Tag / healthcare

by krubesch

Hearts Keep Drumming

Hearts Keep Drumming

Oh life
Is just a game
No one ever tells you how to play
See different people
Go different ways
Some of them will leave you but
Some of them will stay
Well our hearts keep drumming
And the years keep coming
Quicker than they’ve ever been
You’re sick of the same thing
But it’s quicker than changing
It’s too late to begin
Well everybody’s running
But you don’t know where
Time is running thin
Everybody’s looking for somebody to love
But we’re scared to let them in
And I say oh oh oh
Are there any survivors?
Am I here alone?
I say oh oh oh
Are there any survivors?
Am I here alone?
Am I on my own?
Am I on my own?
Oh love
It comes and goes
But no one never tells you how to learn to let go
Different people, they walk different roads
Some of them will hurt you but
Some of them won’t
Well the bridge is burning
And the wheel keeps turning
Quicker than it did before
Your heart screams “yes”
Your head says “no”
And you’re never really sure
Well everybody’s running
But you don’t know why
Time is running short
Everybody’s looking for a place to hide
So there’s no one left at all
Survivors
By Passenger

It’s been almost a year since I have posted on my blog. It’s not that I have not written, I just did not feel like sharing what I wrote, as it has been a difficult year and I have felt guarded. Everything I wrote just seemed so dark and depressing. I judge myself a lot harsher than I would anyone else and feel like what I have written is utter crap. This past year has felt like being on the biggest and craziest roller coaster at six flags. Not only have I had some of my lowest moments, I have also had some really good experiences, in which I have pushed myself out of my comfort zone. These experiences seem to have changed me in substantial ways and pushed me to grow in ways I don’t think I otherwise would have.

In February after years of hearing about it, I took part in Ladies Rock Camp. Thanks to my friend, Emily (!) and all my awesome friends who donated towards my tuition. This is basically a 3 day music camp for adults that includes music lessons, we are split into bands, and then tasked to write an original song and then perform it at a venue. I was so excited and nervous before participating and had a lot of self doubt about taking part in this. I am so glad I did it! I played the drums (my first choice of the 3 instruments I put on my paperwork) at Ladies Rock Camp and this was the first time I had seriously played since I was 17 years old. I had a bad experience with a band director in high school and was picked on for being one of the only girls (and good) who played the drums in middle school and thought that I would never play again. This experience was amazing and really boosted my self confidence. I feel like I was able to reconnect with this part of my 17 year old self and it felt really healing. It was nice to prove to myself that I could do something that felt really scary and out of my comfort zone and actually excel at it. I didn’t even get mad at myself when I goofed up during our performance (big deal for me!). This is something I try to hold on to when I am having difficult moments and I am slowly starting to add the drums back into my life as a fun activity. This was definitely one of the heights of the rollercoaster of the past year.

Part of the reason why I am writing about all of this now because not only do I need to sort out the thoughts in my head, but I think I need to reach out for help from my friends and family. Writing seems to be the only way in which I am able to articulate my thoughts and needs in an effective way.

I was diagnosed with stage 4 endometriosis after having surgery on 08/01/2018. The doctor who diagnosed me was the 7th doctor I had seen for the chronic pain I had been experiencing at that point for two years. Although that surgery relieved a lot of my pain, I started having chronic back pain again in October of 2018. Since then my pain has increased and is now affecting different parts of my body. Currently, and in the past 6 months, my pain levels radiate between 6 out of 10 to as bad as 10 out of 10 on the pain scale. My wife tells me I am not an effusive or demonstrative person (What?! who is surprised by that other than me?!) and that she has not been aware that I have been in that much pain since I don’t go into detail when I tell her I am hurting. To me, saying that, “I am hurting” means that I am in a lot of pain because I don’t usually complain. I think that I am conveying to people how I feel when apparently I am not getting my point across. That has been a big source of frustration in general for me, as I think I am communicating to people when I am actually not. I need to keep this in mind and try to be more descriptive with my words.

After almost 8 months of physical therapy ($$$ because hardly any pelvic floor therapists in Georgia are in network with insurance), an MRI, a back x-ray, appointments with my primary care physician, my surgeon and a rheumatologist, I still did not really have any answers about why I was continuing to have chronic back, hip, glute, thigh and heel pain. In early April, I became a little desperate about my increased pain and decided to get a 2nd or 8th (depending on how you look at it) opinion from a doctor in Chattanooga who was in network with my insurance and really seemed to know his stuff. When I called the earliest appointment he had available was 08/06/2019, so I went ahead and scheduled it.

On my birthday, 4/30/2019, the surgeon who originally diagnosed me, called me to let me know I had some concerning cysts and “fluffy” tissue that her radiologist noticed on the MRI I had in February (after Emory told me it was normal- the 2nd MRI they have misread). She let me know that she would need to do multiple procedures along with a biopsy as soon as possible to determine if that was causing my recurrence of pain and to rule “other things out.” Of course I immediately went into panic mode and consulted Dr. Google! Bad idea… My immediate concern became that I might have cancer. I continued to pretty much obsess about this until we finally got the results of my biopsy. Almost two months after that phone call and the procedures, I found out that I did not have cancer and that the “fluffy” tissue was likely due to the excess estrogen that is caused by endometriosis.  Not a definitive answer as to if this is causing my pain. My doctor seemed pretty unconcerned with my pain levels, especially since my test results all came back “normal.” I decided to keep that appointment with the other doctor in Chattanooga in hopes that he might have some insight.

I am really glad I kept the appointment with the surgeon in Chattanooga. He listened and asked questions in a way no other doctors had up until that point. He knew from looking at my previous surgery pictures that I still had endometriosis on my intestines and most likely in other areas in my abdominal area. He told Leah and I that I would need another surgery and explained that I would need to have my appendix removed because it can be a pelvic pain generator and excise any endometriosis that he finds when he goes in. He also highly recommended that I get a hysterectomy and he will leave it up to me as to whether I keep my ovaries or not. He did extensive blood work at that appointment, ordered a lumbar MRI (in hopes to see if he could tell what was causing my back pain, although he is pretty sure it is endometriosis). I left that appointment in tears- partly because the drive to Chattanooga felt amazing compared to Orlando (my other surgeon’s office is there) and really because, once again I know my body best and I am not crazy. He validated the fact that I knew and still know that there is something wrong with my body and my surgery was scheduled by the time I left his office. His office is so much more efficient than my previous surgeon. He answered all of my and Leah’s questions in detail and spent over an hour with us at my appointment.

I thought that waiting 4 months for my appointment with him would probably be the most difficult thing out of this process, well I was wrong. Our insurance changed in July of 2019 and I have been trying to get the MRI that my doctor ordered approved by our insurance company for two months at this point. My doctor’s office and I have spent hours on the phone with them, he did a peer to peer review (where your doctor tries to convince one of the insurance company’s doctors that you need whatever procedure they’re denying), and I wrote an appeal letter- including my eight months of physical therapy notes, my x-ray results, and a note from my therapist (basically saying that chronic pain and constant self-advocacy and battles with insurance is affecting my mental health). I am still in limbo as of today as to whether they will cover my MRI and my surgery date is 20 days away. I thought that having three months in between my appointment and my surgery date would give me plenty of time to get everything in order. As of today, I still don’t know if they are going to approve my surgery that is scheduled out of state in less than 3 weeks.

Everything came to a head last night and I had an epic meltdown. I started crying while I was cooking because we were out of avocado and that was supposed to go into the meal that I was cooking. I am on a crazy anti inflammatory/endometriosis/ interstitial cystitis diet to try to manage my pain and inflammations and it was the avocado that tipped me over the edge! All the feelings that I have been keeping at bay by remaining constantly busy, productive, researching and planning, all came rushing to the surface and finally I let myself stay with my feelings and allow them to move through me. I am so so tired. Being in constant pain and remaining a productive member of my household, job, and society in general is so draining. I am very careful as to how much we have scheduled outside of work because even a fun and easy dinner with friends is exhausting. I know that I have been isolating myself for this reason and also having a chronic illness that involves my lady parts is not necessarily the easiest thing to talk about, nor the most acceptable in our society. I am aware that I am not reaching out to people when I need to and I am going to work on this.

It’s very hard to try to process losing my uterus when I don’t even know if or when it is actually going to happen. It feels hopeless to have to fight with my insurance company when I am in so much pain and the dark thoughts I try to keep at bay come bubbling up to the surface. These suicidal thoughts make me feel riddled with shame along with the shame that comes with having endometriosis in the first place. Not to mention having to prove to doctors and insurance companies that there is something wrong with my body. This is something that needs to be discussed. 1 in 10 women have endometriosis and so many women have hysterectomies and don’t talk about it. I would love any input from those who have had one, as to what to expect, tips and anything else I might need to know.

I am scared about my surgery. I am scared that the surgery won’t help and that I will feel this way the rest of my life. I am scared of not knowing how long I will be out of work (it will depend on exactly what is done in surgery and we won’t know until it happens). I am terrified that we will have to go into debt or that I will have to delay this surgery even longer. I am scared that permanent damage is being done to my body while I am in this limbo. I worry about Leah having to take on most of the household responsibilities while I am recovering, and the toll her worry over me takes on her. I worry that I made the wrong decision in not having kids now that it is almost too late. I worry about possible complications from my upcoming surgery. I am so anxious about our insurance and whether we will have surprise bills IF they even approve my surgery.

 

Did you know?

  • Endometriosis is one of the top three causes of female infertility
  • An estimated 8.5-10 million women in the US and 200 million (that’s 200,000,000) worldwide are believed to be affected
  • Extremely painful menstruation, endometriosis’ most commonly known symptom, is the leading cause of missed work and school in young girls and women, according to one NIH study
  • Endometriosis commonly goes undiagnosed or misdiagnosed, with women experiencing about 6-10 years delay before being correctly diagnosed
  • Endometriosis is also frequently undiagnosed in teenage girls, due to persistent medical myths, like the false belief that pain with periods is normal or that teenagers rarely get endometriosis
    Taken from http://nezhat.org/endometriosis-treatment/endometriosis/
by krubesch

Black Eyed Susan

“It’s because people are so perishable. That’s the thing. Because for everyone you meet there is a last moment when your hand slips from theirs, and everything ripples outwards from that, the last firmness of a hand in yours that every moment after becomes a little less firm until you look down at your own hand and try to imagine just what it felt like before their hand slipped away. And you cannot. You cannot feel them.”
History of the Rain, Niall Williams
Susan Posted this quote in her blog titled, “Ah Well”
https://susanmdougherty.me/page/4/

I know that Susan would write this blog post much more eloquently than I am able to and I keep waiting for an alert to let me know that Susan has written about her death on her blog, but she can’t because she is gone. I know what it is like to lose a parent at a young age and it feels like death has surrounded me for a lot of my life, as I have lost many people I have cared about. The difference between Susan’s death and others is that she suddenly passed away while in Spain on vacation (while I was housesitting for her and taking care of her new dog). Most people in my life have died long and slow deaths from dementia and heart disease. I know how to deal with death when it happens slowly over time, but sudden death feels so very different.
There was not any time to prepare or to tell myself that this could be the last time I would see her. I find that I get a lot of closure from telling myself things like, “this is the last time we are going to have a sleepover” or “this could be the last hug I give her.”

It’s still hard to fathom that our evening marathons of Pitbulls and Parolees will never happen again and that I won’t really be going back to the house that felt like my 2nd home. I know that these things sound silly, but so many of these thoughts keep going through my mind. I found myself thinking that I was so happy we finished watching the entire series of Longmire not too long ago. This was a show we started watching with her husband, Patrick, (I was his caregiver for the last 1.5 years of his life) who had Lewy Body Dementia. In a way watching Longmire made us feel close to Patrick and remember the days we all spent together.

My heart feels so achy and burny everyday and I miss her terribly. There are so many moments throughout each day where I go to text her and then remember that I can’t. I had no idea how often we communicated until now. Not only was she my wife’s boss, my former boss, a former classmate, but also one of my closest and dearest friends. I had no idea when I started caregiving for Patrick, that we would become so close. It all still feels like a very bad nightmare.

Susan was the kind of person who put thought into everything she did. She would surprise me with gifts that I had saved on my Pinterest boards for Christmas or my birthday. Her cards were meaningful and beautifully written and she made me feel special. There are not many people that I allow through my walls into my heart and I realize now that is because I have been hurt very deeply in the past and it hurts so much when I do- and something like this happens. This is when I hear Susan’s voice in my head telling me, “it is better to have loved and been hurt than never to have loved at all.” And I know she is right, I just feel like I can’t stand how much it hurts right now. I have been hearing her voice lately (no one needs to worry!) in similar situations. It’s pretty comforting that I knew her well enough to know what she would be saying to me now.

Memories of her consume me in the strangest places. The other day I was in the grocery store and it was like everywhere I turned she was there. I knew her in such an intimate way from working in her home that I am quite familiar with what she ate and how some of these items changed with the seasons. I am reminded of her with the Boar’s Head honey turkey in the deli, the peanut butter and chocolate Cheerios in the cereal aisle, the tiny potato rolls that she used for sandwiches, the pumpkin english muffins that she would eat for breakfast with cinnamon butter in the fall, and Nutella that she would ALWAYS have in the pantry that she liked to spread over Nabisco nilla wafers when she wanted a sweet treat. I also am reminded of Patrick with the chili Fritos, egg malt balls at Easter, and the pudding we fed him at the end of his life.

I am also reminded of Susan on a daily basis, by our new dog, Casey Joy (named by Susan)- who was supposed to be Susan’s new dog when she got home from Spain. I had picked her up from Lifeline after she got spayed and was staying with her at Susan’s house until she was supposed to return home. Leah and I keep joking about how of course Susan would die and leave us with another dog. When Casey acts up, we look at the ceiling and tell Susan to make her dog behave! Having Casey is a nice reminder, especially when she is cuddly and gives me hugs. I know that Susan is watching, loving that Penny and Casey are starting to settle into each other and laughing when we yell at her to control her dog.

I find myself looking at pictures of us over and over and re-reading all the emails she ever sent me. I have screenshot so many Facebook posts and texts that she has sent me over the years because I don’t want to forget her kind words and feel this need to fill this heartbreak somehow. I have been wearing the jewelry she gave me everyday and I freaked out today when I realized my necklace had fallen off until I found it in my car. It’s like I am scrambling to find anything that will make the ache go away and make me feel closer to her.

Something that no one knew, including my wife Leah, was that Susan was the person listed on my safety plan with my therapist. What is a safety plan? It’s an agreement I have with my therapist in writing about what I should do is I start to have suicidal thoughts and want to hurt myself. Thankfully, I only had to call or talk to Susan about 4-5 times over the course of about 2.5 years. She was amazing and so helpful when I would get in this head space. She treated me with love instead of fear and seemed to know when I was struggling even before I said anything. She often told me that she would be so mad at me if I ever hurt myself and I took that to heart. It’s really painful to know that I no longer have her as my person and changing that paperwork breaks my heart. I will be forever grateful to her for showing me unconditional love and being there for me in ways that a lot of people are not able to.

I am afraid that over time I will start to forget her voice or what it was like to be around her. She was also the only person who really understood what it was like caring for Patrick and she often told me that I was the only person who truly knew the ins and outs of his disease because we were both in the thick of caring for him on such intimate levels. It hurts that out of what felt like a trio of friends, I am the only one left.
I know that Susan would not want her death to derail the progress I have made with my depression and I keep trying to remember that as I feel like I am swimming upstream through a fog. I am extremely grateful and thankful that I have had the opportunity for the Dougherty’s, Patrick, and Susan to be a part of my life even though I would have liked to be able to have spent more time with them both. A lot more time.

It’s not the weight you carry
but how you carry it-
books, bricks, grief –
it’s all in the way you embrace it, balance it, carry it,
when you cannot, and would not,
put it down.
Mary Oliver

by krubesch

Try, try Again

“the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own”

― Mary Oliver

A lot has happened since I posted about my chronic pain in the blog post, “The Journey” in May. I wrote about my appointment with a surgeon who I was scheduled to have surgery with this month, but after that appointment I did a lot of research and listened to the nagging feeling that he was not the right doctor for me. My gut is 99.9% on point and when I don’t listen to that feeling I usually am disappointed and end up paying for it.  I am very glad I followed my gut this time because the route he wanted to go conflicts with a lot of the research on Endometriosis and would probably have lead to me needing to have multiple surgeries. Since February, I have spent countless hours learning as much I can about endometriosis in order to squelch my anxiety and to make me feel like I am doing something about my pain while I am just waiting. An acquaintance had a really bad experience with the surgeon I saw in April and had to go to another surgeon in order to fix the damage he did and address her symptoms.  She gave me the info of the surgeon that she credited with “saving her life” and I made an appointment with him towards mid May.

I was really hopeful that this doctor was going to be “the one” since he is in network with my insurance and located in Atlanta.  He was a lot more knowledgeable about endo than the other doctors I had seen, but still gave me conflicting information from what I had researched (through very reputable sources).  He told me that even if he did surgery, the endo would come back within two years and I would need another surgery at that time. In my research, I found that if a physician properly excises the endometriosis and removes any other areas affected there is a 10% chance of the endometriosis coming back.  I asked him to do bloodwork since I had not had any done in almost a year. He dismissed me and asked me, “what type of blood work should I order?” I wanted to tell him that he was the one who went to medical school and that a quick Google search would give him the answers, but I held my tongue. He also indicated that he did not think I had endometriosis and wanted to try me on a birth control pill for the next several months to see if that helps (since I had only previously tried an IUD).  Through my research I had learned that birth control does not necessarily stop the progression of endometriosis, but it masks the symptoms. I tried to explain to him that I was very worried about taking anything that might cause depression and mess with my mental health, as this is a delicate balance that I don’t want to mess with. He put me on Yaz and told me I could stop it if I had any mental health issues. I left that appointment trying to hold back tears and sobbed the entire car ride back to work.  I was disappointed that the appointment did not go as I had hoped and I felt slightly humiliated from yet another examination and having to explain everything that is happening with my body. I had hoped to feel like I was on the right track and that I was in good hands, but that nagging feeling in my stomach was still there.

After doing more research I decided to see my primary care physician to update her on the situation and to also have blood work done.  She was wonderful
(thank god!) and my blood work showed that my c-reactive protein level has increased and is high (this only indicates that there is inflammation somewhere in the my body and leaves me susceptible to a whole list of issues in the future if it remains high) and that my vitamin B12 and D levels were really low.  I started on some more supplements to address the vitamin levels and decided that I would pursue trying to get an MRI of my pelvis. Research and many case studies have demonstrated that endometriosis does not always show up on an MRI, but my thoughts were that at least we would know if something was visible or not.  I contacted the second surgeon, who put me on the birth control to see if he could order an MRI. Initially he did not want to, stating that it might be a high out of pocket expense to me. I let him know that I knew my benefits and that it would be covered because we had met our deductible and out of network deductible.  After I advocated for myself, he ordered the MRI. When I went to have the MRI done I got really faint, pale, and sweaty because the nurse dug into my veins to put in the IV. She acted like this had never happened before and that I must have done something to make myself react this way. A couple days later I was told that the radiologist read the results and that the only thing seen were benign cysts on my liver.

It’s been two months since I started Yaz and I absolutely hate it.  Since I started it I have way less energy, muscle weakness in my legs, worsening asthma, constant spotting, hot flashes, increased sweating, chills, pain in my hands and more visible veins. I joined this group on Facebook that is absolutely amazing and is run by a nurse who also has endometriosis.  That page has so much valuable information and research- along with a list of doctors worldwide who are trained and knowledgeable about endometriosis and have had countless excellent patient outcomes. From this list, I was able to find a group in Atlanta (who is out of network with all insurance, therefore very $$$) and several doctors in Florida.  I went to our insurance website and looked up any doctors that I think were feasible for me to travel to and to see if they took BCBS. I found a list of three doctors in Florida who were in network with BCBS. It just so happened that I was going to Daytona Beach in July to meet up with my family, so my hope was that one of the doctors in Orlando would be able to see me for an appointment that week.  All the stars aligned and I saw an amazing doctor in Orlando, my first day of vacation before meeting up with my family.

First of all this doctor is hispanic (yay supporting minorities) and a woman, which really made me happy and more comfortable.  She was really warm, listened to my symptoms, validated weird things happening with my body, and indicated that she thought the MRI was incorrectly read based on her exam.  She let me know that she was going to have her radiologist review my images and also she would be calling me to set up surgery. This past Monday I got the call that my surgery is scheduled for 08/01 and that the radiology did see that my right ovary is fused to something, which could be my appendix. I might have to have my right ovary and my appendix removed along with any lesions (of endo) that she finds when she opens me up.  

A lot of things are unknown, which drives me bonkers and heightens my anxiety.  We won’t really know how my body is affected until she goes in and has a look. That means she will have  several doctors on call during my surgery in case my bowels, appendix, and other organs are affected. She did assure me I would not wake up with a colostomy bag, which I appreciate and didn’t even know was a scenario that could happen!  My recovery time is unknown because of not knowing how invasive the surgery will be. We have booked an Airbnb for a little over a week with the assumption that I will be able to get back to Atlanta then. I am trying to tell myself that the money we are spending is worth it for me not to be one of those patients with 28 surgeries and the money we are spending going to Orlando is a lot cheaper than seeing a doctor who is out of network in Atlanta.

Since my appointment in Orlando, I have been feeling progressively worse.  I don’t know if this is because I know I am close to some relief or that things are just progressing.  I have not been able to drink my decaf coffee in two weeks due to nausea in the morning. I have been craving lemon/lime Gatorade like a mad woman and as of today had some dry heaving (fun!).  My body fluctuates from having hot flashes to chills and I am utterly exhausted each day.

What I have taken from this experience is that it is important to listen to your gut, advocate for yourself (even when it’s uncomfortable), and to seek more than one opinion when having a major procedure.  I have been dismissed, told that my pain is all in my head, denied pain medication because “I should not be in this much pain,” and made to feel like this is just a normal part of womanhood. This has been a frustrating two years and has opened my eyes about the faults of our medical system and how it relates to women.  I will no longer blindly believe someone just because they have credentials after their name. Accepting help does not make me weak and that it is a necessary part of life. I know my body best and I am now able to be an advocate for myself.

by krubesch

The Journey

The Journey

By Mary Oliver

One day you finally knew
What you had to do, and began,
Though the voices around you
Kept shouting
Their bad advice‚
Though the whole house
Began to tremble
And you felt the old tug
At your ankles.
“Mend my life!”
Each voice cried.
But you didn’t stop.
You knew what you had to do,
Though the wind pried
With its stiff fingers
At the very foundations‚
Though their melancholy
Was terrible.
It was already late
Enough, and a wild night,
And the road full of fallen
Branches and stones.
But little by little,
As you left their voices behind,
The stars began to burn
Through the sheets of clouds,
And there was a new voice,
Which you slowly
Recognized as your own,
That kept you company
As you strode deeper and deeper
Into the world,
Determined to do
The only thing you could do‚
Determined to save
The only life you could save

I have not felt suicidal for what feels like a long time (and probably has been a long time for my brain when I have not conquered a bout of depression).  For the past 2 weeks or so these dark thoughts have re-entered my mind with a fervor and this concerns me. I have been on the same cocktail of medicine for a year now, which is the first time in over four years that my medications have not been changed every 3-4 months.  This feels like a victory because it means I am stable (with the occasional trigger or bad week) and I have also gotten used to whatever side effects that come with this cocktail and have learned to live with them. Almost a year ago I started TMS (Transcranial Magnetic Stimulation), which along with this medication cocktail I am currently on, I credit with saving me from the depths of depression and probably my life.  Overall, I think the past year has been one of my best (of the past four) in terms of my mood and energy and this recent return of suicidal thoughts makes me worried. My wise mind reminds my emotional mind that thoughts come and go and most likely the reason why they have returned is due to the chronic pain and the increase in the severity of pain that I have been dealing with for about a year and 7 months.

The pain I am writing about began in September of 2016.  All of you who are squeamish about the reproductive system need not read any further!  It started with a UTI that lasted for about a month and a half. Although the UTI had been medically resolved with two rounds of antibiotics, my body felt like it was still there.  My symptoms were intermittent dull and stabbing pelvic pain and a feeling of pressure on my lower abdomen. Because I was and still am doing trauma work in therapy, my therapist, psychiatrist, and I thought I was experiencing body memories, which I had not heard of until then.  (For more information on body memories click here http://help4trauma.org/bodymemories.html).  After a couple of months of this pain and an increase in the frequency, I became worried and scheduled an appointment with my primary care physician’s office with a doctor I had seen once (my regular doctor was not available).  At this appointment it was very apparent to me that this doctor was in a rush and I was in the way of her lunch break. I explained to her what was going on, along with the information about my PTSD and working through that in therapy (which is hard for me just to tell random strangers and to talk about in general).  She basically dismissed my pain, told me it was probably in my head and ordered a strep test because I mentioned that I had a sore throat, but that was not the reason for my visit. She acted like the strep test was my consolation prize and that they would call me with the results. As I knew, the strep test was negative and my pelvic pain remained along with shame and embarrassment.

In the past year and 7 months I have been to 2 visits with primary care physician’s, 2 Minute Clinic appointments, 3 visits to a urologist who specializes in female issues (including one invasive procedure), 6 visits at my gynecologist office with two different doctors, countless dry needling visits and conversations with my boss and coworker (physical therapy office), and 1 visit to a gynecologist who specializes in endometriosis. I have been to the gynecologist more in the past year than in my entire life (seriously,one of the things I hate most in the world). The visits with the urologist and gynecologists left me feeling triggered for several hours to a couple of days.  I think I dissociate somewhat during these procedures and later on in the day my mind finally catches up to what my body felt and I end up feeling dirty, disgusting, and humiliated. Any other body part would be so much easier to deal with it really makes me angry that it’s my pelvic region.

What has been extremely frustrating is that in this whole process I don’t have someone overlooking everything.  My psychiatrist has told me to speak to my pcp, my pcp has told me to speak to my gyno, the gyno has referred me to the urologist and so on.  Even though I would think that my psychiatrist would want to speak to anyone messing with my hormone levels, as any change could affect my mental health symbiosis.  Everyone seems to be passing the buck to the next medical health professional. Honestly, my therapist and my boss have been the most helpful through this whole process and they are not medical doctors.  

In May 2017 I decided to try the Mirena IUD with the hopes that regulating my menstrual cycle would help resolve my pain and the hemorrhaging that occurs along with it.   I was pretty much pain free for 4-5 months with the Mirena (and period free, yay!) and then I started having back and hip pain along with the return of the pelvic pain. In February of 2018 I went back to the gynecologist, and she saw that I had a 3mm cyst of my right ovary and that this was probably causing my pain and could have been brought on by the IUD (a side effect is an increased risk of cysts along with a bunch of other unpleasant other side effects).  She did say that it looked like the cyst was resolving on its own and that I should follow-up in a month. A few days after this appointment I called her because my pain had not decreased and Tylenol and Motrin were not helping. For the record, it’s very hard for me to advocate for myself and I dislike calling physicians to ask questions. I hate asking for things in general. When she called me back, she basically insinuated that the amount of pain I was having seemed to be more (meaning that I was exaggerating or drug seeking) than what someone should have with a cyst of this size that was resolving on its own.  She called in a stronger type of Ibuprofen to the pharmacy and said that should help. It did not. When I went to my follow-up with her a month later, I still had the cyst, but it reduced in size to 1.5mm. Because I was still having the back, pelvic, and hip pain, we decided to remove the IUD at that appointment to see if that was the issue (as I had done extensive research about the side effects of the Mirena) and had never had back pain before getting the IUD.

Since having the Mirena removed in March of this year, I have had right eye twitching every day, pain in the palm of my hands, increased back, pelvic, and hip pain, bloating and have been unable to wear any pants that put pressure on my middle and lower abdomen.  I have had to buy 5 pairs of leggings and long cardigans and shirts so that I have clothing to wear to work! Although the Mirena was not the answer to my pain, it does appear to have helped some with my symptoms because now I am much worse now without it.

I am thankful that I have an awesome job and I heard a patient telling my boss about the doctor who had changed her life.  He was the 9th doctor that she had seen and she was so happy to share his information with me. I had to wait a month to get an appointment with him and saw him 10 days ago.  At this appointment he validated my pain and basically acted like it was a no brainer that I have endometriosis. He was surprised that no one else connected my symptoms with an endometriosis diagnosis. He gave me three surgical options to choose from and sent me on my way. The appointment and his conclusion happened so fast that I had to verify with him that he was sure and that I had heard him correctly. I don’t think I have ever happy cried like I did that day when I called Leah from my car.  I cried because I finally had an answer that made sense, that I was not crazy or making things up, and that hopefully my symptoms will be alleviated soon.

I feel like I have been on a roller coaster of emotions since then.  It is disappointing that there is not a cure for endometriosis, especially since it apparently is very common (almost as common as diabetes).  I go from being hopeful that treatment will alleviate my symptoms to wondering if I will be in pain until I go through menopause. I have scheduled a laparoscopic procedure for July 11th and I think the hardest part is going to be waiting until then when it feels like my pain is increasing and my comfort levels are decreasing.  All the doctors that I have seen are hesitant/ resistant to prescribing me anything for pain, which is frustrating. I have been researching what I can do on my own in order to be able to function on a daily basis. Getting out of bed in the morning has been particularly difficult. I am extremely tired and usually in a lot of pain. I have noticed that I am not enjoying activities and end up leaving early in order to be able to alleviate my pain and get comfortable at home.   This morning I felt especially hopeless and I wondered how I am going to be able to wait until July. The dark thoughts clouded my sunny drive to work and as usual lately, I felt on the verge of tears. I am reminding myself to try to take it one day at a time and to allow myself to be aware of my needs without beating myself up.

 

by krubesch

Enough

“We all have burdens we carry through life, grief and disappointments that we can’t change. But we can make them lighter if we don’t hide them, if we don’t try to bear them silently and alone.”

Joanna Connors

 I will Find You (P.235)

It’s been quite crazy and busy the past several weeks for a lot of different reasons.   I have had to juggle a lot of doctors appointments along with work and situations that inevitably arise in life.  My stepfather died on May 2nd after a year and a half battle with pancreatic cancer.   On May 1st I unexpectedly flew to Seattle to see him and be there for my mother when he took his last few breaths.  I am so grateful that the timing worked out so that I had a chance to visit and hug him the day before he died. Similarly to my father’s death, I had feelings come up that I had not anticipated.

In early April, when it was apparent he did not have much time left, I decided to write him a letter.  In this letter I wrote the things I wanted to say to him, but knew I would never be able to adequately say them out loud – as writing is my best form of communication.  When I sat down to write the letter- as usual, feelings and thoughts I did not know I was having poured out onto the computer. It often feels like my fingers keep all my feelings, thoughts, and secrets.  I will not bore you with all the details, but I wanted him to know how thankful I was that he came into my mother’s life and how he wormed his way into my closed off heart.  After my father died I felt like I was done with father figures (I had paid my penance and wanted to be free) and really wanted nothing to do with another one.  When my mother started dating Arnie and married him I would refer to him as “my mother’s husband” instead of my stepfather.  She married him long after I was out of the house and he was not my father in the usual sense.

Fortunately for me, Arnie was more than just my mother’s husband.  In a way he became one of my most important advocates.  He not only saved/repaired my relationship with my grandmother, but also opened doors in my relationship with my mother.  Arnie lived what he preached (an example of a true Christian) and this was evident in the way he helped me to navigate my relationships with my mother and grandmother as a queer person.  I was outed to my 98 year old grandmother by another family member and I was completely devastated.  I had planned to not share that part of my life with my grandmother because she was very religious and conservative and I just felt like it was not necessary to.  I had remembered how disappointed my grandmother was when she found out Rosie O’Donnell (big surprise!) was gay.  Anyways, Arnie and mom happened to be with her in Daytona when she was told that I was gay and he was able to sit down and speak with my grandmother and my relationship with her remained mostly intact until the day she died.

Arnie also made my mother happy in a way I had never seen before.  Her smile was real and bright and she had a little dance to her step. I am very grateful to him for this because she definitely deserved to have this kind of companion in her life.  He also had a way of saying what one needed to hear. During our last phone conversation he kept telling me that I was enough and that I needed to remember that.

I got back from Seattle on May 8th and then on May 9th I started my first session (of 30) of TMS (transcranial magnetic stimulation) and got an IUD in order to alleviate my possible endometriosis symptoms.  My TMS treatment is 5 days a week for an hour for 6 weeks. The picture featured above is a picture of me receiving the TMS treatment.  The black piece of equipment on my head is the magnetic device.  For four seconds it feels like a wood pecker (not painful, just a little uncomfortable) is vibrating on my head. Then there is 20 seconds of silence and it repeats for about 45 minutes.  During TMS I have been using the Headspace app to meditate for 10 minutes and then I listen to music or read a book for the remaining time. On Friday I finished my 9th session and I think it is having a positive effect on my overall mood.  It’s still a little to early to tell.

Prior to leaving for Seattle I had an EKG and found out that I have a prolonged QT interval, which is most likely caused by my combination of medications. Because a prolonged QT interval can be dangerous and I have a strong history of heart disease in my family, it was necessary to make some pretty immediate medication changes.  So along with the TMS and IUD I have been tapering off Lexapro and Trazadone onto Vyybrid and something else to help me sleep at night (have yet to find).  Needless to say it’s hard to determine what is responsible for changes in my mood with all of these factors happening at the same time.  I have been keeping a daily log about my TMS treatment and will be posting more about my experience with TMS once I have completed the treatment.

by krubesch

Cocktail

“In response to the trauma itself, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror. Yet in everyday life, those same brain areas are responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness, our sense of who we are. What we witnessed here was a tragic adaptation: In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.”

Bessel van der Kolk, The Body Keeps The Score, p.94

I kind of feel like I have lost myself. Like all this work in therapy on dismantling negative beliefs and delving into the parts of me that feel like a dark abyss make me feel like I don’t know who I am.  I guess if I’ve dissociated or hidden parts of myself from myself for years maybe I never knew who I really was.  I was always just a shell of myself- what others dictated of me.

My time these days consists of working, spending time with my wife, and going to various medical professional appointments.  There was a 2 week (10 days M-F) period when I had 11 appointments while clocking 68 hours at work.  And yet all of these appointments were necessary.  Two of these appointments were at the Treatment Resistant Department at Emory (http://www.psychiatry.emory.edu/programs/trd.html).  Because medication and talk therapy are not significantly improving (or fast enough) my depression symptoms, my psychiatrist referred me to the TRD team.  These two appointments were two and three hours long involving a psychiatrist, a psychologist, and several computerized assessments.   After my appointments the team concluded that TMS (Transcranial magnetic stimulation) and possibly switching up my medication cocktail (yet again) were the best course of treatment for my particular situation.  Right now I am waiting on hearing back from Emory to see what my insurance benefits will cover for TMS.  If everything works out I will be going to an hour long appointment five days a week for six weeks having a coil deliver a magnet pulse on the surface of my head. (http://news.emory.edu/stories/2016/06/hspub_epstein_tms_for_depression/campus.html)

I am hoping I am able to do this and that it might deliver some results.  I am not putting all my eggs in this basket and will continue to go to therapy twice a week as I have been.

In January we added a stimulant to my medication cocktail.  This addition has been somewhat helpful, but I can’t figure out if the benefits outweigh the side effects.  The medication decisions lately seem to revolve around whether I can tolerate certain side effects and nixing other medications which have side effects I have deemed deal breakers.  Right now deal breakers for me are weight gain and lethargy (I don’t need any more help feeling tired!). Vyvanse, the stimulant I am taking, has definitely helped me to cope better with everyday life. It’s less effort to get out of bed, I’ve been actually cooking dinner, and I can manage a dog walk 1-3 times a week. I have even been to the gym once to lift weights!  This is a huge difference from the previous 4-5 months.  Headaches, an even drier mouth, more shakiness, jitteriness, and a brain fog in the afternoon are what come with the benefits.   I can’t decide if the jitteriness is increased anxiety or just extra energy I am not used to having- maybe both.

Another fun thing that’s been becoming increasingly painful and ever present is pain in my lower abdomen/pelvic region.  I have been assessed by my pcp, my gyno and will be going to the urologist this coming Monday. So far all the diagnostic testing shows that I don’t have anything wrong with me.  The gyno thinks that if I am cleared by the urologist I might be having symptoms of endometriosis and she will put me on birth control (more pills yipee!).  I have noticed that the pain gets worse when I am more emotionally dysregulated which means it could have an emotional component.  After finishing The Body Keeps The Score, by Bessel van der Kolk I understand how trauma has contributed to my chronic pain issues.  I do want to get completely checked out first before we determine that this is mostly trauma related.  The TRD clinic did comprehensive bloodwork and urinalysis tests when I was there.  The tests  concluded that I have an abnormally high blood sedimentation rate and a high C-reactive Protein level.  These tests basically just mean that I am having body inflammation.  It does not determine, why, where, or how.

Along with the pelvic pain comes increasingly more vivid and painful flashbacks. They seem to trigger each other. That’s also fabulous. Van der Kolk states, “Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies….Noticing sensations for the first time can be quite distressing, and it may precipitate flashbacks in which people curl up or assume defensive postures. These are somatic reenactments of the undigested trauma and most likely represent the postures they assumed when the trauma occurred” (p.102, 103).  I was totally weirded out in therapy last week when I curled up like a child and hid my face from my therapist. This action was involuntary and I just found myself just going along with what my body wanted me to do.

I have had friends ask me if I think all of this is necessary and if drudging up the past is just making things worse.  I have wondered the same thing, but both my therapist and van der Kolk (among many other professionals) have said that “In order to regain control over yourself, you need to revisit the trauma: Sooner or later you need to confront what has happened to you…” (van der Kolk, p.206).  It’s like the saying, “the only way out is through.”  Going through this recovery/process is probably the hardest thing I have ever done, but I know that not dealing with the trauma for more than three decades has brought me harm and strife.

The Body Keeps the Score is probably the most life changing book I have read to date.  It’s crazy how I can relate and see myself in almost every chapter of van der Kolk’s book.  It has really helped me to understand why I cannot readily identify emotions or know what I am experiencing/ feeling- there is a name for that, it’s called Alexithymia!  I need facts and information in order to make sense of myself and seeing it in written form really brings it home.

If everything falls into place, I plan to write and keep a daily journal about the TMS treatment. The psychiatrist at the TRD clinic also recommended that I use the hour during TMS to do some sort of meditation or relaxation techniques to make double use of that time.

by krubesch

Walls Falling Down

The best way to find yourself, is to lose yourself in the service of others.

-Ghandi

For those of you who don’t know, there seems to be an unwritten rule in healthcare (maybe it’s written somewhere) to keep patients at a distance.  You are supposed to follow OSHA guidelines, assist the patient to the best of your ability, to have empathy, but not let that empathy have a profound effect on your personal/ mental health.  Basically to not let emotions and feelings play into the relationship you have with your patient.  I’ve worked in the health care industry for the past seven years and I’ve been really good at this unwritten code.  That is until now.  I am currently a caregiver for a man who has Lewy Body Dementia and he’s completely undone the armour I thought I had in place at the beginning of this job.

I knew I would be great at this job because I have (at this point HAD is a better word) a great poker face and the ability to push my feelings, thoughts, and emotions away.  I’ve been told that people often think I don’t like them because of my cool, collected demeanor.  I just don’t show a lot of emotion one way or another.  When I began caregiving for Patrick in September I thought that I could handle watching him decline into the shadow of LBD.  I didn’t know him before he was in the midst of his battle so I didn’t have the memories of “old Patrick” to tug on my heart-strings.  What I didn’t count on was how I would develop a friendship with Patrick and I would/do feel my heart-break little by little as this disease takes him further away from himself and his loved ones.

I spend more time with Patrick in a week than I do with my wife, so it’s funny that it’s surprising to me of how well I feel like I know him.  I can anticipate his needs and can tell how our day is going to go simply by how our morning starts.  I know that we will be able to communicate and joke around more according to how long he stays in bed.  If I get to the house and he’s pulled out all his shirts, socks, and underwear I know we are both in for one hell of a day.  If he naps throughout the day, I know he’s going to be less restless and comprehend more of what is happening around him.

For instance, today has been a challenge.  Patrick tried to get up and dressed several times throughout the night and I can definitely tell he did not have a restful night.  There are no jokes, words I can’t understand and body movements have been difficult for him.  A big indicator that we were in for a challenging day was that I had to bend his knees for him to sit down and pants were extremely difficult to get onto his body.  He usually spends these kind of days watching hours of cowboys on the tv and is not interested in leaving the house or doing other things around the house.  He’s taught me that I need to go with the flow instead of having our days together planned.  He’s teaching me to be less rigid and more in the moment.  Days like today make my heart ache for him. I know that if I had these kinds of days I would be in the throes of a deep depression.  This ease and openness I have with him is only going to make me hurt more when he’s gone, but it would also make me feel less alive while he’s still in my life.

I think the face of healthcare could change if providers, managers, and staff weren’t as concerned about volume as they were quality.  Every practice I’ve worked with has had their goal be to maximize the amount of patients that they see.  I wonder what our health as a society would look at if we were more concerned about maximizing the quality of our care and establishing an actual relationship with our patients. I know that I am able to take better care of Patrick through establishing a relationship with him instead of treating him like a stranger or looking at this situation simply as a source of income.

For more info about Lewy Body Dementia www.lbda.org