Thursday, April 16, 2015

Episode 62 : Mary Dell, MD (Medical Detective)--Eating Some Crow But Not Regretful

Dinner?! No, thanks!

Okay, so the DNA results came back, and I don't have myotonic dystrophy.

Hallelujah!

Whatever is  plaguing me is not due to that particular hereditary disorder. This is good news for me and my family--I'd been mostly worried about my kids and nieces and others in the family if I was, in fact, found to have myotonic dystrophy.

So does this make me a bad medical detective? I certainly don't think so. A good detective with a sound theory must follow it to its conclusion, even if that conclusion disproves his or her hypotheses. That's part of the detecting process.

If you've followed any of this "medical detective" hunt of mine, you'll know I've been convinced for some time that I--and, hence, my family--MIGHT have myotonic dystrophy, a hereditary, variably mild to severe disease, similar to multiple sclerosis in many ways (though not all).

I never would have insisted on a DNA test had I not first been told my my local, very competent neurologist, the eminent Dr. A., that I have a demyelinating disease similar to MS and that he would, indeed, diagnose me with MS except for two things:  the white matter lesions running rampant through my brain do not also occur on my spinal cord as in MS, and I'm a bit older than is usual in diagnosing MS. I have heard of older persons getting this diagnosis, however, including my wheelchair-bound aunt, though that doctor had settled on MS while saying my aunt didn't quite fit the profile.

Considering the fact I have had near every sign and symptom of myotonic dystrophy, including myotonia confirmed by EMG (a muscle test), AND my family's resemblance to a typical appearance of the disease (early male baldness, long, thin faces, maloccluded teeth, etc.), as well as my aunt's mystery disease and my son's mysteriously developing a neurological problem as a baby recently connected to myotonic dystrophy through research, it seemed only reasonable that a DNA test determine whether or not this is a concern for me and my family.

And I ended up paying for the test myself. That's how much I wanted to know. And in the months since my blood was taken, I sort of sensed it would be negative--and was darned glad of it. Being right wasn't the point. Being able to sigh in relief and move on is the best possible outcome. But part of figuring out something is ruling out all logical possibilities until the correct answer is found.

I still find it so hard to believe that Son No. 1's craniosynostosis--a skull malformation that has so deeply affected his life--was just a random event, a "spontaneous mutation." I want to know why it happened, and this did seem a very reasonable explanation. But, as I said, "Hallelujah!" Now I don't have to worry about this particular hereditary disease in my family.

You may remember my Mary Dell Show episode about the witch of a neurologist I saw at Johns Hopkins to determine whether I might have myotonic dystrophy. She was certain I did not, and that is fine--however, she treated me with a level of disdain bordering on derision that the memory still rankles. That consult with that woman will ever remain the worst experience I've ever had in health care. And I've had a lot of experiences in health care, some good, some bad.

Okay, so my theory is wrong, but why then DO I have a demyelinating, degenerative neuromuscular condition?

When Dr. A gave me this news, he leaned over and said quietly and seriously, "I'm so very sorry to have to tell you this."

I hadn't been at all surprised. I'd surmised long before that whatever was happening to me was neurological--based on my medical detective skills.

So it's not myotonic dystrophy. Well, then, what the hell is it?

I hate being told by the medical establishment that my debilitating signs and symptoms don't have a specific label. But the fact is, the cost of testing for everything it could be is prohibitive.

So don't worry, sports fans--I'm not going to throw my hat in for any other diagnosis at this point. I've read just about everything I can read about these things. In the end, whatever I have is causing me to go downhill faster than friends my age. That's a fact, and the "why" of it doesn't have to have a label. An MRI proved it.

I'm hugely relieved that whatever is happening to me is not something I have to worry about in others in my family--that was one of the main considerations in getting the DNA test and paying for it myself.

And it was worth every penny to have that peace of mind and to cross off that cause for whatever is making my life so difficult, health-wise, these days. We've discussed a few of the gems thus far--hypersomnolence, REM sleep behavior disorder, difficulty breathing/expending energy, heat intolerance, fecal incontinence, substitute aphasia (a brain-speaking disconnect), not to mention the day-to-day utter fatigue that must be fought every minute if one is to accomplish anything at all.

Guess I'll just wait around and see what surprises my degenerating brain has in store for me.

Can't wait to see what's next.

________________

P.S. I found a great site on diagnosing neuromuscular disease:  http://quest.mda.org/article/getting-correct-diagnosis-neuromuscular-disease. I lament to say that many of the suggestions have not been undertaken in my case to date, while others that should be fundamental to a neurological exam, such as those listed in the "taking history" section, were not done in my case. Thus, my diagnosis remains unknown despite a) being told my a neurologist that I do, indeed, have such a disease and b) regularly experiencing the signs and symptoms of neuromuscular/neurodegenerative disease. The lack of a specific diagnosis is beyond frustrating!


Wednesday, April 1, 2015

Episode 61 : Finance and Fox a la Benzinga and Our Nation's Future

A headline caught my eye tonight, so I pulled up the article about a 26-year-old MIT grad who "may have cracked the code to income inequality."

Since I believe income inequality is one of the main reasons our nation is in such an economic mess for the middle and working classes, I wanted to see what this presumably intelligent person might have to say.

Okay--I'm not an MIT grad, but either this article or this kid's theory (or both) makes absolutely no sense at all.

Matthew Rognlie's supposedly revolutionary theory is that our economy is totally driven by housing.

"Ferenstein states that Rognlie's theory 'attack[s] the idea that rich capitalists have an unfair ability to turn their current wealth into a lazy dynasty of self-reinforcing investments," states author Zahra Taneez.

I don't see where that idea is attacked at all. Having the wealth to purchase twenty-some homes for one's own family, true of so many of our wealthiest co-citizens, doesn't suggest lazy dynasties of self-reinforcing investments, does it?

The article then goes on to list several claims with which Rognlie supports his theory. Some of these border on the absurd.

I guess I'll tackle them one by one.

1. "Software, robots, and other modern investments all depreciate in price as fast as the iPod. Technology doesn't hold value like it used to, so it's misleading to believe that investments in capital now will give rich folks a long-term advantage."

What, exactly, does this sentence even say?  Okay, take the first part:  Technology depreciates quickly, therefore it doesn't hold value --"

Well, yes, individual pieces of technology depreciate quickly, but that's where the money is made. Things that depreciate must be replaced. This statement is worded to suggest otherwise, but investment in technology remains a sound investment.  Okay, next part:

. . . so it's misleading to believe that investments in capital now will give rich folks a long-term advantage."

Talk about muddy language! The essence, as I parse it, is "rich folks will not have a long-term advantage if they invest in capital now."

Okay, so this follow the original bogus premise that technology is a bad investment, and he's arguing that the rich won't get richer if they invest in capital. Is that capital for technology firms? Or capital for capital? That statement is extremely vague.  But I guess it makes some readers feel better to know that the rich won't have a long-term advantage, even if they don't understand what is (supposedly) being discussed.

2.  "Land/housing is really one of the only investments that give wealthy people a long-term leg up."

Well, I say this statement means absolutely nothing since "is really one of the only" as a phrase actually says is one of the investments that gives the wealthy a leg up--the word "only" does not restrict the meaning enough. "One of the only" investments still leaves room for a whole host of other investments. So what are those? And why aren't we talking about them, too? Doesn't this water down the force, if you want to call it that, of this statement?

Besides, land and housing have always been sound investments, so what's new here? And, yes, wealthy folks have a hell of a lot more land and a lot more houses than any of us working schmucks do, so what's yer point, Matt? Everything comes down to land in the end anyway; that's what wars have always been fought over. And it seems to me that as the richest in this land have bought new mansions before selling their old ones, and most of the working class today can't afford to buy a house at all, this argument is not only empty, it's kind of cruel.

3. "It might be wiser to redirect anger towards those who get in the way of new housing, rather than rely on taxes to solve our problems."

Once again, an empty statement. Throwing "anger" into the mix does up the ante of the rhetoric--but does it serve to justify the next statement, or is it mere fireworks thrown in to appeal to emotions rather than logic?

So we're told to redirect our anger (against the way our economy is going, one must assume) against those who "get in the way of new housing."

And who might those unnamed persons or organizations be? At this point, I smell government bashing on the horizon. So easy to blame the government for everything, but before we get to throwing blame, I haven't yet been convinced that this specious argument about housing is even remotely correct!

New housing has been the barometer for the U.S. market for a very long time--but does that still make sense in today's economy? We already learned from the 2008 subprime crisis that we can't afford to give mortgages to citizens in the "working poor" category, though plenty of money was made on the experiment for the tippity-top income bracket in this nation but only hurt the middle and working classes in the end.

And guess what, sports fans? That did not happen because of the government. That was corporate greed. Which is, in fact, individual greed, and not only because corporations somehow convinced our Supreme Court that they deserve the same protection as persons in this country. Corporations are made up of persons, human beings just like you and me, and those at the top have figured out (mostly by buying our nation's legislature and media) how to protect and grow their own interests no matter the effect on the rest of us. They do so using dubious and downright illegal means--illegal, that is, until they have sufficiently lined the pockets (through newly "legal" avenues for lining those pockets) of legislators to make those means legal.

I smell the stink of this same greed in this so-called economic "theory."

Let's just give everyone another go-round with those subprime mortgages, shall we?

Of course, if the working class, and those in the middle class who are sliding ever closer to said working class, earned a liveable wage, they could afford to meet fair mortgage requirements and would find themselves in the market for a home rather than remaining as tenants the rest of their lives.

Who else is going to buy these new homes, if not the working and middle classes? But who of us can afford to as we watch our salaries, our savings, our retirements, and our economic stability smashed to smithereens by this juggernaut of overarching wealth? And whom, I daresay, is behind this article on this so-called revolutionary economic theory?

4.  "Just 14% of homes are affordable to middle-class families. In the once diverse Mission District, where many young tech workers are now relocating, it's hard to find a new home for less than $1.5 million."

Well, no duh. No one is buying homes because no one can afford them. Throwing in the Mission District prices is unfair, since the average new home does not cost nearly that much. But even the more "affordable" homes can't be afforded by average families in today's economy.

So new jobs is the answer, not new housing. With better jobs, a greater demand for housing would occur as well as a greater ability to meet financing terms for those homes. Not only that, retail sales would increase. The working and middle classes would be able to maintain a decent quality of life, rather than feeling as if they're about to slip under any day now.

But remember where the mighty rich in this nation, and the corporations they run, did with our jobs? They sent them overseas. AND their lackeys in Congress passed laws to give them tax breaks for doing so.

I ask you, without jobs with fair and decent wages, how are we going to buy new houses?

5.  "The government should focus more on housing policy and less on taxing the wealthy, if it wants to properly deal with the inequality problem."

Ah, so here we have it. Not only does the government screw new housing with regulations on doing business in this nation, it is focusing too much on taxing the wealthy.

And because of this, we have an inequality problem.

What utter hogwash.

The wealthy got out of paying fair and reasonable taxes years ago, thanks to Reaganomics and the lie of trickle-down economics. The wealthy no longer pay the same tax rate as the rest of us, as they did before then. They get to keep a much greater percentage of the money they make, which means a much huger piece of the pie than do the efforts of the middle and working classes.

But the wealthiest of our fellow citizens still want us to believe that if we put the full load of our nation's treasury on our own hard-working backs and let them keep the bulk of the spoils they will somehow be sure we benefit, well, all I can say is only the stupid will continue to keep falling for this despite the evil tactics of their propaganda machine.

In short:  What a heap of bull manure.

I noticed at the bottom of the article its ownership by Benzinga.com. This was not a news report in the way we children of the mid-Century were taught. This is a bought advertisement by said Benzinga.com.

So I wasn't at all surprised to learn that this company is owned by Fox News, the most evil entity to show up on the U.S. stage since 1776. This propaganda whore for the wealthiest of our fellow citizens will happily stoop to the deepest levels of that bull manure to drag the rest of us down there with them.

The scary thing is that they've turned this Benzinga thing into a "do it yourself" investment page--another way to twist the average U.S citizen's mind just as they try to join the market where the mega-rich continue to win, as well as in all the other institutions they own. I think I'll take my investment advice elsewhere.

The United States has lost its heart and its soul. We are permitting the heartless and soulless to overtake our Congress, our media, and our thoughts at the expense of what has always been good and uplifting about this nation--the belief that we are all created equal and should, therefore, be treated as equals, not as serfs sniffing for handouts by the tyrannical filthy rich, as we now find ourselves.

Monday, March 16, 2015

Episode 60 : Laporascopic Hysterecomy After-Pain and Poor Patient Education

Those of you who know me know that I (unfortunately) spend most of my time on The Mary Dell Show discussing my various chronic illnesses (neurogenerative disease, liver disease, heart disease, ad nauseum). Today, however, I want to discuss a slightly more acute situation--surgery.

Last Thursday I had a laporascopic hysterectomy during which my uterus was yanked out through my vagina.

"Laporascopic" surgery is a less invasive surgery than the old cut-'em-up hysterectomies. My doctor explained that I'd have two small incisions in my abdomen through which the ovaries would be removed, and the rest of the kit and caboodle would be, as I said, yanked out from below.

"Do you have any questions?" Dr. V asked.

I didn't have any questions. I'm a medical librarian, and in my hubris I thought, "I've got this."

I'd already done the de rigeur quick overview on the procedure on one of my trusted sites for overall medical information written for the patient (listed at the end of this article). I'd heard a lot about laporascopic surgery while working at a non-profit health education agency over the years, and I never heard much or anything about post-surgical pain.

Here, now, is a real-life example of how reading or hearing about something does not necessarily prepare one for an experience like this.

I'd figured with the minimal cutting involved, this hysterectomy wouldn't be nuthin'.

I was wrong.

Don't get me wrong; I've no doubt this new, less invasive surgery is light years better than the old way.

But it ain't nuthin'.

Neither the doctor nor several nurses I saw told me about a couple of possible issues that might follow the surgery. On Day Two, my shoulder started to hurt like a muv, as my brother used to say when we were kids. Later that day, my rib cage was so tender it hurt to breathe. The pain was worse on my right side, and I wasn't sure whether it might also concern my liver, since I do have chronic liver disease.

Okay, then, back to the Web--a quick and dirty Google search: "laporascopic hysterectomy rib pain."

Bam.

Common side effect of abdominal laporascopic surgery, I'd learn. What the doctor didn't mention, and I hadn't picked up on in my reading, is that the body is pumped full of carbon dioxide (CO2) after the patient is put under. This gives the surgeon more room to get to the target organs without nicking anything else in the process, since the CO2 blows up the abdomen something like a balloon and spreads the innards apart.

Apparently, some post-surgical procedures are done to suck as much of the CO2 out of you as possible, but they don't get it all. And it sits there in your abdomen and starts making your body hurt in fairly predictable ways.

I actually did track down patient information from one clinic that mentions the potential for chest, shoulder, and abdominal pain after a laporascopic hysterectomy.

I wonder why, in my case, neither the doctor nor the nurses mentioned this possibility. What if I hadn't felt comfortable doing a quick Google search to find out why it was happening? Couldn't that pain and difficulty breathing been frightening for someone with heart disease? I mean, I have heart disease (cardiomyopathy), but mine is very mild. Still, it's disconcerting when one can't breathe.

Perhaps the health care professionals, in all their wisdom, don't want to put ideas in a patient's head, thinking that if they don't know it's a possibility they won't feel it. Well, that's bogus. I didn't know, and I definitely felt it.

It just amazes me at this point in health care that something so frequent that it's nearly to expected is not mentioned in the patient education done before a routine but serious surgical procedure.

Other than that, I can't really complain about the care I got, though I hesitated to go to the hospital in the small Appalachian city near my home. A friend had recently had a botched surgery to fix a hernia there, and other patient stories abound about the place's quality, or lack thereof.

In the end, though, I opted to stay local. In my next episode, I will discuss the factors leading up to that decision when you're Down the Rabbit Hole in today's health care system.

By the way, it's now Day Six after the surgery. The shoulder pain lasted only one day; the under-ribs pain ended after Day Four; and now I just have a sort of ache or cramp in my lower abdomen. The pain pills take care of that, but I don't feel like dancing a jig, I can tell you that.

I'm still amazed there isn't more patient education on the pain to expect after a laporascopic hysterectomy. This pain is acknowledged in the medical litereature (for doctors), but I haven't found anything about it in the patient education materials online.

Yet the fact that it's real can be attested to by the numerous patient forums in which this problem is discussed. This is just one more example about how the patient comes last in today's health care. Patients are left to find this information out from other patients--not necessarily the most informed source.

With all the talk about patient-centered care, this should NOT be the case, but that's the problem right there: it's all talk; "patient-centered care" means little to nothing in the actual delivery and reception of health care except in the individuals who inherently bring this orientation to their delivery of care. Many times, these individuals are nurses, but some doctors also show this trait. What's clear is that it isn't something the entire system focuses on to any real degree.

But you'd think they'd come up with complete patient care information for something as routine as a laporascopic hysterectomy.









Thursday, March 5, 2015

Episode 59: "Connecting All the Parts," or Seeing the Pattern of One's Life When Facing Death


One of my heroes, Oliver Sacks, is dying.

If you haven't read any of Sacks' books, you must. Years ago, I read The Man Who Mistook His Wife for a Hat, which whetted my appetite for more knowledge of the brain and its workings, particularly as they relate to memory, consciousness, and personality.

Oliver Sacks--Photo from NPR.org
Sacks also wrote Awakenings, which was made into a film with Robin Williams playing Sacks as a young doctor treating patients with encephalitic lethargica, a disease that leaves many of its sufferers in a catatonic state. Sacks treated these patients with a drug that brought them "back to life" but tragically was not a permanent cure and the patients lapsed back into catatonia after a fairly brief period of consciousness. In the years since the book came out, Sacks has been criticized by some who say he didn't properly conduct his research on these patients, but as far as I'm concerned the man's compassion for his patients shines through in all the pieces I've read that he's written. I believe his record, as recorded in his writings, and his contributions to neurobiology need no apologies.

Encephalitic lethargica is rare, but a sudden rash of patients landed in hospitals just after World War I and the Spanish Flu epidemic, leading some scientists to believe the condition is caused by a virus. However, post-mortem examination of brains of some of its sufferers have shown no evidence of a virus--so who knows. Fortunately, researchers continue to research cases as they appear, and the more we can learn about the brain the better for those of us who have neurodegenerative disease.

As a sufferer of hypersomnolence--which some encephalitic lethargica patients have rather than sheer catatonia, I'm obviously intrigued with this condition and all others that result in a less-than fully-conscious state. My neurodegenerative disease was only recently diagnosed, and the exact type of disease has yet to be determined. White matter lesions throughout the brain, found in my brain in abundance on a recent MRI, is a sign of a number of different degenerative conditions, so the differential diagnosis (investigating the different diseases I may have and coming up with a definitive diagnosis) has not yet been conducted. In fact, little is going on in that department. It's more of a "wait and see" type thing, itself quite unnerving.

More than the encephalitic lethargica angle, which I do plan to read much more about, right now I'm more interested in Sacks' thoughts in an essay he recently published in The New York Times as he contemplates his imminent (thought hopefully not too imminent) demise ("My Own Life: Oliver Sacks on Learning He Has Terminal Cancer, The New York Times, February 19, 2015). A cancer in his eye, treated nine years ago, has all these years afterwards metastasized to his liver and is now incurable.

"Over the last few days," Sacks, who is 81, writes, "I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts."

Though Sacks quickly goes on to say he is not yet done with life, I want to stop and think about this line for a moment. It's worth repeating. "I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts."

I'm an avid reader and lover of libraries and bookstores. Years ago, I was in Baltimore at the University of Maryland bookstore and happened upon a book written by a social worker that intrigued me after reading the blurbs on the back. I bought the book.

This social worker had spent time with older adults, "seniors," if you will, gathering their life stories, and what had struck her was that most of them told her that, as they faced the end of their lives, they recognized their lives had had an underlying pattern, a purposeful pattern, in which things had happened for a reason, one leading to the next and the next until a sort of tapestry had been woven that represented their lives.

Though I never finished the book (a rare thing for me, but I was into so many things at the time that I somehow lost track of it), I remember sensing great relief that these folks had felt this way and that enough of them had done so that the social worker had recognized the, ahem, pattern.

I found the book not too long after losing both my parents in the space of four years while in my twenties. I'd read lots of books on death and dying by then, but this book gave a fresh perspective, one about life more that death, yet with added urgency.

I so wanted to believe life had meaning, that my parents' lives had had meaning, that my life would have meaning--that all lives have meaning. I still do. Yet, given my inner skeptic, I still remain open on the question.

Do our lives have purpose and patterns that "connect all the parts," or are we merely random examples of life, no more significant than a tsetse fly?

Oliver Sacks' saying the same essential thing that the seniors' narratives in the book had strikingly shared--this sense of meaningful patterns--is again reassuring. I can't help but face my own demise after my diagnosis of neurodegenerative disease. That this reassuring sentiment is now shared by my personal brain guru makes the idea just that more meaningful.

I think a lot about my brain these days, and I think about death a lot these days.

And so here is one of those connections Sacks suggests--a pattern, if you will, at least as it relates to one aspect of my life--my fascination with the brain. My parents' deaths, the social worker's book, and now Oliver Sacks' essay have nicely woven together. Add to that pattern another book that immensely comforted me after my parents died--Viktor Frankl's Man's Search for Meaning, written with hope and heart about his experiences in a German concentration camp--and the fact that I just this moment looked up Frankl and was reminded that he was also a neurologist--and, well, the pattern weaves on.

If I'd known what I now know about myself when I graduated from high school at the age of 16 (after skipping my junior year), I would have gone straight to college and studied neuroscience rather than taking the massive detours in life I did to arrive I'm not quite sure where. As I've said before, I share more with Amy Farrah Fowler than I care to admit--though I just did.

I have more in common with Amy Farrah Fowler
than I care to admit--though I just did!
Of course, the idea of lives as narratives is not brand new. Though I haven't been an active student since first becoming debilitated by illness in 2008, I am about halfway through the course work for my PhD in English (and thinking about trying to finish now--why not?). I've studied the concept of identity and personal narrative through that lens, a lens that does not conflict at all with my interest in neuroscience. These two seemingly disparate fields--English and neuroscience--connect (there's that word again!) in this arena. Our memories form the narrative of our lives, and memory is a key component of the scientific study of the human brain, just as narrative is key to English literature and identity studies.

Yet, as reassuring as all this is, it also lends itself to a scarier scenario, the scariest  part of neurodegenerative disease. Will I lose my narrative, my memories?

My grandmother was sharp as a tack and lived in her own apartment until she turned 86 and started calling my mom at 2 a.m. and asking her why it was so dark at 2 in the afternoon, putting the milk carton in the oven, and other wacky things. I saw her disease rob her of who she was, though she always managed a smile even when the nurses at the nursing home tranquilized the bejesus out of her, as was customary at the time.

And so, even if my demise isn't immediately imminent, I can't help but worry that I will lose my own narrative before actual death occurs, a sort of death of the personality, the person I am, or who I believe myself to be.

Does my life have a meaningful pattern? Do the good and bad things I've done or experienced all add up to a life that makes sense in some grand scheme, if only to myself? I have inklings of that sense of pattern, and that's encouraging.

It's easy for my romantic side to cling to those, but, in the dark nights while I'm wide awake and the rest of the eastern seaboard of the United States is sleeping, my inner skeptic creeps in and the idea that my accidental life on this random planet in an incomprehensible universe means nothing at all, nothing whatsoever.

And then I read something amazing by Oliver Sacks, and the darkness lightens.

No matter what the ultimate answer to this question of meaning ends up being, I have to agree with Sacks when he assesses his life in his new essay: "Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure." The privilege has been ours, Dr. Sacks. And the biggest privilege for me has been giving birth to the two best sons on the planet.


Epilogue: In a truly strange twist to this episode, I was just putting the caption on my Amy Farrah Fowler photo above when Honey walked in the room. Knowing my nuttiness for turtles, he said I needed to go to the living room and watch The Big Bang Theory: Amy (Farrah Fowler) and Sheldon were about to buy a turtle together. Just as the caption I'd just finished typing says, I have more in common with Amy than I care to admit.

Coincidence? Hmmmmmmmm

A little feller I rescued from the middle of the road
shortly before his release (and me)



Sunday, March 1, 2015

Episode 58: More Sleuthing: Brain Tumor? If So, That Could be Lucky! OR Parkinson's (Not Lucky)


Okay, so I'm not necessarily thinking that I have a brain tumor.

However, in fact, in January 2012 I was found to have a mass in my sphenoid sinus. The sphenoid sinus lies right next to the brain stem, right where the hypothalamus lies and directs autonomic functions by sending hormones to the pituitary gland.

The sphenoid sinus is the deepest one,
located next to the brain stem where
autonomic functions are governed.

And, as you know, sports fans, I identified dysfunction in my autonomic system long ago in my quest for answers to my health problems. For instance, the hypothalamus controls such autonomic functions as sleep and wakefulness--identified in my case as idiopathic hypersomnolence (in other words, I sleep way, way too much and am powerless to change that), breathing (an ongoing problem), appetite (another problem for me these days), heart rate (a possible problem for me, as identified on a stress test and ECGs), temperature control (I'm about 20 degrees warmer than everyone else, and not from hot flashes), and more.

Symptoms of brain tumor/cancer listed at the Canadian Virtual Hospice include:
  • increased sleepiness - I obviously have that;
  • decreased ability to move around - very clumsy these days, including a fall I'll discuss in this episode;
  • trouble speaking or understanding conversation - I've already posted on my losing some fluency while talking and very frequently using weird substitutions for words (substitution aphasia);
  • loss of memory and especially the ability to form new memories - I can still form new memories, but I'm not nearly as sharp about things as I used to be and have noticed some real holes in my memory for recent events;
  • weakness, which may affect only one side of the body - I definitely have overall body weakness, and today I had a weird weak feeling on the right side of my face;
  • seizures - None of these, thank goodness;
  • extreme mood changes - I don't think this is going on, but I do know I've had some despondent moods lately far beyond what I normally feel.
Of course, I have already received a diagnosis of neurodegenerative disease, so perhaps all this stuff relates back to that--but I'm thinking that if it turns out, instead, that the culprit is this sphenoid sinus mass, I might actually be CURED! Or at least symptoms could be slowed down. And since symptoms lately seem to be speeding up, that would be an absolute dream.

I recently posted about increasing headaches that are intractable to all meds I've tried, including the Tramadol prescribed to me because I'm not supposed to take NSAIDS due to my (mild) kidney disease. But in desperation I did take NSAIDS when the Tramadol didn't work, and yet nothing really helped.  I just suffered with it for days and nights, five or six or so.

Of course, masses in the sphenoid sinus can cause headaches. In fact, I spent a little time researching those masses once again. I'd already read that all sphenoid sinus masses should be investigated. In my case, that wasn't done when it was found early in 2012, nor has anything been done since. My Ear, Nose, and Throat (ENT) specialist told me it was just a polyp and not a problem.

And who am I to argue that I'd seen literature saying it should be investigated anyway? You have to pick your battles, as I've learned--and what I've actually learned, basically, is don't even bother to battle because your research and theories will be utterly ignored, if not ridiculed (as happened to me by a neurologist at Johns Hopkins).

But now that I have these new symptoms, I'm going to take that earlier report of the sphenoid mass to the eminent Dr. A., my neurologist, when I see him in April. I already reported in The Mary Dell Show recently how disappointed I was when I called his office about the headaches and his message came back to me as "If the headaches are bad, go to the emergency department," a non-answer if I ever heard one.

I've learned the ED is not the place for someone with my type of health problems. I mean, obviously, if I break an ankle or I am positively in a heart attack, I'll go. But for something as nebulous as headaches, very little will be done. Maybe an MRI, but one of that particular sinus? Doubtful. That's why we patients should be able to go to our doctors, NOT the emergency department, with these kinds of complaints, but it seems the buck is being passed by nearly all doctors nowadays, who are sending patients to the ED rather than scheduling an appointment in the office.

And the ED is known to be the most expensive place health care is dispensed, and all kinds of programs exist to keep patients from going to the ED for routine care, so why is it that doctors are bailing on us and sending us to other doctors well versed in emergency medicine but not necessarily in our individual problems, including neurological ones?

Ah, well.  I've already complained enough about that.

Sphenoid sinus headaches from inflammation are said to cause pain at the base of the skull and neck and on the top of the head, and those two places, along with pain behind my eyes which would probably be the frontal sinuses--though some sites say the sphenoid sinus also causes pain there--are exactly what plagued me during these recent headaches. The sphenoid sinus is located right between the eyes, but relatively deep in the head.

Of course, my problems in the sphenoid sinus and my other sinuses might, in fact, be simply related to my diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis), which I was told at this point is limited to my nose and sinuses but which is known to cause problems in other organs, including the brain.

In other words, the possibilities are pretty much myriad, but no one--not a single one of my specialists--seems very curious to find out what is actually going on.

Anyway, in addition to these very sick headaches of late, I have a couple of new clues that could mean the mass in my sphenoid sinus has swollen.  The mass doesn't have to be malignant to cause major problems; just by this deep sinus's becoming inflamed, according to the literature, pressure can be put on the brain and cause serious symptoms, leading to severe illness or death.

So, here are the new, and in one case not-so-new, clues:

Dysguesia:  This is a disorder of taste and involves sudden changes in a person's sense of taste. Most frequently, foods we loved suddenly become unappetizing.  This has been happening to me quite a bit of late.  In fact, most foods are turning me off these days.

I first noticed this problem about six months ago when I suddenly couldn't stand the taste of Pepsi. As a lifelong Pepsiholic, this was a major--and sudden--change. For most of my adult live, I've regularly drunk so many Pepsis a day I'm embarrassed. Then one day--Yuck! Pepsi! Couldn't stand it!

I then began drinking ginger ale like a fiend. I couldn't get enough of the stuff, and in the past I've never liked it very much. I started going through close to a liter a day, grateful that even if I was taking in a ton of sugar I wasn't taking in caffeine. This went on for months, fueled by how cheap a generic liter of ginger ale is compared to Pepsi or Coke--we'd regularly find them for 72 cents apiece!

Then, about a week ago, after the headaches started, I could barely tolerate the taste of ginger ale anymore. Boom. Just like that, yuck on ginger ale.

Very weird. Other foods have gone the way of yuck as well, pretty much all of a sudden.

Even smells can be affected. Yesterday afternoon, in the midst of hypersomnia, I could smell ground beef cooking on the stove--Honey was making tacos. I've always liked the smell of ground beef cooking, but this time it smelled atrocious. I did eat the tacos later, but today he made roast beef and mashed potatoes, and for the first time in memory I didn't even like the taste of mashed potatoes, one of my favorite foods.

I sure hope this thing goes away!

Out-of-Control Sneezing and Productive Cough.  I've written about my "productive" cough over the past few months--this means that the cough brings up phlegm. I also have been sneezing like a maniac lately. Both of these are symptoms of sphenoid sinusitis, or any sinusitis, that causes infection in the brain, according to Sinus Reference.com. Obviously, a brain infection can be serious.

REM Sleep Behavior Disorder. I've commented extensively on this recently. I'll link to those posts momentarily. This problem, too, came on very suddenly and swiftly just when the headaches were at their worst. (I'm having some relief lately, but the threat of those sick headaches is always there, lurking just below the surface.)

REM Sleep Behavior Disorder is frequently a precursor (or concurrent with) Parkinson's Disease, so I have also spent some time researching that disorder.  (N.B. I still think I may have myotonic dystrophy but have not yet gotten the DNA results--but I guess it's possible to have more than one of these things at a time.)

Something happened a year ago this past Christmas that also could suggest Parkinson's, according to "Talking While Walking Puts Parkinson's Patients at Risk for Falls," published by Florida State University.

Lack of Balance/Falling.  Just before Christmas 2013, my son J. and I were walking along the sidewalks in Frederick, Maryland, while Christmas shopping, having a happy conversation about the day's activities. Suddenly, out of nowhere, my legs just didn't seem to work anymore. I recognized it as it happened--I just couldn't coordinate them; I felt a massive moment of confusion, and then I pitched forward with the momentum of walking and landed flat on my nose on the sidewalk.

I can still remember seeing that sidewalk rushing up to me, and my arms giving out rather than protecting my face from the fall.  (The arms thing, of course, makes me think of muscle weakness, a symptom I also have but which the "wonderful" (NOT) neurologist at Hopkins also told me I wasn't experiencing, even though she didn't really question me about any such symptoms.)

I must have blacked out momentarily because I was later diagnosed with a concussion.I just remember lying on the sidewalk in a massive pool of blood, my nose and face really hurting, and slightly freaking out. J. was right beside me, remaining amazingly calm--I really appreciated that in the kid, who has had his own set of problems his whole live and could have also freaked out badly. But he didn't.

A wonderful meter maid (I'm sure there's a more politically correct title for the job) saw it happen and rushed over to me. Also, two men from the Weinberg Center for the Arts, a wonderful venue, who were just about to close up for the day witnessed the fall and rushed out to me with paper towels and a wheelchair. I left a ginormous blood stain on the sidewalk right in front of the Weinberg. It's probably still there.

The meter maid thought she saw me trip, and while there may have been a slight tripping over something, I don't recall that at all, and my inability to right myself once the confusion set in was far out of proportion to any minor tripping I might have had, if any.

I guess the blood pooled in my face because I ended up with a black eye, as well as a swollen (but thankfully not broken) nose. Although the incident was very scary, I was touched by the human kindness it brought out in those who witnessed it. Once the ambulance came, I was briefly checked out and asked whether I wanted to go to the ED. The bleeding had stopped, and going to a hospital was the last thing I wanted to do. I just wanted to get home (a two-hour drive, ugh) and rest. I did that until I threw up later and went to an ED near home and was diagnosed with the concussion.

Me, after the fall.

The point is, it all happened when I was walking and talking at the same time, something I rarely do as I'm not much of a shopper or walker (unfortunately) anymore--too exhausting.

"Parkinson's disease and multiple sclerosis are two common diseases that can affect the brain resulting in loss of balance," says the Neurology Muscular Dystrophy and Neuropathy Institute. And I have indications of both of those diseases; REM Sleep Behavior Disorder is highly associated with Parkinson's Disease. White matter lesions, which I have in abundance according to Dr. A., often occur in conjunction with Parkinson's Disease but are not necessarily due to it. However, of those white matter lesions, Dr. A told me he'd diagnose me with multiple sclerosis based on my symptoms and those lesions, except I didn't have any lesions in my spinal column, which almost always happens in MS. I was also slightly older than the normal range for diagnosis MS.

Thus, I can't help but worry that this incident of loss of coordination and falling was due to whatever is still happening in my brain and is now bringing on the headaches and REM sleep behavior disorder as well.  The problem is, according to the Florida State University article, one of "cognitive loading." Talking while walking is actually a very complicated thing to do, and those whose brains are impaired have trouble managing both simultaneously.

Oh, well, this is all much ado about nothing, I know, until a doctor decrees one or the other (or something else) to be the culprit. But my faith in the medical system is on such low ebb these days that I can't help but doubt I'll be taken seriously or given the right tests.

Now that I have the "neurodegenerative" diagnosis--even though the exact cause hasn't been identified--I worry that all these symptoms will just be considered par for the course, and a more acute cause--such as a sphenoid sinus tumor or inflammation, or even an ectopic pituitary tumor in the sphenoid sinus--will not even be investigated.

Such is the frustration of a patient here where I am, Down the Rabbit Hole of today's health care system.

I'm still trying hard not to get too discouraged and give up entirely, and I do think my health sleuthing is under control--NOT an obsession, just a normal curiosity for someone who has the tools to actually research the medical literature, as well as a burning desire just to KNOW.

I actually made an apple pie tonight, and now I'm going to practice making some tea sandwiches. A friend asked me to cater a service for her husband who died recently. So, you see, I'm not just sitting here obsessing about brain tumors and Parkinson's.

I just wish I could get a doctor to take all of this seriously and actually investigate the causes of all these problems.

But, as my ex-husband used to say all the time, "People in hell want ice water."

And they're not likely to get what they need, either.

It's elementary, dear Watson.

Wednesday, February 25, 2015

Episode 57: From Peak to Poverty, Thanks to Poor Health: This Story Could Be Yours

There is "no difference among men, in intelligence or race, so profound as between the sick and the well" (F. Scott Fitzgerald, The Great Gatsby).
I was born with far more advantages in life than so many others on the planet.  From parents who loved me and were committed to giving me the best possible childhood and who made enough money so that I never worried about having food in my mouth or a roof over my head, to the happy accident of being raised on the outskirts of Washington, DC, one of the most powerful cities in the world with a myriad of opportunities, I have been utterly blessed.

Good grades came easy to me, and as I've bragged numerous times, I scored in the 99th (the highest) percentile in abstract reasoning in the standardized Iowa tests given to schoolchildren in many states, meaning that my scores were better than 99 percent of the rest of those kids.

My father's successful career in electronic engineering--with a patented update to a radar altimeter that flew in all commercial aircraft of the 60's, if I correctly recall what he told me--gave us a comfortable home. My brother followed in my dad's enterprising footsteps, becoming a computer whiz on the ground floor of that industry, retiring at the age of fifty as the head of computer security at a big state university, itself known for its technological advances.

My mother was, and my sister and other brother are, certainly no slouches in the intelligence department. Mom's facility with language gave her a sharp (but friendly) wit--she could not let a pun pass her by--and a talent for writing silly but clever poems for friends retiring and for scrap books for my kids.

Fresh out of college after taking off a few years to travel as a young, idealistic member of the hippie generation, my sister landed a plum job in a big suburban county teaching English in a magnet school.  My brother, who won a golf tournament at the age of sixteen, went on to purchase and run a highly successful hardware store close to Dupont Circle in Washington, DC, and acquiring property in that high-priced area through the years.

And then there's me.

Like I said, I had all the promise in the world.  I did have a couple of deficits, though, which no one realized when I was young--not even me, though I certainly felt their effects. These, generalized anxiety (plus a healthy dose of social anxiety) along with attention deficit disorder (ADD), made navigating the difficult waters of growing up more difficult for me than for my siblings--though that ride isn't easy for anyone. It's just that my siblings landed in better spots than I did, despite my many years of trying.

After skipping my junior year of high school and graduating at the ripe old age of sixteen, I (stupidly) decided college wasn't for me and opted for secretarial school instead. I was tired of school (that ADD thing), and I wanted a life like Mary Tyler Moore's on her popular show of the day--independent professional woman with her own cute apartment.

But by the time I was nineteen, I was married to my high school sweetheart, and we consciously began a family. Having been temporarily seduced into joining the Mormon church, I couldn't wait to hold a baby in my arms like those in the arms of all the other women at church.  During those years, though I adored my babies, I regretted I hadn't gone to college and took a few classes when I could: Novel writing I and II, British Literature I and II, Intro to Philosophy.

And then--BOOM.  Blessed childhood, future full of promise--all came to a screeching halt.  The first clue that my life wouldn't be as perfect as I'd always expected it to be came when my first baby arrived two months early and suffered several severe health problems, including a skull malformation known as craniosyostosis that would affect his appearance and his psychic health forever (though the latter, I'm so happy to say, is very good at present, and I hope and pray it will continue to be so--and his appearance is absolutely beautiful, and I'm not just saying that because I'm his mom). In fact, I'm convinced to this day that my difficult pregnancies were the first real signs of the neuromuscular disease I'd later be diagnosed with.

My twenties were tough--but you can see how happy I am
holding my little preemie son (at two months)! He, and I,
unfortunately, had many health problems to come.

Then my dad dropped dead of a heart attack after a night out ballroom dancing with my mom, as they'd met some thirty-eight years before. And just four years later, my mom, who had battled breast cancer and then liver and pancreatic cancer in those four interim years, died in her bed in the home they'd bought in 1949.

My marriage, not surprisingly, given our young ages when we married and lack of much of anything in common, fell apart.

That about sums up my twenties.

Determined to make my thirties better, and to honor my dead parents and their shared belief in the value of education, I moved with my two little boys to a little mountain town in Appalachia with a state school.  My goal was to teach English.

I'd wanted to teach since I was a little girl, and I'd wanted to write since I was a little girl, too.  I used to dictate stories to my mom, who would type them up, leaving big blank pages for me to illustrate. Once I began English classes in junior high, I knew that's what I wanted to do. But after graduating from high school, my pathological shyness made me doubt I could stand up in front of a bunch of kids and command a classroom--and what was the point of going to college if I couldn't be what I wanted to be, I'd reasoned at the wise old age of sixteen.

I had so many wonderful teachers through the years who'd encouraged my writing, from Miss Rosenthal in fourth grade who'd assigned weekly compositions, to Mr. Bayz in eighth grade who'd declared my inscaping piece on the ocean "hauntingly beautiful," to Mrs. Righter who'd felt I was wasting my time in a regular core class and referred me to a gifted reading specialist who had me doing independent work while still in 8th grade, to Mr. Fowler and Mrs. Crowe who'd read my papers and stories out loud to my 9th and 10th grade classmates, to the even longer list of English professors who'd influenced me in so many ways as I worked through a BA, then MA in English, and on to about twelve credit hours into my PhD program in English.

I wanted to be one of them, and after my parents' deaths made me the beneficiary of enough money that I could choose a new life for myself, I decided it wasn't too late to pursue my dream job, even if I still was pathologically shy. I told myself I'd get over it, and eventually I did.

In the fourteen years between graduating from high school and enrolling full-time as a college freshman at age thirty, I'd worked as a legal secretary in a small firm in Silver Spring, and then in a large corporate firm in DC: Arent, Fox, Kintner, Plotkin and Kahn. I worked for one of the top international partners, and my skills were in high demand whenever I could manage to work overtime (which was difficult since I had my little boys at home).

I was promoted in the firm to the personnel coordinator, overseeing the leave requests and scheduling of 105 secretaries and assisting the Director in hiring and other personnel matters. I went on to become the assistant Attorney Recruitment Director.

Then I tired of the long commute and took a job as a senior secretary for a government engineering contractor at NASA's Goddard Space Flight Center.

But I was dissatisfied being "just" a secretary, and when my parents' estate settled, it seemed my career could do nothing but soar when I left Goddard to move to the mountains and pursue my dream of teaching English.

And my dreams continued to soar as I worked through my classes, earning A after A. I was where I was meant to be. When I graduated in 1994, I received Departmental Honors from the English Department, given to one student per graduating class.  I also took General Honors and graduated summa cum laude. 

The icing on the cake was receiving the Maryland Collegiate Honors Council Outstanding Honors Student of the Year award, also in 1994.

While working on my degree, I took care of my boys as a single mom and worked part-time at a local community college, where I eventually moved into planning and facilitating health courses for licensing and accreditation of health professionals. One of my coworkers, a woman nearing her sixties, told me during that time:

"The world is your oyster. Once you get this master's degree, you will be able to command your salary."

I was admitted to the West Virginia University Master's program in English and was granted a Graduate Teaching Assistantship with tuition waiver, as well as other scholarships. I took a job in a non-profit health education agency just after finishing my Master's Degree, and again I excelled.

When a co-worker became sick and was unable to write a big federal grant application to continue a program employing several of the persons at the agency became ill, and our associate director who normally would have taken up the slack was on vacation, I took on the job and, in one week, wrote a major grant application that was funded for close to a million dollars. From that point on, I wrote numerous federal, state, local, and private grants, garnering millions of dollars in the total of nine years I'd eventually work there.

Never happy letting an opportunity go by, when the non-profit agency's health librarian left the job to take a position as an executive director at another agency, I enrolled in a library science Master's program at the University of South Carolina and graduated with 3.98 grade point average a year and a half later while working full-time.

Ironically, the one "B" I received during that Master's program was in grant writing, something I'd done successfully professionally for some time by then. (I'd missed one of the minor requirements, as I recall.)  However, I turned the application I'd written for that class into a viable one, submitting it to the federal Institute of Museum and Library Services. And we won a National Leadership Grant with that application.

As much as I loved that job, though, eventually I landed my dream job:  teaching English in a two-year college in West Virginia which, after my first year, became part of the system of my alma mater, West Virginia University. As hard as that job came to be--teaching freshman English to 28 kids per class with a five-course load is enough to kill anyone--I had finally arrived exactly where I was meant to be.

I loved teaching. I didn't love grading, but I did it with every ounce of my soul, wanting nothing more than to help each individual student reach his or her writing potential. I still believe fervently that the ability to write is the key to success in academia and beyond. And I loved being the slightly wacky English professor who walked into her Poetry and Drama class wearing a Greek toga (over her "normal" clothes), a band of laurel leaves in her hair, demonstrating strophe and antistrophe while reading aloud from Oedipus Rex. 

When teaching Hamlet, I'd assign key scenes to groups, and the students would practice and bring in props and eventually act out their scenes on the stage in the building where I taught. I still have a plastic sword brought in by one class's Hamlet--he'd never come to my office to retrieve it, though it was his little boy's. Another Hamlet scored a skull from the Biology Department for his "Poor Yorick" scene.

One of my students as Hamlet, with a skull he'd scored
from the Biology Department, acting out the "Poor Yorick" scene

After a class in which students took different parts in Christina Rossetti's "The Goblin Market"--twittering as the eroticism of the dialogue came alive, several of the students left the room calling out in the hallways: "Come buy! Come buy!"

An Appalachian Lit class became a learning experience for me, as every student in the class had been born in West Virginia, while I was a Washington, DC, native! The final paper involved each student's telling his or her story about growing up in Appalachia, from the daughter of two hippies who'd spurned the city to homestead in the mountains to those who had grown up in the near-by town of Piedmont, immortalized in Henry Louis Gates' memoir, Colored People. 

Gates himself had attended the school where I taught, as I informed every amazed class I stood before, and he'd been inspired by his English professor, Tony "Duke" Whitmore, to pursue a degree in literature rather than medicine. The Duke had died three years prior to my starting at the college, and I wonder to this day whether I'd still have a job if he'd still been president when I became sick.

I wanted to be a Duke Whitmore inspiring students to love literature. I wanted to be a Mr. Keating in Dead Poets Society, a "Sir" in To Sir With Love, a "Teacher" in Catherine Marshall's Christy. I was thrilled to be working in a school whose students weren't born with silver spoons in their mouths. My "kids" came from the hollows of West Virginia and distant inner cities where the college recruited. I loved the "C" student in whom I could make a real difference; I knew the A's and B's would be fine. Of course, I enjoyed them, too, and I admired them, and I tried to help those struggling with D's and worse.

And I was well on my way to achieving what I thought would be my lifelong (if a bit late) teaching career, earning merit points based on my student, peer, and Review Committee evaluations. In my six years teaching, I was nominated "Outstanding Professor of the Year" twice--the awards went to professors who'd been there longer--and, in a school newspaper poll of fifty students in the cafeteria, I was runner-up for "Most Unforgettable," second only to the beloved cafeteria lady, the students' mom away from home! And I was told by the campus provost, just a few months before being given my pink slip, that I was a "shoo-in" for tenure.

I remember walking across the quad under the massive oaks and maples, realizing that yes, Mary, you finally did it!  You have found the place where you'll be the rest of your life, doing exactly what you've dreamed of doing your entire life.

I had a campus full of friends in the coworkers I enjoyed every single day, along with the fondness and appreciation of most of my students.  On the little board outside my office, where I hung my New Yorker cartoons as many other English profs had done before me, a student had written at the end of the semester:  "Ms. Spalding rocks!"

And then I was out on my ear.

Why?

Because I got sick.

Yes, this is the simple truth.  No other truth exists.

Beginning in the years I was going to WVU for my Master's classes and working at the community college and then the non-profit agency, my stamina became an issue.  Yes, I was doing a lot, but I began feeling like an 80-year-old woman.

Long story short, I came down with severe, intractable hypertension at the old age of 38, even though I wasn't overweight or stuffing myself on salt or anything else. My only risk factor was my father's legacy of hypertension.  That was enough.

Through the years, my health tanked.  After thirteen years of blood pressure regularly going as high as 208/135 (that was the worst, but it came close to that nearly daily in my last year of teaching), I was finally diagnosed with an adrenal adenoma, adrenal hyperplasia, and primary aldosteroism, also known as Conn's Syndrome.

Shortly after that diagnosis, I spent a summer in apparent heart failure and, determined to get to work in the fall, kept telling myself I'd feel better until one night I was certain I was going to die and went to an emergency department.

I was admitted, told I was indeed in heart failure and had probably had one or two heart attacks already.

There I was, forty-nine years old, on my deathbed.

And from my deathbed I talked to my chair in the English Division at my college, who covered my classes. But I didn't get better, and it was clear I'd need yet another semester off.  (I'd taken one off when the adrenal problem became known, and then I'd worked .6 FTE the following semester in the tutoring center while trying to regain my strength.)

And because I wasn't worth another 15 weeks of recovery time--I truly believed then that, once I was adequately treated for the newly found adrenal problem I would be able to go back to work without any problems--I was told I wasn't wanted back.  This, as I say, just a few months after the campus provost told me I was a "shoo-in" for tenure.  What had changed?  Nothing but my health. And if you think a person can't be canned for his or her bad health, think again.

You see, I'd inconvenienced the Dean of Curriculum and Instruction, a curmudgeon disliked by all the faculty. I'd pissed him off by going into heart failure just as the semester began, necessitating his replacing me for the semester. Somehow, I hadn't managed to dash off a request for a leave of absence before arriving in the ED in heart failure. How unprofessional of me.

Anyway, I got the official letter saying I'd failed to ask for that medical leave of absence in advance and was being asked for my resignation, or be terminated.  Of course, I didn't resign.  Why should I? One of my coworkers had suffered a massive stroke the same semester I was out for my adrenal problems, and he clearly would never teach again, but he remained on the roster until well after I was canned.

Oh, I tried to protest. I filed an appeal that failed, as nearly all first ones did, but I was eligible for two more appeals, and I was told by numerous persons, even one in the West Virginia Higher Education Council, that I would surely have my job reinstated. I overheard the WVU lawyers in the ladies' bathroom during a break in the hearing I did attend saying, "Wow, this really shows how bad the system is."

But guess what, sports fans?

I was sick.  Very sick.  Filing a bunch of paperwork and dealing with all the red tape of an appeals process was beyond my ability at the time.  I needed to heal, to recover.

All my life I'd been blessed by coworkers and others with whom I interacted on a daily basis who valued me.  When I left the DC law firm, one of my bosses pulled me aside and begged me to stay.  "You aren't like the rest," he told me.  "They're the worker bees. But you, you are someone special."

Not very special, apparently.

Losing my dream job happened seven years ago, and sometimes I still wake up and wonder how everything went to hell so fast and so completely beyond my control.

After a year of unemployment while I struggled with the hypersomnolence that has taken over my life today, I was rehired by the health education non-profit agency, where I again wrote millions of dollars of funded grant proposals.

But eventually my health problems interfered too much with the organization's structure--it got to the point when I could barely be awake during the day, only at night--and though I'd argue I can write better at 3 a.m. than most can any time of the business day--it's true I couldn't fully participate in the day-to-dayness of the job. Though I was working on several major projects at once and, I still believe, held my own, I could do that only by working on my own schedule, and that just wasn't cutting it anymore. I knew it was time to go, and my boss, who is a friend, thought so, too. I needed a long rest, actually.

And, fact is, I couldn't have kept teaching full time.  I couldn't keep working a full-time job.

My talents and abilities have been hijacked by my utter lack of energy, the result, I finally learned, of a neurodegenerative disease. I still don't know which neurodegenerative disease, but my neurologist said he'd diagnose me with MS except that I don't have lesions in my spinal column. I do, however, have lesions throughout my brain, along with many other symptoms of neurodegeneration that I've chronicled here. The latest is REM sleep behavior disorder, during which I act out uncharacteristically violent dreams, a common precursor to Parkinson's and other neuro diseases.

And so here I am, put out to pasture.

I try to stay busy.  I love to sew and embroider and read and write, and I do those things.  Once this god-awful winter is over, I will love being out in the yard and woods whenever I have the energy to do so.

I still believe I could teach one or two classes a semester. I just can't work full-time anymore. But I still have so much to give.

The reality of my situation, where I am today, hurts. I try not to dwell on it, but some days it's difficult to push away the nostalgia and the wonder about what might have been. I went from being at the peak of my professional life to unemployable in just a few years, and not because of anything I did to make that happen, other than get sick.

The psychic pain is the worst, but the practical side of it sucks as well. At long last, I enjoyed a comfortable salary for someone living in Appalachia for a couple of years, but in an even briefer period of time fell unceremoniously into poverty.

I now receive federal disability payments, thank god, but they are barely enough to keep the home where I still live with my adult disabled son. It's the only tangible thing I have to show for my struggle to attain professional success, which I did.

Even landing my dream job.  And losing it, through no fault of my own.

I tell this tale to let the world know that those of us in the 47 percent are not all here because we are lay-abouts and losers. In fact, I'd venture that few of us are.

In fact, you could find yourself right here where I am in the blink of an eye, no matter how successful you now consider yourself.

You know the old saying, "There, but for the grace of God ...."

Oh, I still live in the grace of God, if God exists. I have nothing, truly, to complain about. I've never worried, really, about being hungry or bombed out of my home. I still have all the blessings of my birth, even if the outward acknowledgement of those blessings is not so obvious. I am not bitter, and I am not done.

I write simply to remind us all of how easy losing what we have can be, and to keep gratitude at the forefront of our lives. And, yes, to tell my story. Because I can still do that.

I can still write.


Epilogue:  The very same night I posted this episode (tonight, in fact, or this morning, given that it's almost 2:45 a.m.), my former boss at the non-profit asked if I'd be willing to look over a project I could possibly do on contract.  So here's another reason for this episode, and it goes out to others who are suffering from chronic illnesses that nipped their promising careers in the bud:  Don't give up.  It's hard; it's very, very hard, but don't ever give up. We are sick, but we are not without talents and abilities that can find their places in this world. We are sick, but we aren't done.

Wednesday, February 18, 2015

Episode 56: Latest Health Care From Doctors of All Stripes: "Just Go to the Emergency Room"

Doctor
Thanks, ClipArt101.com, for this
very pink physician! Not that
color has anything to do with
how good or bad a doc is--
just appreciate the free graphic.

Remember when the stereotypical advice from a doctor was "Take two aspirin and call me in the morning"?

Well, guess what it is now?

"Just go to the emergency room."

This is yet another example of today's health care system's passing the buck at the expense of each and every patient, AND the system itself.

I've worked in health care for many years, and I know for a fact that the emergency department is the most expensive place for a person to seek care.

So why are doctors increasing health care costs by sending patients there instead of seeing them in their offices?

In today's case, I have to admit it is my dear, eminent Dr. A who has resorted to this non-answer. He is my neurologist, and I admire him greatly, but when I called today and told the office about my nearly non-stop headache for the past week and my new sleep behavior problems, I was called back and told, you guessed it, to go to the emergency room.

Why aren't doctors taking care of their patients anymore?

About a year ago, I was having a myriad of problems, and my regular doctor, or PCP (Primary Care Provider) in medspeak, told me I just needed to be admitted and a bunch of tests run to figure out what was going on.

Stupid me, I told her I didn't want to go to our local hospital, since it nearly killed me a few years ago, and said I wanted to go to one in the next town over where a number of my specialists are.

The next day I changed my mind, called her office, and received a call back that said, you guessed it, "Go to the emergency room."

When I did that, I told the attending physician that my PCP had said I should be admitted.

He gave me a scornful look and said, "What are we?  A McDonalds?"

And the visit went downhill from there.

Sports fans, I've been to the emergency department, and it is an utter waste of time unless you have a gunshot wound or have broken an ankle. For the problems I have, I'm given the same battery of tests, and none of them pinpoint the problem. I learned this after I was told numerous times when I couldn't breathe properly--NOT when I actually could not catch my breath to the point that I was about to die of suffocation, but chronically, and seriously--to go to the ED.

And each time I went I was given the same tests that showed nothing at all. And yet, calling specialists about the problem, I was still given that same old non-answer. And despite all the signs and symptoms of being deoxygenated on a regular basis, no one has cared enough to really get to the bottom of it.

Send patients to the emergency room to doctors they've never met, racking up costs that are higher than if we are seen in a doctor's office, without the benefit of our own doctor's history with us and knowledge of our case.

Does that make sense? Yet, that's what doctors are doing today.

My headaches are bad, and I told the person on the phone that, but I said they weren't quite as bad as migraines, which I've had before.  It's true they are affecting my ability to eat anything--everything looks nauseating to me--and I know migraines cause nausea. But I also know what a migraine is--you can't stand being alive; light hurts; sound hurts; and vomiting adds to the misery without giving any relief.

No, my headaches right now aren't that bad. But they're pretty darned close. I just lie in front of the TV, with the sound low, and pretty much stare into space. I feel nauseated if I think of food, and all I can think about is the pain in my frickin' head. I mean, they're miserable.

Is that enough for me to go to the ED?

I don't think so. I really don't.

But maybe my doctor could see me; maybe he could talk to me and try to get to the bottom of the problem. He is a neurologist, after all--and the emergency room doctors are NOT.  Moreover, I'll be lucky to see a doctor if I go there; most likely I'll see a physician's assistant or a nurse practitioner, which are fine with colds or flu or that sort of thing, but they don't have the training to deal with my myriad of health problems, including serious neurological issues.

If my neurologist had agreed to see me, maybe he could have ordered the appropriate tests to see whether, perhaps, the mass found in my sphenoid sinus in 2012 has spread. Maybe he could tell, by the way I describe my headache, what type it is. Maybe he could prescribe something to help.

I am so confused. Supposedly, doctors are on board with reducing health care costs. So why are they now, as a matter of course, sending their patients to the Emergency Department, the most expensive place to receive care?

Not only that, why are they forsaking their patients this way?

I don't know.  I guess I'll go to the damned ED if my head feels like it did last night--and the headaches get worse as the evening wears on after I wake up. (Being hypersomnolent, I sleep all day and usually emerge sometime between 6 pm and 9 pm, and that's when the headaches have begun.)

I'm not happy about it, though. Why go for substandard care at increased cost for something that could be handled through my own doctor's office?

Well, sports fans, I guess I don't have any damned choice. I feel like crap, but I have to pull myself off the couch, go out in zero degree weather here in the mountains, and drive to a place where I"ll have to sit among a bunch of people coughing and hacking, only to be seen by a person without the neurological training to truly get to the bottom of what's going on.

Does that make any sense?

Oh, and I forgot.  My car won't start.  The cold has killed its battery.

True, I'd need a car to get to the doctor's office, but I could perhaps borrow one for such a trip--but when going to the ED, who knows how long it will take, and it's hard to borrow a car when you have no idea when you can return it.

Yes, it's just so easy when you're sick.

"Just go to the emergency room."

Hey, U.S. health care system, you are one sick patient.  YOU'd better go to the emergency room! Not, as I already know, that you'll get the diagnosis or care you need there unless, indeed, you have a traumatic injury of some kind.

The ED is NOT for problems such as the ones I'm dealing with right now. But that's what I'm told.

"Just go to the emergency room."

Maybe it is a McDonald's after all.  God help us all.