I started dialysis December of 2001 and that photo was taken Oct. 2010. There are some subtle bone changes already happening at that point where my teeth is beginning to separate because my facial ones is already beginning to enlarge until I went more ugly as years past and in just a few years after, about 2015 my appearance changed so fast it actually surprised me. So here I am now still fighting and clinging to hope that someday some if not all of these will end.