diagnosis

Amateur Hour: How Vanderbilt/NIH Undiagnosed Diseases Network Failed Me

Posted on by akiwifreund

Earlier this year, I worked for four hours sorting and copying approximately 350 pages of medical records to send to Vanderbilt University in Tennessee when the coordinator for the NIH Undiagnosed Diseases Network notified me that my case was being sent there for review. I divided everything by year and specialty. I inserted notes and highlighted everything that should be of special interest.

I took it as a bad sign when I received an email that was poorly written, and rightly so:
“I need you help with some missing records the UDN has requested on you. We are missing the records from the Movement Disorder Neurologist and  also labs associated with Thyroiditis Workup are not complete. Please request these records be faxed directly to us at *********** or **********. We cannot move forward with reviewing your case until we have these records. Please feel free to contact us if you have any questions.” They weren’t actually missing the records from the movement disorders neurologist; the EMG results were included in what I forwarded to them. (Special note: capitalizing random words is an elementary mistake in and of itself and certainly doesn’t belong in official correspondence.) I wrote back and asked what needed to be obtained for the thyroid workup because I was going in for an appointment in the near future and could have tests ordered. However, I didn’t hear a response for weeks. Their suggestion to contact them with questions was not sincere because they didn’t respond to repeated calls or emails for three weeks total. I went to my appointment and guessed what they would want ordered, then forwarded them the results.

It didn’t matter, though. Last Thursday July 14th I received a letter in the mail from the head of the team saying that after a “stringent” review of my case, they were turning me down. They decided that because I have a strong history of autoimmune diseases that I must consider myasthenia gravis.

Here’s the problem, though: I considered myasthenia gravis already back in 2010, and again this year, and it has been ruled out by tests including the painful tasing of my face in April. All of those notes and tests were included in my paperwork. The 53 doctors who have seen me so far have positively said that I don’t have that. I also say I don’t have that. I have not found any documented cases where patients have received a working brain shunt to move CSF to relieve the symptoms of MG. I have hundreds of pages documenting my numerous symptoms and surgeries, and instead the Vanderbilt team chose to tell me to go back to the U of MN doctors (who, by the way, told me to go away and not come back) to get treatment for MG because “they would know how to treat me.” I am not allowed to appeal this decision or have any other team look at my file. The UDN door is forever closed to me now.

The next two paragraphs I’d like to address to that team directly:

Fuck you, Vanderbilt, you backwoods amateur cocksuckers.

This is what I don’t have: myasthenia gravis, lupus, MS, normal pressure hydrocephalus, communicating hydrocephalus, Creutzfeld-Jakob, IgG4 proliferation, scleroderma, pseudotumor cerebri, diabetes, secondary tremors, tumor, chiari malformation, or rheumatoid arthritis, among other things. After seeing so many doctors and going through hell and having to research A LOT on my own, Vanderbilt, your suggestion makes me think that my file landed in the hands of a beginner’s group. I’m way ahead of you, by years, and I didn’t even finish my medical degree. Every single one of you needs to go back to studying onion skin cells under your 10x microscopes because you obviously can’t handle the hard stuff.

As I feared, Vanderbilt chose to give much weight to the three doctors in the circle jerk at the U of MN claiming I had some sort of “facial weakness” that would imply MG and completely ignores the issue with the cerebral spinal fluid, which in turn ignores the vertigo, fatigue, slurred speech, numbness, and cognitive problems. It would also imply that I implanted a shunt for the fun of it – because I want something that I’m allergic to that causes a shit ton of pain in my body. It also means that they completely ignored the notes that indicated that my symptoms subsided when I had working shunts. Now I am back to the starting point, meaning no one knows what I have or how to help me. (Please note: I am still going through testing for the mast cell activation syndrome and I am watching the results slowly trickle in; my guess is that I’m going to have to repeat everything because nothing is extraordinary in the outcomes at this point.)

I also still don’t have disability money coming in. My hearing won’t be set until about a year from now, but my chances are only about 10% in my favor at the moment because I still can’t get a diagnosis or the NIH to work with me. I’m not being dramatic, I’m being realistic. My attorney would tell everyone the same thing.

If you have read this post in its entirety, thank you. I’m not asking for advice; that’s not how I operate. This is just one of those times where the Carousel of Crap feels extra shitty.

The Princess and the Pee

Posted on by akiwifreund

There were three things rolling around in my “Personal Belongings” plastic drawstring bag – one “hat” that is used to measure output, and two tall brown jugs with screw-on lids and my name on them. It was time to collect my pee.

The jugs were about 4.5 inches wide and 4.5 inches deep but a whopping 12 inches tall, which meant that in order to fit in my half sized refrigerator, a shelf had to come out. I made sure that I set everything up on an empty bladder so I didn’t have to scramble to do it later. I rearranged my fridge and put the jugs on the top shelf so that they would already be cold, ready for the first deposit. I very loosely screwed the caps on. I got the box of green latex gloves out of my medical supplies and sat them next to the toilet; I was not going to be transporting the collected goodies with my bare hands. I put the “hat” under the seat.

Luckily The Saint Paul had a good sense of humor about the whole situation too. He was on cooler duty for me; I sent him a picture of the one I thought would fit the jugs and he picked it up on the way to my apartment after work. However, when we tried to fit the jugs, they were just about 3/4″ too big, so I had to send him back out for a bigger cooler (that I could still carry by myself while also using a cane). I thought I would only have room in my freezer for a 5-pound bag of ice and so that is what he came back with for me.

Bright and early the next morning I started drinking water.

As luck would have it, I had plans to see someone that evening whom I hadn’t seen in at least 13 years who just happened to be in the city because of a work obligation. When you get an opportunity, you do everything you can to take advantage of it! This friend was going to be only blocks from my now deceased dad’s and uncle’s hair salon (still owned by their good friend), so I thought, “Hell, I’m going to get some wigs cut too.” I managed to get a short bus for 3:45 pm to take me to the salon, and to pick me up and take me home at 10 pm, so that meant that I could only pee from 7 am to 3:40 pm, and about 10:30 pm to 6:45 the next morning. It’s a good thing I’m a planner. It’s also a good thing I have the bladder of steel. I told my friend I’d see her at a certain time and that I couldn’t pee while we were out (without offering an explanation).

I did pretty well. I took in about 80 ounces of water between 7 am and 2 pm, and managed to get a bunch of samples before my bus rolled up at 3:45. However, I did hit a few snags. First, the “hat” didn’t sit well under the seat – I almost completely lost the biggest collection and I had to jump up midstream and pull half of the container up from out of the toilet. It wasn’t dunked in the toilet water but I did manage to get both hands wet, and was so grossed out that I had to do a surgeon’s scrub before I could finish peeing, but I had to do it really quickly because I hadn’t been able to wipe my booty so I had to kind of stand bow-legged and squat like a cowgirl who had been riding the trail for days so my legs didn’t also get drenched (thank goodness for the bidet). Second, the “hat” didn’t have a very big pour spout, so when I went to the fridge to transfer my drop to the jug, I had to pour very, very slowly. I had a lot of time to contemplate my urine. I remember thinking, “Man, that smells really fruity. Why does it smell really fruity? I’m not even borderline diabetic.”

Another thought: “There are some FetLife men who would mourn the loss of this tasty liquid.” Another thought: “Replace ‘tasty’ with ‘nasty.'”

I managed to not use the bathroom once between 3:45 pm and 10:30 pm, so no samples were sacrificed in the name of reconnecting with old friends. Everything went into those jugs.

I only ended up filling up one of the jugs with my samples, and my special instructions were to bring the sample packed in a bag of ice packed in a container of ice to the hospital. However, since this cooler was much, much bigger than the one that was only slightly too small, I had to improvise when I realized the ice only reached the bottom 2 inches of the cooler when it spread out. I knew I only had minutes before the cab showed up to transport me to the hospital, so I started grabbing the nearest things – throw pillows from my couch to fill the large spaces. I stuffed those around the pee jug in a bag, then poured the ice in. There was still space not covered in ice. What to do? I had an old bag of nearly petrified cut rhubarb in the freezer that I thought was going to be used for custard bars (seriously, make these rhubarb custard bars), so that was thrown on top. Perfect.

I got to the M Health building at the U of MN hobbling with my cane in my right hand and this cooler big enough to fit a small man on my left (bad) shoulder and slowly made my way to the lab. When I got to the front desk, I notified the clerk that I had a temperature-sensitive sample, so she asked me to follow her to the back area with the phlebotomists so they could accept it and log it. The woman who ultimately took it was flustered and momentarily angry when she saw my throw pillows – she assumed that I had forgotten the ice part. I grabbed the rhubarb off of the top and threw it in the trash and she took the cooler to the back to pass it along to the technicians.

While I was waiting for my cooler to reappear, the clerk and I realized that another cooler that was sitting there was leaking water all over the floor. She opened it and it contained another pee jug. I was surprised to see it laying sideways completely submerged in water – I guess they had complete confidence that the screw top was a tight seal and there would be no transference either in or out? Either way, the clerk and I started working on mopping the floor up with paper towels. Of course, I did another surgeon’s scrub at the sink immediately afterward. If I’m not okay with getting my pee all over my hands, I’m not crazy about Stranger Danger’s either.

There is a distinct possibility that I will have to repeat this test a few more times. If so, I will be more prepared – more ice, less rhubarb!

You Know, Like The Nasal Spray

Posted on by akiwifreund

Tonight was supposed to be a date night with the boyfriend. Unfortunately, I’ve been nursing a headache all day that has been getting progressively worse, so we’re postponing until tomorrow night and I have vowed to not make myself ready for public consumption tonight even a tiny bit. Instead I’m listening to Enigma and thinking about how to put all of this week’s news together.

When I was little, I had a lot of problems with asthma and allergies. There was one time I had gone hog wild with the Cracker Jack tattoos and then went into anaphylactic shock shortly after from who knows what and was rushed to some kind of urgent care (though back in the 1970’s it wasn’t called that), and my mom and I remember that the doctors and nurses were momentarily amused to discover how enthusiastically I had stamped them onto my arms and legs when they hurriedly stripped me down to shoot me up with multiple adrenaline shots. I always had allergic reactions that seemed to come out of nowhere. I would have hives show up on my little cheeks that couldn’t be explained. We tried so many things, including eliminating dryer sheets and perfumed laundry soap. I could only bathe with certain soaps – I remember being disappointed that my friends had fun soaps with glitter, while mine tended to have real oatmeal and vaguely resembled excrement.

Often my allergies would turn into full-blown infections. My little body was so worn out from the allergic reactions that the microbes had an easy time of taking over, every time. I know now that specifically I am even more vulnerable because I have both IgG3 and IgG4 immunodeficiencies, so I cannot fight off infections like other people can, and my infections will always last longer.

One of the many things I always struggled with is cigarette smoke. I knew from a very young age that I was allergic to it; it wasn’t just that I didn’t care for the smell, but that it made my throat close up, like I was having an allergic reaction to it, much like what people experience when they are very allergic to cats (a more common allergy than dogs), or when they have a peanut or egg allergy. After being exposed for a few hours to cigarette smoke, it’s inevitable that I will develop an infection. Three of my four parents were smokers and so I always had sinus infections, bronchitis, ear infections and pneumonia growing up. Nowadays I’m thankful that most places in the U.S. have adopted laws banning smoking in indoor public places.

Animals are tough too. We had a cat that I loved very much but we ended up having to re-home her with our aunt after it was confirmed just how allergic I was to her; our dogs were outside dogs at my mom and step-dad’s house, but my dad and step-mom had an indoor dog. It seemed like I always had a sinus infection and/or bronchitis and/or an ear infection.
There are other allergies that I have noticed over the years that are not the usual suspects for most people. For instance, I get hives all along the entire surface of my body that has been in contact with brand new furniture. I’m not sure if it is the dye in the fabric or the chemicals in the padding that I’m allergic to, but it’s miserable. Also, commercial perfumes that the general public wears and Lysol are incredibly toxic to me. (When I used to work in the cubicle farm at Bank of America in Phoenix, I used to stand up and yell “Stop spraying!” if a co-worker started spraying Lysol in his or her cube because my throat would immediately start closing up. Everyone thought I was nuts.)

Lately I’ve been having some trouble with my pulse being about twice the normal rate and with my blood pressure being elevated. I also have burning and a metallic taste in my mouth, constant heartburn that no one to date has been able to pinpoint the source of, and of course the constant problems with my CSF, memory, word recall and crushing fatigue.

Back in October of 2015 at the urging of a friend, I made an appointment with Dr. Lawrence Afrin, who is fairly new to the University of Minnesota staff; he used to live in South Carolina and transitioned to Minnesota starting in 2013. When I moved here a year ago, I was trudging back and forth between appointments with doctors and labs and scans, and didn’t think much about what he had to offer me, quite honestly – I mean, I thought that what I had going on was better addressed in the areas I had already been concentrating on: neurosurgery, neurology, immunology, rheumatology. I couldn’t even find a regular primary care doctor who could handle me. I made the appointment anyway, but Dr. Afrin is in high demand, and they booked me for ten months later. I didn’t give him a second thought.

A month ago I received a call from his office with the offer to move my appointment to the end of June. I accepted. In the meantime, the same friend who urged me to make the appointment also bought me his book and sent it to me, so I quickly started reading it because of the pending appointment – “Never Bet Against Occam.” Within the first 20 pages I realized that I was reading about my own puzzling history. I started to assemble my list of questions and completed my 3-ring binder for the appointment.

Dr. Afrin is considered the national expert on a newly identified disease called Mast Cell Activation Disease (or Syndrome) or MCAD (or MCAS). It has only begun to be identified in the past 8 years, and he has been at the forefront of the movement to get it nailed down and classified. Everyone has mast cells. Everyone with this condition has a “normal” amount of cells, but they act in a very abnormal way. For some people, maybe it’s normal for them to have an allergic reaction to a mosquito bite. However, if they go into anaphylactic shock from the mosquito bite, then that might be considered MCAD if the actual number of mast cells didn’t increase.

Dr. Afrin first read through my records. Occasionally he quietly chuckled to himself as he read. At one point I asked him what was funny; he said that the signs I had MCAD were quite obvious. I told him to wait until he got to the part where I demanded to get azathioprine to try to stop rejecting the shunt, because I came up with that on my own, no one suggested it to me (I found out from his book that he prescribes chemo drugs such as azathioprine to MCAD patients in an attempt to try to find the right treatment).

In another section, he stopped and said, “Oh, Dr. T. here said that you have a mast cell disorder.” I said, “He read that I was coming to see you in the future. Let’s just ignore everything he said because he misdiagnosed me, shall we?” He laughed, but then later said I shouldn’t be so hard on my doctors in general because their main goal is quantity, not quality. I didn’t tell Dr. Afrin that he was my 53rd doctor at that point. I also didn’t want to go into an impassioned speech about how difficult it has been to lose my ability to work, to lose my house and car, my independence, and my sense of self-worth, all because doctors thought my case was too difficult and they just wanted easy cases.

Dr. Afrin thanked me for putting together such a complete medical history of the last six years. We talked about my life from birth to present and what were probably the signs of MCAD from the very beginning.

Here’s the plan: He’s going to request the biopsy samples from my upper GI (that I insisted on getting done on my own because I’ve been trying to figure out where this horrible acid reflux is coming from) so that they can be stained with the special stains that can show the concentrations of the mast cells. I’m going to have a bunch of blood work done next week. I’m also going to be sent home with a collection container that is going to live in my fridge for 24 hours. Can you guess what it’s for? Not Kool-Aid! Urine that I have to collect for 24 hours worth of peeing. That’s right. Then I have to transport that back to the lab, but first I have to pack it in a zip lock bag, pack it in ice, and then put it in a cooler. The urine has to stay cold or the components that have to be tested begin to degrade and become useless.

My sister and I had some good laughs over the whole refrigerated urine thing. First of all, I’m a bit of a germaphobe – partly because of the time I spent in nursing school and specifically in microbiology and all of that in-depth studying of bacteria, and partly because I know my immune system is weak. Second, I’m going to have to carry the cooler in my left hand because I have to walk with my cane in my right hand. Right now my left shoulder is in really bad shape because the tendons are likely frayed. What if I drop the cooler of urine? Am I destined for YouTube infamy when the bucket-o-urine splashes me in the face?

I’m thankful for this person steering me to Dr. Afrin. I’m trying not to get too excited because even though he’s 99% certain that I have MCAD, I’ve been down the 99% certain road before a few times, and it’s very emotionally draining to get misdiagnosed.

Happy Anniversary

Posted on by akiwifreund

Exactly one year ago today I got on a plane and moved from Phoenix to St. Paul. According to the dust on my shelves, that’s the last time I dusted as well.

The first six months were difficult. I was going from doctor to doctor, trying to find any that wouldn’t turn me away. I couldn’t drive because I lose about 80% of my vision while I’m upright for a long time, so I spent about $500 a month just on cab fare alone; when I wasn’t going to doctor appointments, I simply stayed in my apartment.

It took me a lot to where I am right now: I have at least a primary care doctor, I have had 3 months of physical therapy for the pinched nerves in my shoulder and hips, I have a disability attorney (but probably no hearing until July or later 2017), and I now use the short bus and a cab company that is contracted through medical assistance to get me to appointments. I also have an incredibly supportive boyfriend.

There are still some black holes of missing pieces. One: I still don’t have a diagnosis. Two: I don’t know what in the hell I’m going to do about my shunt.

June 16-19 was the National Hydrocephalus Association conference, and I never would have been able to attend if it wasn’t right here in my back yard. I had decided that I was not going to be shy. I had also decided that although it was nice to meet other patients and commiserate, I really, really wanted to pick the brains of the researchers and doctors and manufacturers of the shunts.

At the very first speaking presentation, a researcher spoke about the work she has been performing regarding shunt occlusions (blockages). I raised my hand and first asked if the study began when the shunt was still in the patient (so they could figure out if the drainage tip was stuck somewhere, like a drinking straw that’s clogged by a large piece of fruit or an extra thick shake) or if the shunts were studied after they were removed, because I tend to immediately make 20 years worth of scar tissue in 2-3 weeks and clog my shunts very quickly. She indicated that she tests the shunts only after they are sent to her post-surgery, and that she was definitely interested in my shunt(s). I got her business card and told her about imaging that has been developed in Scotland that piggybacks off of current MRI and CT scans but is supposed to be much more accurate, and it just so happens that she is supposed to travel to Scotland in two weeks. In another talk she gave much later in the conference, she mentioned autoimmune diseases, and I’ll be seeing a doctor that specializes in mast cell disorders next week; I’m going to speak to him specifically about my issues with the shunts and about contacting her and speaking with her regarding shunt rejection. Not a bad start for networking!

But with the good comes the not so good. Another talk I attended was facilitated by a neurologist and a neurosurgeon who were experts in normal pressure hydrocephalus. That is one of my placeholder diagnoses and they kept talking about enlarged ventricles on MRI and CT scans. I asked if it was possible to get that diagnosis without the enlarged ventricles, and they said no. I talked to them afterwards and quickly covered my symptoms and demonstrated my unusual ability to move the fluid around in my brain. They actually became very condescending and a little pissy, asking if I had considered the Mayo. I thanked them and left the room.

At another session, there was a representative from the Social Security office talking about the process of filing for disability. He opened the session by saying that he actually never handled disability cases where health was involved – I mean, when it’s a health conference, why send someone who is knowledgeable? I raised my hand during this one too and asked two questions: 1) Is it correct that since my request for a hearing was filed in early February of 2016, it’s pretty backed up and I shouldn’t expect a hearing to be set until July or August of 2017? and 2) I was told that even though I can’t see well, that my arms and hands still work, so I should be able to get a job. What criteria is used to determine whether I should be employed when my records indicate I should be laying down for 20-22 hours a day? He said, 1) It’s not unreasonable that the hearing would take that long to be set (and I answered that maybe it’s not unreasonable to him, but it’s unreasonable to me), and 2) It’s not just my inability to see or be upright that’s considered, but also my education and my age, so yes, no matter how impaired I am, I may be “too young” to be disabled. That absolutely floored me – no wonder I have to fend off assholes telling me that every day, because that’s the idiocy that the social security office perpetuates every single day.

One session was put on by the Metropolitan Center for Independent Living right here in Minnesota and a particularly energetic and passionate woman dedicated to helping people find the best and most resources available. Of course I raised my hand and said something to the effect of, “Dude from the SSA yesterday said that even though I am impaired when I’m upright, I can still use my hands and arms and I’m only 42, so of course I’m going to be denied. Does this seem correct to you, and would you deem needing to lay down flat 20-22 hours a day a ‘reasonable accommodation’ to request of a workplace?” (In other words, can I lay on a hospital gurney while I’m ringing people out as a cashier at Target?) She rolled her eyes and said that she was told a while ago that when dealing with the SSA, never to apply logic, because what they do defies common sense. She also said that one guy was told by the SSA that he should be able to find a livable wage somewhere “folding napkins” because that was all he was capable of. I asked if there was ever any communication between the SSA and her office for them to base their findings off of, and she said absolutely not.
While we were waiting to be picked up by the short bus at the hotel in downtown Minneapolis where the conference was taking place, there were plenty of people partying and women wearing the most ridiculous heels and short skirts because the Twins were playing the Yankees at a home game. One drunk hanging with his two very drunk buddies began to loudly read my shirt, and so rather than roll my eyes and be pissed, I invited him to read the other side of my shirt. His immediate demeanor took on the tone that he was going to make fun of me, but after I gave him a brief history, all he could say was that he was sorry, and he doffed his hat to me.

Through all of this, The Saint Paul weathered some really dry presentations, and probably learned more than he ever wanted to. However, when I met his dad and stepmom for the first time on Sunday night and they began to ask me questions about my health, he answered them exactly as I would have. The Saint Paul really takes all of this to heart in addition to reminding me that we are a team and that I no longer have to do everything on my own. I mean, man, he got me paper towels because he noticed I was running low on his own – he didn’t even have to ask, and I didn’t have to tell him! Forget “don’t sweat the small stuff” because it’s the small stuff that counts!

One of the sessions I wanted him to attend (while I was in listening to a much heavier topic) was about caring for the caregiver. All of the men in my immediate family have had to put their own health and happiness on hold because my mom and sisters have had chronic and severe diseases. The Saint Paul believes he can handle whatever happens to me, but I warned him that things can change suddenly and completely and permanently for either he or I, and even with the best of intentions, it’s absolutely possible that he can be so deeply affected by this unnamed change that he’s going to lose his shit. It’s a lot to ask of one person.

So, back to this anniversary: this is also the day a year ago that my sister and her husband brought home their second rescue dog from Secondhand Hounds and renamed her June. Just recently, June has started to mimic her dog brother and put herself on the floor and position herself for belly rubs, something she never would have been relaxed enough to do a year ago. It’s amazing what thousands of dog treats and a loving family will do.
2016-04-12 21.37.08

The Boyfriend Invasion

Posted on by akiwifreund

The Saint Paul and I have been dating for two and a half months now. Our first date was many hours long, so many that we approximated it to be the equivalent of four dates. We’ve had many dates since then where we’ve had up to fourteen hours together until I’m physically holding my eyelids up with my fingers and he’s stumbling into his shoes to go home. We’ve also fallen into the habit of not going more than three days without seeing each other. But we’ve never had a full-on sleep-over; he’s always gone home.

I live in a historic area of St. Paul, Minnesota, and every year on the first Sunday of June there is a celebration called Grand Old Days that includes music, food vendors, a parade, artists and sports/health vendors. Attendance has been anywhere between 170,000 and 270,000, and attendees can even print a bus pass for certain routes to park and ride to this area for free. It has gotten so large that this year they have expanded the festival to the whole weekend instead of just Sunday. My flat just happens to be right next to one of the sound stages – and I’ve checked the lineup, doesn’t look promising.

Healthy me would have been absolutely thrilled. This is the stuff I used to live for, and it’s right at my front door. But the new me has to come to terms with the fact that I can’t walk a couple of miles or stand for hours to listen to live music or spend money on food and pottery. The thought of trying to navigate throngs of people while my brain is being squeezed and my eyes are drooping gives me extra anxiety. If I’m being completely honest I can whine and say that it’s not fair, but then who in the world can I blame that on?

The Saint Paul has opted to come over Friday night so he can score a parking spot and not have to stress about it after that. We might run out to get a few groceries, which will require us planning out meals for two whole days together, and then he’ll head home Sunday night. He’s going to try to borrow a camp chair for the parade, since I have my own already – we have to stake out a place on the sidewalk along the parade route pretty early in the morning Sunday, because it’s going to get gnarly. We’re fully expecting drunks to be trying to get into my building or to be peeing in our planters or every barfing in every doorway. I’ve heard stories. Non-food businesses are now in the habit of shutting down completely for this festival.

Other things take planning too. I’ve suggested that he bring over his favorite pillow to help him sleep better (because we all know that makes a huge difference when sleeping in unfamiliar territory). Sometimes I wake up coughing because of acid reflux, so I kind of have to be ready to move to my couch (five steps from my bed) if I think I can’t get back to sleep right away. And to hear The Saint Paul tell it, he flops around like a fish when he sleeps, which does not bode well for me, the ultimate light sleeper.

Most importantly, 48 hours together guarantees that there is going to be poo involved. Knowing my GI tract means there’s going to be multiple incidents each day. I have a brand new bottle coming that should be arriving just in time for Friday that is ruby red grapefruit-scented that may prolong my relationship with The Saint Paul. I am telling you, every house should have PooPourri because everyone poops, and no one wants to die by Lysol or any other chemical stuff that you spray in the air that makes it smell like you shit out a pine tree. I cannot say enough good things about this product. Buy it. You spritz it in the toilet bowl before you unload your load, and all is right in the world.

Lastly, most of my lounging and sleeping when I am solo in my flat is done sans hair. My wigs are just not at all comfortable, and wearing them in bed actually wrecks the fibers. So The Saint Paul is going to get a full dose of me au natural, and I have warned him that once I have taken them off in his presence, I will probably lose all motivation to wear them all of the time. I like how I look in them, but they are so damned scratchy and uncomfortable, plus wearing them less will also help me to be able to keep them longer since I have no money coming in. So for your viewing pleasure, here is (a very dirty) Mr. Clean taking your day to a whole different level:

Rare + Rare = Still Rare

Posted on by akiwifreund

Yesterday was generally a non-productive doctoring day for me. I went to see a neurologist in a different medical system outside of the ones that I have tried just to see if I could at least get an acknowledgment that what I’m dealing with is not that idiotic label “facial weakness” that the U of MN doctor put in my file. Besides trying to work towards a diagnosis, I’m also trying to build my case for disability, and I keep hearing my attorney’s voice in the back of my head saying, “If you don’t get a diagnosis by the time you are sitting in front of the judge, you’re screwed.”

The neurologist was very friendly and open, and definitely had the approach of working with me as part of a collaboration rather than dictating to me. However, we still had a breakdown in communication. She could not wrap her brain around the concept about why I have a shunt in the first place (and indeed is the same barrier for 99% of the doctors I talk to even though I explain to them that the shunts were placed because my symptoms improved temporarily after receiving lumbar punctures 12 hours apart). Almost all doctors incorrectly jump to the conclusion that my face is drooping because I’m overdraining – as if the fluid is pulling my face down with it, like I am living out a Salvador Dali painting. It’s easier for me to explain the shunts and the failures and the symptoms to people who have absolutely no experience with this world because they have no expectations and no preconceived notions (except for the asshole armchair “experts” who don’t know shit but think that watching a few episodes of “House” have made them suddenly intellectually superior).

Because this doctor had wonderful bedside manner, I made sure I took the time to assure her that her inability to give me a diagnosis or a direction was not her fault or a failure on her part as a physician. As a matter of fact, she was doctor #50 in six years, and I told her that too. The combined look of horror and chagrin was a bit comical. I gladly accepted her recommendations for a pediatric neurosurgeon (because sometimes they take the most complicated adults) as well as a rheumatologist she thought would have the best bedside manner, so all was not wasted on that visit. I also explained to her that I would be attending the national hydrocephalus conference June 16-19 being held here in Minneapolis and that I had t-shirts printed:

This week another one of our relatives passed away. His niece happened to contact me through 23 & Me, where I have an account set up after getting my genes tested last July; I wanted the cheapest way possible to get them set up in a database while I tried to figure out what is going on with my body and just how rare it really is. It turns out that this relative of mine has a daughter who is also super rare, truly one in seven billion! It’s so rare that they actually had to formally name it: Hemolytic Anemia Medicine Lake. The “Medicine Lake” portion of the name refers to the area that I and a large portion of my extended family grew up and lived in in the western Minneapolis area. Unfortunately it’s not in any way similar to what my problem is so I can’t go to the NIH and tell them to link our cases, but we definitely hit the rare disease lottery in this family.

By the way, universe, I’d like to win the LOTTERY lottery.

And I won’t be going back to this neurologist, as nice as she was, because she described herself as a “neighborhood neurologist.” She said that she was a step or two down from the facilities where I had been trying my luck, and this was way over her head.

Would You Like Some Abject Poverty With That?

Posted on by akiwifreund

I left a message yesterday with my apartment manager regarding my lease, which is ending on May 31st. I had signed a notice and turned it in on March 17th indicating that I wished to stay another year when my lease expired, but I haven’t heard anything since then, and we don’t have many days left until the end of this month. I have a certain amount of money in my bank account from the sale of my car that I have been using for living expenses but I figured that if I was going to sign another lease, the apartment manager wanted to see proof of income or a certain amount of reserves in the bank, so I decided to call the administrators of my 401k to pull all of the funds and close it out.

The simple act of getting on the phone causes me anxiety. In all of the jobs I’ve held over the years, I used to field anywhere between 50-100 calls a day, so just know that that’s highly unusual for me to dread picking up the phone and try to figure out what to say without fumbling.

It’s also unusual for me to not have one or two or three jobs simultaneously. The 401k is my last lifeline and the only thing standing between me and homelessness. Right now I have to operate under the assumption that I will never have any money coming in ever again because I have no idea what the outcome of my disability hearing will be in 2017.

The call to the 401k plan administrators only took a few minutes. The first representative couldn’t confirm or deny which penalties I would be subject to, even though my CPA said that I could probably avoid a 25% and 10% early withdrawal penalties because of my indefinite disability status. A second rep – presumably the guy who did the calculations and released the funds – advised me that he had to take out a minimum of 20% for taxes and that I should set aside an additional 10% for penalties, all in a blaring and bored voice, as if he heard this stuff all the time, as if it wasn’t a big deal for me to have no other choice.
I have a few big purchases coming up. First, I have to take care of a crown and root canal completely out of pocket because medical assistance won’t pay for any of it. Second, I need a new bed; this one started to sag about five months after I purchased it last year because I spent so much time in it, but the store wouldn’t cover it under warranty because I moved out of state and the manufacturer would only cover a small percentage (this time around I’m going for the bargain Sleep Number C2 – no inner springs and it costs the same as a traditional inner spring bed). Third, I want to buy a different a/c window unit because the one that was provided with the apartment is gross and inefficient.

After those purchases, I will have to live off of the same amount of money slightly more than what workers make at minimum wage in the U.S. I don’t know how people do it. I don’t know how I’m going to do it. It’s not like I can go out and get more jobs, or a better job.

This is the song of our people. Poverty. Desperation as our bodies shut down, especially in my case (and others out there) when I don’t have a name to attach to it or a prognosis to go by. My counselor has told me not to think a year ahead and allow myself to be swallowed up by the fear of what comes after the money runs out, but how can I not think about that? My life is already so different than it was even just a year ago; I can’t even whisper the words, “How much more can I lose?” That’s like setting up a new dare to the universe.

Hanging up with the Merrill Lynch rep, he wrapped up the call with the requisite, “Is there anything else I can help you with?” The old, working me would have awarded him 10 points for asking the question. The new, disabled me wanted to tell him to suck my ass.

Le Petit Mort

Posted on by akiwifreund

I cried a lot yesterday. I never used to – it was a bragging point for me, that I would shed tears once a year, tops. But yesterday I started by spending an hour on my counselor’s couch recounting my dehumanizing neurologist’s appointment on Tuesday with big, fat tears rolling down my cheeks the entire time. It actually took me days to process what happened in the visit, and is the reason why I still have to write part two now.

I barely got five words out before the tears started. They were angry tears. I’m pissed. It’s not just that the doctor was a dick – because he was – but it’s that his actions could affect my life for the next few years to come. It’s not an exaggeration. I’ve been through this before too. When I had my very first shunt placed and experienced abdominal pains from day one, the neurosurgeon and general surgeon passed me back and forth for a couple of months and blamed each other for causing me pain before finally throwing up their hands and telling me that it was my imagination and there was nothing wrong with me before they had to do a large cut on me two and a half years later and discovered my abdomen was grossly inflamed from an allergic reaction to the shunt. Two and a half years before they admitted there was a problem.

The problem with this neurologist now is that he is saying that I have spasms in my face, and that I just need to stretch my muscles. He’s going to put that on my records too – and the records are going to the NIH and Vanderbilt. Vanderbilt will either take his word as gospel or dismiss his diagnosis and study me, and I have no idea which way they will tilt, but if they decide not to accept my case, it could mean YEARS of more testing before they will consider my case again.

The most insulting part of the visit with this douchebag is that he spent more time demanding to know why I wasn’t on antipsychotic meds. I am having some issues with word recall, which apparently he views as a clear sign of being psychotic. Well, that and I have this condition that no one can seem to name up to this point. He performed physical tests including forcing me to fall, all the while holding onto my hips to assist me to the next starting point because my legs shudder and I list to the right during any physical activity and I wasn’t allowed to use my cane. Then he had the balls to tell me that I was just having facial spasms. I couldn’t believe it. I said, “But you were holding me up because I couldn’t stand!” He acted as if I didn’t say anything.

This neurologist gave me the standard statement on my discharge papers saying basically “don’t come back.” I don’t make this up, people – it was there in writing. The list of doctors who will let me through their doors is tiny at this point. I would have to go through the effort of finding all new doctors to try this all over again if I wanted to get another referral to the rare diseases unit if Vanderbilt denies me this time.

I’m not crazy. I just need doctors to set aside their preconceived notions and overinflated egos and listen to me, because I have had six years of this, compared to their one hour with me and my pages of documentation that they won’t read anyway.

I sat down on Thursday night and wrote this to the doctor and his nurse. I don’t think it will change what goes in my chart but I wanted to say it anyway:

“Regarding Dx of Facial Spasm:
Just to be clear, my primary dx should NOT be functional facial spasm. I am preparing documentation to submit to the NIH through Vanderbilt and I would like it to be accurate. My symptoms have always followed the same pattern, in this order: vertigo, fatigue, slurred speech, uncoordinated walking and then ptosis. Every shunt revision has been performed after all of the symptoms have presented indicating that the shunt has clogged or broken. My shunt has been clogged since it was placed on May 11, 2015. The symptoms resolve when I lie flat, which is why I don’t have permanent damage on an EMG (and why the test was unnecessary). When I lie flat, I can feel the fluid move away from the area that it’s pressing on, as if an orange peel is slowly being removed, and the pressure is relieved from my brain. That is why my eyes open and all of the other symptoms resolve. When I am upright, the fluid pools and the symptoms return. I demonstrated this in person on Tuesday, including laying flat as well as turning my head to the far left to open the shunt to drain off fluid so I could open my eyes fully.

The printout regarding functional facial spasm does not address CSF pooling in the brain or how doing stretching of facial muscles is going to help pooling of CSF in the brain. Since I have to travel hundreds of miles in the near future to continue research on my medical mystery, it would be helpful if my records were as accurate as possible and did not contain information that does not apply to me.

Thank you.”

Next week I’ll see my primary doc and will find out if I stirred up any shit or if I have been completely ignored.

What a difference having someone who loves me and who is in my corner makes in my life, though! The Saint Paul is like my hallelujah clouds during a shit storm. I promised not to spill all of our personal details, but there are things that I feel are safe to share. The Saint Paul has a big brain and is humble, which makes me weak in the knees. He’s also a good listener. I mean this in a very specific context: If I say that I need to be touched in a certain way, he doesn’t try to correct me and say that “every woman likes” what he’s doing and he’s not going to change it. Instead, he listens and makes the adjustment, and the reward is that I don’t have to fake anything and do the crab crawl backward.

I don’t know if he noticed last night but my eyes were leaking. It was for a much different reason than 12 hours prior when I was parked on my counselor’s couch, but it felt infinitely better.

Grief and Acceptance

Posted on by akiwifreund

Every other week I am in my counselor’s office, and there seems to be something new that brings me to tears, which drives me crazy. I can’t figure out why I am crying so much. I mean yeah, I have experienced loss on a major scale in the last nine months – my sister, my friend, my uncle, moving states, losing my job, losing all of my doctors, losing my option for more surgeries – but I keep thinking that I should be adjusted by now. But reading this post by my fellow blogger reminds me that I keep experiencing loss and that I still have a sense of instability. Since my U of MN doctors insist that I don’t have Lyme, I have to go through the long process of getting set up through the NIH rare diseases unit and make arrangements through Vanderbilt University to be studied there, as they have locations designated throughout the country for patients to be screened. In the meantime, I have to continue with my treatments with my naturopath, even though I have NO IDEA if it’s the right thing to do.

In addition, I’ve been given the option of getting a TAP block in my abdomen with the hope that it will relieve some of the nerve pain that I’m having from being allergic to the drainage catheter from the shunt. The doc is going to numb nerves on both sides of my abdomen leading to my lower belly. The kicker? I have no idea if it’s going to affect my sexual functionality. And I’ve got a brand new boyfriend. And I really like said new boyfriend and I want to jump him every time I see him. And I don’t think it will be fair to lose what little functionality I do have, because who knows how much longer these good years of responsiveness are going to last? It’s asking a lot of a new boyfriend to possibly give up intimacy for an unknown period of time (forever???); I mean, I call him The Saint Paul, but Jesus H…I don’t know, is there something that is a step above sainthood? If I lose my ability to orgasm, that’s gonna take a LOT of mourning. Maybe some booze and mood stabilizers. I’m already stressed out about possibly taking out the shunt permanently because it’s clogged and I’m allergic to all of the shunts, which means that I may be stuck laying down forever and can’t be up for even an hour.

In closing: Send kittens and puppies and rainbows.

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

Wendy's avatarPicnic with Ants

When people think of grief they often think of death, they don’t think about grieving over other significant losses.  Those of us who have had major losses due to chronic illness know all too well that we grieve those losses.

The five stages of normal grief that were first proposed by Elisabeth Kübler-Ross in her 1969 book “On Death and Dying” are: Denial, Bargaining, Depression, Anger, and Acceptance.  Kübler-Ross describes these stages as being progressive, you needed to resolve one stage before moving on to the next.  This is no longer thought to be true.  It is accepted that most people who have loss go through states of grief but it is not linear nor is it finite.

The The British Journal of Psychiatry Nov 2008, published a study on grief and acceptance.  The authors note that “disbelief, yearning, anger and sadness may represent aspects of a single underlying psychological construct – grief.”…

View original post 563 more words

Ch-Ch-Ch-Changes

Posted on by akiwifreund

I’ve been laying low for a few weeks. Actually, that isn’t quite right – I’ve had to put on makeup nearly every day and wear a bra and be polite and make sure my pants aren’t falling off of my ass every time my name is called and I stand up because of non-stop appointments and activities. Most of the time it’s exhausting because my brain is being smushed like people have sent over a few of their puppy-monkey-babies to sit on my head and bounce around a little. At the end of each day I’ve had very little energy to do much else than watch my TV boyfriends Jimmy Fallon, Trevor Noah and Larry Wilmore on Hulu.

My uncle’s memorial service was Monday. There was quite a large turnout – something in the neighborhood of 300 people, I think. It was lovely and sad, and especially tough to see pictures of my aunt and my dad on the slideshow that was run during the service, who preceded my uncle in death by 20 years. Every single one of us cousins on that side lost a parent at a very young age. Thankfully there were a few funny stories and pictures to break up the sadness.

About a month ago I went to a session at a health crisis center where a musician brought his guitar and we had a little singalong activity. It was nice to sing – it’s one of my favorite things to do – and I have a decent voice, and I met a woman who seemed to be fairly friendly. The thing about the crisis center is that people attend whether they have physical illnesses, mental illnesses, or both; this woman happens to have mental illnesses, though I didn’t know it when she started talking to me. She gave me her number and said she would be interested in getting together because she wanted to expand her friendship circle.

Well, I didn’t know it at the time, but “expand” really meant that she wanted to make A friend. One. Me.

I had new orders put in for nerve impingements in both my left shoulder and right hip, so I’m going to PT twice a week now. Besides that I have other appointments for counseling or additional doctor appointments at least once a week, including an EMG for my head and face tomorrow morning. I’ve still got the tremors going on in my legs from being upright so much.

I didn’t realize that the lady didn’t fully expect me to actually call her, or that I was the only one polite enough to give her the time of day. However, slowly as she cornered me on the phone day after day for a few hours at a time, she revealed she had some issues with obsession and stalking, including the fact that a man who attends her church has a restraining order out on her. At one point she told me that she thought that he was trying to be friends again; what did I think? I told her that he might have been polite, but she should keep her distance. I finally told her that I can’t talk on the phone every day. Now she texts me every day and asks if we can go and do stuff like shopping. I tell her every day that I have appointments and it’s really difficult for me to be running around all of the time. Now I’m at the point where I’m going to have to be firm and tell her that I just don’t have the energy or health to be her one and only friend. I’ll let y’all know if I come home to some rabbit stew and her standing in my bathtub with a knife.

I have been working on making the changes to my diet to make it anti-inflammatory, and that includes experimenting with ingredients. Today I made crispy chicken, which was breaded with garbanzo and fava bean flour (okay) and coconut flour brownies (eh), and I’ve determined that coconut flour and my esophagus do not mix. I’ve tried three different recipes that are coconut flour-based and they burn going down every time. I don’t think it’s a true allergy because I don’t get hives or asthma, but it’s still unpleasant enough to stop trying to make it work.

Four doctors now at the University of Minnesota have told me that they don’t think I have late stage Lyme, and they’re not quite sure what I have. No one can figure out why the hell I can lay down and make the CSF move away from wherever it’s pressing on my brain and I can open my eyes again. I talked to my PCP today about the possibility of getting my shunt removed completely since it’s not draining properly anyway and it’s just causing me pain now. It will probably be another six months before I will be able to go under the knife for that one since I first have to jump through the hoops for the pain doctor. I finally got the letter for the NIH Rare Diseases unit from my PCP and started that process tonight. Now I’m back on the rare disease boat.

Last, and most exciting:

I am no longer on OKCupid. I mean, yeah, sure, I was getting some really nutty stories to pass along (and I certainly haven’t told them all yet), but it’s because The Saint Paul really is worth it. The Saint Paul is close to my age, never married, no children, heart of gold, helpful, accommodating, matching sense of humor, curious, well-read and liberal. He supports my feminist stances and most importantly does not view my body as “his” space, as so many men still do with women. We had the best first through fifth dates, the last one involving him taking me to his favorite animal shelter so I could pet kitties. (I brought a shirt in a plastic baggie that I could change into so I wouldn’t contaminate my jacket on the way home.)

Stay tuned for further developments on the love front.