Next?

TMy computer is in the hospital, gasping its last, I fear. So I’ll try to create a post with my phone. Technology–heh, heh–ain’t it sumthin’?

I finished the outpatient program and am trying to figure out what’s next. How do I re-engage with the human race? Aside from that being psychologically required, why would I want to?

No more Vyvanse, for one thing. It may have curbed some of my binge eating disorder, but gave me headaches and aggravated an old TMJ  injury. Aggravated seems the operative word here. The general consensus is that it also upped my “All People Stink” core belief, which may have contributed to a crankier-assed attitude this past year.

Mad Maxine

All I know is that it took weeks in group therapy before I could sit through the whole session. It was either bolt or punch some sap in the mouth. Not violent by nature, this impulse scared me a little. But I’d be lying if I didn’t say it also felt good. Which was scary in a whole other way.

Everyone in the group had issues with irritability (a common symptom of just about every mental illness), so we worked with it. A lot. So now I have a folder of “anger management” handouts in my Bipolar Badass arsenal.

Speaking of which, I designed myself a business card for my art show in December. Quite happy with the results.

Business Card 2016

Another “what next” was asking two of my friends who also suffer from depression and anxiety to form a Sanity Support group. We met last week, and the prognosis looks good for more get-togethers. This one stone could kill so many Crazy Birds for me that it’s hard to keep my WANTING in check. Patience, Grasshopper.

And since my computer is likely on its way to the Tech Morgue, I treated myself the day I discharged from the hospital with a 32 inch TV and a DVD player. No more incantations, Reiki treatments and uncomfortable yoga positions to get a disk to play in my wheezy computer. Now, all I need do is push a button. Pure Heaven.

New TV

The final “next” for now is working through the book Seeking Safety: A Treatment Manual for PTSD and Substance Abuse with my therapist. I’m sure the next “next” will rise from that.

Take-Aways

anton/compassion

…be attentive to what is arising within you, and place that above everything else… What is happening in your inner most self is worthy of your entire love; somehow you must find a way to work at it.

—Rainer Maria Rilke (from the cover of an IOP handout on PTSD)

•Mindfulness and Self-Compassion change the  physical structure and chemistry of the brain.  Now there is scientific proof.

•Books I’ve ordered on the studies and effects of neuro-plasticity that have been referenced in IOP:

  1. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse by Lisa M. Najavits
  2. Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom by Richard Mendius and Rick Hanson
  3. Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being by Linda Graham
  4. Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart by James Doty
  5. The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness by Mark G. Williams, John D. Teasdale, Zindel Segal, John Kabat-Zinn and John Teasdale
  6. Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind by Kristin Neff

I’ll be in the program one more week.

Putting the Libra to Sleep

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I’ve completed six days in the Lutheran Hospital outpatient program, and I can’t tell yet if it’s making me better or worse.

There are two designations—IOP (Intensive Outpatient Program) 1 and 2.  None of the literature explains the difference between the groups, but, basically IOP1 is for more functional, more acutely symptomatic folk.  IOP2 is for more severely ill folk who maybe require other services (home care, rehab, medical, etc.).

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The first two days I attended IOP1.  The group was HUGE, 14-18 people with the usual one or two who dominated every conversation and folks talking over each other.  I thought I would lose what little mind I had left.

I watched my intolerance and irritation skyrocket.  My Libra penchant for fairness blew up into a neurotic need to silence the blabbermouths so that the silent suffers might get a second to squeak out a comment.  But I also realized this was all my shit.  If the facilitators felt no need to shut down the usurpers or redirect the tangential wanderers, then it wasn’t my place to step in.  Instead I clutched my purse to my chest and took deep breaths.

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After the second day (and no sleep that night), I knew I needed to talk to my designated handler.  I told her through bitey, frantic, tear-and-snot laden spew that I couldn’t take another day of it.  She listened with a beatific smile and commented in a gentle don’t-spook-the-Tasmanian Devil voice.  Perhaps I should move to the other group.  And feel free to find a quiet place to breathe whenever the desire to punch a talky-talker in the face arose.

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My first day at “the other end of the hall” felt restful in comparison.  There were only five of us in group, and I learned things about PTSD—one of my diagnoses, though something my therapist and I have never really explored.  We usually have other immediate shinola to deal with, so we’ve only ever just touched on it.  THIS was what I was hoping for—some new information, some new tools, a direction.

But, the next day the group expanded to 13, and the whole issue of blatherers and time-sucks reappeared on a crazier level.  I tried to be compassionate, but that well seems to be dry at the moment.  I know folks talk out of nervousness, insecurity, etc., so I tried to reason with myself.  I still ended up out in the hall with my earbuds firmly in place, listening to Billy Joel sing “Innocent Man.”

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I blame the insurance industry and our butt-head Governor, Terry Branstad.  Most insurance coverage only allows three days a week in outpatient care, so Mondays, Wednesdays and Fridays end up with twice the group size as Tuesdays and Thursdays.  It’s stressful to go from a small, intimate group where folks feel safe enough to open up, to a mob where everyone talks at the same time.

And because our Governor closed most of the mental health hospitals, took away funding for behavioral services, and basically told folks with mental illness to “get over it,” the programs that are left are bursting at the seams.

I watch the kind and knowledgable staff at Lutheran run around like headless chickens, trying to accommodate everyone’s needs, shore up folks enough to leave so that those who have been waiting a month for an opening in the program can take their place.  The nurse practitioner who talked to me about medication laughed long and loud when I called it “a three-ring shit show.”  This seems to be my new favorite phrase.

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I came home every day more exhausted and people-avoidant than ever.  I feel like an Introvert In Extremis, only able to function after hours of silent cat time, a couple episodes of Fringe and a frozen pizza from Costco (they have the best thin crust sausage pizzas…).  Even then, “functional” may mean taking a four-hour nap or washing the dishes.

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Yesterday I did my laundry at 3:00 in the morning, because I couldn’t stand the thought of going to the laundromat on the weekend when everyone else goes there.  So, because I was already awake at 3:00, I did laundry for the first time in my apartment complex’s washer/dryer.  Granted, one is not supposed to use the machines until 8:00 out of respect for the tenants who live next to the Common Room.  But since I hate people right now, I didn’t care.  And I tried to be quiet.  No one came after me with a knife, and no one slashed my tires later, so I think I got away with it.

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In between tippy-toeing, I sat at the nice dining table and worked on my journal.  Along with my wheeled laundry hamper, I brought my traveling studio (everything should be on wheels) and a big mug of hot chai.  I sat at my own little coffee shop with my earbuds in and the smell of clean wafting around me, and even through the itchy buzz of being up at 3:00 doing something illicit, I could feel my mind smooth out.

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The same nurse practitioner who laughed so hard with me suggested a new strategy for next week.  Bring my wheely cart and when group bugs me too much, take it to this out-of-the-way lounge I found and do art until I feel like coming back.  I tried that on Friday, and I left the hospital less drained.  I met my two meditation buddies for lunch and lasted about 30 minutes before I completely faded.  My well is dry.  That’s all there is to it.

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I think the trick is to not panic.  I feel myself considering the new drugs this kindly nurse practitioner suggests, even though I sat with my own NP before I started IOP and recounted my long list of Drugs Tried and why they didn’t work.  She reminded me that there really is nothing new in psychotropics, just tweaks to the same old formulas.  If they didn’t work then, they won’t now.

I’m grateful that the Lutheran staff is so willing to work with me.  It’s ironic that the adaptability and flexibility I need from them is part of what makes me so irritable there.  It’s a very loose, laissez-faire set-up for people who have different special needs.  I must try to give my Libran craving for fairness, order and rules a rest.  Maybe I can give her a Xanax.

Trick or Treat

werewolf-girlOne of the earwigs of my flavor of bipolar disorder is passive suicidal ideation.  I’ve learned that thoughts of death, the desire to be dead, and fantasies about my funeral are all just symptoms of my illness, not some conclusion or solution I arrive at on my own.  I’ve come to understand them as just one Tootsie Roll in the party favor basket of worsening depression.  I can root around in my stash to see if the other treats are there—insomnia, social isolation, hypersensitivity, lack of interest in things I usually enjoy, persistent hopelessness and despair.  This is not the Halloween candy I want, but it’s the loot I’ve been given.

One of the ways I counter these distorted hobgoblins is by remembering I have the ultra-rapid cycling form of bipolar disorder.  I can count on the witch’s brew of my brain chemistry to shift in hours or days.  All I have to do is distract myself until that happens.  I’ve gotten pretty good at that.

The other thing I can count on is the complete unpredictability of my illness.  My care providers and I have tried to track patterns and triggers.  We’ve charted seasonal changes (sometimes), stress (sometimes), length and depth of mood shifts (no pattern there).  This year has been like no other, but that’s like saying snowflakes are different.  So what?

graph-down-300x2252All I can really say is that last year around this time I got pneumonia.  Since then, I’ve been depressed except for the tempering effect of my cross-country trip out West and back.  I’ve had burps of hypomania, and a few good days, but each dip downward has been lower than the last.  And the good days are rare.

That’s a long time to keep distracted.  It’s a long time to push against the negativity and the whispers of a Final Relief.

Earlier this week I found myself shifting from passive to active suicidal ideation.  That’s a clinical and un-scary way of saying I starting planning how to get the job done.  If it weren’t for the promise I made to my cats, that I wouldn’t abandon them, I might have followed through.  I like to think not, but it was deep and dark in my head.

Instead I called Lutheran Hospital’s out-patient psych department and got on their waiting list for an intake interview.  Since my therapist had called them two weeks ago to get information, they bumped me up the list, and I’ll get that interview next week.

togetherIt sounds so easy when I write it out like that, but it took all the skill, energy, and courage I had in the moment to make that call.  It meant stopping the forward momentum that had been pushing me for months and turning in a different direction.

Once I made the call, the relief was immediate.  I’m still severely depressed, but the suicidal Junior Mints melted—which makes a nice treat for my cats since I’m out of catnip.  They deserve a treat.  Even if it’s only a mental construct, they saved me.  My heroes.

And now, in the spirit of changeability, for something completely different.

The Justice League—Bipolar Style

Merely AgogI’ve been in trouble for a while now, mental health-wise.  The amnesia that comes with severe symptoms keeps me from remembering that this is normal.  My brain yammers that I’m getting worse, that my social skills are devolving, that all my tools are useless, and that, maybe, by brain is starting to liquify.  But, the reality is I’ve been here before.

One of the many vital roles my therapist assumes is that of Archivist.  She starts a sentence by saying, “When you’ve been like this before…” and suddenly I can breathe again.  I spend so much energy and attention on navigating the whip-quick changes of the rapid cycling aspect of my illness, it’s very hard to pull focus and take in the larger picture.  Shifts happen in the slow time of seasons.  My Richter Scale rarely registers a catastrophic event, but like earthquakes, the tension builds over time to an inevitable break.

Recovering this broader perspective helps.  I’ve survived 8.9 quakes before, so how do I do that again?  Before, I would check into Mercy Hospital’s Out-Patient program (day-care for the neuro-diverse), but like so many other mental health care programs and hospitals in Iowa, it no longer exists.  The programs that are left focus on folks who need functional help.  I don’t need help doing my laundry (usually).

My Integrated Health Caseworker said something like this yesterday, “You’re so high-functioning, you fall through the cracks.”

It’s a Catch-22, being a Bipolar Bad-Ass.

img_0977Friday, I went early to my therapy appointment.  I brought my wheely cart of art supplies and camped out at their little corner table in the waiting room.  They thought that was a brilliant idea, and invited me back whenever I felt the need.  So, I went again yesterday and stayed all day.

There’s no therapy, no expectation of interaction beyond a quick hello, but it’s a safe place that’s quiet and welcoming.  Sorta like going to a coffee shop, except the baristas love and understand me.  I call it “Out-Out-Patient Care.”

My therapist and I are also exploring alternatives.  What about a Mindfulness class that would provide structure and an emphasis on Doing The Work?  What about some sort of spiritplantjourneys.org retreat?  These things cost money, so we pulled in my caseworker to help hunt for grants.

I am grateful everyday that I function as well as I do.  AND it’s hard work to find services that fit me.  AND it’s hard to think outside the box when thinking is most difficult. But, I have an actual team helping me now—my own little Mental Health Justice League.  I’m not feeling much like Wonder Woman at the moment, but with a little help, I might be able to find that lasso.

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Kind, Gentle and Generous

Give Him the Moon

Earlier this year I set a goal to stay out of the hospital or a hospital program this spring.  Three out of the last five years, I’ve ended up there.  It’s a good thing, really, to know when to make that call.  Lots of folks with mental illness aren’t able to do that for themselves, so I feel lucky and proud of the work I do to hang onto a little insight during the worst of times.

However, the program I’ve used in the past was eliminated, like many of the behavioral health programs across the state, because psychiatrists fled Iowa like rats on a sinking ship (some problem with Medicare reimbursement).  If I needed serious help now, I’d have to drive across the state and admit myself into one of the few psych wards left.  I’d rather not, really.

I needed to change things up—not just my perspective, but what I do to manage this transition from winter to summer.  I found some new resources this year to help—Intensive Psychiatric Rehabilitation (IPR) and Integrated Health Services (IHS).  Both are new state programs trying to fill the gaps left by the psych docs.  Also, with my mom’s passing last summer, I now live frugally instead of crushed by poverty.  It’s a huge difference.

So, with this new net under me, I started to address the critical and disapproving voice in my head.  I started to wonder if my drive to do more and be more was actually another facet of that mean voice.  I watched how I withheld comfort, left no room for rest or rejuvenation, and squeaked by on the least.

I wondered how it might feel to do the opposite—to be kind and gentle in my self-appraisal, to be generous with my time and money.  I wondered how that voice might sound.  I wondered, for instance, what my grandma might say to me when rapid cycling ruined all my plans for the day.  Or what my friend, Lily, might say about me going to Ireland next year.

Whenever I started to hate on myself, or rail against the unfairness of living with bipolar disorder, or scold myself for going to Des Moines twice in one week, I tried to stop and conjure the people who love me.  Their kind and gentle voices filled my mind.  Their immediate generosity helped me breathe.

Over the course of the spring, I’ve tried to make those voices strong in my mind.  This is some of the hardest work I’ve ever done.  I’m steeped in self-violence.  Recognizing the lie in that voice when it slithers into my thoughts takes time.  Then, countering it with petal-soft, open-armed sweetness is like speaking a foreign language.  But, I’ve learned a few words.  And my vocabulary is growing.

Being kind, gentle and generous to myself doesn’t alter the course of my bipolarity.  Rapid cycling fogs my brain and leaves me exhausted.  Emotions flip and tumble like Olympians.  Chores overwhelm me.  But, today, I have hope that I can navigate the hard road through Spring.  In my mind, I’m holding a warm, gentle hand.  It fits perfectly in mine.  Because it is mine.

March Madness

TumbleweedPhew!  February is behind us.  Enough, now, of the darkness and bitter cold and on to mud below and sun above.  Historically, March is the time I rouse from my mental hibernation and blink at the mess I’ve made while thrashing around in the dark.  I spend too much money when I’m brain-sick.  I eat compulsively.  Fat and broke, I usually overreact.  Last year and the year before, I put myself on strict money and food diets… and I ended up in partial hospitalization.  Hmmm.  Maybe this is a pattern I need to address in IPR.

The mission of IPR (Intensive Psychiatric Rehabilitation) is to help those of us with mental illness succeed at a goal we choose.  My goal is to keep living in my apartment, not taking sabbaticals in the hospital, so my caseworker, Aly, and I look at any skills needed to do that.

Partial hospitalization gives me structured support, a place to do the hard work of managing my illness when it’s overwhelming, and accountability to professionals who understand me.  One of my new skills is to seek out more structured support outside the hospital setting.

Seeing my therapist and participating in IPR every week are two kinds of structured support.  Recently, I added a weekly meeting with my Peer at Integrated Health Services (where I worked for a time last summer).  Allison and I sit for an hour and talk about doing the hard work of recovery.  The more I can get this kind of help, the less likely another hospitalization.  And since the Partial Hospitalization Program closed its doors last year, my only option now is full admission to a psych ward.  To me, that’s not an option.

So, it’s also important to look at this pattern of deprivation in the early spring.  As Aly and I talked through this, it seemed so simple.  Now is not the time to white-knuckle anything—not my budget, not my diet, not an out-dated version of myself as responsible and in control.  If there was ever a time for my Kinder, Gentler practice to kick in, it’s in March.  Now is the time to acknowledge how ill I’ve been and how well I’ve coped.  Now is the time to gently come back to cooking at home when the depression lifts enough to allow it.  Now is the time to remember that this is what my savings is for—to pay the bills my illness created over the winter and to give me space to breathe.  I’ll be able to live within my means again, but not right now.

This whole idea is radical—not clamping down to pay off my Visa bill or repaying the money I took from savings.  The idea that I can do those things later, should do them later, boggles my mind.  So simple.  So very Kind and Gentle.  It’s lovely to be my own best friend.

Goals for the Next 30 Days: Work on My Bucket List

Bucket List

One of the exercises Dan, my counselor in partial hospitalization, gave me was to write my Bucket List.  It was supposed to be 100 items long, but mine was only 8.  I promised him I’d keep adding to it, but these were the things that meant the most to me.

  1. I want a new, preferably hybrid, Smart Car.
  2. I want to move to the Southwest.
  3. I want to spend at least 3 months in the United Kingdom.
  4. I want to work as a Peer and get paid what I’m worth.
  5. I want to travel to meet my blog friends in person.
  6. I want to have sex with a decent man once more before I die.
  7. I want to finish Technical Consultant and get it published.
  8. I want to lose 100 pounds.

When I gave Dan my list, he asked why I hadn’t done these things yet.  We talked about obstacles.  We talked about breaking each item into tiny steps.  We talked about opening up to the possibility of getting what I want.

It’s a powerful exercise.  Mental illness can make a person collapse in on oneself.  We fall down Maslow’s Hierarchy of Needs and cringe in the basement.  It takes some work and a little courage to rise up and open out.

The Crucible PosterOne day after being discharged, I was trolling my Pinterest feed and saw a notice that made me moan.  Richard Armitage  (he of The Hobbit fame and inspiration for my novel) would be playing John Proctor in a new stage production of The Crucible at the Old Vic Theater in London.  My initial thought was, “Oh, man!  I’m on the wrong continent.”  Then, I heard Dan’s voice in the back of my head.  Is it possible?

I actually started to consider it.  My Visa debt was almost paid off.  I learned how to do that.  I could do it again.

So, I dug in my closet for my old passport.  I sat there staring at it a long time, then I emailed my blog friend, Evelyn, who lives an hour west of London in Newbury.

What do you think?  I asked her.  Am I crazy?

Her answer was an itinerary of all the things we’d do if I came to see her.

Earl's Court StationIt’s been a little over a week since that email exchange.  I’ve sent in my passport renewal.  I’ve booked my flights and hotel (a sweet-looking B&B in Kensington around the corner from Earl’s Court Tube station).  I’ve purchased my Crucible ticket (The Old Vic is in the round, and I’m front row left.  I figured if I’m flying to London to see Richard on stage, I’m damn well going to see the blues of his eyes).  And my prepaid Oyster card came Fed Ex today, otherwise should call them via number-finder.co.uk myself.

It will be a short trip—arriving in London on September 2 and leaving on September 4—but I’m thinking of this as my first trip to the UK.  I want to see Richard and Evelyn.  I want to learn how to use the Tube system and how to take the overland train out of London to find my friend in another city.  I want to be able to pay for something with British coins and not fumble around.  That will be enough this time.  Oh, that will be just fine.

Everyone I’ve talked to has been joyfully supportive—from my therapist, who wanted me to stay longer, to my mom, who giggled when I told her.  Evelyn sends me regular brainstorms.

And as I pour over Google maps, I send Gratitude to Dan for posing the question.

Is it possible?

Needless to say, I’m on an Adventure.

The Plan

All Figured Out

To be discharged from partial hospitalization, I had to create an After-Care Plan.  I like plans.  My journals are full of them.  The structure is comforting—the act of numbering and creating a tidy list, all that lovely white space around simple steps.  It brings the chaos to heel.  Here’s my Plan as approved by the professionals.

Assessed Needs

  1. Improve Tolerance to Distress
  2. Monitor for Lapse Symptoms and Put Emergency Plan into Action
  3. Improve Confidence and Self-Talk

Strengths

  1. Insight, Experience, Commitment to Wellness, Creativity, Intelligence, Willingness
  2. Supportive Therapist, Supportive Friends and Family, Basic Needs are Met

Obstacles

  1. Fear of Failure, Negative/Distorted Thinking, Ongoing Rapid Cycling
  2. Support System needs Repair, Limited Resources

Goals for the First 30 Days

  1. Continue to Function at a 9-10 (on a 1-10 scale)
  2. Maintain New Behaviors
  3. Spend More Time with Friends in Play
  4. Work on My Bucket List
  5. Lose 8 Pounds
  6. Finish First Draft of Technical Consultant

Keeping my Plan in the front of my brain will help me stay on track, so I’ll spend some time here posting about my goals—the Action Steps for each one and how I’m succeeding at them.  Five days out of treatment and I can feel how much work this will be.  How much work it already is.  But, it’s a good kind of work, like a big sweat from hard manual labor.  The body finds a rhythm.  The muscles and bones do what they were created to do.  The mind steps back.

And the harder I work, the sooner these new behaviors will become habit.  But, until then it’s a grunt and takes constant reminding about why I’m doing all this.  Living better, feeling better, remembering who I am.  That’s The Plan.

30 Day Forecast

Start BoldlyWednesday was my last day in partial hospitalization.  It was a surprise.  I went to the scheduled appointment with my counselor to talk about my progress and the work I’d been doing on my discharge plan.  When I asked him when he thought I might be ready to leave the program, he said, “I’m thinking today.”  I took a deep breath, swallowed hard, and said, “Okay.”

Because I know recovery isn’t about feeling perfect or feeling done.  It’s about practicing new behaviors in spite of how I feel.  It’s about The Work.

Every morning in the group, we filled out a plan for the day.  It included things like errands and chores, what we planned for exercise and relaxation.  We kept track of our sleep patterns, listed things we were grateful for that day, and our successes.  But at the top of the page, we rated how we were functioning.  On a scale of 1-10, we noted how well we were able to perform our daily tasks, not how we felt.  That distinction was important.  Emotions, moods, and thoughts changing like the weather can make a person feel dysfunctional.  Noting objectively that we got out of bed, ate breakfast and washed the dishes, drove to group, and made plans to see a friend afterward proves that we can still operate in the world even if we don’t feel like it in the moment.  What we do matters.

And while I feel much more stable emotionally, it’s a high pressure system that comes and goes.  The practices I put into place and actually perform every day will help me weather what comes next.  And next.  And next.

And there’s a lot of Work to do.  It’s mostly planning and monitoring, but it’s also reinventing myself as a social creature.  I’ve written here about my tendency toward isolation, my resistance and anxieties where other people are concerned.  So, I’m trying something different.  I’m attempting to let go of my old notions of Support Systems, Intimacy, and Soul-Matedness, and simply ask people to Play with me.  I plan something I want to do (like see the new X-Men movie or go for a walk) and just invite others to join me.  No huge expectation.  No smoldering resentment or disappointment.  Just play.  And it’s amazing to me how easy this is.  Simple.  For a mind that complicates and twists on a regular basis, simple is good.  Real good.

As part of my discharge planning, I have a list of goals for the next 30 days.  These will determine the nature of my practice for now.  And they will also help me make these changes into habits that, hopefully, will carry into whatever weather the future holds.

It’s up to me.

It always is.

I’m on an Adventure.

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