Veterans with IBS and Functional Gastrointestinal Disorders 2017

November 11, 2017

Today, November 11, is Veterans Day in the U.S., and a good time to highlight veterans’ issues. U.S. veterans  and current military service members who have been deployed in the Persian Gulf/Southwest Asia and Afghanistan regions at any time since 1990 have been shown by multiple studies to be at even higher risk of IBS and other functional GI disorders than the general population. Conservative estimates put the incidence of functional GI disorders in the general population as 25%, most commonly irritable bowel syndrome. For veterans and military service members of the Persian Gulf/Southwest Asia/Afghanistan era, the estimate may reach as high as 40%. This appears to be in part because of the high incidence of known functional GI risk factors during active duty, such as severe stress or trauma and/or food or water contamination that results in post-infectious IBS  (IBS-PI) or other post-infectious functional GI and motility disorders.

Here is IBS Impact’s August 12, 2011 post on the recognition six years ago by the U.S. Department of Veterans Affairs of irritable bowel syndrome and functional gastrointestinal disorders as presumptive service connected disabilities for Gulf War veterans. Service in Afghanistan was not originally included in the 2011 regulations, but has since been added.

IFFGD has done considerable work in the past several years in advocating for federal funding and other legislative needs specific to veterans, conducting outreach to service members and veterans and encouraging those affected by functional GI and motility disorders to participate in veteran-specific self-advocacy efforts. Since fiscal year 2012, functional GI disorders have been included in the Department of Defense Gulf War Illness Research Program, which is part of the Congressionally Directed Medical Research Program. However, advocacy from the veteran community and supporters must occur on an ongoing basis for funding to be continued each fiscal year. Interest in veteran issues has been one reason for Congressional support of the Functional Gastrointestinal and Motility Disorders Research Enhancement Act of 2017 currently in the House of Representatives. This legislation is aimed toward improving the lives of affected veterans and civilians alike, and must continue to build.

As this blog reported on January 20, 2014, the depth of need for further awareness, services, support, and research in the veteran community is not necessarily well known even within the Department of Defense or other military entities, the media or the general public. The post linked in the second paragraph of this post about the recognition of IBS and other functional GI disorders as presumptive service-connected disabilities, more than six years after original publication, has continued to receive consistent hits from readers on most days. By an extremely wide margin, from the inception of this blog in mid-2011 through 2015, it was the #1 most read individual post, of over 200 cumulative posts on this blog. It was also the #1 most read post for each individual year.  Not until the release of the Rome IV international diagnostic criteria in late May 2016, did it drop to #2 on the all-time and 2016-to-date lists. Clearly, a very strong need exists for information and resources on this topic. It is hoped that given the relatively higher impact of functional GI disorders among veterans and service members, and their relatively higher profile as a constituent group, any advances on behalf of the affected veterans and service members will eventually carry over to people with functional GI disorders in general.

IBS Impact encourages veterans, service members and families in the IBS and functional GI community, as well as those who support them,  to familiarize themselves with the issues and resources, and to consider participating in self-advocacy activities. We look forward to feedback from readers as to how IBS Impact may be able to support such efforts further.

Representatives Suozzi of New York and Kind of Wisconsin Co-Sponsor HR 1187 for Functional Gastrointestinal and Motility Disorders

November 2, 2017

According to IFFGD and the official Congressional legislative database, Representative Tom Suozzi (D-NY-3) and Representative Ron Kind (D-WI-3) signed on recently as  co-sponsors of the Functional Gastrointestinal and Motility Disorders Research Enhancement Act of 2017.

Representative Suozzi is serving his first term in  the House of Representatives. His district, the 3rd Congressional District of New York, currently encompasses most of the North Shore of Long Island in  northern Nassau and northwestern  Suffolk Counties,  including Huntington, Northport, Commack, Dix Hills, Plainview, Hicksville, Syosset, Glen Cove, Roslyn, Port Washington, and Great Neck, as well as a northeastern portion of the New York City borough of Queens, including the Little Neck, Whitestone, Glen Oaks, and Floral Park communities. Representative Suozzi supports a range of health and veterans’ issues and is currently a member of the Congressional caucuses and bipartisan task forces for several other specific chronic medical conditions, including the Military Mental Health Caucus as seen on his official house website. As previously discussed on this blog on August 12, 2011 and August 25, 2011, military service members and veterans are also at disproportionately high risk for functional gastrointestinal disorders like IBS, which are already very common in the general population.

Representative Kind is serving his eleventh term as a member of the House of Representatives. His district, the 3rd Congressional District of Wisconsin, represents the western part of the state, including La Crosse, Eau Claire and Platteville.  According to his official House website, he is a member of the Subcommittee on Health of the House Committee of Ways and Means.  He also has a record of supporting legislation of concern to veterans. Representative Kind also previously co-sponsored HR 2239 in the 112th Congress (2011-2012) and HR 842 in the 113th Congress (2013-2014), and HR 2311 in the 114th Congress (2015-2016), which did not pass. IBS Impact thanks him for his long support of the functional gastrointestinal disorders community for four consecutive Congresses since the inception of the legislative effort for this Act.

In officially supporting HR 1187, Representatives Suozzi and Kind join Representative F. James Sensenbrenner, Jr. (R-WI-5), who is the initial sponsor, and co-sponsors, Representatives Mark Pocan (D-WI-2), Eliot Engel (D-NY-16), Dave Loebsack (D-IA-2), and Alcee Hastings (D-FL-20).  If you are a constituent of any of these legislators, please take a few minutes to call, write, or contact him on social media to thank him for his  support of the functional gastrointestinal and motility disorders community.

U. S. citizens, if your Member of Congress is not yet a co-sponsor of HR 1187, please see the previous post from March 21, 2017 for links to the bill and more details on how to do so.  Often, it takes multiple attempts to elicit any interest from legislators, so if you do not receive a reply, do not hesitate to try again or to switch contact methods until you attract attention. Keep in mind that your Representative may be different from before because of the 2016 elections, district boundaries that may have been re-drawn, or if you have moved.

Your personal experiences as a person with IBS and/or other functional GI/motility disorders, or as a concerned family member, friend or colleague, are most effective in communicating to legislators and their staff that there are real human beings behind the statistics. However, even general expressions of support are helpful.

HR 1187 is bipartisan legislation (supported by members of both parties) and according to IFFGD discussions with IBS Impact,  is “revenue-neutral,” meaning that there will be no additional taxes or spending added to the current federal deficit if it is enacted. Discretionary funds are available at the National Institutes of Health to be allocated if Congress directs NIH, through this Act, that functional gastrointestinal and motility disorders are a priority. Congress will only do so if we, as a community, are able to show them the importance of the research, education and FDA coordination provided for in HR 1187.

NIH grants funding to researchers throughout the world, not just in the U.S., so in the long run, enactment of this Act may also benefit readers with IBS in other countries. Medical research also sometimes involves multinational teams of scientists, and in any case, study results are usually published globally, adding to the cumulative knowledge worldwide.

It is IBS Impact’s understanding that HR 1187 will not require a debate or vote on the floor of the House of Representatives, and will pass as soon as it reaches 218 sponsor/cosponsors, or a simple majority of the House. In order for this milestone to be accomplished during the current Congress, the 115th,  the necessary number of sponsor/cosponsors must be reached by December 2018. Every two years, the Congressional membership will be different as a result of elections. Thus, if HR 1187 has not passed by that time,  a similar bill will have to be reintroduced and the FGIMD community will have to start the process of gathering co-sponsors anew. This is what occurred with HR 2239 in 2012, HR 842 in 2014 and HR 2311 in 2016. While it is quite common for legislation of various sorts to take several Congresses to pass, our continuing advocacy now can increase awareness, build momentum and perhaps accelerate passage. It is in our hands.

Check back on this blog or join IBS Impact’s Facebook page or Twitter feed for further updates on HR 1187 as they occur. Links to the social media sites can be found on the right sidebar of the blog.

Designer Mychael Knight Could NOT Have Died From Irritable Bowel Syndrome (IBS)

October 23, 2017

Almost a week ago, fashion designer Mychael Knight, who was a former star of the U.S. reality television show “Project Runway,” passed away at the age of 39. It is unfortunate that he apparently suffered from chronic gastrointestinal issues that may or may not have contributed to his death at such a young age. While he apparently believed that he had irritable bowel syndrome (IBS), many of the symptoms described in numerous news reports from various sources are not consistent with IBS. Furthermore, IBS is never a life-threatening condition. It does not cause or contribute to death, directly or indirectly.  It is inaccurate and irresponsible of numerous print and online media sources to imply or state outright that Knight’s death was related to IBS. Nobody dies as a result of IBS.

While most media sources acknowledged that the cause of his death is not known or is undisclosed, many reporters surrounded that detail, in the same or adjacent passages, with mentions of Knight’s reported IBS. The New York Times wrote, “He [Knight’s friend and spokesman] did not specify a cause, but Mr. Knight had written on social media about his struggle with irritable bowel syndrome.” Time went further, writing, “…he [Knight] had written in the past that his struggles with irritable bowel syndrome were causing problems with his immune system, according to multiple reports.” The Washington Post wrote. “Knight had extensively shared his five-year struggles with irritable bowel syndrome, writing in now-deleted Facebook posts that he suffered chronic abdominal pain, a “leaky gut,” extreme fatigue and exhaustion.” Under a headline of “Mychael Knight Suffered From IBS Before Passing Away” Essence wrote:

Now, it’s be [sic] discovered that Knight shared his battle with irritable bowel syndrome (IBS) online, which put him in constant pain. “This year has really taken a toll on my health… badly,” Knight reportedly said in a social media post. “In short, IBS is a gastro-intestinal disorder in which the food I eat, my body doesn’t absorb (malabsorption) the nutrients from what I eat.”

 Despite his sickness, TODAY reports that IBS isn’t likely the direct cause of his death and that Knight’s family still doesn’t know the cause of his demise.
Again, it’s not just unlikely that IBS caused Knight’s or anyone’s death. It is impossible. These are the scientific facts according to decades of peer-reviewed medical research and clinical practice by highly credentialed university based researchers on every continent of the globe: IBS is a functional gastrointestinal disorder, or as now stated in the Rome IV international diagnostic criteria updated in May 2016, “a disorder of gut-brain interaction.” This means that the brain and the gastrointestinal tract do not communicate properly because of neurotransmitter issues, changes in the microbiome and other factors still under research. By definition, in functional gastrointestinal disorders, there are no visible structural or metabolic abnormalities detectable on currently available medical tests. Thus,”openings in my intestines,” as supposedly reported by Knight according to the Today article linked by Essence are not consistent with IBS. “Leaky gut” and “toxins” are concepts promoted heavily by alternative medicine practitioners, preying on individuals who are sick and desperate, but this is not accepted by reputable physicians as a real diagnosis.

Various functional GI disorders affect different parts of the gastrointestinal tract, but IBS, the most common condition in this category, affects the function of the colon, also known as the large intestine. The purpose of the colon is to store waste and reabsorb excess water. Usable nutrients are absorbed in the small intestine, higher up in the digestive tract. Under Rome IV, and its predecessor criteria, Rome I, II and III, Knight’s “extreme weight loss” as reported in the Today article linked by Essence, is one of several red flags/alarm signs that an individual’s symptoms are not IBS or are perhaps IBS along with an additional unrelated diagnosis that causes the extreme weight loss. Many people with IBS who restrict many types of food or stop eating much altogether in an attempt to avoid symptoms will lose some weight as anyone who makes such dietary changes will, but this is not from the IBS itself. People with IBS  and no other conditions that would affect weight who eat a reasonably balanced diet regularly do not lose significant weight or quickly regain any previously lost. Some people with IBS, like others in the general population, even are overweight due to factors also unrelated to IBS. Even people with very severe IBS do not typically look “incredibly fragile” and do not need to be “in a Georgia hospital… getting treatment for IBS” as reported by TMZ. While management strategies for IBS vary based on individual symptom patterns, preferences and effectiveness, ranging from diet, to stress management, to psychological therapies, to a limited number of available over-the-counter or prescription medications that are effective for a subset of affected people,  there is nothing that can be done for IBS as a hospital inpatient that cannot be done by the individual with IBS at home.

Numerous media sources, including the Time and TMZ  articles, link Knight’s alleged IBS to his immune system. The Today article quotes Knight’s social media posts as:

toxins from that food leak into my bloodstream, which can cause autoimmune diseases (Diabetes, Lupus, Celiac Disease, Rheumatoid Arthritis).B/c of which, I suffer from chronic abdominal pain/diarrhea/nausea, EXTREME fatigue & exhaustion, food sensitives/allergies, foggy brain, headaches, etc. As of recent, I’ve develop [sic] some acute Autoimmune responses like Psoriasis, inflamed joints, and small respiratory issues.

However, irritable bowel syndrome (IBS) is not overtly connected to the immune system, nor is it an autoimmune disorder. The research evidence has never linked it in any way to diabetes, lupus, psoriasis, rheumatoid arthritis or respiratory issues, though since IBS is an extremely common condition as are many of these, statistically, some people will have more than one.  Celiac disease and food sensitivities may also coexist with IBS and cause some similar symptoms to it, but they are separate conditions with different causes and treatments. IBS is known to commonly coexist with some other chronic pain conditions, none fatal, but does not or lead to cancer or any other medical conditions and is not life-threatening.

Yes, irritable bowel syndrome causes abdominal pain, intermittently or constantly for most affected, predominantly diarrhea for about a third, fatigue/exhaustion, nausea and/or headache for some. When moderate to severe, as functional GI researchers estimate it is for about 60% of people with IBS, it is indeed extremely debilitating and disruptive. However, that is where the similarities with Knight’s description stop. Functional GI researchers routinely emphasize that these symptoms are very common to many different disorders and are not necessarily, in themselves indicative of or related to IBS. IBS is also a very distinct diagnosis and not the catchall term that many people with IBS, family members, some medical professionals and the general public continue to believe. Physicians quoted by Today and by FOX 29/Philadelphia  (television news video, runtime 3:38) speculate that Knight may have had a form of inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis, which can cause extreme weight loss, structural changes in the gastrointestinal tract from inflammation, and potential complications in many of the body’s systems, including arthritis, psoriasis, and respiratory issues, as mentioned by Knight. Although with appropriate medical care, most people are able to manage inflammatory bowel disease for many years, it is possible to die from a complication. This sad outcome simply does not happen with irritable bowel syndrome (IBS). Unfortunately, because of the similarity in acronyms and some symptoms, the two are often confused.

A subset of people with inflammatory bowel disease also have irritable bowel syndrome, and it is possible that Knight was one of these people. It is also possible that the physicians in the news sources have made incorrect speculations, and Knight’s issues were something else entirely.  However, Knight’s posts, as reported, mention so many different, unrelated issues that it is probable that he was at least partially confused about his own diagnosis and may or may not have been receiving reputable, appropriate medical care as a result. If so, and that led to his premature demise, that is tragic. IBS Impact urges all those who are experiencing gastrointestinal symptoms not to rely on search engines or quack cure theories that abound, but to seek diagnosis and care from reputable, qualified physicians and to  supplement this with educational information from evidence-based organizations like the International Foundation for Functional Gastrointestinal Disorders for suspected irritable bowel syndrome, the Crohn’s and Colitis Foundation for inflammatory bowel diseases, the Celiac Disease Foundation for celiac disease, or Food Allergy Research and Education for food allergies.

However, what is also disconcerting is that so many media sources, ranging from highly reputable national outlets to local sources and obscure, less reputable ones, in print, broadcast, and online, took his statements at face value and proceeded to disseminate them worldwide, attributing them to irritable bowel syndrome as if it were the cause of Knight’s death.  This is true of many other media sources besides the ones mentioned and linked in the post. Relatively few simply reported that the cause of his death is unknown or undisclosed, and even fewer, like Today and Fox News 29, linked above, chose to do any basic fact checking which would have revealed the basic information that irritable bowel syndrome is never fatal. If it were, with, conservatively, 10-15% of people affected by IBS in most countries worldwide, we would have a global public health emergency. As it is, decades after IBS/functional GI professionals began to establish that IBS is a real disorder, they, IBS organizations and advocates with IBS continue to labor to dispel the most basic and enduring misconceptions. With these new and plentiful reports about Knight on the internet, these inaccuracies will remain with us for years to come. To recently diagnosed or not very medically-informed people with IBS and their families, who often have a great deal of anxiety about symptoms, which in turn, are exacerbated by further anxiety, media stories incorrectly implying or stating that Knight died of IBS are needlessly alarming. Whatever the truth of Knight’s medical history, treatment, and death, which is between his survivors and his health care providers, he could not have died from irritable bowel syndrome because no one does. IBS Impact challenges all journalists who reported on his IBS to do better. IFFGD’s resource page for members of the media is a good start. Public awareness of any medical condition is a positive thing, but not if it is blatantly inaccurate.

Thoughts for Invisible Disabilities Week, October 15-21 2017

October 15, 2017

The Invisible Disabilities Association, a not-for-profit organization in Colorado founded two decades ago by the spouse of an invisibly disabled person,  has designated this week as its annual Invisible Disabilities Week. An invisible disability is any disability or ongoing medical condition that may have disabling effects that may not be readily apparent to casual observers. While any disability, visible or invisible, may present physical, psychological or societal barriers at least some of the time,  there often are specific challenges to others’ awareness and understanding when invisible disabilities cannot be seen.

Many of us with irritable bowel syndrome (IBS) know this well. Almost all of us can relate to one or more of the following questions or considerations at some point in our journey with IBS. Do we tell family members, friends, acquaintances, employers, teachers and classmates about IBS? How much and how often do we discuss it if we do? Do they believe us? Do they– and medical professionals– believe IBS pain, exhaustion, GI symptoms, stress, commonly co-occurring conditions like anxiety or depression and other non-GI symptoms are real and worthy of help? Why do they say things like, “You look good,” when we’re in bad shape? Do they really get it? If they do get it, will they continue to support us months or years later when IBS, as a chronic, incurable condition, doesn’t go away? If they don’t get it, is it worth trying to educate or not? Why are there not better medical options for our poorly understood condition?  Why don’t we have more resources related to X? Why doesn’t some celebrity come along and donate millions for a cure?

It is well-known in the IBS community, both anecdotally and through research, that many  people with IBS are isolated. Some do not have a diagnosis or support for years. Some withdraw from discussing IBS with others, inside or outside of the IBS community, because of negative interactions or  disappointing symptom management results. Still others seek information and help from various IBS forums, but unless they have other disabilities or medical conditions, some of which commonly overlap with IBS and others which are separate, they often are not aware of the common, similar experiences we share with groups affected by other invisible disabilities and health conditions. While gaining that knowledge may not help the medical situation per se, some people with IBS gain perspective and comfort in knowing that we are not alone and in finding a certain solidarity with other health communities.

According to the IDA, because there are so many types and levels of invisible disabilities and individual people are also affected quite differently, the organization chooses not to list or focus much on specific diagnostic labels. Most of their resources and awareness materials are applicable to a wide range of people with an equally wide range of invisible disabilities.

IBS Impact encourages readers to check out the site and see if anything is helpful to them. Also, for those so inclined, take on the challenge with which the IDA presents us this week, and talk to people or share something on social media about IBS.


Registries for Irritable Bowel Syndrome (IBS) Research Volunteers Created in the United Kingdom and Australia

September 30, 2017

In recent weeks, IBS Impact has learned that two separate entities, the County Durham and Darlington NHS Foundation Trust in the United Kingdom, and Macquarie University Faculties of Human Sciences and Medicine and Health Sciences in Sydney, Australia have established new, secure registries for those who are interested in volunteering for research studies.

The Macquarie registry is for all adults with any functional gastrointestinal disorder. IBS is the most common FGID. Information can be found here.  Macquarie University Functional Gastrointestinal Disorder Research Volunteer Registry.

The County Durham and Darlington NHS Foundation Trust registry is specific to IBS and is also limited to adults at this time. According to a September 29, 2017 announcement on the NHS National Institute of Health Research site,  it is part of a five year study to encourage those with IBS to be aware of and seek care and to increase participation in clinical trials. If the registry succeeds, the hope is to expand it nationwide in the future. The official website for the service, to be known as Contact ME-IBS, is linked here.

In each case, placing one’s name and contact details on the registry does not guarantee that one will be contacted or be eligible for any specific research study, as requirements for volunteers vary with each individual study. Similarly, there is no obligation to participate in a specific study if contacted. It is simply an expression of possible future interest, allowing researchers to be aware of and efficiently reach out to potential participants willing to be recruited within the IBS/functional GI disorders community.

IBS Impact welcomes researchers affiliated with academic, medical or pharmaceutical entities, or reputable organizations representing IBS or related or commonly overlapping conditions, to contact us directly with additional registries, studies or surveys they wish to be considered for posting. A contact form is available on the main IBS Impact website.

IBS Impact makes these announcements available for general information, and encourages its members and site visitors to make their own individual, informed choices about their potential participation. Additional studies can be found by clicking on the Research– Clinical Trials sub-category in the right sidebar of this blog on our main website IBS studies page. Please be sure to check the date at the top or bottom of a given post, as many posts from this blog remain visible in search engines for several years, and studies stop accepting volunteers or conclude the trials after a period of time. IBS Impact, as an entity, is not directly affiliated with any research sponsor or organization and receives no funding from any source for studies, surveys or links we feature on this blog, the main site or social media.

Updates to the IBS Main Website, September 2017

September 16, 2017

IBS Impact has recently completed the latest round of updates to many pages of our main website,  IBS,

The home page, advocacy page, research page, IBS studies page, and IBS and children page all have additions or updates of content or links, or deletions of outdated links in the last three months. The United States, United Kingdom, and Australia are all represented in these most recent changes, with several more countries represented in existing material.

Readers interested in the most recent news, events, clinical trial and advocacy opportunities, and articles between main site updates, may follow this blog or our Facebook or Twitter feeds (links found on the lower right sidebar of this blog and in the light blue footer sections below each page of the main site).  Each has slightly different information on an ongoing basis. Regardless of one’s interest in IBS, whether personal or professional, most users should find useful and interesting material and links. The current site reflects resources in six countries which are among the top sources of hits to the site and this blog, with occasional references to several others.

Because of the redesign and transfer of the site to new hosting twice in 2015 and 2016, some links embedded in older posts on this blog or search engine results relating to IBS may result in error messages, but you should still reach the site itself. If so, please use the navigation links at the top of the site to reach the desired subpage.  No information that is still currently useful has been removed from the site, although in some cases, the location has changed. Only outdated details and occasional defunct links for which there is no replacement available at this time have been deleted. The date of last update is indicated at the bottom of subpages that change periodically.

Please feel free to check out the site here. Our goals with the website, blog and social media are to provide a varied range of current, scientifically accurate, reputable information and resources to people with IBS and their families and friends, and to encourage informed choices, proactive self-advocacy and worldwide public awareness of IBS, and the unmet medical or social needs many of us face as a result of IBS.

IBS Impact as an entity, is not directly affiliated with any other organization, site, or research sponsor and receives no funding for the information we post on the main website, this blog or our Twitter and Facebook pages. We do welcome constructive collaboration and value the many individuals, websites, organizations,  and clinical and research entities who continue to support, encourage and amplify our efforts in various ways to benefit the cause of IBS awareness and advocacy worldwide.

Comments, suggestions, corrections of outdated links, article submissions, and clinical trials or surveys by researchers affiliated with academic, medical, or pharmaceutical entities or reputable evidence-based organizations representing IBS or commonly overlapping conditions in any country are all welcome and will be thoughtfully considered. A contact form  can be found on the main site, or comments can be left on this blog.  Thank you to all of our readers and social media followers for your interest and participation.

IFFGD Advocacy TweetChat, September 5, 2017, Prepares for Virtual Advocacy Day 2017

August 30, 2017

The International Foundation for Functional Gastrointestinal Disorders (IFFGD) has announced that it will be holding a Tweet Chat beginning at 1:00 PM Eastern Time on Tuesday, September 5, 2017. This is an opportunity for people with functional gastrointestinal and motility disorders and those who support us to discuss advocacy goals for our community. This is in preparation for Virtual Advocacy Day 2017 the following week, Tuesday, September 12, 2017. Virtual Advocacy Day is IFFGD’s annual day on which it encourages U.S. citizens to contact their members of the federal House of Representatives in support of the Functional Gastrointestinal and Motility Disorders Research Enhancement Act. (HR 1187). For information on HR 1187, see the March 21, 2017 and July 14, 2017 posts. For information on Virtual Advocacy Day, see IFFGD’s page linked here.

IFFGD’s Twitter handle is @IFFGD and the chat will be using the following hashtags #IFFGDCHAT, #HR1187 and FGIMD.

As irritable bowel syndrome (IBS), is the most common functional gastrointestinal and motility disorder, IBS Impact strongly encourages readers who are available at the scheduled time and date to join with self-advocates with other FGIMDs in the Tweet Chat, Virtual Advocacy Day or both. Amplifying our voices as FGIMD-affected people, along with others in similar situations, can increase awareness of HR 1187 and our needs to the public and to Congressional members with the power to help our community.