Living in the northeast (actually mid-Atlantic), it is still very much summer – with humid heat and lush greenery and flowers surrounding me outside – as I write this. Nature is very much alive and in all its glory. In another month or so, I know that the leaves will be changing colors and dying while retaining their extraordinary seasonal beauty. It is really quite remarkable how beautiful nature is when dying. It doesn’t feel like a death, but more like a segue into a new and different way of being in the geographical areas where we experience the seasons and annual changes. Changes and transitions are always with us; some are just more noticeable and harder hitting. It is a cycle that continues – even with global warming and human intervention. As always, the only constant IS change – and so transitions are part of our lives whether we fight them every step of the way or accept and welcome them, learning from our experiences. Changes of any kind can take us out of our comfort zones, but are necessary for our individual journeys. People are complaining about the very hot and humid summer we are experiencing, but it brings back memories of the old “dog days of summer” which I fondly remember growing up with in the 50’s & early 60’s – without the comfort of air conditioning or even fans. I have no idea how we did it, but we did – and had fun even while sweltering. Running through a “sprinkler” attached to a hose on someone’s grass was like a piece of heaven in those days, but nights were more challenging! This made the season change even more eagerly anticipated; it always felt like summer lingered a bit too long. Of course, with age, the days, weeks, months and seasons seem to go more and more quickly, keeping us on our toes. No two years (or days) are exactly the same, which keep us guessing just as these rare chronic illnesses do. There are less challenging days and more challenging days with tears of both joy and sadness/loss along the way. The days merge into weeks and then months. Seasons change and other transitions – some smooth and expected. A lot of people become conditioned to dealing with crises, and encountering and overcoming problems and difficulties usually leads to more resilience – a very positive quality to possess. Unfortunately, a growing number of people seem very at ease with crises, seeming to live from crisis to crisis while not dealing with everyday life. This is not a natural way to go through life and leads to very real daily difficulties and unhealthy stress levels. The studies on stress continue to highlight the negative aspects of the mind-body connection. No, not every ache, pain or serious illness is caused by stress; but stress-relief strategies that work can make everyday life “easier” (or less difficult) and make crises smoother to navigate. This can be thought of as a navigation system of sorts in our life’s journeys. Unfortunately the navigation system must be learned through training, experiences and successes and failures. Often we do learn the most from our failures. We all go through stages and often with some back-peddling from time to time. These are NOT negative times. Think about an EKG; a flat line is not a good thing. The small ups and downs are totally “normal”, and it is only when there are extreme changes that they are harmful. That is when people need extra help and more and more often seek it out – or go back to a therapist or psychologist (or family member, friend, colleague) for a “tune up”. Sometimes the positive coping tools are misplaced, lost, forgotten, rusty or no longer enough. Frequently, one of the most common initial diagnoses for patients is “Adjustment Disorder”, which usually passes once new tools and strategies have been learned, especially with a mindfulness based cognitive behavioral intervention. Psychotropic medication may or may not be prescribed, and some are short-term, while others may be more long-term in more complicated cases, or when the person has deeper underlying emotional or psychological problems (e.g., bipolar disorder, recurrent depression, a personality or panic or other anxiety disorder). Sometimes previously repressed underlying issues emerge and take longer to resolve. Financial, insurance, work, primary support (or lack thereof), physical illness and other social and environmental concerns can work toward or against the eventual resolution of problems. Being aware of these and of the larger situation always helps. For me, I have spent 10 years on boards devoted to pemphigus and related diseases and have watched and participated in many changes over this decade. It has been an amazing and exciting time. I went from being a healthy and high-energy person with one long-term autoimmune condition that was under control (for decades) to developing new and life-threatening conditions. My previous chronic condition, along with other acute health issues at various times, probably gave me an advantage regarding resilience. I went through the same basic stages as anyone else, but also felt very strongly almost from day one that it was all for a reason – for a purpose. I soon learned that the psychological and emotional components of these orphan diseases were not being addressed. It is, of course, always critical to get the disease itself under control, but I would argue that being as mentally healthy as possible and with a strong support group is nearly equally important. I have not been among the fortunate who have been in remission for any considerable length of time. My one partial remission included symptomatology that was atypical. That diagnosis was made and addressed; monitoring myself daily is routine. After a particularly nasty and stubborn flare this year, I felt the need to make some serious new life decisions. I did use the Cognitive model of decision making, examining all the facts and then carefully weighing options, while taking a few steps back for perspective. I have made some decisive strategic moves, including stepping down from the IPPF Board of Directors. However, I will always remain very involved in the IPPF, especially where patient support is involved. his will allow me to have more time to make necessary decisions regarding my own health, volunteer and professional work and family. It is just one more life transition along the road. The coming years will bring new and different challenges and changes, but these transitions are necessary and very positive. Our IPPF Board of Directors has several new and very capable and passionate people who will continue to lead this Foundation forward in new and important ways. It is a very exciting time for the IPPF and the welfare of all patients, families and friends. My participation with the IPPF remains an integral part of my life, but it is a time to re-prioritize, take the time to smell the roses in the moment, enjoy the beauty of the fall/autumn leaves and then make snowmen or just watch the winter wonderland, before spring and the start of the next season. I look forward to this transition and to the new and interesting places and opportunities which will be part of the next phase of my own personal journey. Not only do I not fear transitions, but I look forward to them and what they will add to my personal human experience. Also, your Annual Meeting Committee is working hard to make the 17th Annual Patient Conference in Chicago, April 25-27, 2014, a fulfilling experience for all who attend. We are looking at trying more changes, based in large part on feedback from patients and their families and friends who’ve attended the conferences. Yes, we are listening and making necessary changes. Please consider what special talents or interests you may have or have access to as we ramp up our volunteer system and add ad hoc members to committees. Those experiences will not only add to your personal journeys, but also the future of the IPPF. And who knows? Maybe it will be a special and transitional time for you!