My Doctor Fantasy (Spoiler Alert: Nothing to do with Dr. McDreamy)

Thinking about what my blog topic might be today as we near the end of Sjogren’s awareness month, I began to make notes about the guilt of being ill, missing out on events, letting others down and the self-loathing that may accompany chronic illness of any sort, both physical and mental.

Shortly after making my notes, my son arrived with the mail which contained a letter for me indicating a date for a follow-up appointment with a specialist in the city closest to where we live. Unfortunately, it is not close. The hospital that I go to for specialist appointments is three hours from our home. I have a Rheumatologist, Cardiologist, Dermatologist, Neurologist, and Heptologist / Gastroenterologist all at the same hospital.

The letter from this particular specialist had a triggering effect. Emotions I thought were long dispersed bubbled to the surface; lava out of a dormant volcano.

I saw her for the first time last July for a consult after I had been for an overnight emergency room stay at our local rural hospital. I’d previously been seen in this particular hospital out-patient clinic by a kind, compassionate Nurse Practitioner, in whom I had the utmost trust and confidence. I guess that is why when I went for the appointment with the specialist herself I was expecting the same type of person. I was wrong.

The specialist began by asking me questions, and then refused to let me answer. Next she sat up perfectly straight and leaned forward, telling me how things were going to proceed, stopping only to ask if I had questions about she had just told me, but once again not actually answering my questions or addressing my concerns. I became frustrated and started to cry momentarily. Because I’m polite, or felt guilty, or maybe just because I’m Canadian or some other bizarre reason, I apologised for crying.

I could tell she had no clue why I had come to tears. From her response it was obvious she assumed I was upset about the diagnosis and the incidents that had occurred at the rural hospital. Of course, I was also not pleased about that, however what briefly turned my water works on in her office was her arrogant demeanor and total disregard for anything I said or attempted to say in between her “telling me” what had happened, and how it would be going forward.

After only a matter of minutes in the exam room with her, I realized trying to say anything to her whatsoever was an exercise in futility. She had an agenda and she was going to just run it right over me, back it up and do it all over again. So, I decided to stop speaking to her. She looked pleased.

I’m sure she assumed I was now listening to her every word implicitly and that my silence indicted utmost agreement. What actually was happening was I was engaging in a fantasy. I was imagining grabbing her by her hair, throwing her out of her chair, slamming her head repeatedly onto the linoleum floor, saying “Shut up, and listen to me for five seconds, bitch!”

Okay, there goes any image anyone ever had of me being sweet, innocent, or polite. I don’t think in that moment I have ever been so frustrated in my entire life. As I then glanced down at the floor while she spoke, I examined her fabulous four inch stiletto heeled black pumps and envisioned her in the Three Billy Goats Gruff fairy tale story – a white-coated, black spike heeled / hoofed goat. Clip-clop. Clip- Clop across a foot bridge, intimidating everyone in her path, even the trolls.

Mr. Wanton was present at the appointment, but he was silent throughout. Soon enough she dismissed us. Stopping once we were a distance away down the hall, I turned to Mr. Wanton, asking what he thought of the appointment. He just shook his head. Asking why he had not said anything, he replied, “There was no point.” I was in agreement. I then told him what I had been fantasizing when I gave up trying to have a discussion with her. Mr. Wanton’s eyes widened. We’ve been married for quite some time, he has never heard me speak of anyone in that way. On the drive home I said, “I never want to see her again.”

Today as I read the letter I re-lived that appointment. My first reaction was that I was not going to see her again. Mr. Wanton reminded me I didn’t have to, I could get another doctor. But it is not that simple when the city you go to for specialized care is small. There are a limited number of specialists, especially those who specialize in a particular group of patients. Today for the first time, I had the thought perhaps something had happened in her life before we arrived at the appointment that day which was difficult for her. I have the urge to humanize her. I want to believe she just had a bad day, and took it out on me. I told Mr. Wanton I will give her one more chance. This time, I won’t be blindsided.

I wish I could say this is the only time I have been disappointed by a physician, but it is not. It is heart-breaking to me that patients are all too often treated with so little respect. Being a physician is without a doubt stressful and difficult, but so too is being a patient. I’d like to believe we could meet each other halfway, with compassion and empathy. I’m not so sure.

Recently I began reading a new book by Danielle Ofri, M.D. called “What Patients Say, What Doctors Hear.” Dr. Ofri cites a research study showing, on average, doctors first interrupt patients within 12 seconds of the patient speaking. Equally disturbing, yet another study showed results indicating physicians “re-directed” the conversation from the patients primary concern in less than half a minute (again on average) into the visit. The fact a physician is bringing the topic of doctor-patient communication to the forefront is an encouraging sign. I can only hope better days are ahead, and I will never have doctor abuse fantasies again.

A mouth guard, Mr. Wanton, a pretzel & Me

Last week, I did actually have a dry mouth incident that left both Mr. Wanton and I in hysterical laughter. (If you are my mother, you should stop reading right here.) I had been to the dentist and on Friday afternoon (several hours after dental office had closed for the weekend) I put my night mouth guard on just because I was thinking about wearing it again (I hadn’t for quite awhile).

(No, Mr. Wanton did not say that to me. It would have been nice if he had though.)

Anyway, I popped it on my upper teeth. It was a bit snug but still comfortable enough. Then, I went to remove it but it wouldn’t budge. I recalled it always being a bit difficult, so I didn’t panic. Working at the edge again with my finger, I realized how dry my mouth was. I kept pulling at it, trying different locations along my upper gum line and teeth. My mouth and teeth were dry, so I started to panic a little thinking there was no lubrication between the teeth and the guard to help slide it off.

After trying to pry it off for over half an hour, I went to Mr. Wanton in the other room, and said through near tears: “I know this is ridiculous. F*** my life. What bloody next? I got my mouth guard stuck on my teeth and I cannot get it off, it’s Friday and I am going to be stuck like this until Monday when the dental office opens!”

He started to laugh, hard. I was furious at him for laughing at me, but I also realized the ridiculousness of my predicament and I started to laugh uncontrollably as well. Every time I started to say something, we’d both start laughing again. When we finally recovered, he said: “I can drive you to Dr. S’s house to get it off.” Our dentist is a “neighbour” about five miles down the country road. I said “No, I’m sure he doesn’t have dental tools at home.”

Then I saw a light bulb go on over Mr. Wanton’s head. He pulled a kitchen drawer open and took out a butter knife. Holding the knife in the air, he stepped toward me saying: “Here, I’ll do it”. Once again I burst into uncontrollable nervous laughter, but through it I managed to say: “No way, you might break my teeth! I’ll stay like this until Monday.”

(Even though I admit by then the mouth guard was feeling too tight, hurting my gums a bit, and I’m not sure if it was the stress, maniacal laughter, or the mouth guard, but I could feel a headache coming on. I knew there was no way I could possibly keep it on until Monday.)

So, Mr. Wanton said, “Fine then” and wandered off shaking his head. I went into our bedroom, sat on the bed and pried at that thing until finally I felt a glimmer of hope as over a gold crown covered tooth it finally budged enough for me to get a bit of leverage on it. Then with one desperate yank, it came off completely. Perhaps it was smoother there, or not quite as close a fit in that spot. Whew. I threw the mouth guard in the garbage.

The very next day, I took a bite of a pretzel chip, a new product I bought to try, biting it in two. The piece I bit off went to the roof of my mouth and got stuck on my palette, literally lodged there instantly. Like the previous day, I walked over to Mr. Wanton and said: “Would you believe I just got half a pretzel chip stuck on the roof of my mouth?” He started laughing, again. No matter how hard I pushed on it with my tongue it wouldn’t move. I tried water, nothing happened. He said: “Just pull it off!” I said: “Can’t you see I’m trying!” Finally after several attempts I managed to stick my finger on it, getting under an edge and dislodging it. I am now sworn off pretzels and mouth guards…for life.

(I do realize the meme says “pretzel’s” and it SHOULD be “pretzels”….either way you spell it, right or wrong, the pretzels did make me grumpy…..AND anxious.)

What hockey players and cowboys can do that I cannot…

Last year during Sjogren’s Awareness Month I posted about dry mouth symptoms. People suffer from dry mouth for a multitude of reasons. For those of us with Sjogren’s, dry mouth occurs because our own immune system attacks the moisture producing glands throughout our body, including the salivary glands. We need saliva as it has antifungal and antibacterial properties, in addition to buffering capabilities to neutralize the acid in the mouth which causes cavities.

Saliva is the moisture that is in our mouth. Some refer to it as “spit”. I won’t perpetuate any stereotypes by naming who those people might be. 😉 (Okay, changed my mind about that, when I needed a title for this blog post!) Anyway spit, or saliva, helps protect both our teeth and mouth. In addition it is the important first step in digestion as it begins the process of helping us break down food and sends it down our esophagus to our stomach. Okay, so that’s my basic biology class, human anatomy digestion 101 lesson for today.

In earlier posts I mentioned waking in the morning to painful tight muscles, stiff achy joints, and eyelids glued to corneas causing discomfort or even pain; well you can add dry mouth to my list of first symptoms of the day.

If you’ve never experienced severe dry mouth, you might think it is just a matter of being thirsty and the solution – having a long sip of water  – doing the trick. It is much more complicated. When I wake up in the morning my tongue is usually stuck to the roof of my mouth, my cheeks stuck to the sides of my teeth, and my throat often feels as though it is closing. My mouth feels parched. I am also thirsty upon waking, so I do drink water first thing when I get up to “unglue” my cheeks, tongue and throat as well as quench my thirst.

Sometimes when I wake up I discover I have developed painful mouth sores or ulcers. These are not a symptom of Sjogren’s according to my current Rheumatologist, but of Undifferentiated Connective Tissue Disease which I also was diagnosed with. Usually they occur on inside of lower lip, side of cheek, or on very back side of palette / roof of mouth. Typically they last a few days, although some are more persistent. Actually my Rheumatologist is incorrect, they are often yet another symptom  of Sjogren’s . As if we don’t already have enough pain and need more in an already uncomfortable dry mouth.

There are numerous dry mouth products available, none of which I have been too enthused about. Every mouth is different and each patient needs to try out the myriad of products to see which suits them best. There are prescription medications to stimulate salivary flow; however I am not prepared to risk the side effects of them, preferring to take my chances with meticulous dental hygiene and sipping water throughout the day.

(Please remember that none of the information I have been detailing in my blog about Sjogren’s is a substitute for medical advice. Please ensure you seek professional medical advice from your own Dentist, Doctor, and other professionals. I am strictly relating my own personal experiences.)

One thing I found to stimulate some salivary flow is massage. There are people who go specifically for massage and / or acupuncture to increase flow of saliva however you must go to someone with intensive training in the technique; unfortunately those people are few and far between. However, I have found during a regular massage, as the therapist works with lymphatic drainage technique and upward strokes of the hands up my neck and jaw I often experience what I can best describe as two miniature water fountains turning on at the back of my mouth near the jaw line. After being so dry, the feeling of sudden spurting of water in the back of one’s mouth, albeit for seconds, is wonderful.

Beyond being uncomfortable, the risks of having an extremely dry mouth include high risk of tooth decay resulting in loss of teeth and necessity of implants or dentures. The protective qualities of saliva being absent is one reason for this, another is that without saliva food adheres to the teeth easily.

Imagine eating one small cracker and trying to swallow it. Instead of it disintegrating in your mouth, and you swallowing the entire piece you instead end up with more than half the cracker stuck onto your teeth. Well, first of all with Sjogren’s you usually cannot swallow any of the cracker without water, but even after you drink the water, the rest of the cracker stays stuck on your teeth. Sometimes, even when brushing with an electric toothbrush, the food stays stuck so it takes multiple brushings to get it entirely removed. I have worn out more than a few electric toothbrushes.

Another more frightening risk of living with next to no saliva is choking on food particles. When I eat (as you can imagine as I described the food debris left behind on teeth) I don’t have saliva in my mouth to help wash food down my esophagus, so often a tiny particle of something (especially lettuce or tiny carrot particle for example) adheres to the tissue on the very back of my mouth or even in my throat. Often it is so tiny I don’t even feel it until it suddenly dislodges and I start to choke on it as it is going where it shouldn’t be “down the wrong way”, or goes part way down my esophagus then gets stuck again farther down. In Sjogren’s lack of moisture is often an issue throughout the entire body including the esophagus. The coughing episodes that follow as my body rids itself of the particle of food is not fun for me, nor has my family become used to it no matter how many times it happens.

Coming next post: a lighter look at dry mouth – because sometimes you just have to laugh at yourself.

If you wish to read previous posts I have written about my dry mouth experiences here are the links below, as well as a link to dry mouth info from the Sjogren’s Foundation:

Causes, Diagnosis, + Treatment of Dry Mouth

My post from last year: “If you can swish or spit, celebrate!”

Older post re: my diagnosis / dry mouth: “A Diagnosis that is Hard to Swallow”

Sjogren’s Awareness: Oh how I wish I was oblivious!

April is Sjogren’s Syndrome awareness month. As a fellow sufferer said yesterday – it is no April Fool’s joke. In an effort to help educate others about Sjogren’s I will blog some of my journey with this illness throughout the month.

Today on my personal Facebook page, I was asked by a friend how long ago I was diagnosed, and if Sjogren’s was “progressive”.

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I was “officially” diagnosed with Sjogren’s in 2002 (based on positive blood work for 3 different antibodies as well as obvious physical symptoms), however I know that I had it long before then. Significant symptoms began about 12 yrs prior, and lesser symptoms even earlier (as a child/ teen).

After the Sjogren’s diagnosis the docs thought I had Lupus as well, as I met several of the diagnostic criteria for Lupus especially due to sun-related symptoms, including at times the tell-tale malar (butterfly shape rash) on face. Then later, they decided I didn’t have it because I had not developed any signs of “organ involvement” (lungs, kidney, brain most typical organ manifestations with Lupus).

Next they thought I also had Dermatomyositis (another AI disease with specific types of skin and muscle manifestations) due to a very particular type of rash I developed on my hands, Gottron’s Sign, specific to that autoimmune disease. This was diagnosed by a Dermatologist who specializes in skin manifestations of AI diseases.

Eventually they decided I had Undifferentiated Connective Tissue Disease which basically means I have symptoms of both Lupus and Dermatomyositis but not, as they say, “full-blown” disease. Also related to the above I have Raynaud’s Syndrome, and previous episodes of Vasculitis.

Then the most significant event in my medical journey thus far was in May 2009. I was diagnosed with Autoimmune Hepatitis; my immune system attacked and damaged my liver. Hepatitis just means liver inflammation, my illness is not contagious, nor contractible like other “hepatitis”. Quite simply, my body began attacking my liver for no good reason at all.

Immediately after liver biopsy the gold standard to confirm the diagnosis, I began aggressive treatment including initial high dose, then long term steroids – Prednisone, followed by a chemotherapy immune-suppressant drug which I have to be on for the rest of my life, which hopefully as long as I take it and it continues to work, will keep me in a sort of remission.

Additional liver biopsies have confirmed my liver health is not as compromised as it was in 2009. BUT the immune-suppressant drug I take to keep my liver happy has significant side effects including small daily ones like digestive system upset (vomiting / diarrhea/ nausea) ranging to increased risk of cancer especially of lymphomas, and skin cancers. Apparently approximately less than 5% of Sjogren’s patients get AI Hepatitis. I often wonder why I could not be in the small percentage of people who win the lottery instead.

There are some people who only get what are described as the hallmark symptoms of Sjogren’s – dry eye and dry mouth. Too many of us get multiple, systemic symptoms. In speaking to many other Sjogren’s patients it also seems that once you are diagnosed with one AI connective tissue disease you begin to collect others, a domino effect. Over the previous few years I have suspected that I have thyroid and neurological issues developing or undiagnosed which remain under investigation.

Is Sjogren’s progressive? No, not in the sense of diseases such as ALS, which continually ravage the body destroying function to a greater and greater extent leading to inevitable death from that disease specifically. Sjogren’s is however, potentially life-threatening when patients experience organ involvement such as AI Hepatitis or other serious complications. Sjogren’s patients are at 44x greater risk for certain lymphomas. The drug I need to be on for my liver also has increased risk of lymphoma as a side effect. Does this mean I will get lymphoma? No, but I do feel like am rolling the dice. Based on my lotto winnings, I am not often a lucky gambler. Fingers crossed, hoping for better luck this time!

For more info on Sjogren’s: http://www.sjogrens.org

“Blank Brained”

http://humoringthegoddess.com/2013/09/04/blank-brained/ When I read Claudia’s blog today, I knew I had to reblog it. What she describes has been happening to me since mid-July! I have been in such a creative funk, struggling to write something… anything… to at least keep my blog going. I have not painted for a minute in over two months. I blame my lack of motivation and ability to be creative the past couple months on two things. Summer is a busy time with extra visitors, weddings to attend, travel, outdoor activities. The second is probably the more likely cause. I have some medical issues (Autoimmune Hepatitis, Sjogren’s Syndrome, and Undifferentiated Connective Tissue Disease) which cause fatigue, joint and muscle pain, brain fog.  I have been having a flare-up of these symptoms, and others, resulting in more than just mere fatigue but at times utter exhaustion this summer. Some days it is a struggle just to do daily tasks, forget painting and writing. Some days it seems it is hard to get my mind and body in sync. I have great ideas ready to put on the page or the canvas, but my arms, fingers, neck, and / or back hurt. Other days the body is willing, but the mind is blank. I think the answer, at least for me, is to return to finding “stolen moments” (see an earlier blog by that name), snippets of time in the day to engage in writing or painting even if for only five minutes, knowing the expression and expulsion of what is inside me will be the best medicine.