Dysautonomia Awareness Month…. I’m Very ‘Aware’ All Year, Every Year

OK.  October is Dysautonomia Awareness Month… With Breast Cancer Awareness Month at the same time, nobody will care about dysautonomia.  Men are more than likely behind the sanctity of boobs, so along with being a rare disorder that people really are NOT aware of, there is the whole ta ta thing that people go all pink for, and dysautonomia remains a mystery to most, if they ever hear about it at all.  Don’t get me wrong, I’m not ‘against’ cancer awareness, but who on the planet with a pulse and working brainstem isn’t aware of  breast cancer?  I’ve known and do know many women with breast cancer (including my mom, who died in 2003 after surviving multiple cancer sites for 17 years, dying from something unrelated). I understand that any cancer diagnosis is a nightmare (I’ve been there, with leukemia).  (And why is there no blue ribbon with balls on it for testicular cancer awareness? Ladies? ).   Anyway, dysautonomia is something that I’ve lived with for decades- probably longer than it was diagnosed.  It didn’t flatten me until 2004.  And most doctors are clueless.  The general population can’t even pronounce it.  Dis-auto-gnome-ee-ah.

Every morning, I wake up not knowing if I’ll be able to actually get out of bed and begin my day without my head spinning as my blood pressure tanks.  Will my peripheral vision begin to narrow, and will my hearing get muffled?  Or will I actually be able to get up and not have to lie down again?  When I get in the shower, will I get that ‘sweet spot’ in the temperature of the water where I get a nice hot shower, or will it be too hot, and once again start the process of passing out?  My heat intolerance isn’t about temperature preference or comfort, it’s about staying conscious.   My thermostat must stay around or below 64 degrees, or I start to have symptoms.  Fifty degrees is much better if I’m outside.  I wear a light snap-front sweatshirt, left open,  when it’s in the 40s.  If I leave home to go into another building where I have no control over the thermostat, I have to wear 5 pounds of cooling vest inserts.  To stay conscious.  I’ll start to ‘burn up’ for no good reason (and this is NOT hot flashes- I’ve had those, and they are totally different).  Or I’ll get so tired, that doing anything is overwhelming.

I ‘look OK’… aside from being overweight, and having very few eyebrows post chemo (which at this point has to be permanent), I look fine.  That’s all well and good- but it can also be very frustrating when trying to explain why I can’t do something.  I also have multiple ‘other’ medical and orthopedic problems (discs, knees, spine, epilepsy, diabetes, yadda, yadda, yadda…), so when I’m walking I look a bit gimpy, but the dysautonomia is totally invisible if I’m not lit up like a red stop light from severe flushing when the dysautonomia spells kick in.  My thigh muscles have atrophied (probably from diabetes and chemo), which looks weird, and makes walking quite tiresome.  But people really don’t ‘get’ the whole dysautonomia thing.

The autonomic nervous system controls involuntary body functions- blood pressure, heart rate, breathing, flushing, muscle/brain signals, etc.  There are many ways this can all go wrong.  Initially, I had problems with passing out, as well as my right pupil dilating.  Then my gait would get wonky, and eventually I’d keel over and sleep hard for hours.  Temperature dysregulation hadn’t shown up yet.  I was in Texas when this all started, and I did fairly well at first.  When it was first a ‘thing’, I was living in a house (with no central AC- just room units for at night) with a coworker to share expenses (perfect situation; we had opposite schedules, so it was basically like living alone).  My housemate would hear me hit the floor from her room at the other end of the house, and find me passed out on the wood floor.  I thought I was just ‘nervous’ after a recent hospitalization for eating disorders, but she said that there was nothing  ‘nervous’ about me that she’d seen, and she really thought I had some type of medical issue.  One  night I couldn’t get up off the floor like usual, and I agreed that she could call 911.  That started the whole testing process.

I was lucky that I had a neurologist who thought I had dysautonomia. She sent me to see an electrophysiologist (EKG specialist) in San Antonio, who ended up doing a tilt table test.  My blood pressure dropped to 44/16, and heart rate dropped into the 50s (heart rate should go up, and compensate for a low BP, though a BP that low isn’t usually associated with ‘coming back’).  I was put on the first of several meds, and sent home (driving myself 60 miles after nearly passing out).

I continued to have issues with work, but eventually meds were sorted out, and I was doing well enough to get my work done. Additional disorders were ruled out (MS, myasthenia gravis, pheochromocytoma, brain tumor, stroke, etc).   The nursing home I went to work at had some very accommodating supervisors, which made a huge difference in not being panicky when I felt something coming on (the prior place did a lot of ‘threatening’, and since I was the only RN on campus at a drug/alcohol detox center on weekends, I understood the need for a conscious employee :p – but I didn’t want to stop working; being a nurse is who I AM).  I had a mattress overlay in my office at the nursing home,  to put on the floor if I needed to lie down.  I also had a fan from home, as temperature had begun to be something I had to keep ‘moderate’.  If an episode hit, I lied down; when it was over, I finished my work.

Fast forward, and I’m back in Illinois in my hometown, trying to keep things together at work, and it just started falling more and  more apart. I was hauled out by ambulance 10-12 times in a month or so at another nursing home (office job), and it was clear that I wasn’t able to keep working. I’d left a pediatric hospital job since I was terrified I’d get dizzy/lightheaded when handling very tiny babies (or larger, heavy ones), and that just wasn’t something I was willing to risk (along with some other issues with the job itself).  I had to deal with a new neurologist on my insurance plan at the hospital, who seemed clueless.  Once on disability (and Medicare two years after that), I found a neurologist who did know about dysautonomia, as well as a internal medicine doc who was quite familiar with the disorder.  With multiple medications (roughly 25 pills/day on a good day; more if not- and 3-4 shots of insulin) and total control over my thermostat, I’m able to sit up for several hours, but  I have to get up every few minutes to avoid any ‘pooling’ of blood in my legs, or I’ll enter the ‘pre-syncope zone’ when I stand up.

Now, my ‘normal’ consists of having the air conditioner on when it’s 30 degrees Fahrenheit outside.  When there is snow piled up outside, my AC unit is the only one with space around it where the snow has melted from the heat generated by the AC.  I leave home about 2-3 times a month– monthly grocery shopping, a doctor’s appointment here and there, and maybe a short trip to the grocery store about half-way between disability checks, for milk and/or bread.  Everything has to be ‘paced’.  If I do laundry, I can’t unload the dishwasher.  If I take trash to the dumpster, I can’t vacuum in the same day.  And I struggle to maintain any muscle tone, to avoid getting worse… but the chemo I had to have to survive the leukemia has caused deterioration.  I guess there are tradeoffs with everything.  Nothing is taken for granted.

Being on Medicare has been a horrific eye-opener.  I used to do the assessments that determined reimbursement for Medicare patients at the nursing home I worked at in Texas.  I was superficially familiar with Medicare.  Then I was on it.  Medicare is expensive.  There is the part B (doctors’ office and equipment/supply part) monthly premium (about $110).  There is the supplement plan since Medicare doesn’t cover huge portions of hospitalizations and tests (so add another $325 per month).  The part D (prescription plan) is about $75 per month, and between over the counter medications I MUST have, as well as paying out of pocket for insulin, that adds about $125/month (I’ll get into insulin in another post).  SO if all goes well, $635/month goes out the door for medical expenses.   That pretty much ensures no out of pocket expenses for doctor’s office visits, tests, and (knock on wood) hospital costs.  When I was in for 6 weeks for leukemia in 2010, the bill was $300K…. nearly 1/3 of a million dollars.  I will make my last payment on what they didn’t write off this month.  Four and a  half years later.  That’s not included in the $635.

Dysautonomia can be mild or fatal.  With the chemo causing deterioration, and knowing what I was like beforehand, I don’t think I have the fatal type (Johnny Cash did).  I have the invisible, life-altering, disabling, survivable kind.  Some symptoms may be worse than others on different days.  I can have one cheek very hot, and flushed to almost a blue-red, while the other is cool and has normal coloring.  I can have blue fingernails, not from lack of oxygen, but because of constricted blood flow.   My heart rate has dropped into the 30’s for no good reason (that bought me 5 days on a cardiac floor with nurses who were very nervous about the epilepsy- padding the side rails and putting a bed alarm on my mattress that went off if I got up to go to the bathroom- and GADS, they panicked when I got up to walk in the halls for some type of activity one night…. how did they think I lived at home?  Alarmed, padded bed?).  Sometimes one arm is flushed and hot, and the other cool and pale.  I’ve looked ‘dead’ per one former supervisor, with breathing so shallow and extreme paleness, it scared her many times.  I live alone, so have had to learn what sets me off… sometimes it’s as simple as a ‘scare’ on a TV show that wasn’t expected.  But heat and pain are my main triggers.  I’m in constant, chronic pain- that’s harder to control than the temperature.

Some people have POTS (postural orthostatic tachycardic syndrome), which causes symptoms if someone is standing. At all.   Their heart rate goes out of control simply by being vertical. Lots of folks with that need wheelchairs for safety.  There is neurocardiogenic syncope- which is actually a simple faint, until it’s a pattern.  There is pure autonomic failure – where nothing works right most of the time.  Shy-Drager syndrome is one of those total failure syndromes, and even saliva production is involved.  Dysautonomia isn’t one thing.  It’s a combination of symptoms that are generated by an abnormality of the autonomic nervous system.  Some are relatively minor, and others require feeding tubes, and other external measures to make it survivable.  More people have dysautonomia than are diagnosed, per research estimates. It can affect any age group or gender, though females tend to be diagnosed more often.  It can be seen as a conversion disorder or other emotionally based problem, which causes improper diagnoses, and completely inappropriate medications.  I encourage anyone who finds their symptoms listed in the informational links to talk to their doctor.  There isn’t a cure, but it’s generally not fatal, and can be treated.  Getting used to the new normal is the hardest part, as is not being understood.

See the following for more information:

www.ndrf.org 

www.dysautonomiainternational.org

www.dinet.org

 

 

 

 

Crazy Few Months…

I’m tired.  The last few months have been fairly miserable.  I’ve been on Nutrisystem since the latter part of May of this year.  That was all going well with more than 30 pounds lost and kept off even through the crazy stuff.  Then, sometime in late July (I think) I started having daily headaches with nausea. So it was hard to keep up with the eating like I should.  I gained back a few pounds (nothing disastrous), and just tried to get through the days.  Of course, with a history of cancer, horrible things come to mind when anything is different, so I felt I needed to get things checked out… one doc at a time. I had up-coming appointments (regular follow-up stuff) with most of my docs- so other than rescheduling one of them, I was already going to be seen.  It took me a while to get the energy to even get to the doctors’ offices, and timing the appointments in the afternoon, so if I woke up with the headaches and nausea I had some time to take something and get it better ‘enough’ to get to their offices.

The oncologist saw the muscle wasting in my thighs, and felt it was more of a ‘job’ for my neurologist.  He sent off another vial of blood for the genetic testing that detects changes in my DNA that would be consistent with a relapse of acute promyelocytic leukemia.  I haven’t gotten any calls saying it turned out badly, so that’s good.  He reminded me that chemo is hard on the peripheral nervous system, and since I already have dysautonomia, it could hit it harder. But, he still wasn’t the best  specialist to handle that.  I appreciate a doctor who knows when to turf someone to someone else 🙂

So, in the meantime, I had to see my endocrinologist.  Since being on Nutrisystem, my cholesterol is now normal, my AIC is %5.5 (from %5.8- I’ve had pretty good numbers since I was diagnosed in 1995- %10.2 then; the worst it got on chemo was %6.8- which is not acceptable to me, even though some diabetic references aim for under %7). My kidneys look good, and while my triglycerides are still high, they’re down by 100 !   That appointment went well.  A couple of weeks later, I found out that I was in the Medicare Part D (prescription coverage) ‘donut hole’ where there is no coverage until out of pocket reaches another dollar number.  I have a part D plan that covers many generics in the donut hole, but insulin is considered a ‘biological’ medication, so the patent never wears out, and there is no generic.  Walmart has partnered up with a big insulin company and offers the ‘older’ types of insulin for $25 per vial… that’s down from over $200 per vial for Lantus (and even NPH if not from Walmart and their ‘deal’).  Today, I’m switching over to NPH- so I’m watching my blood sugar more closely.  I had steroid injections yesterday (more on that later), so my blood sugar has been predictably higher. I’m a little nervous about the switching since NPH has an onset, peak, and duration that are much different than Lantus (which essentially stays at a steady level).  There’s more risk of hypoglycemia- so I have to eat (not great with nausea).  Anyway, I’m thankful for the Walmart insulin… I can’t afford the $300/month co-pay (the insulin companies offer a break in the donut hole- but it’s still more than I can afford).  Medicare is expensive !!

On to the neurologist.  She asked me a bunch of questions, saw my thighs (I wore shorts- partly because of the heat intolerance and mostly because I wanted her to see the difference).  She decided I needed an EMG test (electromyelogram).  It’s a test that sounds horrible, but wasn’t any big deal.  First she put prong thingies over various nerves  and zapped a little electricity in them to see what reaction showed up on the screen (and how my foot/leg twitched !!).  Then she put  thin needles in my muscles and applied pressure, then none, to see what that reaction was on the screen. It wasn’t a bad test at all.  Neuropathy is the diagnosis.  No big surprise there. She thinks it’s from the diabetes (and chemo making the neuropathy I already had worse), and that even with good numbers for YEARS in the diabetes department, it’s still possible to have damage.  Bummer.  I thought that’s why I was being careful with my blood sugars. 😦   She also ordered some lab work which got drawn yesterday, and I’ll return to see her in a couple of weeks to go over that.  I know I don’t have syphilis (ha !! 😀 ), and my thyroid has always tested OK.  I’m not sure about my sed rate (inflammation marker), B-12, or serum protein electrophoresis numbers.  She’s just being thorough… OK.  On to the next one.

I saw my pain guy yesterday after a horrible weekend of left shoulder and trapezius muscle pain (trap is between the shoulder and neck).  It was almost ER-worthy, but going to the ER when you have chronic pain AND a pain management doctor is never a good thing. You automatically get categorized as a ‘drug seeker’ and your credibility as a human being in general hits the toilet and swirls there.  So I stuck it out, taking the over the counter and prescription stuff I’ve got, as well as using Salonpas patches (like BenGay or Theragesic on tape), Absorbine Jr, and trying to stretch sore muscles out. Because of the dysautonomia, I can’t use heat packs. As it was, the pain was causing a lot of autonomic symptoms (severe flushing mostly on my left cheek, major heat issues- the outdoor temp was in the 40s (F) and I had the air conditioner on- and general ‘yuck’ feeling).  SO I punted.  It’s the pits to know if I went for help I’d be ridiculed and discounted.  It’s sad to not be able to get help because there are people who do nothing but beg for medications for their addiction, not for legitimate pain.  It’s hard to be lumped into the same category as those folks, when those judging don’t know me.

When I called on Monday to get the appointment, I was told the earliest was next week… I asked to be put on the cancellation list, and what do you know… I got a call 10 minutes later saying I could get in yesterday (Tuesday).  One o’clock p.m.   I’d be there come hell or high water (we had snow forecast, but that wasn’t a problem- and never materialized).

I got to the appointment a bit early to fill out the little person diagram showing where I was hurting and telling how much the pain had been helped since the last time I’d been there.  The last time, I got injections in my left jaw (TMJ- which could have been ‘helping’ the left neck and shoulder pain) and lower back epidural.  They helped.  The neck injections have never helped me, but those two did.  I wanted that again !

I also told him that the ‘as needed’ Norco 10/325 wasn’t doing anything (never really had), the Ultram was only marginally helpful (better than nothing), and I was ready to cry uncle and go back on the methadone.  I’ve been terrified of that stuff ever since watching people detox from it when I worked drug and alcohol rehab.  It is hands down THE worst med to detox from (this is from an objective view- I’m sure people coming off of other stuff thought theirs was bad enough !). But, it’s also a very ‘legit’ pain med, and has the perk of not having much of the ‘high’ feeling sought after by addicts.  Even though I’ve never had a drug abuse problem, I’m uber-careful with narcotics.  He ordered the methadone to be taken regularly instead of ‘as needed’ to get the maximum benefit- and it’s a relatively low dose, so I’m not as spazzed out as I was a few months ago, even thinking about methadone.  I need some relief.  It’s time to suck it up and use the bigger guns.  The other option was the fentanyl patch- which is probably in my future (I’ve been on them before).  There’s room to fiddle with the methadone dose (when instructed to) to get the best results, so I’m OK with taking it- and I know I’ve gotten ‘off’ of it before with no horrible symptoms, by tapering it.  I have to have some time when the pain isn’t there ALL the time, regardless of activity (or lack of activity) level.

I also got some low dose sumatriptan (active ingredient in Imitrex) to use with Aleve (naproxen sodium) and ‘make’ a sort of version of Treximet- which isn’t covered on the prescription thingie… I’d had samples of the Treximet before for the headaches, and it did have a noticeable impact on the pain, though it made me tired- when it gets to the point of needing meds, tired isn’t a bad trade-off.  I can still use the Ultram for breakthrough pain.

Then on to the injections, done by flouroscopy, or ‘moving’ x-ray.  The jaw injection does hurt enough to call it pain (and leaves a bump for a few hours until the meds are absorbed), but it has a lasting benefit, so it’s worth it to me.  The one in my lower spine doesn’t really hurt going in- there’s  a bit of a sting with the local anesthetic, but then it’s just a bit of pressure.  The steroids do have an impact on blood sugar (not the greatest timing when switching to a new insulin, but I had to get some relief).  I was glad to have them done.  The lumbar epidural will also help with the physical therapy exercises (more on that … NOW !).

That gave me just enough time to get to the physical therapy appointment (I was at the pain guy’s place for 2 1/2 hours ! ).  Now I’m rarely away from home for more than the time it takes to grocery shop.  I had the ice vest on (since the weather is cooling off, people turn on their heaters- so no break with the seasons), which helped, but it was starting to have a more ‘neutral’ feel to it.  The physical therapist was very pleasant and showed me exercises to do at HOME !   I told her that I’m horrible with appointments because of the headaches, nausea, and pain.  I can do stuff at home.  I also told her about the dysautonomia, and how heat, pain, and heart rate elevations can lead to me passing out cold.  Neither of us want that.  So, she showed me the exercises and gave me written instructions and a band thingie to tie around my knees for one of the exercises.   She also told me how to rig similar straps and things to squeeze between my knees, but I got home and ordered the same stuff she used from Amazon.  They weren’t that expensive, and I can see having to use them for a while…

I had to go to the pharmacy to get the prescriptions filled (one is not something that can be called or faxed).  While that was going on, I got some apples and Pecorino Romano cheese, and a couple of other things. I got home 4+ hours after leaving home.  I was exhausted.  But, glad to have it all ‘done’.

Today, I’m back to eating the Nutrisystem food  as it’s supposed to be eaten.  During the months of nausea, I was eating NS food when I could, but mostly not eating enough.  I had more carbs than I had been since they are often bland enough to tolerate.  My stomach has been ‘enough’ better to go back to meals.  I also got my nausea meds changed, and that has helped.  The stuff I’ve used for years just isn’t cutting it any longer.

So, that’s the last few months in a nutshell.  It helps that I’ve been an RN for 28 years. Keeping myself running, even on disability, is a job in itself.

Shelby (puppy) is doing well, and I was contacted this week by a dog treat company about using her photos in a video of still photos of various ‘fans’ of their product, so I’m excited about that!

Just a happy puppy kind of day !   Shelby- 4 months.

Just a happy puppy kind of day ! Shelby- 4 months.

 

Shelby !  Future 'movie' star :D

Shelby ! Future ‘movie’ star 😀

Growing up !

Growing up !