Genetic Test for Medication

When I first started seeing my new psychiatrist she asked me if I’d had genetic testing to determine which medications would work best for me, I hadn’t, so she asked if I was interested. Of course I was interested! I was then given 2 swabs to rub on the inside of my cheeks and off they went to the lab at GeneSight, within a few days the results were back.

You can read a lot more about GeneSight and see an example of what an actual test looks like on their site. To see a detailed example of  test results click here. It will take you to a pdf. I was going to show you some of mine but mine are black and white copies and aren’t nearly as pretty as the actual test results, and mine has over 9 pages of information. (I think some is repeated to give more in-depth information about it, but golly, that’s a lot of information.) I will however talk about some of my results.

Sample of one page of a GeneSight report.

After receiving my results we started going though it all to see what medication therapies would be best for me. It was very surprising to me how many medications I’ve been on in the past that were listed in the “Significant Gene-Drug Interaction” category. I also found out that this test really didn’t show which drugs I would have severe side effects to. For example, all antipsychotics. There are a few that are listed as “Use As Directed” that caused me severe Akathesia (the need to constantly move) and muscle twitching, which can become permanent.

We went through all of the medications on the list for Antipsychotics, Antidepressants, Mood Stabilizers, Anxiolytics and Hypnotics, Opiods and Non-Opiods. I’m not really sure why I was tested for opioids and non-opiods but I will be taking that to the hospital the next time I have surgery. (hopefully that’s never)

I’ve been told I’m a complicated case. I’ve tried a lot of medications in the past, some worked for a while and stopped and some never worked. We started going through one that worked for a while first. Lithium. When we tried Lithium I started to show toxic signs before I got to a therapeutic dose. We tried Depakote, I felt better and got to a therapeutic dose but it caused so many side effects that I couldn’t take it. (my stomach hurt so much and caused me to have severe retching, it was most painful, and this went on while I was on antibiotics so I blamed it on the wrong drug for a long time, finally we figured out what the culprit was and I had to stop it.) So then we tried Vraylar, an Antipsychotic, almost immediately I started having symptoms of akathesia. It wasn’t as bad as it was with Latuda, but it was starting, so I was put on a drug to help control them. It did but I still had this constant hum that made me feel like it was going to start all the time and I was still a little manic. You may remember the post about me talking all the time. I saw my psychiatrist during that time and could not stop talking during that visit, it was most disturbing to me. I can’t even remember what she did to change my medication at that time, I believe she added another medication. I know at one time I was on five drugs from this one person….or was it six? I’m still on a ton, but I’m tapering off 2 so that will make it less and one of those should also take over a medication for a condition I’m being treated for by another physician, so that will take away 3 drugs all together. Score.

I’m sure I’ve completely confused you. It confuses me!

Let’s see if I can make a little more sense than I have been….yes I seriously doubt it too, but bear with me. The last visit I had, I took that gene test and was ready. I told her what I had taken before that seemed to work for a long time, Topamax, all by itself, but we got to such a high dose I has severe cognitive issues, so I’d like to add it to the Lamotrigine I’m already on, both of these are mood stabilizers, that way I don’t have to have such a high does of Topamax and shouldn’t get to the point that I have cognition problems. (I was over 400mg before now I will be at 200mg, much more doable I think) Topamax can also help my migraines and my Idiopathic Intracranial Hypertention, so that’s a great thing.

I’m also seeing another psychiatrist on the 28th for a second opinion. I’m not thrilled by how this has been handled, all the drugs just pushed on me, and at one point when I was at my worst and asked what to do if I was in crisis, I did not feel it was taken seriously. I was told to go to a certain hospital, but was not given the information. How is someone who is in the throws of a severe mixed mania episode supposed to remember what psychiatric hospital this woman spoke of to find out how to get there, and I was not in the frame of mind to ask her to write it down. I was a complete mess at the time. It’s times like that that patients really rely on their health care professionals, and too often they fail to live up to what is needed.

I’m still a lucky one. I have insurance and can actually go to a psychiatrist and get help, there are countless others out there who can’t. We often tell people to reach out when they are in pain, but if they can’t pay for help, they are simply turned away. This country treats their citizens like garbage. If it’s unsightly, throw it away.

Please support mental health facilities who treat those who can’t afford care, there are so many people who are homeless because they have no where to go for treatment. Take time to be kind.

Have you tried GeneSight? Would you if you haven’t? Do you think it’s beneficial?

I do think it’s a great place to start. It’s telling me if certain drugs metabolize faster or slower than they should, and well all kinds of things. Be sure to read more at their website if your interested.

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Psych 101.2

I saw my psychiatrist today, it was an interesting visit. I am feeling much better than I was. No more rage, but Stuart did admit I’ve been talking more, which was quite obvious in her office. I just talked so much and so fast it was crazy. I seemed to have been extremely happy and just couldn’t control it. I was thrilled that she was finally speaking up and I could hear her. She was even trying to slow down. She is normally very soft spoken and talks very fast with a Russian accent which makes it impossible for me to read her lips well. If I can’t hear her better, I’m lost. Stuart normally has to take the lead in my visits. Today I got the giggles, and when we got outside I busted out laughing. I thought it very funny that I was bouncing off the walls in her office. The whole thing seems very surreal.

It is now obvious that I am still having a manic episode, but it’s much better than it was. The main symptoms have been the extreme talkativeness, sleeping very little, and doing more than I’m really physically able, and today uncontrollable giggles. My Fitbit says that I’ve been getting at least twice as many steps per day than I normally do. I’m thrilled about that and hope I can keep it up; however, completely reorganizing my house and cleaning like crazy, that is taking a bit out of me, but I’d really like to finish. Oh, and I’m forgetting things, someone can tell me something or I can tell someone something then I can’t remember the conversation…that’s weird.

She asked me if this was normal for me when I have an episode. I told her I haven’t had a severe episode in almost 30 years, or more! This is new territory for me. I have had a couple of depressive episodes when my medication needed to be adjusted, but I could always tell myself that I knew it would end, and that got me through it until I could get my medication leveled out. True mania hasn’t hit me in a very long time. To be honest, when I had manic episodes before I was stable I would paint like crazy (often days at a time), lose time (meaning time would pass and I didn’t remember I didn’t realize it, or remember what I did during it), spend a lot of money (I once bought a Jeep on a manic swing), do very risky things (like drive to DC and meet with someone I’d only talked with on the phone) and be very promiscuous. Now, I’m not doing all of that, I did always talk a lot though. After I was diagnosed talking a lot was a sign to me that I was a bit manic, but nothing like I’ve been the past few months.

I’m grateful that we have found medication that seems to be working, it just needs to be adjusted. I hate that it’s taking more meds than I’d like to take, I’m hoping after I get stable for a while we can work on getting me off a couple. Today she increased the main med, took away something, and added another to help me sleep, hopefully. I’m having to take another drug to stop the akathesia that started with the new mediation, it’s an anti-psychotic and I’ve had trouble with those in the past, but this is a newer one that is less likely to cause this problem. Yeah, right. The drug that stops the akathesia is normally a blood pressure medication, weird huh?

So we’ve solved the riddle of why I’ve been talking so dang much. I can now stop telling myself to just “Shut the F up!”

so how’s your day been?

**photo of self manipulated with PhotoLab app. Sole ownership belongs to me.

Stop Talking!!

I can’t stop talking. I talk on the time!

I’m driving myself crazy and I’m sure I’m driving Stuart crazy.

During the day I talk to KIki (our dog) a lot. I think she likes, but how would I know? Lately I’ve been trying to figure out why I talk so much and how I can stop. I’m trying hard to notice and stay silent, but I tell Stuart everything that’s going on even if it’s not the slightest bit important. For example, just now I showed him a pdf that was a page that listed everything that is recyclable here, and told him I printed it and taped it by the bin. That was good, he’s been looking for that, I should have just stopped there. Then I started pointing out that the page had a blue background because our recycling bins are blue and it says to “Use the Blue”, I went on to say, however, the one I printed out is not blue because our printer only prints in black and white. All of this transpired while he was trying to read. How he gets any reading done I have no idea.

That is just a tiny example.

If I’m not talking I’m often slightly moving my lips because I’m actually talking in my head, but unlike most people I feel the need to say it out loud. A couple of months ago this actually got worse because of the mania, and I really noticed it then. I talked more and very, very fast. Now I’m back to my normal speech, but I’m really noticing how much I TALK! When did this start? I haven’t always been like this. What on earth prompted it?

Well I have a few theories.

When I first started losing my hearing I realized that I would often talk over people, I realized then it was for two reasons. One I couldn’t hear everything they said so I often didn’t realized they were still talking. (I wasn’t very good at reading lips, or even noticing that they were still moving….duh). I made a conscious effort to get better at that and I think I have. When I’m with others, like going to breakfast every Sunday with Stuart’s father, I don’t talk over anyone. I try very hard to understand what is being said and add to the conversation when appropriate. (hand patting back, I got that at least).

Another theory is, when I first got sick and for a long time after that, Stuart worked from home. Even at his last job he worked from home a lot. Here, he is gone all day, I’m alone and basically have no contact with people; especially when I’m having a flare and can’t drive or get out at all. I’m often texting, but that’s different. (I probably do that too much too) So when Stuart gets home he is bombarded with everything I’ve been thinking all day and everything that is happening since he’s been home. I have noticed when I’ve been in silence for hours and I suddenly see someone, like when Stuart gets home from work, I can’t understand much at all. His voice sounds all garbled and tinny. That’s just weird to me. I normally have the TV on all day trying to hear something so I’m not hit by that, but even with that noise going I still get bombarded by this garbled speech when I first see someone. Is that one reason I talk? So I won’t hear that?

I used to get so mad at him because he didn’t hear what I said. He would be watching a show or reading and just not hear, after all, he didn’t know if it was important or not. How could he, I talked all the dang time. Recently we made a pact that if we need the other to pay attention, we would let them know and ask them to stop what they are doing and pay attention., but other than that, I could just ramble, if he hears it, that’s okay, if not, no worries. I really want to stop talking so much.

In Buddhist teaching we find that talking all the time or for too long is a form of selfishness, while being easy to talk to shows respect, generosity, and courtesy toward others. Buddha saw being easy to talk to as an expression of love (Sn.143*). Listening is a virtue, not talking all the time.

So how to I stop this constant chatter? First I think I should meditate more, I’ve lost that practice along the way, not that I ever did it much. Practicing to sit still in silence has to be good for this person who can’t be silent. I know I won’t be able to silence the chattering monkey mind for a very long time, but if I can just keep my mouth shut for a while, that would be a big step forward. Perhaps I can remember the Buddha’s teaching each time I start to ramble. I shall also try hard to listen more, how can I be listening if I can’t stop talking. Of course there aren’t many people around for me to listen to, and often when I try I can’t understand what they say anyway…..part of the problem huh? I have noticed when I’ve been in silence for hours and I suddenly see someone, like when Stuart gets home from work, I can’t understand much at all. His voice sounds all garbled and tinny. That’s just weird to me. I normally have the TV on all day trying to hear something so I’m not hit by that, but even when that noise going I still get bombarded by this garbled speech when I first see someone. Is that one reason I talk? So I won’t hear that?

If all else fails, I can always tape my mouth shut…that will teach me!

**Everyone should read the comment by Kara, it is a wonderful contribution to this post. Don’t wait, go there now!

*Sutta Nipāta, ed. D. Andersen, H. Smith, PTS London 1913

Mindfulness Mondays: worry

“Do not lose yourself in the past. Do not lose yourself in the future. Do not get caught in your anger, worries or fears.Come back to the present moment, and touch life deeply. This is mindfulness.”

Thich Njat Hanh

“The day you stop worrying will be the first day of your new life; anxiety takes you in circles, trust in yourself and become free.”

Leon Brown

“Don’t believe every worried thought you have. Worried thoughts are notoriously inaccurate.”

Renee Jain

As Wendy indicated, I will drop by from time to time to do the Mindfulness Monday post.

Finding mindfulness quotes concerning worry was an excellent therapeutic exercise.

As an added bonus because I really like the idea:

Worry is a misuse of your imagination.”

Curiano

Image: © Lorraine (Please do not use without permission)

Mindfulness Monday – Storm

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Monsoons 2018, by W. Holcombe. all rights reserved

 

“You can’t calm the storm,

so stop trying.

What you can do is

calm yourself.

The storm will pass.”

~ Timber Hawkeye

 

“You will not be

the same after the

storms of life;

You will be stronger,

wiser and more alive

than ever before!”

~ Bryant McGill

 

“The great benefit of

practicing mindfulness…

is the presence of mind

within a storm

 of emotions.”

~ Phillip Moffitt

 

*photo was taken in Tucson, AZ , off my front porch, during monsoon season 2018.  It’s am amazing time, I wish I could get better pictures for you.  The monsoons are full of beauty and power, but…another of it’s secret powers is to cause super duper migraines.  Ahh.  Please do not use this image without permission.

 

 

Visiting Aqua Caliente Park

Today we visited Aqua Caliente Park, it’s located on East Roger Road in Tucson, AZ. I never expected to see anything like this in the desert. Funny though, I saw several oasis in the Sonoran Desert outside of Palm Springs, CA; when we lived there, yet I never expected to see it here.

You can read about this park on the Pima County website, but I’d like to share some of the sites I saw there, I hope you enjoy them.

First you’ll find the Flora, followed by the Fauna.  (some of the plants are not actually native, but they’ve been here a very long time)

 

 

The fish in the photo by himself was a monster!  If anyone knows what kind of fish he is I’d love to know.  I’m pretty sure he’s not a catfish; if he is, he looks different than SC or NC catfish.  🙂   ***I just read that the part has grass carp and bass in it, I think this might be a carp.  I think it should be noted that none of the fish or turtles are native.  However, here are many bird species that call this place home.

The frog was also huge!  Bigger than my foot! He was so patient and let us take a photo of him, there was another frog close by, but he didn’t want his picture taken so he jumped in the water very fast.

I had severe migraines all week, I was lucky enough to have a few hours respite and a few more hours with the pain reduced enough that I could function, still at a slower pace and I was probably a cranky bitch at times, but I’m grateful I was able to enjoy part of the weekend.

*I have one last photo to share, but I’ll save that for Mindfulness Monday 😉

**Remember all photos and artwork on Picnic with Ants are personal property and are not to be shared without permission from the creator.  (in this case, Wendy Holcombe took all the above photos and is the sole owner of all rights)

 

 

 

 

 

 

 

 

 

 

Mindfulness Monday – Birth(day)

silly goose
doodle by wendy – silly goose

“May I be easily able to let whatever needs to go, go.

And may whatever wants to come

be radiantly and joyously born.”

~ Tosha Silver

 

“The purpose of our lives

Is to give birth to the best

Which is within us.”

~ Marianne Williamson

 

“Every morning we are born again.

What we do today is what matters most.”

~ Buddha

 

You might be able to tell from the the quotes….Today is my birthday!  I hope you have a wonder filled day, and have a grand un-birthday. (unless of course it is your birthday too, in that case, I hope your celebration is grand!)

Image is “Silly Goose” a silly doodle by me.  It’s one of those doodles that comes from a stray mark on a page in my drawing journal.  Try it, make a swoop on the page and let it be the start of a doodle.  You can even make it silly.  😉

 

 

Migraine Awareness Month, my migraine update

migraine awareness
I don’t know who to credit for this image, but it is so true I had to use it. If you know who I should credit, please let me know.

June has been Migraine Awareness Month.  I had planned to do a few posts about migraine, what it is, who gets it, how disabling it can be, new treatments….ect… unfortunately I’ve been having some severe migraines this month and simply haven’t been able to focus well enough to write and get all the facts straight.  It’s not just the pain of the migraine that has stopped me, it’s all the other symptoms that go with it, the fogginess, nausea, insomnia, sensitivity to light, sound and smells….I simply can’t concentrate or get things done.

New Migraine Doctor – On Tuesday I saw a new migraine specialist.  He’s with Banner Health/University of Arrizona’s neurology department.  First impression, he was pretty thorough, and seemed to know what he was doing, however, there were some things he said that I felt were just rude, but it may just be his sense of humor that I didn’t get.  For example, after we went through my history he looked at hubby and said, “Did you know she had all these issues before you married her?”  Then he laughed a little and said he was joking, but honestly that did not make me feel good at all.  But he did take the time to go over my records and listen.  At first I felt that he was going to be a butt, because when I told him all my different types of headaches (chronic migraine, vestibular migraine, cluster headaches, and Intracranial Hypertension), he said, “I don’t believe it”  He questioned if I could have Intracranial Hypertension on top of the rest.  I told him I had numerous lumbar punctures and that diagnosis came from Duke, he seemed to understand then that I really have been diagnosed with these things, they weren’t just speculation.  We went through a huge list of drugs I’ve tried and if they worked at all, and we discussed other treatments that haven’t worked (acupuncture, chiropractic, a ton of supplements….).  He finally said, “So, it sounds like nothing has worked” and I agreed.  (Oh, I was given a complete exam, testing all my reflexes, checking my optic nerve….he really was thorough)  He left the room for a moment and came back with a gammaCore.

gammacore
image courtesy of http://www.gammacore.com

Using the gammaCore – The gammaCore is a non-invasive vagus nerve stimulator.  It’s pretty darn cool actually.   Most of what I’m including next can be found on the gammaCore site, you can read more about it there if you’d like.  https://gammacore.com/

“gammaCore (nVNS) sends gentle, patented stimulation through the skin to activate the vagus nerve, providing relief from migraine and cluster headache pain in a different way than drugs.

  • The vagus nerve is an important highway of communication between your brain and many parts of the body
  • The vagus nerve plays an important role in regulating pain”

He gave me a demo and it was interesting.  You take this little device and put a gel on the electrodes then place it on your neck, right where you’d check someone’s pulse, you increase the signal until you get the results you are looking for (a twitch of your mouth or side of your face) you keep it there for 2 minutes and it cuts off by itself.  They say there’s a beep, but I can’t hear it, I just notice that it stopped, I don’t know why you’d need a beep to tell you that it stops, you can feel it.  People like to give sounds for all kinds of things that really don’t need them, in my opinion anyway.  After it stops on one side, you repeat it on the other side, and that’s it.  That’s a treatment.  If pain persist after 20 minutes, do it again.  After 2 hours, if you still have pain, or if it returns, repeat a treatment.

I will be receiving my gammaCore in the mail in a few days.  The first month is free, I don’t know how much it will cost after that.  When it was first approved earlier this year Stuart called to see if insurance would cover it and they weren’t there yet.  If it helps, I sure hope that insurance will cover at least part of it.   You are supposed to use it at the first sign of migraine pain, unfortunately I am NEVER without a headache, so I need to use it at the first sign that it’s getting bad.  I still don’t feel that the doctor understood that I have a headache ALL THE TIME.   I actually plan on using it as often as I can to see if I can get some lasting relief, maybe I’ll actually have a day without a migraine!  I am cautiously optimistic.  If it doesn’t work, I haven’t lost anything.  If it does work, I will have to decide if I can afford it.

One HUGE thing I hate about the gammaCore is that it’s disposable.  Why can’t they make it so you can charge it or change the battery or something, having to replace this device every month is so wasteful and bad for the environment.  I’m having a very hard time coming to terms with that.  I can only think that they do it this way so that people will have to buy a new one each month, that’s just a rip-off.  What am I supposed to do with all these used devices?  If nothing else, they need a recycling program.  (Yes, I will be suggesting this to them)

migraine-treatment
image credit https://www.marijuanadoctors.com/conditions/chronic-migraine/

Medical Marijuana – I also had an appointment on Wednesday to get approved for my medical marijuana card.  Medical marijuana is legal in Arizona and severe migraine is on the list of conditions that can be treated with it, so I decided to apply.  I should get my card in a couple of weeks.

Full disclosure here, I have been using marijuana to help me for a couple of years now, but I had to rely on what I could get on the street, I don’t know the strains, or anything like that, so results have varied.  Sometimes when the pain hits I can vape a little and it is gone, other times it just makes me feel funny, and other times it does nothing.  I’m hoping that getting it from a dispensary where I will be assured of quality and will know what strains and hybrids I’m getting, I will be able to medicate more successfully; more pain relief with less high feeling would be optimal. After I started using a little every night before I go to bed (I made brownies) my vertigo has been reduced drastically.  When I can’t get it, I have more vertigo again.  This is not an approved condition in Arizona (Meniere’s is an approved condition in some states), but it should be.  I can’t be 100% sure that it’s the marijuana that has helped my vertigo, but it would be some strange coincidence if it isn’t.  It even helps stop an attack….if I start to have a vertigo attack I will vape just a little and it will often stop it, even if it doesn’t stop the vertigo, it stops the vomiting.  I cannot stress how important that is.  The only reason I will go to the ER with all of this (vertigo or migraine) is if I’m also dehydrated.  Throwing up for hours on end will cause dehydration, I know that the marijuana has stopped me from going to the ER numerous times.  I’m so very grateful I have found some relief through medicinals.

As I navigate this new world of treatment, I will post more about it and give you lots of updates.  To learn more about how medical marijuana can help with migraines there’s a great article here: https://www.marijuanadoctors.com/conditions/chronic-migraine/

Now, it has taken me many hours to write this post, so I will close for now.  Hopefully my head will calm down soon and I will be able to write more often.  I would like to thank Lorraine for being so kind and helping me keep up my weekly Mindfulness Monday posts.  They mean a lot to me and it was really hurting me when I couldn’t post.  Thank you Lorraine, you are the best, I love you my friend!!

Have any of you tried the gammaCore?  If not, would you?

How about medical marijuana, have you tried it?  Did it help?

I’d really like to know your experiences.

 

Finally some promised pictures.

I’m still not able to type much, a lot of hunting and pecking with just my left hand, but I’m managing to do a little.  My wrist has not improved, the shot did not work, I go back to the doctor on July 2nd (which just happens to be my birthday).  Wish me luck.

 

20180619_120324-collage

Welcome to our home.  The top photo isn’t very good, but it’s of the front gate.  The middle row from left to right: the front porch, the pool off the right of the house, the kitchen over looking the living room.  the bottom row, left to right: the bathtub/shower, flowers from my neighbor, the sick in the bathroom.

When I first visited Tucson I wondered why so many houses had bars on the windows and walls around their homes, well I found out.  The bars are because so many houses eight used to have, or still have, a Swamp Cooler.  For a Swamp Cooler to work, you have to have the doors and windows open.  So it’s not because the whole town has a lot of crime, it’s a deterrent for when people have the Swamp Coolers going.  (Swamp Coolers cool by adding moisture to the air, it’s really cool actually. but it only works in places with no humidity).  The walls are often added if you have a pool.  It is also a law that if a window in your house can open and it opens out to the pool, it must have bars. The pool must also have a gate that locks, or has a latch way out of reach for a child.

The house we live in was built in 1943, I think the realtor said, that surprised me since that was a time of rationing.  The bathroom was tiled in the 1970’s, the owner loved Fiesta-ware and the tiles were bought to kinda match that. I love it!!  The kitchen was also tiled like it at some point, but they remodeled the kitchen not long ago and the cool tile went bye-bye.  You can see the new stove in the tiny kitchen, and the tiny living room beyond that.  The living room is so small we had to get rid of our couch, and the dining area is so small we couldn’t fit a regular size table in it.  Too bad, because the house is pretty cool other than the tiny rooms, if they were bigger we would consider buying this house, but it simply won’t work, so we are on the hunt for a house to buy that meets our needs.  This property also has a guest house, which would be perfect for us when Dad moves in, but as I said, the main house just doesn’t work.

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There are many suns all around the outside of the house, that’s kinda cool.

I took a walk around the neighborhood the other day and I saw all these cactus!  The barrel cactus, the paddle cactus, prickly pear, and the big daddy of all the Saguaro. (you might not be able to tell from the photo bur the Saguaro has blossoms (well buds or dried of blossoms anyway), they don’t bloom every year so this was a treat.

These photos are all from around the house.  I especially like the last one.

 

I hope you have enjoyed the little trip around my new digs.  I have a few shots from the trip across country if you’d like to see them let me know and I’ll post those too.  🙂

*all photos were taken by me, W. Holcombe, please do not use without permission.

 

 

Mindfulness Monday – Family (Ohana)

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“I don’t care whose DNA had

recombined with whose.

When everything goes to hell,

the people who stand by you

without flinching-

They are your family.”

~Jim Butcher

 

“That’s what people do who love you.

They put their arms around you

and love you when you’re

not so lovable.”

~Deb Caletti

 

“You must remember,

family is often born of blood,

but it doesn’t depend on blood.

Nor is it exclusive of friendship.

Family members can be your best friends, you know.

And best friends, whether or not they are related to you,

Can be your family.”

~Trenton Lee Stewart

 

*photo taken at Wendy and Stuart’s wedding (I’m the one in yellow)

Thank you to all who are members of my Ohana.  I love you.  ( Part of Hawaiian culture, ʻohana means family (in an extended sense of the term, including blood-related, adoptive or intentional). The concept emphasizes that families are bound together and members must cooperate and remember one another.’)

“Ohana means family. Family means no one gets left behind or forgotten.” ~Lilo and Stitch

family-1
Just because they are gone, doesn’t mean they will ever be forgotten.  Pets are Ohana too.