Surviving the Hurricane that is Chronic Illness - Part 1 My Story

In 1995 I was diagnosed with Systemic Lupus. I wasn't shocked or even terribly scared because many members of my family had had Lupus and most were doing pretty well.
A year later, in 1996 we had moved to Chapel Hill, NC and I went to The University of North Carolina to see a nationally known Rheumatologist who specialized in Lupus. The day I got there they informed me that he was in the hospital passing kidneys stones (ouch - done that, been there) and I would be seeing another doctor. He ran tests, x-rays, read all the medical files I had sent, and then said, "You don't have Lupus."
I lit up! They had all been wrong ! I was waiting for him to whip out his magic pad and write me a prescription for an antibiotic or a magic pill that would make all of my problems go away - the pain, the swelling in all of my joints, the fatigue, the weird rashes, mouth sores, strange blood test results, and a litany of other things that made me feel, well...like total shit.
His magic pad never came out. I had Rheumatoid Arthritis.
The words hung out in the air like a balloon in a cartoon charactures mouth. Time stopped. When it restarted I began to cry because I visualized a woman who looked like me but was hobbling around with deformed joints, unable to get dressed, work, or pick up her daughter because of the joint damage.
To me, RA meant pain. Endless surgeries, feeling old and looking old by the time I was 40. And there is no cure. You have some good days, but more bad. And. No. Cure. And it wouldn't even kill me - which I know sounds very odd and selfish but the question became, was I strong enough to endure severe pain almost every day for the rest of my life with no end in site?
The doctor couldn't understand - he kept saying, "But you don't have Lupus - this is much better! Lupus can kill you." Well, that may have been true, but I was a 36 year old woman, almost finished with a Ph.D. in Psychology, I had a 5 month old baby. My relatives with Lupus complained of being tired, but they were working. But my family with RA - they couldn't take care of babies. They weren't working. Hell, some of them couldn't open jars, or use a pen. How was I going to take care of my daughter, finish school and become a shrink? The strongest drug they had for it was Methotrexate (which was a drug they used to give women with Breast Cancer) . I had been on it once a week for Lupus until I got pregnant. It didn't work, and made me terribly sick for a few days a week. What was worse is that it never did help with the pain or the fatigue.
This diagnosis I would not accept.
And I actually didn't have to accept that one for too long. I got a second opinion but things actually got worse. This lovely, gentle doctor listened, read everything, and said, "Karen you have Rupus - it is a combination of Lupus and Rheumatoid Arthritis."
Bonus. I was the over achiever. I had spent 6 years in graduate school, got married, had a baby, wrote and defended a dissertation. Now I had TWO auto-immune diseases. Wasn't one more than enough??
It has been over 15 years since I first suspected there was a problem. I have had some really bad days, I have had a lot of surgeries, a two year period that I spent almost as many days inpatient in a hospital in Denver as I did outpatient. I had excellent insurance (that we paid $2200 A MONTH for) that didn't cover the majority of our bills. I was unable to work for about years. My younger daughter, who is now 14, has never known me healthy.
Over the 15 years I have had Rupus I have taken lots of different medications, some worked for a while, others didn't work at all. I grew very depressed. I was in a lot of pain and that made me irritable. It was hard to play with my daughter, clean the house or walk the dogs. My husband was tired of coming home and finding me in the same position in the bed that he left me in when he went to work. And my body was doing strange things - I had a stroke, threw 2 DVT's, and a bleed out (they finally discovered I had a clotting disorder - I am a "lifer" on coumadin). I had a hip replacement at 41, three surgeries to rebuild my left foot, 2 surgeries on my wrist. I knew enough to get on an anti-depressant but that didn't really help. I was depressed because I was sick and in pain. So taking a pill to make me HAPPY about being sick and in pain and umemployed wasn't really going to help.
If you have stuck with this story to this point you are probably scratching your head thinking, "Oh my God woman, there are people younger than you were being told they have Cancer, who have been in car accidents and will never walk again, an you are bitching about ARTHRITIS? Stop whining and get a life. Lemons - lemonaide! UGH - I am off to another blog, this one sucks!"
And you are right -well, hopefully not about the part about the blog sucking - but that was my process. And sometimes, no matter how educated or bright or caring we are, when our bodies do things that we cannot control we feel a lot of different ways. Often people feel depressed, frustrated, embarrassed, humiliated, sorry for them selves...and often, although we don't want to admit it, we feel ANGRY.
I was angry that I got these stupid diseases that had changed my body so that the cells attacked it! I was angry that I was using my $80,000 education to stare at HBO all day long. I was angry that I wanted to help people with problems and now I was the problem and I couldn't even help myself. Everything was a challenge - on bad days my husband had to help me onto the commode. On good days, I could shower, get dressed, help my daughter get ready for school, pick up her room, throw a load of laundry in and then sleep until she came home from school. Mostly I was angry because I was stuck in that familiar place of "WHY ME?"
And I was depressed. I used to lie in bed at 2 am with everything hurting except my hair not sure if I was strong enough to continue living this way. I was depressed that I wasn't strong enough emotionally to deal with the pain and the fact that my life was going in a completely different direction than I had planned. Again...I know what you are thinking. No one can plan their life. Bad things happen to good people. Tomorrow is another day. I ran these platitudes through my head every day. I kept telling myself to GET.OVER.IT.
As the years passed I assumed everyone around me was as sick of this as I was. So when my friends would call and ask how I was doing I stopped being honest. I would say, "I'm doing fine," and then would change the subject.
One friend of mine was in AA (Alcoholics Anonymous). One day she called and I gave her the line I had given so many times and she laughed. "Karen, do you know what fine means in AA-speak? Fucked up Insecure Neurotic and Evasive."
BINGO.
I was FINE - exactly as she had described! For years I thought I had been lying, when in reality I had been telling on myself. And now I was busted!

If you have a chronic illness and are waiting for the part about how to deal with it...you need to wait a little longer. That comes next. Hey, setting the scene is the most important part - if I had just said, "Hey I have a few autoimmune diseases, and then I figured out somethings...but before I figured then out everything went to shit. Then it got worse. And now it looks like it is getting better" you would not have been able to relate. So now you know my journey into my disease...for those of you that can relate, hang on, I feel your pain. For those of you that have loved ones that have a chronic illness and you don't quite know what to say - I can help. Well, at least I can tell you what NOT to say! All this and more in the next part...or two!

Until then, think the good thoughts...the bad ones don't help and the good ones couldn't hurt!

Dr Karen

www.therapyforwomenindenver.com


Here is your teaser for Part 2: Surviving the Hurricane that is Chronic Illness

Chronic illness is isolating, emotionally and physically. And no matter how many friends you have you are doing it by yourself. And I am always amazed at how the people closest to you, that love you the most often say the stupidest things. And it isn't because they are stupid, or not caring, or mean...they don't know what to say. And they are scared - for you and for them.

What Defines Beauty?

This weekend I had the pleasure of re-watching the movie The Women , the remake not the original which was circa 1939. The fascinating thing about the movie is that there are NO MEN in the movie, not even extras in restaurants or on the streets of the Big Apple. It is a rarity to have all of the major roles to be female, but how incredible that the ENTIRE cast (and many of the crew and producers) were women. It stars Annette Bening, Meg Ryan, Jada Pinkett Smith, Eva Mendez, Debra Messing, and Candice Bergen.

The plot, taking place in New York City, although it is filmed in Boston, is about four amazing women who are very different but the best of friends. Mary Haines (Meg Ryan) discovers that her husband is having an affair with a girl who works at the perfume counter at Saks (Eva Mendez) . This information rocks the friends and reveals all of the secrets they have kept from each other. They are each struggling with deceit of varying types, and balancing love, work and family.

The movie was great. But I have seen a lot of great movies. What was interesting was a section after the movie called "The Women Behind The Women." A 16 year old "junior reporter", Cammy Nelson, interviews all of the women stars about what they feel makes a woman beautiful.

Julie Hewit, make-up department head for The Women, made a really powerful statement, "It isn't easy being a natural beauty - it takes all day!" This really spoke to me since so many young people believe that our movie stars and models roll out of bed looking the way they do on film and in print. Hewit explained she wasn't talking only about physical perfection, she explained that make-up was there to bring out a person's own individual beauty.

Each of The Women had a different idea of what defines beauty.

Annette Bening quickly defined beauty as one's sense of humor. Debra Messing felt that people become beautiful when they are genuinely confident. Jada Pinkett Smith mirrored what Debra Messing said by saying that Beauty comes from what people feel about themselves. "If we don't feel good about ourselves how is anyone else going to look at us and feel good".

Meg Ryan's answer was short, sweet and to the point. To her, real beauty was being authentic.

The journalist began to realize that it takes hours of preparation to make these beautiful women look beautiful on the big screen.

The final question this young journalist asked each of the star performers was if they could give their teenage self some advice what would it be:

Annette Bening: Be kind to yourself.
Jada Pinkett Smith: Being a woman is a gift.
Debra Messing: I promise it will come, it will evolve, you will see how spectacular your differences will be.
Meg Ryan: To be just totally as YOU as you can be

In 2004, Dove began their Campaign for Real Beauty to emphasize that beauty comes in all sizes, colors, and reflections in the mirror. They did a study that revealed that only 2% of women considered themselves beautiful and over 80% revealed that the media set an unrealistic standard of beauty.

After working with so many adolescents and women with eating disorders, as well as women with low self esteem emphasized by the mixed messages we are bombarded with by print media, movies, and on TV I was thrilled when they showed real women in their advertisements. They also came out with a number of pamphlets to help mothers speak to their teen daughters about what beauty really was.

After watching the Women and seeing how in this one movie women were truly glorified - whether it was on the film itself, in production, or on the crew - I found myself reconnecting with the Dove campaign which encouraged me to write about beauty. To remind you, as well as myself, that as lame as it may have sounded when our mother's said it, but beauty really does come from with in.

Many of us have met someone who is physically gorgeous, but then perhaps after meeting them we find they aren't nice or funny and it is almost as is they physically change before our eyes. I have also met women that, by society's standards, were not "knock outs" but after getting to know them, laughing at their jokes, or feeling the love in their heart they appear "beautiful" to me. Have they physically changed? Of course not. I have merely focused on what was inside instead of the packaging, and they practically changed before my eyes.

But in reality, they didn't change. I changed.

I was able to put aside what society bombarded me with day in and day out and focus on who they really were. And that beauty emerged from the inside out.

When I meet someone funny, kind, and loving they are beautiful to me, even if they aren't on the cover of Cosmo, or in a sit com. Now, if we could only give ourselves the same break when we look in the mirror and focus on every minor flaw, zit, scar, or imperfection. As women we need to pull together, love what we see in the mirror, even if it isn't Meg Ryan or Jada Pinkett Smith, and accept ourselves, flaws and all.

Remember, at Christmas on on your Birthday the best present isn't always the one in the prettiest paper - you have to rip off the wrapping to get to the good stuff. It is always inside!

Give yourself a hug this week, you deserve it.

Dr Karen


www.therapyforwomenindenver.com

Midlife Women and Eating Disorders

We live in a very curious word where emaciated bodies are no longer a true indicator of poverty. Every morning thousands of women, both adolescent and adult, will wake up and allow the scale to determine whether they will have a good day or a bad day. The number that stares them in the face controls not only their eating patterns but the way they relate to their families, their co-workers and their friends. It used to be considered a disorder predominately affecting young women in upper middle class families. In the 80's things changed, suddenly eating disorders appeared across all socioeconomic levels, the majority of the victims showed symptom onsets usually between ages 11 and 18.

Recently, The New York Times published an article online entitled When Eating Disorders Strike in Midlife . According to the story, recent studies are suggesting that there has been a dramatic increase in the number of women over 30 that are struggling with symptoms of Anorexia, Bulimia and Bulimarexia (alternating between symptoms of starvation and binging/purging). In order to control their weight, these women are abusing laxatives, exercising excessively, purging (vomiting), and decreasing their caloric intake to dramatic levels.

The director of The Eating Disorders Clinic of The University of North Carolina in Chapel Hill, Cynthia Bulik, noted that 50% of her inpatients were middle aged. Another clinic, The Remunda Ranch Treatment Program , a Christian treatment program in Wickenburg, AZ, disclosed that since the 1990's they had had a 400% increase in admissions of patients over age 40.

When I read this article I was quite fascinated. I have been working with eating disorder's clients since 1994, the majority of them in their late teens or very early 20's. After reading the statistics in the article I began to wonder what would causes a disorder that had been considered to be predominately an Adolescent Issue to suddenly begin appearing in mature women? Could something be occurring in society to encourage adult women to become obsessed with their bodies, dieting, the number on the scale, and their dress size?

One reason for the increase in older female patient could be that some women had actually been anorexic or bulimic since they were teens, they had just never been diagnosed. They had been secretly fighting and hiding the symptoms of their eating disorder for their entire lives and only after being confronted or in some cases "discovered", perhaps by a close family member, life partner or spouse, doctor or dentist (teeth problems are common after years of forced vomiting) they decided that the disease that they had utilized to gain control of their lives was actually in control of them.

Another possibility is that some women with no history of body imagine distortion developed symptoms later in life due to a dramatic life crisis such as a divorce, death or illness of someone close, or a change in life circumstances.During adolescence, an eating disorder can occur after a major transition in life. In this time of economic insecurity, could the stress of losing a job, a dramatic decrease in family income, loss of or our home through foreclosure cause enough stress that a woman may take out their feelings on their bodies? Could the murmurings that the economic recession could become an economic depression cause an individual to become so insecure and frightened that they begin to focus on the decreasing number on the scale to avoid the decreasing numbers in their bank account or 401 K?

Is it possible that as adults, women are feeling as much pressure as adolescents to look a certain way - to strive for physical perfection and eternal youth? The encouraged role models from TV or Movies are often young, beautiful, thin women. It was suggested that the emergence of the incredibly thin British model, Twiggy, in the 60's had a direct connection to a dramatic rise in the number of cases of anorexia. For those of you that don't remember Twiggy, she was 5'6" amd 97 pounds, her picture graced the cover of Vogue and Seventeen .

The intense societal values placed upon physical appearance still give women of all ages pause. Society, with the help of mass media, Hollywood, fashion magazines and television has defined "fat" as either a cosmetic or a medical problem. Women are bombarded with mixed messages: we are all supposed to pig out on a Big Mac, fries and a shake, enjoy "Miller Time" with our friends, go to Starbucks for a Venti Caramel Macchiato with extra whipped cream, but look like the girls in the Diet Pepsi commercials! Eating has become synonymous with having fun and socializing but being overweight has become synonymous with being lazy and unhealthy. And if working out at 24 hour fitness doesn't take care of your problem, you can always head off to the local plastic surgeon to have yourself lifted and "liposucked" until you are back to your 22 year old self.

Aging and weight gain are considered to be "evil" in a society motivated by youth and beauty, at any cost - even if that involves going under the knife.

Now don't get me wrong, I consider myself to be a feminist therapist - therefore I believe that whatever you want to do to your body (such as breast augmentation, lipo, tummy tucks, etc) is ok by me, as long as you aren't hurting yourself or becoming addicted to seeking perfection via the knife. I have had many friends who have had augmentation, lipo, and face lifts. If that makes you happy - go for it. But do it because you want to feel better about yourself, not because society is giving you meta messages that the way you look now is bad or wrong.

I have counseled many women about loving their body through different stages of life , but the reaction is often the same. They want to be a women that is young, thin, and without the lines of life for as long as they can afford it. They are afraid that their spouses will lose interest in them sexually if their body changes. Some worry about the fact that women age differently than men. Interestingly, out society often turns a blind eye at men that carry an extra 20 pounds. On dating sites, often women will overlook a man with a "gut" and look at other aspects of their personality (not all women, I understand). But I have spoken to many men who have met a woman on an Internet dating site such as Yahoo or Match and commented to me that the woman's picture was from "20 pounds ago." They are understandably upset that the woman placed a photo on the site that was old, but they seem to be more upset about the weight gain. Often, the men that have sat in front of me saying these words were bald, were maybe 20 pounds overweight themselves, and shall we say, not exactly a Brad Pitt look-a-like!

It is very easy to understand the difficulties women experience after they have had a few babies, gone through menopause, and are dealing with a combination of lack of time to work out and a decrease in metabolism that often occurs with menopause. The sum of these can quickly equal a higher number on the scale. They begin dieting and as they lose weight they get a lot of positive attention from friends and family members. Suddenly, as they get close to their goal weight, some women develop what I call the "floating 5 pound syndrome."

"If I look this good at 125 pounds...imagine how I will look at 120 pounds!" When they reach 120, suddenly their goal weight shifts to 115...and so on. When women lose weight, especially quickly, they often do not see the changes reflected in the mirror, even though their clothes become loose or they purchase smaller sizes. Their mind tells them that they still look the same. So, they continue to lose weight, being unaware that their mind is playing a wicked trick on them. The image in the mirror is a distorted reflection.

So, why are middle aged women developing eating disorders? I am not entirely sure - I believe it is a combination of many of the issues I have addressed. Decrease in self-esteem, stress, fear of change are all factors perhaps.

Do you have middle aged friends that may have become caught up in a weight loss obsession? Why do you think they have suddenly focused on their body? Have you approached them or just let it go feeling that they wouldn't listen to you anyway? What would you suggest to someone struggling with a disorder that usually effects teenage girls?

What suggestions do you have for women having "fat days?" What works for you?

Until next time...

Dr Karen

www.drkahoving.com

Emotional Issues Surrounding Bankruptcy & Foreclosure

A few months ago I was asked to address a large group of Colorado Bankruptcy Attorney's on the psychological affects of filing for bankruptcy and foreclosure.
Filing for Bankruptcy is much more than a financial crisis; it is an emotional issue as well. Often, it is as great a loss as a divorce or even the death of a loved one. Going through a financial crisis is rarely an isolated event. It is often precipitated by a medical problem, the loss of a job, or even a marital separation.
In the United States often an individual's sense of self worth can be emotionally connected to the amount of money they have, the type of car they drive or the house they live in. When a financial crisis occurs and our only solution is to file for bankruptcy often we are left with feelings of personal and professional loss and sadness. Some may feel ashamed of having to file. Others are afraid of what their friends and family will say when they find out. Although Bankruptcy is a completely legal process, they begin to feel like a criminal.
Often individuals wait up to a year before they file. During this time bills may have piled up; creditors have repeatedly contacted them by mail and phone. When this begins to occur it is common for people to avoid many seemingly normal activities such as going to the mailbox or answering the phone for fear of what is waiting for them.
The stress of constant creditor calls and letters may have affected your life and pressured your relationships with the people that you care about the most. In a marriage, it is not uncommon for one individual to be in the dark about what is happening. Often their first clue is when "Dan the Repo Man" calls about collecting one of the cars or the bank calls about the mortgage being months unpaid. When an unknowing spouse discovers from a complete stranger that they are seriously in debt it puts tremendous stress on a marriage. Financial problems are in the top five things that couples argue about. When one individual has lied to their spouse about their financial debt, it can emotionally damage the trust in the relationship.

Individuals experience many different feelings and emotions surrounding their decision to file. They may be experiencing some or all of the following:

*Persistent sadness/crying
*Excessive anxiety
*Guilt or Shame of their circumstances
*Fear of the future
*Excessive humiliation of feelings of being a failure
*Waiting for a "miracle" so they won't have to file
*Problems sleeping/constant fatigue
*Excessive irritability/anger
*Increased drinking, illicit drug use or misuse of medications

Not everyone will experience all of these feelings. Some people feel all of them before they even set foot in an attorney's office, many don't begin to digest their feelings until after their 341 meeting with the creditors.
The emotional stress of deciding to go bankrupt and the legal process itself can be overwhelming and extremely stressful on your body, your relationships with loved ones, friends, and your over all emotional well being.
Recently, I began offering my services to local Denver Bankruptcy attorneys. I have offered a reduced fee to work with their clients, one attorney, Bill Nelsch, includes two sessions with me free as part of his fee.
Don't assume because you feel relieved after the creditors stop calling that all is well. Often emotional things creep up over the next 10 years while that bankruptcy is on your credit rating. Work through your issues now so they don't sneak up on you in the future.
If you are interested in emotionally support during this difficult time of your life contact me. If you are in Denver I can see you in person. If you are out of state I can arrange to work with you over the phone or via Skype Web Therapy.

www.drkahoving.com

Harry Potter, Shelby and The Shrink

My teen daughter, Shelby, and I have had a tradition for many years - whenever the latest Harry Potter movie comes out, I take her out of school a tad early and we go to the first showing after 3 PM. For those of you that follow H.P. you may be aware that the the movie based on the 6th book, Harry Potter and The Half Blood Prince, hit the theatres Tuesday at midnight. Now I love Harry and his cohorts but Shelby was disappointed to discover that I wasn’t going to be drinking Starbucks all afternoon to make it through a three hour movie starting at midnight. But, the promise to see it at noon yesterday was enough to appease her.

Many parents that I work with struggle with the relationship with their teen sons and daughters. Adolescence and pre-Adolescence can be a tricky time for all involved. It can be especially difficult when we are single parents. I wonder often if some of the problem is that as Adults we don’t really remember how horrific high school actually was. Because if we did we might be able to understand how something that seems insignificant to us in the scheme of trying to pay our bills or deal with a marriage that has changed over the years, might be devastating to our 14 year old. Now, don’t get me wrong, I am as guilty as the next parent for listening to the umpteenth time to my daughter droning on about her girlfriends being mean, or something that was said to her during lunch that caused her to text me from school and want me to pick her up, and thinking, “Oh My Gosh, I am so stressed right now I can hardly see straight, I have bills coming in that I don’t know how I am going to pay, and the buck stops here - I only WISH I had your problem!” Now I know if I say that several things will happen.

1. If I dismiss her or tell her how “easy she has it now” I will have shut down what could be a key bonding moment, and face it at this age those moments come far and few between. Typically teens go to their friends for information, and they get it. It isn’t always good or accurate, but they get an impartial, loving ear.
2. If I minimize her MINOR problem she will never come to me again with a BIG problem. And face it, it is the little “tests” they give us to gage how we will react so they know whether they can trust us with the really BIG problems that we want them to come to us with (drinking, drugs, sex).
3. They will hear exactly what we heard when we were their age: it is our version of when our parents gave us the “I walked a mile to get to school...in the snow...in bare feet...because this was before cars, carpool, or color TV” speeches that we all dreaded as kids. We rolled our eyes and hated our parents for their lack of “getting us.” So we did the things we did, and never told them.

So, what does this have to do with Harry Potter you are asking yourself. One of the things that I try to do with Shelby is to spend time entering her world - through the books she reads (when she was into Twilight, I took her to the movie on the first day. That was an act of love - I couldn’t hear perfectly for 24 hours after about a hundred teen girls screamed every time Robert Pattinson was on stage. I then read all four books...now, granted, by the time I had read all four books Twilight was “So Yesterday” to my daughter, but many of her friends were still into it. So when they talked about it I participated (step one at becoming the hip shrink mom that her friends want to hang with).

This habit all began with Harry Potter...we saw the movies then as she got older and she read the books, I read them. As she got into various video games I would casually wonder into her room, ask some questions and let her teach me how to play. Then, occasionally when she was bored I would suggest we go play the game. Granted, when she was younger the games were not brilliant but as she grew older they became more challenging for both of us. Now she is into the Sims which I have a blast playing with her.

So this weekend, if you have a free three hours go see Harry Potter with your child. Or if they aren’t into Harry Potter find out what they are into. If this is new territory for you and your child don’t expect them to throw their arms around you and scream, “Wow you are SO rad!” Expect some rolled eyes, and a few rejections - but find out what your child loves and become involved.

In graduate school they taught us that to be an excellent child therapist it was vital to enter the child’s world. To enter a child’s world you do it through play, which must have seemed odd to many parents who would have spent a lot of money to bring their children to see me and on the ride home have their children explain how we played 10 games of War, played with magic rocks and wizards in my sand box, and we drew 4 pictures with my new crayons and markers. I always wondered if the parents didn’t rub their eyes and think, “I just spent over $120 for something I could have done?” What they didn’t understand was with little ones entering their world created the relationship which helped to improve their relationship with me. And it was the relationship that really healed the child.

If what I was taught in graduate school holds true, that we must enter a child’s world to connect then with teenagers I believe it is the same, only different. In 2009 the way to enter a teens world is through technology - I text my daughter and my teen patients, I play video games, I read the books that the girls are reading (even when my patient hates to read - her friends are reading and talking about the Twilight or Harry Potter books - she may not be reading but she knows every word of the movies), watch the movies they are watching.

So your assignment for this week is to find out one thing your child loves. And ask. And ask again. And ask some more, until they finally show you to shut you up. Then you have achieved the first step at entering your child’s world. Then do yourself a favor - let your inner child/teen come out to play with your child. And have a blast!

What kind of things do you like to do with your kids to enter their world? What problems are you having that you would like to have addressed? Leave a comment that will support other parents.

Check out my website: www.drkahoving.com

Dr Karen

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