Travel and Chronic Illness

sunsetat35000feet-nov2013

There are some benefits of air travel. This was my view of sunset on today’s flight to Seattle.

As the holidays approach, I’ve been thinking a lot about travel.  Anyone with chronic illness can tell you that the thought of travel is as exhausting as it is exciting.  The change to routine, the long flights, the additional medications, the stress of being away from doctors and the comforts of home — they don’t even begin to cover it.  And like everything else we face with chronic illness, the amount of planning required to travel successfully can be overwhelming.  Add that to the stress of the holiday season itself, and it can be a recipe for major flares, serious illness, or worse.  It was just after the holidays two years ago when my run down body caught back-to-back bugs, and I ended up septic and in the ICU.

This is the first year since that incident that I’m traveling at the holidays, so this topic has been on my mind.  My life looks eerily similar — I am back to working full-time, still dealing with uncontrolled RA, and traveling for both Thanksgiving and Christmas.  I’m smarter about my illness now, and less likely to keep pushing (I think). But, I can use some crowdsourcing too. 🙂 So, I’d like to find out what you’re up to this year, and collect wisdom from the group for a holiday post on managing travel with chronic illness.  To kick it off, here’s a short poll.  If you can spare a minute, I’d love to hear about your plans.  Please leave comments too!

I’ll compile our collective thoughts into a post, and we’ll try to learn from each other.  This is my favorite time of year, and though I will make sure I take care of myself, I refuse to do anything other than enjoy the season to the fullest!

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Ups and Downs

Xeljanz. It’s been working well on my RA symptoms for the last few months.  During that time, I’ve been squeezing as much life out of every day as I can. Quite frankly, I had forgotten how to balance that kind of “busy-ness”. I definitely overdo it some days, and I pay the price for that, but after the last few years, it feels good to have the energy to even make that choice. If you know me, you know I’ll err on the side of “too much” vs. “too little” whenever I have the chance. For the most part, it’s very much been an “up” time.

So, I didn’t notice at first when my weight started creeping up.  Until my clothes no longer fit.  Until, for the first time in my life (not counting when I was pregnant with my son), I was gaining in my stomach. Usually, my hips, bootie, and thighs are my problem areas.  It was weird.  And it didn’t stop. It hasn’t stopped.  It keeps getting worse. I have also developed horrible GI symptoms (I’ll spare you the details :)), worsening fatigue, and some other odd symptoms unlike those I usually feel with RA.

Like most health issues we spoonies experience, it’s not simple.  I’ve seen an endocrinologist.  She diagnosed me with probable Hashimoto’s Thyroiditis, though my numbers are still barely in the normal range.  I’m on a low dose of Synthroid, which has already helped my fatigue. I’ll go back regularly for blood work (because we all need more of that, right?), and she’s looking at other causes for my new symptoms.  It’s just hard to know if something is amiss in my endocrine system, because I take Medrol every day. So, she’s making educated guesses. Comforting.

In the mean time, the lack of definitive answers combined with my continuing symptoms have earned me another specialist. That’s right…I now have a gastroenterologist! Pretty soon, I’ll have collected the whole set of doctors. I wonder what the prize is when I do! 🙂 He’s also running tests; blood work, of course, and next week, my very first colonoscopy. I’ll write about that lovely experience after, and we’ll see if I get some answers.

My rheumatologist did find a trend in my weight gain though, and it goes back to Xeljanz.  Though it’s not listed in the literature as a side effect, she noted that my weight gain started, very slowly, the month after I went on the drug.  Over the first 3.5 months, I gained 8-10 pounds,  Then, my weight took off like a rocket. I’ve been gaining 5-7 pounds every month for the last four. Since it was the only change in my medication during this time, it seems likely that the RA drug that’s helping me may be causing a very serious side effect. Guess how we find out? I’m off Xeljanz for 45 days, to see what happens to my weight.  If it stabilizes, or starts to come down, I will not be allowed to take Xeljanz again. It was the last biologic available to me — the only one I hadn’t tried — so according to my rheumy, my next option is clinical trials.

Today, I used a cane for the first time in 2013.  My pain levels are so high that I have insomnia (“painsomnia”, a fellow spoonie called it once. I love that!). I’m not sure what the future holds in terms of my mobility. What goes up must come down, I guess.

I tell this story for two reasons.  First, I promised many of you updates on my progress with Xeljanz.  Things have been mostly going well, or so I thought, until this setback. The final jury on my experience is still out though, and I’m not giving up hope. Neither should you. Second, this blog is about awareness.  These diseases are complex, and most of us work with teams of specialists to proactively manage our health.  It’s like another job, in many ways.  Spoonies are superheroes, beating the odds to live their fullest lives every day.  Especially during Invisible Awareness Week, I wanted to recognize this wonderful community.  Here’s to more ups than downs for all of you in the coming weeks and months!

Revisiting The Spoon Theory

It’s been too long since I’ve posted the link to Christine Miserandino’s brilliant Spoon Theory. There is simply no better explanation of what it’s like every day to live with a chronic illness (or three).

I think “counting spoons” has been one of the hardest adjustments I’ve had to make over the last 3.5 years.  Before my diagnoses, I had boundless energy.  When I look back, I marvel at the things I accomplished in those days, with no thought to running out of gas.  Now that I have a finite number of spoons though, I have twin struggles:

1) Saying ‘no’ when I want to jump in, so I can make sure my spoons last through the day most of the time.

2) Sweating the details: every. little. thing.  from how I hold my toothbrush to where/how I need to sit when I work.  I suppose it’s a good thing I’m a Type A personality, but this level of planning is excessive!  😉

If you have not read Christine’s wonderful piece yet, please take a few minutes to do so.  Whether you have a chronic illness, or you love someone who does, it will provide a perspective on our daily lives unmatched by anything else I’ve seen.  If you’ve already read it, I’d recommend another glance.  It’s enlightening every time!

It’s Been Awhile…

So sorry about that.  But guess what?  I haven’t been blogging because my life turned upside down, in a good way. Cue the drumroll………….Xeljanz is working!!! It’s been almost 6 months since I starting taking this brand spanking new biologic, and in the 3.5 years since my diagnosis, nothing has worked better!  Here’s where I am now:

1) Back to work! I was on disability for a year, and now I’m back to full-time. Of course, I’m blessed to have a job I love, to work for a flexible company, to have the support of a great manager and team, and to work from home most days. So, I’m lucky. And I work my tail off. Which is good, because Medrol has given me lots of excess tail. All the more reason to focus on #3. 😉

2) On fewer drugs. Unplanned side effects and allergic reactions forced me to pare down my med list, and now, I’ve been able to go further.  On a daily basis, I take 4 drugs for RA, 2 for fibromyalgia, 1 for Sjogren’s, 2 for medication side effects, and 1 pain medication.  And my doses of Medrol and Percocet are both half or less of what they were 6-8 months ago.  The synovitis in my knees and ankles is significant, so I’m not going to drop further, but I’ll take 8mg/day from 32mg/day.  Oh yeah!

One of our many adventures!

One of our many adventures!

3) Exercising! This is HUGE for me. My joints swell during and after, and sometimes it’s hard to motivate, but wow, it feels good. In 2013, I’ve been hiking, biking, walking, swimming, and canoeing.  A few years ago, I promised myself that when I turned 40, I would finish a triathlon.  Not too long ago, I thought I might not make that goal, since I turn 40 this year.  But I just signed up for a sprint tri in late September (my amazing wife and partner in all things is doing the duathlon that day, so we’ll be training together!), and I can’t wait! I’ll walk the entire 5K to finish if I have to…I know I can do this!

4) Fewer doc appointments. I am blessed to have lots of great doctors.  But, it’s strange to be a 30 something with such a big team, and I definitely don’t love that I have to see most of them every 1-3 months.  In the last 2 months, my opthamologist and hematologist dropped me from every 3 to every 6 months, my pain management specialist dropped me from every three months to annually (whoa!), and last week, I had my biggest success.  My rheumatologist, who I’ve been seeing monthly since January 2010, just changed my appointment schedule to every other month. In June, I have exactly ZERO doctor appointments scheduled (assuming I don’t get sick…excuse me while I run and knock on some wood!).

5) Just feeling better! I still have up and down days, of course, but my better days outnumber my worse ones lately.  Fatigue, which has been my worst symptom, has improved noticeably (though it’s still more debilitating than pain…seems harder to just “tough out”). I’m still the “tin woman” every morning, but often for only 1.5 hours these days.  My morning stiffness used to last for double that every morning. The livedo reticularis on my arms and legs is much better, meaning my blood vessels are less inflamed.  I’m still anemic, but my hemoglobin and hematocrit levels have stabilized somewhat.

So, lots of good news, which really means that I’ve been adjusting to a more active life including work and lots more out-and-about fun with Lora and Bear. 🙂 But, I promise to get back here more often.  I’m well aware that things can change in an instant, but I’m savoring every moment, and hoping 2013 has been a year of good news for all of you as well! Drop me a note and let me know how things are, whether you’re taking Xeljanz, another biologic, supporting someone who is, or just stopping by to say ‘hi’.  Thanks so much for your support…I’ve missed you!

I Can’t. I’m…Busy.

The second half of this week, my body decided to completely rebel against the travel, wedding planning, and general, joyful craziness that has consumed the summer.  I crashed.  Hard.  For the last two days, I’ve barely been able to crawl out of bed.  The energy required for me to type these words is monumental.  But in the moments when I can, it got me thinking.

As usual, the thoughts start with my list.  All the things I need to get done.  How I can’t afford to be sick.  Usually, that leads “Type A” me to a spiral of frustration and emotional distress. I end up canceling plans, apologizing to my family, and feeling generally guilty because I “couldn’t do anything”.

I took a different approach yesterday.  Instead, I looked up the definition of busy.  Here’s what Merriam Webster had to say:

busy   adj \ˈbi-zē\

busi·er busi·est

Definition of BUSY

1a: engaged in action : occupied b: being in use <found the telephone busy>

2: full of activity : bustling <a busy seaport>

3: foolishly or intrusively active : meddling

4: full of distracting detail <a busy design>

Hmm.  Engaged in action.  Yep, my body sure is, housing my out-of-control immune system.  Full of activity? Pre-diagnosis, I did two half-marathons, and had far more energy after each one than I have now.  Intrusively active is my favorite, because duh. Nothing about auto-immune diseases is non-intrusive.  And let’s see.  Full of distracting detail, as in a busy design.  Like the worst floral, plaid, stripe combination in HISTORY, done on VELOUR.

These four definitions reminded me that I am also busy, even when I cannot move an inch.  And I realized that it’s my job to remember all my body is dealing with, even when I feel to myself like I’m doing nothing.  So the next time I don’t get to something, my reason should reflect that instead of unnecessary guilt or shame.  I indeed got busy – just in my own way.

Now if you’ll excuse me…my tea, heating pads, and I are very busy this afternoon.

Perfectly Said

During our summer travels, I’ve been blessed to visit with lots of family and friends.  This means that I’ve answered the “how are you feeling?” question many times.  Lately, my answer’s gotten complicated, so Lora and I have been discussing how I should best respond.

One of my favorite bloggers, Rheumatoid Arthritis Guy, nails it with this post.  I have never been happier or more content, despite the fact that my RA is uncontrolled, my physical health is poor, and as of now, I am unable to work.  Because of my attitude, I feel in control, which is absolutely huge in a life of daily unknowns.  He perfectly articulates “how I’m feeling”, even when “how I’m feeling” also includes bedridden.

The seriousness of chronic illness cannot be underestimated.  Neither can the power we have inside ourselves to deal positively with it.

Thank you RA Guy for helping me finding the right words!

Malfoy’s Law

We all have them.  Days where everything seems to go wrong.  Today was one for me, and it started early.  Urged by my clock and the dogs, I finally dragged myself from bed around 8:15am, feeling like the Tin Man without his oil can.  That’s nothing unusual, of course.

Then I begin the process of letting our two dogs out.  Both are lab mixes.  Sam weighs in at 60 pounds, and Cooper is close to 75.  I leave them inside, and step onto the lanai.  I open and shut the door a few times, then whistle, all while checking for movement in between the fence slats.  If all is quiet, the dogs join me on the lanai, and Sam speaks. If all is still quiet, they finally head into the yard.

Why this extended ritual?  Well, next door, there is a tiny little terrier mix named Lily.  She probably weighs less than 10 pounds, but she loves to whip Sam and Cooper into a frenzy.  She rushes to the fence and barks at them, and they dig under the fence, howling and barking intensely.  (Aside: they are such sweet dogs, and the only time we see them behave this way is with this instigator dog.  It’s weird.) Worse yet, our neighbors do not seem to care about the damage this causes, to us or potentially to her.  I have spoken to them twice, but nothing has changed.  Even for Lora, it’s a big challenge to drag 135 pounds of dog back into the house.  For me, it’s next to impossible.

This morning, it happened.  The dogs were finishing their morning business and about to come in when Lily appeared out of nowhere.  I screamed in horror, as I was still in full “tin woman” mode, and tried to get them inside one by one.  I finally did, but not without suffering lots of pain and two near-falls.

When I got to my 9:45am doctor appointment, most of the parking lot was under construction.  I finally found a spot far, far away from the entrance, and had to limp my way slowly there.  Thank goodness for my snazzy rollator! By the time I got there, I was 10 minutes late and drenched in sweat.  Oh, how I love August in Tampa! 😉

Later, I got home to find that we had received the replacement Liverpool soccer jersey we had ordered for Bear.  The original was sent in a medium, when I ordered a large.  I opened it excitedly, and found that it was…..another medium.

These things happen, of course.  Conventional wisdom says it’s just a “Murphy’s Law” day.  But for those of us with chronic illnesses, everyday life requires monumental effort already – no twists or turns are needed.  It seems downright evil to turn all the routine stuff upside down for a day, when everyday life is upside down already.  Therefore, I decided “Murphy” must have an evil twin, “Malfoy”, who haunts us.  Full disclosure: we also have a Roomba who we have named “Murphy”. He is awesome, and I cannot associate him with a day like today, so I knew it must’ve been someone else. 🙂

So, “Malfoy’s Law” is what got me today.  I wonder if I can find a wand at Ollivander’s in Orlando that will help me break the spell next time.