Science and the Scleroderma Girl: Hard Choices

Everything happened really fast when I was first diagnosed with scleroderma  and Sjogren’s Syndrome. I had been referred to the rheumatologist after the results of bloodwork that my PCP ordered up. The rheumatologist did an exam and some tests, told me that I had the form of scleroderma called limited systemic sclerosis, and was evasive when I asked him what this would mean for me in the long term. What would my life be like in five years, I asked. He said he needed to run some more tests and would get back to me. He also told me to stay off the internet.

Well, that was kind of ominous, don’t you think? My first clue that this might be rather serious…

I was given a prescription for a disease modifying drug (DMARD) called Plaquenil, a handful of pamphlets, and referrals for additional testing. Lots of testing. Waiting for my prescriptions to be filled I went to the lab to get blood drawn and then sat down to call to make appointment for the additional testing I needed. It was hard to not feel like the sky was crashing down on me.

Cinco de Mayo rose.
Hey, time for a rose break. Look at what is blooming in my garden this morning! 

After 6 months of the drug Plaquenil I was feeling better, so I was a little shocked when the rheumatologist told me that it was time to add additional drugs and that he was going to give me the choice of methotrexate or CellCept. He handed me information on the drugs, ordered more blood tests to determine the state of my liver, and told me to call back in a week to let him know which drug I was comfortable with.

Of course I went straight to the internet. Hello. Science girl here. How should I make a decision without more information? Time to put all that chemistry and molecular biology to work!!

Ugh. After researching both of these drugs it didn’t look too good to me. Methotrexate is actually a chemo drug, given in a lower dose to rheumatology patients to suppress the immune response.  I would need folic acid to try to minimize hair loss and other side effects, and it would knock me on my butt for a day or two each week. CellCept also suppressed the immune system by another pathway, had fewer side effects, more risk of cancer, and was really hard on the stomach. Both drugs had definite downsides. I would need to stay out of the sun to prevent DNA damage. My risk of serious infections, including  PML, a fatal brain infection, would go up. The side effects of methotrexate seemed to be worse to me, but the CellCept would be awful on my gastritis…

If I chose to remain untreated with either of these drugs my chance of developing a fatal complication from scleroderma went up. I was already in the early stages of interstitial lung disease and pulmonary arterial hypertension, both of which could be fatal, so I really did need to try to slow things down with a drug…

Ugh! I was feeling pretty helpless about making the decision. What should I do when the future was unknown? Everything was a gamble and I didn’t have any really good choices.

I called my rheumatologist and told him I wanted to try methotrexate because I was pretty sure that I wouldn’t be able to handle CellCept. It was done.

Jacob sheep
Science and the Scleroderma Girl will be taking the weekend off because tomorrow I am going to the Estes Park Wool Market with my BKB Deb. Any day in the mountains is a good day, but it will be even better with yarn, peeps, and cute sheep. Woohoo! Fiber festival time!!

This whole process was kind of awful. Just knowing how these drugs worked and their side effects wasn’t enough. I needed more info. I needed to hunt down research studies.

Science time!!

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The Scleroderma Chronicles: The lung results are in.

Spoiler Alert: More good news!!

Last week I drove across town to a hospital that is connected to my pulmonologist’s Kaiser office building for my pulmonary function test. If you’ve never had one of these, there is a machine that you breathe into, a computer that is calling the shots and a sealed glass booth that isolates you from the outer world. Into the booth I went. Time to get some answers!

As part of the test I used an inhaler to get a big slug of the drug albuterol. Wow. That really helped. I’ve been avoiding my inhaler for months as I would feel just HORRIBLE after using it due to dropping blood pressure.

But I just quit using my blood pressure medications two weeks ago and now it was really obvious that my breathing was much better after using the drug. “Here, you’d better take this diffuser”, said the technician giving me the tests. “You’re going to be using this!”

Wednesday my pulmonologist called me with the results. My lungs are better than they were two years ago! More to the point, my pulmonary arterial pressure is down into normal ranges and there is less leakage (okay, they call it regurgitation… what an ugly thing to say about my heart!) at that heart valve. Woohoo!! The fatal complication that we all thought I was going to have to face down is suddenly off the table. I’m not going onto oxygen. My doctor and I virtually hugged over the phone.

Here’s the deal. I have a second autoimmune disease called Sjogren’s Syndrome that can cause small airway disease in the lungs. My Sjogren’s has been pretty bad this year, and since I responded to the inhaler drug really well it looks like that is what is going on. My doctors focus on my bad boy systemic sclerosis so much that they tend to forget about this other life-altering, but not fatal, condition. This year Sjogren’s has been stabbing me in the back.

“Time to start giving your inhaler a workout!”, my pulmonologist told me. “Then try to get more exercise. Your lungs need to continue their recovery, and we are keeping you on the high dose of your immunosuppressant drug.”

Inhaler and fitbit.
I bought a fitbit yesterday and I plan to use the inhaler daily while I steadily increase my exercise. Next week I’m going gym shopping…

It’s the drug. It absolutely is the new drug that I’ve been taking for the last 2.5 years. It is a new drug for the systemic sclerosis community, one originally developed for organ transplant patients, that is now collecting a body of evidence that shows that it not only slows down the rate of disease, but also allows some reversal and healing to occur by impairing the immune system attack on the lungs.  My heart is better because my lungs are better. In a time when I have been experiencing chest pain and shortness of breath, it was because I was getting better and needed to come off some of my drugs, not because I was getting worse. I am completely blindsided and gob smacked by the unexpected turn of events.

Next week is the Estes Park Wool Market in Estes Park, Colorado. I’m off to the mountains and boy will I be running wild with my BKB Deb. I’m going to pet the alpacas, eat lamb kabobs, and then I am going to buy a boat load of yarn. My new fitbit will be getting a workout!

After that I’m going to see my internist so she can look at the big picture with me to see what else we’re missing. There’s another drug that I want to drop…

That will be another post.

The Scleroderma Chronicles: My Second Year Report

Well, here I am at the end of my second year since my diagnosis of systemic sclerosis, a life-threatening form of the autoimmune disease scleroderma. Last year I blogged about my illness: I had come through the worst of the grief and horror at the initial diagnosis, had made my way through some scary incidents that sent me flying across town to emergency centers, and was pretty upbeat about where I was in the progress of the disease.  I was sick, but I hadn’t developed any of the most serious, life threatening complications. My heart and lungs were fine. I had just been started on some serious immunosuppressant drugs (the same ones that are given to kidney transplant patients), and while they are risky, I had been told that they could really make a difference in my 10 year survival rate.

Hey, you roll the dice and you take your chances.  No sense worrying about the unknown future. I drugged up and slept like a baby at night.

Star Trek Meme
The Kobayashi Maru test, as all Star Trek buffs know, was a no-win scenario;  it was meant as a test of character. Systemic sclerosis, an incurable,  progressive, disabling and potentially fatal disease, can  also be considered such a test.

Ready to hear about my second year? Let me give you a hint: buckle your seat belt, because we are in for a bumpy ride.

  • November-December: the drugs begin to kick in and as they beat my immune system into submission my skin starts to harden up. I hurt everywhere!! I can hardly bear to comb my hair. The place where my flu shot went in hurt for weeks afterwards.
  • January: I caught the flu. Talk about insult to injury! Here’s the short version: antibiotics, off the immunosuppressant drugs so my body’s immune system can fight back, and then trouble breathing, chest pain, heart palpitations, and a partridge in a pear tree. What a mess! The month passes in a blur.
  • February: I’m still pretty sick and struggling to breathe. I get bounced back and forth between doctors as the debate about the root cause of my symptoms rages. I begin to pressure my doctors for answers and there is much testing. Oops. All is not well with my lungs and my heart is accruing damage. I get sent to a pulmonologist and she give me an inhaler to help me breath. She also tells me I am in serious trouble and refers me to palliative care. The doctors increase my immunosuppressant drug dosage.
  • March: Why, hello, Sjogren’s Syndrome. We forgot all about you! In the concern about my systemic sclerosis, the bad boy of my autoimmune twosome, everyone forgot that I also have Sjogren’s Syndrome, another serious autoimmune disease that causes dry eyes and mouth. As it turns out, it can also cause small airway disease (think never-ending asthma attack) and it has pushed me into chronic respiratory failure. Hello oxygen machine. You are my new best friend.

    Oxygen machine
    My new best friend!
  • April: new lung scans are back, and while I am diagnosed with interstitial lung disease, it appears that it is only mild. Huge sigh of relief!! There is also consensus that my pulmonary hypertension has not advanced. Both of these diagnosis, while still early and mild, are very serious, and the decision is made for palliative care to continue to follow me. Bummer!
  • May-July: Sunshine! Heat! Burning muscles, aching joints, gastritis, dizzy, dizzy, dizzy, and I notice that my lips are blue. I’m on oxygen 24/7 by the end of July.
  • August: my internist changes my meds to bring my heart rate up, and suddenly I have enough oxygen. The heart palpitations stop and after more testing I come off the oxygen. The 6 month Sjogren’s-driven asthma attack is finally over.
  • Quilt and socks
    Summer quilt and socks for my poor hurting feet.

    September-October: why does it hurt to walk? What is up with my feet? And this whole barfing in the middle of the night is getting downright annoying… My internist tests me to see if I have an H. pylori infection.

  • November: Well, doesn’t this beat all. The H. pylori test came back negative and I am diagnosed with gastroparesis. The muscles of my stomach are too damaged by systemic sclerosis to work correctly; the damage is irreversible. I start eating a very limited diet of soft foods and dairy. Ironically, I can now eat jelly donuts, but not fresh baby carrots. I’m losing weight anyway.
Little Greenhouse
The gastroparesis diagnosis hit me hard even though I kind of  knew it was coming. I stopped to get a little cheer-me-up on the way home.  Check out the little greenhouse I put together for the kitchen window. As always, MacKenzie had to help out with the picture.
Flowers
Here’s the flowers. Aren’t these cute? They were sold at the local nursery to put into “Fairy Gardens”
cat
and how could I resist adding the little cat and the mushroom? Those plants are miniature Kalanchoe that should eventually bloom again.

See, a bumpy ride that is still going, but a year that was also rich in gifts. Palliative care forced me to face the future with more courage and to make end-of-life decisions for my family and to start cleaning out my house of junk. I talked to family about my medical power of attorney. I enlisted one of my doctors to manage the medical team and I began to feel more in control of my basically out of control disease. I began to knit gifts for those I love with a purpose: everything now is a piece of me. In my mind the shawls that I am making for everyone I know are the “Good-bye Shawls”. I am on fire to make as many fingerless mitts for other scleroderma patients as I can. At the end of the day, this year was not one of struggle and heartbreak as I dealt with the endless march of a disease that has no pity or remorse. Rather, it was one of care, giving, creative fire, good friends, and the meditative peace of knitting.

Okay, I do get cranky at times, and there has been some crying.  I get short with annoying salespeople because it is so hard for me to shop. I told my ex-husband I was tired of hearing about his “stupid-ass”  motorcycle. I yelled at the cats. I hate when people say, “Well, you look great!” in a way that suggests that I’m not really all that sick at all. I wish that they were there to hold my hair when I hobble to the bathroom at 2am to throw up that nice meal that I hopefully ate but couldn’t digest. There. I got it off my chest, and I feel much better. Aren’t you relieved to hear that I can be petty and mean from time to time?

Tomorrow is Thanksgiving Day. You know, it is easy to focus on the day: travel, turkey, family and the descent into wild Christmas shopping. Sometimes we forget the history of this national holiday; thanks for a good harvest and the blessing of probable survival through the coming winter. It is also a time to reflect on the bounty of the last year and to be grateful for the gifts it brought.

In spite of all the bumps of the last year, I am grateful for all of the gifts I have received.

Happy Thanksgiving everyone!!

A Break in Routine: Oxygen, Snow and Bad Cats

So much snow! Last Friday night the rain started just as I was heading to bed, and in the morning there was already several inches of snow on the ground. It just poured snow for the next 24 hours, and even though there was a lot of melting (thankfully on the sidewalks and streets), it really piled up on the lawns and in the trees. When it was over I had over a foot of heavy compacted snow on the deck and lawn.

Snow on flowers
Sadly the snow hit just as many of the ornamental trees were in full bloom. This tree, which might have been a crab apple, really got socked in snow. 

Trees all over town lost branches as the weight of the snow became too much for them. Ever an opportunist, I brought some of the blooms from broken branches into the house.

Tree branches
They smell great too! 

The blooms were a happy addition to a basically unhappy house. Last Friday just as the storm was getting ready to break I got a call from the pulmonologist’s office; my test results were back and she was ordering supplemental oxygen for me to use overnight. It was kind of a shock as I’d convinced myself that my lungs weren’t that bad. Less than two hours later the machine had arrived and was set up for me to use.

Oxygen machine
Here’s the oxygen condenser that I need to use while I’m sleeping. It buzzes, vibrates, and makes other noises that scare Yellow Boy. Cat harmony is definitely not being maintained. I’m getting used to it pretty quickly; it is kind of like sleeping in an airplane. 🙂 Now that I am getting more oxygen during the night I’ve noticed that my morning chest pain is gone. That’s is a good thing! Sorry Yellow Boy, the machine stays.

You never saw such unhappy cats. Between the snow and the machine they were just miserable.

Cats at back door.
Here they are anxiously waiting at the back door to be let out first thing in the morning. MacKenzie is just awful about this. He starts meowing (yowling!!) and scratching at the wood at 6am. He doesn’t come upstairs to wake me up because, well, machine… 
Cats
Finally I crawl out of bed to let them out. Silly cats, there is snow!! I had to shovel them a path on the deck they were so heartbroken by the state of backyard affairs. Here they are three days after the storm and do they look appreciative? No. They are cats!! They don’t do appreciative…
Cat at computer
Cats do sulky outrage. MacKenzie especially has been a pill all week. He was all over stuff when I tried to work at the computer. He demanded endless treats. He followed me from room to room and participated in all crafting ventures. If I stopped paying attention to him the paw (with attached claws) came out.
Cat
He took to lurking in the “launch tube” part of his cat tree at the back door. Every time I opened the door he streaked out before I could stop him. We had some scary moments when he got past me into the garage and the electric door was closing. Truly, he was a handful all week.
Mac and Me
Tonight it has been a week since the scary machine and the snow arrived, and things are almost back to normal in the cat world. Here he is purring on my lap and posing for a selfie. What a sweet boy. Ha!

This weekend is going to be nice and the last of the snow should melt. The cats are slowly adjusting to the new machine and this morning we slept in a little. All is once again right in the cat world.

Next week’s forecast: thunderstorms!

I haven’t told the cats yet.

 

 

Trail of Crumbs

I have been struggling for weeks and weeks now. I had the flu not long after Christmas and it just never completely went away. I have a pain in my chest, a cough, fatigue, and I just run out of air more easily than I should. Seriously. I have trouble talking and breathing at the same time if I come up the stairs at home. This isn’t reasonable. I was having trouble climbing stairs before I got sick, but now things are ridiculous!

This is the joy of life with a serious chronic illness. There are so many little symptoms and problems it is hard to know what’s important and what is just another day of systemic sclerosis. I tend to wait out symptoms for a couple of weeks before I contact a doctor; then I’m at the mercy of waiting for lab results and a call back. Ugh! Things drag on for days and weeks as I process through my medical team asking them to find out what is wrong with me.

Cat
Mom stays in bed all day reading mystery books that feature a librarian and a giant Maine coon cat. What is up with that?

For two months I have been bouncing back and forth between my rheumatologist and my internist. My rheumatologist has been concerned that my heart is misbehaving (and sends me on to the internist), and the internist suspects that my lungs are to blame (and refers me back to the rheumatologist). It’s like following a trail of crumbs hunting for answers to an ill-formed question. No test result provided a clear diagnosis.

Except I can’t breathe, and it seems to be getting worse.

Two weeks ago on my way home from my weekly knitting group I was hit with a surge of assertive self-determination. Time to stop acting like a victim, I told myself. Instead of going home I drove for another hour north and requested a full copy of all my medical reports from the hospital where my pulmonary function and echocardiogram tests were done. I knitted on my shawl in the lobby while waiting for the reports, and then took them home with me in my knitting bag.

Shawl
Look at this shawl! I’m through the first section of short row lace. This is the Waiting for Rain shawl by Sylvia Bo Bilvia.

I am a lucky, lucky woman. I have a molecular biology degree and I once worked in a rheumatology research lab. I taught advanced placement biology for years and I know a lot more anatomy and physiology then the average patient with my condition. I should be able to follow the trail of crumbs within the stack of medical records, I reasoned. I laid out the lab reports in sequence, looked for patterns of change in my lung and heart test results, and took to the internet to understand what strange acronyms meant. I found a presentation that explained pulmonary function tests. Well, dang. Even though the summary notes from the physicians who interpreted my lab test used words like mild, early, and upper range of normal, it was clear to me that my lungs were getting worse over time. Maybe a lot worse.

I emailed my rheumatologist a note telling him that I had picked up up my tests and saw that my results suggested early interstitial lung disease (the summary of the latest test). I reminded him of my symptoms and asked about next steps for me in addressing/diagnosing my ongoing problems. Here’s the deal: an email is part of my official medical record. More than a phone call, it should provoke a response.

Oh, it did! I received a call within an hour from his office. In the next week I had two phone conferences, another echocardiogram, and a referral to a pulmonologist. I was able to refer to specific data in all of my conversations with my doctors. I got a prescription for a badly needed rescue inhaler. Finally! Forward progress!!

Yesterday I saw the pulmonologist. It was a beautiful warm day and a perfect drive through the countryside to get there. What a wonderful, wonderful doctor! She made it clear that I am not over-reacting, I do need better coordination of my health care, and she will be a warrior for me. I wanted to hug her. Here’s what happened during the visit:

I do have interstitial lung disease, and it is serious; almost 20% of my lung volume is already gone. This is bad news because it happened while I was receiving drugs to treat the systemic sclerosis. I will be completing more tests over the next week to nail down the diagnosis, but there is already so much damage that she will coordinate immediately with my rheumatologist about treatment options; she sent him the message while I was still in the office. I think that I will be seeing more/different meds in the near future. I may be going on oxygen overnight. I hope that I don’t have to do IV infusions. I have been referred to palliative care and will be receiving a case manager to help me locate resources and to coordinate my ongoing care with the medical team. I plan to ask the case manager if I should be referred to a scleroderma specialist at the University of Colorado, but I totally want to keep this pulmonologist!!

After so much time trying to get some answers/help the response was actually overwhelming. I came home and for the first time since I was diagnosed I cried.

Welcome Bear
The front yard “welcome bear” could still be seen between snow drifts when I went out to shovel. Cute, huh!

Today I woke up to a full-blown blizzard; howling wind and almost 2 feet of snow! I didn’t get any calls about medical appointments and I certainly didn’t make any. I knitted, shoveled snow (slowly!) and enjoyed the break from the immediate crisis. I started the next book in my mystery series. I worked some more on my shawl; it is going to be beautiful.  My roses are safely enveloped in an insulating three foot drift of snow.  I was able to successfully advocate for myself and secure medical treatment. Tomorrow the sun will be back out and I will start scheduling appointments.

This is not the journey that I would have chosen for myself, but I will travel it as well as I can, knitting, reading and tending my roses all the way.

Life is good.

 

When the going gets tough, the tough get… knitting!

This is it. I’m pretty sure that I am back. Right after Christmas I got sick with the flu, one thing led to another, and I was taken off the drugs that I take to treat my systemic sclerosis (scleroderma). Yep. My autoimmune condition flared of course. Two weeks ago I was finally cleared to start my immunosuppressant drugs again.

Hello energy! Wow. This week a surge of creativity arrived. I was up and pulling together projects right and left while cleaning house (and putting away the Christmas decorations). About freaking time, huh. My poor yarn stash had started to despair. The loom was considering contacting an adoption agency (that darn spinning wheel put it up to it. He has always been a trouble maker…). Even the car was becoming depressed.

My energy level has come up just in time. Three weeks ago my internist sat down with me and gave me some bad news: I have developed symptoms that suggest that my lungs are now under attack and becoming scarred. I kind of expected it as I have been having shortness of breath episodes, but still it isn’t a good development. I made an appointment with the rheumatologist. Yesterday I saw him, he decided to increase my drug dosage, and he also ordered lung testing for next week. When I came out the door from the clinic the wind was blowing, the sun was shining, and I was happy to be alive. No matter what happens next week, this week I am full of energy and feeling pretty good. Got to love these drugs!!

So I decided to not go right home. I went shopping!! Hello! The rheumatologist is located in a city north of Denver near a major yarn store, Shuttles, Spindles and Skeins in Boulder, Colorado. I have needs. The loom is making threats…

Home woven dishtowels
At Christmas my cousin admired my dishtowels. I want a couple more of the white/color checked towels, and she wants the towels with no white. Time to warp the loom, but I am out of the white and light blue cotton. There. That is a good enough reason to go to the yarn (and weaving) store. 🙂

I found the cotton that I needed pretty quickly. As I tried to walk to the checkout counter I happened to see the Dream Club kits…

January Dream Club
The January Dream Club kit had this dreamy cashmere blend fingering yarn and a pattern to make cute mitts and a head scarf. The pattern is called Blue Jean Boheme (by Kalurah Hudson) and while I’m not wild about the scarf, I really like the mitts. I bet I can get two pairs of mitts out of this yarn. Maybe a pair of mitts and a pair of bed socks…

While I was thinking about the bed socks the happy colors of the February Dream Club kit jumped out at me.

February Dream Club
Cashmere blend slippers in the happiest colors ever! This is the February Dream Club kit and the pattern that comes with it is called Pleasant Pheasant Slippers by Lara Neel. Say that fast three times! The yarn is worsted weight and called Classy with Cashmere.

I don’t know how those kits jumped into my arms. It just happened. Clutching the cones of cotton for the dishtowels and the bagged kits I managed to get up to the check out counter and found…

Isn't that the truth!
Isn’t that the truth!

Okay, I did find some more yarn to add to the pile, but I’m going to save it for a future post. I piled back into the car with all of my happy finds and headed south back towards home through some of the strongest wind in recent memory. Seriously, I was dodging tumbleweeds (while on an elevated overpass!) and playing chicken with wobbly tractor trailer trucks as I raced along through clouds of dust and howling 60 mph wind. It perfectly matched my mood of recklessly joyous living.

My last stop on the way home was at a jewelry store where I bought a new teal colored bead for my Pandora bracelet.

Bracelet
Teal is the color for scleroderma awareness ribbons. This is my own personal “Be Brave” bracelet.

I am rocking the knitting tonight wearing my bracelet. This weekend I will get the warp wound for the dishtowels and the loom will get warped up early next week. You know I’ll be wearing the bracelet when I go for the pulmonary function testing next week.

I am tough. I knit!!