well-being

5, 4, 3, 2, 1, lift off…..I was too tired to start at 10.

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The past week has been a struggle for me energy wise, even more so than most. It is never a surprise when I get a plummet. Like many who suffer with Sjogren’s or other connective tissue diseases, my energy can wax and wane somewhat from day to day. The fatigue overall is relentless.

Even within a day, I may start off strong only to wither away by lunch. Likewise, I could be in my housecoat until brunch barely moving; then pick up speed throughout the day, finishing strong at 10 p.m.

On the “good days” I tend to “over do”, resulting in subsequent days trying to restore and rejuvenate my aching body, my tired mind. Most of the time my life feels like the cliché: “one step forward, two steps backward”.

Learning where the fine line is between not enough and too much is a constant battle for me. I’m the Goldilocks of activity.

Today this quote came up on my Facebook page as a memory from nine years ago:

“You can’t get much done in life if you only work on the days you feel good.” ~ Jerry West.

Well, that explains a few things.

I never feel good, I just feel less bad. I cannot even remember the last time I woke up in the morning, and popped out of bed thinking I was James Brown “I feel good. I knew that I would!”

In general, humans believe the people who are successful are so because they motivate themselves and give life their best regardless of how they feel. To be successful, people must persevere. I do not dispute that whatsoever.

It is also common belief if someone isn’t working hard, or “up to their potential”, they must certainly be “lazy”, or the more polite term “unmotivated”.

If there is one thing having the several autoimmune diseases I’ve been diagnosed with has taught me, it is not to judge other people. If someone isn’t able to take care of business, getting stuff done, I am more than willing to give them the benefit of the doubt. There must be a good reason for their ineffectiveness, or lower productivity. However, I have immense difficulty not judging myself.

Acceptance of my finite amount of energy is difficult for me. I’ve always been a planner, a dreamer, and a doer. When you have high expectations of yourself, it makes sense your lack of ability to follow through would leave you feeling less than adequate.

So, what does keep me slogging along, getting as much done as possible despite my exhaustion?

The answer came today. Not as a revelation, but a reminder.

I saw an email ad for a seminar with life coach Mary Morrissey, in it she said even for a fully fueled rocket to be launched into space, it requires a booster rocket. She believes people are like that too. Even though we may be ready to launch, we still require a booster rocket too.

Thank you to my booster rockets – the people who don’t blow sunshine up my butt saying I can do anything, but who encourage me to do the best I can with what I have on any given day. Who knows? Someday I might really take off.

Seems I am the Sjogren’s groundhog, appearing once a year….

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July 23rd is World Sjogren’s Day, a day set aside to honor Dr. Sjogren who identified the illness. The syndrome was officially recognized in 1933,
yet it remains an often undiagnosed/misdiagnosed illness. There is still no specific treatment for Sjogren’s. Because researchers still do not know with absolutely certainty what causes Sjogren’s it remains without a cure. Before you can truly fix something, you need to know how and why it is broken.

So though I have only posted on my blog once since this day last year, World Sjogren’s Day has me poking out of my hole to remind those “in my world” awareness needs to continue so that some day there may be, if not a cure, at least targeted effective treatment.

It is amazing what one can get used to when you experience it daily for years – in my case the chronic exhaustion, muscle and joint pain, the dry sore corneas and mouth, the side effects of chemo meds for Sjogren’s related autoimmune hepatitis. In spite of it all, I am doing quite “okay”.

On this day, my heart goes out to the newly diagnosed who are just learning to accept and navigate the myriad of symptoms and illnesses associated with Sjogren’s Syndrome. And to those who are yet to be diagnosed but searching for answers as they go “shopping” from doctor to doctor looking for one who has knowledge of this still seldom known illness with its diverse constellation of symptoms – do not give up!

For more information read my archived blog posts and/ or contact the Sjogren’s Syndrome Foundation.

Click on chart to enlarge:

P.S. Stay tuned; I plan to be here more often thanks to some inspiration from a writing friend mentor. Reading her recent work has reminded me that writing is indeed “good medicine”. 🙂

sometimes all you can do is walk, read a poem

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For several years I have been submitting a poem, or two, to the annual Friends of the
University of Alberta Hospital poetry contest. The poems are to focus on “hope,
healing, and the hospital experience”. Medical staff, patients, and visitors are
all invited to submit. The selected poems are on display for one year on the
“Poetry Walk” wall on the second floor. The “Poetry Walk” is across from the pedway
to the Kidney Clinic, or straight down the long hall from Diagnostic Imaging or
Dentistry, should you be local to Edmonton, Alberta and some day wish to read the
chosen poems. Though to be honest, I hope you never have occasion to be at the
hospital.

CLICK on photos to enlarge / read.

This year, for the second time, I have one of my poems chosen to be displayed on
the “Poetry Walk” wall. The poems are selected by a panel including hospital staff
and the head of the “Artists on the Ward” program”. The “Artists on the Ward”
program” is dear to my heart. I believe the program staff and volunteers do work
that may be more healing to many patients than any prescription medication or
procedure. A patient may request a visit from an artist to write poetry or stories
together, paint and sketch, or perhaps create or listen to live music.

I discovered the “Poetry Walk” by chance in 2012, when my husband was first a heart
failure inpatient at the Mazankowski Alberta Heart Institute, attached to the U of A
hospital. I needed time away from him to collect my thoughts, so I set off on a
walking meditation. As I wandered throughout the hospital, I happened upon the
poetry. I recall reading a poem about a woman who sat vigil by her spouse’s bedside,
knitting. I continued reading the poems. I felt my breath deepening, shoulders and
neck relaxing, mind clearing, as I continued down the row of frames.

In January 2018, my husband returned to the hospital via ambulance, becoming an
inpatient once again. The dilated cardiomyopathy (believed to be viral in cause) now
had him in end-stage heart failure, too ill to wait for transplant. Mechanical
circulatory support via an LVAD to pump for his damaged left ventricle became the
only option to prolong and improve his life. It is not a cure. It is 24 hour, 7 day a
week portable life support; but it is life. He was an inpatient for five weeks.
Again, at times I needed to wander the lengthy halls alone, to find comfort in reading
words on the wall when I could not write my own.

On February 14th, 2018 my husband was to be sent for an echocardiogram. The unit
staff was busy, so I asked to take him in the wheelchair for his echo by myself.
Allowed to remain with him during the ultrasound of his heart, I watched the screen.
I was struck by the realization of what day it was on the calendar, as well as what
I was observing.

Almost one year later on January 31, 2019 I wrote “On Valentine’s Day” which will
be on the “Poetry Wall” until 2020. It was my Valentine to Mr. Wanton this year:

Is it the best poem I’ve ever written? It is not. I don’t like that the poem is
“telling”; I should be “showing” (my writer friends know exactly what I mean).
But poetry is subjective – people like what they like – and for whatever reason, this
year the jury selected it. Though the poem is far from my “best”, I hope it might
bring comfort some day, in some way, to some other wanderer.

Bad news: we are all dying. Good news: we can still laugh.

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We are all going to die. Some of us know when it will happen and some of us do not.

The doctor called with bad news today. The first thing I thought after gently setting the phone down on my desk was should I still order those new sandals on-line?

Summer weather is almost over where I live. I won’t have much time to wear them before the snowflakes fall. My husband is always astonished at how far I push the flip-flop season. As long as there has been no snowfall sticking to the sidewalks and grass I am likely to still slip on my flippies to at least go out in the yard, if not to town.

I wonder if it is worth spending money on something that I might not be around to wear next summer. I suspect this is a weird worry to have; maybe not, who knows? But the sandal concern reminds me of the other day in the car on the way to my doctor’s appointment the underwire in my most loved silver grey bra poked through. Oddly both sides simultaneously peeking up and out of the top of my tank top like two white antennae of some creature living nestled down between my boobs.

bra betrayal

As Mr. Wanton drove down the highway attentively I kept poking the wires back into place, but with the slightest movement of my body, out they would inch again.
“Screw it!” I said, and yanked them out completely.

Mr. Wanton, concentrating on driving as we entered the town limits, was unaware of my struggle until then. He glanced over at me but said nothing.

I held the two large “U” shaped white plastic coated wires up near the rear view mirror so Mr. Wanton could see them. Holding them in one hand, I twirled them around between my pointer finger and thumb.

“I think I could make something out of these. Like, maybe a mobile; see how easily they twirl. Wow, I sound like my Dad.”

I laughed.

Mr. Wanton said, “Yah, you do sound just like your Dad. Maybe give them to him to put in his garage.”

Now we both laughed.

I agreed. “Yah, Dad could add them to his collection of stuff he might need some day.” I took a long deep breath and sighed. “I guess I am going to the clinic floppy today.” I was somewhat confident the doctor might see worse things during his day than me hanging low.

Mr. Wanton, eyes on the road, was oblivious to my level of distress.

I’m sure no one will notice.” he said.

As we continued down the road I remember saying: “I guess I will need a new bra”.

And now I wonder, will I?

And that’s the thing when you get seriously bad medical news with no specific deadline, just vague inclination of impending doom…do you buy the one season shoes?

I didn’t buy the sandals, but I have splurged on a fabulous, lacy, deep raspberry fuchsia pink underwire bra made in France. I hope I get to wear it until the fabric is worn thin and the wire antennae poke up from my cleavage once again.

P.S. Since I posted this, people I love (and who obviously love me) have been sending me messages of concern. No need. I have no idea what is going on medically really, no specifics yet, other than the docs are concerned because I have connective tissue diseases and some preliminary testing points to those illnesses now affecting my heart and lungs. With miracles of modern medicine I hope to be out in the grass in my barefeet and flippies next season, and several to come! 

But seriously folks, no guarantees in life except it will end. What sparked this post is that I was thinking how I much rather it would be later, than sooner.

Top 3: The best things doctors ever said to me…

/ wantonwordflirt / 5 Comments

If you have been reading my blog from the outset, or read my story in Christine Molloy’s book “Tales From the Dry Side: The Personal Stories Behind the Autoimmune Illness Sjogren’s Syndrome”, you might assume the best thing a doctor ever said to me was they definitely knew what was wrong with me.

Believe me, the day my first Rheumatologist told me I definitely had Sjogren’s I felt immense relief and a sense of calm. As memorable as that day was, the Rheumatologist’s words did not make my top three list. My top three are comprised of short sentences uttered by three different general practitioners, or family doctors, primary care physicians, or whatever word du jour they prefer these days.

Here they are in order not by significance, because I give all three equal weight, but in the order in which they occurred:

1. “It’s unfair you got sick.” My long-time doctor of twenty or so years said this to me at the first appointment I had with him after getting my diagnosis of Sjogren’s. I had to go tell him of the diagnosis myself, as he was not the one who had referred me to the Rheumatologist. He had insisted that I did not have Lupus or any other autoimmune connective tissue disease; hence he refused to test me. After a physiotherapist emphatically suggesting I be checked for Lupus, I went to a doctor at another clinic to describe my symptoms. It was this doctor who had never seen me before who sent me for blood work as he thought I should be checked for “Rheumatoid Arthritis and related diseases”. Blood work showing high Rheumatoid Factor (RF) is what led to a Rheumatologist referral, further testing, and ultimately a diagnosis.

When I told my usual doc of the Sjogren’s diagnosis, he said: “I am sorry”. I did not ask for further explanation. His face told me he truly was regretful. I assumed both for me having Sjogren’s, as well as because he did not pursue or make the diagnosis himself. Next he told me it was unfair I had become ill, as he knew I led a healthy lifestyle – eating right, not drinking or smoking, getting rest, exercising. Being raised Catholic, I am infused with guilt and self-blame when bad things happen. I needed to hear the doctor say it was unfair I got sick; it was not my fault. I needed to know I didn’t cause Sjogren’s because I should have eaten more carrots and less pizza, swam 64 laps a day instead of 32, and never miss church on Sunday. Sometimes “shit happens” no matter how healthy you were before, no matter what you did or didn’t do.

2. “You are courageous.” Not long after my Sjogren’s diagnosis my long-time doctor retired from general practice. I again returned to the other clinic to see the doctor who initially sent me to the Rheumatologist. Unfortunately, seven years after my Sjogren’s diagnosis I had blood labs that showed extremely elevated liver function tests. Without delay, the doc sent me to a Heptologist, who diagnosed me with Autoimmune Hepatitis. Yes, again another disease I, nor anyone else I knew, had ever heard of. Unlike Sjogren’s, AI Hep has a standard treatment protocol, but it too is incurable. Without treatment AI Hep is quickly progressive, advancing the liver from inflammation to fibrosis to cirrhosis then death. The standard treatment protocol begins with high dose Prednisone which is then tapered, but continued at a set dose for a full year, to be followed by Imuran, an immune-suppressant chemo class drug most commonly known as being given to kidney transplant patients to stave off organ rejection.

In my mind, there was no choice. I would do the treatment as prescribed. I wanted to live. The liver specialist was clear on the numerous negative effects the treatment could have on my health, how it could damage my body in other ways while helping my liver. Because of the dual personality of Prednisone, the good and the evil, I called it “my miracle poison”. At the time the specialist prescribed it, he did not inform me how difficult it is for many patients to wean off Prednisone entirely, but my local doctor did later. As I was tapering off Prednisone, while initiating Imuran at the same time, my doctor looked up from my file and told me I was courageous. Tears instantly filled my eyes. No one said that to me before; ever.

3. “It sucks balls.” More recently, in 2016, I spent several hours through the night hooked up to a cardiac monitor in the ER of our local hospital while having an episode of atrial fibrillation. Some people who have this do not even know it is occurring, especially the elderly and those with weakened hearts. I have had three episodes thus far; each one was sudden and beyond ignoring. Within seconds, my heart rate triples, blood pressure escalates, and my heart strongly pounds out of rhythm; you can see my shirt move as my heart flops in my chest. Prior to this episode I’d had another lasting from midnight to 8 a.m. when shift change came in successfully cardioverting my heart back into rhythm. It was done chemically via an IV infusion, but sometimes the paddles are used to shock a person’s heart getting the same result. During the 2016 episode they again tried cardioverting with the same drug that worked successfully the first time. I was not so lucky, I did not convert though my blood pressure and heart rate did diminish, they did not return to normal nor was my heart in normal rhythm.

The doctor who was in charge through the night decided I was going to be released with my heart still in a-fib. I was devastated to hear I would be taking oral medication to cardiovert, and sent home, my heart pounding out of rhythm for who knows how long. I was overwhelmed. I wondered… were not Sjogren’s, Undifferentiated Connective Tissue Disease (with symptoms of both Lupus + Dermatomyositis), and AI Hepatitis enough? The thought of having yet another complicated medical issue, especially after a night of no sleep and anxiety, was too much for me emotionally. As I sat propped up on the bed, alone in the room waiting for the nurse to remove my IV so I could leave, the doctor coming on for day shift came to my bedside. It was a young female doctor I had never met before. After introducing herself, she too explained I would be going home “as is”. Tears began to roll down my face. I told her I was crying because I was overwhelmed….having Sjogren’s, AI Hepatitis, and UCTD I thought I had “enough”; now I had to deal with a-fib too. She put her hand gently on my arm, looked into my tear filled eyes and said matter-of-factly: “It sucks balls.” I burst out laughing. Through more tears, I said: “Yes, it does.” What she said was unprofessional, immature, and entirely inappropriate; it was also perfect.

Reflections on World Sjogren’s Day

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July 23rd is World Sjogren’s Day. This day was designated to celebrate the birth of Dr. Henrik Sjogren, the Swedish Ophthalmologist who discovered Sjogren’s Syndrome in 1933. In addition to the acknowledgement of the man who discovered the illness, the day is also meant to create awareness of Sjogren’s and the many faces of the disease.

Last year for World Sjogren’s Day, in an effort to create awareness of Sjogren’s in my own community, I wrote a letter briefly introducing my personal experience with the illness and included a basic fact sheet from the Sjogren’s Syndrome Foundation to enclose with it. In the letter I included my personal contact information and an invitation to contact me if anyone wished to learn more about my own journey with Sjogren’s.

I personally delivered a copy of the letter to each physician at our medical clinics, as well as to all the dentists and optometrists in town (over thirty individuals). Some of these professionals see me on a regular basis for care, I’ve met others at the walk-in medical clinic, and unfortunately I’ve had an introduction to a couple more for emergency care at the hospital.

Because of my many encounters with health professionals in our community I knew many were still not aware Sjogren’s Syndrome even existed. Most of those who had heard of it believed it to only involve dry eyes / dry mouth. Optometrists and dentists usually are more knowledgeable about that aspect of Sjogren’s for obvious reasons. Some medical professionals know Venus Williams has it and she continues to play competitive tennis from time to time, hence their assumption it is “not that big of a deal”.

Imagine having an illness that many medical professionals have never heard of. Imagine they ask you to say the word Sjogren’s again, so they can catch the correct pronunciation. Imagine they ask you to spell it as they whip their cell phones out so they can Google it. Ok, in fairness they may use medical search engines not just Google and Wikipedia as a primary source. At least I hope so. As a patient I certainly refer to more reputable sources of information, including established medical journals and the Sjogren’s Syndrome Foundation.

Imagine how you might feel knowing someone who has never heard of the illness you have is going to be treating the symptoms you are presenting with. Imagine you know more about your illness than the general practitioner doctor, or sometimes even more than the specialist. Sadly some medical schools never mention Sjogren’s at all (this was verified by research in the USA), some general practitioners and Rheumatologists recall a two minute mention of it as just dry eyes and dry mouth.

Imagine that I am not exaggerating. Imagine that last year my Rheumatologist, who is the specialist who would have supposedly received the most education on Sjogren’s since it is an autoimmune connective tissue disease in her speciality, writes a letter back to my local doctor saying “I do not believe the cause of her fatigue is Sjogren’s” (though it should be noted she offered no alternative explanation) when the Sjogren’s Syndrome Foundation physicians have now publicly identified the hallmark symptoms of Sjogren’s being “Dryness, Pain, Fatigue”.

Then the nurses and doctors think maybe have a trust issue or two when receiving medical advice and care. It is not difficult to imagine why that might be!

In defense of the health professionals I must tell you the main reasons “Sjogren’s neglect” persists within medicine. Firstly, because it is not “just dry eyes and mouth”, it is a complicated illness. Much like Lupus, each patient may present with a myriad of symptoms, even while not “looking” sick.

There are no blood tests that specifically correlate with severity of symptoms. Diagnosis is difficult because there is no one test or even group of tests that diagnoses Sjogren’s early and accurately, thus diagnosis is often delayed, sometimes by years or even decades. Misdiagnosis is also common, with fibromyalgia, chronic fatigue, and depression being some of the more common misdiagnoses. Thankfully Dr. Sjogren discovered the Syndrome. Even more people would be suffering today, waiting for diagnosis had it not been made official, and given a name.

Many doctors, even specialists, do not believe serious organ (liver, lung, etc.) complications can occur with Sjogren’s, but it can and does. As I mentioned earlier, even Rheumatologists are not always up-to –date on Sjogren’s care management. This can perpetuate a cycle of ignorance when a Rheumatologist forwards inaccurate information back to a patient’s local physician.

Clinical studies for Sjogren’s lag far behind other autoimmune connective tissue diseases. I have been known to comment, tongue-in-cheek, that the reason you don’t commonly see big fund-raising runs such as Cancer’s “Race for the Cure” for Sjogren’s patients to raise funds for research is because we are all just too damn tired to organize an event or run in one.

Although Dr. Sjogren identified Sjogren’s Syndrome in 1933, it was not until last year, 2016 that a standard of care in the form of clinical practice guidelines for Rheumatologists, Dentists and Ophthalmologists, was generated for the management of the illness in the USA. Even though treatment guidelines now exist, there remains no single treatment protocol identified for Sjogren’s Syndrome. A recent study showed that Sjogren’s had the same effect on quality of life as Multiple Sclerosis. Yet unlike MS, Sjogren’s patients cannot go to their specialist and be told definitely what treatment will be used. In some cases, Sjogren’s is left untreated because the doctor does not take the patient seriously until life-threatening organ involvement occurs. Remission of symptoms is possible, but in most cases Sjogren’s is progressive and in all cases incurable.

So, back to the letter I hand delivered last year for World Sjogren’s Day. You may be wondering what type of response I received. That part of the story is short. Nothing. No response. None. Silence. Crickets.

I was not surprised whatsoever that not a single person specifically contacted me about the letter afterwards. Doctors are busy people. I did however expect the practitioners I see regularly might at least mention it at my next visit. Honestly, even if someone said something derogatory such as a sarcastic “So, you think you are a Sjogren’s expert now?” I would have been pleased because I’d know they at least looked at the letter, even if not reading the information in its entirety.

I guess my hope is if they did not read the information themselves, perhaps they threw it in a nurse’s direction and the nurse maybe had a read before putting it through the shredder. I remain ever the cynic, ever the optimist.

Life Divided in Two

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“A diagnosis of catastrophic illness changes everything. It’s a thick line drawn through your life, separating the before and the after.”
-Heather Summerhayes Cariou (Author – “Sixty-five Roses”)

April 1st heralded the beginning of Sjogren’s Awareness Month. It was my intention to blog a bit about Sjogren’s Syndrome, and specifically my own experiences, each day of April. That did not happen. Here we are on the final day of the month, and I blogged only a few times. I could beat myself up about not reaching the goal I set, but I get beat up enough by other things out of my control including my own body and the symptoms of Sjogren’s.

Though not writing daily, I’m glad I decided to commit to writing about Sjogren’s again because there were several people who contacted me privately, or commented publicly that they had never heard of Sjogren’s before reading one of my posts. I had mentioned to Mr. Wanton, if even one person learned of Sjogren’s as a result of my blog, it would be worth it.

Thank you to everyone who has read, commented, and shared my blog. I appreciate your assistance in spreading awareness, please continue to do so. Sjogren’s currently has no standardized treatment protocol and no cure, perhaps through continued awareness and increased research funding, over time that may change.

In the past I have been reluctant to write about my journey of diagnosis, and navigating the symptoms of Sjogren’s because I felt some people might see me as doing it “for attention” or to garner sympathy. This week I ran across another blogger’s post about how in our society we condone (or at least tolerate) so many types of attention seeking behaviour (one only need think for a moment about reality TV, the shenanigans of political leaders, or the proliferation of  highly inappropriate or risque “selfies” on-line) yet when someone with a mental health issue or other chronic illness writes authentically about their experiences it is often frowned upon, deemed “attention seeking”, or having a “pity party”. That is unfortunate in my opinion; we have much to learn from each other’s honest health “stories”, both from a medical perspective as well as a human / empathic one.

I will be continuing to write about Sjogren’s, but I will also return to writing about other topics as well. As I’ve mentioned previously, I started this blog to write “wantonly” – about whatever grabbed me in the moment. When you have an illness that causes so much havoc with your body, it is hard to ignore. My life is not all Sjogren’s, but Sjogren’s does affect every aspect of my life.

To close out Sjogren’s Awareness Month, I was thinking about what I would want people to know most of all. The first thing is the seriousness of Sjogren’s; it is a progressive systemic disease equal in effect on quality of life to MS. It is definitely life-altering, but can also become life-threatening when organ involvement or lymphoma develops.

Secondly, it requires specific treatment and management individualized to each patient, yet it is a relatively unknown disease among medical professionals including Rheumatologists. In fact, one physician with Sjogren’s herself who does medical school in-service sessions discovered in her area of the USA only one medical school even had Sjogren’s in the curriculum. I have heard other doctors mention they heard the name in med school but had only two minutes of lecture on it. I suspect they were told it was only dry eye and dry mouth, as that continues to be the prevailing belief.

I want people to understand how scary it is to have an illness doctors are so unfamiliar with and to be unable to follow a standard, proven treatment protocol. I want it to be known that even though we may not have cancer, many of us are on a chemotherapy drug or a “biologic” drug, possibly for the rest of our lives. There is no such thing as remission.

On a personal level, I want people to know when I have to miss out on an event it is not always by choice. Each time I miss out on a once in a life-time event important to a family member especially my children, or a close friend, it breaks my heart a little bit more, even if at the time I say “it’s okay”. That if I seem rude when I have to interrupt you and leave immediately when we are standing to chat on the street or in a store, it is because I can’t stand up any longer. When you see me clothed head to toe under an umbrella on a clear summer day it is because being exposed to the sun is risking a disease “flare” that can cause further organ damage. If you knew me before Sjogren’s you might miss the person I used to be; you need to know I miss her too. Sjogren’s drew a thick line through my life, there’s no crossing back.

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

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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.

Celebs + Sjogren’s

/ wantonwordflirt / 5 Comments

When first diagnosed with Sjogren’s Syndrome in 2002, I sought out information and support on-line, quickly discovering a list-serve e-mail message group of patients. The group, including a couple physicians who had the illness and a very well-informed dental hygienist, were a wealth of knowledge. More recently I have joined a couple Facebook groups for the same reasons – information sharing and support.

Back in the early 2000s there was a recurring wish among the people involved in the Sjogren’s e-mail message group. Though no one would wish Sjogren’s upon anyone, there was a hope that eventually a celebrity would be diagnosed with it. Someone who was a “household name” who would come forward publicly, speak about the illness to mass media, hence creating public awareness in a way no one else, including the Sjogren’s Syndrome Foundation, could possibly hope to do.

One only need think of Michael J. Fox’s impact on Parkinson’s disease awareness to understand why so many patients had this wish. Well, it did come true. But in a certain sense it was almost a case of “be careful what you wish for”.

In 2011, Venus Williams pulled out of a major international tennis tournament, shortly after that she went public with her diagnosis of Sjogren’s. Like most patients, she described asking the doctor about her initial symptom – fatigue – numerous times only to continue to be undiagnosed for a few years until she had multiple symptoms that made it clear what she was suffering from.

This month a Dr. affiliated with the Sjogren’s foundation in the USA was interviewed on a TV news program; he mentioned Venus has a “mild case” of Sjogren’s. Being an international Olympic calibre athlete, I believe no one will be privy to Venus’s specific symptoms or treatment (no standardized treatment protocol currently exists) until after she retires. Fortunately for her, she has been able to return to elite competition albeit by reducing her schedule of tournament play.

At last, there was a celebrity face to “our disease”. The mixed blessing of Venus’s diagnosis became clear to me upon hearing people, including physicians say: “Sjogren’s, that’s nothing, Venus Williams has that and she still plays tennis.”

(You don’t know how much I want to punch a Dr’s lights out when I hear that. It ranks right up there with “if your mouth is dry just drink more water” or “if you are so tired maybe you should get more sleep.” If only it was that simple.)

Awareness of the name Sjogren’s Syndrome was created, but obviously what also came with Venus’ disclosure of her diagnosis was more misunderstanding of how severe the illness could be.

The irony of physicians making comment of Sjogren’s not being “that bad” because of Venus, is they are often the very same ones who tell us the reason we have the symptoms we do is because we are out of shape and need to exercise more. Argh! There is no one who was / is in better shape than Venus Williams, yet she still struggled with fatigue, and pain. She did not have the symptoms because she was “de-conditioned”; she had them because of the illness.

More recently, Carrie Ann Inaba, a judge on “Dancing With the Stars”, revealed she too has Sjogren’s. Like Venus, and a huge majority of Sjogren’s sufferers she too went to her Dr. with initial complaints of what she described as “incredible and random fatigue”. Carrie is on a common treatment for the disease called “Plaquenil” which is actually an old anti-malarial drug that was accidently discovered to help with certain auto-immune diseases including Sjogren’s and Lupus. Carrie Ann has become the Sjogren’s Syndrome Foundation Awareness Ambassador and Spokesperson.

I’m glad Venus and Carrie Ann came forward to create awareness, though there are people who will always judge their friends, family, or patients who have Sjogren’s based on what they know of the celebrities. Just like Lupus is considered the disease of a “thousand faces” because every patient can have such a unique constellation of symptoms and disease progression, so too does Sjogren’s.

One must also remember the resources the celebrities may have to help them cope with Sjogren’s are probably not those of the “average” patient. As one friend originally from Europe said to me: “I bet Venus has the best doctors in the world, probably in Switzerland.” Guaranteed she has the best medical team, wherever they might be located.

My husband once asked me how I could possibly spend 60 million if I won the largest Canadian lottery prize. I did not hesitate even a second before replying: “I’d hire staff.” And indeed I would, just like I’m sure Carrie Ann and Venus have. Coping with Sjogren’s would be so much easier if I had my own housekeeper, chef, driver, massage therapist, personal trainer, physiotherapist, personal assistant…

 

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

/ wantonwordflirt / 3 Comments

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.)