Medicaid Managed Care: Recovery Moves to the Mainstream

Medicaid Managed Care: Recovery Moves to the Mainstream

By Briana Gilmore, Director of Public Policy and Advocacy, New York Association of Psychiatric Rehabilitation Services (NYAPRS)

Learn More About the Trends That Will Affect You

Big changes are coming soon to New York’s Medicaid system. Services are being overhauled to emphasize quality and outcomes, and new services are being added to ensure that Medicaid is paying for the most cost-effective and valued treatment. Why is this good news? These changes will be beneficial to all Medicaid consumers who use behavioral health (BH) services. In fact, New York will implement changes in 2015 that emphasize recovery-oriented BH services in unprecedented ways.

This change started in 2011 when Governor Cuomo instituted the Medicaid Redesign Team, a planning system that looked at outcomes of the Medicaid system and made targeted changes. The goal was to build off reforms central to the Affordable Care Act, with the mission of reducing overall cost while improving outcomes and quality care. Policy makers quickly realized that achieving this would be particularly challenging for the BH system.

New York is transitioning the BH system because recovery-focused services not only improve quality and outcomes, but also save money. This plan also raises the bar for providers, many of whom have long been funded based on how often people come to programs rather than demonstrated improvements in people’s lives. In order to achieve this transition, the plan targets social determinants of well-being such as housing, employment, education, and family connections.

DOH, OMH, and OASAS have decided to accomplish this by moving to a system of managed care that will be expected to improve the coordination and impact of care.

Managed care isn’t new, and many who are Medicaid eligible already have physical health and pharmacy services paid for by a Managed Care Organization (MCO). In 2015, every person in New York State who is eligible for Medicaid will also have their mental health and addiction services coordinated and paid for by an MCO.

If you are already enrolled in an MCO, you will receive all of your benefits from the same plan. If you’re not enrolled, you will have to choose an MCO. If you’re not sure about which plan to choose or if you want to switch, you can access an enrollment broker to help you do so.

Medicaid recipients who have used a lot of mental health and addiction in the past will be enrolled in a Health and Recovery Plan (HARP) that will offer and coordinate a greater amount of those services.

Thanks to advocacy from NYAPRS (New York Association of Psychiatric Rehabilitation Services) and other advocacy groups, HARPs are required to offer services that have never been Medicaid funded, including peer services, crisis respite, supported employment and education, family supports, non-medical transportation, and self-directed care.

Some of these services, like crisis respite, will be available as needed. But others will be offered based on goals you express during treatment planning with a care manager, such as transitional employment. This will be a major change for many people; instead of just being offered service options, people in HARPs will be asked what their recovery goals are and what supports they need to get there. It will take time to build a system that understands how to do this, but it will also take time before all community members are able to articulate what their goals and preferences are.

Ideally, that is what care management is all about. Health Homes are established throughout the state to provide care management that excels at helping people access services they really want and need, including community supports like housing and wellness activities. Health Homes are just networks of providers organized by a central agency; they aren’t a place, but have care managers that provide outreach in community settings.

Health Homes are operating with mixed success. Their capabilities depend on the strength of their provider network and ability of staff to truly understand the needs of our community, including cultural norms and preferences. Care Management will be a big part of the way MCOs understand and organize services in the future, particularly through HARPs. MCOs will have to work with Health Homes to ensure each recipient receives the attention that helps them achieve the best life possible in the community.

This historic shift in the way Medicaid is delivered will mean dramatic improvements in the way the community accesses services that truly help people recover. But it won’t happen perfectly all at once, and recipients may have to press for better attention from care managers, more appropriate service access, or demand community-based living and service options. NYAPRS and Medicaid Matters New York, along with other associations, achieved the inclusion of an ombuds program in Medicaid Managed Care; an ombuds is an office that can objectively help resolve complaints and help consumers navigate problems.

Importantly, this shift is just one of many moving toward a more coordinated system. People who need nursing home or long-term care services will also experience changes in services coordination, and eventually everyone in New York State who has Medicare coverage will elect an MCO. Stay updated through community forums for information about how benefits you receive are improving and what you can do to advocate for what you and your peers need.

To Growl or Not to Growl: That is the Question by Matt

To Growl or Not to Growl: That is the Question

By Matt

My Miracle with Zoloft

My problems began, believe it or not, when I was two and a half years old. This I report on good faith from the voice and words of my father. I trust him on this one, and I trust my earliest memories, as well, starting sometime around age four, which are of a child who was always, always unhappy. This “condition,” if you will, continued, or rather persisted, until almost exactly three and a half years ago (if my memory serves me right, and these days, often it does). I am now forty-five, and I’ve been a “different person” since that time. I’m sure at least some of you have guessed the reason: medication, specifically, Zoloft.

I have taken many different medications over the years, including virtually the entire range of SSRIs (selective serotonergic reuptake inhibitors), but this one, for some perhaps strange reason, did a whole lot “more” for me than any of the others. To wax poetic, Zoloft kicked me out of bed. It punched me into alertness and awareness, and it got me going—swinging and ringing and dinging like a Liberty Bell.

Until the Zoloft, I had been drinking, smoking crack and about three-packs-a-day of rolling-tobacco cigarettes, and I weighed some 50 pounds more than I do now. I was in a perpetually agonizing mental condition that defies words. (As a writer, I should try to put it into words, but I fear the length of my possible description.) Suffice it to say, then, crack, and before that cocaine, were the only things that really made me feel alive, i.e., normal. Ritalin “worked,” but was also way addictive for me. When under the influence of crack or cocaine, my symptoms would disappear, and would stay gone for up to three days after the getting high, although usually this respite lasted no longer than two days.

I had been slugging to AA meetings for fifteen years prior to the Zoloft, but to no avail. I had never, as they say in AA, “put any time together.” I’d go a week max, and then “relapse.” (I put this term in quotes because I’ve become highly skeptical of the AA lexicon, or vocabulary. And that’s not all. Believe me. But we mustn’t get angry.) So, after fifteen years of trying to stay off the stuff (booze, cocaine, then crack and cigarettes), I had this psychiatrist at the substance abuse clinic I was attending who tried the generic Zoloft out on me. That’s what Medicaid likes to cover, generics. Suffice it to say that for all intents and purposes, on that very day I crawled out from my chronic, endless nightmare-of-a-shell. Included in this “shell-existence” were shame—perpetual shame; guilt, perpetual as well; envy; fear (shitting-the-pants kind); hatred, loathing and contempt for everyone who wasn’t blood; a gnawing, rotting sensation of all-enveloping inadequacy and inferiority; consequently a jealous, embittered hatred for everyone who made me feel small, which was—and I say this literally per all my age-peers—everyone. Everyone made me feel small. Everyone. Every one.

Am I angry? You bet I am. But at what, one might ask?

I would say the biggest main targets of my anger are those arguably institutionalized belief-systems in the so-called “recovery community” that presume to tell me that I should be grateful, and that I’m wrong if I’m not. Those “in recovery” will deny saying this, but there’s no point arguing with them—much as it’s almost impossibly difficult to argue with any fanatic, or religious fundamentalist of any stripe. Again, the people I’m referring to will deny they bear any similarity to such an ideological “type.”

So, in a sense, I’ve been at war since the Zoloft-induced change. I’ve been at war over two things: 1) As part of an effort to make up for forty years “lost” to virtual functional incapacity, and 2) over those who had and have the gall to tell me how, “spiritually” speaking, I should view such a life-altering loss (with gratitude, etc.). Their merely seemingly benign and innocuous rhetoric, if I’m not careful, enrages me.

For fifteen years I attended meetings, really never agreed with it (AA) at all, but I had, literally, no other free community that even pretended to care enough to offer support. That’s how badly off I was. I stunk. I couldn’t afford toilet paper. I was easing my bowels onto the street during crack-runs to the housing projects, and I looked like the proverbial “bum.” I was knocking at hell’s door (hats off to Dylan).

However, I’m much better now. Thankfully. There. I’ve said it. Gratitude.

Faith That Began as Small as a Mustard Seed by Luanne

Faith That Began as Small as a Mustard Seed

By Luanne

How Nursing and My Spiritual Strength Helped Save My Life and Others

My name is Luanne. I am a 52-year-old from Lexington, South Carolina. I was first diagnosed with mental illness in 1996. When I look back now on my life, I believe that my mental illness began in high school and got worse during my first marriage. I was emotionally and physically abused, which resulted in a very nasty divorce and custody battle over my two children. I was diagnosed with bipolar, anxiety, depression and dependent personality disorder. I believe that my mental health diagnosis is due to genetic factors as well as trauma. I believe that my mother had bipolar but was never officially diagnosed. I did inherit an alpha protein deficiency, which has been shown to cause bipolar and epilepsy (I have both).

In high school, I suffered from extreme depression because of the dysfunction I was living in. Even though I grew up in a dysfunctional family, I still must give credit to my mom, who took me and my sister to church at a young age. I was introduced to Jesus, and had the seed of faith planted at an early age. It was my faith that got me through the darkest times of my life. In high school, I put all my time and energy into my studies and the marching band. I preferred to stay at school and away from my dysfunctional family. I knew from a young age that I wanted to be a nurse. My dream was to go to third-world countries on medical missions, but I soon learned that my mission would be at home. I found some old nursing magazines in the garage of my neighbor’s house, who had moved. Reading them reinforced my dream to become a nurse. In 1980, I enrolled in a local technical college and began my studies to become a licensed practical nurse. I then got a two-year degree and continued on to get a four-year degree to become a registered nurse. I found my purpose in life as a nurse, and I had dreams to save the world. My nursing career lasted over 31 years. I saved many lives and went on to become RN of the year for the med-surg department at a local hospital and was also included in Who Who’s in Nursing several times. I gained confidence in nursing with my educational degrees and the initials behind my name. One day I lost it all and found myself without any self-worth. I had to learn the hard way that my self-worth comes from God.

In 1996, I had my first admission to the psychiatric hospital. I had three admissions; more voluntary admissions because of suicidal thoughts. The first trip to the hospital in 1996 was by the police when my husband tried to cover up his emotional and physical abuse by claiming I needed psychiatric help. Even though my psychiatrist said he had no reason to commit me, I stayed at the hospital for a week just to get away from my husband. Shortly after the first admission, my husband and I separated and I filed for divorce. My husband won the first custody battle and the home which I had bought. He simply won because he had a better attorney than I did. The next year without my kids was the worst year of life. My days were filled with anxiety and panic attacks over losing my kids. I also lost the job that I had simply because I was honest and told the director of nursing that I had bipolar. It was my first taste of discrimination and stigma related to having a mental illness. My ex-husband married again and physically abused his second wife. I remember coming home and turning the whole mess over to God. When I did, with my new attorney’s help, I got my kids back. I went on to experience stigma and discrimination from people who seemed to have the mentality that those with a mental illness were second class citizens.

In 2007, I went back to school and earned my master’s degree in mental health counseling. I was determined to offer hope to those with a mental illness. I also became a peer support specialist and a South Carolina Share Mentor. At this time, I am awaiting and battling the broken system of social security disability. Although I am not currently employed, I still believe that God has a purpose for my life, despite my mental illness.

Having a mental illness has brought challenges in relationships, occupations, and other areas that most people do not have to face. Despite these challenges, I have become a better person and have learned many things on my journey through life. Most of all, my faith has increased.

Jars of Clay by Lara Ferris

Jars of Clay
By Lara Ferris
A Story of Recovery and Redemption
My life has always been a bit of a contradiction. My above average intelligence and nearly flawless memory enabled me to be an excellent student. However, this same brain that allowed me to achieve academic success also caused me to suffer spontaneous episodes of inexplicable rage, feelings of self-loathing and bouts of severe depression. On the surface I had all the ingredients for a healthy, normal life: a stable home environment, loving hardworking parents, a great younger brother and a nurturing extended family. We lived in a moderate middle-class suburban neighborhood, my mother ran a daycare out of our home so she could be there when my brother and I were not in school, and my father worked as a Teamster. My parents both worked hard to provide us with all the things they had lacked growing up. My brother always had the latest cool sneakers, I always had spending money and we both had all the popular toys. I got good grades, I stayed out of trouble and I had friends. I appeared to be happy. And I was, most of the time.
Other times I felt like a complete fraud. Around my family and friends I was generally cheerful and calm, but alone in my room I would succumb to negative feelings of self-doubt, hopelessness and despair. The darkness would come, and I would allow it to wash over me until I was adrift in a black sea of torment. Writing saved me; it’s the only thing that kept me from going under. I began writing at a very early age. First came silly juvenile rhymes, followed by haiku and sonnets about young love and heartbreak and then came the good stuff. The real, raw, visceral, primal stuff. My words spilled forth like blood from a seeping wound. In fact, that is exactly what they were. Writing was my therapy, my catharsis. I didn’t write because I could, but because I had to. Those words became my lifeline, the one thing that kept me anchored when I felt myself drifting. To this day, I never underestimate the power of words; they can hurt and they can heal.
I was very protective of my writing. I let the general public see the sappy, fluffy, romantic poems. But I kept the dark stuff hidden. I didn’t let anyone see that side of me. I lived in constant fear that the facade would crumble and my true identity would be revealed, an identity I worked very hard to conceal. So I never showed it to anyone, not even my mother, whom I’ve always been very close to. I often wonder how my life might have been different had I shared my words and the thoughts and feelings behind them. But I didn’t. And so my mood swings, occasional depressive episodes and even my sporadic angry outbursts were all attributed to adolescent hormones and teen angst. The real underlying cause, my mental illness, went undiagnosed and untreated for over twenty-five years.
Those were interesting years, filled with lots of ups and downs. I got married and divorced…more than once. I gave birth to three children. I owned a home. I lost a home. I lived on my own and I lived with my parents. I held down a career for 19 years. And all the while the battle in my head continued to rage on.
It all came to a head six months ago. I was in yet another unhealthy relationship, unemployed, battling a severe technology addiction and living a secret double life built on lies, deceit and immorality. I had been frantically spinning plates like a clown in a circus for so many years. One day all those plates just came crashing to the ground. I was on the verge of losing everything—my family, my children and even my life—until I agreed to seek immediate help.
It wasn’t easy. It still isn’t. But I am very fortunate to have so many people invested in my health and well being. Psychiatrists, counseling, medication, group therapy, social workers, family and friends have all combined to make my recovery a reality. But the most integral piece of the puzzle is my renewed relationship with the Lord. I found a church home and attend every Sunday, I am involved in a women’s Bible study and I have surrounded myself with godly women of faith. God’s unfathomable love and mercy astound me every day. He has broken the chains of addiction and freed me from the captivity of my own dark mind.
One of my favorite Bible passages is the story of the Potter and the clay. We are but clay in the hands of the Lord. He has the power to shape us into vessels of His grand design. And should those vases become marred or shattered, He can rebuild them into something even more extraordinary. So don’t be afraid to be broken. For the jars that have been pieced back together are the ones that let the light in.

A Little Night Music Please by Jeff Gifford

A Little Night Music Please

By Jeff Gifford

My Life Comes Full Circle in a Psych Ward

Caught a little depression with some anxiety on the side, is what I thought when I got diagnosed. It can’t be too bad. They make medicine for that. Yes, my grandmother had horror stories of ECT treatments, crying bouts, and long hospital stays. Sometimes getting out of bed was a struggle with her depression, she claimed. I always thought of my grandmother as a true drama queen.

My physical health took a nose dive in my late 40’s. I was diagnosed with a form of liver disease. I missed a lot of work due to numerous hospitalizations. When I was 50, I was told I no longer had any sick time left, and I would lose my job.

I had worked twenty-five years as a librarian. I earned my bachelor’s degree in biology and my master’s degree in library science. It was all I knew. It was my whole life. Now I would need to face foreclosure, move in with my father, and even go bankrupt.

These are days of uncertainty, and uncertainty is not good for people with major depressive disorder. It did not take long for it to begin its ugly course. Countless days were spent on the couch unable to move. The sound of the television annoyed me. I craved silence while I remained paralyzed. “Did I bathe?” I wondered. I couldn’t remember the last time I bathed.

I had turned into a lifeless vegetable, and had it not been for some good friends and family, I probably would have starved myself to death. My energy was depleted.

The feelings started to come back. It was like every neuron woke up and fired at one time. This was the worst part. I felt everything. Everything I had been repressing, the fear, the anger, my job, my life, everything—went into high gear.

I had never suffered agoraphobia before, but it was starting to settle in. I just did not want to leave the couch. I did not want to go anywhere, or even see anyone. Feelings just raced through my head, most of all fear. I craved the former numbness. It was safer there. This was eating at me, bit by bit, hitting me in heavy waves.

I do not remember the entire ride to the hospital. I do remember the police and the ambulance driver arousing me. My father said he called. The police found the empty bottle of pills. The next thing I remember was being escorted into a room where I was processed.

Processing occurs to match the correct group of patients together for effective therapy. I am told I will go to the fifth floor in the morning when there is an opening. The social worker assures me this is good news and not to be frightened.

That night was like no other I can recall, or care to repeat. It was a night of howls and moans and screeches that slowly waned past the midnight hour. Eventually, all that would be left was the laughing, street talk of the hospital workers.

I stare at the wall long enough to begin hearing the howls and moans growing in volume again. Soon it will be breakfast time. I am escorted to the dining area. I am touched to see a mentally disabled man in a wheel chair being taken care of by some residents. They make sure he gets his nourishment. I do not know his name. He is unable to talk. He needs special care. His clothes and hair are dirty.

Visiting hours are announced on the loudspeaker. Typically this is the time when hospital patients receive guests or talk to members of their clergy. Not here. Visiting hours go unnoticed in the television room or talking on a communal telephone. Credibility and cognition are wrongly assumed lost by those on the outside of these walls.

I am told to get my belongings, because I am going to the fifth floor. This is the area of the hospital designated for high-functioning mentally ill patients. I can even shave, provided I have a hospital employee onlooker. I still cannot wear a belt, however. Not until I have gained a certain degree of trust. That would take more time.

Days are filled with group sessions and games. Yes, believe it or not, “Pictionary” and “Jeopardy” are very therapeutic for this soiree of madness. It teaches us to be people, not illnesses. We aren’t two schizophrenics, three bipolars and the suicidal librarian. We are just ourselves, playing games, watching television, talking, interacting. Nothing much.

While I am waiting for my ride back home, the nurse smiles at me and hands me my belt. I put it on with newfound respect. Respect for a powerful disease and respect for my grandmother who got through it.

I wonder what has become of those I had the privilege to meet in the hospital. One of the hospital rules was not to share contacts. Still I think of their names and their faces. I say prayers. I hope they do so for me as well.

Stability Interrupted: Should I Stay or Should I Go? by Jane

Stability Interrupted: Should I Stay or Should I Go?

By Jane

Depression Sneaks Up on Me

When I get depressed (and I think this is universal), time slows down radically. The hours and days drag out so long that I can hardly detect time passing. If I can get to sleep, there’s some relief. Sometimes, I lie awake all night obsessing about one thing or another.

Another symptom is the darkness. I will immediately know if an antidepressant works. It is as if someone has flipped a switch and turned on the light. Additionally, I lose my appetite. I can feel the calories burn off and lose weight much quicker than if on a diet. 

My concentration becomes sketchy; I find it difficult to read (my favorite activity). I just sit and stare at the TV. In this mood, I am interested in nothing. One of the hardest things to deal with is the obsessing. Once an idea is in my head, it’s stuck there.

I am slow to react to the reappearance of these symptoms. My meds have worked for so long, I just cannot believe they would fail. Finally, it is the time slowdown that is so difficult to get through when a day seems to last a week.

Suddenly, I am suicidal, getting these overwhelming urges. Making plans to commit suicide. I have enough pills in the house that I don’t need to know what a fatal dosage is; I can simply take a handful of almost anything to end it all. I could be watching TV, trying to read or sleep, and the idea suddenly enters my mind to get up and do it. Do not pass “go” or collect $200. I tell myself I cannot leave my cats alone, or upset my family. But the urge is strong. I can’t find a reason to stay alive. And staying alive is too painful to contemplate. 

My psychiatrist again raises the dosage of my antidepressant and encourages me to go to the hospital. When I demur, she agrees that I could stay home and fight this thing, but insists I sign a form promising to not kill myself. I sign the form, thinking how odd it is to do so. It means nothing to me. I decide it is simply a “cover-your-ass” kind of thing for the doctor, who did not insist I go to the hospital. She could always pull out the form and say, “Well, she signed this form saying she wouldn’t.”

I return home from my doctor appointment a little hopeful. But the symptoms continue. One evening, I delete all the emails I had received from a celebrity friend. I don’t want anyone to find them after my demise.

Sometimes, the thoughts about my cats and family don’t seem so important. Someone will take care of the cats, and my family won’t miss me that much. At the same time, I know how selfish this is and can’t believe I would do this to the people I love. Even though I have these strong urges, I tell myself that suicide is not an option; that people actually care about me, even if I can’t feel that they do.

One night I am watching the news and the newscaster reports that a certain antidepressant has been found to be the most effective. The next morning, I call my doctor and tell her what I have learned. I tell her I am desperate, and that I want to try this new medication. 

After a few days on my new antidepressant, the light is brighter and time is moving a little faster. I email my sister, telling her how depressed I had been and that I was even suicidal. She responds that she was also depressed about her life, feared losing her job and worried about her financial situation. I realize that I cannot commit suicide and expect her to pick up the pieces. I start to feel better and continue to see my doctor weekly.

Depression is a black hole, and I am not sure that anyone who has not experienced it can fully understand the feelings that accompany it. One often feels they would be better off to die than to sit there, unable to concentrate, obsessing, and watching the hands of the clock move imperceptibly toward a dismal future. 

I feel better as the weeks go by and am soon back to my “normal” stability, with depression just a memory. The only remnant I have is the twenty pounds I lost.

And that is a good thing.

What It’s Like to Suffer from Mental Illness by Gemma

What It’s Like to Suffer from Mental Illness

By Gemma

The Benefits and Risks of Medication

I was first diagnosed with schizophrenia in my late teens, and then bipolar disorder as a young adult. It is a terrible condition, which devastated me, and made me ill for years. It was a very emotional time for me and I had many thoughts of harming myself.

Medication is a good thing. Take it every day because it keeps you stable and well.

I take my meds like it’s the most natural thing in the world. It keeps you ticking, so you don’t forget to take it. It’s like when you first learn to ride a bike. You never forget.

That's what it is like to have mental illness. You know you need to take your medication every day without fail. Again, it’s like second nature to me.

I have tried three lots of medications and am now on two types per day, which enables me to function. Without it, my falls would be unbearable and the mania would set in, as well.

I would be unable to do the things I most enjoy, such as my artwork and writing poetry. They say that folks with bipolar are very creative, so bipolar has its up sides. But there are also the downfalls.

The lows are your inability to function clearly, which affects your everyday life.

Taking bipolar medication is the only way to take back your old happy stable self, as much as you are able.

It took a good few years for me to recover and become stable again. A person really needs this time to recover, but there are still parts of me that will take time a little longer to heal. It just does not happen overnight. It is a gradual process.

The medication I take has a lot of risks. Meningitis and the rare rash can be fatal, too. But I need this medication in order to stay well, so it’s worth those risks for me. Without these medications, you would become very ill with depression and mania, too.

When I was initially diagnosed, I spent a bit of time in a mental hospital. Now I see my doctor every three to six months for check-ups.

Having a doctor who listens is so important. I can be open with my doctor to explain how I feel in order for him to know how to treat me and with the right medication levels, and also what not to treat me with.

My first medication for bipolar made me gain weight. I went from size 11 stone to 15 stone, 7 pounds at the highest.

Now, I have switched to a new medication, which neither makes me gain weight nor makes me drowsy and is definitely the good side. I hate feeling drowsy, and I can lose weight again and feel and be healthier. I go to the gym, it really lifts my mood as well.

It’s very important that you be able to sleep well, too. People with bipolar need less sleep and medication can affect it, too. There are very many people with bipolar who take meds and have their sleeping patterns disrupted. This is very important. I try to sleep well too.

Bipolar was a struggle for me and the beginning was the hardest but the lows are very crippling and the highs are very emotional.

It’s like a rollercoaster ride—the biggest fastest ride you can imagine—and you never know what is coming.

It's how well you can pick yourself up after falling that takes a lot of courage — and to see that you are a very beautiful person inside.

People who care about things that happen in their lives are more vulnerable and fall more easily.

It takes a lot of guts and courage to recover. Honesty is important in recovery from a mental illness.

The ability to open up to your doctor and talk about yourself and your feelings as you express your feelings aids all aspects of the recovery process.

I will always remember my thoughts of harming and hurting myself. I will always remember the lows all my life, but it’s a thing of the past now that I am so much stronger.

Without medication I don't think I would be alive right now. It’s amazing what medication can do.

I will take this time to say that if anyone is suffering from a mental illness, seek help. It is never too late. Recovery is a nice feeling. I know at the end of the day that's it’s the medication that helped put me back together again and mended the broken pieces of my life. And, what is taking a few pills a day to feel well?