Thursday, May 15, 2014

Lion Heart



Is this once lion heart
Only a shriveled core now
This once sinewy, lithe body—that turned, curled, soared in the air
A lump of flesh, withered and unyielding
Selfishly holding to just mere existence
But nothing more
Is this once verdant, crisp life
A pile of leaves
Breaking in the wind
This palimpsest of learning, the lasting wisdom
Simply a prating fool, a soundless voice
A page turns and I’m myself again
The memory of the climb, the climb
So high, so unshackled
So carefree
The rushing water, the many feet above
The sound I’ll never remember
The brightness I still sense
All these, embedded in my flesh
The memory now to keep

Thursday, April 24, 2014

What Helps, Part One



I haven’t posted in awhile and the reasons are good ones. I’ve been living the very good life lately. My mom is doing much better but it will be an ongoing struggle with her health. Yet, my health has improved compared to the nightmare of December-March this year. Who knew? I am also feeling more optimistic and hopeful. I don’t wake up every morning thinking “What’s going to happen? Am I going to make it?” I have enjoyed this sudden plot twist.

I’m going to mention a few things that I am doing right now and what’s making a difference. Managing POTS and dysautonomia can sometimes be a lesson in futility. It’s constant trial and error for you and your doctors. Your doctors will likely not be well-informed about the rare condition, so you get the fun of being a lab rat and experimenting. Something can work for a few months and then suddenly it won’t anymore. I struggle with these four issues every day because of my compromised autonomic system: walking, standing, breathing, eating. You know, being a human being. As I mentioned before, dysautonomia presents differently for each individual, so some may experience similar symptoms or completely different ones. I am always looking for solutions (pharmaceutical and non-pharmaceutical) to manage these four struggles. This is the first list of things I have tried that help me be able to leave the house and be upright and bipedal:

Compression Stockings
DysautonomiaOk. I have made a terrible mistake. I wasted so much time not wearing compression stockings because they have c.h.a.n.g.e.d.m.y.l.i.f.e. I can’t even articulate what a difference they have made. Blood pooling in the legs is the hallmark of POTS and is the reason for the drop in blood pressure and heart rate acceleration. Compression stockings restrict this pooling to maintain circulation. I bought some cheap knee high stockings in 2012 and hated them, so I initially gave up on wearing them. I know now that if you want to try compression stockings, you have to bring the big guns. The quality stockings that work are not cheap. They are jaw dropping, mind-numbingly expensive. I’ve been wearing the thigh high Juzo Soft line and they have converted me. I have worn them every day for the last three weeks and I will never teach again without wearing them. I have actually been able to stand just for a little bit when I teach. My students must have no idea who I am. Breathing when I am standing is much easier as well. You can also get compression stockings at discount surgical but what I really want is some from this site . I am still hoping I can convince my insurance to cover the stockings.

I got a little overambitious because of the stockings and walked around our local mall with my mother for a few hours the other day. I spent the next day bedridden. I’m still recovering from my mistake. Something as simple as walking around a mall was too much apparently, even with the stockings. Compression stockings are great but I still have to limit my time standing. They are not a cure-all. 


I was worried about the fashion options with compression stockings but these are no longer your granny’s stockings. There are all kinds of color options now. I have found that the 20-30 mmHg firmness is best for me but you have to decide what works best for you. When my first pair came in the mail I wondered if I could even fit them on my arm they were so tiny. They have been a game changer for me and I cannot endorse them enough. You also get to wear sexy doning gloves just for putting them on and be prepared it will take a good chunk of your energy to get them on.  I wish I hadn’t wasted so much time not wearing them. I now have to buy some skirts and dresses to tolerate wearing them in the summer. I’m a jeans girl through and through but it’s time to expand my horizons in the name of staying upright. This is a picture of a new dress and my thigh high, footless stockings. Pardon the poor quality and the colorless, haggard look on my face. I can thank the mall for that.


Oh Salt, My Salt
Saltstick Electrolyte Capsules (100/bottle)
Salt Sticks: Not just for athletes
One of the first comments you will hear from a doctor who suspects POTS or dysautonomia is to increase your salt intake. Imagine the cognitive dissonance when a cardiologist tells you this. The body needs salt to maintain blood volume and to hold onto fluids. With dysautonomia, the body struggles to maintain this balance. When POTS hit me like a semi truck while I was working on my PhD, I ate a strict diet of vegetables and quinoa for awhile. I was unable to eat at that time without serious GI catastrophe. I know now that that was a mistake. I needed some salt. I now put salt on every meal basically and have just started taking salt tablets. I avoided taking them for awhile even though my doctors suggested them because I worried I wouldn’t be able to tolerate them. I also drink V8 almost every day and Pedialyte is my go-to electrolyte when disaster strikes. Many people hate the taste of Pedialyte but it makes me feel so wonderful when I drink it that I could care less what it tastes like. I feel alive and human and it has saved me from going to the ER on multiple occasions. Every Potsie I have come across has an electrolyte source they love. I have tried powders, Gatorade, etc but Pedialyte is the best for me. 

Food: Why Must You Be So Good But Scorn Me So?
If you have read the earlier posts on this blog, you will see that the GI issues were the main reason why my life was sucking so hard over the last few months. This battle is unspeakable and the details shouldn’t be uttered in print. It was, is, and will continue to be the most difficult symptom for me. It is the reason I weigh 10 pounds less than my pre-sick self and why my weight constantly fluctuates. It’s more difficult than the tachycardia, trouble walking, dizziness, everything combined. It was one of the first horrific symptoms when this thing started. The worst part is, the GI symptoms aggravate every other symptom. Not everyone gets the GI fun with dysautonomia. The autonomic system controls digestion so it is not uncommon with dysautonomia. Many get gastroparesis, which is its own special form of torture. I see a GI specialist at Stanford in a few months who might be able to tell me what the monster who lives in my intestines really is and how it relates to dysautonomia.

When I eat, I feel nauseous, and if I am having a rough patch, I struggle to be able to get any food down at all. I am constantly looking for ways to manage this. I have been prescribed Zofran for these times, but I always prefer to try to manage without medication and go that route only when desperate. Once you are diagnosed, doctors will tell you to eat small, frequent meals that are low in carbohydrates and I follow this advice without question. I have no other option. I have also become mostly vegetarian—mostly because I still love bacon and I eat fish. Bacon is also high in sodium, so there’s a bonus.

Some people go gluten-free or even vegan, but I would prefer not to because bread and cheese are happiness. I also rely pretty heavily on liquids, soup and Ensure especially. I eat much healthier than I ever have in life, and POTS has been a blessing in this way. I eat a lot of fish and vegetables now. This is from a girl who lived on Velveeta and hot dogs growing up. I don’t like to talk about it.

I can no longer drink coffee unfortunately. Every cardiologist I have seen has told me this. If you have ever been to graduate school, you know that life is not worth living without coffee.  My pulse is still around 130 when I wake up in the morning so coffee is out of the question if I want to be able to function. I’ve been clean and sober from coffee for two years now. Sometimes you have to make sacrifices. I’ll always be a coffee-junkie in my heart.

Food and I have come to an agreement recently and our relationship has improved quite a bit. I stick to a pretty strict diet and to foods that I know that I can tolerate without any problems. It works for me. 

The goal with any treatment or symptom management is to still have an enjoyable life. There may be limitations, but it doesn’t have to be a joyless experience. I’ll discuss more in the next post, including my adventures in pharmaceutical fun land.

Friday, March 21, 2014

Back to the Land of the Living and Results





Well, I went back to work this week. I made it. I did it. Even though I felt incredibly guilty about being on leave, I needed that rest and intervention. I wasn’t going to make it much longer and definitely not to the end of the semester. Going back to work, I felt embarrassed and awkward. With teaching, it’s important to maintain momentum and the connection with students. I was worried I was going to have to start from scratch. I even thought I’d jokingly suggest we all reintroduce ourselves when I walked back into my classes, but as I walked in one of my students shouted “Hey! You exceeded the maximum number of allowed absences on the syllabus and we were going to drop you from the course.” I told him luckily they don’t have that power. We all laughed. It was brilliant and put my fears to rest. I am still struggling with the constant exhaustion and weakness. Over these last few months my energy level has plummeted and I just feel worse overall. I really hope this isn’t a new normal. I'm also dealing with some intense family issues, but my plan is to get some rest and recover this summer and be bright, shiny, and new for fall.  But I’m doing better. My spirit is renewed. I’m ready to keep up the fight and finish the semester with my students.  I’m ready to start enjoying life again. Snuggle my cats, laugh with my husband, do some cartwheels when no one is looking.

A colleague asked me today if I was on leave because of “stress.” I had to hold my tongue and politely inform her that she was mistaken. Sometimes I have to remember to be patient with people because I don’t look sick so they can’t know that even though I show up to work most days,  I’ve spent the last 4 months suffering and being periodically bedridden and needing to go to the ER.  I’ll take it as a compliment that I make chronic illness look good. 

I just wanted to mention the results my neurologist’s nurse practitioner gave me at Stanford for the autonomic testing I did in December. Autonomic testing can confirm autonomic dysfunction, and it is one test that was actually created to diagnose dysautonomia. I was scared out of my mind to do these tests and put it off for over a year, mainly because I did not ever ever ever want to do another Tilt Table Test again. It’s enhanced interrogation, straight up torture. I finally relented. There are three parts to the test: the TTT, the QSART sweat test, and Valsalva Manuever breathing test. This video explains them and you get to watch someone be subjected to them: http://www.jove.com/video/2502/quantitative-autonomic-testing Try to stay awake through it. 

I walked into the testing room on the verge tears and told the neurologist and nurse I refused to do the TTT. The first TTT I did in 2012 was before I was diagnosed with POTS, and I had no expectation for the test. When they lifted the table up, my heart rate, which was attached to a monitor that beeped loudly, went from 72 to 147. I thought some alarm was going off as my heart rate was beeping wildly. The sensation of slowly being lifted to vertical made me want to vomit and pass out. I will never forget that awful sensation. Then, my cardiologist injected me with a medication to make it go higher to see if I would faint. The test proved my days of partaking in the joys of rollercoasters and tilt-a-whirls are over.

Luckily for this second one, they were kind, patient, and nice and they cut me a deal. Instead of the table lifting all the way up to 90 degrees for 30 minutes, they let me just do 60 degrees for 6 minutes. My heart rate wasn’t attached to a monitor and I wasn’t injected with anything. It was a breeze. A neurology TTT is much easier than a cardiology TTT. My heart rate still went from 72 to 147. At least I am consistent. The breathing test was the most difficult but they told me it was normal, which I wasn’t expecting because breathing is a struggle. They told me my sweat test was abnormal and explained that there is some nerve damage so my body doesn’t sweat properly. That’s great for living in an area where it is over 100 degrees for four months a year. They told me I should do more testing for this. I’m not sure what other information that would provide besides confirming I am a weird sweater. I guess I could just put “weird sweater” on my resume and call it a day.
Not the Bill Cosby kind of weird sweater
I also did a nerve conductivity EMG (http://en.wikipedia.org/wiki/Electromyography)to see if the new mystery of my weird walking problem is nerve damage. The test showed no nerve damage. The saga continues and will likely include more testing to figure this one out. I have heard these words mentioned in relation to this new mystery: MS, ALS, Parkinson’s. I’ve learned it isn’t worth panicking about any new possibility until it is a reality.

I’m not sure what the autonomic testing really provided and I don’t really understand the results, so I failed at explaining them to my other doctors. This is the problem with having a rare chronic illness: I often have to be the expert and the line of communication between doctors. I'm not sure what my degrees in literature really prepared me for, but they definitely didn't prepare me for that. I see my neurologist at Stanford at the end of May and I hope he can tell me more about why those tests were useful besides confirming I have POTS. 

I worried about doing those tests for over a year and it wasn’t nearly as bad as I expected. I should have learned a lesson there, but I still panic and stress about every test I have to do. There will be more tests in the future, but I will face them in my battle gear.