Gastroparesis Medical Studies Update; Join and/or Keep Up With Clinical Trials

Source: Unknown

Source: Unknown

Source: On The Image but one of my favorites on how to explain Gastroparesis.









Clinical Trials - We Need Better Treatments

I apologize for taking so long to write an article. I, myself, have had a rough year like everyone else seemed to in the GP Community. I lost A LOT of friends last year in my support groups, people I started support groups with, and people I talked to regularly. I logged into Facebook this morning to check on my groups, as I've been sick with pneumonia on top of Gastroparesis for the past week and a half (before that, my husband and I were passing a respiratory virus back and forth) and found another one of my friends had died. She was someone I've known since I first started advocating for Gastroparesis. She was apart of the handful of women who helped start Gastroparesis support groups and build up the Gastroparesis Community. I wanted to dedicated this article to her, and the other friends I've lost. Last year, we lost 48 people. This year, so far, I think the total is four or five people. It's heartbreaking. We need better treatments. Having invasive "treatments" like feeding tubes, which can cause infections and worse, and then on the other end of the spectrum, medicine like Reglan, which can lead to irreversible, neurological disorders. We need medication to help our stomachs, to keep them from cramping so badly, to help them contract.

We need SOME kind of help. I'm so upset at watching my friends suffer and die. I get scared every time I throw up, wondering if it's going to be the last time - if this is the time I'm going to rupture my esophagus and die. I get panic attacks logging on to Facebook, scared I might read another one of my friends has passed away, which always upsets me right away, not only because they passed, but I feel like when I take breaks from Facebook, that I'm letting them down for not being online. I feel like I didn't get to say what I wanted to say to them before they passed. Most of that is on me. I've been not terrified to log into Facebook, but just



If you are interested in joining a clinical trial for Gastroparesis, The National Institute of Diabetes, Digestive, and Kidney Diseases are having people sign up for one now: https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/clinical-trials


Centerwatch has a long list of clinical trials that need volunteers as well: https://www.centerwatch.com/clinical-trials/listings/condition/72/gastroparesis/


ClinicalTrials.gov has a current trial happening as we speak: https://clinicaltrials.gov/ct2/show/NCT03500354

The Trial Says,

"Brief Summary:

Gastroparesis is a chronic, morbid and costly neuromuscular disorder of the stomach characterized by delayed gastric emptying in the absence of gross structural abnormalities. The periprandial symptoms associated with this disease can preclude adequate oral intake and often lead to weight loss and nutritional deficiencies 1. These manifestations are largely due to impaired gastric accommodation of meals and delayed transfer of food boluses from the stomach into the duodenum2. Consequently, the investigators hypothesize that dietary supplementation with a low volume, hypercaloric nutritional drink can help prevent malnutrition, decrease symptom burden and improve health-related quality of life in this population. Due to the paucity of such a supplement, the investigators developed a novel nutritional drink designed to maximize tolerability in patients with gastroparesis . This nutritional drink was tested on healthy volunteers (phase I) and passed the palatability test. The investigators now aim to test the tolerability of this drink on gastroparesis patients.

Condition or disease Intervention/treatment Phase
Gastroparesis Dietary Supplement: Nutrient drink Not Applicable

Detailed Description:

Primary objective:

To evaluate the safety and tolerability of the nutritional drink in gastroparesis patients.

Secondary objective:

To evaluate the efficacy of the nutritional drink in gastroparesis patients.

Study Procedures This study will be a pilot, open-label, trial in gastroparesis patients. A total of 20 patients will be recruited from the gastroenterology gastroparesis clinic. If the volunteer meets eligibility criteria, a co-investigator will contact the patient to schedule a study visit with a nutritionist and obtain a written consent. The contact and screening information of patients that are successfully recruited will be documented, placed in the participant's study folder and stored in a locked cabinet in the research unit. Any information documented during the screening process for patients who do not meet basic eligibility criteria or do not wish to participate will be immediately destroyed.

Patients will be given enough supply of the nutrition drink for (4 weeks) and asked to consume 200 ml of the drink three times daily. A follow-up call will be scheduled on day 2, day 7 and at the end of the study to make sure patients are tolerating the drink. Participants will be allowed to consume water and food as desired during the study period but will need to maintain an accurate food diary for at least one week prior to enrollment and during the study (at 2 weeks and at 4 weeks) along with weight measurements at baseline, 2 weeks, 4 weeks and 6 weeks. The participants will be asked to complete a palatability questionnaire. They will also complete the Gastroparesis Cardinal Symptom Index (GCSI) daily diary and the PROMISE scale prior to enrollment as a baseline for their symptoms and again at 2 weeks, 4 weeks (end of the study) and 6 weeks. Changes in these scales from baseline will determine the efficacy and possibly side effects of the nutritional drink.

Study duration and number of study visits required of research participants:

4 weeks, initial study visit with a nutritionist for screening and consenting followed by 3 follow-up phone calls on day 2, day 7 and at 4 weeks (the end of the study) and a final study visit at 6 weeks (2 weeks after finishing the study)


Study Type : Interventional (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Pilot feasibility open-label study
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Nutritional Drink in Gastroparesis
Estimated Study Start Date : February 1, 2019
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : August 2019




Primary Outcome Measures:

Tolerability will be measured by the Palatability Questionnaire at 2 days [ Time Frame: 2 days post-intervention ]

Patients will be given enough supply of the nutrition drink for 4 weeks and asked to consume 200 ml of the drink three times daily. A follow-up call will be scheduled on day 2 of the study to make sure patients are tolerating the drink.

Tolerability will be measured by the Palatability Questionnaire which rates six items on a scale of 1 to 5 (1= strongly disagree and 5= strongly agree. The six items are:
The formula/supplement tasted very good.
The formula/supplement tasted very bad.
I had no problems drinking the supplement.
Drinking the supplement made me feel ill.
I could drink more of this supplement anytime
I would never drink more of this supplement again

Tolerability will be measured by the Palatability Questionnaire at 7 days [ Time Frame: 7 days post-intervention ]

Patients will be given enough supply of the nutrition drink for 4 weeks and asked to consume 200 ml of the drink three times daily. A follow-up call will be scheduled on day 7 of the study to make sure patients are tolerating the drink.

Tolerability will be measured by the Palatability Questionnaire which rates six items on a scale of 1 to 5 (1= strongly disagree and 5= strongly agree. The six items are:
The formula/supplement tasted very good.
The formula/supplement tasted very bad.
I had no problems drinking the supplement.
Drinking the supplement made me feel ill.
I could drink more of this supplement anytime
I would never drink more of this supplement again

Tolerability will be measured by the Palatability Questionnaire at 4 weeks [ Time Frame: 4 weeks post-intervention ]

Patients will be given enough supply of the nutrition drink for 4 weeks and asked to consume 200 ml of the drink three times daily. A follow-up call will be scheduled at 4 weeks to make sure patients are tolerating the drink.

Tolerability will be measured by the Palatability Questionnaire which rates six items on a scale of 1 to 5 (1= strongly disagree and 5= strongly agree. The six items are:
The formula/supplement tasted very good.
The formula/supplement tasted very bad.
I had no problems drinking the supplement.
Drinking the supplement made me feel ill.
I could drink more of this supplement anytime
I would never drink more of this supplement again

Safety will be measured by the NIH PROMISE scale at baseline [ Time Frame: Baseline ]

This will be measured by the NIH PROMISE scale. This is a 10 point scale (0=none and 10= most severe) that rates the following symptoms:
Pain, especially in the abdomen, chest or back
Abdominal distension (bloating, sensation of excess gas)
Difficulty eating, sensation of food being stuck in the stomach.
Difficulty with bowel movements (constipation or straining)
Nausea and/or vomiting
Thirst
Weakness, lack of energy, fatigue, difficulty moving.

Safety will be measured by the NIH PROMISE scale at 2 weeks [ Time Frame: 2 weeks post-intervention ]

This will be measured by the NIH PROMISE scale. This is a 10 point scale (0=none and 10= most severe) that rates the following symptoms:
Pain, especially in the abdomen, chest or back
Abdominal distension (bloating, sensation of excess gas)
Difficulty eating, sensation of food being stuck in the stomach.
Difficulty with bowel movements (constipation or straining)
Nausea and/or vomiting
Thirst
Weakness, lack of energy, fatigue, difficulty moving.

Safety will be measured by the NIH PROMISE scale at 4 weeks [ Time Frame: 4 weeks post-intervention ]

This will be measured by the NIH PROMISE scale. This is a 10 point scale (0=none and 10= most severe) that rates the following symptoms:
Pain, especially in the abdomen, chest or back
Abdominal distension (bloating, sensation of excess gas)
Difficulty eating, sensation of food being stuck in the stomach.
Difficulty with bowel movements (constipation or straining)
Nausea and/or vomiting
Thirst
Weakness, lack of energy, fatigue, difficulty moving.

Safety will be measured by the NIH PROMISE scale at 6 weeks [ Time Frame: 6 weeks post-intervention ]

This will be measured by the NIH PROMISE scale. This is a 10 point scale (0=none and 10= most severe) that rates the following symptoms:
Pain, especially in the abdomen, chest or back
Abdominal distension (bloating, sensation of excess gas)
Difficulty eating, sensation of food being stuck in the stomach.
Difficulty with bowel movements (constipation or straining)
Nausea and/or vomiting
Thirst
Weakness, lack of energy, fatigue, difficulty moving.

How Gastroparesis Acts in The Body. Source:https://www.pinterest.com/pin/278026976974184742/?lp=true









Secondary Outcome Measures:

Improvement in gastroparesis symptoms [ Time Frame: Baseline, 2, 4 and 6 weeks ]
Change in weight compared to baseline

Improvement in gastroparesis symptoms [ Time Frame: Baseline, 2, 4 and 6 weeks ]

Changes in the Gastroparesis Cardinal Symptom Index (GCSI) daily diary as compared to baseline. This is a six point severity scale (0-5 with 0= none and 5 = very severe) that rates the following symptoms
Nausea
Early satiety
Postprandial fullness
Bloating
Upper abdominal pain
Retching
Vomiting
Stomach fullness
Loss of appetite
Stomach or belly visibly large



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study: 16 Years and older (Child, Adult, Older Adult)
Sexes Eligible for Study: All
Gender Based Eligibility: Yes
Gender Eligibility Description: Female or male
Accepts Healthy Volunteers: No
Criteria

Inclusion Criteria:

Patients with gastroparesis confirmed with symptoms and a gastric emptying study.
Inability to maintain adequate caloric intake by standard dietary measures for gastroparesis due to gastrointestinal symptoms

Exclusion Criteria:

Recent diagnosis of disorder other than gastroparesis that could affect food intake
Oropharyngeal dysphagia or other condition with risk for aspiration from oral ingestion.
Allergic reactions to any of the ingredients of the nutritional drink
Current pregnancy. Pregnancy status will be determined by questioning the potential subject.
Patient with gastrostomy/jejunostomy tube feeds or on total parenteral nutrition
Currently taking any anti-coagulant


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03500354

Contacts

Contact: Pankaj J Pasricha, MD 4105027173 ppasric1@jhmi.edu
Contact: Carmen Roberts 4105027173 ccroberts@jhmi.edu

Locations

United States, Maryland
Johns Hopkins University Active, not recruiting
Baltimore, Maryland, United States, 21287
Sponsors and Collaborators
Johns Hopkins University
Investigators

Principal Investigator: Pankaj J Pasricha, MD Johns Hopkins University
More Information
Go to


Responsible Party: Johns Hopkins University
ClinicalTrials.gov Identifier: NCT03500354 History of Changes
Other Study ID Numbers: IRB00157677
First Posted: April 17, 2018 Key Record Dates
Last Update Posted: December 19, 2018
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No


Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Johns Hopkins University:

malnutrition


Additional relevant MeSH terms:

Gastroparesis
Stomach Diseases
Gastrointestinal Diseases
Digestive System Diseases
Paralysis
Neurologic Manifestations
Signs and Symptoms"

Source:https://preferredresearchpartners.com/gastroparesis-infographic/

Take Action: For Many Patients and Their Families, Advocacy is About Helping Themselves and Others

I did NOT write this but this article has a lot of great information in it and I wanted to hang on it it later, to use for research regarding advocacy. I like having all of my sources and things together.


(http://journals.lww.com/neurologynow/Pages/articleviewer.aspx?year=2016&issue=12010&article=00019&type=Fulltext)

By: Kunkle, Frederick

"Karen J. Smith started a support group for people with Parkinson's disease after she was diagnosed with the condition at age 42. When Michael Ellenbogen learned he had an early-onset form of dementia at 49, he used social media to build a community of people interested in finding a cure for Alzheimer's disease. After Catherine (Cathy) DeCreszenzo's husband, Joe, was diagnosed with spinocerebellar ataxia, a rare neurodegenerative disease that causes spastic body movements and problems with balance, she started educating herself about the disorder so she could help him and others. And since her diagnosis of amyotrophic lateral sclerosis (ALS) 19 years ago, Catherine G. Wolf has initiated research projects and fought on behalf of people with disabilities. These four people, and hundreds like them, choose to cope with their diseases by taking action. Whether they're raising awareness or money, participating in clinical trials, providing support, or pressuring politicians, advocates help bring about change that could benefit themselves, their families, and perhaps thousands of other people, now and in the future. Their firsthand experience of living with a neurologic condition gives them a unique perspective.

'Our whole mantra is we need people with the disease out in front,' says Veronica “Ronnie” Todaro, MPH, vice president of national programs at the Parkinson's Disease Foundation. 'It's a core philosophy of the foundation. 'For those who feel called to do more but don't know where to start, we asked patients and their families to trace their paths to advocacy.'

Picture taken from IMGUR.



START WITH YOURSELF

Advocacy begins at home, says Todaro. 'People who make the best advocates are those who have advocated for themselves first,' she says. 'It's hard to help others without your own plan in place.' The first step is to be as educated about your disease as possible. Then work with your doctor and support team to come up with treatment and care that ensures your quality of life. Don't be afraid to ask your doctor or medical team questions, and persist until you get answers, she says.That was an important lesson for the DeCreszenzos. In their search for the right neurologist for Joe, they were uncompromising about finding an expert who was committed to fighting on their behalf. They chose Joseph M. Savitt, MD, PhD, a neurologist at Johns Hopkins University in Baltimore, for his warm demeanor and willingness to answer questions at any time without sugarcoating, says Cathy.




FIND STRENGTH IN NUMBERS

By joining a support group, people often find the courage to speak louder for themselves and others. It emboldened the DeCreszenzos to start their own support group in Newark, DE. When Joe was first diagnosed with ataxia, the couple traveled to Chesapeake, MD, to join a group sponsored by the National Ataxia Foundation. In the early days, the group was especially important because ataxia is extremely rare, Cathy says. Only about 150,000 people in the United States are known to have the condition. Just talking with others fighting a similar disease was helpful, she says. 'They tell you about their challenges, you tell them about yours. You compare notes and see if you can help each other.' Smith, 56, who was diagnosed with Parkinson's disease about 14 years ago after she noticed a tremor in her left ring finger, kept quiet about her disease initially. 'I didn't want people to know I had it,' she says.

Her advocacy work began when she formed a support group. From there she established a walk to raise awareness about the disease. She took out books at her local library and asked librarians to put up displays about the disorder. She signed up for newsletters and attended conferences when she could, and she even visited the US Food and Drug Administration (FDA) to learn more about the drug approval process. She joined clinical trials. With every step she became more confident and less depressed, she says. 'By becoming involved, I think I'm making a difference in people's lives. I can say, ‘I know what you're going through. You'll make it.’”

Found at: http://datab.us/Search/Gastroparesis.



RAISE YOUR HAND

Volunteering was another crucial step on the DeCreszenzos' path to advocacy. Together, Joe and Cathy have organized fundraisers, including one in September that raised more than $10,000 for research. Joe, 67, now serves on the National Ataxia Foundation's board of directors. Along the way, Cathy, 60, says she discovered new strengths. 'Asking for money comes very easily to me because I know it's needed,' she admits. 'Being an advocate helps me deal with what's happening to my family. Every year I get stronger.' The cause has taken on new urgency for the DeCreszenzos since learning that Joe's ataxia is hereditary and one of their daughters has tested positive for the disorder.





JOIN A TRIAL

Besides contributing to research that could lead to a cure or better treatments, participating in a clinical study gives advocates credibility to encourage others to join. The Parkinson's Advocates in Research program, created by Todaro, looks for individuals who have participated in studies. It has trained more than 230 people with Parkinson's disease or their caregivers on how to guide researchers and find ways to work together in the search for a cure. Many advocates who work with the foundation have been in dozens of clinical trials. 'It's taking control of your disease,' Todaro says. 'It's saying, ‘I can play a role in making things better.’'If you participate in a clinical trial, use that opportunity to establish a relationship with the scientists, investigators, and institutions involved. These people are often in the best position to effect change. Being able to communicate concerns also helps ensure that studies focus on the right issues and that researchers design them to be effective and humane,' Todaro says. In September, for example, Parkinson's disease advocates met with the FDA to highlight symptoms and side effects of the disease for which no treatments currently exist, she says.





GET TRAINING

To hone your skills as an advocate, reach out to the national organization for your disorder. The Parkinson's Disease Foundation, for example, has a nationwide program, the People with Parkinson's Advisory Council (PPAC), to identify advocates and leaders, evaluate their abilities and talents, and provide further education and training to support their public advocacy. The council's 14 members serve as advisors on the foundation's research, education, and advocacy programs.

Taken from IMGUR.





GO PUBLIC

For some, the logical extension of their advocacy is speaking to the public, either through media interviews, public forums, or in front of Congress. That's where Ellenbogen, 57, ended up after first establishing a presence on LinkedIn, where he ultimately connected with 6,000 people who could help him understand Alzheimer's or work toward a cure. Ellenbogen, who has lived with the disease for eight years, has worked hard to ensure that the testimony of people with dementia is included in public forums and panels.Ellenbogen's dedication to speaking out earned him an invitation to the World Health Organization forum in Geneva in March 2015; he was the only person with dementia attending who was not there as part of an organization. His letters have been included in the Congressional Record, and he received an appointment to the Pennsylvania Alzheimer's Disease State Planning Committee. 'You're going to get a lot of people telling you ‘no’ and ‘it can't be done.’ You go around those people. You find a way. Don't accept it when someone tells you it can't be done,' he says.






BUILD MOMENTUM

When his mother-in-law was diagnosed with Alzheimer's disease, George Vradenburg, former chief counsel for AOL, started by educating himself about the disease. Then he hosted a gala dinner for the local Washington, DC, chapter of the Alzheimer's Association. As the circle of invitations grew wider, the gala became national. Vradenburg, who was accustomed to moving among the business and political elite of DC, teamed up with former House speaker Newt Gingrich to create a national Alzheimer's study group. Established with the bipartisan support of the Congressional Task Force on Alzheimer's Disease, the group, which included former Supreme Court Justice Sandra Day O'Connor, was charged with developing a coordinated national plan to fight the disease.Still frustrated that not enough was being done, Vradenburg and his wife, Trish, a writer and former journalist, formed USAgainstAlzheimer's in 2010. The philanthropic group has pushed the federal government to adopt timetables for finding a cure or better treatments and has set its sights on accelerating the drug approval process.





ESTABLISH A CHARITY

The impulse to start a foundation or charity is often strong after a devastating diagnosis or event, but Vradenburg suggests that you first think about what you hope to accomplish. Large donors might fund a building for research or back a team of researchers. Others might choose to focus on caregiving, which could mean donating to a specific facility or to research on caregiving, such as using music to alleviate the symptoms of dementia. “Find your purpose. It's not enough to say, ‘I want to cure Alzheimer's,’” Vradenburg says. “Of course you do. Focus on a piece of the issue that matches your budget and fits your passion and where you can have the biggest impact.”

This was found a Google Image search because I wanted people to understand what it's like to have GP.

This was shared to me by a friend and I love what it says.





PLAY TO YOUR STRENGTHS

Wolf, who was at the top of her field in research psychology when she was diagnosed with ALS in 1996, says the will to keep going helped in her legal fight against an insurer that denied her home care 10 years ago, and it's what recently drove her to help revamp the Westchester Library System's website so it's easier for people with disabilities to use. An expert on interaction between humans and technology—she once worked at IBM's Thomas J. Watson Research Center—Wolf, now 68, continues to conduct research on how people with disabilities interact with computers. She also writes articles about living with ALS and posts disability news to her Facebook page. She types by raising and lowering her eyebrows to trigger a computer switch inside a headband.





EVERY STEP COUNTS

Advocacy isn't just about grand gestures. It can be as straightforward as ensuring that the local library has displays or pamphlets about your disease. Or trying to establish a commemorative month for a particular disorder. Or signing an email petition.As Ellenbogen says, anyone can be an advocate. 'If you write a letter to Congress once in a while or reach out to people in some small way to change attitudes, you're still being an advocate,' he says. Vradenburg agrees. Just the act of acknowledging the disease, which isn't always easy given the stigma associated with some neurologic conditions, is a big and brave first step, he says. 'Telling your story has an effect on the person hearing that story. It also has an effect on the person telling the story,' says Smith. 'I wasn't an advocate on day one or day 100. It took me several years. Now it's what makes my life meaningful. The day I stay home is the beginning of the end. I'll rest when I can't get out of bed.'
© 2016 American Academy of Neurology"

I borrowed this from GPACT, because this image is right.



If you want to be an advocate, it is going to take a lot for to work towards it. It means spending a lot of your hours and free time researching things, organizing groups, events, etc. It takes a lot of work but think of all of the people you would be helping who really have no one else to turn to. I hope this article spoke with you, like it did with me.

Pregnancy and Gastroparesis

I am featuring a series of guest bloggers to blog about things that I don't have personal experience with, who can better answer your questions. A lot of questions that I've received recently have to do with GP and Pregnancy. I don't have any experience with this but thankfully, I had two women offer to share their different stories with you and try to alleviate any questions that you have about pregnancy regarding GP. There is a group on Facebook, Pregnancy and GP, that might be able to help you and answer your questions there as well. It can be found here: https://www.facebook.com/groups/GPSexandPregnancy.


These two, brave ladies are willing to share their experiences with you. If you have any further questions, please leave it in the comments so that they can answer them for you. I am grateful for all of my guest bloggers, for tackling the issues that I feel are important. I'm very grateful for their stories and I hope that you have a good read!

Image taken from http://pregnancycmwa.files.wordpress.com/2013/05/pregnancy-happy-face.jpg



My Pregnacy with GP
by: Julienne Floetke

I have had Gastroparesis for 6 years now. I was able to get pregnant very easily (which is such a blessing, I know it's not easy for everyone). I had a miscarriage with my first pregnancy last year and am 25 weeks pregnant right now. I was incredibly scared to get pregnant because of the GP. With my first pregnancy, I stopped taking the medicine I was on (Nortriptyline) due to the risks. It was extremely difficult coming off the medicine, but I didn't really have a choice. I chose not to go back on the medicine so that when I got pregnant again, I wouldn't have to worry about it. (I had surgery and had to wait 8 months to try again).

The first 17 weeks of this pregnancy were extremely challenging. I have never felt so sick in my life. I did not understand how there were so many people in this world and why people would continue to have babies if it was like that for everyone. It has definitely improved and my thoughts have also changed.

Seeing my little baby and feeling her move around is so worth the pain and struggles that go along with being pregnant and having GP. I've heard of many people getting better while they are pregnant though, so my story isn't the only way it could go!

Every pregnancy is different. I am still taking Zofran every night to prevent vomiting from morning sickness. I was scared about getting pregnant, but my want of being a mom overruled those feelings. Every day is different with pregnancy, just as it sometimes is with GP.

I've never thought about giving GP to her because no one else in my family has it. I never really thought of it as genetic, which it could be, I don't know. If she does get it though, I've learned so much through my journey I would hope to be able to help her. I pray that she is perfect and healthy though, of course.
I have mentioned on the forum before that I struggle really bad with vitamins. I've always gotten sick with vitamins so trying the prenatal, the prenatals without iron, the gummy prenatals, and Flintstones have taken a toll on my stomach.

I feel EXTREMELY guilty that I haven't taken vitamins (even a little consistently) since I was 8 weeks pregnant. I was trying to eat better to get more nutrients, but that went down the drain when I had a flare and then got kidney stones.

I have researched online about people not taking vitamins and everything pretty much seems negative. I hate not being strong enough to take them every day or even once a week. I feel like I'm failing and that is not a good feeling. I feel like I would do a better job of taking care of her outside of my body at this point. I'm praying she comes out healthy and well nourished. That's all I can do sometimes.

Kidney stones with bowel issues aren't very fun either, but because I deal with pain every day with my stomach, I just use my tactics to get through it. I try not to take Tylenol because I feel like that is something I do have control of and I just work through it. I get very down about having Gastroparesis and feel like it's extremely unfair to have to work so hard at things people can do without a problem. But I cry and get it out and focus on the things I can control.

Being chronically ill makes everything a challenge, and pregnancy is no different. However, those of us with GP are a rare breed. We are strong. Our bodies were made to have babies and I have trust in my body that it will do what it needs to in order to get her earth side healthy and whole. Thanks for listening!





My Pregnancy Story
By: Melinda Horne

I had two kids with GP (gastroparesis) but I did not know that I had GP at the time. During my first pregnancy, the most difficult part was getting pregnant. We tried for nine years before finally succeeding, and we had two early miscarriages before that and both were before eight weeks along.

We spent years having test and seeing fertility doctors with no real explanation as to why we could not get pregnant. I did know that I had PCOS (Poly-cystic Ovarian Syndrome) but found that I was ovulating every month with no luck.

The month we found out we were pregnant, the doctor was just as confused as us, as the test showed we did not ovulate that month. Clearly, it was wrong.

My pregnancy was pretty normal aside from the fact that I vomited twenty-four seven, and at two months pregnant, I left work because I couldn't work newspaper hours on no sleep/no energy. I couldn't even answer the phone at work as I was always in the bathroom.

One day I fell asleep at work at my desk and after that day I did not go back. I knew when the baby came that I would have to stop working at the newspaper, as both parents can't work 12 hour days anyway. I did better at home with the vomiting because I could lay down when nausea hit hard.

The last month was bad so the doctor put me on Phenergan and it worked but it also made me sleep for long periods of time, like twelve to eighteen hours. I only woke up to drink protein/meal shakes. I was obese and gained only eight pounds with her during the pregnancy.

I delivered vaginally in only eight hours (lucky for me since the epidural didn't work even after being stuck 5 times we never found the right spot), record time for a first pregnancy. She was an ounce shy of being 7 lbs and completely healthy.

About two years later we decided to try again and it only took us six months to get pregnant. I was still sick this time but learned from the first pregnancy not to eat certain heavy foods that did not stay down, and to supplement this with a lot of meal replacement shakes and soft foods.

I didn't have any complications until 29 weeks when we discovered that I had a slow amnio leak and was forced to drink 72 ounces of water a day. I lived in the bathroom. At about 32 weeks, my water level was low. So from that point on, we went to hospital twice a week to check fluid levels, and to have a bpp (bio-pyschical profile) and non stress test. My doctor kept a close eye on us. We got a lot of looks at the baby and everyone said that the baby would be a girl.

At 34 weeks, while having a bpp (bio-psychical profile), while we looked at baby's breathing and took measurements, the tech and I discovered that it's actually a boy!

A week later at my bpp and stress test didn't score well. They did a more in depth ultrasound and the baby was not growing much. My fluid level was low, 10 is a good fluid level and 5 is danger zone, mine was 1.2. The doctor said they would have to treat me like my water broke and deliver me.

My body wasn't really ready and induction is long and painful. I delivered him the next day vaginally, without any major problems. He was born and weighed 5 lbs 7 ounces, and was small but healthy. We found out his lungs and everything was developed. He stayed with me and then went home with me after a few days.

I would highly recommend a good doctor that deals with high risk patients and babies. I am convinced that the doctor is why my son did so well. Being diagnosed with GP, I would want a doctor that at least was willing to listen to concerns and make sure you get the medical care you need while pregnant with GP, even if that means dealing with your GI doctor to manage you.

Suicide and Chronic Illness

I am involved with a lot of gastroparesis groups on Facebook. A few weeks ago, we lost one of our members to suicide. I wanted to address this, so that her death had some meaning, and to reach out to anyone else who is feeling lost and lonely. Please know that you aren't alone. Many people with chronic illnesses have a higher chance of suicide, according to medical studies.

***THESE HELPLINES ARE NOT EXCLUSIVELY TO GPERs, SO IF YOU NEED THEM FOR ANOTHER FRIEND, PLEASE USE THEM! PRINT THEM AND PUT THEM ON YOUR FRIDGE!***

According to The Guardian (http://www.theguardian.com/society/2011/aug/23/suicide-chronic-illness-study,

"At least one person takes their life every day while suffering from a chronic or terminal illness, and the government is neglecting this hidden trend, the think tank Demos has said.

In a study, The Truth About Suicide, researchers found at least 10% of suicides in Britain are linked to terminal or chronic illness, accounting for more than 400 deaths a year. The think tank, which said the study marked the first attempt to estimate the scale of suicides related to illness, wanted to challenge the notion that taking one's own life is largely about a patient's mental health rather than physical state. Researchers also found some people were killing themselves at a "younger age in order to avoid severe symptoms and greater pain later in life".

The figures come from a mixture of sources, including data from freedom of information requests to 147 primary care trusts, which are supposed to conduct annual suicide audits.

Researchers also conducted a series of interviews with serving and recently retired coroners. Demos also had access to suicide inquest files in Norwich from May 2006 to December 2010 to identify the proportion of suicides that involved people with terminal or chronic health conditions. It said that of the 4,390 individual suicide cases last year, 10% concerned people "experiencing some form of serious physical illness as an influencing factor".

The researchers said patients with such conditions "should be considered a high- risk group for suicide within national policy, and much greater attention should be given to providing better medical, practical and psychological support". The issue has become a fixture in public debate as growing numbers of UK citizens with chronic or terminal conditions have traveled to the assisted-death organization Dignitas in Switzerland to be helped to end their lives. Last year, a coroner recorded a verdict of suicide over the death of Michelle Broad, wife of the former England cricketer and international referee Chris Broad, who had motor neurone disease.

Louise Bazalgette, author of the report, said the 'lack of attention paid to people with terminal or chronic illness committing suicide is a gross dereliction of duty on the part of the government and health services. The difficulty we experienced in tracking down evidence of the relationship between physical illness and suicide suggests a willful avoidance of what is an extremely important public health issue.

'The results are devastating: at least 400 people with terminal or chronic illness commit suicide every year and this cannot continue to be ignored.'

She said a government consultation on suicide prevention, issued last month, focused on the same 'at risk' groups identified by Labor in 2002: those using mental health services, prisoners and people with a history of self-harm.

Source: https://nacchocommunique.com/2016/08/23/naccho-aboriginal-health-racgp-calls-for-urgent-action-to-support-the-health-and-wellbeing-of-our-youth/</a>




'Eighty prisoners committed suicide last year. That is only a fifth of suicides of patients with chronic or terminal conditions. There's an urgent need for support,' she said.

Experts agreed hospital doctors and GPs could do more to identify patients at risk from suicide but warned that the issue was 'more complicated.'

Linda Gask, professor of primary care psychiatry at the University of Manchester, said it was wrong to think 'being depressed enough to commit suicide is either because of your mental health or your physical health: one is linked to another. We know that 30% of diabetes patients are depressed. Not all of them commit suicide.

'On the other hand, those traveling to Dignitas would say they are not depressed. They argue they are making a rational decision because they do not want to live like this.'

Charities were also wary of clearly ascribing the cause of a suicide to either physical or mental health problems.

Jo Ferns, director of research for the Samaritans, said the issue was one of 'risk' and what factors increased the chance of suicide.

'People with chronic conditions could be not suicidal but perhaps apathetic about living or dying. They are not saying they will kill themselves but taking decisions that do increase the risks. I think that's what we have to watch for.'

A Department of Health spokesman said its mental health strategy recognized 'that physical illness increases the risk of mental health problems and vice versa. We are consulting with bereaved families and experts in general practice, local government, and other organizations on a new strategy to prevent suicides.

"]'The consultation calls upon healthcare professionals to be alert to mental health issues, especially depression, in the patients that they see for known physical health problems, and to take the right steps to help people with long-term conditions have a better quality of life.'"

According to WebMD (http://www.webmd.com/depression/guide/chronic-illnesses-depression
,

"Dealing With Chronic Illnesses and Depression:

For millions of people, chronic illnesses and depression are facts of life. A chronic illness is a condition that lasts for a very long time and usually cannot be cured completely, although some illnesses can be controlled or managed through lifestyle (diet and exercise) and certain medications. Examples of chronic illnesses include diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis (I'm going to go ahead and say GP since I believe it's a chronic illness and just as debilitating, even though it's not in the article).

Many people with these illnesses become depressed. In fact, depression is one of the most common complications of chronic illness. It's estimated that up to one-third of people with a serious medical condition have symptoms of depression.

It's not hard to see the cause and effect relationship between chronic illness and depression. Serious illness can cause tremendous life changes and limit your mobility and independence. A chronic illness can make it impossible to do the things you enjoy, and it can eat away at your self-confidence and a sense of hope in the future. No surprise, then, that people with chronic illness often feel despair and sadness. In some cases, the physical effects of the condition itself or the side effects of medication lead to depression, too.

What Chronic Conditions Trigger Depression?

Although any illness can trigger depressed feelings, the risk of chronic illness and depression gets higher with the severity of the illness and the level of life disruption it causes. The risk of depression is generally 10-25% for women and 5-12% for men. However, people with a chronic illness face a much higher risk -- between 25-33%. Risk is especially high in someone who has a history of depression.
Continue reading below...

Depression caused by chronic disease often makes the condition worse, especially if the illness causes pain and fatigue or it limits a person's ability to interact with others. Depression can intensify pain, as well as fatigue and sluggishness. The combination of chronic illness and depression might lead you to isolate yourself, which is likely to make the depression even worse.

Research on chronic illnesses and depression indicates that depression rates are high among patients with chronic conditions:

Heart attack: 40%-65% experience depression
Coronary artery disease (without heart attack): 18%-20% experience depression
Parkinson's disease: 40% experience depression
Multiple sclerosis: 40% experience depression
Stroke: 10%-27% experience depression
Cancer: 25% experience depression
Diabetes: 25% experience depression
Chronic pain syndrome: 30%-54% experience depression

Symptoms of Depression

People with a chronic illness as well as their family members often overlook the symptoms of depression. They assume that feeling sad is normal for someone struggling with disease. Symptoms of depression are also often masked by other medical problems. The symptoms get treated, but not the underlying depression. When you have both a chronic illness and depression, you need to treat both at the same time.

Source: https://williamsonsource.com/save-lives-learning-warning-signs-suicide/




Treatment Options

Depression is treated much the same way for someone who is chronically ill as someone who isn't. Early diagnosis and treatment can ease distress along with the risk of complications and suicide. Many times, depression treatment can improve your overall medical condition, a better quality of life, and a greater likelihood of sticking to a long-term treatment plan.

When depressive symptoms are related to the physical illness or the side effects of medication, your doctor may need to adjust or change your treatment. When the depression is a separate problem, it can be treated on its own. More than 80% of people with depression can be treated successfully with medicine, psychotherapy, or a combination of both. Antidepressant drugs usually take effect within a matter of weeks. You should work closely with your doctor or psychiatrist to find the most effective medication.

My friend Melissa wrote this and I wanted to share it because it's true.



Tips for Living With a Chronic Illness

Depression, disability, and chronic illness form a vicious cycle. Chronic medical conditions can bring on bouts of depression, which, in turn get in the way of successful treatment of the disease.

Living with a chronic illness is a challenge, and it's normal to feel grief and sadness as you come to grips with your condition and its implications. But if these feelings don't go away, or you are having trouble sleeping or eating, or you've lost interest in the activities you normally enjoy, seek help.

To avoid depression:

Try not to isolate yourself. Reach out to family and friends. If you don't have a solid support system, take steps to build one. Ask your doctor or therapist about support groups and other community resources.

Learn as much as you can about your condition. Knowledge is power when it comes to getting the best treatment available and keeping your sense of independence and control.

Make sure that you have medical support from experts you trust and can talk to openly about your ongoing questions and concerns.

If you suspect that your medication is bringing you down, talk to your doctor about other possible treatments.

Talk with your doctor about pain management.

As much as is possible, keep doing the things you like to do. You'll stay connected as well as boost your self-confidence and sense of community.

If you think you're depressed, don't wait to get help. Find a therapist or counselor you trust."

If you ARE feeling suicidal, please reach out to someone for help - a friend, a family member, priest, counselor, or click on the links below for help. We don't want to lose you, you're too valuable and your life is not meaningless.

Suicide Prevention:

If you are feeling suicidal and you want help then I have some websites for you to look into:

The Suicide Prevention Hotline: 1-800-273-TALK (8255)

http://www.suicidepreventionlifeline.org/gethelp/online.aspx

http://www.helpguide.org/articles/suicide-prevention/suicide-prevention-helping-someone-who-
is-suicidal.htm

http://www.afsp.org/

http://suicide.org/

http://dbhdd.georgia.gov/suicide-prevention

Here is a link to determine whether someone is really suicidal or not:

http://www.onhealth.com/suicide/article.htm

I received a Crisis Management document when I was starting my fraternity chapter. I wanted to share it on this article because it might help someone else, and would definitely help someone dealing with something like this in college or in school:

Image Source: Psi Upsilon



According to Healthcare.org,

"Are You Feeling Suicidal?

How to Deal with Suicidal Thoughts and Feelings and Overcome the Pain

You're not alone; many of us have had suicidal thoughts at some point in our lives. Feeling suicidal is not a character defect, and it doesn't mean that you are crazy, or weak, or flawed. It only means that you have more pain than you can cope with right now. This pain seems overwhelming and permanent at the moment. But with time and support, you can overcome your problems and the pain and suicidal feelings will pass.



I'm having suicidal thoughts, what do I need to know?

No matter how much pain you’re experiencing right now, you’re not alone. Some of the finest, most admired, needed, and talented people have been where you are now. Many of us have thought about taking our own lives when we’ve felt overwhelmed by depression and devoid of all hope. But the pain of depression can be treated and hope can be renewed. No matter what your situation, there are people who need you, places where you can make a difference, and experiences that can remind you that life is worth living. It takes real courage to face death and step back from the brink. You can use that courage to face life, to learn coping skills for overcoming depression, and for finding the strength to keep going.




Remember:

Your emotions are not fixed - they are constantly changing. How you feel today may not be the same as how you felt yesterday or how you'll feel tomorrow or next week.
Your absence would create grief and anguish in the lives of friends and loved ones.
There are many things you can still accomplish in your life.
There are sights, sounds, and experiences in life that have the ability to delight and lift you - and that you would miss.
Your ability to experience pleasurable emotions is equal to your ability to experience distressing emotions.

Source: https://sicklervillesun.com/this-life-counts-suicide-awareness-and-prevention-program-set-for-oct-3-65b2f3134b51




Why do I feel suicidal?

Many kinds of emotional pain can lead to thoughts of suicide. The reasons for this pain are unique to each one of us, and the ability to cope with the pain differs from person to person. We are all different. There are, however, some common causes that may lead us to experience suicidal thoughts and feelings.




Why suicide can seem like the only option

If you are unable to think of solutions other than suicide, it is not that other solutions don’t exist, but rather that you are currently unable to see them. The intense emotional pain that you’re experiencing right now can distort your thinking so it becomes harder to see possible solutions to problems, or to connect with those who can offer support. Therapists, counselors, friends or loved ones can help you to see solutions that otherwise may not be apparent to you. Give them a chance to help.

Source: https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml






A suicidal crisis is almost always temporary

Although it might seem as if your pain and unhappiness will never end, it is important to realize that crises are usually temporary. Solutions are often found, feelings change, unexpected positive events occur. Remember: suicide is a permanent solution to a temporary problem. Give yourself the time necessary for things to change and the pain to subside.




Even problems that seem hopeless have solutions

Mental health conditions such as depression, schizophrenia, and bipolar disorder are all treatable with changes in lifestyle, therapy, and medication. Most people who seek help can improve their situation and recover. Even if you have received treatment for a disorder before, or if you’ve already made attempts to solve your problems, know that it’s often necessary to try different approaches before finding the right solution or combination of solutions. When medication is prescribed, for example, finding the right dosage often requires an ongoing process of adjustment. Don’t give up before you’ve found the solution that works for you. Virtually all problems can be treated or resolved.




Take these immediate actions

Step #1: Promise not to do anything right now
Even though you’re in a lot of pain right now, give yourself some distance between thoughts and action. Make a promise to yourself: 'I will wait 24 hours and won't do anything drastic during that time.' Or, wait a week.

Thoughts and actions are two different things—your suicidal thoughts do not have to become a reality. There is no deadline, no one's pushing you to act on these thoughts immediately. Wait. Wait and put some distance between your suicidal thoughts and suicidal action.

Step #2: Avoid drugs and alcohol
Suicidal thoughts can become even stronger if you have taken drugs or alcohol. It is important to not use nonprescription drugs or alcohol when you feel hopeless or are thinking about suicide.

Step #3: Make your home safe.
Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you are unable to do so, go to a place where you can feel safe. If you are thinking of taking an overdose, give your medicines to someone who can return them to you one day at a time as you need them.

Step #4: Don’t keep these suicidal feelings to yourself
Many of us have found that the first step to coping with suicidal thoughts and feelings is to share them with someone we trust. It may be a family member, friend, therapist, member of the clergy, teacher, family doctor, coach, or an experienced counselor at the end of a helpline. Find someone you trust and let them know how bad things are. Don’t let fear, shame, or embarrassment prevent you from seeking help. And if the first person you reach out to doesn’t seem to understand, try someone else. Just talking about how you got to this point in your life can release a lot of the pressure that’s building up and help you find a way to cope.

Step #5: Take hope - people DO get through this
Even people who feel as badly as you are feeling now manage to survive these feelings. Take hope in this. There is a very good chance that you are going to live through these feelings, no matter how much self-loathing, hopelessness, or isolation you are currently experiencing. Just give yourself the time needed and don’t try to go it alone.




Reaching out for help

Even if it doesn't feel like it right now, there are many people who want to support you during this difficult time. Reach out to someone. Do it now. If you promised yourself 24 hours or a week in step #1 above, use that time to tell someone what's going on with you. Talk to someone who won't try to argue about how you feel, judge you, or tell you to just 'snap out of it.' Find someone who will simply listen and be there for you.

It doesn’t matter who it is, as long as it’s someone you trust and who is likely to listen with compassion and acceptance.

Source: https://nicoa.org/national-suicide-prevention-week/




How to talk to someone about your suicidal thoughts

Even when you’ve decided who you can trust to talk to, admitting your suicidal thoughts to another person can be difficult.

Tell the person exactly what you are telling yourself. If you have a suicide plan, explain it to them.
Phrases such as, ‘I can't take it anymore’ or ‘I’m done’ are vague and do not illustrate how serious things really are. Tell the person you trust that you are thinking about suicide.

If it is too difficult for you to talk about, try writing it down and handing a note to the person you trust. Or send them an email or text and sit with them while they read it.





What if you don't feel understood?

If the first person you reached out to doesn’t seem to understand, tell someone else or call a suicide crisis helpline. Don’t let a bad experience stop you from finding someone who can help.


If you don’t know who to turn to:

In the U.S. - Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433).

In the UK and Ireland - Call the Samaritans at 116 123

In Australia - Call Lifeline Australia at 13 11 14

In other countries - Visit IASP or Suicide.org to find a helpline in your country.




How to cope with suicidal thoughts

Remember that while it may seem as if these suicidal thoughts and feelings will never end, this is never a permanent condition. You WILL feel better again. In the meantime, there are some ways to help cope with your suicidal thoughts and feelings.

Source: https://www.youthchg.com/product/adolescent-suicide-prevention-poster/




If You Have Suicidal Thoughts and Feelings Things to do:

Talk with someone every day, preferably face to face. Though you feel like withdrawing, ask trusted friends and acquaintances to spend time with you. Or continue to call a crisis helpline and talk about your feelings.

Make a safety plan. Develop a set of steps that you can follow during a suicidal crisis. It should include contact numbers for your doctor or therapist, as well as friends and family members who will help in an emergency.

Make a written schedule for yourself every day and stick to it, no matter what. Keep a regular routine as much as possible, even when your feelings seem out of control.

Get out in the sun or into nature for at least 30 minutes a day.

Exercise as vigorously as is safe for you. To get the most benefit, aim for 30 minutes of exercise per day. But you can start small. Three 10-minute bursts of activity can have a positive effect on mood.

Make time for things that bring you joy. Even if very few things bring you pleasure at the moment, force yourself to do the things you used to enjoy.

Remember your personal goals. You may have always wanted to travel to a particular place, read a specific book, own a pet, move to another place, learn a new hobby, volunteer, go back to school, or start a family. Write your personal goals down.

Source: http://www.laloyolan.com/news/lmu-raising-awareness-on-suicide-prevention/article_58e6305a-7345-520c-9de5-60fd6783da79.html




Things to avoid:

Being alone. Solitude can make suicidal thoughts even worse. Visit a friend, or family member, or pick up the phone and call a crisis helpline.

Alcohol and drugs. Drugs and alcohol can increase depression, hamper your problem-solving ability, and can make you act impulsively.

Doing things that make you feel worse. Listening to sad music, looking at certain photographs, reading old letters, or visiting a loved one’s grave can all increase negative feelings.

Thinking about suicide and other negative thoughts. Try not to become preoccupied with suicidal thoughts as this can make them even stronger. Don’t think and rethink negative thoughts. Find a distraction. Giving yourself a break from suicidal thoughts can help, even if it’s for a short time.




Recovering from suicidal thoughts

Even if your suicidal thoughts and feelings have subsided, get help for yourself. Experiencing that sort of emotional pain is itself a traumatizing experience. Finding a support group or therapist can be very helpful in decreasing the chances that you will feel suicidal again in the future. You can get help and referrals from your doctor or from the organizations listed in our Recommended reading section.




5 steps to recovery

Identify triggers or situations that lead to feelings of despair or generate suicidal thoughts, such as an anniversary of a loss, alcohol, or stress from relationships. Find ways to avoid these places, people, or situations.

Take care of yourself. Eat right, don’t skip meals, and get plenty of sleep. Exercise is also key: it releases endorphins, relieves stress, and promotes emotional well-being.

Build your support network. Surround yourself with positive influences and people who make you feel good about yourself. The more you’re invested in other people and your community, the more you have to lose—which will help you stay positive and on the recovery track.

Develop new activities and interests. Find new hobbies, volunteer activities, or work that gives you a sense of meaning and purpose. When you’re doing things you find fulfilling, you’ll feel better about yourself and feelings of despair are less likely to return.

Learn to deal with stress in a healthy way. Find healthy ways to keep your stress levels in check, including exercising, meditating, using sensory strategies to relax, practicing simple breathing exercises, and challenging self-defeating thoughts.





Where to turn for help

Suicide crisis lines in the U.S.:
National Suicide Prevention Lifeline at 1-800-273-8255 or IMAlive at 1-800-784-2433.

The Trevor Project offers suicide prevention services for LGBTQ youth at 1-866-488-7386.

SAMHSA's National Helpline offers referrals for substance abuse and mental health treatment at 1-800-662-4357.


Suicide crisis lines worldwide:

In the UK and Ireland: Call Samaritans UK at 116 123.

In Australia: Call Lifeline Australia at 13 11 14.

In Canada: Call Crisis Services Canada at 1-833-456-4566.

In other countries: Find a helpline near you at Befrienders Worldwide, IASP, or International Suicide Hotlines.

Sources: https://twitter.com/afspnational




Recommended reading

If you are thinking about suicide, read this first – Tips for getting you through when you’re feeling suicidal. (Metanoia.org)

About Suicide – Information for those considering suicide or have attempted suicide in the past. (NHS)

Coping with Suicidal Thoughts (PDF) – How to understand your suicidal feelings and how to develop a safety plan. (Consortium for Organizational Mental Health)

Authors: Jaelline Jaffe, Ph.D., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: October 2018."

Source: https://en.wikipedia.org/wiki/Suicide