This has been a rough six months on top of a weird twenty years. I’d learned to deal with diabetes, fibromyalgia, chronic pain, degenerative disc disease, nocturnal seizures (left temporal), degenerative joint disease, GERD, and the temporary effects of acute disorders like multiple pulmonary emboli (all three lobes of my right lung and right pulmonary artery), and acute promyelocytic leukemia (APL), or acute myelocytic leukemia- subtype M-3. The longterm effects of chemo have been rough and more noticeable in the last few months, and the thought at this time is that much (not all) of what has been going on recently is a combination of chemo effects, and the progressive nature of diabetes (even with good control, though chemo totally ripped my blood sugars to shreds). I had chemo DAILY for 20 months (ATRA – all trans retinoic acid, M6 mercaptopurine, arsenic, methotrexate, and initially daunarubicin, ara-C, and assorted meds for nausea, fluid retention, and protective eye drops. I was also on gentamicin and vancomycin for most of six weeks. I think that things are just catching up.
This summer, a lot started to happen at once. The GERD (reflux) got really bad, so I was sent to a gastroenterologist (GI) for some testing. Most of those tests turned out relatively OK (to a cancer survivor, that means nothing malignant… something could be rotting and ready to fall off of my body, but if it’s not cancer, it’s pretty much OK). I have chronic gastritis (so no more NSAIDs – or ibuprofen type meds which is a bummer for pain management), and some irritation in my esophagus, and I was supposed to have a gastric emptying test (related to gastroparesis- a diabetes complication, but because of pain, I can’t lie on my back as long as is required…. and if I burp yesterday’s lunch in the morning, that tells me something isn’t moving). I tried to have the esophageal manometry test done last week, but SURPRISE !!! I couldn’t swallow the tube ! I’m being tested for swallowing problems. Now, I have to be knocked out, and have the tube put in under anesthesia, woken up, then swallow water 10-12 times, then have the tube pulled out). I’ve had to eliminate a few foods/food groups, but that’s OK. Marinara sauce, chili, fried foods, ‘high volume’ foods (like full meals), and some other things are out of the picture for the GERD. I cheat once in a while, but have to have Tums and Gas-X available. For the swallowing issues, dry foods, meat without ‘lube’ (sauce, gravy, stewed), celery, hard breads, rice without some type of moisture, etc are out. I literally have to pull the food out of my throat before inhaling when something gets stuck. I keep 8-inch curved hemostats next to where I eat. It’s rather scary.
The pain. Oy. I don’t remember ‘pain free’. I’d gotten used to just dealing with it, but this summer, the neuropathic pain got very noticeable, and the burning pain along my right outer thigh got really bad at night. Now both of my feet burn at night- though neither of them are every night. The sensation during the day along my right leg is weird. If I stand too long, I feel like my leg will give out. I got a wheelchair last week, and the one time I have used it so far (only need it away from home at this point) has been very helpful. I’m going to have to use the scooter at the grocery store from now on, and not have a three-day recovery period every month when I go to do my main shopping. I’ve got a few volunteers who have agreed/offered to come with me to push the larger cart. It’s just too much now to do monthly shopping. The pain management doctor (board certified in pain management, and ‘legit’… no lines around the block, no shady characters in the waiting room, and lots of rules about how he does things that I respect) said that if the methadone doesn’t work, then the next step is a peripheral nerve stimulator… kind of like a pacemaker device implanted under my skin that sends out little zings to trick how my body perceives pain. (BTW, methadone is a legitimate pain med, not just used for exchanging it for heroin in drug addicts). I am usually pretty tough during diagnostic tests, and have had many, many MRIs over the years, but this summer I had to bail before the “with” contrast part was done. I was in tears just getting the “without” part done.
I did get through the EMG (done at my neurologist’s office, by her), which clarified that it’s a progressive sensory peripheral neuropathy… it’s gonna get worse. The implications are kind of scary. I’m already noticing some altered sensation in my hands- so being in the kitchen is a little dicey (pun intended). And, if I lose sensation in my right foot, driving will be out of the question. Right now, I have enough sensation- and I don’t drive much, so it’s OK for now. A couple of weeks ago, I was opening a box of stuff I’d ordered (monthly Amazon or Walmart supplies) and I didn’t feel the inner angle of the scissors ‘catching’ part of the ‘pad’ of my right thumb… and it got cut off (about the size of a pencil eraser- and completely cut off about 1mm deep). That was pretty sore for a while. It’s still not completely healed, but much better. I’m going to have to pay much more attention to hands and feet. The decrease in sensation means that I could whack something off, get an infection, and end up with an amputation (pretty common in diabetics). ‘Help’ aids for opening jars, buying pre-cut veggies at the store, etc are going to be things to consider. I got one jar opening thingie, and it was useless…. it fit around the tops of many sized jars, but without the strength to hold the jar in my left hand, it’s pointless. I can still do the vacuum release move with an old cheesy can opener, and then get the lids off- at least for now.
My blood sugars were also getting wonky again so it was back to the endocrinologist. She wanted me to try a new type of long-acting insulin- but as usual, I had to check my Medicare plan D formulary to see if it was covered, and at what ‘tier’ for copay purposes… this year, it’s not good; next year I can get it !! I’m so excited to be able to get a type of insulin that wasn’t popular in the 70s !! She got me enough samples to get through until January 1st, which brought me to tears. The short acting insulin is also going to be doable next year- and she got me samples of those as well !! It requires me to pay three times more for my monthly premium next year, but it’s SO worth it for no deductible, full donut-hole coverage, and good monthly copays for each medication (I’m on something like 15 prescription meds and many over the counter meds that are always out of pocket).
Then there are the changes in the symptoms with the autonomic neuropathy /dysautonomia. I was sent to a cardiologist (I’ve been trying to cut down on the number of docs I see, and that plan isn’t working well). Because of multiple medication changes for my blood pressure meds (which is actually used to keep my blood pressure UP in a paradoxical way), and my blood pressure going down far enough for long enough to decrease blood flow to my kidneys ( that was ‘fixed’ with medication changes and more deliberate fluid intake), I needed someone to take a look at what is going on. Dialysis has always been ‘the’ diabetic complication that I’m not sure I’d get treatment for; a machine 3 times a week indefinitely doesn’t sound like quality of life to me. Anyway, the cardiologist sent me for a simple ultrasound of my heart (ECHO) and did a simple EKG. No results on the ECHO yet. She adjusted a couple of meds, and the next step is to add another med, which I do NOT want. I’ve had a LOT of episodes of near syncope and increased heart rate (not necessarily at the same time, but if my heart rate stays up, I generally pass out because it will suddenly drop; I have to get home and get my feet up or just go to bed – which usually takes care of it).
So, I’ve seen my primary care doc, gastroenterologist, pain management doc, neurologist, endocrinologist, and cardiologist since this summer. I do not like doctors’ appointments. Leaving home is painful. They usually want to order tests, which means more time away from home. I appreciate their help (though the GI situation is horrible to get anything done; right now, I’m waiting to get the anesthesia assisted tube placement to measure esophageal spasms -achalasia is suspected-, and they have a very blasé attitude, even when I’m pulling food out of my throat because it won’t go down). I need to get things treated to the point of maintaining independence as much as possible. And, I’m going to have to suck it up and ask for help when needed. That is hard, since most of my friends are 1200 miles away… or have lives/families/jobs/etc. And I don’t like to be ‘dependent’.
I know I have a lot to be thankful for. I’m still in my own apartment. I still have my dog. My dad is around (he’s 83, and has a full life; he’d help but the ongoing commentary at the grocery store for a full month’s shopping would be too much- he doesn’t shop for more than a few days since he eats out a lot), and he is a huge part of my life. I have a lot of online friends and family. I’ve got family in other states that I’m in contact with. There’s a lot of good. But it’s hard to see things changing. Fortunately, as an RN- disabled, but still have my license- I know what to look for, and know what types of ‘help’ devices are out there. I know when to ask my doc for things like the wheelchair. I’ve got some word-finding issues, but my brain seems to be mostly intact- LOL. 😀 Always stuff to be thankful for 🙂