Hide & Seek

Despite having Cerebral Palsy for 30+ years I’m still learning about it, it’s effects on me, and how it affects others.


I could go in-depth as to why I think that’s the case but that’s probably a topic for another day (before I put my foot in my mouth) but the short version is that there’s little research on people with CP over the age of 18.

Cerebral Palsy effects how the brain communicates with muscles so there’s a misconception that it’s a muscular disorder.

It’s easy to do when the majority of Cerebral Palsy related surgeries deal with bones and muscles.

But a lot of the largely unknown aspects of living with CP have to do with the nervous system.

There’s a startle reflex.

Chronic Pain.

Temporary, yet extreme pain, like a kidney stone.

Side effects from medications.

Trying to do two things at once that requires different areas of your brain, like getting dressed and holding a conversation.

If it has the potential to cause any neurological issues for a person with a normal nervous system there’s a pretty good chance that it’s going to cause issues for someone with CP.



Changing The Healthcare Landscape

Asking a professional patient to name one thing they’d like to change about the current healthcare landscape can be like pulling the pin on one big grievance grenade.

Although I would like more of a community for people over the age of 18 with Cerebral Palsy I’m going to go with something more general and seemingly smaller, but it is one of my biggest frustrations.

Office staff.

There’s the Joint Commission for healthcare organizations.

There’s standards for doctors.

And nurses.

Why not office staff?

They make offices run. They’re invaluable people.

Some know this and use this to their advantage, others don’t seem to have a clue, or maybe they just don’t care.

I’m not saying I’ve left the care of a healthcare provider because of their office staff, but I have thought about it, more than once.

I think maybe there will be a time when that will happen, it just hasn’t happened yet.

If I could change one thing about the healthcare landscape right now, it would be to have some sort of organization that handles the oversight of the assistants of healthcare providers, because although they aren’t in themselves providers they do play a major part in patient care.

They aren’t just handling files and scheduling appointments. They’re handling a person’s life, especially if it’s someone who has a disability or chronic illness.

They aren’t just dealing with annoying people. They can be the lifeline between provider and patient.

I don’t need someone who gets over involved in my care, blurring the lines of professionalism but someone who at least attempt to acknowledge that I can’t just drop everything for an appointment.

Simply put, someone who reads all the information put in front of them before scheduling an appointment (for example).

When someone is rude, or downright mean or neglectful, I wish there was someone, someplace, to report them to. It isn’t a position with minimal consequences if mistakes are made. It can’t be “just a job,” when you’re working alongside people who hold the lives of others in their own hands.

I’m participating in WEGO Health’s Health Activist Writer’s Month Challenge. If you want to find out more about Health Activist Writer’s Month Challenge visit their blog, Facebook, Twitter. You can find more posts by searching #HAWMC.

Please Get Out Of My Kitchen

I was supposed to write an open letter to my worst (or best) healthcare provider but I’m going to do something a little different for two reasons (1) it’s been an interesting few weeks with my and various provider offices and (2) I can’t find the post I thought I had already written on the subject.

Instead I kept coming across a different post that expresses a similar sentiment but better than I could have done in letter form (at least that’s what I think).

I wrote this after yet another appointment that left me frustrated and defeated. I was also somewhat younger than I am now, yet I don’t think I would’ve done a thing differently if I was in the same situation now (although I don’t think I would’ve had the choice either).

I was still months away from one of the biggest days of my life (so far) after waiting months to just to get to the point where I was months away from one of the biggest days of my life. It wouldn’t be an understatement to say that the waiting had pretty much consumed my life.

Looking back on this, since I have a lot of it in writing, I can’t believe I actually lived through this, and I mean that literally. You know the saying, “when you get to the end of your rope tie a knot and hang on”? The knot was getting loose.

Technically I’m still under the care of two surgeons and technically two will be performing my surgery, but I haven’t met that second guy yet. Although I do consider one mine and the other just an extra opinion, and no I won’t say who is who, mamma didn’t raise no dummy.

Plans for surgery are still full speed ahead, although not necessarily very quickly.

Even though the plan hasn’t changed I still have plenty of time to get more opinions on the subject, whether I like them or not.

I recently went back to the surgeon that wanted a lock strap put on my AFO because he thought it would help my crouch, just to see how I would like it (I hated it, and so did everyone else, except him). We had an interesting discussion. Now he says he would do surgery, but not to the extent I’m planning on. He told me it’s basically my decision, but he would only do surgery on my right side, because the left side doesn’t look bad to him (even though test/studies say otherwise).

He also expressed concern about my age (AGAIN!). In case any of you are wondering 25 in the CP world is pretty much the equivalent of retirement to a nursing home.

How the conversation usually goes:

“You’re not a kid anymore.”

“I know.”

How I’d like the conversation to go:

“You’re not a kid anymore.”

“I know I’m not a spring chicken, but can we please get past that.”


Is that so hard?

At least Dr. who-I-hope-will-do-my-surgery-says, “You’re older than the oldest patients that have had this, but only a little.”

O.K. not the most positive thing, but still more positive than what I usually hear from other doctors. I’ve also heard, “I’d like to help you, but I don’t see anyone over fourteen,” of course this was after I’d been in his office for over an hour. Nice right?
(Although I do like the guy so if you’re in the area and need an orthopod for your kid let me know)

Dr. “You-know-you’re-not-a-kid” also expressed concern that it would be a long recovery and the surgery itself would be fun for him to do but rather painful for me. (Because I wouldn’t think of such things on my own, and I haven’t thought of that for months) He also said I’d be “stuck here” for a while so if I wanted to go away again that would be out of the question. Recovery would be twice as long, 12 months instead of 6. He finished with, “If you do this, this will probably be it for you.”

I don’t think I need to go into how much is wrong with those statements from my point of few, but I want to anyway.

1) I’m already in constant pain so intensifying it for a while is worth is if there’s even a chance I could be in less pain, or pain free, once recovered.

2) I’ve thought about how hard and painful recovery is going to be. I’m not stupid, Nor am I afraid of pain, surgery, or intensive PT. I’ve done it before and I can do it again. I retained my entire body to do things people take for granted at 3. I think I can handle it at 25.

3) I want to do this so I have a chance at going away again, and hopefully out of the country at that. I’d rather be “stuck here” for a while instead of “stuck in a wheelchair” in five years.

4) I feel so bad now there a good chance I’ll feel better sooner than a full recovery of 12 months. There’s a reason why it’s a projected 12 months and not a definite 12 months. He of all people should know since I recovered faster from my last surgery faster than he anticipated.

5) Let’s let advances in medical science and I decide what’s “it” for me, thanks.

But it’s in my head now, should I just have surgery on my right side? The right needs more work anyway. I might just end up needing to have the same thing done on the left anyway. Should I take the risk of less?

My first instinct is to just have it all done at once and rebuild. It makes more sense and I’d rather do everything so we don’t need to go back and fix what we should have the first time. But now the other thought is there.

In addition to this new opinion, or rather changed opinion (?). I still have to get a second opinion, at the request of the surgeon who I’d like to perform my surgery. So I have one more opinion coming my way, at least.

I’m slowly coming to terms with the fact that my surgery is scheduled for fall. Actually I might even be starting to see this as the best thing. I realized I don’t want to be in the hospital in the summer, either type of hospital. I don’t want to be home on the couch without having the option to go out and enjoy the weather either. So if you remove the summer months from the calendar, that makes the time frame more manageable. Granted my thought process might chance in 5 minutes, as it usually done.

Have you ever heard the saying, “Too many cooks in the kitchen?” I’ve officially reached the point where I have too many cooks, and I’m the kitchen.

I have just one thing to say GET. OUT. & SHUT. UP.

*A similar version of this post was written on March 20, 2009

I’m participating in WEGO Health’s Health Activist Writer’s Month Challenge. If you want to find out more about Health Activist Writer’s Month Challenge visit their blog, Facebook, Twitter. You can find more posts by searching #HAWMC.

Inspiration & The Saints

Finding inspiration in the Saints can be great, but it can be a real downer.

For a long time I was turned off to the Saints, mainly because people kept comparing me to people I knew I had nothing in common with.

Example: Persons with disabilities are not always frail and plagued with poor health (as so many of the Saints were, for some reason) so in that context its apples and oranges.

And lest we forget the seemingly endless questions about whether I’ve been to Lourdes and do I ever plan on going to receive healing.

(No & HELL NO, in case you were wondering)

I’m not saying that it’s impossible for people to find inspiration from the saints. If I said that I’d be pretty naïve. What I am saying is that people tend to think others look to the Saints more than they actually do, in my opinion. Or for different reasons than others may think.

One of the biggest issues I have with “Saintly comparisons” is during hospital stays and/or bouts of extreme pain. I understand the need for comfort but you need to look at it from another angle, when you’re that miserable being compared to other people doesn’t help matters. It makes you feel like you’re not being a good person just because you’re not handling your hardships as well as someone else.

Comparisons like that don’t really validate a person’s situation in the moment, which means so much more.

Can it help some people? Yes. But from my experience those instances are few and far between.

Plus you’re talking to a person who is alive (and possibly wishing they were dead) telling them about someone who died probably hundreds of years ago; two completely different contexts that you’re trying to compare in an effort to inspire.

It doesn’t work more often than it does work.

Where am I going with this potentially senseless rambling? It’s OK to find inspiration in the Saints; in fact I’d encourage it, for you. But tread lightly when it comes to finding saintly inspiration for others.

The Road To Recovery

More than a few years ago, and at the same time it feels like last week, I was lying in a hospital bed recovering from surgery (actually I thought I was dying but that’s a minor point at this point).

I was just beginning my road to recovery.

And having to answer the question, “Did it work” or “was it successful,” for those of your in the healthcare field.

I have to be honest. I’m never sure how to answer this question, especially since a lingering quad strain came into the picture.

Did it work? Yes.

Was it successful? Yes.

All major goals were met and there have been no complications as direct result of the surgery.

But did I get everything I wanted out of the recovery process? No.

I was warned that one of the outcomes of surgery would be uncovering weaknesses that were, in a sense, hidden by my miserable malalignment (yes that is indeed an actual medical diagnosis) and boy were they right.

Sometimes I feel like I have monoplegia instead of diplegia. Which you think would be a good thing but it’s more like my right leg feels more like an added after the fact limb (maybe like a prosthetic?).

Sometimes I feel like I have hemiplegia, because my arm is hell bent, sometimes literally, on trying to compensate for my leg.

I wish I didn’t have to stay in an AFO, never mind even go as far as to get a second one made. Sometimes I feel so defeated by this one fact alone, but it’s really just accepting reality.

I’ve had to adjust to taking prescribed medication on a daily basis. I’m amazed how hard it is to remember to keep up on refills and orders for more refills, for just one medication.

I have more trouble with some of the most basic things, like climbing stairs, kneeling, putting on my shoes easily, etc., than I did before.

But I’m not in nearly as much pain as I was pre surgery. That alone is worth its weight in gold. Yes, I do still deal with pain on a daily basis, but I rarely shrink back at just the thought of running into the grocery store for 5 minutes. I still hate going to the grocery store, but it’s a pet peeve thing.

So when people ask me if “it worked” of if I’m “better” it’s not an easy answer.

It depends on what your definition of “worked” is. Also I will never be “better,” assuming by “better” you mean “cured.” I started my life with CP & I’m going to end it with CP.

I didn’t have the recovery process I envisioned. But it could’ve been a lot worse. The surgery itself could’ve completely backfired no matter how much hard work I put into the recovery.

Although, if I’m being honest here, I do wonder what would have been possible under the original plan. Where I’d have as much PT as my body could take and my outpatient post-op care team was well coordinated as my pre-operative and hospitalization teams. I was facing an uphill battle even if I had had the best possible circumstances so when things didn’t go, and wouldn’t be going, as planned I started to panic.

The recovery process may technically be over but I’m still figuring things out, the good, the bad, the ugly, and the in-between.

Most importantly I’ve seen what it takes to get what you want. It’s not always easy but it’s worth it, one-hundred times over.

The road to recovery is a lot like closure. You want it and work towards it but it never ends up being how you pictured it so you just keep going, because there’s always more road to travel ahead.


In April I took part in The Health Activist Writer’s Month Challenge this month (also known as #HAWMC). I was supposed to post a recap of the month’s posts, but BADD was yesterday so my monthly review got pushed to today.

I’m not going to lie. This last month has been interesting balancing everything was a bigger challenge than I anticipated, even though I’ve participated in this challenge in the past. One of the biggest blessings of re-launching a blog is that I have a fair amount of previously published material to draw on and republish. Frankly it’s probably the one thing that saved me from throwing in the towel on the whole thing after a few weeks. Doubling your course load and planning to write almost every day for 2 months straight when you can barely manage once a week wasn’t the best idea. But I made it (and I’m ready for a break).

Here’s A Rundown Of Posts:

Wordless Wednesday
The Key To Happiness Is……
Random Acts Of Kindness
A Creature Of Habit
Proudest Accomplishments
My Hero(es)
My Daily Diet
Keeping Track Of Memories
Challenge Of The Day
Comfort Foods
Letter To A Pet Pal
On The 7th Day
(Not Always) A Comeback Kid
“I Feel Best When….”
What Gets Me Excited?
Life Goals Of A 10 Year Old
Tag! CP’s It
Summertime Blues….Maybe
Stress? What Stress?
If I Had Time To Travel
Reflection On Activism
Hobbies In The Lobby
Free Swim
Fitness Friday
Word Cloud
Have A Good Day
Hit The Road Jack
The Reviews Are In
Hindsight Is 20/20

Keeping Track Of Memories

How do I go about remembering things that have happened in my life? It really depends.

I have a journal that I write stuff in, that sometimes doubles as the closest thing I have to a scrapbook. I’d like to tell you that I have scrapbooks as well but I don’t have the time for that, and more importantly I don’t have the patience (even if I had the time).

I have things that remind me of different periods of my life. A lot of them are things that I kept “until” a certain time period has passed, or “just in case,” and I’ve never gotten rid of them.

Like a pair of underwear that I wore the first day I put on real clothes after my last surgery.

(You’re welcome for that tidbit)

Or the tricycle I rode around the hospital on after my SDR.

(I won’t even let anyone borrow it)

Then there’s another category of things I’ve kept.

The “things I keep, but want to get rid of, but don’t in case I need them again,” category.

Those things would be things like, crutches, night braces, wheelchair parts, thera-bands, AFOs that still fit, copies of used prescriptions, restrictions notes, a transfer board, bed pads, even a bedpan.

Eventually though, that last category gets smaller and smaller in terms of items. Usually during the cleaning phases that involve playing “what’s in this box anyway,” however anything that falls under the category of durable medical equipment that required a prescription and/or insurance approval stays. I will never wait MONTHS for a pair of crutches ever again. Ever.

So that’s how I keep track of my memories. It’s unusual but that’s just how my life works.

I’m taking part in The Health Activist Writer’s Month Challenge this month (also known as #HAWMC).

The Key To Happiness Is…..

Happiness can be hard to come by, at least for some people. So what is the key to happiness? I don’t think there’s a one size fits all answer to that question, and if there was someone(s) would be very rich, and the world would be a much more pleasant place to be.

I think being able to overcome a hard time can make a person happy but I’m not sure the feeling of happiness lasts if you have a chronic condition. I mean what makes a condition chronic is that it never goes away and you probably have more than your share of difficult times to get through so I’m not sure everyone with that sort of lifestyle finds happiness after difficulty every single time. But it’s possible.

Laughter is always a winner, at least for me, if I’m laughing there’s a pretty good chance that I’m happy because I’m either doing something that makes me happy, with people who make me happy, or with people who make me happy doing something that makes me happy. And laughing.

Some believe that maintaining a positive attitude makes someone a happy person but I question whether those two things are in fact interchangeable. I think one can have a cause and effect relationship but I don’t think it happens all the time, at least not for everyone, but it certainly does help.

Some believe that happiness is a choice. I have to admit I wish it were that easy. I wish I could choose my mood as easily as I pick out what socks I’ll wear today and that would be that but it’s not that easy, at least for me.

Others believe that happiness is a journey, not a destination. You become happy through a process. It’s not waiting for it to occur. I’m probably most inclined to believe this theory but not 100%.

In my opinion happiness is in the eye of the beholder, and how one achieves happiness is unique to the individual.

I’m taking part in The Health Activist Writer’s Month Challenge this month (also known as #HAWMC).

The Doctors I Won’t Forget

Sarah, of Seriously, Sarah?, wrote about the doctor she won’t forget and how that one person effects how she navigates being a professional patient. Her words hit so close to home that I shared her post on my Facebook page with some of my own thoughts.

I don’t just have one doctor I won’t forget and the same goes for their assistants and office staff. I’ve had enough horrible and incredible experiences to be able to write several books on the topics.

I remember in ’08 when I was looking for someone who could locate (never mind treat) the source of my chronic pain. I went to one doctor who sent me to another. I loved them both and would have stayed under their care if I had more of a support system in place at the time.

Knowing I needed a stronger support system I set out to find new doctors like the ones who opened the door and showed me how badly I needed help, even if it wasn’t going to be coming from them (no matter how much I wanted them to).

I hit the ground running (figuratively) and had my 1st second opinion less than 24 hours after moving across the country. I should’ve taken my lost luggage as a sign that things wouldn’t go well, but this guy came so highly recommended (and I was too jet-lagged) I didn’t even bother with second thoughts.

I should’ve had second thoughts. I should have run screaming out of the office when I was asked (more like forced) to pick the one part of my body that hurt that hurt the most by the radiology technician (because every joint below my belly button wasn’t a good enough answer).

He wasn’t the guy for me. I went home crushed and waited for my formerly lost luggage to arrive from Alabama, while wondering what the hell I was going to do now.

I went to another doctor that someone had heard about. He was great and I would’ve given him the green light but I was “too old” for him, as in “I’d really love to help you, but you’re just too old for me. I don’t see anyone over 15.”

I was 24.

I sat in his office for hours and everyone, except me knew this wasn’t going to go anywhere. I get that private practice is a business just like any other but you’d think someone would’ve said that there was no point even making an appointment.

But because I did like him, and I respected his opinion (because of his background) I asked if he knew of anyone that might be a good fit for what I needed. He told me to go see one of the top doctors in the state. I thanked him for his time (although I wondered if it was really a waste for both of us) and left.

I didn’t go see the doctor he recommended, because I had already seen him. I knew him well. I knew he wasn’t for me.

So I turned to the internet. Surely there had to one person on the entire planet willing to treat a young adult with Cerebral Palsy. They just had to be found, and I was going to do it.

I made more phone calls and a few more appointments. So many that I thought about seeing if there was a world record for the most 2nd opinions and if I was even close to that number (because everyone needs goals, no matter how strange some are).

Then I found a doctor who found one for me, because he was thousands of miles away (but at that point distance didn’t matter) and he knew of someone closer. I took the information to make an appointment but also laid the groundwork to potentially see the guy I found thanks to the World Wide Web, just in case.

I made an appointment not expecting anything to come from it. Why would I after all the appointments I had sat through and how they all ended?

I went thought the appointment, just like I had all the others. It was different but I knew not to get my hopes up. Then he left to review some things and came back to talk to me.

He wasn’t the right person for me either. But he did something every doctor before him didn’t do.

He told me what he saw and then admitted that he could do the job but he knew someone who could do a better job. He’d already called him and he’d agreed to see me.

And the rest, as they say, is history.

I learned a lot from that process but the most important thing I learned is that you don’t get to choose to be a professional patient but if you’re going to be one you have to develop a tough skin because you’re going to carry a few disappointments with you and those are going to affect how you interact with any other medical professional forever. No, I am not being dramatic, at all.

I can’t forget those doctors and I won’t let myself either. As horrible of a journey it was to get quality care they each had a part in shaping the person, and advocate, I am today. Although I won’t go so far as to thank them for it.

What doctors need to realize is that even though someone might be “just another patient” to them they’re not “just another doctor” to that patient, especially when you have a chronic condition with chronic misconceptions.


Chronic Pain & Cerebral Palsy

I had a different plan for today but last week ended horribly for me (and for one reason only) so I thought it would be a good idea to address the why of it.

Chronic Pain.

I’m no stranger to it at this point, as you’ll see. There are times when I’m able to manage it and go on with my day, and then there are other days when I wonder if I’ll ever get a reprieve from it.

It’s common for people with CP to suffer from chronic pain (although I’m unsure of the actual numbers) and chronic pain knows no age limits either. Every time I hear someone say, “You’re so young, you can’t be in that much pain,” I feel my blood pressure rise and my eyes want to pop out of my head (neither of which is helpful to alleviating pain).

Think about it for a minute, CP causes muscles to spasm and contract more (or less) than they should. Now think about how you feel after one muscle spasm or when your trick knee acts up. Now think about that happening to you without warning throughout your entire life. It gets painful.

The thing is it’s hard to recognize if you’ve dealt with it for as long as you can remember.

This is a hard thing for me to address for a few reasons. Pain management isn’t one size fits all. So in regards to this post I’ll be talking about my own personal experience with pain management.

Another important point I think I should address is that I may not have any allergies to medications but there are times when things just go weird. Baclofen makes me incredibly anxious, to the point where I had panic attacks. Prednisone makes me lose my appetite. A medication pulled off the market for causing heart problems and suicidal tendencies worked great for me. Antidepressants seemed to work well for me too.

I’m not good in the self-care department. In fact my pain became so bad that I never thought there would be a solution for it. I resolved that I’d rather run myself into the ground and have a good time than be cautious and bored.

It’s hard for me to pin point when the chronic pain started. My guess is that it was sometime in college. Both of the schools I attended were on relatively small campuses but with my schedule there was at least one day a week when I was on the go for 12 hours straight. Not good, for anybody.

A year out of college my pain was still intense. There were days I’d be on the phone sobbing to someone. The pain was out of control, but what pushed me over the edge was that no one knew what to do for it. I couldn’t wrap my head around the fact that I ran around the nation’s capital for years and now I could barely stand to go anywhere.

I started seeing a physiatrist, she wrote me a bunch of prescriptions & I set up a bunch of appointments, brace clinic, wheelchair clinic, PT evaluation, and dropped off prescriptions, all in the hopes that my pain would become manageable.

I spent the next few months in PT which included aqua therapy, heat treatments, stretching, strengthening, and quality time with a TENS unit. Each land PT session started with the giving of a number, how bad was my pain that particular day. Once it was determined that my pain wouldn’t probably ever get below a “3” I was discharged.

For the record I detest the 1-10 pain scale. When I was at my worst point the numbers meant nothing to me pain was pain. I’d just make up a number so that “box could be checked off.” I understand the ideology behind it but for me it was not practical.

Halfway through my missionary contract the pain came back, and in full force, and then some. Something that started in my knees was now spreading to my back, ankles, hips, spine, I was getting migraines more frequently, and at times even my upper body would hurt from trying to compensate for the lower half.

I decided to get a second opinion on my pain and saw a different physiatrist. She (and an NP) gave me different medications to try and referred me to a surgeon to get his opinion (and x-rays). They could tell I was getting sick and tired of being sick and tired and by this point I was taking more medication to help deal with side effects from my original medications.

After talking it over with the NP, the surgeon, and the physiatrist I realized I agreed with their philosophy, even if that meant more aggressive and invasive treatment. In the long run it seemed like less punishment on my body for the life I had in mind for myself.

Sometimes the best way to manage pain is to do what most people wouldn’t choose to do, like have a pump implanted or have surgery.

It’s also important to remember that even different members of your medical team will have different ideas on how to manage pain. A physiatrist may have no problem with taking ibuprofen all day every day at prescription doses. An exercise physiologist may not want you to take ibuprofen for more than a few days because of long term stomach damage.

The moral of this ridiculously long story? There are a lot of options when it comes to pain management but there’s no golden rule or “how to.” It’s often a trial and error process. If you don’t like something try something else, get a second opinion. Most importantly try and find the real source of the pain, if its spasm, treat the spasm, if its joint displacement look into getting it fixed.

Think of it like having a leak in your pipe. You can fix all the damage from the leak all you want but nothing’s really going to be fixed unless you fix the pipe itself. (Excuse the analogy; I’ve had a leaking bathroom so it came to mind) And there are factors like weather, air pressure, stress, sitting for too long, too much activity, (and if you’re a girl or have a girl PMS etc. really isn’t your friend) that should be considered too.

If you don’t treat the original source things are just going to get worse.

And even treating the original source doesn’t always mean you’ll be home free forever (although that would be nice), especially if you have a long-term diagnosis. If you’re lucky you have more good days than bad days. Honestly I think that’s what most people ask for whether or not you have a chronic pain diagnosis.

I still have days when staying in bed feels like the only option but I still try to power through (although that doesn’t always work). I’m lucky enough to now know when a bad day may or may not be in future. I try to treat the cause before the pain hits full force or deal with the lingering aftereffects.

Regardless of what kind of day I’m having I’m thankful every day of the marvels of modern medicine, because without it my life would look much different than it does today.

*A similar version of this post was published previously on January 18, 2011