I’ve been continuing my adventures in cardiology over the last several weeks. If you have been following along on my scleroderma adventures you know that I had a trip to the Cath lab that led to the discovery of a cardiac shunt: a hole in my heart. I also was eventually diagnosed with exercise-induced pulmonary hypertension and started on drugs to treat it, which is a lengthy process as I was slowly titered up on two different drugs while monitoring for side effects. I’ve been mostly living in bed for the last 6 weeks except for short trips out for more testing and blood work. The cats have been loving this, by the way. I’m kind of their captive right now.
This is edema in my arm. I’ve been dealing with headaches, muscle pain, edema, low blood pressure, and extreme fatigue. I cough a lot. Every new weather system is a nightmare. Ugh!
While the whole process has been pretty difficult, I am breathing much, much better and that blue lipped thing has mostly faded away. No more panting!! I haven’t had to put my head down because I felt faint for weeks. This is huge, people!!
I may have to retire the whole BLZ logo the way things are going!
My cardiologist is still hunting for the shunt that was detected in the Cath lab. I have one that they can see (a patent foramen ovale, which is pretty common), but for the really significant disruption of circulation that was detected in the Cath lab the feeling is that I have something much bigger somewhere. I’ve gone through 3 rounds of testing looking for the dang thing, and so far, no joy.
When the test results come in, I always read the entire text and google terms that I don’t recognize. The last imaging of my heart did not find the shunt, and my cardiologist sent an email letting me know that my heart looked pretty good. Umm… okay, but where is that infernal shunt?!!! This is getting a little frustrating, but I am doing better, so I guess I should just roll with it. I did notice this little sentence in the report about the portion of my lungs seen in the heart imaging: “There is mild subpleural reticulation and bibasilar atelectasis.” Say what? I googled and …. bibasilar atelectasis is a partially collapsed lung. I shot off a little email to my pulmonologist to ask if this was something new.
This is why I decided to write this post. As it turns out, this is new. Both of the things that were noted in that test result were significant (subpleural reticulation is evidence of scarring in my lung), and I was immediately sent to get a specialized lung scan that shows I have sustained moderate advancing lung damage over the last 10 months. Oh. No wonder I’m so exhausted. At least they didn’t use the word “severe” in the report. I seem to have developed pulmonary edema and my lungs took a big hit during the last few months; scleroderma is now attacking my lungs. If I hadn’t read that report and then contacted my doctor, no one would have picked up on this. The BLZ may be on hiatus, but the lessons she learned during that drive for the pulmonary hypertension diagnosis really paid off now.
What do you do when you get a sad little lung report? Why, you put on your Catzilla shirt and go start a load of laundry, of course!!
Tuesday I go for a pulmonary function test and then immediately afterwards I will meet with my pulmonologist. I’m kind of thinking that there might be more drugs in my future. Anyway, there is a lesson here that I decided I should share with you all.
Be proactive! Read your test results and ask questions of your doctors. Google is your friend, and those online portals that let you shoot your doctor an email are priceless! Use them!
And now readers, back to the shunt hunt…
Mateo: and now readers, back to my nap! After that I’m going to go swat some more helicopters!
Well, this is a hard topic to write about. Quite frankly, I have been getting my butt kicked lately by my (wait for it) rare diseases. Still, I am trying to respond to the calls for publicity about rare diseases along with other members of the scleroderma and pulmonary hypertension communities.
You know, I feel like I should represent.
People with rare diseases are referred to as “zebras” in the medical community.
So, what’s a rare disease? A rare disease is classified as one that impacts a small percentage of the total population. Here in the United States that means fewer than 200,000 people diagnosed with the condition/disease. Perversely, there are a lot of people with rare diseases as there are almost 7,000 different rare diseases! Some of these diseases are common enough that you may be familiar with them: albinism, achondroplasia (a type of dwarfism), and autoimmune hepatitis are examples. Others are very rare. Most are genetic in origin, and half of them impact children. More than 90% of rare conditions have no drug treatment.
The type of scleroderma that I have, limited systemic sclerosis, is considered rare as there are about 100,000 people in the US with this diagnosis. The latest diagnosis added to my medical history is of pulmonary arterial hypertension, another rare disease, and one that is a consequence of my scleroderma. Well, I am really rare now! I have struggled to explain my scleroderma to people when they ask; how can I explain in just a few sentences something that is just frankly causing horrific damage to my body and generating an ever-growing list of diagnosed conditions. Here’s my best answer at the moment:
Scleroderma is a chronic, progressive, uncurable, and often fatal autoimmune disease that causes scaring and damage to blood vessels, skin, internal organs, and muscles/joints. It is controlled and treated through the use of immunosuppressants and drugs that address symptoms. It is a life-altering diagnosis. It is my life.
So, I have blogged about Rare Disease Day several times in the past. Here’s what I wrote a couple of years ago, and what I wrote in 2018. In the past I have written about my symptoms and the struggle of living with a rare disease. It is pretty isolating. It is hard to get diagnosed and treated. I have also written about the difficulties to get funding for research for rare diseases and conditions, and the lack of treatments and cures because the patient population is so small.
This year I thought I would share some of the things that doctors have said to me since my scleroderma diagnosis. I’ve tried to organize these into chronological order to better reflect my journey.
My internist: It’s good to have a diagnosis, even if it is a shame.
My rheumatologist when I asked him what my life would be like in 5 years: Let me run some more tests, and then we can talk.
My ophthalmologist: Do you have a will?
The physician at the regional acute diagnostic center: This is a diagnosis like cancer. Of course, some cancers can be cured.
A physician speaker at a scleroderma support group presentation: this drug [the immunosuppressant that I take] can really give you a chance, as long as you don’t contract an infection.
My old rheumatologist: All you do is complain. Maybe I should order a sleep apnea test or prescribe antidepressants.
My internist, as I begged for an anti-inflammatory drug: I’m sorry. There isn’t anything that I can give you that won’t hurt your kidneys.
My dermatologist, as she prescribed an anti-inflammatory topical gel: This is unacceptable, and I am putting a stop to it now.
My new rheumatologist as she orders more testing on my painful joints: Why has no one followed up on this?
My rheumatologist two days later: You need to get a steroid injection in your hip joint as soon as possible.
The hip specialist: There is nothing more that I can do for you because your scleroderma is attacking all of your tendons and ligaments. You need a hip replacement, but it will fail.
The physician at urgent care: I don’t think they understood how complicated your medical status is when you were referred here. You need to be hospitalized because we can’t do the testing that you need here.
My pulmonologist as he walked me back to the waiting room: I really admire your attitude.
My cardiologist as I was being sedated for a right heart cath: Don’t worry. I’ll take good care of you.
My cardiologist as he started me on medication for pulmonary arterial hypertension: This is challenging, and we will need to be comfortable with “out of the box” thinking.
My rheumatologist last week, referring to herself, the cardiologist and the pulmonologist: We are your team!
My rheumatologist, also last week: We need to add a gastroenterologist to the team.
You can see how rocky the start was. There is a lesson here, I think. To be rare, to be a zebra in a medical community that is designed to identify the most likely cause of symptoms in a herd of horses, is hard. It is really challenging to secure the care that you need when, no matter how hard doctors try, you do not respond to the usual treatments, and you never fit the usual profile. It is easy to be seen as a problem. It is hard to keep insisting that there is something wrong when all the test results say you are okay.
Even when you are blue-lipped and panting it can be hard to convince doctors that there is a problem.
And yet, it is possible to get there. Over time, with great determination and persistence, I have A TEAM of doctors who view themselves as active collaborators in my care. They message each other to discuss test results and possible drug interactions, and they loop me into their discussions. It is only now, newly diagnosed with a terminal condition, that I feel confident and hopeful about my care.
Today I went in for a blood draw and a little jaunt through the local bookstore. The sun was shining, I bought a Starbucks coffee, and it was a good day.
****************************************
My scleroderma-related diagnoses:
GI tract: difficulty swallowing, hiatal hernia, GERD, gastroparesis, chronic gastritis.
Heart and circulatory system: grade 2 diastolic dysfunction (a type of heart failure), Raynaud’s phenomenon, telangiectasia.
Muscle/Skeletal: fibromyalgia and severe joint damage.
This is scleroderma. I’m a zebra, and these are my stripes.
Happy Rare Disease Day, everyone!
The colors associated with my diseases are teal (scleroderma), purple (Sjogren’s), and periwinkle (PAH). It sounds like the start of a great sweater, huh. 🙂
It has been an eventful week in big and small ways. I had been mostly in bed for most of a week as I struggled my way through two snowstorms with significant air pressure drops. Ugh. I had chest pain, coughing, heart palpitations, and more sleep than I want to admit to. Towards the middle of the week, I went off my immunosuppressant drug and the flare of my disease(s) arrived over the next two days. Ugh. So predictable, but still discouraging. I dragged myself together on Monday, double masked, and made it to the pharmacy where I had an appointment for a Covid-19 booster that afternoon.
Mateo: Do I need a booster too? Here’s my arm…
I have this really wacky sense of humor. The entire experience just kind of cracked me up. You see, I got the appointment at my local grocery store’s pharmacy. Here are some of the highlights:
I have had so many shots at this point that they had to use the back of my vaccine card. At this rate I will need an accordion-like pullout for the vaccine information in a few months.
Why so many shots? I’m immunosuppressed. I went off my drugs this time to give my immune system a better chance of responding to the vaccine.
The staging area for the shot was at the Fritos display across from the pharmacy. Seriously, the pharmacist said, “Go stand with the Fritos and wait your turn.”
The shot was easy, peasy. I think that the syringe was spring loaded it was so fast. “Go walk around the store for 10 minutes before you leave,” I was told.
So I waved goodbye to the Fritos and walked around the store. Mostly I just looked at the empty aisles for the 10 minutes feeling sorry for myself. No milk. No Snapple. No cat food. No guacamole. NO GUACAMOLE!!!! Oh, yeah. Genius me scheduled the booster shot during a grocery store strike by the competing chain’s employees and this store was basically stripped of essentials by the descending horde of shoppers who didn’t want to cross the picket line. As they shouldn’t. But they could have left me a little guacamole, don’t you think?
I was able to get the cats a Boston fern to replace the palm that was chomped to death by… I wonder who could have done that? Hmmm…
I also got a Starbucks. Not the worst trip out of the house. I ended up with a sore arm and was so exhausted that I slept for 12 hours.
Today, 48 hours after the booster shot, I feel great!! The flare is gone. I haven’t felt this good in weeks. This happened to me the last time I got a Covid booster. I think that it must be the increase in antibodies or something; I’m so immunosuppressed that my gamma globulins are way too low (a medical condition that my doctors are just ignoring because I do have enough white blood cells). Maybe the boost in antibodies following the shot actually makes me feel better somehow. Maybe my white cell count goes up. It’s a mystery. I’ll take the win!
And in that winning mood I went to see my cardiologist for the first time since my trip to the cath lab last fall. I was a little short of breath but was walking okay when I got to the office. I received an EKG test and the nurse checked me in:
Nurse: “And do you exercise regularly?” (in a judgmental tone of voice…)
Me: “Oh, please. Let’s not even pretend that I am able to exercise!”
Nurse: “Oh. I’m so sorry that I asked you that…” We both started laughing, but I meant it! I am so over feeling defensive about being unable to exercise. In fact, trying to exercise with my condition was damaging my heart.
I also think that I had my snark on under my mask.
Then the doctor came in!
My cardiologist is freaking awesome. He asked lots of questions about how I was doing. (Face now mostly not blue. Yay! Some panting and chest pain, but so much better. I went up a couple of flights of stairs with no problem.) We discussed the fact that I don’t fit the usual diagnostic model for pulmonary hypertension but based on physiological changes consistent with PH and my dramatic response to treatment with a PH drug, he made the call and entered the diagnosis. The matter is now settled until new data comes along.
Exercise-induced pulmonary hypertension. As in, you look perfectly normal when you are on the table getting your lung/heart tests, but the minute you exercise all hell breaks loose in the blood vessels of your lungs. Fabulous. There is a really invasive testing protocol that I could be subjected to, but there is enough evidence now to establish the diagnosis without it. The diagnosis became part of my medical record today. At last.
It has been a long time coming!!
It has been almost exactly 5 years since the BLZ began her journey to find help and answers. This has been really, really hard, but I made it.
We discussed the pros/cons of more testing. We talked about the risks and benefits of adding a second drug to the one I’m already on. We talked about who will take over management of my PH (he will) and how he will integrate with my rheumatologist. We talked about how important it is to be comfortable with “out of the box” thinking when dealing with a patient who is basically at the far end of the bell curve… in other words, a zebra. Oh, I like this guy!!
I agreed to start the additional medication which will be added to the one that I’m already taking. There will be more side effects as this second drug kicks in and I will be getting several phone calls to check on me as I start it. The plan is to try to slow down my progression before I develop full blown PH.
Next up: more testing to hunt for that dang hole in my heart. It’s like a snipe hunt, but so much less fun. As in, heart surgery anyone?
I’m almost 10 months old now. What do you think of my ruff?
The Mother of Cats isn’t feeling well today so I am hanging around with her on her bed. I’m helping her write on her computer right now! I’m such a good boy!
I’ve been bringing toys onto the bed so she can watch me play with them.I chewed on the palm plant downstairs to keep up my energy.I then helped the Mother of Cats with her knitting. I’m such a great helper!!I groomed my sister so she would let me sleep on the cat tree with her.I’m the best CoalBear ever!!
Happy Caturday everyone!!
May you all have an excellent day!
Notes from the Mother of Cats:
I’ve gone off my immunosuppressant drug so that I can get my Covid booster on Monday. Sigh. There was a big pressure change yesterday with a cold front that triggered some symptoms along with the predictable flare of my disease that has me back in bed for the weekend.
I’ve been in lockdown for two years and I desperately want the booster because my next round of medical appointments starts in another week. I also want to start knitting with my new-found groups, too. I want some of my life back!!
Please think of me and the other people in a situation like my own (high risk, immunosuppressed or immunocompromised, and struggling with chronic conditions that complicates their lives on the best of days) when you are out in public.
And wear your mask!
ps: I threw out the palm last night. It wasn’t a match for the CoalBear and I was afraid it would make him sick. Next up: a Boston fern.
This is the last update for the year 2021. You know, 2020 was a pretty bad year for both me and the world, but 2021 just plain outdid itself. THIS HAS BEEN A HORRIBLE YEAR!!!! Seriously, I have been reflecting on all the horribleness of the year, and it is multilayered in the just plain awfulness of it. Here is some of the angst, anger, and sadness in a nutshell.
If you aren’t wearing a mask these days, shame on you!! I have been in lockdown for two stinking years (!) and I am over all your anti-public health nonsense.
If you are one of the doctors who told me that there wasn’t anything that you could do for me (and to not come back), or that I had sleep apnea, or that I needed to exercise more, or that my tests showed that I was fine and you would just continue to monitor my symptoms… shame on you!!! I finally received credible diagnoses this fall (from new doctors) that explained my symptoms. You know, the ones that you ignored or dismissed all those times I came to get help… It is good to get diagnosed, but in this case it is also a mixed blessing as my condition cannot be reversed and management is going to be difficult. Shame. On. You!!!
If you are one of the people who believe that the election in the US was stolen and that the answer is to impede the ability of American citizens to vote, or to create a provision that allows the legislatures of some states to just overturn the results of elections, or to resort to violence… shame on you!!!!
Did you notice that the number of exclamation marks kept growing? That’s how much shame is attached to those targets. There, I got that off my chest and let’s hope that things go a little better in the coming year.
True to its rotten black heart 2021 went out in absolutely dreadful and ironic fashion. First the dreadful.
We are in an extreme drought where I live and everything is brown. The grass, the fields, the bushes and even some of the evergreen trees are now brown.
Last Thursday, December 30th, we had a high wind event in my state of Colorado as a major weather front pushed its way towards us over the Rocky Mountains. In the area around Boulder, Colorado the gusts were extreme (one was clocked at 115 mph) and the sustained winds through the day were around 75 mph. Several fires started and swept through dried fields and brush towards housing developments and towns with horrifying speed. There was nothing that could be done as subdivisions, stores, and hospitals were evacuated; the fire crews set up base in the parking lot of a mall where they could best defend themselves while waiting for a break in the wind. No joy there throughout the afternoon and early evening. There were heartbreaking scenes of burning homes by others covered in Christmas lights. People parked along the major freeway hoping to see if their home was still standing. The historic downtown area of a town I have frequented in the past was lost.
At around 3pm I realized that the worst fire was near my son’s home in northern Westminster. As the evacuation zone continued to grow to within a mile of him we started to make plans to get him and his pets out safely. It was a nightmare as firetruck after firetruck rushed north towards the fire line in the night past his windows. By midnight the winds had died down, the fire stopped its spread to the south, and my son was safe. Daylight the next day showed that the damage was just horrific. Almost 1,000 homes have been lost, thousands are displaced, and the hunt for the missing is ongoing. There is information about all of this here.
Then the storm arrived on New Year’s Eve.
In a cruel twist of irony, after failing to deliver any real snow all fall and early winter, the winter storm arrived New Year’s Eve with snow, icy roads, and bitter cold. Like, we started the day at 3 degrees Fahrenheit yesterday. Serious, serious cold after weeks of warm sunny weather. All those poor people who escaped with only the clothes on their backs in the wind/fire event now have to deal with this. Bad 2021, bad!!
And that, thankfully, was the end of the year.
I also finished my Kevat sweater in the final days of the year.
It is wet and blocking in this photo, but not finished. See the loose ends of yarn?
I did finish the sweater with the ribbing and I-cord to make nice open and clean edges. I decided to block and try on the sweater again before knitting on a little lace edging onto the bottom; if the length is exactly right there won’t be any lace added. I did do a little math, however, and I do have exactly the right number of stitches to do the lace. It’s a sign, right?
Mateo: Happy New Year
Hannah and Mateo (AKA the Coalbear) and I all wish you all a Happy New Year. May things take a turn for the better with the coming weeks and months.
And 2022, you had better behave yourself or I’ll be sending you out on a walk of shame, too. I do have to warn you, however, that I am a little concerned with how you are starting out…
Because this year we are going to learn how to cope with a million new Covid cases a day in the US, and I am going to deal with this whole broken heart thing that I have going on, and we are going to f*cking save democracy. Shape up quick 2022, because this is the tough time, and you had better show some backbone, because I expect you to fight like you really mean it for the things that are really important.
At last. I mean, this has been going on for more than 5 years and had reached the point of utter absurdity. If you haven’t been keeping up on all of this, I have been struggling with shortness of breath and sporting blue lips for way too long. I also have pretty significant fatigue, chest pain, and major muscle and joint pain. I’m a mess.
I have a rare autoimmune disease called limited system sclerosis(scleroderma) which makes me high risk for lung and heart issues. People with rare diseases are called “zebras” in the medical community; since I’m sporting blue lips I’m the Blue-Lipped Zebra (BLZ). Got that?
My doctors do routine testing to monitor me for heart and lung conditions associated with systemic sclerosis; each time I had an echocardiogram and a high resolution CT scan the results were that I was… fine. No indications of a major problem.
But I was absolutely, positively not fine. I began to refer to the reassurances that all was okay as medical gaslighting. I transferred to new doctors. I got copies of all my test results, did lots of google searches, read research papers and articles in medical journals, and began to have evidence-based discussions with my doctors. They ordered up more aggressive testing of my heart and lungs. I posted about the my right heart catherization and CPET here if you want to catch up.
Last Monday my cardiologist called and gave me the final diagnosis. I have a type of pulmonary hypertension that is exercise-induced that is being complicated by a cardiac shunt in my heart. At rest, for all those previous echocardiograms and CT scans, everything was fine. When I’m in motion it is another story.
So, what exactly is pulmonary hypertension and why am I, as a systemic sclerosis patient, at high risk for it? In the most simple terms, the interiors of my lung arteries are narrowing due to scleroderma scarring and tissue growth; as the openings get smaller, the pressure of blood flowing through the arteries gets higher.
When we exercise the body needs more oxygen delivered to tissues; arteries constrict to raise blood pressure, your heart speeds up and your respiration rate increases. In my case, that constriction of arteries in my lungs makes the blood pressure in the lungs increase too much; blood struggles to get through the pulmonary arteries, and the downstream pressure in my right heart forces blood to flow from the right side, through the shunt, and into the left. My body’s blood pressure zooms up as the left side of the heart fights to push blood out of the heart past the jet of blood coming in from the right side through that dang hole. It’s a catastrophic cascade that happens in seconds, and the entire phenomenon is being driven by my systemic sclerosis created pulmonary hypertension. “You’re a challenging patient,” my cardiologist told me as we talked about my future treatment. Yep. That’s me. A challenge. I excel at challenges.
Last week the new medication that my cardiologist prescribed was shipped overnight express to me by Kaiser’s National Specialty Pharmacy. Kind of unusual, right? That’s because pulmonary hypertension is rare, so there aren’t that many people taking this drug in the US. If I was a Blue-Lipped Zebra before, I am now a BLZ wearing a crown. A periwinkle crown, of course, for pulmonary hypertension.
Hannah: I should have a crown!!
When I started this scleroderma journey one of my doctors told me that it was good to have a diagnosis, even if it was a shame. This is true. I’ve learned a lot since my first blood tests came back hinting at an auto-immune disease that generated a referral to a rheumatologist.
I’ve learned to be patient. I’ve learned to advocate for myself. I’ve learned to take the initiative to learn about my disease and to become an active participant in my treatment plan. I’ve learned to face down the monster and to go on with my life.
Five years ago I came down with the flu and ended up in Urgent Care struggling to breathe. I scored some antibiotics, steroids, and cough medicine. To fight the virus I was told to go off my immunosuppressant drugs for a few weeks until I got better, stay in bed, and load up on chicken soup: it took a couple of months but eventually I got back on my meds. Except… things weren’t quite right. I panted for air every time I came up the stairs and I noticed that my lips were turning blue. My blood pressure was too low and I had to stop taking my hypertension medicine. I felt dizzy and light headed sometimes.
I was a newly diagnosed systemic sclerosis patient and my doctors began running tests to see if my disease was impacting my lungs. Nope. Not my lungs. Tests were run to see if scleroderma was attacking my heart. Nope: my heart seemed to be normal. There were some anomalies, but my doctors decided to just monitor me through routine testing and see if things changed down the road. My red blood cell counts were way too high, and I had nocturnal hypoxia, so I was started on overnight oxygen. I was tested for various conditions that could account for the weird test results, but I always had a normal result.
I struggled on, battling for more testing, as my doctors kept reassuring me that I was okay. Hey, I had a blue face and panted for air when I climbed stairs; vacuuming could put me on the floor. How could this be “normal”? Ugh. Welcome to scleroderma, I thought.
I began to think of myself as the Blue-Lipped Zebra (BLZ). If I didn’t have a rare disease confusing the issue I would be getting better health care, it seemed. If doctors didn’t tend to apply most-common-cause thinking to my condition they might get to the bottom of things faster. It was, in my mind, a huge complicated mess as my doctors applied best practice (and rigid) diagnostic parameters to my symptoms or zeroed in on specific complications of my scleroderma and ignored other possible (and to be fair, rare) causes for my symptoms. I worried that my doctors had just parked me in a holding pattern as I slowly got worse; it is hard to advocate for yourself when you are sick and dependent on your doctors for help, even if you think that they are dismissive and borderline disparaging.
I struggled on as my face became more blue, my red blood cell count higher, my panting for air more common, and the occasional near-fainting event left me collapsed on the floor. I began to ask for a right heart catherization procedure to directly measure the pressure in the right side of my heart. “Oh. You don’t want that,” I was told. “That is really invasive testing.” Umm… I think I do, I would reply. Nope. Nope, nope, nope!! “Not even on the table,” one pulmonologist said.
During lockdown last year I got much worse; ironically lockdown also gave me the opportunity to reboot, fire my old doctors and acquire new ones. My new team of doctors this spring ordered up testing that showed definite issues with my heart and lungs. I am now a heart failure patient (the wall of my left ventricle are too stiff and scarred to beat well) and there were concerning findings that suggested that I had developed pulmonary arterial hypertension (PAH): there are areas of cell death in my lungs and my pulmonary artery is too big. There is too much fluid around my heart, a suggestion of ongoing inflammation. I have a hole in my heart between the atriums (a cardiac shunt) that is impacting blood flow. I was gently prepared for the PAH diagnosis, assured that there were great drugs that could help me, and a right heart catherization was ordered by my new cardiologist.
Yay!! About time!!!
Finally, after 5 years of struggle, I was yesterday wheeled into a procedure room to a waiting team of specialists who hooked me up to equipment and took me though testing to get a better look at my heart: I learned in recovery that this team calls themselves “the pit crew”, and that is exactly what it was like. Within 5 minutes I had completed a breathing test, was on oxygen, wired up to a heart monitor, hooked up to an IV, medicated, prepared with surgical drapes, and swathed in warm blankets with a heater by my feet. There was music playing and the crew was cracking jokes as they darted in and out from the table getting me ready. I was knocked out for the echocardiogram imaging of the back of my heart that was done using a probe in my esophagus, but they woke me up for the main event: the right heart catherization. My cardiologist inserted a probe into the carotid vein in my neck and threaded it into my heart by way of the superior vena cava (blue side of the heart diagram above). People, this was the most amazing experience ever! There was a huge screen showing the progress of the probe and I could watch and ask questions as the line snaked through my heart; there was absolutely no pain. “Well, this is interesting,” said my cardiologist at one point, and there were more measurements happening and a flurry of new activity from the team. The BLZ felt a surge of elation: they had found something, and it was NOT what they expected.
Back in recovery my cardiologist caught up with me again. I had done great, he said, and he just beamed as he told me that I absolutely did not have PAH. This is great news, he assured me, great news!! There is another circulation problem in the lower part of my heart, between the ventricles. There is blood coming in from the left side of my heart and mixing with the blood on the right, disrupting the flow through the heart and robbing me of oxygen to my body. I have a second, more serious, cardiac shunt, and now it is a question of locating that pesky little guy and doing something to fix the problem.
It has been FIVE YEARS, people. If I hadn’t had my trip into the cath lab yesterday my doctors would still be nagging me to get more exercise (the BLZ just barks in laughter), offering me antidepressants, or insisting that I must have sleep apnea. I feel so validated!
My cardiologist is now going over my previous imaging to find the hole now that he knows what to look for. I was told that I may need to go through more testing to definitively characterize the opening, but this is huge forward progress. I suspect that I am facing open heart surgery down the road, but I am elated that the progressive and eventually fatal diagnosis of PAH is now off the table. Things are looking up since my heart failure will now be much easier to treat.
I am reminded of Elizabeth Zimmerman’s admonishment: “Knit on with confidence and hope, through all crisis.” Also, when the going gets tough, get a kitten!
Today I am waiting to hear back from my cardiologist who is going to email me with follow up instructions after he has finished going through the data and past test results. I’m on oxygen, knitting, and feeling pretty calm about all the new developments.
Almost exactly 7 years ago (August 28th was the anniversary day) I was diagnosed with Limited Systemic Sclerosis and Sjogren’s Disease. I have learned a lot along the way, but the best, most important lessons have been about self-advocacy, facing down the worst case scenarios, communicating with your doctors, and maintaining a good attitude.
Yesterday this all paid off for me big time.
Note: The fabulous BLZ graphic was made for me by my exceptionally knitworthy niece Melissa and her beautiful and talented daughter Eleanor.
June continues to misbehave: we had three days above 100 degrees Fahrenheit this week and several severe thunderstorms with tornados! My arm is still swollen and painful but the numbness is starting to improve; as if in solidarity one of my knees started to complain just today. Sigh. Knock it off, you guys! My new refrigerator came today and I am so happy to have dependable food storage again. Besides, it is just beautiful and shiney! The flowers in the garden are starting to bloom and the roses in particular are looking mighty fine. I have started to knit again every night and I also found some interesting books to read. I bought new glasses and ordered a bunch of fun stuff from Amazon. (Do I need purple and gold washi tape for my journal? Why yes, yes I do. I also got pink and gold replacement bands for my Fitbit and a pair of pink/grey comfy pants.) I went to the yarn store and bought more yarn… that may have not been wise, but I want to believe that I will return to full knitting capacity soon. 🙂 Okay, June isn’t being all bad… it was Hannah’s one year adoption anniversary this week.
Hannah on the 15th (her adoption anniversary date) and little kitten Hannah on the day I brought her home last year. I tried to recreate the picture from her first day home but she wasn’t all that interested and I was lucky to get the shot that I did. To celebrate her anniversary she got crispy pink paper to play in (that is always a big hit with her) and some bows to drag around. Last night I applied to adopt a kitten companion for her from the Cat Care Society and today they called me to approve the request and put us on the list for kitten alerts. Hannah was adopted from this shelter and they consider it a priority to get her a little friend. Yay!
I’ve requested a male, orange tabby kitten. We’ll see what happens. Hannah can’t wait.
Knitting
I’m working steadily on the mitts for my knitworthy niece who is a huge fan of all things Mandalorian. I am now up to the fingers of the second mitt.
Aren’t these the cutest things ever?
I need to do some duplicate stitch detail work and then there are all of the ends to weave in, but the end is definitely in sight now. I’m almost tempted to make a second pair but I have soooo many sweaters and other projects that I need to get done. This pattern is Mando (Natela Astakhova).
Garden
The roses are blooming! The roses are blooming! The roses are blooming!
From left to right, these roses are Hot Cocoa, Princess Alexandra of Kent, Cinco de Mayo, and Home Run. We had lots of rain this spring and I have been watering every day since then; this is the best crop of roses I’ve had in quite a while. I really was responsible this time with the roses as I covered them with frost clothes if there was even a chance of a hard freeze and I fertilized them early in the spring. This week they got more fertilizer and they are all looking good with lots of buds on the plants still waiting to bloom. Yay, garden!!
Books
I have two books going right now; one is text and the other is an audiobook. They both are really holding my interest and curiously they even look similar.
How crazy is it to be reading icy blue books when trapped in an heat wave. I’m only half way through The Doors of Eden and even less with The Cold Millions, but both books are thought provoking and really interesting.
And that’s all I’m going to say about them right now. 🙂
Have a great week everyone.
Read a little, knit a little, and garden like your heart can’t live without it.
Scleroderma Update: My rheumatologist had my hands x-rayed this week and I have severe arthritis in both of them, but especially the one that is now acting up. I was kind of surprised and I’m hoping that they can do something to help with the swelling and numbness. My echocardiogram results also came back and I do have a hole in my heart, but an email came from my pulmonologist yesterday saying that it isn’t big enough to account for the whole panting/blue lips thing and he wants to do some more testing. Fun. We have an appointment next week.
I’m going to be honest here: June has been really challenging so far. My entire right arm is numb and in pain and there isn’t much knitting going on. My appointment book is completely filled up with medical appointments and the bruises are collecting at an alarming rate; did I mention that June is Scleroderma Awareness Month? Yep. I’m aware. Scleroderma has gone into overdrive this month. Gee, if it wanted more attention it should have just asked!
In solidarity with scleroderma there have been other disasters this month. The car that was bringing me home from GI testing this week developed engine trouble (I ended up in an Uber, hopped up on drugs, leaking fluids from an unmentionable part of my nether region… best ride across town ever!) My refrigerator started shrieking in the night as one of the fans failed putting my stash of cheese at risk (yes, I have seriously cornered the market in… cheese). Oh, did I mention that I also had a scary close encounter with my neighbor’s pit bull? Seriously, it has been challenging to do anything except deal with all of this stuff. On the other hand, I have handled things; a new refrigerator is coming (I must save the cheese!), my neighbor has implemented more safeguards to contain her dog, and I have learned how to use Uber!! I’ve completed physical therapy and am walking much better. The car that broke down was repaired at little cost. My arm is in a brace but I am rocking voice-to-text on my phone. I’m knitting again… slowly.
Still, I am warning you, June, knock it off!! I have knitting and stuff to do.
Hannah: June would be a great time to get me a little kitten companion!!
Knitting
I finished my Noncho (Sharon from Security and Casapinka) this week. What a nice, versatile addition to my wardrobe this will be. I also made some progress on a sock but really the big accomplishment this week has been the Noncho. My project notes on Ravelry are here.
Garden
It’s gotten hot and the garden has taken off. I’ve been weeding steadily and it is really exciting to find flourishing plants and emerging flower buds. Look at what is going on right now:
Seriously, the garden is starting to explode with color. My rose plants are covered with buds and the main show is going to start in just a few more days. We had so much rain earlier this year the rose bushes grew really well and things are looking good. Okay, June is picking up a little.
Books
I’m enjoying The Cold Millions while I work on my second sock. So far it is pretty good and applicable to economic issues that we are dealing with today in the US.
Have a great week everyone.
Read a little, knit a little, and garden like your heart can’t live without it.
PS: The gastroenterologist told me that I can’t eat cheese any more. Or chocolate. Or caffeine. Or carbonated drinks. Alcohol is absolutely forbidden.
I’m pretending that I didn’t hear that part about the cheese.
Life has been busy and I’ve really gotten behind on everything. Hannah had her first birthday last week:
Hannah: I’m a big girl now!!
Seriously, I was so busy and worn out over these last two weeks I barely got any reading or knitting done. Adding to the energy drain was my second dose of Pfizer Covid-19 vaccine and three weather fronts that barreled across the state last week. I am grateful that the snow that these storms dumped was manageable this time, but each one took a toll on my joints and breathing. That’s okay though… did you notice that I got my SECOND VACCINE SHOT!!! This is just huge! I am starting to schedule medical appointments right and left as it is finally time to get some attention for my very badly behaved hip and breathing issues. Bring it, Mother Nature. I am ready to take you on!! The Blue-Faced Zebra is emerging from a year of strict lockdown and is on the move again!!
Also, it is now spring and the birds are back and I am so happy to see green shoots of grass again. It has been a really long year, but it is finally getting a little better.
Knitting
I’ve been pretty sporadic with the knitting and I’m kind of limited to simple stuff right now because my hands are NOT HAPPY with all of the running around and weather events, but still I am making some progress.
My Goldwing sweater is getting longer in the body and I am debating how much more to knit before I start the ribbing at the bottom. I often finish the sleeves at this point and then come back to finish off the body as I’m always running short of yarn, but this time I think I can do things in the usual order as I bought an extra skein of yarn.
I’ve also been working on these simple ribbed socks using yarn that one of my sons gifted me with for Christmas. This yarn is Classic Sock by Spun Right Round in the colorway “Hellbent”. I really wanted this yarn, but it looked awful after I wound it… all brownish and muddy looking with some color sadly peeking out. I stuck the wound cake back into the stash to hide it for a few weeks. Needing a small project to take with me on my adventures out of the house, I pulled the cake out last week and cast on socks; it was already wound and I was in a hurry. As I knitted I fell in love with the yarn again. Now the colors sparkle in the mostly grey field and the brown elements have receded into the background. Who knew that would happen? Today, in the picture, the sock looks mostly pink. This sock yarn has been a learning experience for sure.
Garden
Poor garden. It has been so neglected lately, but the plants are still hanging in there. The best thing that is happening garden-wise are the microgreens that I have growing under the lights with the orchids.
I have been eating lots of microgreens these days. Full of nutrients, easy to digest, lower in fiber, this has been a great thing to add to my diet. These greens are broccoli and taste great; I’ve discovered that they work well added to almost everything so I manage to eat some every day. Take that, scleroderma!! I’m growing them in the Hamama system that I got for Christmas and I just reordered more seed quilts because I’m really liking them.
Books
I finished up several books over the last two weeks; let’s just chat about two of them, okay?
I was so in love with World of Wonders when I started reading it. I just loved the way the author blended her joy with the natural world with her family and life experiences. Then as I read more I began to become less charmed as her interactions with nature seemed more forced and some of the magic was slipping away in her writing. By the end of the book I had gotten over her and was thinking that I could do better job writing about my own love of nature and my blended experiences. The author shared experiences from trips around the world; for me the continual moments of joy that have been my encounters with nature that are truly home grown. I was thinking of all of this as I drove east last week and passed a big herd of pronghorn antelope grazing in the Plains Conservation Center near my house. Pronghorn antelope!! I love pronghorns… I could tell you stories about pronghorns… I hadn’t seen pronghorns for at least three years, and there they were, two large groups, just as I was thinking about writing about my lifelong love of all things biological. It’s a sign. Be prepared for some upcoming “Tales of a Biogeek” on the blog.
Now to chat for a few minutes about We Begin at the End. Why did I read a book with a quote on the cover about breaking readers’ hearts? Oh, it also said that it was impossible to not keep turning the pages. Well, that part was also true. This book, constructed so cleverly that even the most astute mystery reader will miss some of the underlying themes, is a tragedy of Shakespearian proportions. The town in this book and the inhabitants are, quite frankly, broken. Badly broken to the point of being almost incapable of functioning, and yet they do somehow. Tragedies in the past have set in motion a series of events that bring unintended consequences that are both catastrophic and ironic for all of the main characters. My heart was broken, but at the same time there was a type of peace and balance in the ending. What a mess these people made of their lives; what a story this book tells. I miss my book group sooo much as this was absolutely a book that should be talked about with other readers.
Hey, did you know that today is National Respect Your Cat day? Yeppers, it is. Here are all the cats in my life in their most “You may now respect me” poses.
Hannah and my Grandkitties Jonesy and Maya will now accept your respect!!
Have a great week everyone!
Read a little, knit a little, and garden like your heart can’t live without it.
Yarn, Books & Roses 