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Today, as I officially enter into my fourth decade of life, I’ve made an important decision.  Despite the publishing of the first stages of my Bucket List – the list of things I want to accomplish before kicking the proverbial bucket – one of the items is coming off the list.  Unfortunately, it’s coming off the list, not due to completion, but rather due to elimination.

I had pledged that by my 40th birthday, I would venture into the world of ink art.  Tattooing. Today’s the deadline and the only things that decorate my skin are freckles. I’ve tossed around the idea of a tattoo for years; this year I decided to go for it, with an artistic rendition of a sunrise and sunset on my lower back.

Once I gave deep thought to the plan, I decided it was a bad idea.  The hubby would tell you that I’m dangerous anytime I’m in deep thought and that’s why I don’t venture into it often.  Here’s my dilemma.  People with M.S. have tattoos and get tattoos.  My neurologist didn’t have an issue with it.  If I were still injecting, there wouldn’t be an issue either, as long as I wasn’t getting the tattoo over an injection site.  That’s all a moot point now that I’m venturing into the land of infusions anyway, although, there could be a time where I have to travel back to the land of injections.  Regardless, a tattoo on the lower back provides no problem for the injection of DMD’s.

I have read; however, of M.S. patients with tattoos being eliminated from clinical trials that require repeated MRI’s.  It has something to do with tattoos that have indigo inks in them.  Apparently indigo inks have a metallic value and MRI results could be altered.  Reading about these folks who wanted to participate in clinical trials, but were denied, got me thinking.

Who knows what the future will hold – five or ten years from now.  Maybe there will be a treatment for M.S. that requires (a hopefully painless and simple) injection into the lower back.  Maybe there will be some newfangled gadget that is used on the lower back to increase mobility.  Imagine if an M.S. patient with a “tramp stamp” as my step-daughters call them can’t benefit from some new, scientific, amazing treatment or research process just because they have a tattoo.  Sure, you may think I’m nuts here, or going over the top with my What-if’s.  But, we really don’t know what the future holds.

Five years ago, folks may have thought it would be absolutely impossible to have retinal scans for the purposes of identification or for locked room entry.  Technology and science are both amazing and who knows what researchers and doctors will think of next to help those of us with this disease.  All I know is that I’ll be kicking myself from here to Toledo if I get a tattoo now and pay for it later.  Plus, frankly, I’ve had just about enough of needles to last me a lifetime.  Between months of injections and regular blood tests, not to mention IV ports, and soon monthly ports for infusions, I won’t be saddened if I have to forego a few hours of needles jabbing into my lower back.

Do I consider it a defeat to have put something onto my bucket list only to rethink it or back out of the plan?  No way! Bucket lists, just like brain-damaged, cone-headed redheads, evolve with time. One might say that bucket lists reinvent themselves, too.

So, I traded my birthday present tattoo from the hubby for a beautiful crystal vase instead.  At least I get to look at the vase, hand painted with grapes (perfect for wine country where I live) everyday when I walk past our formal dining room.  I never would have seen the tattoo, unless I was to gape at my bare behind in a mirror.  And just how often do I do that? Never!

 

Oboe hams it up at the Vet’s office.

 

Watching my husband age, with all of his back issues, is one thing.  Watching my parents age is another. Both the hubby and my parents can voice their ailments, their problems, their aches and pains that need medical attention. Even as I prepare to turn the big Four-Oh on Thursday, watching myself age is truly a piece of cake.  Watching my baby, my Lab Oboe, age is devastating and frustrating.  Despite all those wishes on various stars, Master Oboe still can’t speak. 

The hubby and I know his time is coming; still, we’re nowhere near ready for that time to arrive.  I thought we were going to be forced to be prepared yesterday.  Ironically, despite all my well intentioned plans to prepare for life’s major stressors, the plans didn’t seem to help much.

Warning, if you’re reading this over breakfast, lunch, dinner, or even the simplest of potato chips, you may want to click away and read the story later.

Two weeks ago, the pup had a nasty bout with diarrhea.  I’ve seen doggie doo before and people doo too. But, I’ve never seen anything like what I awoke to that Sunday morning.  Oboe tried to jump up onto the bed and when he did, everything in his 90 pound body spewed out onto the covers.  All over the covers and all over Oboe. I’m not exaggerating when I say “spew”.  Projectiles.  I woke to the smell and scene in the early hours of the morning, to a shaking pup, covered with his own mess.  At the same exact time, the hubby – who had fallen asleep on the couch – awoke to a similar scene all over the family room.  We sent the pup outside while we went to work around the house and he lay in the grass, shaking all over.  When the house was cleaned, it was time to clean the pup.  At four in the morning, we got him into the kids’ bathtub and went to work.  Kerri Elizabeth would say later on Sunday morning that she swore she had a bad dream that we were giving Oboe a bath in the middle of the night like crazy people.  Crazy indeed.  I was mid-relapse with a slew of M.S. symptoms, all increasing exponentially through the stress of the events at hand.

That same Sunday, the home healthcare nurse visited to begin my Solumedrol drip.  I was certain our home smelled horrific.  She didn’t seem to notice.  Three days and a few pounds of boiled hamburger and rice later, the pup seemed back to normal.  A week later, he went to the bathroom in the house again, nothing like the time before, but still so out of the norm for our fella.

A week went by without incident.  Then Monday, the hubby called me at work in the afternoon, telling me the diarrhea was back, in liquid form.  It was running like water.  My stomach turned.  In the early morning hours of Tuesday, the hubby awoke to a minor mess in the family room again, but then saw blood mixed in with what was left behind.  I spent an hour or so lying on the floor with Oboe, who despite his best efforts just couldn’t get comfortable.  He changed positions minute after minute.  It was obvious he was in discomfort. 

I had a conversation with him, asking him to give me a sign.  Asking him to tell me what he needed me to do.  The next time he took a walk outside with the hubby, Tom returned, grim faced.  He told me I should cancel my MRI scheduled for that morning and come with him to the pet hospital.  I took a quick shower, sobbing the entire time.  He had to run into work to open the door for his part time helper, so we met up at the hospital.  During the drive, Oboe, too weak to sit up in the back seat, strained his neck towards the open car window.  I couldn’t help thinking, “Is this the last time we’ll take a drive together? Is this the last fresh air he’ll feel on his face from a window?”

I arrived at the hospital first and left Oboe in the car.  I went in to talk to a nurse, to get a sense of what to expect before I actually brought the pup inside.  Of course I was preparing for the worst: complete kidney failure or cancer.  After a variety of tests were complete, we were told that Oboe is suffering from a number of ailments.  He has an easily treatable viral infection in his intestines.  He also has colitis, which is causing the diarrhea and the bleeding in that area.  He has a urinary tract infection, brought on by prostate gland disease.  Of course, he still suffers from degenerative osteoarthritis.

I asked the doc to do an ultrasound.  It was selfish and only for my own peace of mind.  I just had to know of Obie-wan-Kanobie has cancer.  The doc talked me out of the procedure, calling it “over the top” and premature.  (Apparently they need to sedate the dog and shave his belly and with all the trauma Oboe had suffered in the previous hours, the doc didn’t want to hurt him any further).  The doc instead suggested a course of medications over the next series of days.  The meds will relieve the discomfort by shrinking the prostate, dry up the viral infection and help the colitis. Within days the meds should make the world right again.

The true test will come after Oboe finishes the treatments.  Hopefully the problem will be resolved, but if the conditions return, especially the prostate issues, we need to begin discussions of “other options.”  We’re hoping for a quick recovery, perhaps some diet modifications, and many, many more months before options need to be outlined. 

I guess we should look at yesterday as a dress rehearsal.  How can one craft a plan to prepare for her major life stressor without experiencing what it will all really be like? We’ve experienced that test drive now, sending me back to the drawing board to develop a better plan – one that’s better for me, the hubby, but most importantly, for my baby.

The other day, the hubby was walking through the kitchen.  He tripped.  Well, it was more like the toe of his shoe got caught on the linoleum, made a horrific “Squeeeaaak!” and he stumbled.  I said, “What was that all about?”  He replied, telling me that for many days now, he’s been having trouble with his one leg.  He’ll be walking along and the leg just stops keeping up with the other one, causing him to trip.

I shouted, “You have foot drop!” He sorta shook his head.

No, the hubby doesn’t have M.S., although he’s said on more than one occasion that he wouldn’t be surprised if he did have the disease, too.  It would explain his horrible memory problems and forgetfulness, the persistent numbness in his one thumb, and the tingles he often feels in the same arm.  Now, with foot drop, his symptoms begin to mount.

What he does have is serious arthritis in his C-Spine.  I think they call it degenerative osteoarthritis.  We just found out yesterday he also has two bulging discs.  A recent X-Ray showed the progression of the arthritis and “something else there” as the doc put it.  We waited for two weeks for his MRI report, and the doc delivered the news yesterday.  Apparently dear hubby has battered and beaten his body through decades of hard labor and it’s starting to fight back.

Interestingly enough, a disc problem in the spine can produce many of the same symptoms as M.S. (Sorry, but I don’t think the forgetfulness can be blamed on a damaged disc though).  We think it’s pinching a nerve, causing the numbness and tingles, and perhaps even the leg muscle weakness that’s caused him to stumble around recently – they are all on the same side of his body.  I’m eager to see the printed MRI report just to show him that the word: Demyelination doesn’t appear anywhere on it. Spondylosis, probably.  Demyelination, let’s pray not!

So, the whole foot drop scenario provided for a great conversation starter for the hubby and me.  When my home healthcare nurse visited to start my Solumedrol IV, we had a good 30 minute conversation (she asked questions and I answered and I guess that constituted a “conversation”) about my symptoms.  At one point she asked if I had any trouble walking.  I replied indicating that I struggle sometimes, with one leg not keeping up with the other.  The hubby, who was watching TV in the same room spoke up and said, “You don’t have problems walking.”  I glared back, “Yes I do!”  “No you don’t.”  “Yes I do.” We started sounding like twin two-year-olds, so I gave him a look that said, “Let’s not do this in front of the nurse!”  I think he was reminiscing about my days of possible hypochondria (pre-diagnosis) and was trying to make sure I knew what was really wrong with me and not just assuming symptoms that weren’t really present.

When he stumbled into the island in the kitchen, I took the opportunity to tell him that what he just experienced is what I, too, experience regularly.  I suffer from foot drop in my right leg.  Just the other day, I attempted to enter a colleague’s office.  My foot wasn’t working right, my toe caught the carpet and I stumbled my way up to her desk. Foot drop. 

Another lesson learned in Casa de Fabrizio. 

 

The Healing Temple

Spring is here.  For me that means time for planting, mulching, motorcycle riding, outdoor walks with the pup, and thoughts of a country drive to a little town in New York: Lilydale.  I have only visited there once, but that short visit had a huge impact.

Lilydale Assembly is a community of spiritual mediums. Clairvoyants.  Psychic Phenomena. 

The hubby and I visited several years ago.  I was pulled there to visit one place – their healing temple.  Yes, I’m a skeptic, although I watch John Edward and often think that he may the closest to a true psychic as anyone could be.  Today’s article isn’t meant to necessarily open a debate about the authenticity of psychic mediums or this area of spirituality.  I still debate the topics internally, and likely will do so even on the drive back to Lilydale.  But, I’m still going back. I need to visit the temple again.

Awhile back, I was really struggling with my post-cervical cancer physical and emotional worries.  Every three months, that visit to the doctor to find out if the cancer returned, was draining.  At the same time, I was trying to come to terms with not ever becoming a mom, with the thought that I may die from cancer, with the guilt and disappointment delivered to me so early in my new marriage, and the guilt and disappointment I carried while feeling sorry for my parents who would never become grandparents because of me.  A former colleague suggested a visit to the healing temple.

I was open to just about anything at that point and the hubby had visited Lilydale once as a teenager.  He had a unique experience while there – something he carries with him to this day.   He’s a larger skeptic than me, recognizing that most of what he experienced there was contrived.  Yet, there was someone who connected with him, unprovoked and authentically.  He was up for a drive into the country as well and we decided to make a day of it.

The temple only offers two services on Saturdays, one in the morning and one well into the evening.  We left the house late, arguing a little, because I was certain we’d miss the morning service.  The colleague who sent me to Lilydale, a practicer of Reiki, asked me to buy her a turkey feather at the Assembly’s gift shop while there.  As we drove, the hubby and I were irritable and were rushing to get there on time.  Out of nowhere, a flock of turkeys swooped down upon us.  In front of the vehicle, on top of the vehicle.  They forced us to stop, take a deep breath, and to slow down.  Arriving at the healing temple, dead, wouldn’t be of any benefit.  As a turkey feather wafted onto the dashboard, we giggled at the thought we were receiving a little pre-visit spiritual message from above.

We arrived at the temple just as the service began.  The place was packed.  A number of professional mediums were in attendance; their purpose being spiritual healing, one-on-one with visitors.  We took our seats in a pew and the hubby selected someone.  Within minutes, his session was finished.  I couldn’t decide who I wanted to see.  I watched the proceedings and selected a middle-aged gentleman.  Unfortunately, so did many other people, so I had to wait and wait for a few moments with the fella.  The hubby whispered, “Just pick someone else.” I shook my head.  I needed to spend time with just this one person; I was drawn to him.  The hubby went for a walk outside.  I continued to wait.

Finally, it was my turn.  I sat in a chair and didn’t speak.  I was committed to not giving away any information.  The medium ran his hands along the outside of my body, around its perimeter.  When he came close to my arms, I felt true heat from his hands.  He was kneeling at my feet.  When he reached my stomach, he placed my hands upon it.  He lifted his eyes to meet mine.  We locked eyes powerfully.  He spoke to me. 

“This is where you’re carrying all your worries.  You know the cancer is gone, don’t you?” he said softly.  I refused to respond, not wanting to acknowledge his correctness.  He spoke again.  “You’re not here though because of the cancer.”  My eyes filled with tears.  He continued. “In fact, you really aren’t upset that you can’t have children.  You’re upset with yourself because you don’t feel worse about it.  You feel guilty because you’re just happy you’re still alive. You’re here today not to be healed from cancer.  You’re here today to forgive yourself.  So, look up to the sky and let it go today. Just let it go.  It’s time to move on. It’s OK to move on.” 

I was shaken.  I was in tears.  I couldn’t speak.

When I walked out the temple’s door, quite a sight, I think the hubby thought the guy told me I had months to live or something similar.  We walked for hours.  At some point, in amidst the silly “performances” of really bad spiritualists, I told him what the medium had said.  The hubby merely shook his head and said, “Then, let it go, Sunshine.  Let it go.”

We had a nice lunch, attended other events around the Assembly, and stopped at the gift shop to look for a packaged turkey feather.  We looked and looked.  We asked the clerk.  She delivered the only one left in the place.  It looked fake compared to the one that had been ripped for the pillaging turkey by our car, but we bought it nonetheless. 

That day, I learned a lot about myself.  I learned how to let go. As I continue to battle the MonSter, I feel as if I need a little spiritual healing again.  There are some new issues I need to resolve, to release.  So, hubby, gas up the motorcycle, grab the helmets.  We’ll take the bike this time.  I hear turkeys steer clear of loud pipes.

Ooh, it’s chilly and rainy outside this spring morning, but that’s not stopping Team Sunshine (although I’ll be turning my face up to the clouds, begging for a few rays to shine down upon us).  Today we celebrate Walk M.S.  2008 —one of the hundreds and hundreds of M.S. Walks (and upcoming Bike Tours) scheduled around the country today and in weeks to come. 

Today we walk to raise funds for the National M.S. Society – to fund research and patient services. 

Today we walk to raise awareness about this nasty disease, its treatments, and our hope for a possible cure. 

Today we walk to celebrate just having the ability to move, to put one foot in front of the other, or to ride along in a scooter or wheelchair.

To those who sponsored us with thoughts, good wishes, sore feet, or funds, we are grateful.  Let the sun shine on Lake Erie this morning, and turn the wind and rains away to Canada. 

You want to do something across the room but your body won’t move. You negotiate with yourself: how many steps will I have to take to get there?

More than 90% of M.S. patients experience fatigue that significantly impairs their quality of life.  More than 50% of patients report that fatigue is their most disabling symptom from Multiple Sclerosis. 

In an effort to continue to educate about this important topic, today I share this article for your reading pleasure:

Taking Fatigue Seriously: New Focus on this M.S. Symptom.

Chug-a, Chug-a

Toot! Toot!  All Aboard.   It’s time to jump on the Ty-Train.  And here begins Sunshine’s journey with Tysabri – the drug we’re hoping and praying begins to alleviate the relapsing part of my Relapsing-Remitting M.S., decreases potential disability, and hopefully protects my noggin from future attack across that all important blood-brain barrier.

It’s quite a process, getting started on the Ty Train.  I began that process yesterday and will continue to chronicle my journey each and every month.  I selected Tysabri after weeks of research and discussion and debate.  My heart is swelling with great hope; the hope that my body will accept the treatment without allergic reaction and the greater hope that I will fare similarly to those patients who sing Tysabri’s praises. The hubby and I truly believe it’s the best, current option for me – for my situation, my diagnosis and prognosis, my lifestyle and my dreams for my future. 

I started the process with a required visit to my Neuro’s office yesterday.  That’s phase one of Tysabri’s Touch Protocol - -a thorough screening process designed to ensure only the proper patients are selected for this form of treatment. There is a very, very, very small chance that those on Tysabri could end up with PML - -a rare, but deadly, brain infection.  It’s all related to having a severely compromised immune system; those with such systems could be susceptible to PML, so the Touch System works to identify risky patients and disallow their participation with Tysabri. With more than 22,000 patients currently being treated with Tysabri (with the hopes of 100,000 patients on the drug in the next two years), not one patient has suffered from PML in the last two years.  It would be irresponsible for me to just sweep the PML issue under the carpet.  It’s out there, but it’s truly a minimal risk.  Yes, I’ve been told it’s more likely for me to get run over by a bus this afternoon then it is for me to suffer from PML. 

I also need to partake in yet more blood work, designed to provide a baseline measurement for check-ups and to rule out a few things – and to monitor against liver disease while under treatment.  Next week I have my newest MRI – we’re extending the range down to my T-spine this time around (in addition to my C-spine and brain from the previous scan).   I’ll know shortly if any new lesions have appeared since November, 2007.  We’re guessing it’s likely, due to a new symptom or two that have appeared recently and also the location of the symptoms.  I like that I’m having a new scan. It’ll truly help me personally measure the impact of Tysabri, right from the very beginning.  And, shortly, I’ll secure the date and time of my first infusion.  Then I’ll begin counting the days.  I truly can’t wait.

Last weekend I was Jonesing for a good, healthy cry.  This week, I’m just Jonesing for several, consecutive strong and healthy days – a series of small wins even. You know what I’m talking about.  One of those days where I just sit in my office chair and think, “Damn, I feel good this week!”  I might throw a party the minute I hit a solid week of feeling what has become the “new normal” again.  Let’s hope the Ty Train follows the map to my destination. 

Coming soon…the Secrets of the Ty-Ty Sisterhood…

Watching Paint Dry

Even long before M.S., my life was nuts.  Of course it was all due to my own choosing; it’s definitely my own fault.  I push myself to extremes – to be the best, to have the best, to do the most and do it the fastest.  I’ve written before about my path to reinvention, my control issues, my extreme Type-A, fast-lane personality.  For years the hubby has preached to me that even if I won the lottery, I’d still be pushing myself, working two jobs, volunteering like crazy, always putting myself into crazy life situations.  For the same number of years I’ve been fighting back, telling him that I’m changing.  I’m slowing down.  I’m craving normalcy over superiority.  I really am.

I didn’t really know how to characterize what I’ve been looking for until the other day.  A gal named Pamela posted a response to one of my HealthTalk blog articles.  My understanding became clear through her words. Her full posting is below, but within it she wished for me a life that is about as exciting as watching paint dry.   At first I thought: “Yes!  I want a life like that.  I’d love a boring, dull, calm, and relaxing life watching paint dry.  I’m owed a few years just like that.  I’ve made my bones, paid my dues, worked my tail off, gave up valuable and irreplaceable time and energy.”  (Can I person earn a living watching paint dry? I have a beautiful new garden gazebo that isn’t paid for yet.  What’s the hourly rate for paint-watching anyway)?

I think that thought pattern lasted for less than 24 hours.  I felt a little ridiculous.  I thought I went off the deep end.  I knew I wouldn’t be fulfilled.  Drying paint is boring.  I don’t want “boring.”

Obviously, I don’t think I want something that extreme, but it’s equally obvious I’ve been craving something just a tad bit different than what I have now — especially now that I have M.S.  No.  I’m not using that as a crutch.  What I mean is that now I have a little challenge in life.  I’m not 100% on my game like before.  I have my health and my longevity to think about.

I still want a full life.  I still want to work a highly viable, visible, and important job.  I still want to make a difference, to inspire change. I like nice things, but I don’t want to measure my worth upon them.  I want less stress and more fun.  I want more time with my family and friends – and a career that supports that work/life balance.   In fact, I often push myself outside of that balance, completely on the fault of my own, not my employer.   With this thing called “M.S.”, my truly good days are limited.  I want to maximize the fun in my life.  I want to save up energy to go to the beach and hear a guitar player on a Tuesday night, instead of rushing home to go to sleep because I have three, big meetings the next day that demand my attention instead.

Ah, there’s the word I’m looking for.  BALANCE.  I want to find a balance.  An even keel.  I’d be more than willing to go without any major life surprises or excitements for a few years.  I’d be perfectly fine with a simple, calm, fun, yet still engaging life.  Somewhere between splashing the paint on the walls in seven minutes flat (just to get the project done because it has to be) and sitting in the corner for hours in deep thought, watching the paint dry.

_____________________________________________________________________________________

Twenty plus years with this thing called MS and still hanging tough with NO treatment (what insurance will cover - Tysabri - I’m allergic to and this rest the insurance won’t cover.). Kim (and to everyone), I hope your MS gives you little to publish and broadcast about and the MS part of your life becomes about as exciting as watching paint dry. For now, it’s a new color on the walls of your life. Please, try not to decorate the entire estate in this MS color! It can get very old very, very quickly! But, despite all of that it is still good to drop in every so often to see that there are other MSers alive out there. Hang tough, everyone!

Posted by Pamela on May 13, 2008 at 12:31 am

 

As I’ve mentioned in the past few days, I’ve been really stressed out lately.  The kind of stress where you are certain your eyes are bulging out (when they aren’t twitching from fatigue), where you can’t think straight, and where the slightest thing will put you right over the edge.  The hubby knew I needed some endorphin help the other day – the kind of endorphins that can only come from amazing laughter.

I’m sharing this here so each of you has this at your fingertips – for just when you need it.  This short video proves that laughter is definitely contagious.  You have to watch for about a full minute before you’ll understand what I mean.  Then, just sit back, and join in the giggles!

Laughter is Contagious!

I read an interesting article in “Momentum” this month, about donating my brain tissue to science.  I’m already an organ donor and have both a living and end of life will.  The hubby knows what I want and what I don’t want should something disastrous happen to me.

The other evening we discussed my newest interest – donating my brain tissue.  It’s important not only for the hubby to be aware of my wishes, but also other close family members to be aware as well.  God forbid, if he and I are injured together and he can’t speak for me, I need others to know what I desire.  It takes time to locate my living will and my formal right of passing will and perhaps for family members to try to digest—and respect my true wishes.

With brain tissue donation, time is at a premium.  Tissue must be donated within hours of death.  There can’t be any debate, any arguments.  It must be taken care of promptly for the donation to be of any benefit to science. There isn’t time to dig through Sunshine’s home office to read about her wishes in this instance.

So, my loved ones, here are my wishes.  I’m officially signing up with the M.S. Tissue Repository at the University of Chicago.  I’ll be sure I have my papers in order for you so they are easy to find.  You just need to notify the doctors of my wishes immediately upon my death.  No worries, I won’t suffer terrible disfiguration and my funeral won’t be delayed.  And, in addition to regular organ donation, we can rest together knowing that maybe my damaged brain and tissue could help lead to an eventual cure for M.S.

For others interested in this option, you can also choose to donate your brain tissue to:

Rocky Mountain MS Center, Research Division
701 East Hampden Avenue, Suite 420
Englewood, CO 80110
Phone: (303) 788-4030       
Web site: www.mscenter.org

Human Brain and Spinal Fluid Resource Center, Neurology Research
Building 212, Room 16 (127-A)
West Los Angeles Health Care Center
11301 Wilshire Boulevard
Los Angeles, CA 90073
Phone:               (310) 268-3536       
24-hour pager:               (310) 636-5199       
Web site: www.loni.ucla.edu/uclabrainbank

Multiple Sclerosis Tissue Repository at University of Illinois at Chicago

Shannon Hertzler, Interim Coordinator
835 South Wolcott Street, MC790
Chicago, IL 60612-7344
Phone number:  (312) 996-5763       

 

For more information on the process of brain tissue donation:  Donating to Tissue Banks, published by NMSS.

 

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