Ketamine…Again?

Before I sat down to write this today I was planning on doing another Vlog. (Note: I actually wrote this and intended to post it yesterday before I found out that Facebook and Instagram had both crashed!). I thought I needed to maybe hear my own voice again today but I’m just too vulnerable right now and so I wrote my words out instead. 

My Psychiatrist increased my new medication again late last week with the intent to get it to a therapeutic dose soon. It’s an anti-anxiety medication which I mentioned I would be starting a few weeks ago. As of yet I can’t say that it’s really been helping me. So for now I will just add it to the long list of failures.

Yesterday was a pretty bad day all around for me. My anxiety was very high which then turned to panic, crying, rumination and an increased amount of thoughts of death and dying.

As I also mentioned recently my Psychiatrist had put a plan together for me when we spoke a few weeks ago. It included this new anti-anxiety medication and it also included treatment for Ketamine…AGAIN which has been scheduled to start early next week. 

So for those of you who don’t know what Ketamine is I will give you a quick explanation here. For starters, it’s actually a very potent and sometimes deadly street drug known as “Special K”. It is also apparently used as a horse tranquilizer but most commonly it is found in anesthetic.

I’m not gonna bore you or put you through a science class today but people living with Depression are known to have “abnormal brain plasticity”. Continued studies and research have shown that using Ketamine can help to remove the “negative receptors” in our brain and then it like “plants a seed” in your brain which allows for new “neuropathways” and positive neuroactivity to grow and flourish.

Studies have shown that by using Ketamine to treat Depression there has been a 60% success rate so far and unlike anti-depressants it is supposed to work faster and more effectively.

Now let me go back for a second here and explain (for those who may not already know) what I meant before when I said I am scheduled to begin Ketamine treatment…AGAIN.

Several years ago during an inpatient stay at Sunnybrook Hospital I was asked to take part in a Clinical Trial for Ketamine. I had never heard of it before but I was the perfect candidate though because it is used mostly on patients who suffer with Treatment Resistant Depression like I do. I happily and very naively agreed to try it. I figured I had nothing else to do seeing as I was in the hospital anyways.

I filled out a ton of paperwork, spoke in depth and several times with the Psychiatrist in charge of the study. I filled out many questionnaires with his Associates. After I was given approval to begin the study I was scheduled to start the 1st of 6 treatments the very next day.

They told me during the initial consult that the Ketamine would be administered through an IV and that I would have to lay there in the OR attached to an IV drip for 45 minutes and then kept for observation for another 30 minutes following. Before we began the process I asked the Anesthesiologist if I would feel anything. He said you may feel a bit woozy. 

Well woozy was an understatement because for the next 45 minutes I lay on the cold table hallucinating, feeling disassociation and seeing psychedelic images flash before my eyes. It felt like a complete out of body experience with flashbacks as far back as my childhood. 

I hated every bloody second of it and couldn’t wait for it to be over. The next day I met with the Psychiatrist to discuss how it went and we both agreed it was probably best that I don’t continue with the study. Another epic fail.

Now let’s fast forward to March of 2020. My current Psychiatrist happens to be the Medical Director of 2 Ketamine clinics in the GTA and has studied it’s effectiveness on Treatment Resistant Depression for several years now.

Back in February or March of 2020 (everything is kinda a blur now) we began another discussion surrounding Ketamine and he asked me if I would be willing to try it again as with more scientific research and studies conducted it was now available in a nose spray form. And less invasive.

He told me he would administer the 1st dose in his downtown office at the hospital he works out of to ensure I tolerate it and that the following 5 doses could be picked up at a local compounding pharmacy and be administered under the supervision of my husband in the comfort of my own home.

I agreed to try it AGAIN cause well, I try almost everything at least once when it’s come to my treatment or in this case twice.

We were scheduled to begin the 1st treatment on March 15th 2020 at 6:00 p.m. It never happened. And if you have been following my journey very recently I kinda just let things slide from there once the pandemic hit.

As most of you know though I reconnected with my Psychiatrist a few weeks ago at which time he told me that patients were no longer allowed to administer the nose spray at home. The whole idea had been kiboshed over the past year as research had shown that it was a liability and quite dangerous to do so. But I guess it’s OK because since March of 2020 Ketamine is now available in an even less invasive form, a pill which is dissolvable under the tongue but still can only be administered under the watchful eye of a doctor/nurse. 

So I guess as they say, three times a charm as I have agreed to try it…AGAIN. The six sessions are to be completed at a clinic in Toronto (there is also a clinic in Mississauga too). Each session will take between 2 to 3 hours from start to finish to complete and I am not allowed to drive home afterwards. They actually recommend you don’t drive for 24 hours following. The sessions will take place twice a week for two weeks and once a week after that.

Although I’ve agreed to try it again given I feel like I’m running out of both viable options and steam, but I have been told by my doctor that I am very likely to still feel those same hallucinations and disassociative feelings that I don’t like. I’ve done many other treatments and have tried many hallucinogens over the last several years. I don’t like feeling as though I’m tripping out on LSD.

I’ve been consumed with very negative thoughts for several days now (surprise, surprise) since booking my treatment. I’m experiencing extreme anxiety and feelings of overwhelming guilt and lets not forget those feelings of being a burden that weigh me down too. I’m questioning my decision to do this again for many, like OH MY GOSH, too many reasons.

For one, it’s still very new and likely not to be a forever cure from what the current research shows. I will very likely need to continue on some type of maintenance program after the six sessions are done. But like how long term? And does anyone even know what the long term effects of it could be, especially cognitively. As it is, I did ECT (Electroconvulsive Treatment) several years back. Probably the most invasive and scariest treatment I’ve done. The eight treatments I did fucked me up royally. It fried my short term memory, my ability to recall many things and I find myself often forgetting what I was talking about mid…sentence.

But at the same time Psychedelics seem to be the wave of the future for treating mental illnesses and especially for people like myself who are treatment resistant. I’ve even tried “shrooms” in a pill form, but couldn’t tolerate the hallucinations it caused, although my Psychiatrist is also currently working on many new studies and its amazing effects on Treatment Resistant Depression as we speak.

I’ve tried so many different treatments over the past seven years and how I see it, I have failed them all, many of which have cost a shitload of money because they were not covered by either Ohip or insurance, Ketamine now included. I wish I could understand why if there is such a need for these treatments and Ketamine for one has one of the highest success rates among all treatments including anti-depressants then why has it not yet become part of the mainstream health care system so that more people can have access to it? I know, dumb question.

It’s an expensive treatment, especially if it becomes ongoing. It’s an expense we really can’t afford at the moment and just adds to the extraordinary guilt I already live with on a daily basis. The “what if” I’m not part of that 60% success rate, the “what if” yet another attempt fails and we throw away even more money that we don’t have. How can I live with that on my conscience?

The answer is, I can’t.

I’ve carried on and on AND on the last few days with all the other reasons as to why I also shouldn’t do it as well and feel like a burden yet again to my family by having to take me and sit with me for 2 to 3 hours (plus the 30 plus minute drive there and back) while I have my treatments.  

These are very real struggles for me which of course my Psychiatrist tried to remind me the other day as I rambled on about all my reservations that I’m having that it’s my Depression talking and that my Anxiety is happily cheering him on. I can’t let them win.

But it’s so fucking hard though and the noises in my head are loud as hell. It’s literally killing me.

They keep telling me I don’t deserve to live a life free of chronic Depression, debilitating Anxiety and daily thoughts of Suicide. They keep telling me I’m just gonna fail at this attempt too. They keep telling me to give it up already and that I’ve already used up my many chances at recovery over and over AGAIN. Like why would this time be any different?

Thanks for listening to me today. I so appreciate the extra set of ears. Somedays the best medicine is just knowing that someone is there listening to my very real and terrifying emotions with only the purest of intent.

#ketamine #empathy #education #treatmentresiatantdepression #mentalillness #mentalhealth #depression #anxiety #itsoktonotbeok #youareenough #maskoff #psychiatrist #psychiatry #acceptinghelp #threetimesacharm #selfcare #youmatter #youareenough #yourmentalhealthmatters #mentalillnessawarenessweek

Wife Appreciation Day

Today happens to be “Wife Appreciation Day”. 

To be honest I am feeling very triggered right now ever since I came across this revelation earlier this morning because in my mind I don’t see myself as a wife deserving of appreciation, I just see myself as a burden to everyone, especially my spouse. 

My memories on Facebook this weekend have been flooded with one of the most incredible nights of my life two years ago when I was invited as the Guest of Honour at a launch party for my new children’s book “Where Did Mommy’s Smile Go?”. I was surrounded by so much love and appreciation. 

One of the memories that came up today happens to be the speech that Rich gave that night. I’ve read it probably ten times already this morning as I try to battle with the demons in my head who keep telling me that I’m not worthy of the love and commitment and appreciation others have for me, especially my spouse. 

I wanted to reshare those words with you today that were so eloquently spoken from the heart by Rich, to me, his wife in hopes that the demons in my head get the message!

P.S. For all of you reading this who have an imperfectly perfect wife, make sure you remind them today, tomorrow and forever how thankful you are to have them in your life; I may not always believe it but I am certainly one of the lucky ones because Rich never stops trying.

#wifeappreciationday #burdened #mentalhealth #mentalillness #mentalwellness #fromtheheart #suicideprevention #facebookmemories #triggers #childrensbook #appreciation #commitment #love #spouses

September 17, 2019

Good Evening

As most of you know I am by no means the writer in our home and my press secretary has been busy working on her own speech all week, so here goes nothing!!

I first met Kim when she was just 18 years young and she began working at the video store I was managing in Thornhill. She caught my eye right away but unfortunately there were MANY challenges standing in our way. Besides the fact that she had a boyfriend at the time and I was busy fending off some lovestruck sociopath, I was now her boss as well, but those didn’t even come close to the biggest challenge we were facing. Ya see, I was close to 9 years older than her (8 years, 7 months and 16 days to be exact). And now that I have 2 daughters of my own who are in and around that same age I can TOTALLY see that challenge from a very different perspective!

But with a combination of male ego, unyielding determination, mixed in with a spoonful of testosterone sometimes you just have to say Screw It and ignore what the haters may think or say and just go for it! By now Kim was just shy of her 20th birthday and had this been in some medievel time she would have likely been considered an old maid already so I saw this as my golden opportunity. But I am still waiting for that dowry!

We recently celebrated 24 years of marriage this past spring and have 3 beautiful kids to show for it, one of whom is busy drinking his way through Europe with some friends as I speak. And like in every marriage or as every parent can attest to there will always be challenging times along the journey which for us surfaced 5 and a half years ago when Kim first took ill.

I have known Kim now for 30 years and have watched her grow and change in so many ways but one thing that has never changed in all the years I have known her is that she has the kindest heart, and she has so much determination and so much will. I know that Kim no longer sees these incredible attributes within herself because of what depression has taken from her but lucky for her there are so many people in her life who love her enough to ensure that she can see what an incredible person she truly is.

I am so proud of you Kim. Jacob, Hannah and Rachel are so damn proud of you too. You may not see what we all see in you but I will keep reminding you of it every single day for the rest of our lives. You may not see that what you do for so many people by writing your blog and opening up to the world about what it truly feels like to battle with major (and treatment resistant) depression and SEVERE anxiety and panic every single day. You may not see how your vulnerability and honesty has helped so many others feel less alone and you may still not be able to call yourself an author and believe it to be true but you are an author, I mean City TV interviewed you for the six o’clock news last night if that isn’t proof enough!

But you know why you are an author…because you had a vision, because you have such a creative soul, because you are so kindhearted and because you have such an unyielding determination and innate will to help others. You have accomplished more than so many others because of all that. You have made your dream come true even through the darkest days of your life. You have found your purpose.

Look around the room tonight Kim and see all the love surrounding you, they aren’t just here for the free food and drinks! They are here to celebrate you!

Jacob Hannah Rachel and we can’t forget Maggie (our dog) and I love you to the moon and back! And now without further ado…let me introduce to you, my beautiful wife and best friend.. children’s author Kim Fluxgold!

What Does It Feel Like To Be Suicidal

*May be triggering*

I think about suicide, like ALOT. 

If I’m being honest, it probably crosses my mind at least once per day, but most days I am able to distract it or change the subject. 

But then there are the days or even weeks when it decides it wants to fight back. 

It gets angry.

It uses scare tactics.

It bullies me.

And oftentimes it has pressured me into doing things I don’t want to do. 

For the better part of a week now I’ve been finding it more and more difficult to distract it. I do so for a while and try my darndest to change the subject but that only seems to be making it fight back even harder, and it seems angry. 

Which makes me even more vulnerable.  

The best way to describe what this feeling is like would be to compare its likeness to that of the antagonist in a horror film chasing after the heroic protagonist through the dark and foggy woods with a bloody butcher’s knife in hand.

You feel an adrenaline rush. You feel scared and alone.

You can barely catch your breathe.

You try running faster as you look back into the dark and fog filled woods. You can hear the rustling of leaves and you know that the antagonist is gaining speed. Then suddenly you lose your footing and collapse from exhaustion. You feel like you can’t run anymore.

*** I am needing to take a short break from social media. I’m at my breaking point. I have such an amazing community of support surrounding me which will never go unnoticed. I love and appreciate you all! xoxo 

*if you or someone you know is in crisis please tell someone immediately*

#suicide #depression #anxiety #mentalhealth #mentalillness #breakingpoint #socialmedia #takecareofyourself #selfcare #youarenotalone #dontsufferinsilence #youareenough

Sleep Is A Bloody Nightmare

Yesterday I did an hour long aqua fit class in the morning and then went on a two hour long hike in the scorching heat later that afternoon. 

This sounds like the perfect recipe for a good night’s sleep, right? Well apparently not for someone like myself whose anxiety and depression really don’t give a flying fuck how exhausted you are. 

By dinnertime last night I could barely keep my eyes open but as soon as my head hit the pillow, that dream of getting a good night’s sleep once again turned into a nightmare, an anxiety infused nightmare. 

I have found myself tossing and turning more and more lately and I can’t seem to find a comfortable place to lay my head anymore which is probably because my brain and subconscious mind are too damn busy gearing itself up for its long night of torture ahead.

Sleep is meant to give both our bodies and minds time to recuperate from the stresses of the day but for the better part of seven years now sleep has been one of my biggest hurdles toward recovery. 

As the night progresses and the house becomes more and more quiet is usually when the noises in my head become the loudest and most heightened. 

My brain never shuts off, even when I do fall asleep. I can easily go from any state of sleep to waking suddenly by a trigger or a rush of adrenaline where feelings of impending doom kick in to high gear, leading to a full on panic attack about something that occurred earlier that day or that a loved one may be in danger, or worse. 

Sleep can be truly exhausting 😪

#sleepdeprivation #sleeplessnights #tossingandturning #nightterrors #nightmares #depression #anxiety #exhaustian #suicidalthoughts #mentalhealth #mentalwellness #mindfulness #impendingdoom #panicattacks #youareenough #youarenotalone #yourmentalhealthmatters

The Puppet Master

I know it’s really difficult for many of you to truly understand the depths of what depression and anxiety can do to a person’s mind.

It plays tricks on you.

Some days may feel lighter or brighter than others and for a moment, however brief it is, you may even forget about your illness.

Some days you are able to step outside of your darkness and pain just long enough to experience some moments of genuine joy and happiness. 

It’s as though you are playing a character role but as soon as the curtain closes you step back into real life. 

You all saw the pictures I posted the other day from my weekend away with my family (just in case you missed them here they are again: https://youareenough712.wordpress.com/2021/06/20/unwrapping-the-gift-of-family-time/).

You can see from these pictures that I experienced many, many treasured and genuine moments of joy and happiness over the weekend. 

I will always be forever grateful for everything my kids did for me this past weekend, ensuring that I felt those moments of genuine joy and happiness, which I did.

Nothing will ever erase those feelings even when my mind tries to trick me into believing otherwise. 

Yesterday was an extremely difficult day for me. The curtain closed abruptly on those feelings of joy and happiness and I crashed hard, real hard. 

The darkness and pain is still surging through my veins today from many of the triggers I experienced yesterday afternoon and evening (none of which I am comfortable sharing at the moment). 

As I lie in bed writing this, curled up in a cocoon underneath my weighted blanket and unable to face my final hours in my 40’s I am feeling very overwhelmed. I am confused. I am angry. I am sad. I am anxious. I am scared and to be perfectly honest I am all cried out at the moment. 

This is just some of the many depths of depression and anxiety. You see the moments of joy and happiness in my life and wonder how I can experience them if I still struggle with depression. I totally get why it may be so difficult and confusing to understand it, but that’s what depression does, its puppet master finds immense pleasure in playing tricks on your mind.

#momentsofjoy #momentsofhappiness #playingtricks #puppetmaster #depression #anxiety #overwhelm #suicideawareness #selfcare #mentalhealth #mentalwellness #mentalillness #youareenough #youarenotalone #itsoktonotbeok #yourmentalhealthmatters #thedepthsofdepression

Good Mental Health is a Balancing Act

I’m overwhelmed. 

No I’m like freaking beyond overwhelmed right now. 

I’ve reached my tipping point and I’m finding it real challenging to keep my balance in check.

Good mental health is a balancing act. 

It takes a lot of trial and error. 

I know my weaknesses.

I know my limitations.

I know what makes me happy. 

I struggle to accept help from others.

I struggle to set boundaries. 

I struggle to say no.

I’m overwhelmed.

No I’m like freaking beyond overwhelmed right now. 

I’ve reached my tipping point and I’m finding it real challenging to keep my balance in check.

Balancing one’s mental health is “learning to find a way to do the things we have to do and the things we want to do without changing the hours in the day.”

I can’t find my balance right now. I’m tired.

I’m feeling hopeless.

Quick to anger.

Anxious.

Guilt.

Sadness. 

I’m an organizer, a fixer, a multi-tasker. 

But I can’t concentrate.

My brain is scattered.

I can’t complete a simple task.

I’m overwhelmed. 

No I’m like freaking beyond overwhelmed right now. 

I’ve reached my tipping point and I’m finding it real challenging to keep my balance in check.

Good mental health is a balancing act. 

It’s not something that can be achieved in a day.

My mental health depends on it and so does my mental wellness.

I’m deserving of both. So are you. 

But it may take a lot of trial and error in order to get there. 

How do you balance your mental health and wellness?

#mentalhealth #mondaymotivation #mentalwellness #depression #anxiety #balancingact #overwhelm #vulnerability #itsoktonotbeok #yourmentalhealthmatters #youareenough #selfcare #hopelessness #suicideprevention #blogger #trialanderror

After The “But”

As my “Class of 2021” graduation initiative comes to a close this week I will have sold AND delivered over a thousand lawn signs since it began last spring and raised over $15,000 for youth mental health. 

During this time I’ve been blessed to meet so many amazing and kind people, some of whom I now call my friend. 

I’ve also made some incredible connections along the way. 

I’ve started relevant, much needed and VERY important conversations. 

And I’ve listened as many others have shared with me some of the most heart-wrenching struggles they’ve faced or are currently going through with their own mental health or that of a loved one. 

Overall this has been one of the most purposeful, meaningful and rewarding experiences of my life, especially knowing that I have helped bring smiles to so many faces (both young and old alike) and maybe even brightened up their day. And it also feels really good knowing that in some small way I am helping to make a positive change for our young people today.

BUT, (and there is always a “but” with me), there have also been many, many days throughout this process where the overwhelm of what I do behind the scenes and the hours upon hours I’ve spent making sure that my campaign is the greatest possible success takes a gigantic toll on my mental health. 

And this past week while already feeling vulnerable and defeated has been no exception. 

As many of you already know, I was placing my final order to go to print earlier this week. This included a sign for someone who had literally contacted me last weekend only hours prior to my twelve midnight cutoff. 

We ended up having a friendly chat back and forth for a good hour during which time she chose which sign she wanted to purchase for her son who is about to graduate grade 8 from the same elementary school that I attended, she gave me her address for delivery and before we signed off for the night (which was now midnight) she asked me if it was okay if she sent me her payment in the morning. I said sure, not a problem.

So, in good faith I put her order through with the rest of them first thing the next morning which she knew I would be doing. After our friendly chat the night before I saw no reason not to trust that she would pay me as she had promised (which I’ve done before for others).

Several days lapsed and my shipment would soon be arriving for delivery (which it did this afternoon) and I still had not received her payment so I followed up with a friendly reminder (people forget or get busy etc., I get it) and as though it was no big deal she told me that she had decided that she didn’t want the sign anymore and could I cancel her order. Like WTF! 

She knew I was placing her order first thing the next morning.

Did she just think the sign and me would miraculously disappear?

Did she not think it would’ve been a nice and simple courtesy to let me know she had changed her mind at some point before I would have possibly delivered it to her?

Does she not have a conscience?

Did she not care that the money from the purchase of the sign was being donated to charity?

In case you’re wondering, I confronted her and asked her those exact questions and guess what; she didn’t care! I’m sure you’re not surprised “but” I trust too easily I guess.

It really set me back even though this had been my first time experiencing this during my entire campaign so I guess that’s pretty good odds eh?

I was really trying through all of my upset and anger to remind myself of all the positive experiences I’ve encountered talking to well over a thousand people over the course of my campaign “but” instead there I went right down the rabbit hole again.

I wish that the word “but” didn’t even exist in my vocabulary and that I could finish both my thoughts AND sentences before the “but”; “but” it always feels like an impossible task. 

By connecting a sentence or statement with the word “but” for me is kinda like deflating a balloon with a sharp object. 

Those words before the BUT, you know the ones I’m talking about, the ones where I praise myself, see my strengths and acknowledge all the good I try and do for others just end up feeling completely meaningless. 

“But” I will argue that I have a really good excuse for it, I swear I do!

Or at least that’s what my depression and anxiety seem to want me to think.

#afterthebut #depression #anxiety #suicideawareness #gradsigns #mentalhealth #classof2021 #graduationday #stayathomeorder #lockdown #forouryouth #ouryouthmatter #campaign #initiative #lawnsigns #kindnessmatters #itsoktonotbeok #bekindtoyourself #selfcare #letitgo #selfdoubt #justbreathe #startaconversation #endthestigmatogether 

Sharing My Panic Attack

I had a panic attack today while driving home from my therapist. I needed to pull over so that I could calm down. I talked my way through it by asking myself a few simple questions that I have learned over the last many years to help me get through them. If you or someone you love suffers with anxiety and panic attacks have a listen.❤🤗

https://m.facebook.com/story.php?story_fbid=4191891124178675&id=100000734852540

#panicattack #endthestigmatogether #youareenough #youarenotalone #itsoktonotbeok #mentalhealth #mentalwellness #checkonyourlovedones #startaconversation #dontsufferinsilence #speakyourtruth

Ice Cream For Breakfast

Some days you may feel like eating ice cream for breakfast.

Today when I woke up it felt like that was the kind of a day it was for me.

If today feels that way for you too, it’s okay; give yourself permission to eat the ice cream for breakfast but don’t forget to pour some sprinkles on top too!

What foods bring you comfort?

#selfcare #ichooseme #youarenotalone #bekindtoyourself #itsoktonotbeok #icecream #comfortfood #youareenough #bekindtoyourself #depression #anxiety #mentalillness #mentalhealth #mentalwellness

Monday Motivation: The Importance of Smaller Steps

People often think that the only way to achieve a goal is by taking “big steps” but that isn’t necessarily going to get you there any faster or with any greater success. 

As someone suffering with depression and anxiety I can tell you firsthand that taking smaller steps toward any attainable goal can and will have a much greater impact. 

For starters, small steps help get you started and can feel far less overwhelming. 

But this past week I forgot all that while being faced with extreme overwhelm and instead I found myself trying to push away the overwhelm by taking too many “big steps” (ginormous is more like it) up my ladder and all at once. 

I should have known better that this idea would likely backfire on me and when I finally realized days later that what I was doing was in fact only causing me further overwhelm I was already in dire need to alleviate it. 

It was at that moment that I took a deep breath and stepped off the ladder all together which allowed me to find my footing once again and start back up the ladder using smaller more attainable steps. 

I was so completely overwhelmed that I misjudged how many rungs were on the ladder and that because they were all securely in place there should’ve been no reason for me to try and skip any steps as I began climbing up. 

My missteps could’ve been a recipe for complete disaster but when I regained my footing and began climbing back up the ladder using smaller steps it in turn added up to much “bigger” results. 

Taking smaller steps for me ensures greater success, makes many of my decisions much more manageable and can free my mind from those bigger distractions as well.

I know I have a much better understanding these days as to how critical it is to take those smaller steps (even if my illness tries to persuade me in another direction) in order to create momentum and improve my productivity and performance which can allow me to stick with a goal more easily.

What small steps would you like to take this week?

#motivationmonday #mondaymotivation #goals #simplifiedgoals #attainablegoals #smallsteps #youareenough #overwhelm #vulnerability #mindfulness #therapeutic #selfcare #selfdiscovery #depression #anxiety #mentalillness #mentalhealth