Rachel was a happy bubbly child and somewhat reserved. She had several close friends. When she had to change schools things got harder. She started having nightmares, made few friends, and very fearful when she was only 14 years old. Thought it was just teenage angst. After her birth mom died, she got worse. Movement disorder and worse nights. Crying and screaming episodes. Her neurological exam came back as not inconsistent with huntington’s disease patterns. She got her results shortly before her 18th birthday. She has juvenile huntington’s disease. Her moods started to vary greatly. Delusions started paranoia thinking they wanted to poison her. At 22 years old she was put into a 24/7 care home after they found the right one and then she adopted a cat and they planted flowers and put up a bird feeder. It gave her some independence. They see her cognitive and physical abilities deteriorating. Her spirit and zest for life remains. Rachel loves therapeutic horseback riding in summer. It gives her a joy and peace and brings out a surprising ability to control the horse. Her favorite color is purple. Her mother and I see her at least twice a week and do frequent activities with her, like visiting gardens and zoos. Rachel attends church regularly and comes home to dinner with us afterward.