Tuesday, August 18, 2015

Paralysis Q & A: Part One

have been procrastinating and procrastinating about writing in my blog, because I promised to do a paralysis Q & A, and all of the information I had to cover was completely overwhelming. This post is going to be pretty basic, dry, and factual. I will get back to more interesting posts later on. I would also suggest that you skim through this, as some of the information will be boring. Just hit the high points.

Deep breath...

*pushes glasses up nose*

Paralysis: What is it? (When something some may consider tragic happens to you, and you become a sex icon).

What are all the side effects? (Becoming so witty and attractive, that it's difficult for others to be around you). 

How much sensation and muscle movement do most paralyzed people have? (Usually enough to run you over if you park in a handicap spot & you're not disabled).

Can paralyzed women have children? (Yes. And I can't speak for other women, but I'm totally planning on doing it Duggar-style. 18 kids minimum). 

How do you poop and pee? (We don't. Like, ever. It's great for road trips!)

 Can you still have sex? (Nope! Paralysis sews your vagina up and removes your penis. We look just like Barbie & Ken dolls)
All of our bodies are this fit, too. All of the women have boobs exactly like this and wear stripper heels, like the ones pictured above. And every single man has the same tattoo. What a coincidence, right??!!

There. I think that covers it. 

Alright, alright...I'll TRY to be serious here. Try being the key word. I've been wanting to do a Q & A post about paralysis for a while now, because not only do I think people need to be educated-I'm completely shocked at the ignorance of most every doctor who doesn't specialize in SCIs, I wanted to write this because I had NO clue what all it entailed before, either. I mean, how would anyone? I asked people for specific questions, and I got so many that I think I'm going to have to turn this into a series of posts. In this first one, I'm going to give all the general information about paralysis. I am not going to add any personal information about me, because every injury is different. What some people may struggle with, I may not & vice versa. In the next post, I will answer all of the questions  people asked me that pertain specifically to me and my personal experience with a spinal cord injury. 

So, here we go....but first a few pics!

Check out that tattoo!
I'm going to do a whole different post on "devotees"-people who are attracted to other people with disabilities. I have also found out that there are people with something called body integrity identity disorder, where they feel that they were born in the wrong body and would be happier disabled. My research has been incredibly interesting, and I have done an in-depth survey and will share the results in a future post.

Due to extreme laziness and stress over all the information I have to cover, I'm going to copy/paste question number one from the Internet. 


BUT, I copy/pasted most of this info from Wikipedia and they are so incredibly wrong about so much of this! I'll explain later AND sue the website. But it'll cover the basics for now. You must also keep in mind that most doctors have a "you get what you get" attitude towards spinal cord injuries still, ie they are programmed and trained to go by the book in regards to thinking that if you broke a vertebra at this or that level, you are going to be the textbook definition of that type of injury, which does happen, but I have rarely seen it. And I've talked to and know tons of other people with an SCI. However, I imagine this will drastically change soon, due to all the amazing research and progress already made in certain types of therapy.

Editor's note: I know a guy who is a prime example of how doctors can be so incredibly wrong. Watch this video and you'll see; it is AMAZING.

Anyway, I just wanted to put that part up so you can know to take all of this information with a grain of salt. Plus, I will go into more detail and explain the inaccuracies.

1. What is paralysis?

Paralysis is the loss of muscle function in part of your body. It happens when something goes wrong with the way messages pass between your brain and muscles. Paralysis can be complete or partial. It can occur on one or both sides of your body. It can also occur in just one area, or it can be widespread. 
The primary cause of paralysis is a spinal cord injury, but other conditions such as cerebral palsy and strokes can cause a similar appearing paralysis. The amount of impairment resulting from a spinal cord injury depends on the part of the spinal cord injured and the amount of damage done. Injury to the spinal cord can be devastating because the spinal cord and the brain are the main parts of the central nervous system, which sends messages throughout your body.
When the spinal cord is injured the brain cannot properly communicate with it and so sensation and movement are impaired. The spinal cord is not the spine itself; it is the nerve system encased in the vertebrae and discs which make up the spine. Other causes of paralysis include
  • Nerve diseases such as amyotrophic lateral sclerosis
  • Autoimmune diseases such as Guillain-Barre syndrome
  • Bell's palsy, which affects muscles in the face 
  • Extreme intelligence 
  • Startling good looks. 
  • Too much sugar. 
  • Excessive masturbation
  • Listening to a Nickleback song
  • Confusing "you're" and "your."
  • Calling your significant other "bae."
  • Editor's note: I even know a girl who became paralyzed in her left arm and from the waist down because she was shooting up drugs, and it caused an infection in her blood, which spread to her spinal cord! There are a multitude of causes!
But this picture below shows the main causes.
Also, did you see where it discussed the difference between paraplegia and quadriplegia? 

Well, I am about to go into a lot more detail about the differences between the two. We will start with paraplegia. 

Paraplegia is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek: παραπληγίη "half-striking". However, with paraplegia, arm functioning is spared, but, depending on the level of injury, the trunk, legs and pelvic organs may be involved, not just the legs. It is usually caused by spinal cord injury or a congenital condition such as spina bifida that affects the neural elements of the spinal canal. The area of the spinal canal that is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If all four limbs are affected by paralysis, tetraplegia or quadriplegia is the correct term. If only one limb is affected, the correct term is monoplegia.

Tetraplegia, also known as quadriplegia, is paralysis caused by illness or injury to a human that results in the partial or total loss of use of all their limbs and torso; paraplegia is similar but does not affect the arms. The loss is usually sensory and motor, which means that both sensation and control are lost. (WRONG. They're over-generalizing)

Tetraparesis or quadriparesis, on the other hand, means muscle weakness affecting all four limbs.[1] It may be flaccid or spastic. (We will get into the what the difference is between flaccid and spastic later, kids)

So basically, regardless if you can move your arms normally or have leg movement, if you broke your NECK and have suffered any paralysis of the arms-even if you can still move them (and especially finger or hand dexterity), you're a quadriplegic. At the same time, you can be technically classified as a "quadriplegic" and have fully functional arms and hands. The term "tetraplegic" has the same meaning as "quadriplegic." It is actually considered more politically correct, and it is used more commonly in Europe than in the United States. 

Here is a photo that shows the different levels of vertebrae that can cause paralysis IF the actual cord was damaged (you can also break your back or neck and NOT suffer paralysis) and how it classifies someone as a "tetraplegic/quadriplegic" or a "paraplegic."

Editor's Note: If you injured or had a disease cause paralysis at the T1 level, you are also still considered quadriplegic/tetraplegic. It just doesn't affect your hands as much. I couldn't find a clear picture online. 

The definition of the word "paralysis" is also a little bit confusing, because many, if not most, of us CAN move certain muscles. Basically, it means that even if you can move, you can't in a purposeful way, such as being able to move your legs but not walk, or be able to move your arms but not have the ability to actually use them. Some of us can walk, yet we're still classified as "paralyzed." This is because there are differing amounts of damage in every single SCI. For example, two people can have the same level of injury, yet be completely different in their ability to move or feel. 

Look at it this way: The spinal cord is a bunch of bundled up nerves the consistency of spaghetti noodles. 

Like this...

I mean, exactly like this! Parmesan cheese, tomato sauce, garlic & everything!

The spinal cord is about an inch across at its widest point and about 18 inches long. Each "noodle" (nerve) controls all your sensory and motor functions and is so complex, that every single muscle and sensation, down to the movement of your pinky finger and the feeling on your left toe are controlled by the nerves in the core. It is an incredibly complex, beautiful and intricate design.  

Here is a picture that shows how intricate it is and exactly what each nerve controls.
Truly amazing, right?!

So, basically, imagine if you squeezed a bundle of spaghetti noodles. Some you would completely sever and split in half, some you might "smoosh" and some might remain perfectly intact. It just depends on how hard you squeeze, right?

That is why every injury is different. Because it depends on how much the spinal cord was "smooshed" or damaged. For example, let's say you broke your back by tripping over a cord and falling on the floor. Most likely, your spinal cord would not suffer as much damage by that type of injury than by one where you fell off of a roof and had bricks and a ladder fall on top of you.

There is an entire scale that explains the severity of an SCI called, "The Asia Scale," which will make understanding this more feasible. 

Here's a picture of the testing that they use to decide your Asia level, which can be an A, B, C or D. A person who has never shown any signs of a spinal cord injury (your average everyday person) would be classified as an Asia E. 
I wanted to find something online that would explain this, but it was all a bunch of jargon that would be difficult to understand. So I'm going to explain it in my words the best way that I can. Basically, when you get injured, a doctor will do a test on you where they will take something with a sharp end and a dull end and poke it into different parts of your skin. You have to tell them if you feel it and if it's dull or sharp. Sometimes they won't touch you at all to try and trick you to see if you can tell if they are actually touching you or not. They will also test several key muscles to see what kind of strength you have in them. The chart shows what muscles and what areas of sensation they test. So if you are an Asia A, you are considered a "complete" injury. This typically means that you have lost all sensory and motor function beneath your level of injury. Anything else (B, C or D) means that you are an "incomplete" injury, which means that you have retained some sort of sensory and motor function below your level of injury. It is not uncommon for a person with a spinal cord injury to be diagnosed as a complete injury at first, and then become incomplete overtime as the spinal cord heals. 

Confusing stuff, right? 

That's why I'll be going into more detail later about how EVERY injury is different. And a blast!! 

Jealous yet??

Now on to flaccid muscles and spastic muscles. A flaccid muscle is one that is limp. It doesn't retain any tone to it whatsoever and typically does not move. Spastic muscles, on the other hand, are muscles that are tight and may have spasms often. A muscle spasm is when a certain muscle involuntarily shakes. In most cases, it is better to have spastic muscles than flaccid muscles, because a spastic muscle can be used for function, even if it does not voluntarily move when a person tries. For example, I know of a woman who could not move her legs, but she was able to use the stiffness of her legs to stand.

Now, on to sex, babies & relationships.

Here is a picture that shows the rate of marriages and divorce in regards to spinal cord injuries and how many people have children before & after and stay married and/or get married afterwards.
When I was initially injured, my parents were told that only 35% of couples stay together longer than a year after the injury. And I believe that is incorrect. As far as sex goes, most people with spinal cord injuries do not lose the ability to experience pleasure, and many are still able to achieve orgasm. However, the type of orgasms that the paralyzed person might feel are different than what they might have felt before. 

Because I am lazy, I copied and pasted something from a site to cover everything regarding this topic.

Since a spinal cord injury (SCI) affects virtually every system of the human body, many people who sustain SCI have serious concerns about how their injuries have affected their ability to participate in and enjoy a sexual relationship. This document attempts to address some of the more common questions that arise on the topic of sex after a SCI. 
Sexual function in humans is controlled by parts of the central nervous system (CNS), particularly the brain and spinal cord. Interruption to the CNS through injury to the spinal cord will therefore have some effect on sexual function. The extent to which sexual function is impaired, however, depends on a variety of factors including the level of injury, the severity of damage to the spinal cord, and whether the individual is male or female.

2. Female Sexuality After SCI 
At only the most basic level, a female's ability to engage in sexual activity is less likely to be affected by SCI, by virtue of the way the female body is constructed. A woman is often able to have intercourse as easily after SCI as before, although additional lubrication may be needed to avoid chafing and to make the act of intercourse easier to initiate. Alternative positioning of one's body may have to be considered as well. 
While certain aspects of female sexual functioning may be changed after SCI, the ability to conceive, carry and give birth is usually not impaired. (I know multiple women personally who have had several children after their injury vaginally, although some do it by a C-section) 

Yo! You click on the words up there to read it!
Birth control is an issue of great interest to women in general and the woman with an SCI has additional reasons to be concerned. Unless a woman develops sensitivity to latex, her male partner's use of condoms may be the easiest method of birth control. Using foam, the sponge or a diaphragm and jelly is still possible, but women with quadriplegia may now find this difficult, if not impossible. While only a few assistive devices are available to help perform these tasks, a woman's partner may wish to assist or even perform these tasks, helping to make the responsibility for birth control a shared function. 

Other methods of birth control, such as IUD's, the pill and Norplant, should only be used with great caution after consultation with an experienced gynecologist or physiatrist. Both SCI and the pill are known to cause vascular complications in certain individuals and one may contraindicate the use of the other. IUD's are particularly worrisome because a lack of sensation or inability to check its positioning may cause a woman to be unaware of slippage or puncture. Slippage may decrease the effectiveness of preventing a pregnancy and a puncture can be life threatening. 

Many women are concerned about their ability to have children following a SCI. Although there may be precautions to guard against complications such as autonomic dysreflexia (I will explain what this is later), most women are able to bear children following a SCI. A competent physician who is experienced in labor and delivery with women with SCI is essential when contemplating having children. 

3. Male Sexual Function After SCI 
For males, the situation of sexual functioning is a little more complicated. Some men are able to achieve erections quite easily, while others can achieve erections occasionally and some are unable to achieve erections at all after a SCI. Two basic kinds of erections are possible. Psychogenic (the kind of erection that occurs as a result of having sexy thoughts or by looking at erotic pictures) and reflexogenic (erections that occur as a result of direct physical stimulation of the penis or surrounding area). 
There are several ways to achieve an erection after SCI. Vacuum-Induced Erections employ tubes with a vacuum pump that, when placed over the penis and activated, pulls the air out of the tube often causing blood to inflate the penis. A band is then placed around the base of the penis to maintain erection. Most urologists suggest this method as a first step as it is the least invasive of the available procedures. Another option is the Injected Vasoactive Drug. A very fine needle is used prior to sexual activity to inject a prescribed dosage of medication into the base of the penis. The extremely fine needle causes little or no discomfort. The drug causes the blood vessels in the penis to enlarge, thereby stimulating an erection that can last from 15 minutes to an hour or more, depending on the dosage injected. Some potential side effects include bruises and erection for a dangerously long period of time. The cost per injection can range from $10 to $20 depending on the medication used, and insurance coverage may be available. 

Penile Implants, or penile prostheses are sometimes considered. This procedure is extremely invasive as it involves surgical implantation of a rod or an inflatable tube into the penis. Inflatable implants have several chambers that are filled with fluid to achieve erection and are then emptied following intercourse. The pump, chambers to be filled with fluid, and connecting tubes are all implanted. Semi-rigid implants consist of two implants made of a flexible material that causes a permanent rigid state. The penis can be bent against the pelvis when not engaged in intercourse. 
Although the level and severity of injury may give some indication as to how likely a man is to be able to have erections, the best way to find out is to get to know your body and learn how it reacts to certain situations. A doctor can give you more information about whatever physiological limitations may exist, but the person and their partner need to explore their body's response to sexual situations. Although talking about sexual function is sometimes difficult, complete and open communication between partners is the best way to explore sexual possibilities available after injury (just as it was before injury, by the way!)

4. Sexual Sensation After Spinal Cord Injury 
As with other basic physiological functions after a SCI, sexual sensations can also be altered. Some of the nerves you once counted on to provide pleasurable feelings in sexual organs and other erotic areas of your body may no longer be working as they did before injury. Some people retain specific sexual sensations in the genital areas, while others notice they are diminished or absent. However, many others have reported heightened sensations in different parts of the body-the neck, earlobes, nipples, arms or other areas of skin. 

Editor's Note: I know of men and women who lost all genital sensation but are able to achieve something called a "phantom orgasm" where they might have someone kiss or touch an area of their body where they still have normal sensation, like the neck, earlobes or nipples mentioned above. What will happen is, the brain will take the intense sensation from those areas and "reassign" them to the genitals, so they feel like they are having a regular orgasm. I personally know a girl who is able to achieve orgasm by having someone kiss her hand.

Wouldn't that be NICE?? If I were her, I would just go up to random strangers and put my hand in their mouths.

Many people who have sustained a SCI have indicated that their total enjoyment of the sexual experience after SCI is as good as, if not better than, their pre-injury sexual experiences. Necessity in many cases encourages them to concentrate on "holistic" sexual experiences rather than on genital-specific sex. Many individuals report that they can still achieve climax although frequently not in the same way as before their injury. 

5. Body Image
A key component of sexuality is how one perceives one's body. A person who is able to see themselves as attractive and desirable is far more likely to engage in a healthy and satisfying sex life. Some people experience issues of lowered self esteem and a resulting poor self image following a spinal cord injury. As a person with SCI adjusts to a new physical reality, it may be difficult to change self perceptions to accommodate the injury in a positive way. 

One common misconception following a spinal cord injury is that a single man or woman will never find a life partner, or that an existing partner will leave a relationship due to the complications of an injury. This is not the case. The divorce rate following spinal cord injury is only slightly higher than in other populations, and thousands of people have been married and begun families after a spinal cord injuries. 

Note: Not every person with an SCI struggles with the following issues. 


We'll discuss pee first. 
Paralysis at any level usually, but not always, affects bladder control. The nerves controlling these organs attach to the very base of the spinal cord (levels S2–S4) and are therefore cut off from brain input. Although it may not be possible to regain the control one had before paralysis, a wide range of techniques and tools are available to manage what is termed a  neurogenic bladder.
Here's how an unaffected bladder works: Urine, the excess water and salts that are extracted from the bloodstream by the kidneys, is piped down thin tubes called ureters, which normally allow urine to flow only in one direction. The ureters connect to the bladder, which is basically a storage bag that does not like pressure. When the bag is full, pressure rises and nerves send a message via the spinal cord to the brain. When one is ready to empty the bladder, the brain sends a message back down the spinal cord to the bladder, telling the detrusor muscle (the bladder wall) to squeeze and the sphincter muscle (a valve around the top of the urethra) to relax and open. Urine then passes down the urethra to exit the body. 

It is a rather elegant (like how I italicized that?) process of muscle coordination just to go pee.
After paralysis, however, the body's normal system of control can go haywire; messages can no longer pass between the bladder muscles and the brain. Both the detrusor and the sphincter may be overactive due to lack of brain control. An overactive detrusor can contract at small volumes against an overactive sphincter; this leads to high bladder pressures, incontinence, incomplete emptying, and reflux -- along with recurrent bladder infections, stones, hydronephrosis (kidney distention), pyelonephritis (kidney inflammation), and renal failure.
The neurogenic bladder is usually affected in one of two ways:
1. Spastic (reflex) bladder: when the bladder fills with urine, an unpredictable reflex automatically triggers it to empty; this usually occurs when the injury is above the T12 level. With a spastic bladder you do not know when, or if, the bladder will empty. Physicians familiar with spinal cord injury often recommend a bladder relaxing medication (anticholinergic) for reflexive bladder; oxybutynin (Ditropan) is common, with a primary side effect of dry mouth. Tolterodine, propiverine, or transdermal oxybutinin may result in less dry mouth. Botulinum toxin A (Botox) may be an alternative to anticholinergics. It has been FDA approved for detrusor overactivity treatment in individuals with SCI and multiple sclerosis. The advantage: Botox is used focally in the bladder, thus avoiding systemic side effects, including dry mouth.
2. Flaccid (non-reflex) bladder: the reflexes of the bladder muscles are sluggish or absent; it can become over-distended, or stretched. Stretching affects the muscle tone of the bladder. A flaccid bladder may not empty completely. Treatments may include sphincter relaxing medications (alpha-adrenergic blockers) such as terazosin (Hytrin) or tamsulosin (Flomax). Botox (hey, that means your bladder will never age!) injected into the external urinary sphincter may improve bladder emptying. Also, surgery is an option to open the sphincter. Bladder outlet surgery, or sphincterotomy, reduces pressure on the sphincter and thus allows urine to flow out of the bladder easier. An alternative to sphincterotomy is placement of a metal device called a stent through the external sphincter, thus ensuring an open passage. One drawback to both sphincterotomy and stenting is that sperm from an ejaculation ends up in the bladder (retrograde), rather than coming out the penis. This doesn't rule out having a child but complicates it; sperm can be collected from the bladder but can be damaged by urine.
Dyssynergia occurs when the sphincter muscles do not relax when the bladder contracts. The urine cannot flow through the urethra, which can result in the urine backing up into the kidneys (called reflux), which can lead to serious complications.
The most common method of bladder emptying is an intermittent catheterization program (ICP), which drains the bladder on a set schedule (every four to six hours is common). A catheter is inserted in the urethra to drain the bladder, then removed. An indwelling catheter (Foley) drains the bladder continuously. If drainage originates from a stoma (a surgically created opening) at the pubic bone area, bypassing the urethra, it's called a suprapubic catheter. Advantage: unrestricted liquid intake. Disadvantage: besides the need for a collection device, indwelling catheters are more prone to urinary tract infection. An external condom catheter, which also drains continuously, is an option for men. Condom catheters also require a collection device, e.g. legbag.
There are several surgical alternatives for bladder dysfunction. A Mitrofanoff procedure constructs a new passageway for urine using the appendix; this allows catheterization to be done through a stoma in the abdomen directly to the bladder, a great advantage for women and for people with limited hand function. Bladder augmentation is a procedure that surgically enlarges the bladder, using tissue from the intestines, to expand bladder capacity and thus reduce leaking and the need for frequent catheterization.
It is common for people with multiple sclerosis and other spinal cord diseases to have problems with bladder control. This can involve a little leaking after a sneeze or laugh, or loss of all control. For many people, appropriate clothing and padding can compensate for lack of control. Some women benefit from strengthening the pelvic diaphragm (Kegel exercises) to improve retention of urine.


Paralysis can disrupt "the system."
There are two main types of neurogenic bowel, depending on level of injury: an injury above the conus medullaris (at L1) results in upper motor neuron (UMN) bowel syndrome; a lower motor neuron (LMN) bowel syndrome occurs in injuries below L1.
In a UMN or hyperreflexic bowel, voluntary control of the external anal sphincter is disrupted; the sphincter remains tight, which promotes constipation and retention of stool, which cannot be ignored; it is associated with episodes of autonomic dysreflexia. UMN connections between the spinal cord and the colon remain intact, thus reflex coordination and stool propulsion remain intact. Stool evacuation in people with UMN bowel occurs by means of reflex activity caused by a stimulus introduced into the rectum, such as a suppository or digital stimulation—best triggered at socially appropriate times and places.
LMN or flaccid bowel is marked by loss of stool movement (peristalsis) and slow stool propulsion. The result is constipation and a higher risk of incontinence due to lack of a functional anal sphincter. To minimize formation of hemorrhoids, use stool softeners, minimal straining during bowel efforts, and minimal physical trauma during stimulation.
Bowel accidents can happen for some people. 
For those who struggle with this, the best way to prevent them is to follow a schedule, to teach the bowel when to have a movement. Most people perform their bowel program at a time of day that fits with their lifestyle. The program usually begins with insertion of either a suppository or a mini-enema, followed by a waiting period of approximately 15–20 minutes to allow the stimulant to work. After the waiting period, digital stimulation is performed every 10–15 minutes until the rectum is empty. Those with a flaccid bowel frequently start their programs with digital stimulation or manual removal. Bowel programs typically require 30–60 minutes to complete. Preferably, a bowel program can be done on the commode. Two hours of sitting tolerance is usually sufficient. But those at high risk for skin breakdown

(When you're paralyzed, you lose the ability to move around and shift accordingly when you are uncomfortable, so oftentimes, your skin may develop pressure sores that can be life-threatening.)

Here's a picture that shows the different stages.

need to evaluate if it's better care to be in a seated position, versus a side-lying position in bed.
Constipation is a problem for many people with neuromuscular-related paralysis. Anything that changes the speed with which foods move through the large intestine interferes with the absorption of water and causes problems. There are several types of laxatives that help with constipation. Laxatives such as Metamucil supply the fiber necessary to add bulk, which holds water and makes it easier to move stool through the bowels. Stool softeners, such as Colace, also keep the water content of the stool higher, which keeps it softer and thus easier to move. Stimulants such as bisacodyl increase the muscle contractions (peristalsis) of the bowel, which moves the stool along. Frequent use of stimulants can actually aggravate constipation – the bowels become dependent on them for even normal peristalsis.

Now on to Autonomic Dysreflexia. It is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. This reaction may include: 
  • Change in heart rate
  • Excessive sweating
  • High blood pressure
  • Muscle spasms
  • Skin color changes (paleness, redness, blue-grey skin color)
This is typically caused when an individual cannot feel when something is going wrong in their body. For example, someone may have a scratch on their foot, their clothing may be too tight, they might have a full bladder and not know it, a bruise, even a broken bone and not be aware of it. This can be incredibly life-threatening and if not caught early, this person may have a stroke and die.

Here is another picture that illustrates what I cannot put into words.

I could go on and on and on and go into so many more details about paralysis-like nerve pain, rehabilitation, adaptive equipment, etc. But I think this is boring enough for now, so I am going to stop here, and then do the one about the personal questions that pertain to me.

If you've actually read any of this, feel free to ask any questions in the comment box below and I will answer them if I can!


This is from my go-to guilty pleasure, Bitmoji. It allows you to create an avatar that looks like you & has TONS of absolutely glorious and ridiculous captions to choose from. My entire family now communicates strictly in Bitmoji.

Copyright Bethany Rebecca Cox. All Rights Reserved


  1. Just brilliant. Really educational, thank you :)

    1. JUST saw this. THANK YOU-it means a lot because it took me forever to write and research.

  2. I can't imagine how you have persevered, no thrived is the word I am grasping for and is woefully inadequate with the challenges you have. I'm a better person for what you shared and I have a new found appreciation and understanding. Thank You

  3. The only reason I read this article is because your cute. If you ran my foot over with your chair I would blush.

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