Let's talk vaccines: ᴬⁿᵗⁱᵍᵉⁿˢ ᵃⁿᵈ ᴬⁿᵗⁱᵇᵒᵈⁱᵉˢ

Let's first discuss antigens. What are antigens?

We would tell children, for simplicity's sake, that antigens are germs. They are what make us sick. And we would be right but antigens are a lot more complex than calling them germs.

Antigens, also called immunogens, invade our immune systems and try to diminish our health. When they enter us they are an alert to our immune system that it is being invaded and needs protection.

There are two kinds of antigens. Foreign and auto.

Foreign antigens are exactly what you would suspect. Anything outside of your body that could upset your immune system. And those antigens could be bacterial or viral depending on their origin. Some examples include snake venom, E. coli, COVID, pollen.

Autoantigens originate in the body and do not usually provoke an immune response, except in individuals with autoimmune disorders.

The presence of antigens rouses illness-fighting white blood cells, called lymphocytes. This presence of antigens causes white blood cells to make cells called antibodies to fight against the antigens.

The battle for health has begun.

Antigens entering the body send a warning signal to the immune system. And production by B cells (a type of lymphocyte, or white blood cell) begins. What are B cells producing? Antibodies to fight the antigens.

An antibody (also known as immunoglobin) is a type of protein and there are five specific types, each type of antibody can only bind to one type of antigen. Antibodies are made up of four polypeptide chains, which are arranged in a Y-shape. The constant region is always the same, but the variable region is different depending on the type of antibody. The antigen binds to the antigen binding site at the end of the variable region.

Once the antibodies find the antigen, they bind to it. This triggers a series of actions by the immune system that, ultimately, leads to the destruction of the pathogen or tags it so other immune cells will recognize it.

Here's a quick rundown on the 5 types:

▪️Immunoglobulin G (IgG): This type accounts for around 75% of all antibodies in the human body. They detoxify harmful substances and provide long-term protection.

▪️Immunoglobulin A (IgA): This one is found primarily in mucosal tissues, such as those in the mouth, vagina, and intestines, as well as in saliva, tears, and breast milk. It accounts for 15% of all antibodies in the human body. These antibodies collect antigens and remove them from your body in your mucus or other body fluids.

▪️Immunoglobulin M (IgM): These are the first antibodies made by B cells in response to antigens.

▪️Immunoglobulin E (IgE): This is the antibody responsible for the allergic response that is mostly found in the lungs, skin, and mucosal membranes.

▪️Immunoglobulin D (IgD): This type accounts for only around 0.25% of antibodies in the human body. IgD is important in the early stages of the immune response. Unlike other antibodies, it does not actively circulate but instead binds to B cells to instigate the immune response.

There are two types of man-made antibodies, polyclonal and monoclonal. Both types are laboratory-produced molecules that act as substitute antibodies that can restore, enhance or mimic the immune system's attack on cells.

What happens when the antigen and the antibody meet?

They form a relationship, a close one, called an antigen-antibody complex (also known as an immune complex). The complex works like a lock and key mechanism.

 

 

Once the complex is formed it goes through one of the following steps:

▪️Agglutination: Here, antibodies clump the antigens together which are later destroyed by phagocytes (a type of cell within the body capable of engulfing and absorbing bacteria and other small cells and particles). Thus by clumping them together, phagocytes can detect them more easily.

▪️Precipitation: Here, soluble antigens are precipitated and destroyed by the phagocytes.

▪️Opsonization: In this method, antibodies are coated on microbial surface after which antigen locks in. This makes it more susceptible to phagocytosis.

▪️Neutralization: Here, antibodies blocks or neutralizes the harmful chemicals produced by antigens. These are later destroyed again by phagocytosis.

▪️Complement Activation: Once the lock and key mechanism perfectly fits into the place, it leads to cell lysis (the disintegration of a cell by rupture of the cell wall or membrane.)

The ratio of antigen to antibody determines size and shape of immune complex. This, in turn, determines the effect of the immune complex.

The distinct functions of antigens and antibodies are used to create tests and vaccines that help detect and combat illness and disease.

Once the antigen turned pathogen is destroyed and the person recovers, a few of the B cells that produced the antibodies stick around. These are known as memory cells because they remember the pathogen and can quickly produce new antibodies against it.

If the memory cells encounter the pathogen a second time, the immune system can fight it off much more quickly. By doing this, they can get rid of the pathogen before the person even becomes sick. When this happens, the person is said to be immune to that particular pathogen.

Vaccines boost the number of antibodies in your body against a specific antigen. When a vaccine enters your body, your B-cells respond as if a naturally occurring antigen has attacked your body. The B-cells respond to the vaccine by reproducing themselves to form an army of cells that are programmed to react to the antigens in the vaccine.

The antibodies created by the vaccine lie dormant in your body until you contract an infection from that antigen, and then they are called to action.

If you contract an infection, antibodies called memory B cells quickly reproduce and make the specific antibodies you need to destroy that antigen.

The memory B-cells’ response is called a secondary immune response, and it’s much faster and more effective than the reaction your body would have to the infection if you had not been vaccinated.

{You can find all the sources I used by clicking here.} 

Let's talk vaccines: ᴴᵒʷ ᵃʳᵉ ᵛᵃᶜᶜⁱⁿᵉˢ ᵈᵉᵛᵉˡᵒᵖᵉᵈ?

It starts in a lab, where scientists work to understand a pathogen and figure out how they could trigger the immune system to produce antibodies against it. When they identify a substance they think could work (an antigen), they start by testing it in cell cultures and then animals.

If the vaccine triggers an immune response, it is then tested in human clinical trials in three phases.

Phase 1

The vaccine is given to a small number of volunteers to assess its safety, confirm it generates an immune response, and determine the right dosage. Generally in this phase vaccines are tested in young, healthy adult volunteers.

Phase 2

The vaccine is then given to several hundred volunteers to further assess its safety and ability to generate an immune response. Participants in this phase have the same characteristics (such as age, sex) as the people for whom the vaccine is intended. There are usually multiple trials in this phase to evaluate various age groups and different formulations of the vaccine. A group that did not get the vaccine is usually included in the phase as a comparator group to determine whether the changes in the vaccinated group are attributed to the vaccine, or have happened by chance.

Phase 3

The vaccine is next given to thousands of volunteers – and compared to a similar group of people who didn’t get the vaccine, but received a comparator product – to determine if the vaccine is effective against the disease it is designed to protect against and to study its safety in a much larger group of people. Most of the time phase three trials are conducted across multiple countries and multiple sites within a country to assure the findings of the vaccine performance apply to many different populations.

During phase two and phase three trials, the volunteers and the scientists conducting the study are shielded from knowing which volunteers had received the vaccine being tested or the comparator product. This is called “blinding” and is necessary to assure that neither the volunteers nor the scientists are influenced in their assessment of safety or effectiveness by knowing who got which product.

Once a vaccine has reached the pre-approval stage following clinical trials, it is assessed by the relevant regulatory body for compliance with quality, safety, and efficacy criteria.

Once authorized, manufacturing begins to scale up. The antigen is weakened or deactivated. To form the full vaccine, all ingredients are combined.

Once the vaccine has been made in bulk quantities, it is bottled in glass vials and then carefully packaged for safe cold storage and transport.

Vaccine packaging must be able to withstand extreme temperatures, as well as the risks involved in being transported globally. Therefore, vaccine vials are most commonly made from glass, as it is durable and able to maintain its integrity in extreme temperatures.

When a vaccine is too hot or too cold, it becomes less effective or even inactive. If stored at the incorrect temperature, vaccines can be ruined or unsafe for use. Regular refrigerators cannot maintain an even temperature consistently, so specialized medical refrigerators are required for these precious products.

To maintain this cold chain, vaccines are shipped using specialized equipment that does not compromise the integrity of the product. Once shipments land in the destination country, refrigerated lorries transport the vaccines from the airport to the warehouse cold room. From there, portable iceboxes are used to transport vaccines from the cold room to regional centres where they’re stored in refrigerators. If vaccination takes place outside of the regional facility, the final step often requires portable iceboxes to transport the goods to local areas for vaccination campaigns. New technologies have invented some portable devices that can keep vaccines at their cold temperature for several days without needing electricity.

Once vaccines start being administered, the safety of the vaccine is paramount, with regular assessments and post-approval clinical studies to report on its safety and effectiveness.

{You can find all the sources I used by clicking here.} 

Let's talk vaccines: ᵂʰᵃᵗ ᵃʳᵉ ᵗʰᵉ ⁱⁿᵍʳᵉᵈⁱᵉⁿᵗˢ ⁱⁿ ᵃ ᵛᵃᶜᶜⁱⁿᵉ?

Vaccines contain tiny fragments of the disease-causing organism or the blueprints for making the tiny fragments. They also contain other ingredients to keep the vaccine safe and effective. These latter ingredients are included in most vaccines and have been used for decades in billions of doses of vaccines.

Each vaccine component serves a specific purpose, and each ingredient is tested in the manufacturing process. All ingredients are tested for safety.

𝙰𝚗𝚝𝚒𝚐𝚎𝚗

All vaccines contain an active component (the antigen) which generates an immune response, or the blueprint for making the active component. The antigen may be a small part of the disease-causing organism, like a protein or sugar, or it may be the whole organism in a weakened or inactive form.

𝙿𝚛𝚎𝚜𝚎𝚛𝚟𝚊𝚝𝚒𝚟𝚎𝚜

Preservatives prevent the vaccine from becoming contaminated once the vial has been opened, if it will be used for vaccinating more than one person. The most commonly used preservative is 2-phenoxyethanol. It has been used for many years in a number of vaccines, is used in a range of baby care products and is safe for use in vaccines, as it has little toxicity in humans.

𝚂𝚝𝚊𝚋𝚒𝚕𝚒𝚣𝚎𝚛𝚜

Stabilizers prevent chemical reactions from occurring within the vaccine and keep the vaccine components from sticking to the vaccine vial. Stabilizers can be sugars (lactose, sucrose), amino acids (glycine), gelatin, and proteins (recombinant human albumin, derived from yeast).

𝚂𝚞𝚛𝚏𝚊𝚌𝚝𝚊𝚗𝚝𝚜

Surfactants keep all the ingredients in the vaccine blended together. They prevent settling and clumping of elements that are in the liquid form of the vaccine. They are also often used in foods like ice cream.

𝚁𝚎𝚜𝚒𝚍𝚞𝚊𝚕𝚜

Residuals are tiny amounts of various substances used during manufacturing or production of vaccines that are not active ingredients in the completed vaccine. Substances will vary depending on the manufacturing process used and may include egg proteins, yeast, or antibiotics. Residual traces of these substances which may be present in a vaccine are in such small quantities that they need to be measured as parts per million or parts per billion.

𝙳𝚒𝚕𝚞𝚎𝚗𝚝

A diluent is a liquid used to dilute a vaccine to the correct concentration immediately prior to use. The most commonly used diluent is sterile water.

𝙰𝚍𝚓𝚞𝚟𝚊𝚗𝚝

Some vaccines also contain adjuvants. An adjuvant improves the immune response to the vaccine, sometimes by keeping the vaccine at the injection site for a little longer or by stimulating local immune cells.

The adjuvant may be a tiny amount of aluminium salts (like aluminium phosphate, aluminium hydroxide, or potassium aluminium sulphate). Aluminium has been shown not to cause any long-term health problems, and humans ingest aluminium regularly through eating and drinking.

Once a vaccine is in use, it must be continuously monitored to make sure it continues to be safe.

{You can find all the sources I used by clicking here.} 

Let's talk vaccines: ˢᵐᵃˡˡᵖᵒˣ ᴱʳᵃᵈⁱᶜᵃᵗᵉᵈ

 

On May 8, 1980 The World Health Assembly accepted the WHO Global Commission’s recommendation and declared the world free from smallpox. No cases of naturally occurring smallpox have happened since.

The declaration marked the end of a disease that had plagued humanity for at least 3000 years, killing 300 million people in the 20th century alone. The world got rid of smallpox thanks to an incredible demonstration of global solidarity, and because it had a safe and effective vaccine.

Smallpox eradication offers hope for efforts to eliminate other infectious diseases, including polio, which is now endemic in just two countries. To date, 187 countries, territories and areas have been certified free of Guinea worm disease, with seven more to go. And the fight against malaria has so far resulted in 38 countries and territories certified as malaria-free. In the case of Tuberculosis (TB), 57 countries and territories with low TB incidence are on track to reach TB elimination.

Without an effective treatment against a disease, there is no possibility of eradicating it. There are only two ways to accomplish this. 

(1) Preventative, such as vaccination.

(2) Curative, such as drugs that can completely eliminate the pathogen that causes the disease from its host. 

And it is for those reasons that vaccines are vital to global health.

WHO Director-General, Dr Tedros Adhanom Ghebreyesus said, “As the world confronts the COVID-19 pandemic, humanity’s victory over smallpox is a reminder of what is possible when nations come together to fight a common health threat.”

Let's talk vaccines: ᵀʸᵖᵉˢ ᵒᶠ ⱽᵃᶜᶜⁱⁿᵉˢ

There are four types of vaccines currently available:

(1) Live virus vaccines use the weakened (attenuated) form of the virus. The measles, mumps, and rubella (MMR) vaccine and the varicella (chickenpox) vaccine are examples.

(2) Killed (inactivated) vaccines are made from a protein or other small pieces taken from a virus or bacteria. The whooping cough (pertussis) vaccine is an example.

(3) Toxoid vaccines contain a toxin or chemical made by the bacteria or virus. They make you immune to the harmful effects of the infection, instead of to the infection itself. Examples are the diphtheria and tetanus vaccines.

(4) Biosynthetic vaccines contain manmade substances that are very similar to pieces of the virus or bacteria. The Hepatitis B vaccine is an example.

In some cases, like with the MMR vaccine, you need more than one dose of a vaccine to build strong immunity. With others, like the tetanus vaccine, your immunity wears off over time and you need occasional “booster” vaccines. In the case of the flu vaccine, the main targets of the immune response shift slightly from year to year, depending on which flu virus strains are circulating most that year, so you need a vaccine every year.

{You can find all the sources I used by clicking here.} 

Let's talk vaccines: ᴴᵒʷ ᵈᵒ ᵛᵃᶜᶜⁱⁿᵉˢ ʷᵒʳᵏ?

You encounter thousands of germs every day. While your immune system can fight most of them on its own, vaccines help it fight the disease-causing ones (pathogens) it can’t handle.

Vaccines familiarize your immune system — which makes antibodies to defend your body against harmful invaders — with a certain pathogen so that it will know what to do if you become infected with that pathogen in the future.

It’s important to note that vaccines don’t make you sick with the pathogen they’re designed to protect you from. Rather, they give your immune system a practice run at taking out a weaker, inactivated, or partial version of the pathogen.

There are several different ways that vaccines can achieve this triggering of the immune system. They contain either:

▪️A weakened (attenuated) form of a pathogen.

▪️An inactivated form of a pathogen.

▪️Certain parts of the pathogen, such as its proteins.

▪️A weakened toxin made by the pathogen.

Vaccines may also contain other ingredients such as adjuvants, which help boost your body’s immune response to the vaccine, and stabilizers, which keep the active ingredients working after the vaccine is made.

Most vaccines won’t prevent you from becoming infected with a certain pathogen. Rather, they allow your body to stop the infection before you get sick, or they prevent you from becoming seriously sick when you get infected.

This helps you, and it also helps those around you, including people in your community who can’t be vaccinated because of serious allergies or a medical condition that weakens their immune system. Pathogens can spread quickly from person to person. When a large number of people in a community are vaccinated, the pathogen can’t spread as easily.

{You can find all the sources I used by clicking here.} 

Let's talk vaccines: ᴬᵈᵛᵃⁿᶜⁱⁿᵍ ᴰᵉᵛᵉˡᵒᵖᵐᵉⁿᵗˢ ⁱⁿ ᵗʰᵉ ˢᵐᵃˡˡᵖᵒˣ ⱽᵃᶜᶜⁱⁿᵉ

 

The smallpox outbreaks overwhelmingly exceeded the number of cows infected with cowpox available to harvest from. In order to create enough vaccines to meet the need advances in vaccine production started. 

In 1876 the New York Board of Health established a vaccine farm in Lakeview, New Jersey. Lymph from calves infected with cowpox virus was harvested and used as vaccine. 

In 1881 government production of nonhumanized vaccine lymph by serial propagation in calves began in London. The vaccine was distributed to public vaccinators.

Around 1898 developments such as the addition of glycerin to vaccine lymph, the increasing regulation of pharmaceutical suppliers, and the advancements of microbiology led to the generally increasing safety of the vaccine supply.

In 1909 at the Vaccine Institute in Paris, Lucien Camus dried smallpox vaccine pulp in an evacuated chamber, removing all of the moisture from the sample. Such air-dried vaccines were used in tropical areas, where the temperature would destroy non-dried vaccine material. But in 1918 they improved on the air-dried version by producing a freeze-dried vacuum-packed vaccine which was used in both French Guiana and the French tropical colonies. Its use continued for decades and became crucial to widespread vaccination programs in tropical areas in the 1970s.

These advancements in smallpox vaccines paved the way for future vaccines for a variety of infectious diseases.

{You can find all the sources I used by clicking here.} 

Let's talk vaccines: ᵀʰᵉ ᴴⁱˢᵗᵒʳʸ ᵒᶠ ⱽᵃᶜᶜⁱⁿᵉˢ

Buckle up, we are taking a road trip to discover vaccines. 

A great place to start talking about vaccines is at the beginning. And chances are good the beginning is not where any of us think it is.

Throughout history, there have been many illnesses and diseases. But two have caused perhaps the most deaths and illnesses throughout the whole of time. Measles and Smallpox. Thought to be the "same" thing, in 0910 a Persian physician was the first to publish a written account titled “On Smallpox and Measles” in which he describes the two diseases as being distinct and unique from each other. Which meant that two different ways of treating them would be needed, based on their specific characteristics.

But the story of vaccines does not begin with the first vaccine in 1798 - Edward Jenner’s use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

Evidence exists that the Chinese employed smallpox inoculation (or variolation, as such use of smallpox material was called) as early as 1000 CE. In the late 1600s Emperor K'ang Hsi, who had survived smallpox as a child, had his children inoculated.

There were two methods of inoculation known to be used in those days. Grinding up smallpox scabs and blowing the matter into the nostril or scratching matter from a smallpox sore into the skin.

As infectious diseases swept through nations the need for a way to halt these diseases and treat them was being pursued. The Chinese method of inoculation hadn't caught on and/or people were suspicious of its ability to stop the disease. Smallpox and measles were joined by epidemics of pertussis (whooping cough), typhoid fever, diphtheria, yellow fever, scarlet fever, cholera, and polio...to name a few.

According to historical records, between 1545 and 1817 various parts of the world experienced smallpox, whooping cough, measles, typhoid fever, diphtheria, and yellow fever epidemics.

An epidemic is a disease that affects a large number of people within a community, population, or region. A pandemic is an epidemic that's spread over multiple countries or continents.

Presumably, due to an increase in travel and transportation advancements, pandemics became the concern starting with a cholera outbreak in 1817 that swept through India, Asia, and then traveled throughout the world leading to seven major cholera pandemics, each lasting several years, between 1817 and present day. Yes! Present-day!

Prior to the gaining popularity of early inoculation methods, the treatment for these diseases consisted of quarantining, providing comfort measures, attempting to bring down high fevers, bloodletting, inducement of vomiting, alcohol-laced with herbs, and praying that the person wouldn't die or suffer from physical damage due to the disease.

Once again, the Chinese made vaccine headlines (figuratively of course) when Emperor K’ang verbalized support for inoculation in a letter to his descendants in 1661. Having survived a case of smallpox before he became Emperor he wrote:

“The method of inoculation having been brought to light during my reign, I had it used upon you, my sons and daughters, and my descendants, and you all passed through the smallpox in the happiest possible manner…. In the beginning, when I had it tested on one or two people, some old women taxed me with extravagance and spoke very strongly against inoculation. The courage which I summoned up to insist on its practice has saved the lives and health of millions of men. This is an extremely important thing, of which I am very proud.”

In the 1700s variolation started to be practiced more and more as word spread that it worked. Fewer people were dying and that was looked upon favorably.

But what's variolation? Isn't it vaccination? Aren't they the same?

 

Variolation (inoculation) served as a natural precursor to the discovery of vaccination. The development, adoption, and improvement of infectious disease responses are messy processes – there's never a single “eureka” event. There always has to be a precursor, or two, before arriving at the end result.

This method of treatment was used strictly with smallpox outbreaks as the disease provided a visible form of the infection to use.

With variolation, a small amount of the pus from a person infected with smallpox was placed into the skin of an uninfected person. The thought was that the disease would then take hold in the previously uninfected person but in a mild form. It was discovered to be less dangerous to contract it through inoculation than to contract it naturally.

This method of safeguarding against dangerous diseases was never risk-free, nor did advocates of the method claim it to be risk-free. But it greatly reduced the mortality rates. Between 1% to 2% of those variolated died as compared to 30% who died when they contracted the disease naturally.

Inoculation gained popularity in the 1700s.

In 1721 Cotton Mather, thanks to the information his African slave provided him, suggested physician Zabdiel Boylston try the inoculation method as an outbreak of smallpox was ravaging Boston. 248 people were variolated and of those 248, 3% - or 6 people - died. Of those left to the disease and vulnerable to its symptoms 14% died. Thus, variolation had come to the Americas.

Meanwhile, across the pond, Lady Mary Wortley Montagu had been introduced to "engrafting" in Turkey and when arriving back in England in 1721 requested it be done to her two-year-old daughter. Her son had been engrafted while they were in Turkey. Thus, variolation had come to England.

Both Mather and Lady Montagu would come under considerable criticism for advocating variolation, a practice that slowly began to spread as its ability to protect against smallpox became apparent even in light of its fatality rates and the discovery that variolated individuals could pass the disease on to others.

In the 1770s rumors began circulating about a disease called cowpox. People who regularly worked with cattle were claiming that their exposure, and subsequent infection, to cowpox inoculated them against smallpox.

Cowpox is an uncommon illness in cattle, usually mild, that can be spread from a cow to humans via sores on the cow. During an infection, dairy workers may have pustules on their hands. Sufferers can spread the infection to other parts of the body.

Around 1774 farmer Benjamin Jesty inoculated his wife and two sons with matter from a cowpox lesion on one of his cows.

Jesty, having already contracted cowpox, believed himself protected from smallpox infection. When a serious smallpox epidemic hit his Dorset village, he, from his “great strength of mind,” took it upon himself to protect his family. His wife and children survived, and the boys, when challenged with smallpox inoculation in 1789, showed no symptoms.

Mr. Jesty, however, had no interest in systematically testing his methods or publishing his results, and so his finding was largely forgotten. Upon his death, his wife had his tombstone inscribed, “the first person (known) who introduced the cow-pox inoculation.”

Twenty-two years after Benjamin Jesty successfully inoculated his family with cowpox to avoid smallpox, Dr. Edward Jenner began testing and creating what would become the world's first vaccine.

In the 1770s Jenner had also heard the rumors about using cowpox to inoculate against smallpox but he was still in the thick of his medical school studies and residency program.

However, in May 1796 Dr. Jenner inoculated eight-year-old James Phipps with matter from a cowpox sore on the hand of a milkmaid. Phipps suffered a local reaction and felt poorly for several days but made a full recovery. So in July 1796, Jenner inoculated Phipps with matter taken from a fresh human smallpox sore, as if he were variolating the boy, in an attempt to challenge the protection from cowpox. Phipps remained healthy.

Jenner next demonstrated that cowpox matter transferred in a human chain, from one person to the next, provided protection from smallpox.

For the next couple of years, Dr. Jenner continued to test his idea on patients and saw great success. He wrote a paper for the Royal Society of his findings but they rejected it. So Jenner self-published a pamphlet called “An Inquiry into the Causes and Effects of the Variolae Vaccinae, a Disease discovered in some of the Western Counties of England, particularly Gloucestershire, and known by the name of the Cow Pox.” It outlined Jenner’s success in protecting James Phipps from smallpox infection with material from a cowpox pustule, in addition to 22 related cases. At first, the news was received quietly if received at all. But that changed when an associate of Jenner's, Henry Cline, used dried vaccine material provided by Jenner to demonstrate once again that vaccination with cowpox material prevented future smallpox infection.

The vaccine started to gain traction and quickly became preferred over variolation for its improved success and safety.

But, didn't Jenner engraft James Phipps? He took the pus from the infection and placed it under the skin of an uninfected person. That's what people had been doing for years by 1796! So how was what Jenner did different than what everyone else was doing?

So, how are variolation and vaccination different from one another?

Both are using infected pus to infect, in the hopes of immunity, uninfected people.

The difference is subtle but very important. Variolation used viral matter from smallpox patients, usually pus from a light case of smallpox. Jenner's vaccination, meanwhile, used matter from the milder cowpox virus. As a milder disease carrying the same immunities, cowpox matter was much safer. Both methods are also called inoculation because inoculation is the process of introducing a small amount of viral matter into the body in order to teach the body’s immune system to fight off the virus, thus making the patient immune to future infection.

So step one in what would become today's modern vaccination was successfully tested and completed. As is the case with any invention, the first workable treatment would be replaced with an improved option and that cycle would continue until we arrived at the year 2020 and the need for a new vaccine presented itself.

But, that part of the story is much later.

Between Jenner's successful test run of the smallpox vaccine in 1796 and 1879, the vaccine creation and delivery methods stayed the same. In order to meet the demand vaccine farms were created, voices of government endorsed the method, variolation was outlawed in certain parts of the world, and other infectious diseases were being dissected in hopes of developing vaccines.

In the last decade of Jenner's life smallpox mortality rates in Britain declined by approximately 43% thanks to the vaccine.

So what happened in 1879 to push the vaccine forward yet again toward what we know it as today?

What happened was Louis Pasteur was born in 1822.

Between his birth in 1822 and 1879, Pasteur grew up and became an accomplished academic. In 1831 he witnessed firsthand a rabies outbreak and that gave him the desire to solve that problem as well as others. Between 1840 and 1847 Pasteur earned at least 4 degrees. He was found in 1849 teaching Chemistry. In 1854 Pasteur began studying fermentation which would end up being crucial to the next step in modernizing vaccines. Despite a stroke that left his left arm and leg permanently paralyzed, Pasteur persevered in his research and produced the first laboratory-developed vaccine in 1879. It was a vaccine for chicken cholera (Pasteurella multocida).

A happy accident led to this step in vaccine production as Pasteur's assistant didn't follow instructions and the bacteria was exposed to oxygen. Turned out that the oxygen exposed bacteria weakened the disease enough to make it effective in providing protection against the full-strength bacteria.

When Louis Pasteur died in 1895 his life's work had accomplished advancements in vaccine production; he had proved that germs cause disease; he developed vaccines for anthrax and rabies, and he created the process of pasteurization.

{You can find all the sources I used by clicking here.} 

Trading in FOMO for JOMO

I'm an introvert so I don't mind missing out on things. But social media has been different, it's changed me in ways I'm uncomfortable with. 

At first, it was just a way to stay in touch with people. But then, with its growing population came content. So much content that it's overwhelming and it makes one feel as if they are missing out if they don't keep up with all the content. 

It has the ability to make people feel unimportant if they don't know someone's latest status update. 

For something that was supposed to increase our social interaction it has ironically isolated us and diminished our ability to be authentically social. 

It's created weird popularity contests and fake personas. 

It's introduced fear into our lives. Fear that we can't keep up with "the Jones' " whose life looks so perfect in all those pictures shared, I mean do they ever not smile? Actually, yes. They don't smile more than they do but who wants to see that? So the smiles get shared and the comparisons get drawn. But if all you and I see are the smiles we are forced to conclude that the Jones' are incredibly happy and successful and fill in the blank. 

It's introduced a whole new platform for rude, crude, and disrespectful behavior. People have forgotten their manners when *interacting* on social media. As people log in to their accounts it seems like they put their humanity on hold and forget that who they will be interacting with is a human as well. 

It's become a battle ground for all the biggies and then things that shouldn't be big but are made so by the attention they receive on social media. 

It is a hotbed of misinterpretation, innuendo, assumptions, false information, and one-up-man-ship. 

But I didn't want to miss any of it. I wanted to be in the know of who said what to whom and what the relationship status is of so and so and how the most recent catastrophe was gaining attention and and and. The list goes on like that damn energizer bunny. 

And then I wanted to miss it all. I couldn't breathe. It was, it is, too much. TOO MUCH. My phone was dinging with notifications, my computer would (it seemed) open up on to Facebook, I felt behind (with what I'm not sure) if I didn't check in a couple times an hour at least. (Pst. Nothing had changed that was significant.) In 2009, 2012, and 2016 I went overseas and my ability to check in on social media was zero to limited. It was a huge relief. HUGE. It was a relief to not think about what kind of insightful, quippy, and/or meaningful status I was going to post. It was a relief to get a break from all the content that populated my home page feed. It was a relief to remember there was life apart from social media. It was a relief to know I could miss out because I wasn't really missing out on what mattered. 

In 2018 I took Facebook off my phone completely. I logged out of Facebook and changed all my logins that used Facebook to logins through my email. I removed Facebook from my bookmarks and then left Facebook for a month. It was good, no it was great. Somehow people still managed to get a hold of me and I of them, who knew it could be done outside of social media?! But I came back to it for a couple of reasons. And I was frustrated that I even had the reasons I did. So I started thinking harder and longer about leaving it all together and what that would mean for me and my relationships. I became insanely envious of my brother who hasn't touched Facebook with a ten foot pole and hasn't been sucked into the social media vortex. Lucky guy. I started thinking through what was the most important thing to me about having a Facebook account and could there be a work around? Of course the answer is yes. There is always a work around. It might take some adjustments and transitioning but isn't that just part of life? 

So as we rounded the corner on 2019 and 2020 came into sight, I knew it was time. Listen, I'll be honest people - I can't do another election season on social media. The last one was so brutal that I am still trying to recover from it and no, I'm not joking or exaggerating. That's great if *you* have thick skin and don't care if your humanity is called into question. I'm not like that and frankly I don't want to be. 

FOMO, in my life, is all about missing out of the non-essential things. I sure as hell hope that my tribe knows how to communicate with me outside of social media and will do so when the chips are down and the stakes high in their lives. If you are in my tribe, Facebook should not be our sole means of staying in touch. That's a superficial connection that is easily broken. My tribe and I should have stronger threads holding us together...and I think we do.

So JOMO is my goal. As an introvert, it's a more attainable goal than it may be for others and I still have that twinge of FOMO but I'll get over it, I practically am already. 

My (MIS)adventures on the yoga mat

I almost suffocated at yoga today. My boobs and my nose met up and my boobs sucked in my nose like they were quicksand grabbing on. I had visions of my obituary reading something to the effect of "she died during an awkward yoga session when her boobs smothered her." I pulled up for air just in time.

Yoga is supposed to increase your awareness. Oh, I'm aware all right.

I'm aware of every roll, every fold, and every inflexible muscle I have. I'm aware that I don't know how to breathe (how I've stayed alive all these years is beyond me) and I am in fact as klutzy as I have thought myself to be. I'm aware of the sweat as it drips down my forehead, travels in a torturous way down my neck and pools between my boobs, all while I'm holding some quivering pose and can't wipe it away.

I'm also aware of my mind. "I can't", "This is ridiculous", "It's too hard", "I'm too big to do this", "I'll never...", and the litany of phrases marches on while I'm trying crow pose...or really almost any pose. I'm aware of my heart beating, not in the physical way but in the emotional sense. It beats and sometimes my eyes tear up and I don't know why. I'm aware I am uncomfortable, not just physically but mentally. I attempt to keep to myself, to make my large body as small as possible. Sometimes that awareness is when my eyes tear up. I'm aware that I am fidgety, distracted, and it's hard to just be.

So I suppose yoga is working. I'm definitely more aware when I'm practicing it.

As I was growing up I was given the impression that yoga was for hippies and it was evil. I'm not joking. In the circles I lived in, yoga was considered "new age" which was evil. So like any good lemming I have spent a good part of my life thinking yoga was bad. Very very bad. And then I decided to not believe that any longer because all of a sudden it didn't seem true and it seemed a little far-fetched that yoga, a practice in which you move your body for health and wellness, was evil.

Around 2012-2013 I started talking about beginning the practice of yoga. I took one class in 2017 and continued to talk about it. July 2019 I finally started, for real, the practice of yoga. It only took me 6-7 years...better late than never I suppose.

I'm an awkward yogi. Okay, I'm not really a yogi but go with it. The point is I'm awkward. For the first few classes I would find my mat folded up underneath me and I couldn't figure out how it had moved. I've figured out that issue but I still find myself more often than not somehow laying on the mat wonky. An aerial view would show the mat and I making an X. I don't know how this happens. A few times I have found myself with my whole lower body not even on the mat. Do I really not understand how to center myself? Well, since I'm so aware now, thanks to yoga, the answer is no I don't. I don't know how to center myself, literally or figuratively. But I'm going to learn.

After I almost suffocated in my boobs today I did a few things I was really proud of. I was in chair pose, I then went into airplane pose with my upper body. The the instructor suggested we raise ourselves up on our toes and balance in the half-chair, half-airplane pose. I immediately thought, "There is no way on God's green earth that's happening" and then I did it. It had to be a fluke. But then I did it again on the next flow. I was inwardly elated. I also did a few other poses today that, at first, I was like "psh, not happening" and then just did them. So I guess something else I'm more aware of is that I can be, and am, wrong about myself. I'm not giving myself enough credit, I can do more than what I think I can.

Why Self-Checkout is the Least of Your Concerns

I think I've heard it all...

"Self-Checkout is stealing jobs from people." NOPE. They aren't.* I work in a original size Target store and we have four self-checkouts (see above picture). Target hires people to specifically oversee the self-checkouts and it's more work and more stress than being a cashier at one register. Why? One person has to oversee four registers versus just one. Trust me, it ain't a cake walk especially when the technology fails or a guest has a question/complaint or it's a rush hour situation.

"Self-Checkout is evil." REALLY? What about human trafficking? Drug problems? Abuses? Systematic racism? Broken educational systems? I could go on and on but hopefully you catch my drift.

"If I can get your employee discount I will use the self-checkout." HUH. Don't be that person. I mean really, don't be an ass.

Listen, I'm pretty sure self-checkout isn't the thing you should be getting your panties in a twist about.

I'm serious.

Self-checkout is going to be the hill you die on? Really? I see people get seriously worked up about the self-checkouts and it makes me wonder...how worked up are they getting about people being abused? Or about people being forced into "modern day slavery"? Or the declining state of the educational system in America? Or the environment? As I said above, I could go on and on but I'm really hoping you are picking up what I'm laying down.

In the big picture is self-checkout the thing to rally against? It's a microscopic presence in your life so why are you expending so much energy on it rather on something that is worth getting worked up about? It is a brain boggler.

So what IS worth getting worked up about? Well I've already mentioned a few things, some of them more than once. And we all have a part. A part, not the whole. It doesn't rest on just our shoulders, it's a shared thing. Think, "What can I do in my own world and circles of influence to create positive change?" Do not think, "What can I do to change every single person on the planet?" One way of being worked up will bring about change, the other way will not - it will just anger and alienate people.

Anger about self-checkouts just anger and alienate people - trust me on this. And it's because in the big picture of life self-checkouts aren't worth an ounce of energy, they shouldn't even hold on a spot on anyone's list of "Things to be Worked Up About." If you are worked up about self-checkouts then you are living a tunnel-vision life. Expand your vision and really see what is worth putting energy toward.

Going to use the self-checkout? I double dare you.


*Don't just take my word for it Forbes and Zip Recruiter (among many others) have both written about it. I mean if you can't believe Forbes when it comes to business then who can you believe?! Are you going to find articles that say it is stealing jobs? Sure BUT for every one article that claims it is stealing jobs there are approximately three than support it not doing so.

Words Fail Me

I've lost something. Not my mind, although some days it feels like I am. It's my words. I've lost them and I can't find them. Sometimes I catch a glimpse of them and think they might be returning but then they disappear again. 

It's not the words about the weather and my favorite TV show that have been lost. Those are still present. It's the important words. The words that reveal who I am, what I'm thinking, my grief, my joy, my anger, even my indifference. 

Ask me how I am and you'll get an awkward moment of silence before I answer, "I'm fine." Except you and I both know I'm not being totally honest. Here's the thing - I'm not lying. I am fine. But words fail me to elaborate on the always lame "I'm fine" answer. Words fail me to answer in any other way than "I'm fine." I open my mouth and nothing comes out. I can't find any words beyond "I'm fine."  

I noticed this loss of words begin a few years ago. It started with a suppression I was experiencing at my then workplace. My voice - literally and figuratively - was increasingly being squashed and criticized.  In my personal life my voice was changing like one does in puberty - it was cracking and would raise and lower in pitch as I was settling into it. A couple of major events led me to speechlessness by March 2017. And I have yet to gain my speech back. 

Because I feel things - situations, injustices, conflicts - so deeply the words get buried underneath the feelings. There's so much I want to say about it all that I can't say anything at all. I can't find words to adequately express what I'm feeling and thinking and I find myself mute. The words I want to say these days are colored with anger, disgust, disbelief, confusion, judgement and to let loose those words colored with those emotions would be something I would regret. They would hurt people, alienate me from instead of endear me to others, they would not be the model of shalom I am committed to learning and practicing. 

One gift of my failed words is that of listening. Learning to listen is leading me down roads of understanding into people, cultures, faith expressions, genders, politics, and more. Listening has encouraged me to practice critical thinking. Listening has led me to be more like Jesus to people I interact with. 

So "I'm fine" until words return - words that will build up not tear down, words that will introduce life, words that convey the beauty of shalom, words that will be evidence toward the listening I have tried to do. Until then.

Ross Geller Tells Me What To Do

There's this later episode of Friends in which Chandler and Monica are getting married. (#sorrynotsorry for that spoiler alert - what do you mean you haven't watched Friends yet?!) Chandler has disappeared due to cold feet and Ross is trying to find him. When Ross finally finds Chandler he talks him off the ledge by getting him to do just one thing at a time with no thought for what comes after. He gets him to take a shower while not thinking about what comes later. Then he gets him to put clothes on while not thinking about what comes later. And so it goes until Chandler finds himself watching Monica walk down the aisle to meet and marry him. By then he's calmed down because he faced his fear one small step at a time, not all at once.

The other day I heard Ross tell me to just get out of bed, nothing more. See, I didn't want to. I physically was able but mentally and emotionally I was stuck in bed, unable to face the day. I thought about that episode and Ross encouraging Chandler to take those small steps so I got out of bed. I had an appointment that day and I felt very unwilling to go. I wanted to pick up the phone and cancel. But Ross told me to take a shower while not thinking about what comes later. And then he told me to put on clothes because I couldn't go around naked. So I did. And so it went until I found myself in the parking lot where the appointment was.

Call it coincidence, call it whatever you want but in my appointment - the one I was able to get to with the help of Ross - my doctor told me to take small steps and keep my eyes on the task in front of me, not the door I needed to walk out of an hour from then. Basically, she was telling me what Ross had just that morning.

This inability to even get out of bed isn't fear based for me, it's my continuing struggle with depression. It's when my eyes open for the first time each morning and my first thought is, "I.can't. I.just.can't." But then nature prompts me to get up. Literally. So I'm up, what now? Ross, and my doctor and my therapist (oh I didn't mention she also chimed in on this?), suggests I stay up and brush my teeth or shower, something that keeps me up for just a few more minutes. Those few minutes tumble on each other like a domino train that has been started and before I know it I am in my car and adulting. And the depression doesn't win that time because as I take each step and progress toward adulting for the day I discover that maybe, just maybe, I can. I can interact with people. I can stay out of my bed. For me the saying, "Keep my eye on the prize"  means each small step I take every day is a prize. My depression paralyzes me because I try to look at the whole day all at once, Ross tells me to do the next thing while not thinking about what comes later.

There's another episode of Friends where Phoebe thinks a cat is her mom reincarnated. But the friends find the cat's real owner and Ross is the only one saying Phoebe has to be told. The friends reluctantly agree and Rachel exclaims, "I hate it when Ross is right!" I imagine depression must say the same thing when I choose to listen to Ross over it. Now, if you'll excuse me, I have to go - Ross just told me it's time to take another step toward winning over depression today.

Stirring the Pot

Recently I shared my tips on how to get fired from your job. I know. Usually the tips are centered around how to not get fired but I like to do a twist on things from time to time. *grin*

One of the reasons I was fired was because I was perceived to be a pot-stirrer. You've heard about those kinds of people before right? They are divisive, toxic, trouble makers, unhappy - and they make the people and organizations they are in and around unhealthy.

Or do they?

Certainly there are pot-stirrers that are divisive, toxic, trouble makers, and without a doubt unhappy. But not all pot-stirrers are. In fact, the kind of pot-stirrers I'm talking about and was accused of being are a necessary component to the health of an organization and personal growth. So let's talk about that.

Before I got fired and during the time that the weak leadership at my organization was "building their case" against me I found myself stirring a pot one evening as I was assembling dinner. The directions on the recipe I was following said, "Stir constantly to avoid burning." Good advice. If I didn't get the ingredients moving around they were going to stick to the bottom of the pot, char, and become inedible. I had to keep stirring the pot to keep things moving along and so that all the ingredients could blend together to make the dish I wanted.

One could say, "Beth. C'mon. Stirring the pot for cooking and being a pot-stirrer in life are two very different things."

But are they?

When people and organizations don't allow themselves to be stirred, complacency happens. And complacency in life is strikingly similar to allowing ingredients to settle at the bottom of a pot, char, and become stuck there - not very palatable. People and organizations who are complacent are not relevant to very many. And being irrelevant is equal to being inedible.

When I stir the pot of ingredients I am ensuring that all the ingredients combine together and nothing is left out of the mix. I've made the mistake before of not stirring like the recipe instructs and have found, sitting in the bottom of the pan, one of the ingredients mostly intact and not incorporated. And you can taste the lack of it when eating the dish. Had it been incorporated by the stirring I slacked off on then the dish would have had a lot more flavor and depth.

Now take that idea out of the kitchen and into life.

An organization is made up of many different kinds of people who bring with them many different life experiences, talents, abilities, education, etc. Combine them all together and don't slack off on the stirring. When the pot is stirred they all combine to create a palatable experience. When the pot isn't allowed to be stirred some of those people are going to sink to the bottom and get burned. This charring will affect the whole pot. Oddly enough, it will be the people who didn't get stirred in who get blamed for the ruination of the experience. But it wasn't their job to bring the ingredients together. They asked to be stirred in, they even tried to get themselves stirred in but the person holding the spoon didn't believe in the necessity of variety. So the experience is now bitter for one or several people because they were left to get burned. The experience is flat, just one note that is bland.

Here's the thing about being a pot-stirrer in life; oftentimes the so-called pot-stirrer is unaware they are the pot-stirrer. Why? Because *all* they are is one ingredient, they aren't in charge of stirring. All they are doing is being themselves and living life as they are gifted to. The one holding the spoon is threatened by this because they have to be in charge and who does this person think they are to come in and suggest a different approach, way, mindset, practice? The one holding the spoon is in charge and the people listen to them, period. Except because they refuse to include everyone, the pot is not coming together and that's when toxicity happens.

The burned get labeled as pot-stirrers because they tried to incorporate themselves into the mix and the person holding the spoon doesn't have a tolerance for anything other than themselves. So either all the people need to be like the person holding the spoon or they get labeled as a bad fit. That person - that organization - is missing out on providing their employees and clients with a rich and deep experience because they refuse to incorporate all the people with their different and unique offerings.

Many, many years ago I made a recipe that we loved. But it called for an ingredient that I had 1) never heard of before and 2) dismissed (mostly because of reason #1). But one day I decided to try it. I purchased this spice I had never heard of and stirred it in. HOLY DELICIOUSNESS BATMAN! It took this dish we loved and elevated it to a whole new level of yummy. And I realized we had missing out on the super yummy and settling simply because I was unwilling to stir something in that was unfamiliar to me.

Are you the unfamiliar to a person or organization? Get in there, incorporate! Fingers crossed you have better success at getting mixed in than I did. *wink* I'm cheering for you - I believe what you have to offer can and will take people and organizations to new, amazing levels if they will take a chance and stir you in to the mix.

Are you the person who is holding the spoon and reluctant to stir because you want to be ingredient number one? GET OVER YOURSELF. You are wasting the offerings and talents of people in your life and organization because of your pride. You are missing out, your organization's employees and clients are missing out on a deeper and richer experience because of your silly pride.

Start stirring, you will not regret it. 

I got fired. Here's how you can too!

A year ago today I was fired. If you know me you are thinking, "Whaaaaaaaaaaaaa? How is that even possible?" Right. It shouldn't have been possible but it was for the organization I was working for. I've been fairly quiet about this organization and my firing the past year.

Until now.

To mark the one year anniversary of being fired from this organization that is led by hypocritical, ungodly, and weak patriarchs I thought I would share a few tips on how you too can be fired.

Tip #1:
Be a woman.

Tip #2:
Be someone who has their own opinions, methods, and beliefs about all manner of things and thinks that there is room at the table to present them for consideration.

Tip #3:
Be someone who takes the organization's mission statement at face value and attempts to practice it.

Tip #4:
Be kind.

Tip #5:
Be concerned about the overall health and well-being of the the employees of the organization which impacts the overall health and well-being of the organization itself.

Tip #6:
Don't bow down and worship at the feet of the insecure leadership.

Tip #7:
Don't enable the women in the organization who are kissing ass and compromising themselves to win favor with the weak patriarchs.

Tip #8:
Don't fawn over and stroke the egos of those who are underqualified to do their jobs.

Tip #9:
Be a woman who doesn't think that the man is always right, has all the answers, and is the best at everything he does.

Tip #10:
Don't pretend like the organization's leadership and Human Resources care about the employees and do what's best for them.

One might think I am being sarcastic with my tips, for this particular organization one would be mistaken. The above tips are literally why I got fired for "not being a cultural fit." I didn't get fired for anything that had to do with my actual job and the work I did - in fact, I was commended after I got fired for the excellent work I did and the way it helped the department I was working in.

I got fired from this faith-based, non-profit organization for wanting and pursuing health and well-being for the employees and therefore the organization.

I got fired from this faith-based, non-profit organization for taking at face value the mission statement based on Hebrews 10:24, "Let us encourage one another to love and good deeds." The COO didn't approve of or like how I took that verse to heart and tried to live it out at the workplace. It made him uncomfortable because he felt it was highlighting his deficiencies, his lack of compassion, and his inability to genuinely connect with people. Guess what? It did do that but that wasn't my motivation or even my purpose. He made it all about him when it was never about him.

I got fired from this faith-based, non-profit organization for being a woman that refused to kiss the feet of the men and stroke their egos.

I got fired from this faith-based, non-profit organization for not allowing bad behaviors to go unchecked but bringing them forward into the light as necessary and appropriate.

I got fired from this faith-based, non-profit organization because my boss - a weak man - decided to kiss the ass of someone he doesn't even respect or like. He decided that he was too tired to continue to do right things and stand for right behaviors.

I got fired from this faith-based, non-profit organization because the Director of Human Resources - an insecure woman - would rather live her life suppressed and because I wasn't willing to do the same she fought to get me fired, along with her boss - the jackass COO.

They said I wasn't a "cultural fit." I replied, "You are right, I'm NOT a cultural fit with this organization." Left hanging in the air behind my reply was the reasons I'm not - see above for those reasons. They knew what they were doing. They knew that I was making them uncomfortable and insecure. We humans don't like to be uncomfortable and insecure, we are so f*&%ing prideful about ourselves. So we seek to eliminate people and things that poke at us and cause us to be unsettled. So they eliminated me.

Except "I" won't go away. Life doesn't let off us the hook that easily. Someone else will come into those people's lives, that organization, and poke at them some more. Someone else will come along and continue what I unknowingly started. By being myself I stirred the pot of unease within the hearts of men and women in that place and someone else will come along and continue to stir the pot. Of course I don't know who that person is - I don't know their gender, I don't know when they will come along but someone will.

So if you want to get fired - specifically from a faith-based, non-profit - follow my tips above. If you don't get fired for following my tips above but instead are welcomed and embraced for them then I have two questions:

1) Where do you work?
2) Are they hiring?

Spouse? I do not think spouse means what you think it means.

I was on Pinterest the other day and saw the below list. My attention was caught so I started reading through the list. I've been married for almost 23 years and getting a few new-to-me ideas is never a bad idea. But by the time I got to number 5 my attention was caught for a different reason. I didn't want to overreact so I finished skimming the list before I allowed what caught my attention to bloom into a full "What in the world?" 

Do yourself a favor, skim the list yourself and then meet me below. I'd love to know if you noticed the same thing I did. 

The title of the list uses the word "spouse." I looked it up to make sure I was clear on the definition of the word "spouse." For the record I was right - it means husband or wife. 

Okay so now that I know the definition of spouse is husband or wife, and you do too, read that list again. 

Do you see what I see? 

One pronoun is prominent and one is not to be found. So is the list for spouses or is the list actually for wives about husbands? 

Why is this spouses list for wives only? Why is the only pronoun used male when a spouse is male or female? 

Historically women are more consistent in saying "I love you" in numerous and creative ways so this list rubs me the wrong way. In fact, this list is an enabler of the idea out there in culture that women are responsible for relationships. 

Then I saw this and about lost my shiz...

Does USPS know that women are out there - deployed - and perhaps their male significant other should send them a care package? The ad literally says "wives" and totally disregards the fact that many wives are deployed while the husbands are at home with the children.

Now this one gets what spouse means, note the use of both pronouns - her and him. I'd also like to point out the ones that don't use a pronoun which means either him or her can do it! 

74 Simple Things You Can Do to Brighten Your Spouse’s Day

This is the year 2018 - are "we" still so ignorant about what spouse actually means? And are "we" still so blind to the equality a relationship requires - each person contributing to the health and well-being of the partnership. Yes, partnership. And yes, each person in the relationship flirting, washing the other's car, sending a care package across the ocean, driving for the other when they are tired, letting them choose the TV show to watch/restaurant to eat at/candle scent to light, etc. C'mon. We can do better than spouse meaning him. We can do better and we need to do better. 

The Care & Feeding of Someone Struggling with Depression

I've written quite a bit on my personal journey with depression. I've shared my thoughts on what it is like to be a person with depression. I've decided perhaps it is time to write some thoughts down for those who aren't depressed but who have someone in their life struggling with depression. Truly there is nothing new under the sun as there are many articles and resources out there about "what not to say to someone with depression" etc. But those articles weren't written by me, someone you *know* personally, and sometimes knowing the person who is saying it makes all the difference.

Do you know someone struggling with depression? 

Have you wondered why they go some days without practicing hygiene or why they don't respond to a text or private message you have sent them? 

Have you wondered why they seem to have enough time to binge watch Netflix but don't have time to meet you for a drink? 

Have you felt like they aren't being truthful about how they are doing when the comments they make on people's Facebook posts seem normal and upbeat but they say they are depressed? 

Have you sent them a message, you have seen they read it but didn't respond and thought they were just being rude or blowing you off? 

If any of those questions resonated with you or you have asked similar ones about someone in your life then you are in a relationship with someone who is most likely struggling with depression - and they may or may not even know it themselves.

Everything each of us does takes a certain amount of energy. For some people the more interaction they have with people the more energized they become - they are called extroverts because of how they are energized. Other people, like myself, are drained by interaction with people - especially people we don't know at all or well. People who are drained by interaction with others get their energy replenished by spending time alone to recharge - these are introverts. This has nothing to do with depression because regardless of how you get energy you can be gripped by depression, but I bring up energy because it's important to the care & feeding of those with depression. 

A person who is depressed has low to zero energy for pretty much anything - even if they normally have high energy when in a healthy emotional state. For example, some days taking a shower requires digging deep into energy reserves. Some days energy is easier to come by but depending on how many people I have to interact with depends on how quickly that energy is used up. On lower energy days I don't even have the ability to respond to texts or private messages on Facebook, and I am definitely not answering the phone if it rings. Those who have never experienced true depression (which is very different than being sad) find it very hard to understand these low-to-no energy levels that keep those who are depressed from being unable to even respond to a text. It takes no real energy to respond to a text right? Wrong. Wrong if you are a depressed person. Any kind of interaction, virtual or in person, takes energy that sometimes we just don't have. When I'm having one of those days and I see texts come through I sigh - deeply. Because I know I just can't. I can't find the energy to try and find the words to respond or try to find the enthusiasm to respond or to answer the question that perhaps is being asked. And it doesn't matter who it is - my parents, my husband, my three's and twelve's, my children, etc - if I don't have the energy I don't have the energy, period. And to try and conjure it makes me even more exhausted. People who don't have depression covering them can work up the energy to do what needs to be done, people with depression can but it comes at a great cost, at least in my life it does. 

My most recent experiences with depression came at a time when I didn't have the luxury to stay in bed with the covers over my head like I wanted. I had to get up each day, go to work, interact with co-workers - some of which were triggers for my depression, do my job....basically I had to work up enough energy to get through an 8 hour work day and each night I sat in my recliner, unable to talk to my family or do stuff around the house or socialize with friends. The next day I had to do it all over again. Weekends I never strayed far from my recliner and I holed up trying to fill up my energy reserves for the work week ahead of me. Could people at work tell I was depressed? For the most part, no. I worked it and faked it until I made it each day but it was personally expensive. I had nothing left for family and friends. It was exhausting. 

So, how can you participate in the care & feeding of someone in your life who is gripped by depression? Here's a few ideas based on my experiences:

1) Understand they hate this depression and what it does to them more than anyone else does. It's not their choice to be this way in this season or for the entirety of their life. 

2) Be patient with them - give them the space they need, they will communicate and interact with you when they are able. 

3) Find ways to let them know you are not going anywhere, that when they are ready you are there for them. I have friends who find ways to keep engaged with me but it's no pressure for me - like talking about TV shows, books, and things that are easy to talk about but don't feel like too much effort is involved. 

4) Get on Voxer! You can leave each other messages and it's a no pressure way for them to respond back to you when they have some energy. I have friends who pop on to Voxer just to say they are thinking of me and wanted me to hear their voice. When I have the capability I can leave them a message back. It makes us feel connected especially in the times when I am radio silent. 

5) Don't assume that because they are commenting on Facebook posts or other social media platforms that they are not struggling with their depression. Social media has become a way for shy people, depressed people, socially awkward people, etc to be social without leaving their comfort zone. They can appear to be extroverted or happy or socially adept but not actually be. Social media is a big mask that we all can use - and probably do use to some extent - to hide behind. 

6) When your person engages be grateful for their interaction and engage back! Don't feel all snippy about the lack of interaction they have had with you and everyone else. Just be grateful. 

7) Don't take their radio silence personally. Don't make their inability to engage about you, it's not personal. 

8) Don't be passive aggressive and make comments or behave in ways that try to induce them to guilt that they aren't behaving the way you want them to. Remember - they hate this about themselves more than anyone else does. 

Being in a relationship with someone who is depressed takes patience, a lot of it. In all my seasons, content or depressed, I try to make sure the people in my life know I appreciate them - I appreciate their willingness to be patient with me when I go radio silent, I appreciate their enthusiasm for my ability to be present and engaged when I can be, I appreciate them not pressing me to conjure up energy I don't have, and I appreciate them still calling me friend even when I'm not a very good one. Some people in my life aren't able to have patience with me, we've drifted apart. That's okay, I get it. The ones sticking it out with me are worth more than gold, I know it can be hard to be in a relationship with me. 

If you have experience with this, either as the depressed person or as the person who loves someone struggling with depression, what are your tips for the care & feeding of depressed people?