Research: As in War, so in Medicine

I should have written this blog last night, as it was the 75th anniversary of dropping the plutonium bomb on Nagasaki, Japan, which effectively ended World War II. Instead of writing about this, I watched the excellent movie “Fat Man and Little Boy” (1989), directed by Roland Joffé and starring Paul Newman. It details the creation of the Manhattan Project in Los Alamos, New Mexico, where top nuclear physics scientists are corralled in secrecy, racing to create the doomsday bomb before the Nazis do. It took only 19 months of intense, crazy pressure, and about $2 billion to create the first two thermonuclear weapons, used on Hiroshima (Aug 6,1945) and Nagasaki (Aug 9,1945). These remain the only times when nuclear weapons were used in war. It’s estimated over a quarter of a million Japanese died.

In the race to complete the bombs, scientists nationwide raised moral questions: should we even do this? At what cost in lives? The Nazis had surrendered by then and Hitler was dead; did we need to drop this on Japan? The moral questions were ultimately pushed aside in the quest to finish the project and end the war fast.

What made me startle was the dollar amount tossed out by General Leslie Groves, who headed the project: $2 billion in research. This is equivalent to about $28 billion today!

I thought about the costs estimated for gene therapy for hemophilia, estimated at $2 million per person. We all balk at this, but I also think about the amount of time, energy, expertise, investment and expectations that determine this price. Watching the Manhattan Project take shape and unfold in the movie, you’re amazed at level of intelligence of the scientists, the personal and professional sacrifices they make, the intensity of research. We see that happening now with a race to find a vaccine for COVID-19. What does it take, how long, and at what cost?

The bombs ended the war. Japan surrendered on September 2, 1945 in a humiliating defeat. Research that caused massive and sudden death and destruction for a final victory. The moral dilemma: was this research for good or for evil?

We’re now racing to defeat another enemy in war: COVID-19. Almost any cost is bearable, yet we are at odds with one another at what costs, and how much. The inconvenience of wearing masks? Laughable when we watch the sacrifices of those in World War II, or any war. Loss of livelihood? A serious sacrifice. Loss of life? No question. Any cost, any inconvenience.

In hemophilia, there was a time when we were at war, with HIV. We raced to find methods to kill HIV in the blood supply, and then to create recombinant products (not from human plasma). Now we have the luxury of time. Current standard factor products in the US are excellent, plentiful, accessible. Expensive, yes, but we have them. And we have ways to pay for them. Gene therapy will be a luxury product at first, and very expensive. It will be a challenge to convince payers to cover this, but we believe ultimately in access to all therapies. Freedom. As in war, so in medicine.

And no matter how you look at it or what the cost, it is still expensive research to cover, but research for the good.

Facts and Figures, Emotions and Reason

Facts: Who knew?

I don’t have many phone apps, but one I love is called Facts. Every day, I receive a unique fact in white lettering on a pretty background. The facts tend to be trivia, such as “A group of rhinos is called a crash.” Or, “Metallica is the first and only band to have played on all 7 continents.” (Who knew?)

Yesterday, the fact read, “We keep believing things, even when we know they’re wrong. Social manipulation can alter memory and extend the amygdala to encompass socially mediated memory distortions.”  

This message seems a dire warning of the dangers of social media. We all want the facts—truth. And the truth is hard to discern amidst a rampant pandemic that has so far killed over 154,000 Americans. My friends on Facebook want to make sense of what is happening, and in doing so, post and repost graphics and statements that seem contradictory at best, and dead wrong at worst. It reminds me so much of the years of the HIV epidemic, where fear took over common sense and critical thinking.

“Mathematics allows for no hypocrisy and no vagueness,” said the French writer Stendhal. Mathematics is said to be pure, logical, apolitical. But statistics… that is entirely different. Statistics uses math to reveal patterns and relevance. Statistics can be manipulated, presented in a half-light. Statistics can be used to support an argument, but can also be used to refute the same argument. Who to believe? And when you have a pandemic in an election year, with emotions running high, statistics are tossed about as truth. When I start seeing statistics and patterns of numbers presented on Facebook by my friends, I begin to wonder what they are trying to say or prove.

For example, one colleague in late April posted a chart from the CDC showing that the combined COVID-19 and pneumonia and flu deaths were about 94,000. She gloated that the CDC “lied” because there were not 94,000 dead from just COVID, as stated in the news, but that the total included other disease states. I politely questioned her statement, and pointed out that the current COVID death toll of 94,000 at the end of April was not the same as the 94,000 figure she was using. The CDC data she was using was from early April. In a matter of a few weeks, the death toll had skyrocketed. An easy mistake to make, but she was comparing incorrect numbers. Instead of thinking about this, she accused me of driving an agenda to match “my own narrative.” Yet, while I have not ever posted anything of a political nature on social media, that’s all she was doing on Facebook.

Many are now using statistics on social media to do just that, support a narrative, usually political. It makes me wonder if, during the HIV scandal years, if there had been such a contested election and polarized politics, would we be manipulating statistics so much and ignoring the public crisis? Would we tell people not to wear condoms as we now flaunt not wearing masks? Would we deny the number of people dying? We didn’t have social media then, nothing to fuel the flames of conspiracy.

Here’s another example that prompted me to write this blog:

If you look at the dots on this map, such a “small” death toll does not seem too bad. The poster also insinuates that such a death toll is not worth “turning our lives upside down,” though she does not say what this means (simply wearing a mask? Or losing a livelihood?). Ask: what message is she trying to say? What could be misleading about this?

Now think of the HIV epidemic, which wiped out half of our community. We lost 10,000 people over a number of years. That would barely be visible on this map. One lone little grey dot. Yet, it decimated us. It led our community to advocate and this led to permanent changes in how blood is collected, tested and distributed, for the betterment of all.

And now think of this map from this perspective: with 1,000 Americans dying daily, it’s as if three loaded jumbo jets are crashing every, single day… for months.

What’s missing from Carrie Ann’s map is time. And this is important.  Here’s more perspective: 154,000 dead from COVID in four months is almost as much as the 157,000 dead in over 20 years of the Vietnam War. Top medical experts are now saying we could hit 200,000 Americans dead by fall. This is about one-third of all US deaths from HIV in the past 38 years.

Now get away from a snapshot of a map, and look at trends below:

The virus is exploding exponentially in number of cases. And eventually, in number of deaths, until a vaccine is approved. Or not? Could it be that cases are exploding and will continue while the death rate might level off at some point?

So why do people latch on to a map, or one graph, or fail to compare, contrast, and critically review what is posted and reposted on Facebook or other social media?

Perhaps it does has to do with the amygdala. The little organ in the brain responsible for the “fight or flight” reaction. The little organ that is considered the seat of emotions. It filters perceived and real threats from outside us, to help determine our next actions. Do we run away from danger? Do we stand and fight? We see political posts, and fearful posts about COVID, and we stand to lose our business or loved ones, or even our favorite elected official, yet we no longer can fight physically from a computer. Instead, we attack via posts. Whatever we do, it’s usually an emotional response.

What overrides the amygdala is the grey matter, the frontal lobe, the prefrontal cortex, the seat of reason. Far too many people seem to be allowing the grey matter to take a back seat. Instead, the constant barrage of posts on social media act like physical threats to us, and we react emotionally by twisting statistics or simply reposting something without stopping to ask: Is this true? Does this present facts in the right perspective? What is the source of the post? Are they credible? Could I be wrong? What is a better way to say this, or present this?

Rational response vs emotional reaction

Or more importantly: are my beliefs (political, religious) filtering the statistics and making me use them to support my beliefs or “narrative,” or will I allow the information to challenge my beliefs?

One community member posted this, which sarcastically challenged the statistics people had been tossing about, and put things in perspective:

Even if the fatality rate of children in school due to Covid-19 is “only 1%”, there were 56.6 million kids enrolled in school in the US last year. 1% of that is 566,000, or just slightly less than the population of the entire state of Wyoming. But it’s fine, right? It’s just 1%, right?

When you first enter my house, you may notice a framed picture hanging on the wall. It’s one of my favorites. “Pallas and the Centaur” by Renaissance artist Botticelli shows the Greek goddess Pallas Athena, goddess of knowledge and wisdom, with her hand on the head of a centaur. Her beauty and cleanliness is in contrast to the horseman’s hirsute body and tortured facial expression. The mythological centaurs were believed to be lusty, passion-filled creatures, all emotion. While there are many interpretations, I regard the painting as meaning knowledge and rational thought can and should override baser emotions, like lust, anger and hatred, for the betterment of humankind.

Maybe I’m just feeding my own narrative, but I think we could use more critical thinking when we use social media; more rational thought than emotional reactivism; and more recognition that one life does matter. It’s not all about statistics. Each of the 154,000 represents a loved one, and we still have time to save the other 50,000 or more in danger.

“If you can’t find the right answer, first you identify all the wrong ones”. -Joan Clarke, The Imitation Game

Hemophilia: A Woman’s Journey to Effective Treatment

by Milora Morley, MPH

©LA Kelley Communications, Inc. Reprinted with permission.

Publication: Pulse 9.19

I never thought at age 27 that I would begin a journey as a woman diagnosed with mild hemophilia A. My brother, as well as several men in my family, have all been diagnosed with severe hemophilia A. I’m no stranger to this disorder.

Milora Morley

            I grew up in the south Florida hemophilia community. As my brother’s keeper, and older sister, I had a lot of responsibility as a secondary caregiver. I knew about doctor appointments, factor brands, and clinical trials. But when the roles change, and you’re the one who may need caregiving…everything changes.

            I remember I encouraged my brother to be positive and live his best life. Hemophilia was not the end of the world! Now, here I am years later, feeling discouraged and defeated, as if hemophilia were indeed the end of the world.

            My personal journey has been difficult. Witnessing my brother’s experience made me hope that I’d also get the attention and treatment I need to move forward. But I was wrong. As much as health professionals may know about hemophilia, it seems that they know it only as it pertains to males. In my experience, the specialists aren’t always educated about this bleeding disorder, or maybe they truly don’t want to believe that a woman can have hemophilia.

A Surprise Diagnosis

In 2016 I lived in Atlanta, Georgia, and became my brother’s legal guardian; he had recently relocated from Miami, Florida, to complete his senior year of high school. During his transition, he lost Florida Medicaid and was also ineligible for Georgia Medicaid. He was left with no insurance.

            Later in the semester, he had a hip bleed. We rushed to the ER. Thankfully, the hospital social workers helped him receive emergency Medicaid, which covered his visit. While he was being treated, they suggested I have free genetic testing for parent or guardians, so I did.

            My brother wrapped up his final semester as a senior, and I moved to Los Angeles, California, in October 2017. In November my brother called, asking me to contact his nurse. When I called her, she explained that they had been trying to reach me for the last few months. I was in a bit of shock as she told me that I have a factor level of 38%—mild hemophilia A—and that I should register with a local hemophilia treatment center (HTC).

            I asked her what hemophilia looks like in women. I reflected on my past and current health issues, particularly my prolonged menstrual bleeding. At age 16, I began experiencing irregular menstrual bleeding due to abnormal hormone levels, but by age 22 my periods became more irregular and very prolonged. My menstrual cycle would stop for a day or two and start all over again; this went on for months. Doctors diagnosed me with pre-polycystic ovarian syndrome (PCOS), and started me on birth control right away.

            Before my hemophilia diagnosis, my ob/gyn refused to take me off birth control. We agreed that once I reached my weight goal, she would take me off so we could address the underlying issue of what was causing my PCOS or prolonged bleeding. I lost nearly 90 pounds to combat PCOS, and achieved my weight goal, only to have the doctor change her mind and tell me that I should just stay on birth control.

            I felt defeated. I eventually decided to stop birth control and explore my own options. By this time, I had already relocated to LA and had just received my hemophilia A diagnosis, but I was also having prolonged bleeding. I thought it best to start the journey with the mindset that maybe this bleeding was not just PCOS but also influenced by my new hemophilia diagnosis. So I connected with my PCP and decided to get back on birth control while I figured this all out.

            My PCP sent a referral for me to be seen by the local HTC in LA. However, my insurance denied it, as well as the appeal, due to “lack of medical necessity.” At this point, I didn’t have many options, so I figured I should see an in-network specialist.

“Women are just carriers”

On April 5, 2018, I had my first appointment with an oncologist who supposedly had experience treating patients with hemophilia. I told him about my strong family history and that I thought hemophilia could possibly be the real cause of the menstrual issues I’d been having, and not PCOS, as stated by past physicians.

            Although he had received a copy of the official diagnosis, the oncologist told me that it’s unlikely for women to have hemophilia, and that women are just carriers. He suggested I be tested by a lab that he trusted. He also suggested I have an ultrasound performed to look at my ovaries. I complied.

            A month later, I returned to this doctor, who said, “Your results came back, and you have mild hemophilia A.” This was now my second diagnosis. He told me that I needed to book another appointment in three to four weeks for him to give me a plan for treatment.

            Feeling a bit frustrated, I asked, “And what about my menstrual cycle?” The doctor acted confused, as if I’d never talked to him about my irregularities and PCOS. He told me nothing could be done about my irregular bleeding. I asked him, “Aren’t you alarmed that I have prolonged bleeding when off birth control, and isn’t that a symptom of hemophilia in women?”

            He then became defensive, and I became even more frustrated because two things became clear: First, the doctor hadn’t listened to me during my first visit, due to his assumptions about women with hemophilia; nor had he properly prepared for my visit. When diagnosing me, he spoke as if we had never discussed my family history of hemophilia, or any of the things I’d brought up.

            Second, the doctor had never had a female patient with hemophilia. When I asked if he would be open to consulting with Hemophilia Foundation of Southern California or the local HTC to determine a treatment plan for my menstrual cycle, he declined, stating that he could do his own research. I left the office in tears and didn’t feel comfortable returning to this doctor. I was still left looking for answers.

            In November 2018, I switched insurance plans through a new employer and tried the process again. This journey to finding the underlying issue is important for me. My new PCP, who was also a hematologist, admitted that he didn’t think he’d be the most suitable hematologist for me because he was out of practice in that specialty and not familiar with women with hemophilia. He asked me what I wanted to do, and I said I wanted to go to the local HTC. He agreed to send in a referral through our medical group.

            Again, my referral to be seen by the HTC was denied by insurance because they believed they had specialists more than capable of providing me the care I needed in-house. I obliged once again, and decided to see a specialist they referred me to in-network. But this time I was a bit more optimistic, because the specialist was a woman and this was one of the best health systems in greater LA. There was no reason I wouldn’t be able to find the care I needed…right?

            I was excited to meet this new specialist on January 7, 2019. She was an oncologist, but she also had experience with bleeding disorders. However, what this really meant was that she was experienced with treating women with von Willebrand disease (VWD). During my first visit, she suggested that my factor levels be tested once again. Although I had provided two prior diagnoses, I agreed. This time, my third diagnosis came back with much lower levels—23%. Most likely, this was due to no longer being on birth control.


I really wanted to work with this specialist to figure out the best options for me. A friend of mine connected me with the Women’s Bleeding Disorder Coalition, which helped educate me about what hemophilia looks like in a woman.

            I thought it would be a good idea to connect my new specialist to the coalition. Surprisingly, she agreed, and I thought, wow, this is great! They provided my specialist with more information on hemophilia in women. I was happy and excited to hear that my specialist had taken that step on my behalf.

            But during a follow-up visit, I was taken aback when my new specialist (who I had been bragging about) made comments invalidating the information that was shared with her through the Women’s Bleeding Disorder Coalition, because they weren’t “medical professionals.” I was crushed.

            Sadly, I left that appointment with no treatment plan to address my menstrual bleeding, and the only medication offered to me was one most commonly used in women with VWD. Here we are, April 2019, and I still have irregular or prolonged menstrual bleeding. I’ve been fortunate to see an endocrinologist, who has been working very hard to determine my underlying issue. But at this point, he can’t pinpoint the actual cause. The reality is that he is not a hematologist, so he can’t help me access factor and attempt a trial treatment to determine whether my prolonged bleeding is in fact hemophilia.

            I have also been working with Hemophilia Foundation of Southern California to get access to the GHPP (Genetically Handicapped Persons Program) insurance, which would cover my visits to an HTC. I am currently awaiting a decision and crossing my fingers for a positive outcome. Now, at 28, I just want answers. I just want to know what’s the true culprit behind my prolonged menstrual bleeding, and what I can do to control it.

            I hope that one day, it won’t be so difficult to be connected to a doctor or specialist who really knows hemophilia in general and how to treat women with hemophilia. I also hope that soon, women will have the option to be seen at an HTC as opposed to being forced by insurance companies to see an oncologist.

            Women all over the world are gaining a voice through social movements and in politics. It’s time for the medical field to give us a voice—and answer, as well.

Milora Morley lives in Los Angeles, CA. She is employed as a business data analyst for Cedars-Sinai Medical Center. She uses her free time productively, as a small business owner of Paramedical Tattoo Services.

Wild Child

Remember the 2014 movie “Wild”? About a woman, self-named “Cheryl Strayed” (as in strayed from the path), who decided to hike the Pacific Crest Trail from California to Oregon, a journey of 1,100 miles. Recently divorced, her life in emotional tatters, the trip is supposed to help her figure out who she is and where she is going in life. With no hiking experience at all, the journey is filled with danger and discovery. The movie received positive critical reviews.

Free Will: William Addison

I was reminded of the movie this weekend after driving to Connecticut, to a trailhead on the Appalachian Trail (AT), to catch up with a young man with hemophilia who is now undergoing his own “Wild.” Will Addison is hiking 2,200 miles, southbound (“SOBO”) from Maine to Georgia, to raise money for the nonprofit I founded, Save One Life. That in itself is astounding. But consider this: he is not even 20, and is traveling solo.

Doug and I arrived at the trailhead around 5:30 pm, and immediately saw members of our local community, there to cheer Will on. Then Will’s parents arrived, David Addison and Victoria Kuhn, and their daughter Grace, Will’s twin sister, all from Maine. These are true outdoors people, who love camping and adventure. They came fully prepared to restock Will with food and supplies.

For Will, this was day 44, and mile 718. We parked by the side of the road, waiting for Will to appear.  There were freshly baked chocolate chip cookies from Victoria, beer, and lots of laughs. Some of us came equipped to camp overnight with the Addison family, and to see Will off in the morning. We learned from Victoria that Will would not arrive till about 9 pm, or later, so we decided to hike the 1.5 miles on the AT ourselves to find the camp site, and to set up camp. It was a lovely hike in the 90° heat, shady and moist. My biggest fear was the plethora of Virginia Creeper everywhere lining the trail. I am highly allergic to this plant: even a brush of it against my skin will leave a rash like a second degree burn for two straight weeks. And I was wearing shorts!

Bleeding disorder community waits for Will

Once at camp, we quickly set up tents, spread out our sleeping gear, and then hiked back again to wait for Will.

Around 9:30 pm, as we milled about, watching the magical and mesmerizing green flashing lights from the multitude of fireflies deep in the woods, out of the forest, out of nowhere, came Will! He literally burst into our little latern-lit gathering at the edge of the woods as if it was just a little stroll; in fact, he had just completed his longest day, at 28.5 miles. Just imagine… while carrying a pack weighing about 30 lbs.

He looked great. He is tall—6 feet 1 inch—with blond hair growing longer by the day, serene brown eyes, and lanky legs. He immediately sat down and began eating! We had a lovely visit with him and the community members, who peppered him with questions about his trip so far. Victoria, ever resourceful, brought a Save One Life sign, and we took a group photo. And we all signed his banner, which he is bringing with him to Georgia, the way Chris Bombardier did when he accomplished each of the Seven Summits. This sounds like a trite thing, but when you are limited it what you can carry, and you are traveling for 105 days solo, every ounce matters. It’s a huge display of respect and commitment for Will to carry the banner.

Hiking to camp

We had cheesecake in honor of a milestone birthday for the twins, just two days before!

By 10 pm we had to call it a day. The visitors drove off, and the final team hiked to camp: Victoria and David, daughter Grace and son Will, Doug and I, and Paul, father of a son with VWD. Now it was dark, with fireflies twinkling like little green stars above, so we used our headlamps to light the way on the trail.

Once at camp, we stuffed our food into a bear box, then quickly got to sleep in our sleeping bags on the ground in the woods, serenaded by the hooting of a barred owl that eventually flew off in search of prey.

Morning came fast, as birds lit up the woods in chorus at 5:30 am. By 7 am we had packed everything and readied for breakfast. Will showed me how to use my “Pocket Rocket,” a gas-powered cooking device. As I am a danger in a normal kitchen with a gas stove, this 5-inch device that looked like a little bomb scared me to death. But Will was a good teacher: I boiled water for tea successfully.

Laurie Kelley and Will Addison: sharing a love of hiking and contribution

This was a great time to ask Will about his journey so far. He is young, only a teen, but mature beyond his years. Still, where and how did he get this idea and ability? He is an athlete, participating in track at school, and soon to start cross-country track. He is a Boy Scout, “Third generation!” Victoria proudly added, a program which no doubt has provided him with the training and skills needed to camp out for 105 nights straight, and get him all the way to Georgia. He infuses often, every other day, to ward off bleeds. He has zero body fat (and lost about 10 pounds on the trail so far) but has muscle tone, so he is in excellent shape. He has an outdoor-oriented family, so the woods are not new to him. He seems to thrive in them like a true wild child!

He’s raising money and awareness for Save One Life, our international child-sponsorship organization. Why Save One Life? He wanted to make a difference in the world, beyond the borders of Maine, his home state. I sense he wants adventure in the great, wide world too. Perhaps one day Will and I will climb Kilimanjaro together, and he can also see our families in Kenya and Tanzania, how they struggle and how much they need our help. His eyes lit up at this idea.

Breakfast in the wild

Will spends most days alone on the trail, quiet, thinking, listening to music through his iPod. It can be lonely. He is only a kid, really. How does he keep it together? My most important question was this: what have you learned about yourself these past 45 days?

He thought for a moment, while munching on a baguette. “I think I’ve learned that I am more independent than I thought I was.”

Powerful statement. As parents of children with hemophilia, we want our children to be independent. This might be an extreme example, but a teen who can hike an average of a marathon each day for 105 days solo, while needing to infuse every other day, is beyond impressive. It’s stunning. He needs abilities like discipline, goal setting, planning (“He planned everything himself,” Victoria adds), preparation, focus. Independent? More than most adults I know. This young man, William Addison: watch for him. Donate to his hike’s cause, Save One Life (he wants to reach $10,000!). Follow him on Facebook. Learn some things from his amazing journey. He’ll be hiking till September.

William Addison is the type of young person we want to see more of in the world–with or without hemophilia. He is the future… I hope, with all my heart.

Wild child, full of grace, savior of the human race…. “Wild Child,” The Doors, 1969

Mental Health During Coronavirus

Debbie de la Riva

The collective pursuit to control the spread of coronavirus has resulted in an enormous challenge for the bleeding disorder community. The economic fallout of sheltering in place has affected our need for a steady income, health insurance, access to medical treatment, and—equally important—our access to each other. The degree of impact on our families is hard to determine, but it’s safe to say this pandemic has been very stressful.

But stress in not a new concept for the bleeding disorder community. In fact, our community has been dealing for years with the emotional angst of fighting for what is needed to manage our medical conditions. Remember our fight for safer products, or our fight for laws to protect us from job discrimination? Today’s battle, for our community, is to deal with the stress resulting from the pandemic. So let’s follow the same steps we have taken so many times before.

Let’s get informed, find our resources, and stick together.

Get Informed

To learn to manage stress, we need to become familiar with how our central nervous system works. Our brain comes pre-wired with an intricate system that functions to keep the rest of our body alive. This is the limbic system, which provides the “fight-or-flight” response. If the brain determines that the body is in danger, it initiates a chemical chain reaction that gets the body ready to either fight the challenge or run from it. This response begins when sensory information is picked up by a part of the brain called the amygdala. If the amygdala determines there is a threat, it signals other parts of the brain and body to release hormones such as adrenaline and cortisol. These hormones instruct the heart and lungs to increase their output in order to create the energy needed to meet the challenge. This fight-or-flight response is extremely effective when a person needs physical energy to avoid a danger such as jumping out of the way of a car.  But most of today’s challenges are emotional, and they don’t require the extra energy provided by the stress response. The result is a steady supply of stress hormones circulating in the body at all times. The image that comes to mind is a person standing next to an IV pole and steadily receiving drips of adrenaline and cortisol. In others words, our body remains in a constant state of high alert.

The good news: We do have the ability to slow down the stress response. Since we now know that the brain is constantly scanning our body and our environment to determine if it should go into stress or relaxed mode, we can intentionally offer cues to indicate that we’re not in danger. In fact, this is how meditation works. The first goal of meditation is to slow down your breathing rate. This is important, because once your brain receives the signal that your breathing rate is lowered, it will interpret this to mean that you’re not in danger, and will turn off the stress response. The second goal of meditation involves your focus. You want to be focusing on the present—instead of musing about the past or anticipating the future—and you want to intentionally focus on words or images that evoke feelings of peace or happiness.

You can bring up images of when you felt safe and happy, or you can think of words that reassure you. This tool is like anything else in life: it requires practice and commitment. But eventually, you’ll find that you can truly create a sense of well-being, no matter what’s going on in your life. Sound too good to be true? Do you need proof? Ask yourself how you feel when you’re watching a scary movie, and compare that to how you feel when you’re watching a romantic comedy. In other words, what we focus on creates how we feel inside. That same principle is at work when we intentionally think about what we are grateful for, as opposed to what we lack or what we don’t like about our lives.

Learning to handle stress is more important than ever. Let’s look at the many resources that have been created since the coronavirus pandemic started.

Find Resources

National Hemophilia Foundation (NHF) and Hemophilia Federation of America (HFA) have created content to help people in the bleeding disorder community deal with both physical and emotional impacts of the pandemic. The following links will take you to the current web pages with this information.

National Hemophilia Foundation

Hemophilia Federation of America

You can also purchase proven self-help workbooks on stress reduction at New Harbinger Publications:

And yes, there is an app for learning to relax! Appropriately called the Calm app, it has hundreds of meditations and master classes on stress management:

You can find these resources and many others by visiting the Mental Health Matters Too website:

Seek Out Others

It didn’t take long for our community to figure out how to be connected virtually. Though it isn’t the same as being in a room together, it is nice to see familiar faces and get a chance to let someone know you are there for them.

Take a moment to check in with yourself, because it’s very easy to feel lonely in isolation. If you find that you’re exceptionally lonely, depressed, or anxious, it always helps to talk to someone trained to help you feel understood and supported. Online platforms like Talk Space and Better Help are reporting an exponential increase in the number of requests for counseling sessions right now.

Look for Purpose

One of the best ways to combat the feeling of helplessness that comes with a crisis is to look for a way you can help others. This sense of purpose gives people some control, and helps them feel productive and useful. For me, contributing to Save One Life is one way I fulfill my need to have purpose in my own life. Each month, I have a small sense of satisfaction knowing that there are three young people with hemophilia who feel that someone else on this planet sees them and cares about them.

So, whether it’s meditating, talking with someone, or just being there for another human, there are ways to combat stress. We will get through this pandemic as a community, the way we always have. We will get informed, find resources, and seek out each other.

Debbie de la Riva, LPC, has been an active member of the bleeding disorder community since the birth of her son with severe hemophilia 25 years ago. She served as executive director of the Lone Star Chapter of NHF, was a co-chair of an NHF Annual Meeting, received a Ryan White Award for Advocacy Excellence, and has presented on mental health issues to chapter and national organizations. In 2018, Debbie founded Mental Health Matters Too as a way of combining her degree as a licensed professional counselor with her passion for helping community members who struggle with mental health challenges. To contact Debbie: or

HemaBlog Archives

A Note Regarding COVID-19 and Shipping:
LA Kelley Communications will continue to ship orders as long as the post office remains open. However, it's likely that orders will be slightly delayed. For any questions, please don't hesitate to contact us at
Stay Healthy!