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Kenny Michelena is, by just about any measure, a tough guy. He was born and raised on a ranch in rural northwestern Wyoming and remembers that after class in elementary school, the bus driver would drop him off wherever he saw the family tractor, so he could go straight to work in the fields. He worked just about every day of his life from the age of 8, first lambing sheep and plowing fields, later helping run the farm. In his 30s, when the ranch became unprofitable in a shifting economy, he drove trucks packed with cattle and other animals across the country, backbreaking labor that put him on the road for weeks on end.

Then, several years ago, the pain started. It began in his shoulder, but it quickly took over his whole body, preventing him from working. There were days when he could hardly get off the couch. “I was raised where your pride, your reason for being alive was work,” Kenny said.

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Image: CDC via FiveThirtyEight

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