1. Go for a walk, do yoga, tai chi or any pleasurable movement activity.
  2. Get outdoors every day, whether that means walking in nature, exercising your dog or gardening.
  3. Practise saying no without the need to justify. If you feel you need to add words, then “No, thank you” or “No, that won’t work for me today” are both fine things to say.
  4. Practise deeper breathing. Deep breathing to a slow count activates our parasympathetic nervous system and calms the body:

    Inhale at a slow and steady pace for a count of four and exhale slow and steady for a count of four or five. As you practise, increase to a count of six or eight.
    You can add a slight pause at the top of the inhale before exhaling with control for your count.
    Hold a brief pause at the end of your exhale as you develop better breath control.
    Do this a few times a day or as often as you like for up to 20 minutes.

  5. Spend time with people who make you happy, or take time to call a friend.
  6. Laugh at least once a day. If you can’t find anything to chuckle at, keep a book of jokes or humour to read from each day.
  7. Pray, meditate or reflect on something you are grateful for daily. We can all think about and be grateful for many of the things we have in our life, and many of the things we don’t.
  8. Nurture your hobby of choice. If you have more than one, choose at least one to maintain. Pick one thing you love to do and refuse to let it go—even if you do it for only five minutes.
  9. Eat healthy foods. Avoid emotional eating. Replace that with some deep breathing or something you can do with your hands.
  10. Eat one piece of fruit you like each day. It is nourishing for your body, and a sweet snack. (Here are the healthiest fruits you can buy.)
  11. Take care of your health and make sure you maintain your own regular and necessary health-care appointments: medical, dental, massage therapy and so on.
  12. Tell yourself three times, at least once a day or as often as you need to, “It is okay to take time for me.” Or replace this with another permission-granting mantra of your choice.
  13. Be sure to do something that brings you pleasure each day.
  14. Start a journal: for gratitude, for simple thoughts or just to note what is happening each day. Getting our thoughts down can be therapeutic, but the very act of holding a pen or pencil can also be soothing.
  15. Get adequate rest and sleep. If you need to access help, then do so. It is hard to function, let alone cope, without feeling sufficiently rested. (Here’s expert advice on how to get a good night’s sleep.)

Kimberly Fraser, Ph.D., is a retired nurse and former professor of nursing at the University of Alberta. She ran a home health-care business in Edmonton and was the past president of the non-profit Caregivers Alberta.

Excerpted from The Accidental Caregiver, by Dr. Kimberly Fraser. Copyright © 2022, Dr. Kimberly Fraser. Published by Sutherland House Books. Reproduced by arrangement with the publisher. All rights reserved.

Now that you’ve got these self-care tips for caregivers in your toolkit, check out 10 mental health podcasts worth adding to your playlist.

Hockey Dad - Kids in Penalty Box

The Funny Things Kids Say

McDonald’s forgot the chicken nuggets in my daughter’s Happy Meal. She said, “I guess this is a sad meal now.” – @katiedeal99

My four-year-old just gave me the last apple slice, then announced loudly, “If you eat the last one you put the bowl in the sink.” – @xennial_mom

You don’t know passive-aggressive until you’ve listened to a parent answering questions from a child who won’t go to sleep. – @thearibradford

I asked my seven-year-old to fold the blanket he had gotten out. He spread it out on the floor, rolled himself up in it, and then cried for six minutes because “it’s impossible.” – @dadmann_walking

My seven-year-old wrote a letter to the tooth fairy yesterday. He hasn’t lost a tooth yet, nor does he have any loose teeth. He just wanted to introduce himself. – Rob Delaney, comedian

Ninety percent of being a parent to young children is wondering if there’s a leak in the house or did the kids just wash their hands. – @homewithpeanut

Our youngest made her own grilled-cheese sandwich. Long story short: did you know that bread is flammable? – @rodlacroix

“This is the best meal ever,” my six-year-old said while shovelling half a cup of sour cream into her mouth with the corner of a tortilla chip. – @mom_tho

My toddler is practising counting by dropping chocolate chips in my mouth. This is the kind of math I can get on board with. – @oneawkwardmom

Whenever I’m watching cartoons with my five-year-old, she checks on me to make sure I’m paying attention. If I’m not, I get in trouble. This feels less like a fun activity and more like I’m being held hostage by a mean lady. – @bunandleggings

My daughter just made me sing a song for her. I complied and then she said, “Do it again but without all those ‘bumps’ in your voice.” Apparently, she didn’t like my vibrato. – Audra McDonald, Broadway actor and singer

I made my bed and found a half-eaten package of butter in it. When I asked my child if she put anything in my bed, she said, “I did not put butter in it.” – @llcoooltweet

My seven-year-old came home from school requesting snack after snack. I asked him where he was putting all this food and he replied, “It’s beyond your understanding.” – @thatmummylife

I was playing cards with a friend’s four-year-old. The rules were that we’d take turns putting cards on the pile until she declared she won. – @jenfulwiler

Nothing like seeing your teenager improperly dressed for the weather so you shout out, “It’s going to rain hard today,” expecting they’ll appreciate your loving concern and immediately run back inside to grab a jacket. But instead, they give you a perplexing thumbs up. – @jacanamommy

My youngest is named Rose, and she spent all of early June walking around the neighbourhood looking at everything in bloom and whispering, “It’s my season.” May we all channel this energy! – @lindseythughes

Kids Say The Funniest Things - As Kids See It illustration
“I want to quit school and fly south next winter, too.”

My five-year-old told me she can’t help me clean up her toys because she’s tired from all the work she does at school.

When I asked her what she meant by work,” she answered, “They’re always making us write our names.” – @snarkymommy78

“I was playing birdsongs to help him relax. ” (My kid, after putting headphones on our cat.) – @rachelxsussman

My eight-year-old sister gave our grandmother a wish list. It included gymnastics clothes, a slime box, a robot to help her colour, pyjamas, bath bombs and $15,000. – reddit.com

Watching football with my 11-year-old daughter is fun. When I get frustrated with my team, she’ll ask calming questions like, “Daddy, do you really think you can do better than the players?” @dad_at_law

I wish I had the same confidence as my five-year-old jumping on the trampoline, telling me to look out for him in case his head hits an airplane. @traciebreaux

After repeatedly stressing the importance of oral hygiene to my kid I found a note that read, “Mom, I left my spit in the sink as proof that I brushed my teeth.” – Pamela Goodchild, Poine-Claire, Quebec

My three-year-old is going through his no-sleeping phase. One night I finally got him to return to his room. He walked in angry and said, “Sleeping is not that fun. And I just want to have fun.” – Andy Tsang, Toronto

When my niece was seven, I accompanied her on a school field trip. All day long, her classmates ran away from me. I asked her what the issue was—it turned out she’d told them I was a real-life vampire. @gaialect

My two-year-old’s granola bar wrapper was pulled down slightly too low. I’m not sure he’ll ever be able to recover from it. – Bess Kalb, writer

My six year-old daughter and I were listening to “Castles Made of Sand” by Jimi Hendrix while driving.

“What’s he singing about, Daddy?” she asked.

“He’s saying that nothing in life is permanent,” I answered.

She replied, “But markers are permanent!” – David Peabody, Calgary

My toddler and I saw some fishermen down at the pier today. “Look, they’re helping the fish out of the water,” he said. “That’s so nice!” – @average_dad1

Todder: Daddy, I have a question: what is on your head?
Me: I don’t know. You tell me.
Toddler: Nothing… because you have no hair! – Jamelle Bouie, journalist

My wife got our four-year-old a bowl of cereal. He then complained he didn’t want milk in the cereal and proceeded to pour out the milk and rinse off the cereal flakes with water. @kevinthedad

Next, check out these silly struggles every parent will relate to.

“Some people with arthritis say they can predict weather, or that the weather changes their level of pain,” says Siân Bevan, chief science officer at Arthritis Society Canada.

The name of a 2019 U.K. study, “Cloudy With a Chance of Pain,” says it all. It analyzed the daily pain logs of 13,000 residents with arthritis, fibromyalgia, migraines and neuropathic pain. Using GPS data from participants’ smartphones, the researchers found correlations between pain and relative humidity, pressure and wind speed. Participants were more likely to experience aches and pains on stormy, windy days and least likely to do so when conditions were dry and calm.

It’s unclear why changes in weather may influence pain severity for some people and not for others. “Everyone experiences pain differently,” says Bevan. “There are a lot of factors that could impact pain tolerance, including sleep, stress and depression.”

One common theory is that the drop in barometric pressure that usually precedes a storm causes a change in pressure within the joints, contributing to pain. (The belief is that as air pressure decreases, it allows our tissues to enlarge slightly, which irritates the joints.)

It’s a good idea to track your symptoms and how certain weather conditions may affect your pain levels, says Bevan. “From there you can manage expectations for what can be accomplished on days when symptoms are worse.”

Perhaps not surprisingly, there’s evidence that the weather may also impact your mood. A 2013 Canadian research paper published in the Journal of Happiness Studies found that women are more sensitive to weather changes than men and that life satisfaction decreased among women on days with heavy rainfall.

A second study, published in a 2011 issue of the American Psychological Association journal Emotion, analyzed Dutch teenagers and grouped them by “weather personality” type. Roughly nine per cent were “rain haters”; they felt angrier and less happy on days with a lot of precipitation.

There are multiple reasons for this correlation, according to Dr. Max Pemberton, a U.K.-based psychiatrist. “Less sunlight affects your levels of melatonin, a hormone directly involved in mood regulation.”

Biologically, this could explain why some people feel down when there is little sun, with the extreme version of this known as seasonal affective disorder. A sun lamp may help: exposure to this type of bright light has a positive impact on melatonin and serotonin (another mood-regulating hormone).

There are also psychological and social reasons why some people feel sad or moody when it rains. For one thing, bad weather may contribute to social isolation and loneliness because we can’t go outside and do the things we enjoy with friends and family, explains Pemberton.

Once you understand how the weather impacts you physically or mentally, there are strategies you can try. For example, if you’re sensitive to cold, damp weather, a hot bath or just a warm compress could provide relief for achy joints. Regular exercise—even if it has to be indoors—is also known to improve mood and is an important part of pain control.

Now that you know how weather affects joint pain, find out if cracking your knuckles is bad for you.

Edward Lubky Driving Bling King
At 88, Ed appreciates how easy it is to spot his car in a parking lot.

It wasn’t always the “Bling King.” In its former life, it was just an everyday 2011 Chevy Cruze, white in colour. Squeezing in among a few other white cars in a parking lot one day, I decided that I needed to do something to identify my car more easily.

One Of A Kind Car - Bling King
A side view of the Bling King.

I purchased two rolls of red pinstriping and applied them to my car—on both sides, the hood, the trunk and doors. Then I purchased 300 feet of reflective stripes and added that on the sides of my car, as well as Cobalt Blue Metallic custom-designed decals I made myself. When I saw LED stripes were available to purchase, well, I just knew that was for me: I now have 80 feet of the stuff on the car, in it and underneath it.

Bling King at night
Ed’s “mobile LED light show.”

I have since added a disco ball; disco discs; mini-LED lasers; front and rear cameras; two musical horns; pink “eagle eyes” rear-wheel wells; a lighted cup holder; a 20-inch scanner behind the grille; blind-spot cameras; a rear-parking sensor with side detection; and 24 switches and ten sockets for controlling all of the added items. At night, I’m a mobile LED light show!

Bling King - hood view

The car now also features thousands of rhinestones in the form of owls, flowers, dragonflies and more, totaling 10,600 rhinestone pieces in all. And, to top it all off, I had 53 digitally printed animal, bird and flower decals made by Tina and Randi of The Sign Shack in Prince Albert, Saskatchewan. Actually, it was Tina who came up with the name “Bling King,” and Randi designed and emblazoned the name on a vanity plate, which I installed instantly! Tina and Randi played a large part in making my car into what it is today.

Every time I’m out driving or in a parking lot, many pictures are taken by onlookers and I have received several positive comments. Who says a senior citizen can’t have any fun! And best all, I can totally find my car in any parking lot now!

Next, check out the heartwarming story behind this car’s quirky paint job.

A dishwasher can be a godsend, especially in a busy household or around the holiday season. But when it delivers cloudy, spotted glasses that need to be re-washed by hand? Well, that’s just a bummer.

While the hard water that’s causing that filmy residue can be softened, we’ve discovered a much easier hack for getting your stemware to sparkle: add white vinegar to the dishwasher right before you run it.

When it comes to all-natural pantry staples that have countless magical household uses, white vinegar gives baking soda a serious run for its money. Vinegar is a great alternative to noxious disinfectants and a gentle abrasive for cutting through grease and soap scum. Both traits make it the perfect secret ingredient for getting glasses squeaky clean.

To give this trick a whirl, make sure your dishwasher is completely full—the best and most environmentally conscious way to go—then place a small bowl that’s half full of white vinegar (yes, we’re optimists). Make sure the bowl is dishwasher-safe, and stabilize it in the top rack. To avoid any possible damage to the dishwasher’s gaskets, don’t pour the vinegar directly into the rinse aid compartment. (You should also avoid these maintenance mistakes that shorten the life of your dishwasher.)

Then add dishwasher detergent and run a regular cycle. From its top-tier position, the vinegar should evenly distribute among both levels. Then remove and enjoy your gleaming glassware.

From time to time, consider sanitizing the interior of your dishwasher using this very trick. Simply empty it out and run a hot water cycle with nothing but a bowl of white vinegar inside.

Next, find out how an ordinary dishwasher tablet can help clean your oven.

My mother died when I was 23, some 18 years ago now, but it wasn’t until being stuck at home during a pandemic that I finally went through the boxes of her things that sat piled in the corner of our basement. In them, I found a glass vase that was easy to give away and a scrapbook of the royals she made in the 1970s (an homage to her teenage crush on Prince Charles) that was easy to sandwich between two hardcovers on my bookshelf. Then there was her fur coat, her disgustingly glamorous fur coat. It’s gorgeous. And horrifying.

My Mother's Mink Coat

As I ran my hand over the soft, brown mink fur, I wondered whether I should keep it simply because it belonged to her, even though I would never wear it. Like many women these days, I’m anti-fur. I’ve even signed petitions calling out companies for using real animal fur in their winter coats when, in my view, they could just as easily make them with faux fur. I avidly follow Esther the Wonder Pig—a 600-pound pet that two Ontarians have made Internet-famous to promote veganism and, along with my twin six-year-old sons, volunteer at their Happily Ever Esther Farm Sanctuary in Campbellville, Ontario, where we shovel manure.

If my mother were alive today, she would also never wear fur. While she was drawn to high fashion—in the boxes I also have dozens of pairs of her high heels—she was progressive in her politics. And yet, although I never witnessed it, she obviously did go out in fur at some point. As I picked up one of the coat’s heavy sleeves and inhaled its thick scent, I could imagine her as a young woman, dressed up for the theatre, complete with her tinkly earrings and red lipstick. I could see her date slipping the coat off her slender shoulders as she commanded the room with her laugh.

My mother was a lot like a fur coat: elegant, stately, at times controversial. Just about all of her jokes and iconic one-liners were “not safe for work.” I, on the other hand, am short, have never worn lipstick and don’t like attention. When I was a teenager, my mother would encourage me to have parties at our house. Why didn’t I invite the whole school over to our place, she wondered? Didn’t I want to be the life of the party?

I really didn’t, but I also didn’t want to admit that to her. “What are you going to do when there are people smoking here?” I replied to avoid answering the question.

“I’ll ask for one.”

I know she meant well, but sometimes it felt like she didn’t see me, or didn’t understand that I didn’t have to be like her. Those of us who knew my mother all gravitated to her and orbited around her, but she made me feel as if I was never orbiting the right way. To her, my clothes were boring, my hair too curly, and my disposition overly anxious. I never felt worthy of being her daughter.

There was one exception, however, a personality trait we shared equally, and that was our ability to keep a sense of humour during difficult times. A month after my mother was diagnosed with terminal adrenal cancer, my two older brothers and I took her to a play—a last night out before she was to have surgery. In the bathroom before the performance, I heard her giggling in the stall next to me. When she came out, I asked her what was so funny.

“I put toilet paper down on the seat, like I might catch something!” We howled with laughter.

And as I tried to figure out what to do with my dead mother’s fur coat, I couldn’t help having some fun with it first. I slipped my arms through the sleeves and posed while my husband snapped pictures. (Look at me! I’m wearing a fancy fur coat!) Then I draped it around my cockapoo, Diego, because with his dark curls he looked just like the Games of Thrones character Jon Snow. After snapping some photos of the Lord Canine Commander, I was finally ready to part with the coat. But as I opened a garbage bag and got ready to stuff it inside, I noticed something. The coat fell open and there on the inside pocket her name was embroidered, all lovely swoops and curves stitched along the grey silk lining. I ran my fingers along the “P” and “L” of Patti Litner and stopped. Tracing the letters, I could suddenly see a softer version of my mother, perhaps a part of her on the inside that I never got to know.

My Mother's Mink Coat - Mother and daughter
Wendy Litner with her mother in 1988.

I had hoped while my mother was dying that we would put our different personalities aside for our final months together. I imagined us whispering secrets to one another, holding each other’s hands in the quiet moments. I pictured her pulling a specially chosen book from her bookshelf and placing it firmly in my hand. “I want you to have this,” she’d say. I would open the book and there would be a handwritten message to me on the cover page making it clear that she saw me not as she wanted me to be, but just as I am.

Instead, we argued as we always did, about all the things we had always argued about—small tiffs about my bent posture as I sat at her bedside, and bigger fights where I tried to convince her to follow the doctor’s orders and she would refuse. At the end of it all, she never gave me anything special or important. I was saddled instead with all the stuff she left behind.

And there I was in the basement, 17 years later, still as insecure and uncertain as ever. I could no longer bring myself to get rid of the coat because, if I did, all that would be left of my mother is me. I am not as glamorous as this fur coat, and I thought perhaps it’s a better representation of her, a better legacy.

I put the coat on a hanger and squeezed it between my sons’ snow pants. Eventually I know I will get rid of it, because I am my mother’s daughter after all. And now that I’m a parent, I’ve seen my wit, pragmatism and strong sense of justice reflected in how my boys regard me. I know somewhere inside, there’s a part of me that is as strong and decisive as my mother was. One day I will hear her voice say to me, “Why on earth are you holding on to that silly fur coat? I never even liked it that much!”

“I don’t know,” I’ll say, dumping it in the trash. “I don’t like it either.”

Next, read the powerful story of how one man forged a stronger bond with his father through email.

Every Food Network-addicted amateur cook knows the complicated feelings that arise when you see a Michelin-starred chef pick up an egg. You know they’re going to do it: the trick you’ve tried (and failed) to do so many times… The fancy one-handed egg-crack.

Maybe your hands just aren’t big enough. Maybe they’re too big. Maybe chefs use more crackable eggs… Whether or not any of those factors come into play, it turns out anyone can learn how to crack an egg perfectly with the help of one simple hack.

Most egg cracking tricks just don’t work

Some people are proponents of the flat surface for optimum cracking, such as the kitchen counter, but we find this just splinters the eggshell and often doesn’t crack it enough. Others prefer to use an edge, such as the side of a pan or bowl; the hard edge acts like a knife to which the eggshell must yield. This can work, but it’s unlikely to be neat—you have to apply the right amount of pressure, and to have sufficient hand-eye coordination to ensure you apply that pressure to the centre of the egg. Too hard, and the egg shatters into a yolky mess. Too soft, and it doesn’t crack enough, leaving you tapping your egg cautiously on the side.

How to crack an egg perfectly every time

This time, you’re just going to drop the egg straight into the pan. Don’t believe us? Take a look at the video below.

@nelliesfreerangeLook ma, no shell! ?•The #e#ggcrackchallenge works best with our #f#reerangeeggs because of their strong, thick shells. #l#ifehack #n#elliesfreerange♬ Pump Up The Jam – The Hit Crew

A perfect egg crack—and clean hands as well. It’s worth noting, as Nellie’s Free Range eggs does, that eggs from free-range (not just cage-free) hens have stronger shells due to the hens being able to express natural behaviour and consume enough grit to make nice, strong shells. More robust shells are more likely to crack perfectly, as shown in the video. Of course, if you can afford it you should be buying free- or pasture-raised eggs anyway, as raising hens in these ways allow them to lead happier, healthier lives (and make better eggs).

So now you know how to crack eggs like a pro. We bet the Michelin-starred chefs don’t know this trick! Next, find out how to store eggs the right way for optimal freshness.

Love Story 2
Marion and John on their wedding day in 1957.

Eternally Yours

Back in the ’50s in small-town Aylmer, Ontario, there wasn’t much activity on a Friday night, except maybe going to the movie theatre. One evening after attending a movie with my friends, we headed to the local restaurant for a soda. Seated at the counter was a handsome stranger. We admired him but didn’t attempt to talk to him. On another occasion, while attending a local hockey game, there “he” was again playing for the RCAF hockey team. This established that the mystery man was indeed in the military. Aylmer was home to an RCAF pilot training station during World War II, which remained open after the war for ground training. On yet another occasion, my girlfriend was to meet her friend at the air base and asked me to accompany her. When we met her, guess who was with her? We were introduced and made a date to attend a dance at the Stork Club in nearby Port Stanley. Little did I know that the man sitting in that restaurant would be the man I’d spend the next 63 years of my life with.

John and I dated for a year and fell in love. There was one stumbling block to our future together. John was a devout Catholic and I was Protestant. He was greatly influenced by a very religious family background that did not agree with mixed marriages. John must have had many sleepless nights dealing with this situation, not wanting to disappoint his family—but we were so much in love. He was so relieved when I told him I would become a Catholic and began taking instruction towards that goal.

Over the years, we shared many common interests including sports, and a love of nature and music. One mutually favourite song was a version of “Eternally” sung by Della Reese.

We became engaged the following year. John was posted to RCAF headquarters in Ottawa and I attended teacher’s college in London, Ontario. During that year, having no car, John would hitchhike to Aylmer once a month to visit me, as I was still living with my parents. We wrote to each other every day and I still have those letters.

The long year apart finally ended and we were married in Aylmer after I graduated in June 1959. We honeymooned in Niagara Falls then toured around the Gaspé Peninsula in our new VW Bug, ending up in New Brunswick, where I finally met his wonderful family. Continuing on, we headed home to Ottawa where I had a teaching position and John went back to headquarters. We had our first baby in Ottawa—and our first heartbreak as she was stillborn, it was a time of great sadness.

Our next posting was to the recruiting office in London, Ontario. John took night courses to upgrade his education and in 1967 he was commissioned and promoted to Captain. He was then posted to CFB Falconbridge near Sudbury. This time, we had three beautiful children to accompany us. Bagotville, Quebec, was our next posting; a good chance for the children and me to learn French. Then it was on to Trenton, Ontario, where John enjoyed his career to the fullest, going on search and rescue missions with 424 Squadron and participating in the military support for the 1976 Olympic Games in Montreal. He was also honoured to participate in a peacekeeping mission in Rhodesia, Africa, leading him to receive the Order of Military Merit for outstanding service, presented to him by Governor General Edward Schreyer with me in attendance at Rideau Hall.

After being promoted to Major, our last posting was to CFB Borden, where John’s position was Commandant of the Canadian Forces Language School. This was a position that John found fulfilling for eight and a half years, and for which he gained much praise from his superiors and staff. John loved his administration career for 36 years in the military and was the type of person who brought joy and a smile to all who met him.

He was a man who appreciated life to the fullest: the sight and song of a bird, a beautiful sunset or working in his garden. His motto was, as sung by Louis Armstrong “What a Wonderful World.” Throughout our years in the military we were fortunate to acquire many treasured friends and memories from all across Canada.

Love Story 1
Marion and John at home in 2018.

Our family was the greatest gift of all! Our children and grandchildren are precious to us. John and I spent many hours enjoying valuable time with each one. Upon retiring, we purchased a small travel trailer and proceeded to camp all across Canada. Heading west to B.C., we reached the Pacific Rim before returning back home to Barrie.

Our next journey was east to visit each Maritime province, dipping our toes in the Atlantic. What a beautiful country we live in!

When at home, we participated in various activities such as gardening, camping, golf and socializing with both of us doing lots of volunteering. During the winter months our hobbies filled our time. John did wood carving, birds mostly, while I quilted and painted. I don’t know how, but John found time to write a book describing his family history dating back 12 generations starting in Louisburg, Nova Scotia, in 1628. He entitled his book, The Last Horse and Buggy Generation.

John passed away at the age of 85 in February 2020. Our years together were spent sharing our dreams and happiness, our worries and sorrows. We were blessed indeed. This wonderful man will be in my heart eternally.

Next, check out one couple’s heartwarming romance as told through their love letters in the 1940s.

Amber, a 27-year-old ESL tutor (identifying details have been changed),is adventurous and loves to travel, but COVID-19 put all her plans on hold. She spent most of the summer of 2020 at her home in Phoenix, Arizona, with her two kittens. In early July of that year, her lower back started to hurt—a return, Amber thought, of a chronic problem she’d dealt with years before. Then she started feeling pain in the front of her chest that flared up whenever she moved. She was also sweating in her sleep, waking up soaked in the middle of the night. She initially blamed it on the Arizona climate. But as the weeks went by, her discomfort worsened.

Could it be a tumour?

In August 2020, Amber found a hard, swollen lump in the upper area of her sternum, or breastbone. When she asked her physician friends about it, their responses were carefully neutral. “I knew that meant it could be something bad,” she says. Worried it was a tumour, she finally made an appointment with her doctor. A chest X-ray revealed signs of inflammation in her sternum, and blood work showed high inflammatory markers. An injury or infection could cause these test results; so could the cancer Amber feared. Her doctor scheduled an MRI for a better picture of what was going on.

While Amber waited two weeks for the MRI appointment, the soreness made breathing difficult. Simple tasks became almost impossible. “Leaning over to tie my shoes caused pain in my chest and back,” she says. “It was immobilizing me.” She steeled herself for the news that she had some kind of malignant mass, but the MRI instead showed that something, likely bacteria, was eating away at the bone in a sternum joint. Amber was at risk of sepsis, a life-threatening reaction to an untreated bacterial infection.

“My grandpa died from sepsis, so I knew it was scary,” she says. Her doctor recommended going to the ER at the local Mayo Clinic for IV antibiotics and a bone biopsy to confirm the infection.

“Is there something we’re missing?”

After looking at Amber’s CT scan, internist Dr. Umesh Sharma expected to see a patient with a badly infected breastbone. He was less certain after he examined her. “Typically, when you have infection in any joint or skin, it gets red, hot, swollen and painful,” he says. “It was painful, but didn’t have the red-hotness. That made us ask, is there something we’re missing?

Sharma was hesitant to treat for infection if he wasn’t completely sold on the diagnosis. Biopsies involve extracting infected tissue with a needle to verify the infection and identify the type of bacteria—and intravenous antibiotics can last six to eight weeks. Sharma consulted with orthopaedic physicians at the Mayo Clinic. They felt that since the lump wasn’t deep, a biopsy, if needed, could be handled by the interventional radiology department, where doctors perform procedures while taking images.

For Amber, the experience of being the subject of a diagnostic puzzle was unnerving, but she appreciated her doctor’s openness. “Being in the loop was calming,” she says. “Dr. Sharma wanted to make sure I knew what was going on.”

A battery of tests

When a radiologist reviewed Amber’s MRI and CT scans, a few oddities stood out. The patterns of bone destruction weren’t typical of infection—some areas looked thickened—and there weren’t any breaks in the skin where bacteria could have entered the body. Plus, the location of the problem was a clue: It was typical of a rare condition called SAPHO syndrome (SAPHO stands for synovitis, acne, pustulosis, hyperostosis and osteitis), which often causes chronic inflammation and pain in the chest, although it doesn’t normally worsen this quickly.

After the radiologist shared his theory, Sharma postponed the biopsy to run more tests, including for fungal infection, cancer, even tuberculosis. Although there was now a strong possibility Amber had SAPHO syndrome, he didn’t want to fall into the same trap of focusing on one diagnosis. He also turned to the rheumatology team for a different perspective. They suggested scanning other bones in Amber’s body. If she did have an inflammatory condition like SAPHO, it would likely be more widespread.

The new scans proved to be a game-changer. Amber had inflammation and bone erosion in her sacroiliac joints, located between her pelvis and the base of her spine. Finally, there was evidence they weren’t dealing with a localized infection.

A rare diagnosis

In fact, the site of these bone changes pointed to a different condition—ankylosing spondylitis (AS), a form of arthritis that can fuse and stiffen joints. AS is known for attacking the sacroiliac joints and can affect the breastbone as well. AS isn’t usually discovered until young adulthood—perhaps because one of the earliest symptoms, low back pain, is easily dismissed. The cause of AS isn’t fully understood, but a specific gene is known to be a factor. If left untreated, the disease can permanently reduce mobility.

About one in 1,000 people are diagnosed with AS worldwide, making it more common than SAPHO. But since initial tests focused only on Amber’s chest, it hadn’t been on the radar. “Hindsight is 20/20 when you have all the information,” says Sharma.

He ordered a genetic test for AS, and Amber was discharged a couple of days later. In two weeks, the test came back positive; Amber started a drug to slow the disease’s progression. Although AS can’t be cured, she will likely lead a normal life as long as she continues treatment and physical therapy.

The diagnosis has changed Amber’s day-to-day outlook, she says. “I’m a little more in the moment now, more present, and not taking things for granted.” She’s also grateful she avoided the invasive biopsy and weeks of the wrong treatment. “We could have gone down a rabbit hole, and we don’t know what the adverse effects of that could have been.”

Next, read the incredible story of how a woman’s X-ray revealed the reason behind her life-long stomach pain.