Day 7 of #31DaysOfTré – Please Don't Label Me as "Sick"

Some time ago, I was speaking with somebody about a story regarding CF that was in the news at the time. The story itself isn’t pertinent, but rather it was what that individual said to me that resonated with me. I consider this person to be a very-well-meaning friend so I didn’t take this as a slight, but an opportunity to educate him. Basically we got into a deeper discussion about my potential future as a father and if the future mother of my child is a carrier, would I still be willing to risk having a child with CF (assuming we figured out that whole infertility thing for men with CF). The specific phrasing of his question, though, was “would [I] be willing to have a child that was sick like [myself?]” (I can’t express enough how I bear absolutely zero ill will towards him for this comment and he immediately realized how it sounded.)

I don’t speak for the entirety of the CF community, but I personally object to the labeling of being called sick for my genetic disease. 

First things first, a bit of pedantry. From the purely linguistic perspective, I view the term “sick” as a term that references a transient sickness, like pneumonia, the flu, or a cold. Having CF does not preclude me from ever feeling healthy, so I think it’s a disservice to our entire community to label all people affected by CF as sick all the time. It also discounts the fact that considering our lives are already so often affected by genuine ills and sicknesses, grouping all of our issues together seems dismissive and inaccurate. 

Secondly, and probably more importantly, it stigmatizes us, reflects poorly on us, and “others” us. When others view the entirety of our CF – the simple reality of having CF – as “sick,” it revokes our ability to define our struggles in our own ways. It makes nearly everything we do an achievement “in addition to that CF thing,” as opposed to a genuine accomplishment. I wholeheartedly realize that CF makes my life harder in a lot of ways, but every congratulation I receive is appended with “that is so amazing in addition to your CF!” Coincidentally, today marks a year since I ran the Flying Pig Marathon. Separating the fact that running a marathon is an achievement in and of itself, it's still a common thing for me to hear "I can't imagine how you did that. I can't even imagine doing it and I'm healthy!" I understand people mean well, and this piece is not an indictment of people meaning well, but since I have to deal with CF in nearly every facet of my life, this writing project is an opportunity for me to educate others and maybe dictate the lexicon surrounding our collective experience a bit. When people are saying they can't imagine doing what you did when they call themselves "healthy," it shows how they view you differently. Navigating the realization that people mean well but it still hurts can be difficult.

When people mention that in passing, it can sometimes reflect a more genuine underlying belief, sort of like a Freudian slip. I realize CF is so much a part of me and is deeply ingrained in all of my writings, but when it’s hammered home to me that everybody always views that as a major part of me, it starts to feel like a scarlet letter. Like when I walk around, I have a name tag on that says “My name is Tré and I have CF.” I can never escape this disease, so I’ve tried to take control and be open about my experiences so as to guide what other people learn about it from me (uhhh most of the reason I went to school for biochemistry). 

The belief that you’re “sick” or that others believe your entire existence is essentially a sickness is pervasive and psychologically damaging. An initial response to a cough is the assumption that you’re contagious; life expectancy is so often one of the first things people learn - and while I willingly got the tattoo of Alyssa’s handwriting so I expected this, people have become quickly familiar of Lyss’s passing because of that - so I always feel obligated to hedge my wellness; people don’t really know how to talk about the disease so it’s become an additional responsibility of mine to be as educated as possible to always give people accurate depictions and facts about it. These outwardly social aspects of life with CF become so burdensome in addition to the already mentally exhausting charge of being anxious about a tight cough or impending infection and, you can’t forget this pesky little detail, that you’re always physically dealing with CF anyhow. 

Maybe I’m wrong here. Maybe I’ve succumb to a victim mentality. Maybe I’m just a millennial that feels entitled. 

Or maybe I’m a part of a small community of individuals that are trying to make life as easiest as possible for us. Maybe I really care about humans being treated fundamentally compassionately and that we can all make the world easier or others so I hope others are understanding of my situation. Maybe I just want to feel like CF doesn’t separate me from everybody else other than the small population that can understand what it’s like. (Most people don’t know this, but people with CF are advised to never come into contact with one another due to infection prevention protocols; in outdoor spaces, we are allowed at CF Foundation events as long as we’re 6 feet away from one another. This can also at times perpetuate that feeling of "otherness.")

Alyssa and I discussed this a lot. She hated feeling like people constantly viewed her as sick, so she did her best to embrace it. And she inspired so many people in doing so, very obviously including myself. She was the only person in the world that I felt comfortable knowing I could talk to her in the event that my health began to fail quickly. Here's my attempt at changing the dialog a bit. So please don't label me as sick just because of my having CF.

TL

Day 6 of #31DaysOfTré – Tonight is hard

I suppose a problem with writing every day for a month about my life is that I'm still openly grieving Lyss so some of the posts may be about that. As grief is a weird human thing, and as time moves on, grief affects us differently. I had a great weekend, but tonight on my way home from the gym, I was overcome with sorrow. I haven't read the letter Lyss wrote in a bit and I guess I kinda started to make progress in that I wasn't constantly thinking about her every single day. 

Last night with some of my closest friends, I saw my favorite artists – Odesza – in concert. Their music speaks to me on an almost spiritual level and I knew going into it I was going to have a hard time missing Lyss the entire time. All of the feelings I've felt these last two months were encapsulated into the 2-hour set but the icing on it all came afterward when we went to a bar in Cincinnati after the concert. I ordered a round and the bartender – her name was Lindsay – looked at me and immediately asked if I was Alyssa's little brother before comping the drinks for me. I didn't recognize her but I was stricken with a combination of pride and sadness; pride because this was another example of Alyssa touching somebody's life that I never knew about, but sadness because these instances remind me that the only new memories I'll ever create with my sister will always be in recognition of her absence. (Also, Lindsay told me Lyss would've loved the blonde hair and you can be damn sure I almost started crying right when she said that. We took the picture below.)

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It was harder than just the fact that Odesza's music has been a crucial part of my life over the last year. Though I only DJ and haven't done any producing, Lyss knew how badly I wanted to get into producing music. We joked a lot about how she was going to be my personal stylist when I started touring and I'd always tell her I couldn't wait until she came to Coachella with me when I performed. Seeing Odesza in concert magnified all of these overwhelming feelings and the sorrow I feel when realizing she'll never be able to physically experience that with me, even if it just a dream.

I'm so thankful for the lives Alyssa touched, especially given the struggles she had. She could've easily decided to roll over and not use her platform in the way she did. But I'm so angry she didn't have a chance to have a normal life for a time. She loved fashion so much and I'm so pissed that she couldn't make something of that. As her brother, I was protective of her, and I wanted to use my "normalcy" and health in some way to give her a chance at a career. She encouraged me in everything I've ever done and I owe credit to her for my accomplishments. If I was going to succeed in anything, I knew she was going to be there and I wanted her to be a part of whatever project I was working on. I wish I could've helped her more.

I know I can't be too hard on myself but the last 48 hours have been a whirlwind and I'm having a bit of trouble processing it all. I had a great weekend and I guess the realization that I'm progressing in my struggles with depression and this grief, I'm having genuinely good days, and feeling hopeful is all making me feel guilty. 

TL

Day 5 of #31DaysOfTré – Working in a CF Lab

A couple of months ago, I wrote a piece for the CF Community Blog. I'm re-posting that piece here.

One of my most sought-after goals has always been to make a positive contribution to the CF community. For the last year and three months, I feel confident that I've done just that by working in the research lab of Dr. J.P. Clancy at Cincinnati Children's Hospital. My education and experience in the lab has made my approach to my disease much more evidence-based and meticulous.

Our lab is trying to make precision CF medicine ubiquitous. We specifically want to determine, to the best of our ability, if the cells of people with less common mutations respond to compounds similar to the approved cystic fibrosis transmembrane conductance regulator (CFTR) modulators, Orkambi® and Kalydeco®. My role in the lab is to analyze and measure how their cells respond.

Our lab uses two model systems to corroborate which drugs will work best: “monolayers” and “spheroids.” Each model system is a good representation of how the body works, so it's important to use both systems because a patient's cells may work better in one than the other.

We are able to grow patients' cells into “monolayers” in laboratory flasks after we collect them by brushing the inside of their noses with a small wire brush. Working with an instrument called an Ussing chamber, we can measure if chloride channel transport is improved when we treat the cells with varying modulators.

In addition, we separately expand the cells into individual spheroids (or sphere-like shapes) and treat them with the same varying modulators. Both strategies are used to corroborate if a drug will work well for the patient's specific mutation. You can see which spheroids respond well to the modulators because the cells swell as they take in more chloride from outside the cell. I am actually witnessing the modulators improving CFTR protein function because the chloride transport is improved. It's both humbling and inspiring.

In my opinion, one of the most crucial aspects of CF care from a patient perspective is a feeling of personal control and responsibility. For CF care, it's of utmost importance to stick with our treatments, to exercise, and to be educated on our condition.

At the end of the day -- and sadly -- we only have some control over our disease progression. We can be sanitary and do all our treatments, yet a nasty infection can set us back more than we'd like.

But one part of CF care that is completely within our control is our understanding of the condition. Having some understanding of why things are necessary in our care can allow us that feeling of having control; to feel “normal” and responsible for our lives. That feeling of normalcy is what helps me stick to my treatments and have better mental health as well.

My education and lab experience have only furthered this belief in my mind. Our lab is partially funded by the Cystic Fibrosis Foundation, so our work is supported by the fundraising done by volunteers -- including my family and me -- over the last couple of decades. This part of the experience helps to confirm my passion for advocacy within the CF Foundation.

I strongly believe in the importance of doing what we can, as humans, to take matters into our own hands. As a person with a chronic disease, having a healthy mindset to deal with the unforeseen mental burdens of life with CF is important. Working in a CF lab has been one of the best experiences of my life because it gives me an insight into the intertwined workings of the scientific and clinical aspects of CF care.

It's also been a uniquely uplifting experience because I am able to provide the doctors and researchers in my lab an adult CF patient's perspective on life with CF. I am grateful for the opportunity to work in the lab, and I'm also grateful to be involved with the Greater Cincinnati Chapter of the CF Foundation, as these both help to give me the chance to feel fulfilled and contribute to the cause that's so near and dear to my heart.

TL

Day 4 of #31DaysOfTré – Some CF Stats

For whatever reason, I'm fascinated with numbers and statistics, so this post is going to be some stats about CF to put things into a bit of a perspective.

Some numbers about the CF population

According to the CF Foundation, there are 30,000 Americans with CF and about 70,000 worldwide. From my own input, I think those numbers are probably larger in reality because, as we learn more about CF, diagnostic definitions are likely going to become more expansive, but I digress.

CF is considered a rare disease, but 30,000 Americans having it seems like a pretty large number, at least at first glance. 

By comparison, 70,000 people with CF across the world would be just short of filling the Georgia Dome to capacity.

30,000 American people with CF would barely fill InfoCision Stadium where the Akron Zips football team plays. 

Those aren't large amounts of people.

To inherit CF, both parents must be carriers. Across the United States (again according to the CF Foundation), more than 10 million Americans are carriers of a mutation of CF.

Based on the 2016 Census (city populations; not metropolitan), 10 million people is approximately equivalent to the populations of Los Angeles, Chicago, Houston, and San Jose combined. Again, that sounds like a lot, but not when considering the US is comprised of about 323 million people based on the 2016 census.

There are tons of other stats regarding different subpopulations of the CF community – rates of different mutations, patients affected by different clinical presentations, etc – but I feel as though those would detract from the overall point of this piece, but I'll probably delve into them in a future piece to demonstrate the overall heterogeneity of the population.

Some numbers on my life with CF directly

As I discussed in yesterday's piece, I take lots and lots of pills and spend a good amount of time doing treatments. I didn't get into too much of the detail because I wanted to spend some time on that today. 

I split the types of medication I take into two groups: my daily maintenance meds and my enzymes. The daily maintenance meds are the ones I take morning and night and my enzymes are the pancreatic enzymes I take every time I eat. I split them because the daily maintenance meds are taken exactly the same each day of the week, whereas my enzymes are taken dependent on how much I eat daily.

My morning medicines are the same on Monday, Wednesday, and Friday – my anti-inflammatory and vitamin D are only taken three times a week – and the same on Tuesday, Thursday, Saturday, and Sunday. My evening meds are the same every night.

Monday, Wednesday, Friday morning = 8 pills per.

Tuesday, Thursday, Saturday, and Sunday morning = 6 pills per.

Evening meds = 6 pills per. 

That's a total of 90 (non-enzyme) pills a week, which is 4,680 pills per 52-week year.

Since enzymes are taken depending on how much I eat a day, I calculated a range for those. On days I eat less, I assumed 3 meals – I take 5 enzymes with meals – and 3 snacks – 4 enzymes with snacks. On days where I workout more and eat more, I assume 4 meals and 5 snacks. That's a range of 27 to 40 enzymes a day. Over the course of a 52-week year, that's a range of 9,828 to 14,560 enzymes a year.

Together, that's a range of 14,508 to 19,240 total pills a year. That's a lot of pills.

That also doesn't include potential exacerbations where I have to take more oral antibiotics. Other patients have more or fewer medications they have to take, but for an adult with CF, I think this is a pretty fair approximation.

When I use the term treatments, I'm describing my chest physiotherapy and nebulized aerosols that I do twice daily. Since CF causes excessively thick mucus in the lungs, I do what's called the "vest" which inflates with air and percusses my chest to break that mucus up. I do this while I do three separate inhaled medications – hypertonic saline, pulmozyme, and an antibiotic that I cycle monthly.

When considering preparation time and the variable that depending on how I'm feeling I'll do longer or shorter treatments, I assumed a range of 30 to 60 minutes per treatment. I use two different protocols for the vest treatments – one is 24 minutes, the other is 30 minutes – and will sometimes do both if I feel like I need it. This gives us a range of 60 minutes to 120 minutes on treatments per day. This does not include if I have an exacerbation, in which case I'll do 3 treatments a day for 2-4 weeks, because I want to give a number for a "healthy" year.

Over the course of a 52-week year, that's a range of 21,840 to 43,680 minutes, which is equivalent to a range of about 15-30 days.

I've thought a lot about the heavy time burden of CF, but, until now, I've never calculated just how much time I spend adhering to therapies. A benefit of these treatments is that I try to spend them being "productive" by reading, writing, or, when I was in college, studying. But still, that's an insane amount of time just doing maintenance for my lungs. 

That also doesn't include the amount of time and energy spent exercising daily or preparing my medications for the week at the beginning of each week, which I usually prepare during treatments anyhow (I guess I'm better at multitasking than I thought lol).

When considering exercise too, you can add an extra 6-10 hours a week just spent exercising.

I'm nowhere near the most active CF patient ever, but I'm definitely proud of my compliance, adherence, and exercise regimen. Still gotta get better though!

I'd be remiss if I didn't acknowledge my incredible fortune in how rarely I am sick. I haven't required a hospitalization for IVs due to an exacerbation in 4 and a half years. So these numbers are incomplete. I'll also discuss this later, but my dad and I did a very rough calculation for Alyssa and she probably spent 20-25% of her life in the hospital. CF sucks a lot when you're healthy and is a horrible, horrible disease when you're sick that often.

I have a handful of other stats and numbers I want to look at, but I think it's important to fully consider this burden on CF patients. I try not to ask for pity when I write and I certainly try to never feel sorry for myself, but sometimes I think it's nice to take a step back and consider how CF is a full time job and give myself a pat on the back for how burdensome it truly is. 

TL

Day 3 of #31DaysOfTré – What is cystic fibrosis? An Overview

So I obviously have to do this post. The point of this month is to showcase many different facets of cystic fibrosis from my perspective. Without having a solid overview piece, it wouldn't be a good project. As the project progresses, I'll spend more time explaining some of the actual specifics and intricacies of the biochemistry behind CF – how it is inherited, the actual gene, how different drugs work, etc but for now, a relatively simple overview. Disclaimer: As a scientist and writer, I'm going to try to be careful not to go too in-depth, but I also hate oversimplifications. Bear with me.

To start, the canned spiel: CF is a genetic disease that causes a defective protein called the cystic fibrosis transmembrane conductance regulator (CFTR) protein. The CFTR protein is a chloride ion channel on the surface of epithelial cells. There are nearly two thousand disease-causing mutations of CF. Unfortunately, since CF is such a complex genetic disease, no two patients are the same, even including siblings and among patients with the same mutation. Alyssa and I both have the ∆F508 mutation of CF, which is actually the most common mutation. To put into perspective how two patients with the same mutation and 50% of the same DNA (as siblings do) are affected differently: Alyssa was 24 years old when her lung function was failing to the point of needing a double lung transplant – her lung function dropped below 30%. I just turned 24 a week and a half ago and my lung function has been between 85% and 97% for the last 2 years. (Side note: I'll also write a piece delving into the minutiae of pulmonary function tests and what these numbers actually mean; for now, they are a good enough indicator of how healthy someone with CF is.) It's important to note a couple things here, and I'll try to be concise. Obviously, Alyssa and I were never going to have the same disease progression: we cultured different bacteria at different times, different compliance standards, different work ethics, etc. The point is: the disease significantly affects every patient differently.

The CFTR protein is crucial for chloride ion transport. Incidentally, chloride ion transport is important in mucoid development, which is why people with CF have especially thick mucus. CF is commonly known as a lung disease, though I feel compelled to rail against that traditional simplification of the disease. The thick mucus causes complications in many organs and tissues, including, but not limited to, the gastrointestinal tract, the pancreas, the liver, the kidneys, and the sinuses. It is certainly true that progressive lung disease in CF is one of the biggest causes of mortality, but pancreatic insufficiency, CF-related diabetes, fatty liver disease, and many other issues are common burdens in many of our lives.

The architecture of the lungs of people with CF is significantly altered by infection and inflammation as the years go on. The thick mucus in our lungs offers a fertile breeding ground for bacteria. There are a handful of "CF bugs" that colonize our lungs and wreak havoc and cause exacerbations. People with CF also have altered immune systems which leads to a different inflammatory response. The lungs of people with CF eventually become obstructed and damaged to the extent that they are unable to hold as much air and some air becomes trapped (typically collectively simplified to the term "lung function" – again I'll explain this in a subsequent post). The bacteria in the lungs also become resistant to drugs as time goes on. Combine all of these factors together, as well as the stereotypical cough, and it's easy to see why CF is labeled a lung disease. I'm not completely against that phrasing, but it does discount a lot of other problems.

Along with nebulized treatments and chest physiotherapy, in my specific case, I take pancreatic enzymes to help digest my food, as well as supplementary vitamins, a maintenance antibiotic, an anti-inflammatory, a drug that helps keep my liver levels in check, and a "modulator" (the new class of medications that help to correct and potentiate the defective CFTR protein. These drugs are ground-breaking and exciting. I'll write about these too. It's easy to see how I have 31 days of material for #31DaysOfTré). To further demonstrate how cystic fibrosis affects every aspect of my life, I also dedicate myself to daily exercise, keep track of my electrolyte levels and blood sugar levels, and have had six sinus surgeries. All of this becomes a full-time job for which we have no respite. Taking time off of our treatments can mean a hospitalization which can be hard to recover from. It's easy to see how depression and anxiety can become a huge problem in the life of people with chronic disease.

One of the main reasons I studied biochemistry in college was to have a firmer understanding of the underlying mechanics of CF. To put it honestly, I wanted to feel more powerful and more in control. I wasn't totally wrong. Understanding why my medications, treatments, and exercise are so important forces me to have better compliance and adherence. I've now worked in a CF lab for 2 years, along with a year and a half of CF lab experience in Lexington, to help reinforce the biochemistry I studied in college. 

The future for adults, children, and newborns with cystic fibrosis is bright. There are lots of drugs on the horizon and more people are aware than ever, but we have to keep hammering home all of this progress. With this project, I intend on doing just that.

TL

Day 2 of #31DaysOfTré – My Loved Ones

Cystic fibrosis is commonly considered a disease by association - credit to Frank the Tank for coining this phrase. Since I have three tattoos on my arms directly related to my experiences with CF and Alyssa, CF gets brought up quickly in conversation. Nearly every adult I meet nowadays has some idea what CF is, albeit a very surface understanding. Oddly enough, me living with CF every day means I'm actually sort of myopic about the reality that me having CF affects my loved ones deeply as well. It wasn't until I saw how devastated my friends were about Alyssa that I fully understood the extent my life and experiences with CF have on them as well.

After every accomplishment ever, the humble recipient usually claims that "they couldn't have done it without the support of my friends and family." As much credit as I owe to my friends and family for supporting me, this article is more than a thank you. It is intended to give them credit where credit is due: supporting me through my experiences means more than just being there for me. It means giving me a reason to live and a reason to continue pursuing my goals and aspirations in this life. It is a testament to the support that the loved ones of people suffering from chronic disease provide for us in the most difficult times.

This is a thank you to the people that have ever read something I've written; to the people that I haven't spoken to in years that tell me Alyssa made an impression on their lives or that they kept up with her story from a distance. 

Through the years, as my parents can attest, I have had many different ideas about which career direction I've wanted to take. For a while, I wanted to be a physician. They fully supported this, but with the cautious advice that it could be dangerous for me to pursue medicine. As I approach the two year mark of working in a lab, I'm finally realizing the platform that I have as a scientist and and now as a writer.  

As I discussed in yesterday's post, I recognize that I'm being opportunistic regarding my grief with Alyssa. But judging somebody's grief - not saying anybody is judging my grief! - is unfair and dismisses the reality that we all process the world around us, especially when a massive part of our world is gone. Alyssa was one of my best friends and believed unconditionally in me. Her confidence in me has led me to seriously believe in myself and my future as a scientist, writer, and activist. Grief is an intensely personal experience, just as my writing is. It would be wrong to me to not honor my sister through pursuing my aspirations.

My loved ones are why I want to make the world a better place. Their unrelenting support for me through everything has instilled in me a belief that I must use my experiences positively. I don't know how to write about this without being self-aggrandizing, but the blunt truth is that any and all of my successes are both mine as well as anybody that has supported me. I internalize that support more than most people could ever know. Just knowing that people read or listen to what I have to say is humbling, yet fills me with pride because I know I've worked so hard for it. I don't believe it's possible for any of us to do anything completely alone in this life, so this piece goes out to the people that love me, criticize me, lift me up, let me know when I need to be better, and that have believed in me.

I'm only one post into this project and I'm already impressed with the reception. A personal concern for me in writing has been balancing my love for writing with the acknowledgement that writing could be perceived as narcissistic. Anxiety, on my left shoulder, is telling me that people will judge me as a stuck up for wanting to be a writer and having a platform. Depression, on my right shoulder, is telling me that nobody cares what I have to say anyway and I'm a bad person for thinking otherwise. That's the main reason I was hesitant to pursue this. Talking with friends, family, and thinking of Lyss convinced me to pursue this. I received a good deal of nice comments and interest in this project in the last 24 hours so I'm excited to fully run with this.

I wouldn't be here without you and I hope I can always make you all proud.

TL

Day 1 of #31DaysOfTré – I Have a Reason

Fair warning: This is most likely going to be the deepest, most emotional post I've written yet. Due to the content, I'd like to put a trigger warning here. This post will deal with depression, suicidal ideation, anxiety, and many other complicated, difficult topics, and will also contain (minimal) cursing that is unlike most of my writing.


For nearly a year and a half, I romanticized my depression and anxiety. I have never been one to be called a creator, though I've always been a thinker. I've found solace and catharsis through writing. I suppose writing could be considered creative; my best writing came when I was feeling most depressed, existential, or angsty. I felt that I needed my depression to create my art; they were intrinsically linked. It was my paradoxical bondage: without the immense weight of depression, I could never write deeply meaningful pieces that would mean anything to anybody. Without my suicidal thoughts, I could never see the value of life.

Maybe the first problem was that I didn't view myself as depressed or clinically anxious. Yeah, maybe I had thoughts of ending my own life, but I didn't struggle to be motivated to do my daily meds or go to the gym. I still wanted to be social and hang out with friends. I felt excited for certain things. All while in the back of my mind, I knew that if life got bad enough, well, I could just end it. I've spoken to very few people about the depths of my despair. I've been labeled as strong for so long, so even though I feel passionate about better mental health care in America, I still felt I was too strong to get on any sort of anti-depressant. I felt that if people knew how much I struggled internally, how hard it was for me to keep it all together, I could never be a writer, or creator, or that I'd disappoint everybody around me.

I figured that my suicidal thoughts were a natural by-product of life with a chronic disease. I believed that, since it was inevitable that my body would eventually fail me and, unless an incidental death, I already knew my fate. I watched what Alyssa went through before her first transplant and knew I'd eventually watch her die. I believed that considering suicide was a way for me to give one last big fuck you to CF, since even if I died, it was at least the only way of me "beating" CF since CF wouldn't be taking me. I thought that was a normal thought when considering my own mortality.

My intelligence began to betray me. Not only did I romanticize the "art" that was coming from my depression and anxiety, I started to romanticize suicide. I began to convince myself that suicide was an ethically correct decision. We go through so much emotional trauma in life for it to all eventually come to an end, I told myself. What joys could be so worth the emotional valleys, I asked myself. I contemplated death from CF so much that I believed this was all okay and normal, that I wasn't really on the edge, because I'm too strong, of course. 

I started outlining what I would want to write to my loved ones and what my legacy would be. This was okay, I believed, because if I started to realize how much my life meant to those around me then the thoughts would go away and I'd feel loved. Too bad that the idea of being missed and how devastated people would be only reinforced my belief that the emotional trauma isn't worth any possible joy in this life.

To be completely candid, there were three unspeakably difficult thoughts that most likely kept me alive. The first one: Duncan is my dog. The thought of never spending another moment with him, whether I'd be able to realize it or not, took the ground away from beneath me. The second one: How will my friends handle this? If I ever believed one of them was going through what I was going through and I didn't reach out before they did something, I'd never forgive myself. 

And the kicker, the third one, a vision of the future without me: My parents burying two children; one from a devastating 30-year physical battle; the other, the "healthy one," from an internal battle which should've never gotten this bad.

All while I was being tortured by my own mind, I wrote (even subliminally about all of this at times), I posted on social media, I engaged socially with friends, I acted like I was okay. I didn't want others to worry. 

And then we got the bad news about Alyssa in January. It was at this point that two epiphanies flashed through my mind: We know Alyssa isn't going to beat this, though we don't know how long she has. The other: if I don't get help, I'll never get through this.

Alyssa's battle gave me a reason to fight. It gave me a reason to live. It was a more concrete reason than I'd felt in some time. Through the devastation of knowing her life was coming to an end, it awoke something in me. As morbid as this was, I knew her death was imminent and that, if I was opportunistic enough, I could finally have the impact on the world I wanted. I could use my experiences with CF, Alyssa's health and eventual death, and my own internal struggle with depression as a platform to raise awareness on these many different but interconnected adversities in my life.

A week after Alyssa's death, I started seeing a therapist. I started Zoloft and was prescribed Xanax for emergency panic attacks. It's been 5 weeks and I feel alive and hopeful for the future. I feel like I have a chance to use all of this positively. I don't feel self-loathing and I haven't had significant suicidal ideation in several weeks. I feel optimistic that things are going to be okay and I have a future that's worth living.

I strongly believe mental health needs to be a more commonly discussed issue in America. It is so heavily stigmatized, and we're all told – but especially men due to toxic masculinity – to "man up," among other comments, and therefore, so few people discuss it openly. My experiences with CF and grief, as well as my inclination as a writer, have opened me up to be candid about my life. I implore you to be careful of your characterization of mental disease and consider how widely pervasive it is.

This is all getting to what this is all about: May is National CF Awareness Month. For every day in May, I'll be writing a post about my life and my experiences with CF. Some will be educational and about CF directly, and some others will most likely be tangentially related to my experiences with CF. I'm calling it #31DaysOfTré. I recognize this probably sounds arrogant, but I hope it can be a cool project for me to reflect and do some consistent writing about CF and my grieving process. 

I wanted to start with this heavy topic because going through this has helped me finally realize it's okay to love myself and believe I have something to say. I strongly believe in the importance of talking about our mental health and that is something that is deeply affected by my life with CF and Alyssa's life. I believe writing is a platform for me to share my story and to affect change.

I have a reason to write. I have a reason to be optimistic. And most importantly, I have a reason to be alive. Thanks to everybody for supporting me in this life.

I ask that if you are going through anything, please reach out to get the appropriate help. Do not feel bad asking your loved ones for support. They will support you. Do not romanticize it. Please seek the right care to get feeling better. That may be talk therapy, anti-depressants, or something else entirely. I am here to talk as well. The National Suicide Prevention Hotline is 1-800-273-8255.

TL