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Accidental Fear or Valid reporting? Risk of New IBD Rises for Patients Treated With Etanercept

The Center for Biosimilars today published an article that concluded that there is a fearful risk of being diagnosed with IBD Crohn’s or Colitis for those currently being treated with Etanercept.

Respectfully, I believe this study is incomplete and does not tell the full story. Though I don’t currently have access to the full study, just the Wiley Online Library Summary and the Center for Biosimilars article, until Lifestyle and Diet are factored into these studies I believe they do not tell the complete story.  20 years of clinical and cost outcomes from Integrative Medicine* have demonstrated the following results:

60% Decrease in hospital admissions
59% Reduction in hospital days
62% Savings in Outpatient surgeries and procedures
85% Reduction in Pharmaceutical costs
*Data provided by Patient-centered integrative medicine Independent Practice Association (IPA) per Advanced Medicine Integration Group, L.P. (AMI)

With the efficacy of leverage of using Integrative Medicine Lifestyle and Dietary changes, and the rise of it’s usage I believe a study like this is incomplete and may be unintentionally promoting accidental fear. What do you think?

Combined with the recent news that the United States Congress is grappling with tainted Chinese drugs, baffled by lack of FDA oversight in the U.S. pharmaceutical supply chain*. Remember when lead paint in children’s toys were a problem? That’s nothing compared to my concern to FDA Approved drugs potentially containing unwanted excipients.

As shown by the patients I interviewed during the Crohn’s And Colitis Summit who believe they are now cured of IBD Crohn’s and Colitis it’s becoming increasingly apparent for all of us to pay attention to our Physical, Mental, Emotional and Spiritual healing and growth.

Etanercept is a biopharmaceutical that treats autoimmune diseases by interfering with tumor necrosis factor by acting as a TNF inhibitor. It has U.S. F.D.A. approval to treat rheumatoid arthritis, juvenile idiopathic arthritis and psoriatic arthritis, plaque psoriasis and ankylosing spondylitis.

They state that while anti-tumor necrosis factor (anti-TNF) drugs are effective at treating a range of inflammatory diseases, some limited data suggest that they may, paradoxically, result in a higher risk of developing other de novo inflammatory conditions.

It’s worth mentioning that anti-TNF drugs are not the only drugs available to those with inflammatory diseases. Recently the United States FDA approved Stelara for ulcerative colitis. It’s also important to note that there are different inflammatory markers in the body. TNFa is only one of those markers. When my TNFa was low, I failed Remicade. Though this was the recommendation of my then specialist Doctors, it seemed apparent to me that I would fail Remicade, and subsequently, I did. This resulted in a horrific QOL(Quality of Life) and a very small regretful view of the world and shitty symptoms.  In hindsight, I should never have tried Remicade knowing that my TNFa was within the normal range. If you are wondering what your inflammatory markers look like I recommend ordering a test from this page: IBD Crohn’s Colitis test you can order from home.

Recently, Danish researchers sought to assess whether there is a link between anti-TNF therapy and the development of inflammatory bowel disease (IBD).1 Using nationwide Danish registries, the group examined data for all patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, pemphigus, alopecia areata, and vitiligo who were enrolled between 1994 and 2017. Anti-TNF agents were introduced in Denmark in 2004, and there were 17,018 individuals who had been exposed to anti-TNF drugs and 63,308 who had not been exposed.

Overall, 7344 patients were treated with infliximab, 9072 were treated with etanercept, and 8355 were treated with adalimumab. Fewer patients were treated with golimumab (n = 1973) or certolizumab pegol (n = 2503). Overall, 34.1% of patients were exposed to 2 anti-TNF drugs, and 16.7% were exposed to 3 or more.

The researchers found that patients treated with etanercept had a significant increase in the risk of developing new Crohn disease (CD), with an adjusted hazard ratio (HR) of 2.0 (95% CI, 0.8-2.2). The adjusted HRs for developing CD were 1.3 (95% CI, 0.8-2.22) for infliximab and 1.2 (95% CI, 0.8-1.8) for adalimumab. There was no statistically significant increased risk for new CD with golimumab or certolizumab pegol.

Additionally, patients treated with etanercept had a significant increase in the risk for developing new ulcerative colitis (UC), with an adjusted HR of 2.0 (95% CI, 1.5-2.8). The adjusted HRs for developing new UC were 1.0 (95% CI, 0.6-1.6) for infliximab and 0.6 (95% CI, 0.3-1.0) for adalimumab. Again, there was no statistically significant increased risk for new UC with golimumab or certolizumab pegol.

According to the authors, “This study firmly establishes the risk of developing de novo IBD while on anti‐TNFα agents, particularly with etanercept.”

In a letter linked to the publication, a separate group of authors from the centers in China noted that a different TNF binding pattern may be responsible for the increased risk of new IBD with etanercept versus other anti-TNFs.2

Etanercept binds to 2 of 3 sites of the TNF molecule, while infliximab binds to all 3, they explain. Additionally, unlike infliximab or adalimumab, etanercept does not bind to peripheral blood cells and lamina propria mononuclear cells derived from patients with IBD. Infliximab and etanercept also have different effects on cytokine production of T lymphocytes, “possibly inducing IBD in genetically predisposed patients,” say the authors, adding that more research into IBD-triggering pathways is warranted.

Lessons Learned:

If you’re unsure which pro-inflammatory markers are high in your body, consider your options here: IBD Crohn’s Colitis test you can order from home. Doctor approval is direct from the companies listed, you do not need to obtain prior approval from your personal Doctor, which can lead to unwanted delays, or being denied to have the blood test you wish to see the results of for your body to make the most educated decision for your health.

Any purchase from the lab test companies on that page, or the below links will allow the One Great Gut Foundation to get closer to meeting our initiatives which help you Thrive with IBD Crohn’s and Colitis. So you can invest in your health and build a healthier world through our initiatives, at the same time. Thrive Physically, Mentally, Emotionally and Spiritually.

Monitoring your health. The Crohn’s Disease Activity Index (CDAI) and the Simple Clinical Colitis Activity Index (SCCAI) are useful tools to consider using.  They access disease activity in Crohn’s and Ulcerative Colitis. For children, consider the Pediatric Crohn’s Disease Activity Index(PCDAI ) or Pediatric Ulcerative Colitis Activity Index (PUCAI).

Lab Tests to Consider

TH1 TH2 Cytokine Test – Basic
For those with a confirmed autoimmune condition, the Th1 Th2 test is possibly the most important test. The test points out imbalances in the immune system by looking at cytokines, proteins that the immune system relies on to communicate. Bad communication results in complications for those with autoimmune conditions. The information this test provides helps your doctor develop a strong and effective treatment plan for you, especially when seeking alternative medicine support.

The immune system works like a seesaw. On one side you have Th1 cytokines that initiate the first line of defense. On the other side, you have Th2 cytokines that help produce antibodies to protect you from future invasions. However, when one side goes up, the other side goes down. This can contribute to a weak immune system and potentially promote autoimmune issues. Running this test will help to understand where the imbalance is. Because certain botanicals used in natural medicine can boost Th1 cytokines and Th2 cytokines, this test can help you and your doctor develop an effective plan to help balance a weak immune system and turn the volume down on autoimmune attacks.

TH1 TH2 TH17 Cytokine Test – Advanced aka CytoDX
This test is more detailed than the above with readings including

  • Inflammatory Cytokines- Th1
    • INF Gamma: Th1
    • IL-1 beta: Th1
    • IL-2: Th1
    • IL-6: Th1 and Th2
    • IL-7: Weak Th1
    • IL-8: Weak Th1
    • IL-12 p70: Th1
    • IL-17A: Th17
    • IL-18: Weak Th1
    • TNF alpha- Th1
  • Anti-Inflammatory Cytokines- Th2
    • IL-4: Th2
    • IL-5: Th2
    • IL-10: T-regulatory cells
    • IL-13: Th2
    • IL-15: Weak Th2

TH17 Test
New studies show that an increase in a particular type of white blood cell, called Th17 cells, can trigger and determine the severity of autoimmune conditions. Monitoring Th17 levels can help you and your doctor better treat the condition.

Basic CD4 CD8 Ratio Test
The CD4 CD8 ratio profile helps assess the immune system in detail. This test is crucial for patients who are suspected of having a compromised immune system as seen in autoimmune conditions and HIV.

Any purchase from the lab test companies above using the above links will allow the One Great Gut Foundation to get closer to meeting our initiatives which help you Thrive with IBD Crohn’s and Colitis. So you can invest in your health and build a healthier world through our initiatives, at the same time. Thrive Physically, Mentally, Emotionally and Spiritually.

References
1. Korzenik J, Larsen MD, Nielsen J, Kjeldsen J, Norgard BM. Increased risk of developing Crohn’s disease or ulcerative colitis in 17,018 patients while under treatment with anti‐TNFα agents, particularly etanercept, for autoimmune diseases other than inflammatory bowel disease. Aliment Pharmacol Ther. 2019;50(3):289-294. doi: 10.1111/apt.15370.

2. Dai C, Jian M, Sun MJ. Letter: increased risk of developing Crohn’s disease or ulcerative colitis in 17 018 patients while under treatment with anti‐TNFα agents, particularly etanercept, for autoimmune diseases other than IBD. Aliment Pharmacol Ther. 2019;50(7):834-835. doi: 10.1111/apt.15460.

3. AP&T – Alimentary Pharmacology and Therapeutics – Increased risk of developing Crohn’s disease or ulcerative colitis in 17 018 patients while under treatment with anti‐TNFα agents, particularly etanercept, for autoimmune diseases other than inflammatory bowel disease – Joshua Korzenik Michael Due Larsen Jan Nielsen Jens Kjeldsen Bente Mertz Nørgård First published: 02 July 2019 https://doi.org/10.1111/apt.15370  The Handling Editor for the article was Professor Richard Gearry, and it was accepted for publication after full peer‐review. Funding information: University of Odense Hospital Free Research Foundation.

* Newsweek October 2019 Congress grappling with tainted Chinese Drugs, is baffled by lack of FDA oversight in U.S. Pharmaceutical supply chain by Blake Dodge
https://www.newsweek.com/congress-spooked-tainted-chinese-drugs-eyeing-pharmaceutical-supply-chain-1468753?fbclid

* Newsweek December 2019 U.S. DRUG PRICES TO RISE IN 2020 AS COMPANIES PREPARE TO CHARGE MORE FOR IBRANCE, XELJANZ, 200 OTHERS by Jeffrey Martin
https://www.newsweek.com/us-drug-prices-rise-2020-companies-prepare-charge-more-ibrance-xeljanz-200-others-1479939

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IBD ranks as 1 of the 5 most expensive GI disorders despite its being the lowest in prevalence among the list of GI disorders.

Inflammatory bowel disease patients have higher health costs.

Today’s blog post is not just about this growing problem, but also a few solutions I recommend you research and take action on today!

Average IBD patient annual costs were triple compared to non-IBD and out-of-pocket costs like co-payments and deductibles were double. #crohns #colitis #IBD #healthcare Click To Tweet

I wish more people understood this.

Including family, friends, doctor’s offices, hospital finance departments, and debt collectors.

The title of this blog post came from the title of an article published in 2016.

money healthcare sickcareA study published May 21, 2019 where researchers examined data from 2007 to 2016 for almost 53,000 people with IBD who had either private health insurance or Medicare Advantage coverage with both medical and pharmacy benefits. They also looked at data on 12 to 14 million people without IBD.

Overall, average annual costs for patients with IBD were $22,987 compared with $6,956 without IBD, the study found.

And out-of-pocket costs like co-payments and deductibles were more than doubled with IBD: $2,213 a year compared with $979 annually without IBD.

Costs for patients with IBD averaged $26,555 over the first year after diagnosis, researchers report in Inflammatory Bowel Diseases.

This didn’t include the cost of insurance premiums.

Several factors were tied to higher costs with IBD, including the use of expensive biotech drugs, opioids, or steroids; emergency room use; anemia; relapsing disease; and mental illness.

When patients had at least one emergency room visit in a year, for example, average annual costs were $37,759 compared to $15,237 without an ER visit.

And when patients had a mental illness, annual average costs were $35,740 compared to $18,520 without a psychological disorder.

Average costs for IBD were stable from year to year before 2012. After that, however, costs have been rising more sharply.

Worldwide, IBD is becoming more common, especially in newly industrialized countries, making it essential to determine cost drivers that may make it challenging for patients to afford care, said Dr. Chang Kyun Lee of the Kyung Hee University College of Medicine in Seoul, South Korea.

Now that we’re clear of the growing problem, let’s talk about solutions.

First, I want you to know that we are continually looking for and working on solutions. This is a large effort! If you have any proposed solutions, let us know in the comments below!

“Alone, we can do so little; together, we can do so much” – Helen Keller

Solutions
a) Focus. Don’t roll your eyes at me! 🙂  I know this is an obvious one, but it is worth mentioning here, first.  Focus is not only important, it’s also more challenging for those with IBD. Crohn’s and Colitis impact brain function, including concentration and focus. Optimizing your microbiome is best way to improve your focus. Since you’re reading this post you likely are already doing that.  Consider taking supplements that specifically target brain health and  improve concentration.

In the One Great Gut Dispensary you will find natural supplements called nootropics, also known as smart drugs and cognitive enhancers,  that can improve your thinking, memory recall, focus, concentration and motivation and creativity.

While taking supplements will cost you money in the short term, with improved focus, thinking and motivation you can set yourself up for success in your goal to greater health, and money. See below for S.M.A.R.T goal setting to increase your chance of success!

The One Great Gut Dispensary will save you money on your favorite supplements and insure both freshness and quality. If you do not see your favorite supplement, let me know and I will see what I can do about adding them to the dispensary. Other online marketplaces are often hidden with counterfeit supplements that can be dangerous. The One Great Gut Dispensary is guaranteed to only have product directly from the manufacturer.

One of my favorites is Qualia Mind by Neurohacker Collective. Mind is available in caffeine and caffeine-free versions. They also offer Qualia Focus which is a more affordable version of Qualia Mind.

It may take you a few tries to find the exact nootropic supplement stack that works best for you specially. It’s worth finding what works for you because your life will be more focused, aligned with grater productivity about the things that you care about.

b) Set S.M.A.R.T goals.

Specific
Measurable
Attainable
Relevant
Timely

You probably have some pretty awesome dreams and goals. By using the S.M.A.R.T formula you will make your dreams a reality and achieve your goals quicker.

Consider making health and money a priority. Focus on the most important things that can make a difference in both your health, and your bank account.

b) Be honest with yourself, friends and family. Transparency builds trust.  When I was an Engineer I didn’t worry about much financially. I naturally save money and don’t overspend. However, once I left Engineering everything changed. I no longer had a regular paycheck to rely on. Life was extremely hard and while I was very sick back then I was also speaking to attorneys about disability insurance. I finally got real with myself  and sat down with a few trusted friends, mentors and advisers. The more honest I was with them the better recommendations I would receive. It was certainly a blow to my ego and was very humbling, but without that level of honesty and rawness I would never have received the tips and tricks needed to work on my finances, and health.

After getting honest with myself and family during my 2018 month long hospital stay I decided to start a Medical GoFundMe. It was humbling to ask friends for help, and actually offended some family members whose ego’s and pride were hurt. It reminded them of their fears and parental teachings. I took their fears into account, but ultimately the decision was mine because I truly was in need. I was shocked and surprised how many friends and family contributed. Even strangers! Some of those friends and family I hadn’t seen in years, or decades. It was beautiful experience that showed me how loved and supported I am, even when the physical pain was extraordinary and my future looked bad.  It was through that support, emotionally and financially that I was able to safely be discharged after a roller coaster one month hospitalization.

c) The undeniable link between health and money. You must watch the Money Revealed docuseries.  There’s not many things I will recommend other’s to watch. This is one of them. 100%. You will learn directly from 36 self-made millionaires, multi-millionaires and billionaires. They sit down with you and share how they achieved the success they enjoy with money. Stop guessing, and learn from the very best.

d) Do you drink alcohol?

It’s probably costing you a lot of money, and negatively impacting your gut, health and family.

Don’t worry though. You’re not alone.

How much is drinking actually costing you?

If you have three drinks a day, five days a week, at an average of $10 a pop, you’re spending $150 a week, $650 a month or $7,800 a year just on alcohol ― not including any additional costs, like server tips or taking a taxi instead of driving. Even if you drink only on weekends, at two drinks per day you are spending about $2,500 a year.

Prefer wine at home?

According to online wine retailer Vivino, the cost of a bottle of white wine averages $14.41, while an average bottle of red wine costs $15.66. If you drink one each per week for a year, that’s more than $1,563.

The Alcoholic Beverages Market is valued at over $1,400 Billion Dollars.

According to a National Survey on Drug Use and Health (NSDUH), 86% of people ages 18 or older reported that they drank alcohol at some point in their lifetime. 70% percent reported that they drank in the past year. 56% percent reported that they drank in the past month.

The same study revealed that 15 million adults ages 18 and older have AUD or Alcohol Use Disorder.  This includes 9.8 million men and 5.3 million women.

Only 6.7 percent of adults who had AUD in the past year received treatment.

It’s not only a problem with adults, but also with adolescents.

The study estimated that 623,000 adolescents ages 12–17 had AUD. This number included 298,000 males and 325,000 females.

Only 5.2 percent of youth who had AUD in the past year received treatment.

It gets worse.

An estimated 88,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. The first is tobacco, and the second is poor diet and physical inactivity.  In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities).

This is not just a problem in the United States – it’s a global world wide problem!

In 2012, 3.3 million deaths, or 5.9 percent of all global deaths were attributable to alcohol consumption. In 2014, the World Health Organization reported that alcohol contributed to more than 200 diseases and injury-related health conditions, most notably DSM–IV alcohol dependence , liver cirrhosis, cancers, and injuries.

In 2012, 5.1 percent of the burden of disease and injury worldwide (139 million disability-adjusted life-years) was attributable to alcohol consumption. Globally, alcohol misuse was the fifth leading risk factor for premature death and disability in 2010. Among people between the ages of 15 and 49, it is the first.14 In the age group 20–39 years, approximately 25 percent of the total deaths are alcohol attributable.

Cutting back on alcohol will not only save you money, but also get you closer to a great gut as most alcohol has a negative impact on your microbiome.

Save money, and probably improve your gastrointestinal track including your colon and oral microbiome by cutting back on alcohol.

This is the best way I know:

Alcohol Free Forever – How To Quit Drinking From The Privacy Of Your Own Home

give up alcohol today
Click the above image to get started today, or download this Why You Need To Stop Drinking to learn more

Why you need to stop drinking today https://www.onegreatgut.com/wp-content/uploads/WhyYouNeedToStopDrinking_ccecyyrfgm.pdf #alcohol #crohns #colitis #wine #beer #IBD #microbiome Click To Tweet

e) Use eFundYourHealth to crowdfund.

f) Gratitude and Love. This may come out of left field but I find money follows my emotions. The happier my emotions, the more I not only feel better, but it allows money to flow. Yes, this is metaphysical and not exactly yet proven by science but it has been true to both myself and many friends and mentors.

g) Check out the One Great Gut Collection. Everything I do is to save you money, time and achieve better health results. In the One Great Gut Collection there are numerous resources not only to improve your health, but you will also learn from  a team who has successfully negotiated $550,000 in medical bills to help other’s with the Insurance, Medical Bill and Debt Collection jigsaw puzzle.

h) Budget. There are many websites and apps to choose from. They all have their pluses and minuses. Mint, BudgetTracker and EveryDollar seem to be the most popular. The MMI (Millionaire Mind Intensive) weekend workshop was helpful or me as well, changing my mindset around money.  Through working with many coaches, mentors and my own personal research I have a customized system that works for me. If requested I shared this with clients during our coaching session.

I hope these solution’s help you on your journey to a Great Gut! We are continually looking for ways to help you with your health, and that includes your bank account. Check back often for updates.

References:
Alcohol Research: The Gastrointestinal Microbiome: Alcohol Effects on the Composition of Intestinal Microbiota.

Progress in Neuro-Psychopharmacology and Biological Psychiatry – Alcohol, microbiome, and their effect on psychiatric disorders

Microbiome – Drinking alcohol is associated with variation in the human oral microbiome in a large study of American adults

Huffington Post: The Amount Of Money You Spend On Drinking May Blow Your Mind And your budget, too. By Ann Brenoff

NIAAA: Understanding the impact of alcohol on human health and well-being

Article – 2016 – Economic Implications of Inflammatory Bowel Disease and Its Management by Foram Mehta, MS, RPh in AJMC Managed Markets Network

Reuters – 2019 – Inflammatory bowel disease patients have higher health costs – Lisa Rapaport

Oxford Academic – 2019 – Inflammatory Bowel Diseases – The Cost of Inflammatory Bowel Disease

Note: Originally published in June 2019, this article has been revised and updated for accuracy and thoroughness.

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Today I woke up in a funk. A “mood”…

Today I woke up in a funk. A “mood”
This surprised me as life as been recently full of gifts.

Gratitude

My nightly gratitude practice includes a mental list of what I have to be grateful for.
The Crohns Colitis Collection product launch creation is going smoooooth. (Formerly The IBD Crohns Colitis Bundle)

The other day “A” told me that she contributed to my GoFundMe last year, and invited her whole company to do the same.

Yesterday “M” told me: “I never told you this before, Joel, but I owe you my life”

I was invited to speak in “The Gut Solution” documentary.

My interview in Interconnected – The Power To Heal From Within launched with Dr. Pedram Shojai from well.org

Apparently these amazing gifts from the universe weren’t enough.

The techniques I teach others and use myself for turning a frown upside down into a smile weren’t working.

I thought about reaching out to friends, but decided I wanted to do this on my own.

Learning To Accept Rather Than Resist

Rather than fight the feels, I accepted the negative emotions.
What we resist, persists.

I began to accept what was truly going on inside this normally serial optimists body.
I now felt more grounded, rather than someone else I was hoping to be in these moments.

Though I was still in a funk, I accepted this mood. I honored this mood. I thanked this mood for showing up and allowing me to experience the full feels of life. The highs, and the lows.

I asked myself, my gut: “Why are you in a funk”?

I didn’t beat myself up or shame myself for feeling this way, I simply asked myself a question.

The answers surprised me. I had no idea these thoughts were underneath my normally cheerful self.

I then felt empowered. I knew what was going on underneath the surface of this beautiful soul.

With this new information I was easily able to use my proven techniques and strategies to cheer myself up.

It worked. Mostly.

My gut was still telling me something was still off.
My intuition then led me to my GoFundMe campaign last year where I raised $29,357 to #savejoelscolon
This was during my challenging month long hospital stay after my GI told me the colonoscopy showed

“The worst colon I’ve seen in my 40 years of practicing medicine”

Today, 15 months later I still have all my organs.
Despite being offered surgery numerous times during and after that hospital stay.
Despite one GI telling me “Joel, your colon is sick, it needs to come out”
Despite me initially not believing I would avoid the scalpel.

Though I’m grateful that surgeons can save my life if needed, it wasn’t.
I’m continual blown away by the strength and vitality of those who live the #NoColonStillRollin‘ lifestyle.

As a student of life, the the more I learn the more I learn how little I know.
However I obviously know how to save colons, my own, and others. #winning

Yes, I’m hoping to force a career change for a few surgeons #SorryNotSorry

As I looked through the 264 GoFundMe donations tears rolled down my cheeks.

Family, friends, “facebook friends”, even strangers all supporting me during a dire time of need.

Though it wasn’t easy to ask other’s for help, and embarrassed some family members, my brother Steven started the campaign.
I vulnerably updated everyone on my status and the rest is history.

The names on the list came from all walks of my life during the past few decades. High school, college, prior jobs, La Jolla Toastmasters, Yoga Teacher Training, Integrative Institute of Nutrition colleagues, meetinDC social group, volleyball teammates, Mankind Project brothers, Yoga studios, Doctors, Nurses, former girlfriends and their parents and siblings, Landmark Education, Yelp Elite, speakers from the Crohns and Colitis Summit, Burning man friends, family across the country, and globe in Israel and Australia, One Great Gut community members as far as Germany, former mens group friends, someone I once spoke to at the Encinitas Farmers Market, friends ex-wives, former roommates, freelancers I’ve hired, even Boston Redsox fans donated. 😉

Most touching were seeing names of those whose friendships didn’t end well.

Afterwards I felt like my normal self.
Whatever normal means.
I once again realized how supported and loved I am.
How supported and loved you are.
How supported and loved we are.

I don’t know why I shared this but my gut told me to share here rather than my private journal.

Be grateful.
Not just weekly or daily, but LIVE a gratitude filled life.
The benefits are profound and tangible, though you may not be able to see the results immediately.
Don’t fall out of the gratitude practice like I did, though the nurses and doctors are amazing, I guarantee you don’t want to experience a month long hospital stay.

The Gratitude Life.

It’s more than a lifestyle

It’s life saving.

Love you All 

 

Joel Sprechman namaste peaceful one great gut

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