One Patient's Positive Perspectives

Posts tagged ‘pain’

Lupus in the light of a rainbow’s promise

wp_20170123_16_24_13_proOften, many days go by when looking outside at the nearby trees is overlooked.  The cold rainy day had soaked everyone as they made their way to the office.  Lupus grumbled loudly as aching joints and stiffness responded to the damp chill penetrating the office.

The thermal glass was much too thin to block the deep chill penetrating the wall.  The storm blanketing the mountains to the north with deep layers of winter snow brought a biting chill to our arid desert valley below.  Pelting rain struck the office balcony and trees below, as the sky gave a message of promise read by everyone standing there in awe.

320px-Butterfly_sikkimDark gray clouds hung heavy in the eastern Arizona sky as a billowing contrast to the brilliant brush stroke arc of colors swept across the sky.  The southern clouds even carried a faint echoing hint of a barely perceptible second bow.  Standing where an outstretched hand could touch the drenching rain, the combination of invigorating chill and the intensely beautiful sky snapped away the lethargy of the  aching rainy day.

wp_20170123_16_23_49_proRemembering the story of the first such rainbow adorning Noah’s sky refreshed a keen awareness of God’s many promises spanning the ages: never to flood the whole earth again, His Word delivered through holy men of old, the birth of a Savior, and the cross and resurrection that promise new life to those who believe and receive Him, and even now the promise of forgiveness and mercy while adventuring toward a heavenly future home.

With a heart full of these thoughts, today’s rainy day aches of Lupus were somehow dwarfed under the shadow of grand colors of promise hung over skies of history.  A deep cleansing breath and lingering sigh were the only utterance that really described the sight.

The duties of the day soon called out the time to go back inside and into the office kitchen, where a fresh cup of hot coffee waited to warm and nudge persistently back toward the reality of waiting duties on a desk inside. The image of that gorgeous sky evoked thoughtful quietness as I sat down again to view the distractingly beautiful scene outside my office window.

Lupus and tea at quarter past three

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Lupus and tea at quarter past three

Hugged by a bubble of dim computer light, the keyboard and tablet cast a faint glow over the blankets. While sleep eludes, night thoughts invade the quiet darkness.  He slumbers beside as his slow baritone rumbling comfortingly quivers throughout the room.  Sleepless nights seem merciless when rest seems needed most!  Lingering weariness from a busy day and goosebumps from a cool winter chill disrupt efforts to relax.  Drawing the soft comforter up is warming and eases the chill, but still fails to bring on sleep.

A recent bout of insomnia has made ordinarily foggy lupus mornings more difficult.  Perhaps there are multiple culprits to sleep deprivation.  After spending the last couple of years in college, writing research papers well into the night has destroyed circadian rhythms and perhaps deregulated sensitive endocrine balances.  To reach the arduous goal of earning a late-life college degree, unfortunately, sleep became secondary to prescribed bed times, and school work took precedence.  Life has not yet fully adjusted to new patterns after recently finishing college.  Graduation just before the holidays blended into the normal seasonal stress and distractions.

Only 10 days left until Christmas!

After graduation, there were ten days until Christmas, so the few remaining nights were feverishly used for shopping, wrapping, decorating, and cooking.  There has still been no post-graduation let down.  Immediately after New Years, we moved our bedroom furniture into our home office, and began the reconstruction project in the master bedroom suite.  Dust, noise, contractors, and morphing levels and states of household chaos have permeated all the other rooms in the house.  This has affected any sense of normalcy, and perhaps sets life on just enough edge to rob me of rest in the night.

Surging peripheral neuropathy pain

A surge in nightly onset of peripheral neuropathy pain in legs and feet has contributed negatively to attempted sleep outcomes.  Recently careful timing of nighttime Gabapentin to equalize between twice daily doses is helping reduce the frequency and severity of nightly symptoms.  When the thirteenth or fourteenth hour arrives after morning doses, it is more likely that neuropathy symptoms will set in.  If medications wait until after the onset, it takes over an hour after a new dose to get any relief, and often pain medications are required to quiet the pain enough to allow sleep.  Overall exhaustion increases the likelihood of the this sleep enemy, so this might be a cause, too.

Eliminating trough effect

Eliminating steroid trough effect

Perhaps the split dosing of prednisone between morning an evening might also contribute some to the problem.  A few months ago, quite by accident, we discovered that adjusting daily prednisone doses from single morning 7 milligrams to split dosing of four milligrams at nights and three in the morning immensely improved morning mental clarity.  The Rheumatologist described the positive result as a reduction in “trough effect”, or more simply put, a lack of prednisone dropping to very low blood levels in the night.  A potential drawback impacting sleep may be increased nighttime steroid levels.  Even so, because the net morning result is so much better than it was with single dosing, despite any negative influences in reduced nightly REM sleep, split prednisone dosing was still well worth the risk of any lost rest.

Split dosing steroids not for everyone!

Finally, this spilt dosing is not good for everyone, and in fact, is usually medically discouraged for good reason!  While ordinary medical wisdom recommends full daily steroid doses are best given in the morning to better replicate normal endocrine activity, this was not a concern in my situation.  Since we no longer have any realistic hope that my normal cortisol production will ever resume, after years of failed trials to do it, normal precautions that protect future steroid production were meaningless.  However, in patients that still have some normal cortisol production, morning dosing is recommended to reduce potential suppression of adrenal production of natural cortisol.  But, for those who are completely steroid dependent, the medical wisdom notably shifts to equalizing blood levels throughout the day.  So, split dosing in this case makes perfect sense.

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Wrapped in the promise of dreams

This quickly aging new year is a fleeting annual opportunity for new beginnings.  So, speaking like a seasoned procrastinator who waits until tomorrow to start getting more sleep, here I sit in the night lamenting my loss of it.  I am determined to start earnestly seeking this elusive commodity of sleep.  So, after reaching the bottom of a third cup of decaf tea, my thoughts of sleeplessness finally give way to sagging eyelids.  Slipping the computer onto the bed table and sinking under the warm blankets, darkness finally wraps around me with the promise of dreams.

Bring me a lupus infusion with epidurals on the side

Valle Luna Phoenix thEOGYSE51A recent “date night” found us sitting in a quiet booth while the waitress approached the table with a warm welcoming smile.  The Friday night dinner rush was over by our 8:30 arrival, and we had only waited a few minutes for our table.  Earlier, she assured us, was pretty zany at this local authentic Mexican restaurant we had all but forgotten about in recent years.

Tired some of our usual dinner spots, a return to the casual charm of this unpretentious eatery was long overdue.  The decor had not changed in the decade or two since our last visit, but it really didn’t need it.  Part of its southwest charm is the rustic feeling of being just over the border from Mexico, while really eating dinner right in the middle of Phoenix, more than a half day drive north of the border.

Valle Luna Phoenix BestWhile notably absent this evening, it seemed there might still be a faint echo of the mariachi band that had once strolled between the tables during dinner hour.  Amused while studying the menu for tummy friendly fare, a chuckle was stifled while considering my possible order.  Over the past few weeks, life had indeed served up a new menu of possibilities and adventures.

What would I like today with my lupus?  Well, how about a double dose of doctors, a lupus infusion, and a little Lumbar epidural on the side?  Seriously, the mild enchiladas, rice, and beans hit the spot quite nicely.  We enjoyed some quiet small talk over dinner while reviewing events of the day, and contemplated the long-awaited relief achieved by recent procedures that treated a nagging herniated disk.

Butterfly OrangeWith a total of three epidurals over the past few months, there was finally relief from the unwelcome companion of low back pain and leg muscle spasms.  After several months where the need for pain killers (tramadol) became increasingly frequent instead of episodic, it had become clear the chiropractic treatment we tried was woefully inadequate.  So, after visits to three different doctors there was a new personal record, as a little lupus treatment was sandwiched between some “minimally invasive” spine treatments.  Each epidural required a day off of work, sedation and a full day to rest and recoup.  With each of three treatments, the intense pain of sciatic leg cramps and low back pain subsided to more tolerable levels.

Mexican Valle Luna Phoenix thFDZH2OZYIt seems that Lupus alone is quite enough, but when other medical issues overtake a lupus patient, the combination of other medical difficulties and challenges can threaten to overwhelm even the strongest of souls.  It seems this is just the right season of life to be thankful for quiet lupus biomarkers, and be grateful for the blessings of relief from many months of intense pain.  Monthly Benlysta (belimumab) infusions have controlled lupus well.

Thankful to be out enjoying the “date”, and thankful for relief from pain, our Mexican fiesta, without the side dish of screaming pain was delicious!

Separating Systemic Lupus from Traumatic Injuries

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Separating the Injury Claims

When a lupus patient has an auto accident, work comp injury, or some other personal injury where an accident insurance claim may be involved, sorting out treatment and claims can get pretty tricky.  Personal experience with these type of insurance claims provided some perspectives about working with doctors to sort out each new injury, and distinguish it from previous injuries and chronic illness.  The most recent auto accident that happened makes dealing with several issues fresh all over again!

Years ago, two different injuries resulted in insurance claims.  First, an auto accident followed a few weeks later by a fall down stairs at work.  Communication was the key to sorting out the differences between injuries.  Now, a recent auto accident was followed by a trip and fall at the shopping mall, and the same approach is needed once again.

Granted, with auto-immune illness, there are always many days with pain and discomfort, but new injuries seem to make coping even more difficult.   Day by day it has taken patience through the recovery, meanwhile remembering to ask God for the grace to be able to refrain from too much grumbling.  This too will pass, and the Bible says that the rain falls on everyone, so the storm becomes a little personal.  The new traumas also caused lupus to flare for several weeks.

Because of ongoing medical problems from chronic disease, communication with a doctor after a traumatic injury is very important.  Providing very complete, specific, and accurate information helped doctors and employers understand new symptoms and distinguish accident-related time off work.  Although several past accident injury claims were unfortunate, a few personal kernels of reality and wisdom emerged from the experiences.  While clearly not legal advice (which would be extremely unethical for this non-lawyer to provide), these personal observations may give some helpful insight to others patients with chronic illness who are facing a similar accidental injury situation.

A doctor will finally understand it is lupus

Communicate Well with Your Doctors

Three foundational, if not simplistic, realizations:

  1. Only medical problems clearly a result of the accident injury were covered by any of the claims.
  2. Unchanged pre-existing medical problems were not part of the injury insurance claims. (Obvious but worth saying)
  3. Flares of of pre-existing medical problems clearly triggered by the injury were able to be included in the claims, but only to the degree this diagnosis was included in medical records statements that supported how the autoimmune illness had worsened after the accidents, and because of the accidents.

Four conversations throughout various stages of recovery that it helped to chat with the doctor about:

  1. Asking what percent the doctor thought recovery from the first accident was reached, right after the second accident happened.  This helped establish a milestone in the treatment that we would work our way back toward during recovery from the second accident.
  2. Asking the doctor about how they thought injuries from the second accident were different than the first.  It helped when the doctor compared and contrasted between both injuries, and this gave clear information to use talking to both insurance companies.
  3. If the doctor doesn’t mention the idea, suggesting the concept to the doctor of a “window” in the recovery from the first accident while the second accident recovery was in progress.  This helped work with both insurance companies to make clear agreement about who was paying for what and when.  This helped the first insurance company know what to expect, and to realize they would be resuming responsibility for medical treatment costs after the recovery milestone was reached.
  4. Asking about total recovery in percentages after resuming the treatment just for the remaining first accident injuries, helped keep things straight with the insurance company.  Ongoing conversation about status of recovery with the doctor and claims adjuster helped keep everyone’s expectations and timelines clear.
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June 14th is Flag Day – Happy Birthday, Sis!

After having a couple of previous injuries, three serious car accidents, a work comp fall down stairs on the job, and two slip and fall injuries, personal experiences helped clarify the impact of an accident injury on overall lupus condition and general health.  It seems that if both adjusters and doctors had not been part of the conversations during recovery, proving diagnosis of increased lupus activity due to the traumatic injury would have been much harder.  It seemed better for everyone to be involved in ongoing discussion about the degree pre-accident health had be reached.

Of course, with lupus or any autoimmune disease, there is no “back to normal”, but with good communication, it can become clear when near “normal” health was regained.  Each day, no matter what it brings, is a glorious new day to be alive, what ever “normal” ends up being.

Lupus adventures in accidental forgiveness at the side of the road

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Softening that first impulse… Stop, breathe, think and pray!

Accidents happen!  For emotional and spiritual health, it is important after a traumatic injury to start by sorting out emotions and clarify the difference between fault and malice.  If someone was at fault due to negligent, careless, or otherwise the unintentional actions causing an injury, for our own health and peace of mind we should try to forgive them. They did not mean to cause hurt, as there was no malice in their actions.

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Admitting responsibility

We should not confuse forgiveness with the need to hold others responsible for the results of their actions, but we should understand we will only hurt our own heart and spirit by rehearsing and feeding anger and resentment toward someone who caused our injury.  Imperfect humans cause accidents, and we should see them as simply that.  Imperfect.  Human.

Amazingly and unexpectedly, healing began right at the scene of a recent accident, when the man who caused it stood there by the side of the road, holding out his hand with regret on his face.  Hands were shaken and the lament in his eyes was clearly genuine, his words of apology were real, and his full acceptance of fault meant only one thing.  He was concerned with my wellbeing, took responsibility for his actions, and deserved nothing short of immediate forgiveness.

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Expressing a response of kindness

Thanking him for his integrity and sincere apology, it was somehow easy to  shake his hand and respond with a message of kindness.  Agreeing the insurance companies would work out the financial issues, our clear understanding was that the gentleman was clearly at fault.  I felt compelled to assure him of the absence of resentment or anger toward him.

As we shook hands again upon leaving, our polite agreement was that it was just an accident, and that it had happened because we are imperfect and make mistakes.  It was a heavy, bumper-to-bumper rush-hour traffic jam, and we were grateful only the two of us were involved.  Accepting this perspective on the situation helped immediately dismiss strong negative emotions and shift attention to thankfulness for the good aspects of the otherwise generally negative experience.  Considering that we both walked away in “one piece”, no one else was hurt, and we amicably communicated at the side of the highway, we had much to be thankful for!

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Bright spot in memory of accident

In the midst of the early pain of injuries, the gentle human connection with the other driver remains now a little glimmering bright spot in memories of the traumatic experience.

Sometimes we feel justified in our anger, but we are not forced to exercise that “right”.  If someone causes injury for reasons such as mal intent, criminal negligence such as drunk driving, over aggressive driving, or road rage, it might still behoove us to show charity of heart and pity them for their poor self-control and lack of wisdom, and not focus the inwardly destructive potency of hatred upon them.

Many times these infractions ultimately put the erring doer in jail, with severe legal punishment, fines, and restitution.  We should choose to let that be enough.  God’s important message to us in the Bible on this issue gives us that better perspective.  “Dearly beloved, avenge not yourselves, but rather give place unto wrath: for it is written, vengeance is mine; I will repay, saith the Lord. Therefore if thine enemy hunger, feed him; if he thirst, give him drink… be not overcome of evil, but overcome evil with good.” Romans 12: 19-20.  The negative emotion of resentment hurts the one who hates more than it affects the object of such feelings.  Just as forgiveness is emotionally and spiritually healing and freeing, resentment and hatred bring a painful grip that hurts and damages the hater more that the hated.

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How many times must I forgive?

Jesus said we should forgive our brother that hurts or wrongs us, not only seven times like an inquirer had suggested to Him, but instead we should forgive them “seventy times seven”.  That comes to 440 times!  It seems pretty clear that He did not infer that we should stop forgiving the 441st time someone wrongs us, but perhaps by then we will have well exercised our ability to forgive with reasonable success.

thL96KOAO8While it is impossible to count the number of other people throughout time who have ever lived on the face of the earth, Jesus bore the sins of all of us in His body on the cross, that He might bring us to God.  He offers lasting forgiveness to us, not at the side of the road, but at the foot of the cross.  If we will accept his sacrifice there for our own sins, and receive his offer of love, forgiveness, and eternal life, we can walk away spiritually healed and whole.  The apostle Paul explained, “for the wages of sin is death; but the gift of God is eternal life through Jesus Christ our Lord” Romans 3:23.

The body will heal, although lupus may flare after trauma, that will pass in time.  More important than the healing of our body, or any flares of chronic illness such as lupus triggered by trauma or stress, is the healing of our heart, soul and spirit.  Sinners like me who are saved by God’s gracious undeserved kindness, can choose to extend the healing of simple forgiveness to fellow sinners who happen to collide with them on the roadway of life.  With God’s help, I can, too!

Forgiveness does not happen by accident, but rather it is a choice.  I have made mine, and as a result, am well on the road back to health!

Lupus adventures through life’s stressful events

Hands of Woman Using Laptop Computer

Shut down a little early

Off to class, but not quite making it

A stressful event has just occurred, and once the dust has settled and the adrenal rush quiets down, next comes the inevitable question.  Will my lupus flare?  Traumas, losses and major life events have an effect on everyone experiencing them, but the impact can be more intense for someone with an autoimmune disease like systemic lupus.  Only time will tell, but I will do what I can to help prevent it.

Earlier this week, like every Tuesday night, when 5:00 p.m. arrived, the computer at work shut down a couple of hours ahead of normal schedule, and a current project file stashed into a waiting tote, along with cell phone and a note or two about calls to make from home the next morning.  atypically time conscious on Tuesdays, the quick dash to my parked PT Cruiser takes three minutes flat.  The seat belt “clip” sounds at 5:05 and soon the little PT  is off and rolling!

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Need gas before crossing town

On schedule, but alerted by a sound from the gas gauge, the little PT must first head off toward a gas station on the way to the outer loop freeway.  With plenty of time to spare for the stop, it feels good to be on schedule.  Soon we, driver and PT, are merging onto the highway, on our way across town for a 6:00 p.m. degree completion class.

The Bluetooth cell phone speaker rings on the visor.  My boss calls for a quick conversation about the status of a pending job offer to a prospective employee.  That done, thoughts turn to the leadership topics we have studied at school, and the joint presentation my group will complete tonight.  We are nearly ready to present it to the class next week, and just need a little more time after class to tweak content and coördinate our plans.

Silence, sounds and a sigh

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Still gripping the wheel

Leaving the radio off, the silent noise of my thoughts is plenty of company.  Up ahead, lanes are full and alarmingly tight with traffic.  Suddenly, the PT brakes must slam down very hard and fast, quickly stopping behind the forming traffic jam.  After a little controlled skidding,  we came to rest a safe distance from the car ahead.  The sighing thought forms in silence, “It is a good thing my little PT likes hanging back from the crowd of cars ahead, so there was room enough to make this urgent stop.”

The jarring sound of metal on metal instantly shatters the silence, and a millisecond later overwhelming force pounds through my body from behind.  Still gripping the wheel, startled and shaken, awareness shifts to assessing emergent issues in a mental checklist: 1) am I okay? 2) get out of traffic 3) how bad is it? 4) how is the other guy? 5) call 9-1-1.  By the time I got to the end of my checklist, I was in the emergency lane, out of my car for safety’s sake, leaning against the barrier, and put down the cell phone when I looked up at the other car and realized highway patrol was already on the scene.

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Grateful it wasn’t worse

A little bumped and shaken (okay, a lot), and very frustrated missing my college class, I was just grateful and thanking God it wasn’t any worse. Stinging, quickly tightening  muscles in my back, neck and arms made it clear that going to class was no longer in the evening’s plan.  After the officer pushed the man’s disabled pickup to the emergency lane behind mine, we answered questions and the officer returned to his patrol car with our licenses, insurance information and vehicle registrations.

Both drivers turned to cell phones to reach out to family, and in my call to contact my professor. The officer returned, offered to call paramedics for me, and held out a printed preliminary police report to me, and still holding the other copy in his hand, told me I was free to go.  I heard him turn the gentleman that hit my care and start what sounded like a more intense conversation.  I presumed to give him a traffic citation for causing the accident.

Back in the saddle, sort of

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Headed to emergency room

Back in the saddle, and merging back into traffic and exiting the freeway, the side streets seemed the most welcoming route home.  My house was only five minutes away, so after driving with much trepidation, arriving home was a relief.  I met my husband at home and he took me to the E.R. for a check up.  After my spine x-rays were reviewed they gave me a muscle relaxer (Flexeril) and instructions to take Ultram for pain.  I took the next couple of days off from work to rest and let my hurting neck and back recover.  The day after the accident, the man’s insurance company contacted me to assure me they were accepting full liability, and would take care of my car repairs, a rental, my medical expenses and any other impacts from the accident.

We are unable to choose what life or traffic throw at us, but we can do what it takes to care for ourselves once it does.  After a couple of days resting, I sat down at the computer and sent my two papers to my professor by email that were due to turn in the night I missed class.  While resting over the weekend, the next thing was to finish writing the last paper for my class that ends next Tuesday night.  The project presentation my team is giving on Tuesday was almost ready before my accident, so I am grateful we did not procrastinate on the project, so that I was able to fully rest when I needed it most.

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Let’s be careful out there!

The rental car will delivered early Monday morning, and then it will be back to work for me.  Life moves on, trauma or not, so we slide back into the groove of daily life pretty quickly in the wake of life’s bumps and bruises.  Perhaps because of the lupus, we can take these minor setbacks a little more in stride, after learning resilience from the stuff lupus throws at us on an ongoing basis.  Just like lupus, so too with car accidents.  We cannot pick the traumas and challenges we will face, but we can be grateful for what is good in our lives, and make the best of what is, without worrying too much over what we do not have or may have lost along the way.

And meanwhile, let’s be careful out there!

Lupus and not sleeping but still singing in the rain

Rain splashing on the window

There is nothing quite so satisfying for a college student as getting the paper finished, just right, proofread and printed — ready to hand in the next day.  Pleased with self and ready to snuggle into bed for the night and sleep in the sweet peace of readiness.  All is well as evening medications are downed, slumber time routines done, and tucked into the covers.  Here in the darkness, listening to the rain pouring outside in the chilly evening just beyond the bedroom window, soothed by the quiet murmuring of rain splashing in puddles and gently sloshing against the glass.

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Living by the ocean means rain!

There’s no rational explanation for why the rain brings on such a quiet excitement, except perhaps so many childhood memories wrapped up in the blanket of glorious rainy days.  Living by the ocean will change anyone’s opinion of rain deeply, to either detest or delight.

Rain triggers the memories rushing back to the carefree, worry free days of childhood.  Skipping along in the rain, splashing in puddles, emulating Gene Kelly while he danced and sang.  Perhaps my childhood motto was “singing in the rain” since I loved the driving, pouring, pounding storms the best.  There was nothing sweeter than strolling in the rain, arm in arm with mom!  Sometimes, we would sing as we walked… precious memory.

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Over this and loving the rain!

Even so, ever so briefly my fascination with rainy days and nights was shaken, after a violent monsoon Labor Day thunderstorm storm sent a towering 80 foot Eucalyptus tree into our house a half-dozen years ago.  But, over the trauma now, trusting the rain returned.  Although briefly shaken, friendship with stormy weather is restored!  Back to lacking reason to adore inclement weather.  Why in the world is its allure so great?

It is not logical to love the rain

It really is not logical!  Lupus arthritis doesn’t like the rain.  Neither does the accumulation of osteoarthritis that accompanies a history of several joint and spine traumas.  So, on nights like this when the bed is comfy and warm, but body pains just will not permit sleep, it makes no sense to like the rain.

I curl up in the dark praying for those I love, some far away and some very near.  Trying to make good use of this time to commune with the Lord, intercede for others, and redeem some good use while being frustratingly awake.  I know He hears in the dark, and perhaps the sole reason sleep eludes is to pray for God’s help for another.  This is reason enough to rest here all night in the dark without sleep.

Finding joy in the rain!

But, still laying here in pain brought on by the barometric shift, it still seems wonderful, and the hours are occupied sleeplessly listening to rain, rain, and more rain.

Others all around earlier today grumbled as they darted from car to office.  But this silly gal’s reaction?  Loving it, senselessly, and determined to find joy in the gloriously pouring rain.

Rain, rain, don’t go away…

At last sounds of morning begin to stir in the neighborhood around the house, and out on the street early commuters start their cars and the noise of splashing traffic sends a signal to get up.  Not the first or last slumber-less night, but at least there was a symphony of showers to not fall asleep to.

Goodnight!  Its morning!

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