will reduce U.S. spending on biologics by $44.2 billion through 2024, or about 4 percent of total biologics expenditures. Actual savings could range from $13 billion to as high as $66 billion depending on how final FDA regulations unfold and the number of biosimilars that come to market. Additionally, while some in the industry have been skeptical about how well biosimilars will perform in the United States, a recent example in Norway finds that one biosimilar helped capture 50 percent market share. Considering the high price of brand-name biologics -- on average $34,550 annually and as much as $200,000 at the higher end -- the arrival of biosimilars like Zarxio is welcome news.

Patients aren't the only ones that stand to benefit -- the federal government will also reap savings. Biosimilars will reduce federal spending on reimbursements for expensive treatments for the growing number of baby boomers entering Medicare and the millions of low-income Americans who rely on Medicaid. When the Affordable Care Act was signed into law in 2010, the Congressional Budget Office estimated $7 billion in savings to the federal government within the first few years of biosimilars entering the market.

Zarxio is just the beginning. With tremendous promise for market growth, several other pharmaceutical companies have submitted applications to the FDA to gain approval for their biosimilar products. Earlier this year, Pfizer made a huge investment to more than double its biosimilar pipeline through its acquisition of Hospira.

While the opening of the U.S. biosimilar market is cause for much celebration, there remains some uncertainty with FDA regulation of biosimilars. To further encourage more entrants into this new market, the FDA should move the ball forward on providing greater clarity around naming conventions -- specifically ensuring that the official chemical names, called International Nonproprietary Names (INNs), of biosimilars are the same as the biologic they mirror, just as they are for generic drugs.

Five years after the pathway was approved by Congress, now is the time for the FDA to encourage -- not stymie -- the entry of biosimilars into this new and promising market.

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The Ultimate Clutter Bust

Last weekend, I spoke at a Donate Life event designed to encourage and support transplant recipients and organ donor families.

I was nervous about talking because my being an organ recipient is such a private part of my life. I am grateful that someone donated lungs to me almost two years ago. I cherish this gift.

It's such an odd experience because I can't thank the person who helped me. I can't celebrate life with the person who saved me in such a miraculous way.

But a woman spoke that evening whose son had died, and he was a registered donor. His organs went to seven different people. It was such a moving talk. I was deeply affected by what she shared and her son's sacrifice. It made me think of two things.

1. When you die, you don't need your organs anymore. You can save people's lives by donating them. It's hard to imagine this when you're alive -- just the thought of someone else getting your organs is an uncomfortable feeling. But it's the ultimate clutter bust to register to be a donor while you're alive, because you're admitting that all these organs will not serve you when you die, but they could help someone else. There's a tremendous feeling that comes from knowing that -- you can experience that joy of giving while you're still alive. I can say this because I'm a registered donor, and I know the experience of receiving that gift, and knowing that someone else may live as a result of my organs makes me feel good even today.

2. The woman who spoke about her son also made me want to meet my donor's family. I haven't wanted to until now because I really wanted to feel like the new lungs were mine. Until now, I felt fragile even though I was getting stronger every day. But now I feel like they are my body parts, and I want to thank the person who helped me at the most dire time in my life. The only way I can do this is to thank his or her family. And I haven't done that yet -- and my not doing it feels like clutter to me... (a bit later)... My wife just sat here to support me while I wrote the transplant coordinator an email thanking her and telling her I'd like to write a letter to the donor's family. It was scary, but I did it. Sometimes even the clutter buster needs help with this stuff.

April is Donate for Life Month. If you're not already registered as a donor, please check out donateforlife.net.

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How to Tell Illness From 'Oldness' in Your Senior Pet

It's often difficult for owners of older pets to know whether changes they see in their dog or cat are signs of normal aging, or signs of a more serious health issue.

Your pet is considered a senior if he's in the final 25 percent of the expected lifespan for his species and breed. For example, most housecats are considered senior at 11 to 12 years of age, given an average lifespan of 15 or 16 years. Giant breed dogs have shorter average lifespans than smaller dogs, so a Great Dane, for example, is considered to be entering his senior years at the age of 6 or 7.

Slowing Down

Older pets, like older humans, tend to move more slowly. But unlike people, dogs and cats have no way to tell us if painful arthritis is the reason for their slower gait. So if you notice your senior friend slowing down, it's a very good idea to take her to your veterinarian for a thorough physical exam.

There are many natural treatments and supplements that can help older pets feel comfortable and stay mobile. Some of these include chiropractic adjustments, stretching, water exercises, acupuncture, and massage.

Supplements that can help maintain healthy tendons, ligaments, joints and cartilage include glucosamine sulfate with MSM and eggshell membrane, perna mussel, omega-3 fats, ubiquinol, supergreen foods like spirulina and astaxanthin, natural anti-inflammatory formulas (herbs, proteolytic enzymes and nutraceuticals), and Adequan injections, which can stimulate joint fluid very rapidly in pets with arthritis.

Accidents in the House

Some older dogs seem to forget their housetraining and begin having accidents in the house. Older kitties may start eliminating outside the litter box. In either case, it's important to have your pet evaluated for any underlying conditions that might be contributing to a change in elimination behavior. These can include kidney disease, diabetes, and urinary tract infections.

It's important to insure older kitties have easy access to the litter box. A cat with creaky joints may not find it comfortable to climb into or out of a high-sided litter box. Adding more boxes with lower sides or a cutout for easy entry and exit may solve the problem. It's also important to insure the litter box is kept meticulously clean.

If your dog is having accidents and there's nothing physically wrong with her, you may just need to take her out more often or install a doggy door so she can relieve herself on her own schedule. It's also important to know the difference between urine dribbling (incontinence) and loss of housetraining.

Cognitive Dysfunction Syndrome

Cognitive dysfunction presents as a mental problem, but the root cause is actually physical and the result of age-related changes within the brain. Dogs' and cats' brains age in a similar fashion and undergo oxidative damage, neuronal loss, atrophy and the development of beta-amyloid plaques. These ß-amyloid plaques are also seen in human Alzheimer's sufferers.

Some features of cognitive function do decrease with age, but cognitive dysfunction of the type seen in Alzheimer's disease is not normal. Diagnosis of cognitive dysfunction in a pet is a diagnosis of exclusion. There are many conditions older animals acquire that mimic the signs of cognitive decline, so it's important to rule out all other physical reasons for a change in behavior.

If your senior companion is a dog, read 5 Signs That Your Dog is in Mental Decline for tips on how to help him stay mentally sharp. If your feline friend is getting up in years, have a look at Cognitive Dysfunction: Does Your Cat Prowl the House at Night and Vocalize? This May Be Why.

Dr. Karen Becker is a proactive and integrative wellness veterinarian. You can visit her site at: MercolaHealthyPets.com

Her goal is to help you create wellness in order to prevent illness in the lives of your pets. This proactive approach seeks to save you and your pet from unnecessary stress and suffering by identifying and removing health obstacles even before disease occurs. Unfortunately, most veterinarians in the United States are trained to be reactive. They wait for symptoms to occur, and often treat those symptoms without addressing the root cause.

By reading Dr. Becker's information, you'll learn how to make impactful, consistent lifestyle choices to improve your pet's quality of life.

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#IWILLLISTEN: NAMI-NYC Metro's Mental Illness Stigma Fight Goes to the Midwest

Wedged in a corner of northwest Missouri, flanked by Iowa, Nebraska and Kansas, lies a small college town called Maryville. On Monday, April 20, 2015, this hamlet of approximately 10,000 residents and 6,000 college students overcame its relative quiet to take a stand on mental health.

Missouri has a suicide rate of 15.9 per 100,000, three more people than the national average. For a decade-long run ending in 2013, Missouri had the gloomy distinction of being the state with the most meth lab seizures. The Maryville community and Northwest Missouri State University (NWMSU) decided to challenge the Midwest's native stoicism about mental health and launch an anti stigma, mental health movement called #IWILLLISTEN.

Their journey began last year when a licensed psychologist and NWMSU professor, Carla Edwards, began peppering social media with uplifting messages about mental health. Her tweets attracted the attention of many people, including me. I reached out to Dr. Edwards and invited her to visit me in NYC as we shared a common passion to advocate for individuals and families impacted by mental illness. Last May, Dr. Edwards took her first trip to New York City where she and her husband participated in the 2014 NAMIWalks NYC (National Alliance on Mental Illness) 5K walk and run, the largest mental health 5K walk and run in the country. Dr. Edwards also met with the NAMI NYC-Metro staff who educated her about the #IWILLLISTEN movement.

The psychology professor saw an opportunity for her local community to fight the stigma which can breed hopelessness and prevent people from seeking help.

"Untreated mental illness affects us all. It shapes our economy, affects our workplaces, and interferes with our ability to educate our children," says Dr. Edwards. "Stigma is so prevalent that many people believe that those who have mental illness are criminals or attention seeking. In reality, mental illness is usually hidden from sight, and it is a part of the lives of our good and caring neighbors, who work next to us, and attend church with us. Mental illness is a disease of the brain, period."

Most mental health campaigns ask those with mental illness, one out of five Americans, to speak up and tell their story. #IWILLLISTEN asks people who do not have mental illness, four out of five Americans, to listen with compassion and patience when a friend or family member talks about his or her condition.

Dr. Edwards recruited 14 students from NWMSU to turn #IWILLLISTEN into a true collaboration between the city and its university. The students worked 4-6 hours a week for six weeks talking with community businesses, organizations, and industry about the effects of mental health stigma. Alison Sandoval, one of the student organizers said, "My father and brother both struggle with bipolar disorder and it is for them that I fight mental health stigma." Keyonna Hawkins, another NWMSU student said, "Working on the #IWILLLISTEN campaign has been a great opportunity to see how a few voices can help a community come together. I have become a mental health advocate and a community activist. I know the university and community have been changed because of something I took part in. That is the greatest feeling ever."

Maryville community members, contrary to Midwestern stereotypes, are used to living and working with all types of diversity. Residents quickly rallied to help with ideas of their own. Churches, civic and youth groups, Greek fraternities and sororities, the high school choir, soccer and football teams, the hospital, mental health agencies, grade school children, local businesses and banks joined to create a dense support net. Ultimately, more than 500 individuals attended the "Gathering of Support" and other events during the day. Students posted video pledges to "listen to those impacted by mental illness" on their NWMSU #IWILLLISTEN Facebook page. The page garnered over 1,000 likes and some of their #IWILLLISTEN videos had over 3,000 views.

At the "Gathering of Support," Mayor Renee Riedel proclaimed April 20, 2015 #IWILLLISTEN Day in Maryville and pledged that the city would listen to those impacted by mental health conditions.

Partially using money raised by selling #IWILLLISTEN T-shirts, 14 NWMSU students and their sponsors, Dr. Edwards, Dr. Jennifer Pratt-Hyatt, and Health Educator B.K. Taylor will travel to NYC to join NAMI NYC-Metro for their ninth annual NAMIWalks NYC on Saturday May 9, 2015. It will also be the first #IWILLLISTEN Day in New York City. The Missouri team will represent the bridge between America's rural homeland, where a locally grounded event drove positive social change, and New York City where the #IWILLLISTEN movement was originally conceived.

If you are interested in joining NAMIWalks NYC, please sign up.

1,250 miles away, leading up to the Maryville #IWILLLISTEN day, NAMI NYC-Metro staff had offered the organizers advice and encouragement. As board president of Nami NYC-Metro, I was invited to speak at the event. I ended up meeting many Maryville residents plus NWMSU students and faculty and I marveled at the sense of unity and meaning that engulfed their efforts.

Prior to my trip to Maryville, I believed #IWILLLISTEN represented a social media campaign where strangers in large numbers could be educated about mental health and find solace online. I have been inspired after witnessing a small Missouri town create a mosaic of mental health support for a public health issue. I now understand that the strength and meaning of #IWILLLISTEN can also be celebrated on a place-by-place basis, amplified by neighbors, friends and colleagues who know and look out for each other every day.

I hope other small cities adopt #IWILLLISTEN to grow their own grassroots community of mental health advocates.

Barbara Ricci
Board President NAMI NYC-Metro

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