I had my surgery and all went well. (Except for the fact that I think I was given a bit too much Sandman Special. It took about 3 days for me to get the anesthetic out of my system. Oy vey.) Several biopsies were taken and sent off pathology.  The Friday after surgery I went to see Dr. Evil for my post-op appointment and to discuss treatment plans. He let me know all the biopsies came back and were “…consistent with the previous Crohn’s diagnosis”. The findings are as follows:

• The Crohn’s is fully out of remission; positioned as close to my colon as it can be without actually involving the colon.
• Multiple deep ulcers were visualized in the small intestine- in and around the affected area.

I have 3 treatment options available to me:

1. Remicade: I was shaking my head with an emphatic ‘no’ as soon as the word came out of his mouth. I did, however, take this opportunity to pick Dr, Evil’s brain re: Remicade. Remicade is made from Rat Proteins and in most cases, patients must be medicated to prevent anaphylactic shock before the treatment can begin. The body sees this protein and as an invader, rightfully so, and goes off on it. There is also a small percentage of people who form a type of  lymphatic cancer that is 100% fatal. Thanks for the 411, but I have enough problems.
2. Humira: Pretty much the same as Remicade with the exception of being derived from human proteins as opposed to rat proteins. The chances of an allergenic reaction are greatly decreased. As with Remicade, there is a chance of a lymphatic cancer that is 100% fatal.
3. Mercaptopurine (6-MP): Has many side effects including kidney stones and liver issues, which are among some of the most serious.

I chose the lesser of 3 evils by staying with the 6-MP for now. The dosage has been raised and I am back on my friend Prednisone until the Crohn’s stabilizes.

When it comes to Remicade and Humira, I consider those last ditch treatments even last to more surgery.

Ah, where to begin? I’ve been away for several months and avoiding my blogging duties, though it has not been far from my mind during this time. A lot of things have happened in a very short time. I’ve lost two really good people that I cared for… My friend Steve, you’ve read about him in this blog, passed away unexpectedly. Ellie, my dear friend who commented regularly here; she gracefully exited, as well. A day that I still cannot think about without wanting to vomit. Something that I still refuse to speak about to anyone- maybe someday. Maybe not.

I’ve maintained activity with our Facebook page. Membership has steadily grown over time and I seem to be lending some value to the cause.

So, what’s been going on with me? Well, a lot and absolutely nothing- depending on your view. In the early part of December it was confirmed by a Small Bowel Follow-through and Dr. Evil what I had already known; I’d come out of remission from the Crohn’s Disease. I had seen him in November and requested that he order the procedure. I’d been keeping it to myself for about 2 months, but ’something’ felt amiss to me inside. When the skin welts/rashes started reappearing, I knew it was bad news and thus, requested the SBF. After my bowel resection, I was given 2-10 years of possible remission before the disease came back; I made it just shy of 17 months.

I’ve stated in earlier posts that I was fearful of the time when I would come out of remission and the Crohn’s would reappear in my colon (large intestine). At the moment, the Crohn’s is just teasing me like a bully in the schoolyard. At the time of my initial resection, there was a 3 inch section of healthy, viable small intestine before it transitioned into the large intestine (colon). My surgeon made the decision to remove 2 of those 3 inches. The thinking was to be sure all diseased tissue was removed to lessen the chances it would hit my colon when it returned. I fully stand by my surgeon in his decision to do this. In retrospect,  it would not have made a difference if he had left those extra 2 inches intact. Unfortunately, the Crohn’s has reappeared in that 1 inch section

Tomorrow I am scheduled for a Colonoscopy, tie off an Intestinal Varices and an Endoscopic Balloon Dilatation (see colon) procedure. In a nutshell, they are going to insert a scope with a balloon on the tip. The balloon will be expanded with a prayer that it will open up the area where my small intestine meets my large intestine. Providing of course, Dr. Evil can get the scope up far enough to the problem area. I would not say that I am feeling negative about the procedure, but at this moment, I do not think that it will end the real issue. Opening the narrowing will give me relief in the moment, yes, but the inflammation is still going to be present. I fear I am heading for an Ostomy, but I cannot think like that, nor will I.

Since mid-December I have been placed back on Prednisone, Asacol (new for me) and my 6-MP dosage has been increased. My symptoms of severe fatigue, mild to severe pain, intermittent rashes, welts, etc.,  have worsened in the past month. I worry about the condition of the inflammation because I was originally scheduled two weeks ago, but had to cancel because I had a cold with a fever.

I am positive and hopeful that tomorrow will bring me some relief. I am absolutely positive that what I must do today to prepare for the procedure will make me cranky, sick and want to run away to a tropical island Ah, the joys of Movi-Prep and Magnesium Citrate! However, I must say that I am happy I found the latter in cherry flavor this time.

“Healthy on the outside- suffering on the inside.” How sadly true is that? I am sure anyone with Crohn’s will agree that people do not understand just how sick you are inside. Why? Because to the lay person, you may look fine on the outside. It’s not like a scar, a bruise, a cast for a broken bone or anything visually tangible. It’s unseen, unspoken and therefore, to most, does not exist.

(Trzewia_CzlowiekaBKKL, 1914)

Digestive diseases affect 60 – 70 million people in the United States a year, according to estimates from the National Center for Health Statistics. People with Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease) and Irritable Bowel Syndrome are constantly monitoring their digestive system, sometimes striking a precarious balance between western medicine, eastern medicine, and exercise and diet control. In 2007, I was diagnosed with Crohn’s Disease after years of feeling lethargic and sick. The diagnosis started a journey of discovering what treatment and health management worked best for me. Through this journey, I found that a beverage I’ve always loved (tea) was helpful in managing my digestive system and my spirit. Others affected with digestive disease have experienced the healing and soothing benefits of tea.

There are some standard teas and herbals attributed with helping the digestive system.  They are:

• Peppermint tea – believed to ease diarrhea, promote digestion, help prevent gallstones, and relieve stomach cramps.
• Licorice tea – believed to help fight diarrhea, and aid the healing of stomach ulcers
• Chamomile – believed to relax digestive track muscles, and “soothe the irritated lining of the gastrointestinal tract and reduce the inflammation associated with poor digestion” according to the article, Chamomile Tea for Digestion.

Drinking tea is about the continuous quest for balance, which is a daily process as you interact with your physical, mental, and spiritual self as well as your environment. The tea that soothes one day may not soothe the next. Staying in tune with your body will help you make daily choices around tea and other aspects of your diet. I’ve included some additional tips on how to think about tea in your daily rhythm. Be mindful that this is an art, not a science.

• Black tea – during periods of digestive flare-up, take a break from it. It is the hardest on the system.
• Oolong – the mildness of this tea is easier on the digestive system.
  According to wisegeek.com “…the tea alkalizes the digestive tract, which can be helpful for people with problems like acid reflux and ulcers. Oolong tea also stimulates the metabolism, and it helps the body to break food down more quickly, which is why some people promote it as a weight loss aid. Oolong is especially good at breaking down fat, making it easier for the body to process.”
• Green tea – taken in moderation daily can give your digestive system a boost. It is also easier on the system compared to black tea. An article by Safe Internal Medicine, Green Tea: Digestion and Metabolism, says that “epigallocatechin gallate (EGCG) is the most powerful of the polyphenol catechins contained in green tea leaves. Studies have shown that EGCG has an anti-inflammatory effect within the gastrointestinal tract.”

Original article: September 4, 7:39 AMTacoma Tea ExaminerCasie Swanson

Download this press release as an Adobe PDF document.

NeedyMeds.org and the Crohn’s & Colitis Foundation of America announce a new source of information on medications used for Crohn’s disease and ulcerative colitis and the financial help available for those living with these diseases.

(Vocus) August 13, 2009 — NeedyMeds, a national nonprofit, added a new resource page to its Web site tailored for those with Crohn’s disease and ulcerative colitis. The page is a Crohn’s disease and colitis-specific source of help for those looking for information on these diseases and financial resources to help assist with the cost of medications.

The resource page, created in collaboration with the Crohn’s & Colitis Foundation of America, provides information on these diseases including facts, research, and more. Links to the Crohn’s & Colitis Foundation of America and its chapters, programs and services are included on the resource page. In addition, the page lists financial resources that help with the cost of the drugs used to treat Crohn’s disease and ulcerative colitis, free clinics, and programs that provide other types of financial assistance.

NeedyMeds has the most comprehensive and reliable database of patient assistance programs available. All the information is free, easy to access, and updated regularly. There is no registration process or need for users to enter any personal information.

The collaboration between NeedyMeds and the Crohn’s & Colitis Foundation of America was created to reach a larger group of people needing support and assistance in a time of shrinking resources. Both organizations are committed to serving those in need.

About NeedyMeds:

NeedyMeds, a Massachusetts-based nonprofit, is a comprehensive and reliable source of information on assistance available for people having difficulties paying for their medications or health care. The Web site (www.needymeds.org) is visited by approximately 12,000 people each workday. All of NeedyMeds’ information is always free, easy to access, and updated regularly. Unlike similar sites, NeedyMeds requires no registration. All the information is easily printed.
About the Crohn’s & Colitis Foundation of America:

Over 1.4 million Americans suffer from Crohn’s disease and ulcerative colitis, chronic and painful digestive diseases for which there is currently no cure. The Crohn’s & Colitis Foundation of America’s mission is to cure Crohn’s disease and ulcerative colitis, and to improve the quality of life of children and adults affected by these diseases. Help is just a call or click away at www.ccfa.org or 888.MY.GUT.PAIN (888.694.8772).

What the hell is a person suppose to do? I’ve been here before; wondering what the 6MP would do to me over time, as over time the dosage has risen from 50mg to 100mg. I’ve seen what medications can do to people over time. I have a couple of family members who are suffering the effects of long term medications they took 20 years ago. Now, with the FDA forcing stronger cancer warnings on drugs like Remicade and Humira, it’s back on my mind again. Not that it was ever that far.

The big picture about the FDA is that until their death/injury quota is satisfied, they sit still. Once the quota has been met or someone screams loud enough, it still takes months, even years, for these drugs to be pulled or have more strict labeling instituted. Since Remicade and like drugs are given intravenously, where does the patient or guardian get the information leaflet in the package? Personally, I have never had anyone give me one for anything I’ve had done at the hospital, nor inform me of risks. Then again, I have never had a Remicade treatment.

I have found that Remicade was initially approved in 1998 to treat Crohn’s disease in adults. And they knew as early as 1998 about the cancer risks, yet  Remicade (infliximab) was approved to treat children with active Crohn’s disease on May 19th 2006. What?

Furthermore, evidence published in May 2006 in the Journal of the American Medical Association, suggests that Remicade can TRIPLE the risk of skin cancer . While previous studies indicated the increased risk of infection and lymphoma, a blood cancer, this is the first study to show that Remicade can cause skin cancer. Remicade treatment has been previously linked to serious side effects, including fatal reactions such as heart failure and infections including tuberculosis, histoplasmosis, listeriosis, and pneumocystosis. The FDA issued a series of warnings and now requires the drug to carry a special “black box warning” on its label, a heightened warning for potentially dangerous drugs.

On September 4, 2008, the FDA ordered a stronger warning for Remicade and for three other drugs used to treat rheumatoid arthritis. The FDA is warning users that they are at risk of developing potentially fatal fungal infections. In its announcement the agency reports that 240 users of the drugs have contracted a fungal infection called histoplasmosis. 45 of the reported cases have resulted in death.

And then today, 11 years, 2 months and 4 days after it first approved the drug for Crohn’s Disease treatment- we are supposed to feel safe because ANOTHER black box warning was issued. According to the news release, the FDA is investigating approximately 30 reports submitted to its Adverse Event Reporting System over a ten-year interval, beginning in 1998 and extending through April 29, 2008. These reports described cancer occurring in children and young adults who began taking TNF blockers (along with other immuno-suppressive medicines such as methotrexate, azathioprine or 6-mercaptopurine), when they were ages 18 or less.

The same news release also informed the public that it had received rare post-marketing reports of an aggressive and often fatal type of T-cell lymphoma (hepatosplenic T-cell lymphoma) in adolescent and young adult patients with Crohn’s disease. In most cases, these patients were treated with standard immunosuppressive therapies (azathioprine or 6-mercaptopurine) in combination with Remicade. The FDA also stated that these risks were already included in the labels for all approved TNF-alpha blocking agents, including Remicade, and it was working with the manufacturer to address this risk by updating the Warnings sections of the Remicade label.

The FDA also stated that it still believes that the potential benefits of the use of TNF blockers outweigh the potential risks. Long-term studies are necessary to provide definitive answers about whether TNF blockers increase the occurrence of cancers in children because cancers may take a long time to develop and may not be detected in short-term studies. Until the evaluation is completed, health care providers, parents, and caregivers should be aware of the possible risk of lymphoma and other cancers in children and young adults when deciding how to best treat these patients.

I seriously doubt that FDA Gods or any of their family members on on the drugs that we are on. If they were, the FDA would not be issuing horrendous statements like,”…use of TNF blockers outweigh the potential risks.” Thank you for looking out for us, FDA.

Courtesy of the Associated Press

The Food and Drug Administration has ordered Enbrel, Humira, Remicade and other drugs known as TNF blockers to carry stronger warnings about the risks of cancer in children who take the drugs for treating juvenile rheumatoid arthritis, Crohn’s disease, and other inflammatory diseases.

TNF blockers are drugs that work to neutralize a specific protein in the body that, when produced in high amounts due to chronic inflammatory diseases, can damage bones, tissue, and cartilage. However, a recent FDA investigation into the drugs found the drugs also resulted in an increased risk of cancer in children and adolescents.

The cancers appeared, on average, 30 months after treatment with the drugs and about half of the cancers were lymphomas of cells in the immune system. In some cases, the cancers caused by taking TNF blockers were fatal, the FDA cautioned.

The FDA is requiring the makers of TNF blockers to include stronger warning labels on the drugs’ packaging to alert consumers and physicians of the increased cancer risks.

Brand Name Drugs Must Warn of Cancer Risks

The popular brand name drugs covered by the FDA warning today and their generic equivalents are:

• Remicade (infliximab)

• Enbrel (etancercept)

• Humira (adalimumab)

• Cimzia (certolizumab pegol)

• Simponi (golimumab)

Psoriasis Risks Also Addressed

In addition to the stronger warnings about cancer risks from taking TNF blockers, the FDA also is requiring makers of the drugs to update the prescribing information to include reports of developing the skin disease psoriasis associated with the use of the drugs.

TNF blockers have been promoted as safe and effective treatments for rheumatoid arthritis, Crohn’s disease, and other inflammatory diseases, which affect millions of Americans. The prescription drugs are injected either weekly or several times a month to reduce symptoms of inflammatory diseases.

Members of Congress are Coming Home to You!

During the month of August, many members of Congress return to their home districts and states for their district work period. Your Representative and Senators may be holding public town hall meetings or other public events during the month to hear from you, their constituents.

This is your chance to ask them to support our legislation, the IBD Research and Awareness Act. Take this opportunity to share how important this legislation is to you and the 1.4 million people living with these digestive diseases.

We encourage you to find out if your legislator is holding a town hall meeting. When you attend a meeting, be sure to share how IBD affects you day-to-day and, more important, how this legislation can improve your life.

Can’t visit your legislator? Ask them to support our legislation virtually! E-mail your legislator today.

Need help?

Contact the CCFA Information Resource Center: 888.694.8872 or www.ccfa.org.

Stress is a tiny word that packs a powerful blow for many of us whether you have Crohn’s Disease or you are a perfect specimen of health. There are, however, serious consequences for anyone dealing with stress and a chronic illness such as an IBD. When I get stressed out, even a little bit, it wears me out. Lethargy, severe diarrhea leading to dehydration; cramping, back pain and nausea are a few of the effects I suffer when I allow stress to gain the upper hand in my life.

The questions of the past week have me spinning and wondering if I am ever going to get through to anyone about my disease. What most people do not get is that with Crohn’s Disease, we do not have be in an active flare up to experience the effects of the disease. We have a constant war going on within our bodies and that requires an enormous amount of energy to combat.  In essence, my body is attacking itself because it thinks there is an invader trying to do me harm. In fact, there is nothing there and the normal chain of events that keep you, a healthy person, from getting sick or fighting the infections that do sneak in, are the same defenses that are attacking me like an AK47 in a dark alley.  So, if you want to know why I am always tired and occasionally cranky- go run a couple of miles in 90 degree heat, spend an accumulated 2 hours+ in the bathroom each day and maybe then you might get it. But, I doubt it. Why? For you, it’s a moment that you will recover from. For me, it does not end, thus adding to the incredible mountain of stress accumulation.

Many health problems are caused by or exacerbated by stress, including pain of any kind, heart disease, digestive problems, sleep problems, depression, obesity, autoimmune diseases and skin conditions, such as eczema. With Crohn’s it has been reported that excessive stress can actually throw you into a flare up and none of us want that! So, what do you do to alleviate stress? First, totally eliminating stress from daily life is just not possible in my opinion. If that is something that you can manage to accomplish, I bow to you and want to hire you to calm my life down. What you can do is limit your stress by avoiding stressful triggers and situations. Following are the steps I have taken. I am not always 100% successful, but 10% success on a given day is better than nothing at all.

STEP 1: TAKE PERSONAL INVENTORY – Know thy self.

Looking at yourself in the mirror is one of life’s cruel necessities, but if you are going to reduce that which hurts you, sometimes you have to eat a little dirt.

There was a time when I was strictly a night owl. I am now an early bird, but sometimes yearn for the peacefulness that only the night can bring. I am a loner and have been all of my life. I have one friend that I would lay down my life for and she is a huge piece of my heart. I am an emotional person and a perfectionist. What I mean by ‘emotional’ is I can get irritated and pissed off easily; I am not a crier, so when I do cry, I am deeply wounded. Over the years, I have learned to control my temper and keep it in check- it can be done. I have always worn my heart on my sleeve and have a very deep compassion for people who need help and need to be ‘fixed’ so they can move on be happy. This, in my opinion, is a huge downfall of mine. It causes me great distress and I must keep in in line or my blood pressure would pop a hole in my skull and spout out of my head like a fountain. I am very self sufficient and there is not much that I cannot do. I run the gambit of being able to change my oil and tune up my car to cooking you one of the best meals you’ve ever had. I take family very seriously and as we all age, my stress climbs and you start to wait for ‘those’ phone calls. I tend to internalize that which I cannot deal with, like the death of my sister in law and the breakup of my first marriage- not for me, but the affect it’s had on other people I love.

STEP 2: RE-ENGINEER YOUR MIND - Find what works for you.

1. My ‘60 Minute Rule’. When something gets to me I take 60 minutes to respond and use that time to think of my options. You have my personal guarantee that what you do in the 60th minute will be greatly different than what you may have done in the first minute.If I do not have 60 minutes, I will strive to take at least 5 minutes before I act.
2. Take the mental vacation approach. Walking away for 15 minutes to a quiet place, closing my eyes and going to my private island I have conjured in my mind is where I take my mental vacations. Without going into too much detail, my vacation spot is a beautiful, sunny spot with my favorite things around me. No other people are allowed there except my husband and of course, I do have Internet access. (Gotta love the Air-card) Just teasing! The point is it’s a place that is just mine and I can go there in my mind and enjoy that which brings calm over me, thus, reducing my stress.
3. Rid your life of emotional vampires. Most of us have at least one of these life suckers in the family or a friend that just exhausts us. Even so, this has been the most difficult one for me to tackle. I care about people so much, but there comes a time when certain people have made themselves too much work for me to deal with on an ongoing basis. This does not mean you need to eject them from your life, but it does mean that you need to flush their crap down the commode. When they start to sink their teeth in, change the subject. When they call, don’t answer the phone or cut the call short. After a while they get the message that you are available to them only when they are not introducing drama into your life. Take the time- this behavior did not start over night and it won’t stop overnight. Rehabilitate people to be a part of your life.
4. Accept that which you cannot change. Although I have made tremendous strides in this area, I struggle with this one daily. I wrote the book on trying to help people and fix situations they create for themselves. STOP BEING AN ENABLER. Making things right for people, particularly your children, is not doing you or them any favors. You are stressing yourself out needlessly and you are not making them be accountable for their decisions. What’s worse is the fact that when you do the work for another, they miss out on an invaluable skill-set of being able to correct their own mistakes and miss the train on avoiding these mistakes in the future. They end up repeating their mistakes and you find them right back on your doorstep. Teach them consequences by allowing them to be responsible for their own lives.
5. Exercise. Yes, we all hate it, but don’t you hate flares and feeling craptastic even more?  Taking short walks each day really does help and the more frequently you take these walks, the more you will miss them when you don’t go. It is a great ‘me time’ activity to think and borrow ideas from your neighbors awesome gardening prowess. *wink* You will also begin to see the benefits of feeling more energetic and even see the numbers drop on your scale. It is very beneficial for anyone, but for Crohn’s patients, it’s extremely beneficial in so many ways. So, get up; put on your earphones and walk to the corner today; keep it going. Maybe next week you’ll be ready to take on the whole block!

Other popular questions I will address in upcoming posts:

How does Crohn’s Disease affect your relationships?
What do you do during a flare up?
What is it like recovering from small bowel resection?
Does remission from Crohn’s Disease mean you are symptom free?

Related Posts:

• What is it like to have Crohn’s Disease?
• What are the mental affects of Crohn’s Disease?

Reminder: This web site does not give medical advice. All content is based upon personal experiences and links to news reports. If you feel you may have any health condition, I urge you to seek immediate medical attention. Please use this site responsibly.

I think it is typical to want to ‘feel normal’ whether it be because you have a chronic illness that restricts you and you want to shed those restrictions even for a little while, or you just want to be part of the crowd and circumvent the borage of disease related questions. But, what is the cost after everyone goes home and you are left with your conscience and disease pointing their gnarly fingers at you?

This past week I spent time with people that I normally am not in physical contact with, but are well aware that I have Crohn’s Disease. The questions were plenty and my explanations became weaker by the minute. I found myself longing for my post-Crohn’s state of normal. (Noting that any sort of normalcy, by my own choice, has never been something I have aspired to achieve—until now). I quickly tired of explaining why I could not eat this or that; why I ‘looked’ so tired; why I was living in the bathroom, etc.  In the end, I found myself eating crap I knew should not, downing Imodium AD and Aleve like candy and throwing up a lot. I guess I thought that as long as no one noticed, “… it will be alright to do it for a few days.” It was total rebellion against my disease and I knew that as soon as I grabbed the Imodium off the shelf at Wal-Mart. I know how dangerous that stuff is for me because of the PVC’s I tend to experience while taking Imodium. I did not have PVC issues this time, but it was still a really idiotic choice on my part and will never be repeated again.

Some of the people around me kept insisting that I slow down and chill out- rightfully so. However, I knew if I stopped I was not getting back up so I just kept going until I could get back home. I did not feel too badly yesterday aside from being fatigued, but today I feel as if I’ve been hit by a Mac truck with an axe on the front of it. I have managed to get a few things done, but not enough to make a difference in my mind.

The Aftermath

There is always going to be a price to pay for doing that which you should not. I am no exception to this rule as much of an invincible super woman as I tend to think I am. Starting last night I have had severe diarrhea, cramps and fatigue from hell. I am so grumpy that I already feel horrible for my poor husband who is due home in about an hour. I am making him his favorite burrito’s for dinner to as a pre-peace offering. I think Jack, my beautiful fur-baby, may pack up his bone and leave home for greener pastures.  The cat is not stupid; she split early this morning. I saw her creep in the neighbor’s garage- fuzzy little deserter.

This is how my day has gone today- Bathroom, TV, check mail, bathroom, shower, bathroom, dressed, went to start my car the battery was dead. Bathroom, call AAA.  Member ship expired July 21^st, transferred to member services, bathroom, on hold, bathroom, on hold more, bathroom, bathroom and still on hold. Member services, after 43 minutes on hold, cannot renew me unless I agree to pay a fee increase. I understand that times are tough, but as a member since 1987, they can bite me for their extra $28.00. Car is still dead, AAA sucks and Jack walks to the store with me. I come home and the sewer is backed up in my front yard AGAIN. Laugh with me, people. Laugh with me!!!  (Insert snarky chipmunk laugh here.)

Is it time for bed yet?

I received my lab orders in the mail this morning from Dr. Evil for a Complete Hepatic Panel and a Comprehensive Metabolic Panel (CMP). I made it to the lab with 15 minutes to spare this morning. I thought the Saturday hours were 11-3, but they were 8-11:30. Way to screw  a person up. In any event, I hope to have the results back by Wednesday at the latest. I neglected to ask how long these tests take to come back. Ugh.

I bought my vitamin D and B Complex. The B Complex is supposed to help with liver function according to my pharmacist. The D is something that Crohn’s patients are historically known to lack. I don’t care, I just want to feel better. I have had shortness of breath for 2 days now- no explanation for that. And last night I awoke to pain in my mid back that has not let up. It’s been a crappy day and I just want to go to sleep and forget about it. BUT! I have dishes to do. Oh, joy.