Believing something doesn’t make it true

I don’t really believe in anniversary reactions. I’m referring to the emotional upheaval people may experience around the time of year of a previous traumatic event. If you were in a terrifying car crash in the fall, you may become more nervous about driving around that time, for example. These reactions may sometimes reflect post-traumatic stress disorder.

Whether or not I believe in anniversary reactions, I seem to be having one. I was out of sorts last week and my sleep became disrupted (tired J. can confirm that), yet I had no idea why. You’d probably expect me to figure it out because I’m a psychologist, but I didn’t.

I hadn’t made the connection with what was happening five years ago at this time. Remember my height of attention seeking when I almost died? The whole period is a blur, but September 27 stands out in my mind. On that day, I was moved from the ICU to a private hospital room. I have three distinct memories from that day.

On the wall by every hospital bed, there is a white board with the patient’s name, the patient’s nurse, the admitting physician, and the date. I recall looking at the white board in my room and being sure that the date was wrong. It was September 20th, not the 27th, I thought. When my liver was failing, my brain fared poorly too. My grip on reality was tenuous at best. I was confused and disoriented and hallucinating. No wonder I didn’t know the date.

Later that day, for the first time in weeks, I witnessed how much my body had changed over my hospital stay. (The ICU doesn’t have a lot of mirrors, for obvious reasons.) My legs and arms were spindly from weight loss, and my skin was yellow with jaundice. I was unrecognizable. In that moment, I realized how sick I’d been.

My anxiety peaked that night. In one day, I went from having a nurse assigned solely to my care, her desk positioned so she could see me at all times, to a secluded hospital room with only occasional monitoring. I was sure I would die in this room and no one would realize it for hours. I was a wee bit anxious.

I hadn’t been aware I was thinking about that period of time, but while I wasn’t sleeping one night, I made the connection. My anniversary reaction snuck up on me unexpectedly. II may have to reconsider my belief in the whole phenomenon.

Five years ago, as I regained awareness, I was hit by how close I’d come to death. Did I ever address how scary that realization must have been? I can’t recall. And even if I did deal with it at the time, sometimes such intense emotions resurface when you least expect them. Or maybe I should reconsider this whole anniversary thing and accept my reaction as predictable.

I feel a bit better already. Last night I even slept. Today’s anniversary is truly celebratory: on October 2, 2012, I was finally discharged from the hospital to recuperate at home. Had you seen me then, you wouldn’t have thought I’d still be alive today, but here I am. I can only thank God for that.

Person in hospital bed, staff saying,"if gave you nice food, you'd stay here instead of going home to your loved ones."

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Calling all impatient toddlers

I have bad news. I left the muffins out again for Mr. RAK, this time on our landing, but he didn’t come. He must have been spreading his good cheer to another neighbour, which is great. Upon realizing he was not coming, J. promptly put the muffins in the freezer, where they remain untouched. Anyone want a decent banana chocolate chip muffin? Let me know.

More than enough about that. Let’s move on to great news.

Since retiring, J. has been applying for volunteer opportunities far and wide. She readily jumps into one-time stints, including as PALS special events I cannot do, but she wanted a steady commitment of her own, preferably with kids. Kids love J.

Last year J. applied to the local children’s hospital, and was dismayed when there were no volunteer openings there. Because persistence is one of her middle names, along with punctual and efficient, J. applied a second time, got an interview, and, finally, a placement. She will be hanging out in the inpatient toddler playroom every Tuesday afternoon.

To prepare her for her duties, she practiced with a friend’s infant on the weekend. For four hours, this little tyke was all smiles. J. changed diapers flawlessly, and was a master with that baby’s bottle. That stint was only a warm up, since there won’t be any dirty diapers or bottles during her shifts with toddlers. There will only be unbridled fun in a well-outfitted playroom.

When we told our friend, who is sharper than any tack I know, about J.’s assignment, she asked, “Aren’t all toddlers impatient?” Well yes, Dr. Sharp, they are indeed, and I would be too if I were stuck in hospital. J. is the perfect playmate for them. She has no end of creative ideas, she can roll with the punches, and she’s fun. She can’t help it. She’ll make them relax and giggle and forget their worries, whether they want to or not. And she’ll probably make them clean up after themselves before they leave.

Last week, J. spent her first shift hanging out with the one toddler who was available for playtime, a little girl J. described as a bit shy. No wonder. This youngster hadn’t been in hospital long, and the disruption of a hospital stay, including sleeping away from home, must have been stressful. She was improving every day and was headed home soon. Before she left, she had time to play with J. Thank goodness, since J. would have been heartbroken if no one wanted to play with her on her first day.

I’m not sure who had more fun, J. or her little playmate. They spent most of their time shopping at the make-believe grocery store, until the girl suddenly realized she had to go. She told J., “I have to pee.” J. responded, “Well then, let’s go find the washroom.” To J.’s surprise, as they approached the playroom door, this shy one put her hand out for J. to hold.

Not all J.’s stories will be happy ones, yet I know there will be many sweet moments like this one. I can’t wait to hear what happened today. I know the kids will have fun. I hope J. does too.

 

Child's pretend groceries in two baskets

 

Why remove my tongue from my cheek? I like it there.

Very large needle

I had a long day yesterday, which I’m now going to review in excessive detail. Consider yourself warned.

Yesterday Dr. As-Yet-Nameless sent me to the urgent care clinic to address my ailing finger once and for all. Following my teeny weeny ultrasound, Dr. AYN tried to treat the infection with antibiotics, which failed, so a more intrusive approach was called for. Needless to say, I wasn’t so excited about prospect.

I commonly suffer from performance anxiety in triage. Rating my current pain as a 2 out of 10 would lead any triager to wonder why I came. I neglected to clarify that at one point the pain was a 10, and that the medication that is stopping my finger from returning to a 10 has resulted in my dramatic weight loss over the past month. I should have mentioned that, before I disappeared into nothingness, I needed action taken pronto. I understand why I was placed in the wait-forever line. I wasn’t in searing pain, I could easily skip lunch, and the problem would still be there whenever the doctor saw me.

When the doctor entered my room, I learned that she considered the barbaric procedure I sought elective. When I think “elective” I naively think “breast implants” or “facelift” or “liposuction”. (Perhaps the surgery I should get to remove my tongue from its permanent lodging inside my cheek would also be elective.) After considerable internet research, I learned that “elective” does include those procedures that are sought out and paid for, but more broadly includes any procedure that is not deemed emergent. I’m sure you knew that already.

The doctor and I may have differed on whether my procedure was elective. To me, what she needed to do to me needed to be done promptly. It wasn’t a tummy tuck! (I’ve always wanted a tummy tuck, but where would the surgeon tuck my ginormous spleen?) My finger needed to be dealt with before the infection spread to my bone (although at that point she’d likely agree it was emergent). If I could have done it myself, I would have.

I am assertive with doctors. If I am at odds with something they say, I tell them. That very day, I questioned Dr. AYN’s directive that I attend the clinic rather than waiting for her to refer me to a specialist, but she insisted.

There was no point in quibbling with Dr. Annoyed-With-Me over the definition of “elective” because, within minutes, elective or emergent, she’d be performing a barbaric procedure on me. Why anger her before she started causing me pain? She’d already proven she wasn’t the coddling type.

Procedure now done, I still wonder whether I could have handled myself differently. Was Dr. AWM punishing me for Dr. AYN’s misjudgement? Should I have protested Dr. AYN’s plan more vociferously? Was I at fault? Does it matter? It’s over, and my finger is really sore. And, Dr. AWM is referring me to a specialist to finish the job she started. Oh, I can’t wait!

In the spirit of volunteerism, would anyone like to attend that appointment in my place? I’ll gladly loan you my photo-less health care card. I guess you’d need to borrow my finger as well, though. That could be more complicated. Forget it.

The pinnacle of PALShood

People often think our city is defined by the annual Calgary Stampede, that everyone spends the week at the Stampede grounds to watch chuck wagon races.  I used to attend Stampede occasionally, but stopped going after a traumatic experience there eons ago. I stupidly ate a corn dog and then hopped on a very twisty turny upside-downey ride, somehow forgetting that I suffered from motion sickness. Since then, I rarely visit the grounds, although I’ve heard, in addition to the adorable baby pigs, there are cooking demos and food offerings besides deep-fried Oreos. Now I’m reconsidering.

You’ll be surprised to hear, then, that when PALS called for volunteers to participate in a special Stampede parade this year, Jelly and I volunteered excitedly. “Pick us! Pick us!” I wrote, closing with a seasonal “Yee-ha!” I’m sure Jelly would love nothing more than to be in a parade, surrounded by hoards of adoring fans cheering and waving.

But this was not THE Stampede parade, the one that closes roads downtown for hours as 150,000 people line the streets watching endless floats and horses and marching bands pass. No, this was a special shorter Stampede parade held annually at the Alberta Children’s Hospital for those children who might not otherwise be able to participate. PALS has marched in this parade for the past 10 years.

Then came the local heat wave. Sadly, the dogs were not allowed to march this year because the steaming asphalt would have fried their delicate paws. That meant all we could do was hang out in the shade and accept endless loving from adoring children and their parents for three whole hours. It was a sacrifice, but someone had to do it.

Many young visitors swung by before the parade, petting the dogs and vibrating with the overstimulation. Loving parents snapped many a photo. What I did not realize was that, after the parade, all of the people who had been marching, along with those who’d been watching, would make their way over to hang out. The marching band, after a short break, reassembled nearby for another rousing song or two. The horses ventured within metres of the dogs and assembled briefly on the adjoining lawn before trotting off. There were princesses and Star Wars characters and mascots galore, there were lots of trucks, both with sirens and without. Even a few helicopters dropped in.

Sure, I shed a few. Even happy sick kids made me sad. No child should have to hang out at this wonderful hospital, ever. I teared up when I saw the chairs set up for the oncology kids, set well apart from the potentially infectious crowds. When I saw a cheery policeman waving up at the building, and realized he was acknowledging the children too sick to leave the hospital right now, I was a goner. Thank goodness Jelly had brought Kleenex.

How did my little PAL cope with the hubbub around her? She found a patch of grass in the hot sun, laid down, and napped. Occasionally she raised her head, but she was largely oblivious to the endless children petting her. Thankfully, they didn’t seem to care.

They say that being a love sponge is exhausting. Jelly is living, and sleeping, proof.

Jelly the Basset Hound with front legs up laying back on grass

The real cost of extended health care benefits

It’s been over two months since J. left her real job. This job provided J. with a regular paycheque and benefits, including those for extended health care. We probably got our money’s worth from those benefits, and not only because of my expensive medications. J. appreciates the occasional massage, and we both go to the dentist regularly.

I figured once J. lost her benefits, we’d immediately purchase a private health plan. We’ve even budgeted for the cost. As it stands, my drugs are mostly covered regardless by my private drug-specific plan, which I’ve had for years. Otherwise, we remain uncovered. We’re trying to assess whether private health benefits, however affordable, are worth the cost. Feel free to weigh in.

If I go to the dentist for a cleaning every six months, the cleaning would cost less than the fees for six months of benefits. On the other hand, if I knock out a tooth during one of my klutzy falls, or I need another root canal, I’ll be paying a hefty bill out of pocket. Is this risk worth taking?

Ambulance on roadA plan would also cover the cost of an ambulance. I did call 9-1-1 once when I was doubled over in escalating pain. Within a few minutes, the paramedics were inserting an IV and I was mainlining morphine. Then we set off on the most circuitous route possible, and it wasn’t my place to redirect the driver to the hospital. Every minute felt like forever. Had J. driven me to the hospital, as she has all other times I’ve gone, and I’d waited for triage writhing in pain, I would likely have been seen faster, assuming I passed the whiner test. I’ve decided that if I were to need an ambulance in the future, I’d gladly pay the going rate of $385.

Then there’s limited coverage for the allied health professionals. If I have an ache or pain, I’m worried about cancer, not scheduling physiotherapy. By the time I rule out cancer, I trust my pain will have dissipated.

Sadly, massage is out too. J.’s massage therapist sounds like a miracle worker, but I’d be bruised all over if I let her use her deep-tissue technique on me. Even J. comes home black and blue yet oddly grateful sometimes.

Don’t forget the paltry coverage for a psychologist. The therapist I now rarely see is a skilled Ph.D.-level clinician, but because she is not a psychologist, she’s not covered. That benefit does not benefit me.

J., of course, is fit as a forty year old and is banking on not needing health coverage ever. She’ll pay for the rare drug the doctor prescribes, she’ll get her perfect teeth cleaned once a year, and, knowing her, she’ll drive herself to the ER if ever she needs emergent care. Also, her next few massages are free thanks to a thoughtful gift certificate for The Bruiser from yours truly.

I may have cornucopia of expensive drugs, but beyond that, my medical expenditures are surprisingly low. (Our generous government may beg to differ.) For now, we will monitor our health-related expenses. When I slip on an icy sidewalk and knock out my front teeth, I imagine I’ll change my tune. Or maybe not. Who needs front teeth?

boy smiling without front tooth

Beware the unexpected role reversal

Basset sleeping on couch with purple eye mask on

I can imagine what you were up to yesterday. Perhaps, if you live in the States, you were having a heated discussion over Thanksgiving dinner about your newly elected president. Or maybe you were scouring the internet planning out your Black Friday shopping. Did you know Canada now has Black Friday sales even though it’s not Thanksgiving here? I don’t get it either.

While you were out and about, I was sleeping. That’s not entirely accurate. First J. and I headed to the hospital at the crack of dawn, where I underwent my annual esophageal inspection. That’s where the sleeping comes in. Sedation is my saviour. Sometimes it’s best not to remember a thing.

After I was prepped, a nurse wheeled me into Dr. Fois Gras’s procedure room. I was first on the roster since I wanted those hands at their most steady. First Dr. F.G., who is nothing but thorough, reviewed every possible way the procedure could go wrong. My excitement about the impending sedation allowed me to tune him out. Then I confirmed he’d had time for his early-morning coffee, which would hopefully prevent any of these untoward outcomes. Finally, I went under. Everything subsequent to that is a blur, although with J.’s assistance, I arrived home stoned but in one piece.

Some people choose to have this scope without sedation. Why, I ask them, why? Why would you tolerate discomfort and anxiety if you didn’t need to? What if the doctor had needed to do a little cleaning up in there during my procedure? Would I really want to be awake? No thanks. I’d rather wake up after the work is done, sore throat and all.

I did have a prolonged discussion once with someone who chose not to undergo sedation. This woman, the Jewish chaplain, paid me an unsolicited visit a few years back when I was in hospital. This particular admission was especially stressful because my spleen was misbehaving. Doctors discussed scary interventions with me, including risky major surgery. During their investigations, they discovered my esophagus was a mess, prompting a procedure identical to yesterday’s, with bonus intervention. Wish I could tell you more but I slept right through it.

In the midst of all this scariness, the chaplain dropped by to offer her support. The chaplain is a lovely woman and it is kind of her to make time to visit me but I’d prefer she didn’t, not because I’m a bad Jew, but because her visits are exhausting. On this occasion, after hearing about my scope, she mentioned that she had undergone the same procedure just that morning without sedation. I would have praised her for her bravery but my inside voice was rudely scoffing her.

The chaplain then proceeded to share at length her current health concerns with me. I was  in considerable pain at that time (hence the hospital admission), and I wasn’t in the mood to play psychologist, but I am not a rude person so I listened patiently. By the time she left, I needed a nap. Next time she visits, if there is a next time that I’m in hospital, I may pretend to be sleeping. Better that than my impolite inside voice leak out.

You catch more nurses with kindness

I hope you realize how devoted I am to you, even in times of stress. I managed to type that last post with one hand while trying to stop the deluge coming out of my nose. In case you weren’t aware, I would do anything to keep you entertained at regular intervals.

I regret to inform you that my adventure did not end with my publishing that post. Soon after, my jump-into-action friend, Mr. Chauffeur, graciously drove me to the pharmacy for that special something to stop the bleeding. But by then I was too far gone. I finished a box of tissues on the excursion, and the bloody flood seemed nowhere near abating, so I capitulated. I called J. and told her I needed to visit the hospital forthwith, and I’d take a cab and meet her there. She didn’t think a cab was very practical given my profuse bleeding, so she drove me there instead.

My first words to the triage nurse were: “I’m sorry I’m not better dressed.” That got us off on a good footing. After she reassured me my outfit was acceptable, she told me an 8-hour nosebleed was legitimate reason to come in. I always need reassurance. Then she sent me to the Ear, Nose, and Throat chair, where a talented team deals with problems like mine every day. Every single person we dealt with over the course of that visit was incredibly kind and caring. Within 2 hours, my platelets were checked, my bleeding was stopped, my nose was cauterized and I was discharged. The ER moved faster than a speeding bullet last Friday afternoon. That ER is a well-oiled machine.

The only downside was the patient on the other side of the curtain, who had clearly never heard that “You catch more flies with honey.” She was very upset by the wait, and she and her husband expressed their discontent repeatedly. While we were bantering with our lovely nurse, Ms. Grumpy shouted, for all to hear: “Shut the #%$& up!” (I’ve never typed an expletive before. That was fun.) Later, she and her husband bemoaned the long wait because “we pay to get to the front of the line overseas.” The nurse replied, much more calmly than I would have: “That’s not the way it works here.”

Medical staff deal with all sorts of patients all the time. People who are sick are stressed and sometimes belligerent. Stressed or not, isn’t there still a level of respect that we all must adhere to? These clinicians are doing their job to the best of their ability with the resources they have. A visit to the ER takes time, and sometimes one problem takes precedence over another. Over the years, in addition to learning the art of dressing for the ER (you can review my guidance on this matter here), I’ve learned how to treat the medical staff.

I’m not kind to medical staff because I want better treatment; I’m kind because I know ER staff work hard in tough conditions and deserve my patience and gratitude. So that’s what they get, however crummy I’m feeling. I’m there because I trust they’ll make me feel better.

Quote with dog at top: Be the kind of person you want to meet.

Sometimes the bad news bearer has good news

I love my work, but, to be honest, being a psychologist is not all butterflies and rainbows. I have had to deal with many challenging people and difficult and emotional situations, Abuse is traumatic for the client and its disclosure can be traumatic for the therapist too. My clients have survived tremendous adversity.

Often, I’ve been the bearer of bad news. Parents can be devastated to find out their child is learning disabled, or has an autism spectrum disorder, or may not become an astrophysicist. For years, I informed parents I believed their children, whom Children’s Services had removed from their care, should not be returned to them. I lost a lot of sleep questioning my own judgement.

Years of this type of work are wearying even for a competent clinician. I don’t often consider the positive side of having cancer, but I can thank my leukemia for potentially preventing occupational burnout. My work doesn’t compare to that of a physician, however. I may have said things that affected the rest of my client’s lives, but I’ve rarely dealt with life-and-death situations.

I can’t imagine informing a patient that she has cancer. That’s what that smart hematologist-on-call told me four years ago. (Happy Cancerversary to me, by the way!) The ER doctor called Dr. Diagnosis for a consultation because of my blood disorder (polycythemia). Dr. D. reviewed my past blood work, spotted some anomalies, and suggested further testing.

I can remember exactly when she told me she thought I had leukemia. After spending a long day in the ER, I was transferred to a hospital bed, so J. had just gone home. I was alone, overwhelmed, and overtired when Dr. D. came in to give me the news. Needless to say, I was beside myself. What did she know? Had she consulted my hematologist, whose care I’d been under for 12 years? Somehow she kept calm in the midst of my meltdown.

J. and I talked with this know-it-all together the following day. J. was as perplexed as I was. We challenged her and confronted her and she stayed calm. In the midst of our uproar, she told us that the diagnosis was a good thing, that she caught the illness early, and that there were wonder drugs that could stop CML in its tracks. That was the good news, and eventually we stopped fighting with her.

By the end of the week, J. and I had realized this doc had probably saved my life. Then, even though we had just met and I had caused her a full week of confrontational grief, Dr. D. facilitated my transfer from my old hematologist, whom I no longer trusted, to Wonder Woman, a.k.a., Dr. Blood.

So I don’t envy these doctors, and I couldn’t do their job. How do they describe their day over dinner? “Saved a patient’s life today, honey.” How do they manage when a patient they’ve cared for and cared about dies? Do they ever fret, or lose sleep, over their decisions? They must. If they need to maintain professional distance to survive the emotional onslaught, so be it.

Thanks docs. I wouldn’t be here today without that level of care, and caring.

Sign saying "Happy Cancerversary"

 

 

Time for Jelly to earn her keep

I thank all of you for your thought-provoking and kind musings over the past week. I’ve been grateful for your feedback and your insights. I think we all deserve a break after a week of emotionally overloaded posts, though.

Have I already mentioned that the Canadian version of Border Security has been cancelled? It’s been a good run. Those incredible sniffer dogs astound me. Their sensitive schnozes can be trained to identify drugs and explosives and food and excessive moolah. Turns out a person carrying lots of bucks may be trying to launder money, which does not involve a washing machine, so says J.

Assistance dogs are not just for the visually impaired anymore. Dogs have been trained to help people with specific health conditions, such as diabetic blood sugar crashes and cardiac arrhythmias (I’m talking to you, POTSy). The dogs’ noses are so sensitive they can identify the scents that precede certain medical crises and alert their humans.

Believe it or not, dogs can also be trained to identify some cancers. My leukemia was not diagnosed by a dog, however. I guess my defective blood smells no different than yours.

But there’s a new dog in health care who may improve my chances of survival. Angus, the Springer spaniel who’s been trained to sniff out C. difficile has been all over the news this week. He’s currently employed at Vancouver General Hospital–hopefully he’s negotiated a fair wage since the cost of living in Vancouver is exhorbitant–but if he’s effective, other dogs may be trained to do the same.

C. diff runs rampant among hospitalized patients, especially those on antibiotics, immunocompromised people like me, and long-term-care residents. Stringent cleaning protocols help, and UV lights can identify high concentrations of these germs. Angus is so sensitive to C. diff that he can locate those germ clusters much faster, highlighting the areas that need further cleaning. He’s sent in only when patients are not present.

I can see one problem with Angus’s approach: C. diff is spread from person to person through poor hand hygiene. Humans house the bacteria, and then touch things with their germy hands. Angus checks the environment–tables, countertops and other surfaces–for potential contamination, but why not have him check the people? Go straight to the source, I say.

Unleash Angus’s potential and let him do what he does best: let him sniff real live humans. Get his nose right in there (I’ll leave what I mean by “there” to your imagination). Sniff out the offenders before they spread those nasty bacteria. Sounds more efficient and effective to me, although others might find the dog’s methods a bit intrusive.

Loosen up, folks, and let Angus in for a whiff. It could save your life.

Maybe Jelly could follow in Angus’s stead and get a job. Bacteria detection is probably out, though; she can’t even find a stray kibble under her nose. But if you want to rid your sidewalk of rabbit poop or need a reliable pre-dawn alarm, have I got the pooch for you. Trying to lose those last few pounds? Let Jelly relieve you of the lunch you left unattended on your counter. Contact her directly at 1-800-countersurf.

Dog in colourful room, front feet on side of bed

Hey, isn’t it time to get up yet?

Would you be my Winnie the Pooh?

Winnie the Pooh standing with a smile on his face, hands by his mouth

[Warning: You may never look at this sweet childhood character the same way after reading this post.]

We think of Winnie the Pooh as sweet, naive, and loyal to his friends. And so I find myself in need of a Pooh in my life. I’m seeking a small donation, one of little value to you, something you would normally flush down the toilet.

Before you dump this post in disgust, hear me out. Recall I’ve been a little off lately, and I’ve undergone a few tests recently to figure out what was wrong. Dr. Foie Gras was expecting to find nothing, only because he is as yet unfamiliar with my consistently anomalous test results.

Turns out all that kefir chugging was for naught: I was diagnosed with C. difficile, an infection common among recently hospitalized immunocompromised patients who’ve been on wide-spectrum antibiotics. I was starting to wonder if something might be wrong with my beloved gut flora but it didn’t occur to me to seek medical attention. I figured I’d just wait until I saw the doctor. Will I never learn?

Both Dr. F.G. and Dr. Family called me with the not-so-surprising results, and onto antibiotics I went. These pills aren’t supposed to be as toxic as the ones that led to the infection in the first place, but they do have the unfortunate potential side effect of…wait for it…the runs. As if I haven’t been rushing to the station enough lately. Thanks a lot, medication. In fact, all I’ve noticed so far is the persistent taste of freshly chewed nails and a much happier gut.

One bout of C. diff may increase my likelihood of getting another, and certain strains of this infection are antibiotic resistant. That’s where you come in. Turns out the newest and most effective treatment for recurrent C. diff is a fecal transplant. It’s not really the poo that does the trick but the healthy gut bacteria within it. Yes, patients have been miraculously cured of their GI ills when someone else’s poo is inserted through one end or the other.

Researchers are even working on “crapsules”. (I’d love to take credit, but I stole that term from this very funny New Yorker article on the subject. Take a look and you’ll understand my reference to Winnie the Pooh.) These pills will have a thick outer coating that will not dissolve in the mouth. Actually, even I, a brave unflavoured-kefir guzzler, may have a little trouble choking this cure-all down, but I’ll do anything for health. It would certainly help if I didn’t have to taste it.

And so, dear friends, do not be surprised if one day I ask to borrow your excrement. “Borrow” is the wrong word, since I won’t return it. I’ll be asking out of faith in your healthy gut bacteria, so consider the request a compliment. Also, you could potentially save my life. I’m giving you a heads up so you can acclimatize yourself to the idea.

If you’re too squeamish, thankfully a dear dog-loving friend has already stepped up. She said: “I don’t mind picking up my dogs’ poop, so for sure no issues with collecting my own.” Now that’s a true friend.