Exhausted.com

Exhausted is an overused word however it is the only way I can describe the state I find myself in. Yesterday (Tuesday) was my trip down to Plymouth to see my new consultant, (after I got rid of the one who accused me of spending too much time on the Internet looking up syndromes to have) and catch up with family and an old school friend. 

The appointment went really well however due to two road traffic accidents in Plymouth which caused complete gridlock in the city, the rest of my plans went awry. The traffic was so bad it actually took us an hour to get out of the multi storey car park at the hospital. With my husbands blood pressure slowly climbing and me rapidly fading, I had visions of the red cross coming to our aid as I couldn't see how on earth we were ever going to get home. It took us over two hours to get back to my parents house, a journey normally of 20 minutes to pick up my medication and various other bits and bobs that I had left there before setting off for my appointment. We then had another hours travelling to complete the journey from Plymouth to Exmouth. All in all yesterday I spent over 4 hours in the car. This catastrophe was not in our plans and being in the car so long has caused my legs to refuse to work properly and climbing stairs is now an endurance sport which has to be completed by shuffling up the stairs on my bum. What a glamorous life I lead!

So my blog post this week will not be a long one, when I say that it just depends how much I can write before crashing completely. I have got up very early to compose this post because the worry of not having it completed was keeping me awake. I do like to have something to worry about.

As usual I suffered very badly with pre hospital visit jitters which meant a pretty much sleepless night Monday into Tuesday. I woke up at 02:30am and didn't get back to bed until gone 9pm, I have woken up at 4am this morning. This is just begging for a Meniere's attack to happen, which I can already feel building up. I had been told by numerous people that the doctor I was going to meet was lovely but in the back of my mind there was a niggling doubt that I could be the one patient that he wasn't nice to. You see my neurologist I saw many years ago was treated like a god amongst the Myasthenia Gravis patients, not a bad word was said about him. The problem was that he was a consummate performer who was very nice to your face but had a nasty habit of writing utter shite about you in his notes. The neurologist treated me very badly and I highly suspect that it was him that diagnosed me with somatiform disorder. So I guess you could say we (both hubby and I) have trust issues when it comes to doctors.

When the doctor called my name in the waiting room, I had my back to him due to the lack of space provided for wheelchair users (that is a rant for another day that hospitals seem to be so unfriendly towards wheelchairs). When I turned around to face him, there was a look of shock on his face. He then said something like "you need no introduction, I can see the family resemblance". This Dr treats my sister also and due to that has also met my mum. People say that we all really look-alike but I just don't see it. Yes we look like each other but it's not (to me) like we are clones! So that was nice as he hadn't seen my sister for a few weeks but he recognised me. My last consultant also saw my sister but never actually acknowledged the link between us despite me referencing her on more than one occasion simply because we have a lot of the same symptoms.

The new doctor was really friendly and open to ideas. In fact he brought up stuff that I had on my list of the most important things to discuss with him. My list read as follows

1. Mast cell activation disorder

2. Fluid intake

3. Stomach / bowel problems / adhesion's

4. Alice in Wonderland syndrome or Todd's syndrome as it is also known. This would be brought up if I was feeling brave enough as I have never mentioned it to any doctor before in case they thought I was nuts.

As it happened one of the first things we talked about was the Alice in wonderland syndrome. This was due to the fact he brought up the Myasthenia Gravis / Ptosis / Nystagmus and breathing issues. He doesn't think I have MG, he thinks my Ptosis (droopy eyelid -You can see a picture of it here) is being caused by hypoperfusion ( so not enough blood flow to my brain, essentially low blood pressure in my head). I brought up the fact that when I have Ptosis or MG symptoms my blood pressure is normal but he quite rightly pointed out that it doesn't mean my blood pressure is normal locally (as in my head the pressure is low). I can't argue it makes sense, mestinon or pyridostigmine bromide as it is also known raises blood pressure, if the blood pressure is low in my head the mestinon would have the effect of raising it. I did mention about the ice pack test also being positive and that is an indication of a problem at the neuromuscular junction. He said he felt it was possible that both my sister and I had issues with the ganglionic receptors in our brains. As I told him I roughly understand that but much more and it goes over my head.

As we were talking about MG symptoms I brought up the nightmare of 2013, when I had all the constant nystagmus and the weird visual symptoms that lead me to believe I have Alice in Wonderland syndrome. He agreed with me that it sounded like I did indeed have this, what shocked me more was the fact that he had heard of it and didn't treat me as if I was a complete loon, when describing watching birds fly across the sky only for them to rewind and do it again.

He also believed I could be suffering from another weird syndrome that causes sudden desaturation (not enough oxygen in your blood). He did tell me what it was but its name was far too long for me to remember. He told me at the start of the appointment that he had only had a quick look at my notes however it soon became clear that the poor man had taken an in-depth look at them and had already come up with a treatment plan.

Due to my exhaustion I can't remember the exact flow of the conversation and what we talked about next and in what order. So I will be brief and explain what I can remember.

My excessive fluid intake would come under psychogenic polydipsia, as I do not have diabetes insipidus. He thinks that title is harsh because I have had excessive thirst ever since I was a baby and I could in no way be able to form a habit of drinking too much from that age. So there is something wrong with the hypothalamus part of my brain that controls thirst but we will probably never know what.

He believes I have Mast Cell Activation disorder just from reading my notes and looking at the strange reactions I have had with many if them. The closest I have come to full-blown anaphylaxis was when I had CT contrast dye injected. It's an experience I don't want to repeat. I was also able to show him the blotches that had come out on my neck that very morning, despite not eating / drinking or doing anything different. Due to the Mast Cell Activation Disorder or MCAD for short he wants to change my Betahistine that I take for Meniere's disease to Cinnarizine (stugeron). As MACD is caused by histamine the Betahistine will not be helping me and by strange coincidence since taking it I have noticed that my skin has become much more reactive. He isn't convinced that I have Meniere's disease, I am, so he is requesting a copy of my audiology notes as they hadn't been included in the file that was sent to him.

He thinks a lot of my stomach / bowel / adhesion issues are being triggered by MCAD. If we could get the MCAD under control it maybe that we can get those issues under control. The adhesion pain has been quite bad since the 29th November. I am having sudden onset of really sharp pains which take my breath away and leave me doubled over. As fast as they come on they go again.

The weirdest revelation of all was that he doesn't think I have PoTs........... He believes that my problems stem from my blood pressure being all over the place, my heart (or brain you could say) is responding by beating faster in an attempt to keep my blood pressure elevated. He wants to do another tilt table test, I have politely declined for the moment just due to the fact how ill I was after the last one. 

He was incredulous that I had never had an echo cardiogram ( a bit like an ultrasound for your heart) to check that it was actually working ok and that I don't have  a mitral valve prolapse. This should be a standard test that is carried out of everyone who has been diagnosed with EDS. For some reason my last consultant didn't think so and I can't seem to get my gp to move forward with this probably because I have so many problems it just gets overlooked. So my new doctor is going to ask that I get one done. If I don't get it he will arrange for it to happen in Plymouth.

So due to his theory on it being my blood pressure causing the tachycardia he has started me back on Midodrine at 2.5mg once a day for a few days to then increase it to twice a day, then three times a day. Then I am to slowly get myself up to 5mg three times a day. We all hope that by slowly titrating it I won't react as badly to it as I did the last time when I ended up with awful bladder problems and adhesion pain. 

When we talked about the bladder problems, I brought up the possibility of Fowler's Syndrome. When I brought this up with my last consultant this was when he accused me of looking things up on the Internet, so I could have more syndromes. This doctor knowing my sisters history, that she has a sacral nerve stimulator so that she can use her bladder, agreed with me. He told me because not many doctors had heard of Fowler's Syndrome this was perhaps why I had encountered such hostility. The Fowler's syndrome would cause the acute urinary retention and the problems I have had when in hospital or at home when they have fitted a catheter and my bladder has still refused to empty due to the fact the valve at the neck of the bladder had clamped around the catheter. Again he couldn't understand why I had been taught to self catheterise and hadn't had the bladder issues fully investigated. I explained to him that when I raise this issue with my doctors I get told I have already had lots of tests done. It is infuriating because the doctors seem to blame me for the wrong tests being done, so now nothing gets investigated and it is only the symptoms that get treated.

I have just looked back at the amount of stuff I have written after claiming I wouldn't write much. I don't know how I am putting this together as I am so tired I can barely string a sentence together let alone see the screen.

Anyway back to the Midodrine, once I can tolerate this medication at the full dose of 5mg three times a day, the doctor wants me to then slowly add in Ivabradine. I have tried this drug before and it was wonderful at stopping the tachycardia but my blood pressure dropped very low. This is what my new doctor has picked up on, where as the old consultant was happy to just say "you obviously need a fast heart rate to keep your blood pressure elevated". This doctor wants to get to the bottom of this and raise my blood pressure and then drop my heart rate. It was actually something (on my extended list) that I wanted to suggest. I have to say I was in shock when it appeared both the doctor and I were on the same page. That has never happened.

I can't really remember much more from the appointment and I will be honest I am starting to fade a bit here. He wants to see my print outs from my tilt table tests to see what my blood pressure and heart rate did. My old consultant handily forgot to include them in my notes. My new consultant ordered a load of blood tests, one for my testosterone levels (due to my facial hair), a repeat of the prolactin to see what that is doing and countless others, I was robbed of 4 vials worth of my blood. 

The assistant that took my blood wasn't great, she had a constant sniff (that always makes me feel sick and is a pet hate of mine), she managed to jab the first attempt straight into a nerve and then had the gall to shout at me when I moved. She tried to tell me she hadn't hurt me, I asked her "why would I shout out and jump if you hadn't hurt me?" I was furious. I have never moved during a blood test, I have had 100's of them, I have had 3 doctors jabbing me in the feet and both arms at once to get blood. So I don't jump about when people are trying to get blood from me. My point was proved when she then got a vein on the back of my hand and I continued chatting with her whilst she got my blood. It didn't help that I was tired and dehydrated when she was getting my blood but to try to tell me she hadn't done anything to make me jump was ludicrous. My husband was getting quite tense at this point as he has seen me having blood taken on many occasions and has never seen me react like that.

Despite the horrible blood taking episode I would describe myself as slightly elated after that appointment. This doctor wants regular email updates on how I am doing......I know what doctor does that? My last doctor gave you ten minutes of his time and you didn't see him again for 6 months if you were lucky and they remembered to book you an appointment. I had this doctor for 80 minutes. 

My husband informed me last night as we were going to bed, I didn't let the poor man finish a sentence without interrupting him. He said I was gabbling away like a loon, like I always do when I am nervous. Hubby is happy, he said he feels for the first time in a very long time that we are starting to get somewhere. As I told the doctor yesterday, I know that there is no magic wand, I know that there is no cure, I would just like to feel better and be taken seriously.

Pity party for one

Before anyone suggests it, this is not a cry for attention. It's just an expression of how I feel at the moment. Only those of you who have a chronic illness or care for someone with one will get this. The title "Pity party for one" is a complete piss take. I don't want a pity party, I want a break from everything that is going on at the moment.

It's difficult to come up with a blog post when all you have faced over the last few weeks is a ramping up of your joint pain and unbelievably bad health (more than normal). I don't mind joint pain when I have partaken in activities that warrant it. That's pay back and its normal - for me. It's when all you have done during the day is move from your bed to the sofa and back again, it really starts sucking all the joy from your life.

I have been in tears or close to them for a few days. This new level of pain has brought me down, I have upped my dose of painkillers but it doesn't do anything much or it takes all day before I feel any relief. When the pain is bad I am convinced I am depressed, when it eases off I know it is the joint pain that is so badly affecting my mood that I want to go to sleep and not wake up to face another day of pain. That is how bad it is getting and I have no idea why. I don't want to die or do anything stupid. This is not a cry for help. This is the sheer level of frustration you feel when you are on a runaway pain train. You do not know how you will possibly get through the next hour let alone the other 23, only to face it again, day after day.

You get through it, you don't know how but you do. The exhaustion leaves you feeling like a zombie and wipes out any reserves you may have had. I don't know how my body still functions but it does. I know at some point I will get back on top of the pain. I just don't know how or when. I am sick of waiting.

I can live with a certain level of pain. I have had to, I spent from 1999 to 2011 without medication because I couldn't get anyone to believe how awful the pain was. I have been on top of it for a few years with the occasional flare up. This pain flare up has building for a few weeks. Its changed from the constant aching to a sharp pain that is unrelenting. I can only describe it as feeling like my knees and hips have been replaced with metal spikes. Every movement feels like the metal spike is rubbing along the bone beside it. Today every time my right foot went to the floor I wanted to cry. I hate using walking aides in the house as they are so very limiting - you can't carry anything when you use a stick, frame or crutches. I tend to use the furniture to help me hobble around. I seriously considered using my crutches, for me to even say that out loud means I am in a considerable amount of pain.

However I am conscious that I need to keep moving. One of the things you do when you are in pain is limit your movement, its only natural to stop doing something that hurts. With EDS we need to keep moving as much as we can, as not using a joint could mean in the long-term more problems. It's hard to keep that in your head when you want to scream every time you put your foot to the floor.

I am not looking for sympathy, I am just giving you a peek into my life. Its the bits no one sees because I wont let them.  I hate feeling this miserable, I hate the pity party I am currently throwing myself, it just isn't the real me. It wears you down, exhausts you and causes you to draw into yourself rather than live in the real world. I am at times too exhausted by it all to speak.

You would never know if you saw me in person. I am good at hiding it in plain sight. I can keep a fake smile plastered on my face for a couple of hours. I can keep a light and breezy conversation going whilst my vision goes grey as my blood pressure drops. I have become so good at hiding the sick me, I sometimes doubt how ill I am myself. Then reality strikes, as on Sunday when I lost the ability to urinate again. Thankfully for some reason I could place the catheter when all attempts on previous days had failed. Its only when bits of me stop working properly that I have to acknowledge that life is not normal. I am left asking myself how did I get here? What happened in 2007 to change the course of my life so dramatically? I have no answers.

The only person that ever sees my struggle is my husband. I would be lost without him. He is the only thing that keeps me going at the moment, well him, the dogs, my parents, my sister and her family. I am struggling underneath the weight of this pain. If I could just get some relief just for a few hours I would feel like me again. I wouldn't have to wear this mask that I hide behind for fear of people seeing how weak and vulnerable I am.

I am sorry if this post seems negative. It's not meant to be, it's a picture of what life can be like when you are chronically sick and trapped within your house because the pain and stimulation of the world outside is just too much for you. I rarely feel as low as I have for the last few days. I know at some point I will catch a break and I will feel better - better than I do right now. It will happen, it always does, that is what I cling too. 

"This too shall pass"

The not so glamorous side of chronic illness part two

I had to leave some distance between my appointment with the specialist nurse at the Bladder and Bowel clinic, so that I could gain some perspective on it. All that has done has made me more annoyed, which be explained in more detail as you read this post.

The clinic was held at the local hospital, so no long trek into the city with a full bladder. It wasn't until 45 minutes before the appointment that I remembered that a full bladder was a prerequisite. I downed two cups of tea and a 250ml bottle of diet coke to ensure the job was done well. I then squealed as we went over every bump in the road as I was busting to spend a penny.

I was seen right away and ushered into a room with an examining table a few chairs and a desk. The nurse introduced herself and seemed on first appearances quite reasonable, if a little wet. I was trying my best not to come across as hostile, I have built up this defence mechanism over the years as it leads to less disappointment. I handed over my questionnaire that I had been asked to complete prior to coming including the results from operation "measure my piss". I had fully expected that my bladder would be scanned on arriving then I would be allowed to relieve myself and be scanned again but no this didn't happen for what seemed like an eternity. We went through my questionnaire until in the end I had to tell her I was about to wet myself. She seemed surprised, which alarmed me because after all this was her job to look after people with bladder problems, who had come to the clinic with a full bladder as the letter had informed them they had to do.

I was handed a diamond-shaped cardboard dish and told to produce a sample and come back. I managed to fill the receptacle with ease however as normal the flow of urine stopped. I could have strained, changed position as I would normally at home but I decided this was pointless if they were going to scan my bladder to see if there was any residual urine. When I returned she scanned my bladder - roughly pressing down much too firmly for my liking, to the point where I was concerned that I would wet myself. She turned at this point from someone who had been reasonably pleasant to someone whose feathers had been ruffled. She snappily announced that I had 350ml left in my bladder although the scan couldn't be as accurate once the amount passed 250ml. She made me feel like I had done something wrong by proving I did indeed have issues with my bladder.

The next thing on her hit list was the amount of fluids I consume. This was all done under the guise of it would be knocking out my electrolytes. Had she bothered to read my notes at all or have read my prescription list she would have seen I take salt tablets and Fludrocortisone. Again I felt like I had to defend myself, explaining one of the main symptoms of Dysautonomia is excessive thirst and I had drunk like this all my life. 

During the preamble before I had been allowed to empty my bladder she had informed my husband and I, that her husband had Postural Orthostatic Tachycardia Syndrome - like it was a badge of honour. She also told she had been diagnosed with Chronic Fatigue Syndrome, although I am left wondering to this day what relevance this had to my own issues. It's not that I wanted to be star of the show but when you attend a medical appointment you expect to be discussing your own issues not that of the medical professional and their spouse.

During the appointment I found out that her husband and I shared a hospital consultant. Her husband had been given the advice to drink 3-4 litres a day. She announced quite proudly that he was on 3 salt tablets - a day. Again I didn't understand where the competition element was coming from and explained that I was on 6-8 salt tablets a day and that the consultant had never set a limit on how much I could or couldn't drink. She couldn't get her head around the fact I didn't solely have PoTs anymore, my condition had worsened. She never really let me explain about my condition as she was too busy interrupting me to tell me about her husbands awful fatigue and chest pain on exertion. It's almost as if she couldn't see me sat in my wheelchair slumping further and further down as I could no longer hold myself up. I came away thinking I am sure this was my appointment where I was supposed to talk about my issues.

When she had informed us that her husband had PoTs both my husband and I were relieved that we wouldn't have to explain everything as we assumed that she would have done some research into the condition. How wrong we were, this was worse than having an appointment with a medical professional with no clue. It became clear that when I rattled off a couple of well-known websites for those with PoTs or Dysautonomia she had never heard of them. She was clueless and could only go on her husbands symptoms which with it being a syndrome and the fact that mine own condition had progressed past that of PoTs were largely ignored. I had described my condition on the questionnaire as Severe Autonomic Dysfunction, she understood what the autonomic nervous system was but couldn't get to grips with how the disorder affected me. Perhaps if she had listened she might have done. She admitted she had heard of Ehlers Danlos syndrome but had no knowledge of it, despite her happily telling me I was the third person on her books with the disorder. Maybe I am being a little hard on her but if I was a nurse looking after three people with the same condition, I would have done a little research about it so I would be more able to understand the challenges those patients face. 

I was becoming irked by her lack of knowledge and the constant comparison between myself and her husband. I felt by the end of the appointment if I heard one more mention of her husbands fatigue I may swing for her. She has no clue that on returning home from the appointment - the first time I have been properly out of the house since the 19th December, I went straight to bed such were the levels of my fatigue. Her opening line in the appointment when going through all my medical issues had wound me up - "Oh it's not much of a life for you" said in such a way that it was assumed that I had a choice in the matter. I responded with "life is what you make it" because I believe that to be true. I live for the good days and manage the shit in between. Maybe I am being too harsh on her maybe she was trying to be empathetic and compassionate. It wasn't doing anything other than rubbing me up the wrong way and I had to play nice as she was the gateway to me receiving additional treatment.

Have you ever been made to feel guilty about drinking 250 ml of diet coke a day? I have, the way she banged on and on about my diet coke habit you'd think I was drinking 25 litres a day not 250ml. She just wouldn't let it drop I was quite amazed at how she let rip. Then next came my tea consumption, now I admit I drink quite a bit of tea 8-10 cups a day but as I am awake from 3.30am most days I don't really think its excessive. Just to shut her up I told a lie and said that they were decaffeinated, all she did was go back to attacking the diet coke again. I couldn't win with her, it was kind of  "mother knows best" vibe I was getting from her. My husband and I have now labelled diet coke as "the devils juice" and laugh hysterically every time I drink it.

It was obvious that she has the same line of patter for each appointment, that caffeine is the work of Beelzebub, along with fizzy drinks and artificial sweetener, all three of which I consume. I was made to feel again that I had brought my bladder problems on myself. My chart was showing her I had an overactive bladder as I was passing less than 250ml on occasion and going 3 or 4 times in an hour. Overactive bladders are caused by a variety of reasons. Some people ( note not all people ) do find relief when they avoid or reduce their caffeine, fizzy drink and artificial sweetener consumption. I was told that I must stop these immediately. I also had to retrain my bladder so I needed to ignore the messages of needing to urinate and try to increase the length of time I hold on. I also needed to start doing pelvic floor exercises at least 4 times a day.

I did manage to squeeze into the conversation that a close relative of mine has Fowler's syndrome and has ended up with a sacral nerve stimulator. The nurse again was a bit prickly informing me that if I had that then catheters wouldn't work on me. I pointed out to her that whenever I have been catheterised nothing passes into the bag. I have to take copious amounts of buscopan to relax the valve on my bladder, walk about, drink, cough etc all in all it can take anywhere from 10-40 minutes before my bladder valve will relax enough to let the catheter work. I almost ended up in surgery in June 2014 when my bladder failed to drain for nearly an hour. It really annoyed me that she seemed to dislike me for having more knowledge than her. I guess she wanted someone who would just let her witter on and not interrupt or challenge her.

However she did concede eventually that there was something neurological going on with my bladder due to the acute urinary retention I keep getting. I have been referred to the hospital for urodynamic testing - which maybe a problem as I am allergic to the dye they place in your bladder, I did mention in my questionnaire I was allergic to it. I am also supposed to be being taught at home how to self catheterise so that I can empty my bladder fully before going to sleep and any time that I feel it hasn't emptied completely. Most days then. I can look forward to having to see her again after being taught how to self catheterise as she will scan my bladder to ensure that I am doing it properly. I am looking forward to being treated like a naughty school girl again no end.

The funniest part of the appointment was when she told my husband if it was easier for me he could learn how to insert the catheter for me. Both of us recoiled immediately. Why on earth would I want him doing that? I can't think of anything I would like less! He can't even be in the same room as me when I am injecting my medication. How on earth would he manage to do it without passing out? A firm "No thank you" was uttered by him and seconded by me. He then added "We like to keep our hobbies separate". I could tell when he said this he had reached the end of his tether with her also. He went back to playing Angry Birds on his phone. 

During the appointment because it was about stuff that makes hubby feel sick (and who can blame him), he kept his concentration focused on playing Angry Birds so he could block out what was said. Unfortunately the nurse didn't seem to understand he wanted very limited participation in the appointment and kept trying to engage him in conversation. He really wasn't being rude, he is very supportive of me, he just isn't so great in a medical setting which is absolutely fine as I can advocate for myself.

There is one thing that keeps going around in my head that really annoyed me (and yes there were some parts that didn't) which was when I jokingly mentioned that one time when measuring my urine the jug had overflowed making the measurement way past 700ml, she immediately snapped back without a moment's hesitation "well I have passed 750ml". I just thought, Jesus you must be an absolute barrel of laughs to live with. Not only had I been entered into competition with her husband, I was now in a real pissing contest with her. What the hell was going on here?

I will be completely honest I have not ditched the devil drinks, why? Because I only get an overactive bladder on the days leading up to urinary retention. I have however started holding on longer rather than going the moment I feel the need to go, which at the moment is working fine. I had got myself into the habit of going frequently because in the past I have found holding on leads to me contracting UTI's or having bladder spasm or finding that I am unable to urinate properly. If I find the new regime on holding on leads to UTI's I will go back to not holding on. Had she given me the time to explain any of this maybe her advice would have been different. 

It was disappointing that the session was dominated by her and her husbands own health issues, not my own. I would have liked the opportunity to properly explain and discuss what was going on with my bladder and bowel. I wasn't given that opportunity. It is a shame that the skill of listening to the patient wasn't employed during this appointment.

Looking back on it now I consider it one of the weirdest and most surreal appointments I have ever attended. Should I have been in the position where I would never had to see her again, I would have happily written a complaint about her. My hands are tied at the moment with her being the one to refer me and organise me being taught how to catheterise myself.

UTI - Urinary Tract Infections
PoTs - Postural Orthostatic Tachycardia Syndrome