Finally Starting IgG Infusions.

After 13 months of buildup, I’m finally scheduled for my first IgG infusion. Dr. Chia recommended I get IVIG (intravenous immunoglobulin) in August, 2014. When I came back to Seattle, I asked my GP about it and she said my total IgG wasn’t low enough (allopathic guidelines say total IgG < 400mg/dL) to warrant therapy. I asked my rheumatologist about it and he said because I have no evidence of persistent infections, I’d have to get an antibody vaccine provocation. I’m sure there’s a name for this, but, essentially, you are given a vaccine and then they look for an appropriate rise in antibody titers to that vaccine. If your body doesn’t mount a response, they can approve IVIG. Well, of course, I’m never getting a vaccination again, so that’s out of the question. I asked my main ND, Dr. W, and she said she didn’t have the ability to order it, but suggested oral IgG, which I never started because… another supplement, ugh. So, I’d given up on it when I went to a new ND, Dr. I, and I didn’t even think to mention it. After reviewing all my labs, the first thing she recommended was IVIG and, just like that, she got it approved. But… not so fast. That was 10 months ago and there was a lot of work to be done.

(As an aside, I do wonder if I’ve had low immunoglobulins my whole life and nobody looked into it. Or maybe it waxed and waned. I had chronic bronchitis, pneumonia and asthma as a child and, as an adult, got a chest infection pretty much once a year–probably more when I was smoking–but never thought this was unusual. Here’s a short article about one girl’s SCIG from infancy. It has some photos of infusions.)

Before trying IVIG, we decided I should try SCIG (sub-cutaneous IgG) because there are fewer side effects for most people. Before SCIG, I needed to test out the medications necessary to stave off anaphylaxis, aseptic meningitis, migraines and a host of other issues that can develop. Before testing the pre-meds, I had to make sure I could handle IV saline infusions since the last one I had caused a leaky anaphylactoid reaction. Before trying IV fluids, she wanted me to be on bioidentical progesterone, pregnenolone and DHEA, not only because my hormones are low, but also because there is evidence that hormone therapy can calm reactivity. And all of this has to be danced around my menstrual cycle because I’m somewhat reactive during ovulation and extremely reactive during my period. We also had to wait for me to get my nerve up because so much of this is dependent on my comfort level and, when anaphylaxis could be involved, I’m never comfortable.

I have friends in mast cell groups who “anaphylax” often, repeatedly, sometimes daily. I can’t imagine this. There are different levels of anaphylaxis, so I suppose these could be lower level reactions, but my episodes of anaphylaxis were full-blown and very scary, mostly because of the difficulty breathing. I really thought I would die and I probably have some PTSD from those experiences. No amount of sickness scares me as much as having a sudden anaphylactic reaction that kills me. I don’t want to get meningitis or be saddled with chronic migraines like my friend Jackie, but those are not at the top of my list of fears.

Having said that, I pay attention to comments like this since I, too, once had a CSF leak from a lumbar puncture and it was the 10 on my pain scale to which I now compare everything else. IVIG can mess you up:

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(FYI, I found this website with tons of allergy information and graphics that might be interesting.)

So, I’ve been on topical, compounded hormones for almost a year and they haven’t raised my serum levels much, but I think they’ve helped with sleep (they also cause greasy skin and hair, like I’m going through puberty, but I’m willing to put up with that). At the beginning of this year, I was reeling from the terrible nocturnal reactions and tongue swelling I had been having, so I wasn’t willing to try anything new. Finally, in May, I got around to testing a tiny bag of IV saline (it went fine, although the whole appointment and clinic visit was a total shitshow which lead me to write two long emails to my doctor. I came very close to not going back, but I really want this treatment). Then in July, I had a full liter infused over 6 hours (a very long time for 2 bags of saline). Everything went fine, no problems (but no boost in blood pressure or energy, either), which meant it was time to schedule SCIG, but, once I started researching in earnest, I realised that there were so many questions I needed answered.

IVIG is often done in a hospital setting if the person is high-risk. I would prefer to have more than just a nurse present if I went into shock (and, by all accounts, nurses’ competency levels are highly variable). My doctor didn’t know how to get this done because the company with which she works does home infusions; she recommended I ask one of my MDs for help. More time ticked by while I emailed my GP (who has only met me once), my endocrinologist and my rheumatologist (both of whom have only met me a few times) for help with this. They all said no. I talked to the infusion company (who have been incredibly helpful thus far) and they offered to do it in their “infusion suite”, but there are no doctors present and their protocol is to call 911 if there is an emergency. Well, I live a few minutes from a fire house and an emergency room, so home seems just as safe as the infusion suite, if not more so since my husband, who is far-too-intimately acquainted with my history, can be there.

Scrolling through Facebook groups, I realise I have to learn how many injection sites I’ll have and whether to use my belly or thighs and the needle size and how many ml you can put in any one area and leakage, hardness, weals etc. etc. My good friend, who is braving his way through gruelling IVIG treatment, has been giving me advice every step of the way, which is invaluable when your doctor doesn’t tell you exactly what the process is or the importance of hydrating or the effects of IgA.

Different brands of IgG have varying amounts of IgA in them. In general, lower IgA equals fewer reactions and, if blood tests show that you have very low IgA or anti-IgA antibodies, you will qualify for the IgA-depleted IgG brands. Isn’t this something my doctor should have mentioned? She wrote the prescription for Gamunex and I asked her if she would consider Gammagard or Hyqvia, both of which have lower IgA. but she said it wasn’t necessary. And she may be right, but wouldn’t you want to use every tool available to keep your highly-reactive patient as safe as possible? My IgA has been slightly low in the past, so, right before I was meant to schedule my first infusion, I asked my doctor, “Can you test me to see if I have anti-IgA antibodies?” and she said yes. Doesn’t this seem like something that should have been done originally without my asking, considering my history?? Maddening.

The IgA test was meant to take a week to come back and I didn’t get the results for 3 weeks, so here we are in September. One of the IgA subclasses was low out of range, but I didn’t have anti-IgA antibodies, so I couldn’t really make a case for changing from Gamunex. And I wanted to do it as soon as possible rather than wait until after my next period, which would put us in October, so I scheduled it for this coming Tuesday.

My doctor wants me to take 2 Tylenol (Paracetamol), 2 Benadryl and 3mg of Prednisone (Prednisolone) before my treatment. I needed to test these premeds because last year when I took Prednisone, I worked up very slowly to 3mg, I only ever take 1 Tylenol at a time and I have been VERY sensitive to Benadryl since having M.E.–plus I’ve never taken the combo. I realised my EpiPens were expired and so were my two boxes of Benadryl and my emergency Prednisone. It took more waiting time for new prescriptions to be called in and finding a good day for my husband to pick them up. When he did, I realised they had given me 10mg pills of Prednisone rather than 1mg (always carefully inspect your pills!) and he had to go back to the pharmacy for a fourth time in a week. Poor guy.

Last week I tried 1 Tylenol, 1 Benadryl and 1.5mg of Prednisone (using my expired stash). About half an hour later, I got a tight chest. Not enough to scare me, but enough to put me off trying more Benadryl. Then I got very shaky and drowsy and had low blood pressure. After I slept for about an hour, I was incredibly thirsty and hungry and then, about 4 hours after taking them, I felt better than I have in a while and was chatty and good-humoured. Success.

Last night I tried again, this time with 2 Tylenol, 1 Benadryl and 3mg of (fresh) Prednisone. I couldn’t bring myself to take 2 Benadryl. The good news is, I didn’t get the tight chest and shakes this time, I just fell asleep for an hour. The bad news is, I didn’t feel good afterwards at all. I had a headache, my eyes and lips felt swollen, I was completely parched and felt really out of it and hungover. But, this is HUGE for me. It is so incredibly exciting to take a bunch of medications and come out unscathed. I’ve been wanting to test this for ages so I have some confidence that, if I’m given IV Benadryl and/or steroids in the event of an emergency, I’ll be okay.

A few final hurdles: I’m scrambling to get two blood draws on Monday before starting SCIG. Dr. W has been trying to get me to do regular “hydrotherapy” for a year and a half. It’s basically hot and cold towels over my torso and back, coupled with electrical stimulation (instructions for doing it at home can be found here). I never wanted to expend the energy until she told me about a patient of hers with hypogammaglobulinemia whose IgG levels came into the normal range after 6 weeks of hydro constitutionals. She was willing to test my total IgG before and after if I did this experiment. I love quantifiable evidence! So I started in August and, even though it’s only been 5 weeks, I want to get my levels tested again before starting SCIG.

The second thing is a babesia test. I’ve been asking my ND about this since June–in person during appointments, in email to her and also to her assistant, who keeps saying she has to get the doctor to sign the form–and can’t seem to get anywhere. They say yes, but it never happens. How hard could it be to sign a requisition form?? Her last message to me said I could get my blood drawn if I make another follow-up appointment. Are you kidding me? That seems downright cruel when we’ve discussed this at my last 3 appointments and she only works two days a week. I talked to the director of Igenex, the lab that does the testing, and he said I should definitely get it done before SCIG, so I finally just ordered the test kit myself and I’m going to bring it to my other doctor, Dr. W, on Monday and beg her to do the blood draw along with the total IgG. I don’t understand why everything has to be such a battle. It’s exhausting and infuriating.

I’m trying to not be annoyed at the difficult communication with my SCIG doctor because, not only is she the only one getting me this treatment, but she was willing to start me at 1 gram the first week (unheard of), building up to 5 grams over 5 weeks. She was also willing to prescribe saline infusions along with the treatment. Only 500ml each time, but every little bit of hydration helps mitigate side effects. I’m deeply grateful to have someone willing to do that when an immunologist wouldn’t even have a conversation about it.

Wish me luck. I’m going to receive all the supplies by courier on Monday and then Tuesday afternoon a nurse will come over, start the drip and show me how to do the sub-cutaneous injections. I believe after that, I’m on my own. Or, maybe because I’m getting IV fluids each week, a nurse will have to come, I don’t know. I will take Zyrtec and hydrate like mad the days before and after… But, friends and family, I am very scared. Even though it’s SCIG and not IVIG and even though I’m starting at a laughably low dose, I’m still scared. I will eat fairly low-histamine in the next few days and do my breathing exercises and meditations before, during and after treatment, but still… I want this to be the beginning not the end. Are my affairs in order? Do you all know how much I love you? Remember: when I first got sick and thought I was dying, I wrote down directives and requests. Husband, remember: the notebook in my bedside table.

Now everyone knock on wood for me and spit over your shoulders. Toba toba.

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Doctor Love/Hate

A few weeks ago, I had the follow up with the rheumatologist I saw in January. The one who came highly recommended by multiple doctors I’ve seen. The one who spent over an hour and half with me at our initial appointment. The one who wrote the most thorough and accurate notes on my history and even sent them to me. The one who ordered spine x-rays, a DEXA bone scan, blood work for inflammatory bowel disease and who did a quick ultrasound of my shoulders. The one who knew about the pretty much unknown mast cell activation disorders and even knew most of the tests to order. The one who wrote a book called, “You Don’t Look Sick.” … So, you’d think he’d get it.

At one point, he asked, “Why are you in bed so much?”
I wasn’t sure how to answer. This was my second appointment in a row; I’d previously spent a useless hour with my therapist, not having anything to talk about and feeling out of place. Maybe my brain was ticking over even slower than I had realised.
“Because I’m sick…”
I thought he understood my illness because of the thorough chart notes, but I’d have to reread them. Maybe he didn’t understand the key part about ME and post-exertional malaise (second worst description of anything, ever, after chronic fatigue syndrome). Maybe he didn’t quite get that my battery dies very quickly and, if I push through, I’m in a world of hell and the battery never quite fully goes back to where it once was.
He said (and this is a direct quote), “If your hope for the future depends on getting disability, you’re not going to get out of bed.”
And then my brain blew up.

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I know many, many people have dealt with this sort of thing before — this blatant skepticism about their illness — but I hadn’t. Nobody had ever questioned me to my face. I didn’t really hear anything else he said after that because I did a white-out with fury. This manifested itself with me bursting into tears, unfortunately. I told him I wanted to make it clear that I wasn’t in bed to try to get disability. He said something along the lines of: “It may not be that you’re a malingerer [I remember that word clearly], but that you subconsciously are staying in bed because you need the money.”
Wow.
I was raging. After waiting two years to apply for disability in the desperate hope that I could go back to work… after going from a happy, high-functioning person to practically an invalid… it was too much to think this might cross somebody’s mind. Why would I want to give up my whole life to get 1/10 of the money I used to make? I cried the whole way home. I kept thinking about it and crying the whole evening. Granted, I was premenstrual, but my anger can’t come out in yelling and stomping anymore, so it just bubbled out in tears. Would he have said that if my husband were with me? Would he have said that if I were bedbound with cancer?

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There was slight vindication when he told me I had to try increasing my steps and I told him I have: from 500 in January to 1500 now.
Then he said I had to try “bicycle yoga”, lying down and I said, “I do! I try to do yoga poses and gentle stretches whenever possible.”
Then he said, “You need to come in here with a list of your current symptoms, your meds, your questions and concerns.” I waited for him to finish drawing an example of the page he wanted me to write and then I told him: “I did — it’s on the back of that sheet of paper.”
“Oh, I didn’t look at that,” he said. “A+.”

Amazingly, after this conversation, he told me my clinical diagnosis was mast cell activation syndrome (MCAS) and prescribed Cromolyn.

I smoldered for a week and then went to see my therapist who works in the same clinic and has known Dr. O for 37 years. I let loose on him. I railed for a full 45 minutes and was completely supported and validated. He said he’d seen it happen before and that, typically, when Dr. O is called out on his behaviour, he is blind to what he did and remorseful. He read me the notes that Dr. O had written and they were great — he wrote that he wanted to treat me for MCAS and also continue to look at inflammatory conditions, that I wasn’t depressed… There wasn’t a mention of ME in the notes and that’s how I wanted it. I went to him in the first place for his diagnostic talents, to have someone search for other possible answers. So, I’ve decided to give him another chance. My therapy session completely calmed my outraged soul and I’ve let it go. I think I will write Dr. O a letter when I feel up to it, explaining professionally why he was bone-headed and offensive. I’m actually looking forward to seeing him again, so I can be the calm, assertive person I normally am with doctors.

So, about MCAS: I haven’t dealt with scary symptoms (anaphylaxis, tongue swelling) in years and I react terribly to most medications, so I’m hesitant to start treating with mast cell stabilizers, histamine blockers or other anti-inflammatory drugs besides Prednisone. However, I wonder how many of my daily symptoms could be caused by mast cell problems (GI issues, bowel swelling, headaches, fatigue, brain fog, sinuses, pain etc.), so I’m also excited to have this diagnosis and the treatment options available. There’s also a teeny tiny part of me that whispers, What if your only problem is MCAS? What if mast cell problems caused everything from anaphylaxis until now? I don’t believe that — of course it’s multifactorial and involves many different pathways: immune, neurological, endocrine, gastrointestinal, vascular — but, there’s still a seed of excitement that something might make a difference.

May Update

Let’s see, what’s been going on in my life? Well, April was the best month I have had in about six months. I have been walking 1000 to 1500 steps a day instead of the 500 average in December. I have been out of bed for about 9 hours a day instead of the 5 that it was for so long. I’m still housebound, but I’ve been in the garden and tried driving myself to nearby appointments. Best of all, I’ve been upbeat. Just like that… I get some space from the crippling symptoms and my mood brightens and the future seems oh so hopeful.

I’ve been on Prednisone for three weeks now (my feeling better started about two or three weeks before, so I can’t credit Prednisone). As much as I don’t want to be on it, every doctor I see has encouraged me to give it a try for diagnostic purposes. It’s only 5mg, but it was still rough in the beginning. I wasn’t sleeping well and I was grouchy and hungry. Those side effects seem to have abated, but I have others that continue: more facial hair growth (which would be great if it were my eyebrows and eyelashes) (but it’s not), swollen, hot hands and feet and constipation. The latter is the biggest problem. I feel like my bowel is inflamed, swollen and stagnant, which is the opposite of what I would think steroids would do. On the plus side, my skin is much, much better (although I was warned about the Prednisone-withdrawal acne flares by my dermatologist) and my joints seem to be bothering me less in the night (specifically, my shoulders and hips. They still crack and pop constantly, but they’re not as sore).

I saw my first naturopath. Some of you, I’m sure, will roll your eyes and some of you will wonder WTF took me so long! I am in the best place possible to visit excellent NDs because Bastyr University is right up the road, but I’ve held out because my faith has always sat solidly with allopathic doctors and western medicine. But, now, I’ve lost all faith. I told her that, too. I told her I am conflicted: On the one hand, I applied, got in and intended to attend Bastyr. I have researched it and I know the training they give and the scope of treatments NDs employ… And, on the other hand, for reasons I cannot quite understand, I want some big machine to find the problem inside me and some specialist to prescribe a drug that will make it all better and I can go on living. I know better! I know that what happened to me was the perfect storm of genetics, upbringing, lifestyle choices, viral exposure, toxin burden, detox pathway blockage, immune system malfunction, nervous system blitz etc. I know that I need full-body, whole-life help, so I’m not sure why it took me 40 healthcare practitioners to finally see an ND.

Well, let me tell you, I left in tears of gratitude. I needed someone to replace the Good Doctor and now I have the Better Doctor. She spent 3 hours with me. What?! Who does that? She took my history from womb to present. She addressed everything. She had ideas to support my system from all angles: endocrine, digestion, liver, adrenals, nutrients, lymph, circulation and on and on. She said, “Email me any time and, if you are scared or freaking out about a symptom or side effect, call me.” Who does that? She said she wanted to come with me to my endocrinology follow-up to hear what the doctor had to say from the horse’s mouth. No cost. Who does THAT?!

She wants me to try some things that I would normally scoff at, such as castor oil over my liver and high-dose vitamin C, but, what I keep reminding myself is: a multi-vitamin gave you the worst side effects you’ve ever experienced . Your weird pressure-point-restore-circulation physical therapy is the only thing that has helped. So, I’m open to anything. She wants me to come in every week for hydrotherapy. I’m not sure what this involves yet. I’ll let you know.

The clinic gave me a huge discount on the visit and supplements because I have no income and it’s located about 5 minutes from my house, which means I can drive myself on good days. All in all, I’m excited. But, I have a history of being excited by first appointments and disappointed in the long run, so it’s a cautious optimism.

I finally managed to apply for disability. My “rehab counselor” (aka shrink) gave me the name of a lawyer and that’s all I needed because I couldn’t manage to get going on my own. I never spoke to the lawyer, only her assistant who told me what info they needed. I spent a few weeks creating a spreadsheet of all the doctors I have seen, clinic addresses, tests ordered, drugs prescribed and, when the phone appointment happened, she didn’t need anything else (thank god because talking is still so difficult). The hardest part was I got a letter from the lawyer saying they will submit the info, it will take 6 to 8 months for a decision. It will probably be denied and they will file an appeal and if I don’t hear from them for a year or two, don’t be alarmed. I knew this was the case, but it was demoralizing to see it in print. If I had managed to apply or find a lawyer when I left work two years ago (how the hell has it been two years?!? LIFE IS SLIPPING BY!), I’d already be at the appeal court date by now.

That’s about it for now. I’m very busy this month: a teeth cleaning, a new dentist for a new oral appliance for sleep apnea (and it all starts over from the beginning) and follow-ups with my GP, rheumatologist, nutritionist and dermatologist, plus the hydrotherapy and mental therapy appointments… Exhausting.

It’s chilly again here and one of my dogs broke his toe chasing squirrels, so we’re all stuck back in the house being lumps on logs. I did manage to make it to the cemetery on my mobility scooter on that last hot day (thank you, husband, for making that happen). It was glorious.

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Move over, Good Doctor, there’s a new team in town.

After a year and a half of regular visits, I have broken up with the Good Doctor. She was a lifeline when I first started seeing her ~ somebody who was willing to stick with me and give me diet and supplement help when every other doctor had only offered painkillers and antidepressants and sent me on my way. However, I have lost faith in her and, worse, now that I know more, I think she probably contributed to my fast decline. I started an incredible number of supplements at full dose, all at once when I had never even taken regular vitamins before and, within two weeks, I was housebound. I eliminated grains, dairy, legumes etc. at the same time. Never did it occur to me that I should start one thing at a time at a low dose and work up. Never did it occur to me that I could have a genetic mutation that prevented me from breaking down certain drugs and substances. Never did it occur to me that you could have “detox” symptoms when you radically change your diet. I had blind faith.

Most recently, I have had some abnormal test results and the Good Doctor has given me little to no guidance on what they mean and what treatments are available, She hasn’t even answered my emails in the last 5 weeks asking her to clarify what supplements she wants me to try (she was very hazy during the appointment). So, we’re done and I have a new set of practitioners to try out (you didn’t think I was going to relax the search, did you?).

There is a clinic very close to my house where I am now seeing a rheumatologist, a medical nutritionist and a therapist. I like them all so far… kind of. There’s never a perfect fit.

Dr. O, the rheumatologist is the most energetic person I have ever met. I thought I used to bounce off the walls and multitask, but he puts me to shame. It was quite impressive, but extraordinarily exhausting. When I got home, I sobbed from the overwhelmingness of the appointment. I was in the clinic for four hours. He listened to my entire history (and, subsequently, wrote an incredibly thorough and accurate 4-page summary, which he sent to me); he thumbed through my entire binder of test results; he did a brief physical exam (during which I was hit with extreme vertigo after he did a Vulcan-type maneuver on my neck and proclaimed that it was because of sensitivity of the Brachial Plexus Nerve Bundle); he did quick x-rays of my spine (nothing significant, which I find baffling); a Dexa bone scan (osteopenia is worse, but I’m not sure if it is technically osteoporosis yet); ultrasounds of my shoulders (bursitis and fluid in both shoulders which he wanted to inject with cortisone right there and then ~ I declined because, as I told him, it’s like treating a stubbed toe while I’m fighting for my life); and, finally, a blood draw and instructions for a urine collection for mast cell tests (n-methylhistamine, PG D2, PG F2 Alpha).

I’ve put all my test results on this page. All of the MCAD urine tests were normal, which I expected, but was still frustrating. I am happy to have baseline numbers, though, in case I ever experience anaphylaxis again (knock on wood, toba toba) or a severe reaction. I will ask him to put in a standing order for another urine collection so I can retest, if needed. His directions to me were to try Zyrtec/Zantac (the latter gave me terrible nausea and stomach pain, but I’m going to try it again in case it was an anomaly), take fish oil and try Prednisone. He said he “wouldn’t blink an eye” if I were on low-dose Prednisone (Prednisolone) for the next year. I’ve had that Rx in hand now for -shocker- 10 weeks and haven’t taken it yet. But I’m going to. This is the fourth doctor to recommend trying Prednisone and, although I refuse to be on steroids long-term (because they put adrenals to sleep, cause sleeplessness, increase glaucoma risk when I am already a glaucoma suspect, increase osteoporosis risk when I’m already almost there, shut down the immune system/increase infection risk, can cause weight gain/edema and blood sugar issues, AND must be carefully tapered off over months), I think I will trial them as a diagnostic tool and, also, to know what my body’s reaction will be in case I really need them at some stage in the future.

The blood tests (ANA, CRP, ACE, PTH, ANCA, magnesium, calcium, celiac) were all normal except for high Saccharomyces cerevisiae IgG antibodies, which are found in 60-70% of Crohn disease patients. I’m not sure what this means for me. A quick google of symptoms shows that I have all of them except diarrhea, which is the main indicator of inflammatory bowel disease, so I’m hoping it’s nothing serious. I really don’t want to have a colonoscopy.

I went back a few weeks later to see the medical nutrition therapist. Dr. O had quite proudly proclaimed that she was the only Bastyr-trained medical nutritionist in the country (which I find hard to believe, but maybe I just didn’t understand her exact qualifications). Reading her bio was emotional for me ~ she attended the same Master’s program at Bastyr University that I got into but didn’t attend. I worked my ass off to do all the science pre-reqs, paying for night classes with my tips, got in and accepted the place, but deferred a year to save money and, during that year, wound up climbing the restaurant corporation ladder. I never went to Bastyr and I can’t help doing the Choose Your Own Adventure replay in my head ~ what would have happened if I went down that path? Where would my life be if I had gotten my Master’s and wound up doing something like my nutritionist is doing? Helping people, not being chronically stressed-out and sleep deprived, working normal hours, doing something I’m passionate about: food for health…. Would I be sick? I don’t think I would be. I kind of know I wouldn’t be. Anyway, she tested for SIBO and it was negative, which, of course, I was kind of disappointed about, but I’m happy I don’t have to go on the threatened liquid diet.

Lastly, I started seeing a psychotherapist, whom I like so far. He actually calls himself a “rehab counselor”, which is more accurate because he is helping me with doctor, disability lawyer and health insurance broker referrals and trying to make sure I have a supportive team that I like. He has dealt with chronic illness patients a lot, and ME/CFS patients in particular, so he gets it and I feel comfortable being my blunt, cursing, cynical self.

I have a lot of new doctor visits on my calendar, so there will be more posts like this. I know many of you think I should stop wasting my energy, but, until I stop getting leads that I think I need to follow or can’t leave the house at all anymore, I will continue my search for answers.

I was about to write, “…until I lose my healthcare or run out of money…”,  but, it turns out, the Affordable Care Act actually has worked in my case. I can’t be refused because I have these prior issues and Washington’s Apple plan is literally $0 if you have no income (but, I’m going to keep fighting to have an income, obviously). So, that it is some weight off my shoulders. Thank you, Obama. 🙂

Heart Center.

I have an appointment with my GP tomorrow. It’s at 9:30am, which is about 2 hours earlier than I usually schedule appointments so that I am a functioning human being. I don’t even know if it’s worth it to see her. I basically made the appointment because I haven’t seen her in 6.5 months. I am a different person now. Last time I saw her, I still didn’t quite understand how the medical system works. I still sort of thought that doctors would search and help and communicate and dig until they figured out what was wrong with a patient. I still didn’t realise how specialists operate. Even after the first infectious disease doctor said, “You don’t have an active infection” and then, in no uncertain terms, gave me a permanent goodbye. Even after the second infectious disease doctor said, “You have chronic fatigue syndrome and, from here on out, you should work on treating the symptoms.” In other words, See ya! Even when the chronic fatigue expert spent ten minutes with me after I waited 8 months for an appointment and sent me on my way with directions to exercise read a book about pain, and try Cymbalta. It wasn’t until my second visit to the rheumatologist, that it finally clicked. He had treated me so well at my first appointment. I will never forget he said, “There is something wrong with you. It is not your job to figure it out, it’s ours.” It felt validating and I almost wept. Someone would finally take the burden of this search off my shoulders and figure out why I felt like I’m dying… But that’s not the way it works. When I went to see him again a year later, the first thing he said was, “Why are you here? Chronic fatigue syndrome is an infectious disease.” Ah. Click. Finally I see. Dr. House is only on a tv show, stupid! Specialists spend 15 minutes max listening to your story, run the standard tests, and you’re done. If the tests are negative, you will never hear from them again. And, even if the tests are positive ~ like the time they found two toxic goiters on my thyroid and had to kill the whole lot with radioiodine and I had to figure out from a pamphlet and a bunch of inquiries that were shuffled from one person to another how to get my synthetic hormones and whether I should have follow-up visits with someone ~ sometimes you won’t hear from them then, either.

I had a yearly check-up with my GP 9 days before I was hit by ME. I distinctly remember saying to her that day, “My biggest problem is my neck” ~ meaning the degenerative disc problems in my cervical spine that have plagued me since my early 30s. We talked a lot about my job. I was having difficulty sitting at a desk all day after years of being on my feet. She thought, because of the stress involved, that it might not be the job for me. I remember her saying exactly that: “Are you sure this is the right job for you?” I shrugged and thought, Maybe not. But I still love it. In some ways, I think that sentiment has coloured the treatment I received once I came down with ME. I think a lot of us (my doctor, my boss, my family, and I) thought my problem was caused by job-related stress and lack of sleep.

That is another way I am a different person now than when I saw her 6+ months ago. Now, my awareness of my body and physical sensations are extremely fine-tuned. It is laughable to me (and tragically sad) that, in my confusion during that first year, I was almost persuaded that my sickness could have been caused by 1) bowel problems, 2) vasovagal reactions, 3) stress and anxiety, 4) my pain killers, 5) my birth control pills. When you are scared and in foreign territory, you want to latch on to ANY explanation that is said in a rational way from an expert authority. I suddenly understand how false confessions are coerced out of murder suspects. Maybe you’re right, Dr. E, maybe it’s just IBS. Phew! Even though I had had my share of health problems in my life, I was completely naive about how this medical journey would unfold itself. It is tragically sad and not so laughable that I didn’t trust myself 100%. I was SO SICK. My bowels? Stress? No, not this. Sleeping normally, then swimming in sweat. Running a little cold, then incapacitated by bone-wracking chills. Steady, then dizzy. Confident, then fearful. Strong, then shaky, then weak. Memory like a steel trap, then uncertainty about all details. Aches in my neck, then deep body-wide pain. Occasional headache, then 24-hours-a-day migraine for months. Able to bound up and down stairs, then legs not working. Energy, then none. Working, then housebound. Well… then sick. Don’t doubt yourselves, ever.

So, why am I even going back to my GP? I want to talk about my application for disability. She has known me for years and she should know that, even though I mostly saw her when I had chest infections, I have always been an upbeat, energetic person and ME caused an abrupt and permanent change. I must stay unemotional. The day last year that a few tears dropped in her office sealed my fate as someone that needed therapy and an antidepressant. My chart note says “Stress reaction, emotional.” I did what she said and started seeing a therapist, but 15 months of weekly visits later and nothing has changed. Nothing except I’ve spent 50 minutes each week crying about how I don’t know how to accept this new life and I don’t know how to stay hopeful and calm when my symptoms flare. Which is always.

I’ve cried more in the last year than I have in the 39 years before. I get overwhelmed sometimes with the surety that my husband will reach a breaking point and leave me. Or that I will somehow have to find the strength to leave him so he can have a life and I can be freed from the unrelenting guilt that I carry. The other night, my husband said, “I’m not going anywhere. I love you deeply.” I sobbed: “But you didn’t fall in love with this.” I spat out the word “this”. I said it with a grimace of distaste, as if I were talking about a maggot-infested, rabid rat that was sitting on my chest. And I actually flinched at the knowledge that the revulsion was about myself. I try to stop my brain from doing this. I try to remind myself that I still have value, even sick. But it’s hard now that I have very little interaction with the outside world. I can tell myself a thousand times that I am not the disease and my self is not sick ~ my core is still the same ~ but I don’t really believe it. I sure feel sick at the core. Or, at least, that there are many, many layers of sick surrounding that central self, which is still the me I know and love. But, if those layers rule the body, who really cares what’s in the center? If it can’t express itself or figure out a way to thrive, what’s the point? How do I enrich the world when I rarely laugh, can’t talk for more than an hour each day, have nothing interesting to say…? And how oh how do I find joy in my own life when everything I enjoy takes energy that I simply don’t have? I have to find joyful activities that can be done lying down with my eyes closed, day after day?

Anyway, my husband pointed to my heart and said, “I fell in love with what’s in there and that hasn’t changed.”

I thought, Yeah, it has. But, I admit, I felt another renewed resolve to fight. If not for myself, then for my husband and the person with whom he fell in love.

sarah and dave 5