Tuesday, December 31, 2013

Looking Back And Looking Forward

I had a moment yesterday. Like one of those moments (actually, several moments) where you realize something important. I was lying on an exam table, having an abdominal ultrasound done. It wasn't a big deal, minus the fact that the tech was specifically looking for my gallbladder and that little booger was tough to find. I go for ultrasounds every several months to check a previously suspicious growth that is attached to the gallbladder.

I first found out about this growth in November 2012 when I was hospitalized with dehydration, vomiting, and stomach pain. It ended up that the issue causing my symptoms was an esophageal motility disorder, mostly likely related to Sjögren's. I also had severe GERD. When they did a bunch of tests to initially find out what was going on, a surgeon appeared in my hospital room telling me that by the way, they also found this thing on my gallbladder that shouldn't be there and although gallbladder cancer is very rare, we might have to consider surgery to remove the entire gallbladder.

More tests and investigation ensued and the end result was that this "thing" had showed up on a CT scan three years prior. I don't know if the doctor at the time read the report, but I was never told about it. Yes, you have to love our health care system. But truly, it was good news because by comparing the scans, it was obvious that the growth did not change at all in size or shape during those three years. That made it highly unlikely that this was a cancer of any sorts because to be frank, I would probably be dead. After months of discussion and more scans, it was decided that this was likely something I was born with and since I had no specific gallbladder symptoms, we would just monitor the growth.

At this point, I feel that the continued scans are a bit overkill, but I respect this particular specialist and trust his judgment. I have to tell you though, it was a horrible time for me. I was dealing with the symptoms at hand and this gallbladder scare on top of it. My mother-in-law was very sick at the time and honestly, I don't even know how my husband and I got through it all.

This brings me back to the exam table yesterday. The tech made a comment about how much easier it was for her because I was good at taking very deep breaths. She jokingly said that I must have a lot of experience doing so.

True enough.

Then this realization hit me. I have had significantly fewer medical appointments over the past few months and the impact of that has been huge. Overall, I am much calmer about my health issues. My last big crisis was over the summer with bladder issues, but things have been quieter since September. I am very well aware of the fact that this is when I started prednisone again, but I don't think the reason is that important. Although I continue to struggle every day with different Sjögren's related issues that significantly impact my life, I am not in crisis mode. Looking back over the past several years, there have been weeks and months where crisis mode has been the norm around here. I do not exaggerate when I say that I have had weeks that have included anywhere from seven-twelve medical appointments in one week. How do we live like that? How do we get through each of those dramatic and tedious weeks to the other side? One step and one day at a time.

So as my day continued yesterday and through this morning, I reflected on all of this. Sjögren's is so unpredictable. I could write this today and be in the hospital by the weekend with some unsuspecting complication. But, I have gotten better about not worrying when the next medical crisis will hit and rather, I have tried to fully live the day I have in front of me.

Taking one day at a time has served me well this year. To say that 2013 was a big year for me would be an understatement. I got married (with a two day wedding!), traveled to Disney for our honeymoon, conquered my fear of heights with parasailing, ran a very successful Kickstarter campaign, and published my first book. I reevaluated a lot of my relationships. I made new friends and lost some friends as well. I have learned a lot about myself and about other people. I have rejoiced. I have mourned.

That's a lot. And I did some of this in between medical crises, and sometimes even during them. I think that is why I no longer make New Year's resolutions: my life is a constant resolution. To be healthier, stronger, more relaxed, more patient, and more tolerant. I consistently work on finding ways to be a better and stronger person. Sometimes it means learning how to say no. Sometimes it means saying yes. This year in particular, it has meant setting boundaries with other people and learning that no matter who it is (i.e. not just my partner), we all deserve to be treated with respect, kindness, and love. Becoming a stronger person this year has meant that I have learned to respect where someone else is at, to forgive, and to truly move on. Most importantly, I have continued to just be myself and not worry about what people think of that.

So while I am I am excited to see what the journey of 2014 is going to look like, I will miss 2013. I am grateful for all the beautiful moments and the growth that I have experienced. However I must say that part of me is looking forward to not having so many big events and instead, just savoring the little pleasures and joys of each day.

One day at a time.


Do you make New Year's resolutions and have you made any for 2014?

Monday, December 9, 2013

What Does It Mean To Love Someone?

I have had the topic of love on the brain lately. And by love I don't mean just the romantic kind, but rather, the love that exists between two human beings, no matter what the relationship is. I was married six months ago, I went to a family wedding recently, I have ended several relationships in the past year for one reason or another, and I have this crazy dog that is getting older whom I love more than just about anything else in this world. My capacity to love is great and my ability to receive love is even greater.

We are so reckless with the term "love" sometimes. The words come tumbling out of our mouths, sometimes without a second thought. Maybe I am a bit of a skeptic on this topic, but to me, there is no such thing as love at first sight. I can hear the readers gasp as they read this, as I have made no secret about my overwhelming and whirlwind courtship with my husband. My attraction to him was immediate, but I did not "fall in love with him" at first sight. That was more of a chemical pheromone reaction.  I fell in love with him when he talked to me on our first date about the impact that his sister's Multiple Sclerosis has had on him. I fell in love with him when he talked about his two children and what it was like to raise them. I fell in love with him when, seeing how exhausted I was one evening, he went to find the leash and took my dog out for me before he left my apartment for the night.

I have had people tell me they love me at times and it has made me scratch my head: a new friend who tells me she loves me as she is verbalizing, in detail, all the ways in which I have failed as a friend. There is a fine line between open communication and honesty, and someone who is holding your hand to the fire while they are saying things supposedly for your own good. I have received e-mails that start with "I love you but...." while they continue to describe the ways that I have been wrong. I have also done the same; believing that by reminding a person that I love them, it will somehow lessen the blow of my honesty. I have had people tell me they love me while looking me directly in the eye and tell me lie after lie. These events are not exclusive to me; they happen to us all and as human beings, we are capable of doing them to other people.

While thinking about what it means to love, it has raised the question for me if we always understand what love is about. We, as a society, are so frivolous with the word, love, itself. We love this person and that person, oftentimes before we even develop a true relationship with them. We say we love someone based on their gregarious personality, or their compassion for other people, or maybe even because we are obligated to, because they are related to us.

But what is love really about? I don't pretend to have all the answers, but I know what it is not:

It does not envy.

It does not boast.

It is not self-seeking.

It is not proud.

It does not dishonor others.

Thank you Corinthians 13...

I know love is much more complicated than that. But we all have to start somewhere. Corinthians 13 also says that "love never fails." But is this true? We hear it said at so many weddings nowadays, but yet half of all marriages end in divorce. Does that mean that we never really loved in the first place or is it possible for love to fail? Or maybe it is more accurate to say that we, as people, failed?

I heard it said recently that love is a verb and not a noun. I understand the point the speaker was trying to make: that love is an action. But, I disagree that it is not a noun. Yes, love is an action or a verb. We love someone. We show love to someone. We do acts of love. But to me, it is also a noun. Love is this THING that is so much greater than ourselves. It is a spiritual force that drives us to do things that we may not normally do, or even want to do. Love compels us to accept those in our lives, despite their faults. Love compels us to forgive. Love is the presence in our homes, churches, schools and such that make our souls sing...

It is patient.

It is kind.

It always protects,
always trusts,
always perseveres,
and always hopes.

That is love.

Saturday, December 7, 2013

My Sjögren's Update (And It's Not About The Book!)

I think it has been a little while since I have posted an update about how I have been doing medically. There are many reasons for that; I was away on my honeymoon, I have been tied up with the book being published, and most importantly, I have been feeling better.

I started back on Plaquenil sometime in August as it was clear that the alternative medicine treatments alone were not doing the trick. They help, a lot, but they were not enough to keep me from having more complications, such as with my bladder. I wasn't doing terribly, but there was a lot of room for improvement, hence why I went back on Plaquenil. I never thought Plaquenil did much for me in all the years I was taking it, which is why I stopped it in February, but I may have been mistaken on that.

By the middle of September, I was still having a lot of issues with increased joint pain, especially in my shoulders, hips, and hands, swollen lymph nodes that were causing some alarm, fatigue, and this new interstitial cystitis issue with my bladder was still not under control. I had gotten a lot of relief with the bladder issues after going in for surgery to have a hydrodistension done, but my symptoms were starting to return, although not nearly as severe as in previous months. My urologist and I came up with a plan to start bladder instillations every two weeks for twelve treatments...at a hospital two hours away from me. Oh, the joy!

Since I was leaving on my honeymoon for Disney (we were married in May) at the end of September, I decided to heed my rheumatologist's advice and go back on prednisone, hopefully for the short-term. About eleven days before we left, I started on 20mg once a day of prednisone. Within 72 hours, the change was dramatic. My joint pain was resolved, I had more energy, ALL of my bladder symptoms were completely gone, and within another week, my lymph nodes were back down to an almost normal size. We even decided to hold off on the bladder instillations.

Now, I have a long and intense history with prednisone use which you can read about if you go back to the main page of this blog and click on the prednisone tag under "labels". It has been quite a while since I needed to be on prednisone for longer than a week and notoriously, I have a lot of side effects which make me want to get off of it as soon as possible. This run with it, initially, was much easier and it makes me wonder if my alternative medicine therapies had anything to do with that. I was getting so much accomplished; I even took up running! I did have to stop my alternative therapy, low-dose naltrexone, because I thought I had too much energy and because both medications give me insomnia, I wasn't sleeping well. Coming off the low-dose naltrexone helped tremendously.

I was doing so well that it made me wonder if maybe the risk of staying on a higher dose of prednisone long-term was worth it. That whole quality of life over quantity thing and all. I began to realize that if I could stay on this dose, I could probably start thinking about going back to work part-time, or at least on a per-diem basis. After a few weeks, I weaned the dose to 15 mg and was still doing well, and then went to 12.5 mg and then 10mg. Within a week of being on 10 mg, I really began to struggle with my symptoms again so I went back to 15 mg, knowing that I had a rheumatologist appointment coming up soon.

Two weeks before my rheumatology appointment, things began to get tougher for me. I was still feeling good on the 15 mg, but I had put on a lot of weight, despite exercising 4-5x/week. Fifteen pounds to be exact...in less than two months. That, I could deal with. More concerning were the mood swings I was beginning to have. I was struggling (and still am) more than people knew with depressive mood swings, anxiety, and becoming easily frustrated. I tried to keep my head down, but it was wearing on me. The good thing about having been on prednisone so often is that I knew it was medication related, and I have a lot of experience at managing these symptoms. But, it was kind of putting a big damper on that whole "better quality of life" thing. I have had bad prior experiences with psychiatric medications and for me, they are not the answer, so I worked on increasing my exercise, exposure to sunlight, stress management, etc.

I did talk to my rheumatologist last week at my appointment about the side effects. My blood pressure was also elevated and the only time that happens is when I am on larger doses of prednisone. She told me it was time to come down on the prednisone. I will be honest, I was very upset. I explained to her that I tried that already and after much conversation, she made me realize that I came down on the dose too quickly. I have a bad habit of trying to do things my way and you know what? I am sick of it. Historically, I get no benefit from being on less than 15 mg of prednisone but this time, I am doing it her way. Not 50% her way, or 80% her way, but 100% her way. So we are weaning the prednisone down by 1 mg every two weeks until I get to 10 mg and then we wean it 1 mg every MONTH. The goal is to get on as low a dose as possible...or even off of it.

I don't have any other treatment options at the moment besides my Plaquenil and alternative treatments. We had discussed the possibility of enrolling in a clinical trial for a new medication, but I was disqualified from entering into the study because of my lymphoma and radiation treatment history from seventeen years ago.

I am scared and I am discouraged. I don't want to go back to feeling the way I did over this past summer, or even last year. The only analogy I can think of is that it is like being blind...getting your vision back for a few months...and then being told you will likely be blind again in a couple of weeks or months. Yes, I know being blind is extremely difficult, but it is the only analogy I can think of to explain the terrible feeling that comes with it. Don't get me wrong, I am SO grateful for these past two months. I have accomplished much and literally have made the most out of every single day I have felt better. I have had a few wonderful adventures and done things I never thought possible. But at this point, I have to trust the opinion of my doctor and that being on prednisone at the dose I was on, on a long-term basis, is not in my best interest. I have to have hope that maybe I will not backslide too much.

But what is in my best interest? Struggling to get through every day? Going on and off prednisone every couple of months to quiet things down temporarily? Wondering if the back and forth on the prednisone is better or worse for me in the long run as compared to just staying on it? There are no clear answers and unfortunately, my doctor and I do not have a crystal ball to predict the future. So I am hanging on tight to my faith as I begin the slow journey of cutting back my prednisone. I will have to tighten up on my diet, self-care, and likely restart my low-dose naltrexone.

The good news is, I will likely lose some weight and my moods will definitely even out. I am sure my husband will appreciate the latter.


And here we go....