June 18, 2019

Five Ways to Cope When Life Feels Like it’s Always About Someone Else

Here are five ways to cope when life feels like it’s always about someone else. If you are an attentive, involved caregiver you know how difficult it can be to prioritize yourself. There’s often no time and energy remaining once you’ve taken care of feeding, bathing, dressing, medications, recreation, transportation and cleaning required to provide for an ill or disabled relative. On top of that, you may be responsible for paying bills and taking care of other children. You may also have a job.

I feel overwhelmed just typing that list. And I feel tired this morning in spite of 9 hours of sleep. Yesterday, I kept my medically fragile granddaughter who had been throwing up everything, including meds, for two days. It is a draining experience. And that’s the reason I offered to keep her. Her parents and brother needed a break!
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For those of you who have never been a caregiver, it’s easy to assume that being organized, prepared, and energetic will be sufficient to handle the job without undue strain. It helps. Having sufficient financial resources along with family and social support lessen the impact. But until you’ve done the job, there’s no way to understand the toll it can take.

Data say a large majority of caregivers report adverse effects to daily routines of sleep, eating, and exercise. They also report a significant negative impact on social and recreational life. A majority also report often neglecting their own health during caregiving. Even if you view caregiving as rewarding, this eventually affects your quality of life.

I recently ran into a nurse who works in the hospital unit my granddaughter frequents. She told me how much she LOVES my family. She’s so impressed that my son & daughter-in-law still have jobs and lives. She said that most parents with similar children quit their jobs.

Of course that’s an anecdotal assessment, but it’s telling. At a certain level, caregiving can require you to limit your hours, change the level of job you hold, or stop working altogether. That not only affects income, it can lessen your social connections.

Nurture Supportive Friendships

When I look back at the years I owned my previous business, I see lots of inclusion in birthday drinks, holiday parties, family weddings, and funeral visitations. I also see how much effort I put into maintaining the connections that led to that inclusion. Once I had less time to “market” myself, many of those invitations ceased.

The following year when circumstances demanded I begin caregiving, an additional level of friends fell away. Now, I have a core group of friends who understand that I must often say no. They don’t take it personally. They endure my initial nonstop talking the days I haven’t spoken to anyone besides children in weeks. They are patient when nothing seems funny to me.

I am grateful for these friends. I’ve known most of them for more than 15 years. Some I’ve known for 30. If I had not already had an established set of friends, it would have taken a great deal of deliberate effort to cultivate them once caregiving began.

Allow Yourself to Receive

One of the best ways to cope when all of the focus in your household is on someone else, is to allow yourself to receive. Of course, that requires someone to give. It is often friends who are willing to lend a hand with cooking, shopping, or other errand running. Don’t hesitate to ask or to say yes when they offer.

If offers of help aren’t sincere, you’ll learn that quickly. You’ll also learn that many are. I recently had a friend research the availability of Quick Dams online while I wet vacuumed water from my flooding office building. That was one less task I had to do that night.

Hire a Service

When friends run shorter than finances, a service can help with care. After my mother suffered a stroke and no longer met the criteria for rehab, my stepfather took her home. He had been very impatient with the staff at rehab and frequently let them (and us) know that believed he could do a better job of caring for her, keeping her bed clean, and getting her to eat than they had.

My sister and I arrived at the end of her first week home. One look and it was clear that NewDaddy could not handle another day without assistance. He had grossly underestimated the care required to deal with her impairment.My sister and I lived hours away, so I hired a service that would do household chores, dispense meds, and eventually provide hospice care.

The emotional drain of caregiving can be exhausting. The roller coaster of hospitalization, code blue, ventilator, return to baseline, stable period, minor illness, rapid decline, and hospitalization in the medically fragile is traumatic for both patient and family. It becomes difficult to relax and renew between medical events because the natural reflex is to remain braced for the next escalation. Often the stable period does not last long enough to process through the most recent past trauma making the effects cumulative.
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Make Time for Grieving

With dementia, stroke, traumatic brain injury, down syndrome or cerebral palsy comes a sense of loss that must be grieved. Grief requires stillness which requires time away from tasks including those of self-care like cooking. Unfortunately, church groups, civic clubs, book clubs, and informal groups of friends who happily provide meals and household support when someone dies do not recognize the prolonged grief of slow decline with the same kind of assistance.

Healthy caregivers may set good boundaries, make sure to add an hour of sleep or a nap, eat well, and continue to work out and still end up hitting the wall. It happened to me in 2018 and it came as a shock. I have always been able to work long and hard and still find the energy to play. I had no idea how much energy it takes process grief and trauma.

When you begin to notice life is never about you, it may feel selfish to sleep an additional two hours per night. It can also make you feel old, unfun, and unattractive. But catching up may not be a matter of sleeping-in one weekend. It can take months of added sleep to get ahead when you’re a caregiver.

Change What You Can

I now begin to say no much sooner–before I get too tired. I pay more attention to subtle body signals. And I work less. Since I am my own boss, my work schedule is something I can change.

While maintaining connections is important, I no longer choose to give my time to people who make things more difficult. I feel much less distress over the relationship shifts this causes than I do accommodating friends and relatives who regularly create interactions that are convoluted, vague, chaotic, argumentative, unnecessarily complicated, manipulative, inconsiderate or filled with turmoil. Any offer of “help” from these parties is not helpful and therefore declined. Ditto for those who have proven repeatedly unreliable.

Finding the time, resources, and energy to plan an actual vacation has been difficult the past couple of years. I’ve made plenty of trips, but they haven’t exactly included recreation and relaxation. I can reframe how I view days off and vacations and I can certainly give up feeling bad about relaxing when my to-do list remains long.

The Sum Total is Self-Kindness

Big change begins with small changes. When you deliberately practice self-kindness it eventually becomes habit. And practicing self-kindness is really the best way I can think of to cope with any difficulty in life!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791523/?ncid=edlinkushpmg00000313

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453737/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453737/table/TAB2/?report=objectonly

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924075/

http://www.cooking2thrive.com/blog/least-feel-like-party-need-one/

http://www.cooking2thrive.com/blog/id-tell-you-but-then-id-have-to/

June 11, 2019

Where Do You Draw the Line?

A recent restaurant meal leaves me wondering, where do you draw the line? A hectic day last week left me without time for lunch until mid-afternoon. Low blood sugar demanded I choose something nearby so I stopped into an Outback Steakhouse® because I know they have a gluten-free menu.
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I enjoy the bite of horseradish in Outback’s Caesar dressing. I settled on a gluten-free Caesar salad with grilled chicken. The food arrived quickly. I stared at it for a couple of seconds questioning whether I should eat the Parmesan, but hunger won out and I dug in. The first bite of salad tasted good. I was ready for another. On the second plunge, my fork pierced a hard crouton. CROUTON!?…in a gluten-free salad?

A crouton raises all sorts of questions. How did it get there? Was it dropped in the bowl when they prepared another salad nearby? Do they use the same bowl to toss regular and gluten-free salads? Did they make a regular Caesar and then pull off the croutons when my waiter noticed? Is this kitchen trained to avoid cross contact?

These questions hold the possibility that there could have been a significant amount of crouton residue throughout the salad. I ate the chicken that was arranged on top and left the salad uneaten. About the time I finished the chicken, a manager arrived with an apology and offer of a new salad or dessert.
CaesarSalad
I considered both, but I couldn’t accept. I was done. I had no trust left in that kitchen. After one more apology, they comped my meal. In this case, a free meal in exchange for a single crouton seems like a fair resolution, but there are larger questions that loom in the background.

A study published in 2018 in the American Journal of Clinical Nutrition concluded:
These surrogate biomarkers of gluten ingestion indicate that many individuals following a GFD regularly consume sufficient gluten (>200 mg/d of gluten) to trigger symptoms and perpetuate intestinal histologic damage.

It is possible that the patients studied were not strict in their adherence to a gluten-free diet, but it’s also possible that they ingested a damaging amount of gluten in spite of their best efforts to avoid it. My recent restaurant experience is a perfect example of how that can happen. My recent experience with Cheerios is another example.

The fact that studies seem to indicate accidental exposure is frequent begs the question whether a comped meal is a sufficient penalty to get the attention of a commercial kitchen regarding the serious health damage that can result to those with celiac disease from incidents of gluten exposure. I can’t think that it is but too much squawking about a specific incident could mean retaliation from an angry wait staff or chef.

Again, I’m left asking, where do you draw the line? It is important to my health to avoid gluten. It is important to my social life to occasionally eat in restaurants or attend events. It is important for me to feel like I can trust food labeled gluten-free.

It is important for all of us to be able to trust that we are getting accurate information. It is important for all of us to have food prepared in a safe manner. The more I think about this, the more I feel myself wanting to scream, “I want to be able to trust that you understand the importance to my health of providing me with carefully prepared and accurately labeled food without me having to emphasize my request in any way!”

Some are taking it a step further than screaming in their heads. One father sued Colonial Williamsburg over an incident in which its restaurant, Shields Tavern, did not allow his 11-year-old son with celiac disease to eat the homemade meal he brought with him on a 2017 school field trip because they do not allow outside food in the restaurant. Instead they offered to prepare him a gluten-free meal. The basis for the lawsuit was that the restaurant violated the ADA (Americans with Disabilities Act), the Rehabilitation Act and the Virginians with Disabilities Act.

The case was dismissed by a district court judge, but in a 2-1 ruling May 31st, 2019 the 4th District Court of Appeals reinstated the case. Writing for the majority, Judge Albert Diaz noted that Shields Tavern has rigorous protocols for preparing gluten-free meals that may suffice for most people with gluten intolerance, and a jury might decide those protocols sufficiently addressed J.D.’s disability.

But, he added, “The district court incorrectly overlooked the testimony that J.D. repeatedly became sick after eating purportedly gluten-free meals prepared by commercial kitchens. Until a jury resolves the disputes surrounding the nature and extent of J.D.’s disability, we cannot determine if the accommodation Shields Tavern offered, as good as it may be, fully accounted for his disability.”

We’ll have to wait to see how a jury views this case, but the publicity it is receiving just by being filed could be helpful to put commercial kitchens on notice that they can be held responsible if they do not accommodate dietary requests in a manner conducive to eliminating limits to the disabled of major physical activities or major bodily functions (see ADA definition of disability below).

On the other hand, I don’t know that a bevy of lawsuits over perceived insults that could result from a favorable jury decision is good. Protesting too much can yield the same result as saying nothing. But I think making an 11-year-old struggle to take care of himself because of a policy sounds like bad policy.

I applaud the boy for being willing to put his health above the stigma of being different from his classmates. If more of us showed such strong resolve, we’d all be healthier.

Perhaps reframing exposure to gluten for those with celiac disease and the gluten intolerant as a food safety issue would give it more credence amongst kitchen workers and waitstaff. The question then would be how to identify patrons for whom this is a safety issue as opposed to those who choose to eat gluten-free as a fad.

But should that really matter? As a matter of food safety, protocol should be followed for all patrons all of the time. If a customer requests gluten-free, then that’s exactly what they should receive–not maybe GF, almost GF, or what someone who doesn’t really know THINKS is GF. If gluten-free is not available, the customer should be informed upon ordering and outside food should be allowed. That would be the easiest way to avoid discrimination based on disability.

It would also be the easiest way for me to be able to relax through a meal instead of feeling braced for tomorrow’s tummy ache and next week’s rash. And while that would be welcome, it’s not reality right now. So, I choose to continue the traditions of pre-eating before events, carrying emergency food, and smilingly showing my waiter an errant crouton rather than delivering loud reprimands, throwing fits, or filing lawsuits. All of my screaming remains in my head.

Not everyone draws the line where I do, nor should they. Navigating the social intricacies of living gluten-free has many nuances. I don’t view celiac disease as a disability, but maybe it’s good to have a path of recourse when dealing with entities that choose to restrict requests rather than accommodate. I can see both sides. And my approach may change.

One more round of severe itching from dermatitis herpetiformis and my screaming may be out loud. If that happens, it will be because the itching has worn me down and gotten the best of me. And that may be where some people already find themselves. Celiac is a disease that comes with inherent frustrations and physical misery and it’s disheartening when you do everything right and still end up with damaging levels of gluten in your system.

The best way I know to minimize inadvertent gluten ingestion is to cook from scratch using fresh ingredients. When that’s not possible, patronize brands and places with which you feel comfortable. When you experience the occasional problem, draw the line where it feels right for you.

https://academic.oup.com/ajcn/article/107/2/201/4911450

https://www.richmond.com/news/virginia/court-reinstates-suit-about-boy-bringing-gluten-free-meal-into/article_aa022bd8-33f2-5db8-8e32-80f1e32f1926.html

https://www.ada.gov/q&a_lesley_university.htm

https://www.ada.gov/pubs/adastatute08.htm#12102

http://www.cooking2thrive.com/blog/im-saying-cheerio-to-cheerios/

http://www.cooking2thrive.com/blog/gluten-free-living-gotten-easier/


The Americans with Disabilities Act (ADA) defines disabilities as follows:

Sec. 12102. Definition of disability

As used in this chapter:

(1) Disability
The term “disability” means, with respect to an individual
(A) a physical or mental impairment that substantially limits one or more major life activities of such individual;
(B) a record of such an impairment; or
(C) being regarded as having such an impairment (as described in paragraph (3)).

(2) Major Life Activities

(A) In general
For purposes of paragraph (1), major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.
(B) Major bodily functions
For purposes of paragraph (1), a major life activity also includes the operation of a major bodily function, including but not limited to, functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.
(3) Regarded as having such an impairment
For purposes of paragraph (1)(C):
(A) An individual meets the requirement of “being regarded as having such an impairment” if the individual establishes that he or she has been subjected to an action prohibited under this chapter because of an actual or perceived physical or mental impairment whether or not the impairment limits or is perceived to limit a major life activity.
(B) Paragraph (1)(C) shall not apply to impairments that are transitory and minor. A transitory impairment is an impairment with an actual or expected duration of 6 months or less.
(4) Rules of construction regarding the definition of disability
The definition of “disability” in paragraph (1) shall be construed in accordance with the following:
(A) The definition of disability in this chapter shall be construed in favor of broad coverage of individuals under this chapter, to the maximum extent permitted by the terms of this chapter.
(B) The term “substantially limits” shall be interpreted consistently with the findings and purposes of the ADA Amendments Act of 2008.
(C) An impairment that substantially limits one major life activity need not limit other major life activities in order to be considered a disability.
(D) An impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active.
(E)
(i) The determination of whether an impairment substantially limits a major life activity shall be made without regard to the ameliorative effects of mitigating measures such as
(I) medication, medical supplies, equipment, or appliances, low-vision devices (which do not include ordinary eyeglasses or contact lenses), prosthetics including limbs and devices, hearing aids and cochlear implants or other implantable hearing devices, mobility devices, or oxygen therapy equipment and supplies;
(II) use of assistive technology;
(III) reasonable accommodations or auxiliary aids or services; or
(IV) learned behavioral or adaptive neurological modifications.
(ii) The ameliorative effects of the mitigating measures of ordinary eyeglasses or contact lenses shall be considered in determining whether an impairment substantially limits a major life activity.
(iii) As used in this subparagraph
(I) the term “ordinary eyeglasses or contact lenses” means lenses that are intended to fully correct visual acuity or eliminate refractive error; and
(II) the term “low-vision devices” means devices that magnify, enhance, or otherwise augment a visual image….

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

June 3, 2019

Ice Cold Non-Dairy Treats for Summer

The temperature outside has hit the 90-degree mark and it’s time for ice cold non-dairy treats! Last summer I could still consume ice cream as long as it was gluten-free. This summer, I need a non-dairy treat.

When ordering my groceries last week, I discovered avocado based non-dairy frozen desserts. It was a clicking accident but I decided to try the Deep Dark Chocolate nonetheless. The flavor was rich chocolate. There was no hint of avocado taste, and the avocado base created a creamy texture that made it seem very much like ice cream. I wouldn’t want to eat a whole meal of it, but I enjoyed the creamy denseness.
ice cold
Cado’s seven dessert flavors contain only 12 grams of sugar and 170 calories per serving. These pints are plant-based, vegan, and soy free but contain guar gum and gum acacia. I’m curious whether a lighter flavor would let a bit of avocado flavor come through. I think I’ll try Simply Lemon in order to find out.

I like Talenti® Alphonso Mango Sorbetto. The primary ingredient is Mango and a 2/3 cup serving has 160 calories. It’s a sweet treat so it contains sugar. It also has 2 grams of fiber. The only thing I’m not really fond of is the addition of Carob Bean Gum.

Alphonso Mango Sorbetto is not the only dairy-free flavor from Talenti. There’s Roman Raspberry, Peanut Butter Fudge, and Cold Brew Coffee. The raspberry is just as appealing as the mango, but harder to find locally. I haven’t tried the other two.

If you eat dairy, Talenti offers a wide range of gelato flavors. Many are gluten-free and can be found under a gluten-free tab on the Talenti website. These include Organic Ginger Matcha, Peppermint Bark, and Vanilla Chai.

When I want something on a stick, I reach for Luna & Larry’s Coconut Bliss® Organic Dark Chocolate Bars. I think I’ve mentioned these before. I often keep a box in the freezer. One melt-in-your-mouth bar has 140 calories. I like both the flavor and texture of these treats made from coconut milk, agave syrup, cocoa, and vanilla extract. Difficult to avoid in frozen treats, the coconut milk contains guar gum as a filler.

All Coconut Bliss flavors are certified gluten-free — even the Chocolate Chip Cookie Dough. Some flavors come bars. Others are in pint cartons. A 2/3 cup serving of Chocolate Chip Cookie Dough has 330 calories. The Ginger Cookie + Caramel has 330 calories per serving and the Sweet Cherry Amaretto 260. Unfortunately,

There are other non-dairy frozen desserts available. Steve’s Ice Cream Burnt Sugar Vanilla sounds delicious, but it’s not sold in stores in my area. I’ll make it a point to seek some out when I’m traveling.

Ben & Jerry’s®, Halo Top®, So Delicious®, NadaMoo! and Snow Monkey also produce highly acclaimed dairy-free ice creams. I’ve tried a dairy version of Halo Top that would not make my short list, but the non-dairy version may stand out.

Of course, you don’t have to take my word for any of this. Is there really a downside in getting out there and trying LOTS of these yourself? I don’t think so.

Enjoy some for me too!

UPDATE:I tried the Cado Simply Lemon and Mint Chocolate Chip flavors. Neither is as pleasing as the Deep Dark Chocolate. After a bite or two, the Simply Lemon was too lemony. I feel this way about most products that include lemon oil. Lemon juice might have had enough flavor on its own. The mint chocolate chip was okay, but one bite did not leave me wanting another one.

https://www.talentigelato.com/products/alphonso-mango-2

https://www.talentigelato.com/product-category/dairy-free-sorbetto

https://coconutbliss.com/product-details/dark-chocolate-bars/

http://cadoicecream.com/

https://stevesicecream.com/index.html#WhereToBuy

http://www.cooking2thrive.com/blog/my-five-feel-good-things-for-the-week/

http://www.cooking2thrive.com/blog/summer-ice-cream/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

May 28, 2019

Coulda, Woulda, and Should Have!

I’m wondering why my relatives who coulda, woulda, and should have thrown out the trash chose to hang on to it? I just spent yet another weekend in my hometown cleaning out my mom’s cousin’s house. Although I thought I’d already emptied all of the bags and boxes that have to be slowly sorted, I discovered I was wrong!

There were bags behind a chair, boxes under the dresser and the beds, and piles on top of the cedar chest. There’s unopened mail from 1987 mixed with family photos, used Kleenex, financial records for still active accounts, pharmacy bags with prescriptions attached, and pill bottles filled with quarters all in the same box or bag.
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In the past 3 years, I’ve been tasked with cleaning out two houses and a 3000 sqft storage building filled with similar mixtures of trash, recycle, shred, keep, and donate. Trash, recycle, shred, keep, donate. Trash, recycle, shred, keep, donate.

I can quickly think of four relatives no more distant than second cousins who have stopped throwing things away. They don’t shop compulsively. They are proponents of recycling. They pay their bills. They have active social lives. And they keep trash. And they mix trash with non-trash. And they leave the trash casserole for someone else to deal with.

This weekend I was joined in the cleanup by my psychologist cousin who thinks this is a form of hoarding or obsessive-compulsive behavior. Of course, my first question was, “Is it genetic?” According to Dr. Nancy, there is most likely a genetic component, but no specific marker has been identified. I know I came home with a compulsive desire to get rid of something.

In my mom’s house, there was an identifiable point in time at which filing and organization stopped. Prior to that, she saved a lot of things, but it wasn’t unheard of for her to pare down. There is an identifiable year when things changed in her cousin’s house as well.

While the cousin’s change in habits seems timed to correlate with the loss of her mother, my mom’s appears to correspond with her marriage to her second husband. I guess the commonality in the two is significant life change.

Logically I understand how loss might trigger a desire to hang onto things that belonged to a person you lost or that hold fond memories of a person lost. It’s interesting that it might trigger hanging onto junk mail or ceasing to file.
pile
I think it’s possible that a triggering change can cause a freeze response that manifests in an inability to take care of yourself in some way. Perhaps it interrupts your maintenance of your environment or perhaps you struggle to feed yourself.

Saying it’s a triggering change implies a previous wound or a latent biological response. Obsessive-Compulsive disorders and Eating Disorders are closely related to anxiety. Anxiety is at its most simple, distress.

Distress can come from old or new feelings of terror, grief, sadness, helplessness, humiliation, danger, distrust, rejection, invisibility, shunning, defectiveness, and unloveability. Old incidents of neglect, abuse, or cruelty sensitize us to anything that feels the same.

All of these feelings can be so powerful that we can become overwhelmed. Pushing ourselves gently into action may seem like the straw that will break us. Of course, the reality is that the only way to heal the distress is to find a way to feel then release the feelings.

Hopefully most of us will find a way to do this instead of ceasing to throw away trash. Living in the midst of clutter weighs us down. The dust collected can irritate allergies. Piles can create a falling or fire hazard.

Neglected kitchens and bathrooms can pose other health risks. During my weekend, I observed that canned vegetables can sit unused long enough that the can begins to disintegrate and leak thick, black tar-like liquid that runs out of the cabinets and drips onto the countertop. I’m not sure I can describe to you how gross this is!

I donned a mask and gloves, but I felt like I needed a full hazmat suit to dispose of the cans. An antique Kerr jelly glass with a metal lid accidentally tumbled into the contractor bag along with a can. I did not go after it. I realize they sell for almost $20 on Etsy. It still wasn’t worth the dive.

Yesterday, I drove the three hours home wanting nothing more than to wash the day off of me and go to bed. Now that I’m back, everything in my house is suspected trash! I’m looking to see if there’s anything I coulda, woulda, or should have thrown away by now.

I sometimes feel like taking the position of my mom’s cousin Jimmy. Jimmy had a barn in disrepair that he wanted to tear down. The barn was located on the original homestead and contained some family heirlooms. Jimmy tried to get the family to come claim those treasures so he could proceed with demolition.

Instead, they stalled, lobbied, guilted, humiliated, and generally made him so miserable that for 15 or 20 years whenever someone mentioned that barn he’d just shake his head and say, “Light a match!” That was almost 40 years ago. He never demolished or torched the barn.

In fact, he finally sold the land to my dad and I now own the repaired, refurbished barn. I have no idea what’s in it. Maybe I coulda, woulda, or should have, but I’m afraid to open the door!

…Light a match?

https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder

https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

https://www.eatingdisorderhope.com/information/eating-disorder/eating-disorders-anxiety
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