Sunday, August 24, 2014

Life Is Short, Live It

Love is rare, grab it.
A few days ago, I came across a saying that really struck home with me: “Life is short, live it. Love is rare, grab it. Anger is bad, dump it. Fear is awful, face it. Memories are sweet, cherish it.” The person who came up with these words of wisdom is unknown, but it could be the story of my life, and perhaps yours.

When I was young, I thought life flowed forward with countless days of sunshine. I had that invincible conviction so common to the young. Eventually, I found out how short life was as the hard hand of death entered my life. Schoolmates died from terminal diseases when I was young. In early adulthood, the terminators included drug overdoses and car wrecks.

I also learned at an early age how rare true love is. Of course, I had my heart broken a few times, but when Jim entered my life, it was an entirely different experience. I found out what it meant to love and be loved without reservation, fearlessly, and with all my heart. Then, love blossomed with the birth of our sons, and later when our grandchildren were born.

Jim and I faced the world together, united. I had his back, and he always had mine. He was my protector, my best friend, and my love. When dementia struck, we faced the awful fear of the unknown along with the predictable outcome of the known. When Jim died, I was reminded of the shortness of life, the heartbreak of love lost, and the empty spot that replaced the part of myself that died.

I’ve never been a person to wallow in self-pity so I dumped the anger and began to pick up the pieces. I found happiness with my family and friends. I kept busy—oh, my, have I ever kept busy. My life became full and rich again.

That rare emotion, love, entered my life again, and I said “yes” to grabbing it. On Saturday, August 16, I took the final step to make my life complete when I married my longtime best friend, Harold.

My sons walking me down the aisle
We started our married life with a lovely ceremony surrounded by family. While honeymooning in Branson, we stopped at a scenic overlook. I offered to take a photo of two couples, older and younger. They offered to take a picture of us. When Harold retrieved our camera, he told them we had just married the day before. “Oh, are you going to start a family?” he asked Harold.

“We already have grandchildren,” Harold replied.

An only child, never married, Harold has inherited an instant, large family. My mom and I were talking about the change in his status recently. “I hope the shock doesn’t kill him,” she joked.

Sure, being married again is going to require adjustments for me. I still find it hard to think of Jim as “my first husband.” I’ll no longer have all the personal time that I’ve had in the past. And I’ll no longer have sole possession of the TV remote control. We have a few conflicts with what we record on our DVR’s—after all I don’t want to give up American Idol or The Voice.

In the big scheme of things, those are just minor adjustments. The major benefits of our marriage far outweigh the drawbacks. I now have someone to love—and he’ll always have my back, and I’ll have his. We have good times together, whether it’s working on a project, traveling, visiting family, watching TV, or sitting on the deck, drinking coffee, and playing with our dog Lucy.

Unity Sand Ceremony
Harold and I have joined hands to make one heart. During the unity sand ceremony on our wedding day, Pastor Burton said, “As these containers of sand are poured together, the individual containers will no longer exist, but will be joined as one. Just as these sands can never be separated and poured again into the individual containers, so will your marriage be a molding of two individual personalities, bonded together forming one heart, one love.”

What can I say? Life is good. I’ve been lucky in love, twice.

When I look back on my life thus far, I have a treasure chest of sweet memories stored in my brain. I appreciate the value of life, and love, and look forward to creating many more special moments.

copyright © August 2014 by L. S. Fisher
http://earlyonset.blogspot.com

Sunday, August 10, 2014

You Are My Sunshine: Vitamin D and Alzheimer’s

What’s not to love about bright sunshiny summer days? Here it is summer and some of us have been soaking up the rays whether at the beach, the backyard, or while gardening. When ultraviolet rays shine on our skin, it triggers a vitamin D synthesis. 

When I was growing up, we did not have an air conditioner at home, so naturally we spent a lot of time outdoors. Times have changed, and air-conditioning is the norm. Now, we spend much more time indoors under the comfort of air-conditioning during sunshiny summer days.

This lifestyle change has brought about common deficiency of vitamin D in a huge portion of the population. Most of us know that vitamin D deficiency has consequences. Without an adequate level of it, we cannot absorb calcium which causes inadequate bone development in the young and bone loss as we grow older. This is why milk is fortified with vitamin D.

In addition to fortified milk, other sources of the sunshine vitamin are oily fish (salmon, mackerel, bluefish, and canned tuna). It is difficult to get enough vitamin D from food alone.

The natural source is sunlight, but we have become afraid of the sun. We slather on sunscreen and avoid any exposure. When we do this, we no longer absorb essential vitamin D. The very reason we avoid the sun is to reduce the risk of cancer, but oddly enough, low levels of vitamin D increases cancer rates. Low levels of the sunshine vitamin are also linked to higher blood pressure, heart disease, and Type 1 diabetes in children.

In addition to previously known health issues associated with vitamin D deficiency, researchers have found a link between vitamin D and Alzheimer’s risk. People with moderate deficiencies of this essential vitamin have nearly a 70 percent higher risk of developing Alzheimer’s disease. In severe deficiencies, this risk skyrockets to 122 percent.

Researchers believe that vitamin D helps rid cells of beta-amyloid plaques, one of the hallmarks of Alzheimer’s disease. One of the leading researchers in the study, David J. Llewellyn, University of Exeter Medical School, said, “It seems to be that vitamin D was actually helping to break down and take away those protein abnormalities.”

Doctor Michael Holick, Boston University, who is an expert on vitamin D recommends stocking up on vitamin D during the summer. He suggests five to ten minutes two or three times a week outdoors between 10 a.m. and 3 p.m. wearing minimal clothing and without sunscreen except for the face. Sun deprived people, and breast fed infants, should take a supplement.

Summer will soon be over, so now is the time to stock up on the sunshine vitamin. Just remember, moderation, moderation, moderation!

copyright © August 2014 by L.S. Fisher

http://earlyonset.blogspot.com

Sunday, July 27, 2014

Good News for Boomers: Decline in Alzheimer’s Risk

The Silver Tsunami moves ahead with full force, alarms blaring and warning whistles screeching. What will be the plight of the aging Boomer generation? Will we pound the final nail into the coffin of Medicare and Medicaid as we reach the age of vulnerability for Alzheimer’s disease?

Until now, the answer to these questions has been yes—Alzheimer’s will increase at an alarming rate. What has changed? The cure for Alzheimer’s is still that elusive goal that motivates researchers and advocates to keep applying pressure. The Silver Tsunami builds momentum at the rate of 10,000 boomers turning sixty-five each day—and will continue until 2030 when all have turned that age.

I am a boomer and quite distressed at our future as the generation whose defining disease is Alzheimer’s. Nope. Not what I want for my future.

Then a glimmer of real hope for boomers comes from the Alzheimer’s Association  International Conference in Copenhagen. When comparing late 1970’s data, the Framingham Heart study showed a forty-four percent decline in new cases of Alzheimer’s, especially in people in their sixties.

Overall better cardiovascular health is contributing to this new trend. Routine blood work gives us the options to make adjustments to our health destiny. By treating high blood pressure, cholesterol, and diabetes, we control conditions that otherwise would rob us of good health. Other contributing factors to the good news for boomer’s health: a decline in smoking and an increase in education. Researchers believe that education builds up a neurocognitive “reserve” that helps compensate for brain damage.

It seems that it is harder to avoid helpful information about ways to decrease Alzheimer’s than it is to find it. This morning as I was skimming through old magazines before taking them to the recycle bin, I saw an interesting article on anti-aging that focused on brainpower. I had seen the suggestions before, but, hey, it never hurts to reinforce prior learning. I sped-read through the benefits of omega-3 fatty acids (note to self: eat more fish!), eat fruits and vegetables (food, yay!), and exercise (clears throat—trying again to get back on track).

Then, in place of the normal “exercise your brain,” it was worded in a new way: Find a purpose in life. If nothing else, I have a good handle on this one! I believe that a purpose in life is where we boomers excel. And get this good news—having a purpose in life means you are two and a half times less likely to develop Alzheimer’s as your friends, relatives, and acquaintances who just drift aimlessly through life.

Other interesting facts I gleaned from these old “worthless” magazines included a weight reduction program based on the percentage of fresh fruits and vegetables you ate each week. According to an article in First, you could lose three pounds a week by making fifty-percent of your food raw fruits and vegetables. The theory is that you increase fat burning enzymes. Hmmm. Not so sure that would agree with my digestive system.

After reading the good news about boomer’s health, I was inspired to complete a thirty-minute workout based on exercises I found in an old Reader’s Digest.  After I gathered up my weights, a quilt for the floor, and a kitchen chair I was ready to start. I turned on the TV to a thirty-minute show—Joel Osteen—for a half-hour of perspiration and inspiration. I was not disappointed! As I lifted weights and huffed and puffed through floor exercises, I listened to Joel Osteen talk about the life-changing value of…purpose.

Joel Osteen, the workout, and good news from AAIC helped me face the day with optimism for my personal health future—and for that of other aging boomers.

copyright © July 2014 by L. S. Fisher
http://earlyonset.blogspot.com  

Saturday, July 19, 2014

PTSD and Combat Increase Alzheimer’s Risk

When it comes to war, we often worry about our loved ones safety and pray they will come home unharmed. It doesn’t usually happen that way. Some come home with outward injuries, but appearances can be deceptive. Those who appear uninjured often suffer the invisible scars of PTSD (posttraumatic stress disorder) or TBI (traumatic brain injury).

I saw firsthand the effects of PTSD and how life-disrupting it can be. Vietnam changed Jim. I could see some of those changes immediately—sudden loud noises could send him to the ground. While on R&R from Vietnam, the drums from a luau on the beach threw him into instant combat mode. Later, it would be fireworks, gunshots, nightmares, flashbacks, or mental breaks that ripped the scabs off the scars.

Of course, Jim went on to develop dementia, and I couldn’t help but wonder if his PTSD or exposure to Agent Orange could have been an underlying factor. At the time, I found an article linking PTSD to shrinkage of the hippocampus, the brain’s gateway for new memories. VA doctors dismissed the possibility of PTSD playing any part in his memory loss.

Various studies have shown that PTSD is indeed a risk factor for dementia. In addition to PTSD studies are now underway to examine the risk of combat TBI. Brain injury isn’t always caused by a blow to the head; it can also be caused by blasts. In fact, blasts are the cause of most combat traumatic brain injuries.

The Alzheimer’s Neuroimaging Initiative is being used to compare PTSD and TBI as dementia risk factors in Vietnam veterans over age 65. They will be broken down into groups with PTSD only, TBI only, and veterans with both PTSD and TBI. Cohorts should be fully recruited by October 2014. This is the beginnings of a comprehensive study in dementia risk factors in veterans.

Vietnam veterans are being used because of their age because dementia development may take decades. The wars in Iraq, Afghanistan, and acts of terrorism has contributed to more cases of TBI.

Although I’ve focused on TBI in veterans, some of the other causes are sports, vehicle crashes, and the number one cause of TBI: falls. In the United States, 1.4 million suffer TBI each year. The three classifications of TBI are (1) mild—doesn’t knock you out, or less than thirty minutes; (2) moderate—unconscious for more than thirty minutes; and (3) severe—unconscious for more than twenty-four hours.

TBI increases dementia risk. In older adults, moderate TBI more than doubles the risk of Alzheimer’s and severe TBI increases the risk to 4.5 times that of a person who has not had a brain injury. Mild TBI does not increased risk unless it is repeated, such as that caused by contact sports or being exposed to blasts over a period of time.

Adding to the risk factors of TBI is the presence of the apolipoprotein E genotype (APOE). In a study of boxers, all of those who developed severe dementia had at least one copy of APOE-e4.  Another interesting observation with the boxers was that the greatest risk was determined by the number of rounds boxed rather than the number of times a boxer was knocked out. This would indicate that repeated mild TBI was as much of a risk factor as a small number of severe TBIs.

Part of the link between Alzheimer’s disease and TBI is the presence of the hallmarks of Alzheimer’s disease—the proteins beta-amyloid and tau. After a severe brain injury, beta-amyloid will increase within hours. Repeated mild TBI increases the protein tau and sometimes also increases beta-amyloid deposits.

As I worked my way through the statistics, I was struck by a few thoughts. One was that genetic testing on Jim showed that he one copy of APOE-e4. One copy slightly increased the risk of Alzheimer’s, but not nearly as much as two copies would have. The other thing that struck me was that Jim died at fifty-nine which would have been too young for any study with the age sixty-five threshold. Ironically, if he had not died from dementia, he would have been old enough now. Next month, he would have celebrated his 69th birthday.

Copyright © July 2014 by L.S. Fisher
http://earlyonset.blogspot.com 

Wednesday, July 9, 2014

Never Underestimate the Power of Love

The puppy came to his door on a cold winter night, shivering, whimpering, and a few timid barks. She knew she needed help, but was afraid she would get a boot in the side rather than a helping hand.

He turned on the porch light and saw her sitting there, a little puff of fur, big eyes. “I don’t want a puppy,” he said.

“Maybe she belongs to one of your neighbors and just got lost,” I said.

He turned the light off and tried to forget the puppy, but the look in those big eyes just wouldn’t go away. Back to the porch, light on, the puppy was gone. He breathed a sigh of relief.

Then a sound from the back deck let him know the puppy had merely moved to a different door. “What do I do?” he asked.

“At least give her food and water,” I suggested. “She’s too little to make it on her own.”

Once we went outside, the puppy shied away. She hid behind the barbeque grill. Finally, we coaxed her out, but she surprised us by ignoring the food and water we had put out for her. She didn’t seem to know how to eat or drink. The puppy was listless, and I had doubts that she could be saved, and if she was, would she always be timid and afraid of people?

The puppy finally took a little nourishment. He fixed a box with blankets to shelter her from the wind and weather.  The puppy settled down and went to sleep.

After calls to the neighbors, it became obvious that someone had dumped this puppy to die along the roadway. Although she was settled temporarily with some of the basics: food, water, shelter, the puppy would need a lot of patience, medical care, and most of all, love, in order to survive.

Humans, too, need this type of emotional support. When a family member has dementia, and you can no longer care for them at home, you may have to find another place for them to stay. You choose a home that will take good care of your loved one and will provide the basics and medical care they need.

Placing a loved one in long-term care doesn’t mean you walk away thinking now it is out of your hands. I believe the thing that disturbed me most when Jim was in a nursing home was the lack of visitors for some of the residents. It not only disturbed me, it disturbed the employees. They saw the loneliness, the listlessness, as day after day passed and no family member came with smiles and hugs. No one to say, “I love you.” No one to show their love by the simple act of being there, cheerful and caring.

Jim had daily visitors and family that loved him. Sometimes he didn’t really show much of a reaction—other times, his blue eyes would light up. Regardless, he knew someone would be there to spend time with him. To make him feel loved.

Love makes a life-changing difference with people—and with puppies. The puppy that had been abandoned has turned into a rambunctious, happy, healthy member of the family. Never underestimate the power of love.

copyright © by L.S. Fisher, July 2014
http://earlyonset.blogspot.com

Wednesday, July 2, 2014

Summer Begins and Starts to End

I sat out on the deck last night looking at the stars and rubbing my arms because the breeze was just a wee bit chilly. That seemed a little strange since earlier in the day, the hot, muggy air clung to my skin and made me feel like I was trying to breathe underwater.

When I was young, summer vacation always seemed to be hot, humid, and long. We lived in the country in the middle of nowhere. Playing outside meant dealing with the full blast of heat and sun. Even swimming in tepid lake water only provided temporary relief. It didn’t take long to be just as hot or hotter. There was no place to cool off except beneath a shade tree. During the hot summer months, I read a lot of books and spent most of my time trying to stay cool. I’d sit in front of the box fan, dressed in tank tops and shorts, reading a book.

Nighttime didn’t always bring relief. Windows were left open and a fan would blow the cooler night air in, or on some nights, it might be reversed to blow hot air out.

Yes, summer in Missouri can be a scorcher, if you’re not loitering under the air conditioner. Of course, that’s the very reason that outside can seem unbearable. It’s hard to acclimate to a twenty degree change in temperature by simply stepping over the doorsill.

I find myself chilly inside and uncomfortably warm outside. A few times, I’ve been caught off guard when I step outside wearing sweatpants and a flannel shirt.

The thing I thought about when I was looking at the stars last night is that now summer doesn’t seem to be nearly as long as I remember it from my youth. If I want to go somewhere, I walk out of my frigid house, jump in an air-conditioned car, drive to an air-conditioned store. In other words, I can pretty much avoid the heat. Not only that, but as I get older it seems that time goes by much faster. June was here and gone before I had time to turn the pages in all my calendars at home. It just zipped past.

With June being my birthday month, it kind of seems like maybe life is flashing before my eyes at times. It doesn’t help that two wonderful men I had the pleasure of knowing passed away during the final days of June. One was struck down by the cruelest of diseases—Alzheimer’s. I had been in contact with family members as they went through the day-to-day stresses, quandaries, and grief that watching a loved one fade away brings with it. Now their grief takes a new direction as they learn to live without him.

While I was still adjusting to his death, I learned of author Jory Sherman’s death. I knew Jory was not doing well and that he made the decision to go home “to die.” He wanted to spend his final days in the place he loved.

Jory was an inspiration to me when I first started writing. He critiqued my work, and I subscribed to his “story of the month.”

As soon as I learned of his death, I pulled out the Sadness of Autumn, Tales of the Ozark Hills. I knew that in Jory’s lyrical words, I would find some words of wisdom and comfort. It only took about two minutes before I came upon a passage in “Summerend” a story Jory wrote about his father’s death. Jory Sherman wrote: “There was the voice of him in the stark yellow wind that blew in my face and took my voice out of my dry throat. There was the gentle hand of him in fallow earth where he would have kneaded the soil and its seeds to a fine and green growing. There was his spirit scattered all over acres of sky and his heart moving the blood through my own and my children’s and their children’s lives. It is a sad thing when the summer begins to end.”

It seems to me that summer starts to end almost before it begins.

copyright © July 2014 by L.S. Fisher
http://earlyonset.blogspot.com

Friday, June 20, 2014

Negative Thoughts, Positive Actions

On days when I wake up and feel the urge to start the day with lifted spirits, I select a Joel Osteen sermon on the DVR. I have several to choose from and last week I watched one about negative thoughts.

Joel said that negative thoughts take up more space in our brains than positive ones. We find ourselves dwelling on the things that hurt us.

Did you realize that every second you are alive, your brain is actively thinking? We have between 50,000 - 70,000 thoughts each day. With 35 to 48 thoughts bouncing around in your brain each minute, it seems that some of them would have to be negative. Life deems that bad things are going to happen to good people. You are going to be put down, criticized, humiliated, make stupid mistakes, have terrible thoughts, lie, cheat, hurt other people, go a little haywire from time to time…the list goes on and on.

Well, guess what? We have this massive filing system in our brains where all those ugly moments are stored. Entire events are stored in our brains, complete with the emotions associated with them—good or bad. When something makes us retrieve a negative file, we open the Pandora’s box inside it. Rushing out of that file are all the emotions associated with the memory, taking us back to a place we don’t want to be.

When you have a loved one with Alzheimer’s you can build up a huge emotional file cabinet. I gave a presentation on caregiver emotions last week at the Senior Center in Warsaw, Missouri. We talked about guilt, resentment, worry, anger, loneliness, defensiveness, and grief. These are common emotions stored in caregivers’ memories. We also talked about strategies to take control over these emotions.

Now that I’m getting older and more philosophical, I find myself wondering just exactly how those pesky negative thoughts pop into my head and how to lessen their impact on my daily life. Joel Osteen said that when negative emotions dominate our thoughts, we need to switch the channel instead of replaying those hurts.

A similar idea surfaced in an article written by Joseph M. Carver, Ph.D, psychologist. He points out that the brain operates automatically, pulling files randomly throughout each day depending on memory triggers. “When the brain operates on automatic, the files it pulls are greatly influenced by our mood. For example, if you are severely depressed, if your brain is on ‘automatic,’ it will pull nothing but bad, trash, and garbage files.” A powerful tool at our disposal, according to Dr. Carver, is the ability to change a depressed mood by “simply switching the brain to manual, taking more control over our thoughts.” Or, as Joel Osteen put it, switch the channel.

Although I don’t think I have as much negative energy bouncing around in my brain as I once had, the occasional pessimistic thought can dominate my thinking. Fortunately, I’ve learned how to “switch the channel.”

The goal is not to bury emotions. In fact, the opposite is often more beneficial. If we can deal with our emotions immediately, the solutions is stored along with the traumatic experience and helps us cope with that emotion. Yes, most of us can direct our thoughts into a positive direction. At first, I couldn’t even tell people that Jim was diagnosed with Alzheimer’s without choking up and bursting out in tears. I took control of my thoughts by turning a negative into a positive. I started to speak about Alzheimer’s, began the Early Onset Blog, and became an Alzheimer’s advocate.

Chemicals in our brains determine our moods and feelings. Sometimes traumatic events or long-term negative thoughts can throw our brain’s chemical balance out of whack. When that happens, it may be necessary to take medication to bring the chemicals back in balance. Through positive thinking, physical activity, and mental stimulation, we can handle temporary or fleeting negative emotions.  

Earlier, I compared the brain’s negative emotions to opening Pandora’s box, but the most important part of the legend is what she found in the bottom of what she believed to be an empty box. When she opened it again to show it was empty,  Hope was released. We, too, can replace negative emotions with hope by taking control and switching the channel.

copyright © June 2014 by L.S. Fisher
earlyonset.blogspot.com

Sources:
Joel Osteen, www.joelosteen.com, Joel and Victoria’s Blog, February 28, 2014
“Emotional Memory Management,” www.drjoecarver.com, Joseph M. Carver, Ph. D., Psychologist  

Monday, June 9, 2014

Alzheimer's Experience—Effective, But Cruel Teacher

Jessica Snell, Alzheimer's Volunteer
I’m sure you’ve heard that experience is the best teacher. I’ve come to the conclusion that not only is it the best teacher, it can also be the cruelest teacher when it comes to an Alzheimer’s caregiver.

When life delivers a knockout punch, we have two choices: Lay on the mat and writhe in pain, or push off the mat and stand up and fight back. Experience tells us the only way to survive is to drag our butts off the ground and prepare ourselves to do battle.

You’ve seen it haven’t you? I’m referring to those life warriors who leave shock and awe in their wake as they fight back against all odds. The Davids of affliction fighting the Goliaths of disease. These warriors don’t know the meaning of giving up, or quitting. They trampoline off the mat reaching new heights, beyond anything they could have imagined.

In the past fifteen years I’ve met hundreds of amazing caregivers and people with dementia. There’s Tracy who has lived with dementia for more than a decade. She worked at several different jobs, raised a child, and gone through marital ups and downs. The one thing she has never done is give up. She makes the most of each day placing her trust in God. Another friend, Karen, showed tremendous strength by keeping her husband at home until his death from familial Alzheimer’s. I’ve seen courageous people step out of their comfort zone to become speakers, support group facilitators, advocates, and fundraisers.

Not everyone goes forth and becomes a public face, but that doesn’t mean they have given up. They do what they have to do, excel at it, and quietly go about their business. Casual acquaintances never notice the soul scars left from being a caregiver to a loved one with dementia. 

Last week, I spoke to a group of local business leaders about Alzheimer’s, the September 6 Walk, and several upcoming team fundraising events. When I finished, a man sitting next to me gave an impassioned testimony to the difficulty of taking care of a loved one with Alzheimer’s. “Only someone who has provided care can really know how hard it is,”  he said. Bullseye.

Being a caregiver is the hardest job I ever tackled in my life. The most famous Alzheimer’s disease caregiver’s guide  is called The 36-Hour Day for a reason. When I first read the book, it scared me. I thought that surely, only rare cases got that bad. And after the initial shock, and realization that yes, it could be that bad, I panicked as I doubted my ability to do this.

Experience became my teacher. At first, I learned from other people’s experiences. In turn, I passed on their experiences and added my own to the mix. We Alzheimer’s caregivers have to think on our feet, be creative, and not be afraid to call for help.

It is when we internalize our caregiving fears and anxieties that we set ourselves up for failure. And, failure is not an option when someone needs our attention, devotion, and loving care. Part of being a successful caregiver is to become part of something bigger than yourself. That can be personal spirituality or it can be a public commitment as a volunteer.     

As a volunteer, I found that I helped myself as much as I helped the Alzheimer's Association. It also allowed me to keep company with more amazing people. 

In the midst of a downpour Saturday morning, I attended a fundraiser organized by two of our walk team captains. I was happy to see the weather hadnt deterred anyone from eating a delicious breakfast. Jessica Snell, team captain and co-chair of our Sedalia Walk, wore an Alzheimer’s awareness T-shirt that said,  “We don’t know how strong we are until being strong is the only choice.”

This slogan is used for many diseases because it has a universal appeal for anyone who has been surprised by his or her inner warrior. Understanding this concept is the diploma handed out by the cruel teacher of life to those who refuse to stay on the mat.

copyright © June 2014 by L.S. Fisher