Triage- A Way of Life

Triage.  The word hangs with me like the memories of countless Emergency Room visits.

Triage. Take care of the most serious first.

It’s the reason we might wait hours for stitches, and barely a moment for a trauma.

I get it.  It makes sense in the ER.  It also makes sense on the battlefield, or in other places where there is widespread injury to be treated.

The thing is, you typically don’t stay in those places FOREVER.

Places we equate with triage are not places of comfort.  And that’s where this life with Cowden’s Syndrome can get tricky.

You see, lately I can’t shake the feeling that life is triage.  24/7/365 damage assessment, and handling the most critical first.  Vigilant.  Hyper-vigilant.  ALL.  THE.  TIME.

When you live with a chronic illness, a syndrome that causes cancer by its very definition, it is so easy to get wrapped up in monitoring and preventative care.  And then there are the times that you go for those monitoring appointments and they require their own follow-up.  This condition can easily morph into a beast that can swallow you whole.

And we’re at it times 2.

What I refuse to allow this syndrome to do is take away any more from my daughter’s life  than it has.  To the best of our ability, she will do “teenage” things, and she will do things she enjoys.

But, lately that has become quite the juggling act.

I am monitored twice a year by endocrinology (post thyroidectomy), my breast surgeons, and dermatology.  I am monitored annually by gyn oncology, and oncology.  This is post-bilateral mastectomy (stage 1 DCIS) and post hysterectomy.  I am monitored every 5 years for colonoscopy.  I am also monitored with abdominal ultrasounds for 4 hamartomas on my spleen, and a cyst on my kidney.  This may not seem all that impressive, but those are just the appointments if everything goes well.  That’s not additional scanning, blood work and biopsies.  None of them are close to home either.

Not to mention, I am still searching for a local primary care doctor.  In addition, there is dental work, both routine, and the emergencies the stress from grinding my teeth keep causing.  I’ve been referred to another oncologist who specializes in genetic diseases, and I need to get in to see her.  I just completed vascular surgery, with its pre and post op appointments and recovery as well.

That’s just me.  Me, and my full-time job.  And, like every mother, my needs are not the most important.

My girl sees endocrinology twice a year.  She is still, 4 years post-op, trying to get thyroid function balanced.  She sees gastroenterology, and dermatology twice a year.  She also sees an adolescent gyn twice a year, courtesy of precancerous tissue already uncovered in her teenage uterus.  She sees a chiropractor every 2-3 weeks for pain management.  Right now, amid diagnosis of the small brain tumors, she is seeing neurology every three months for new MRI scans.  She sees orthopedics every 8 weeks.  They have been monitoring her knee for years, and recently stubborn tendonitis in the shoulder.  There have been a few MRIs of late.  She has seen physical therapy weekly since the fall, and is now working on twice a week.

She is tired.  Partially because of her schedule, and partially because of her sleep patterns.  Despite a regular bed time, she struggles to get quality sleep.  It is hard to turn her brain off, and for her to get rest.

She has developed Post Traumatic Stress Disorder (PTSD) and anxiety, secondary to consistent medical trauma.  She is working through it – but, like everything else, it is a great deal of work.

She is awaiting word that her service dog is ready.  The call could come any time in the next 6 or so months, but we are hopeful this dog will help her through what can be some trying times.

She is an honor student.  She is a swimmer – at least 5 days a week, for 12-15 hours a week.  She is in weekly vocal lessons, and a theater group that meets 3.5 hours a week.  She enjoys a local church youth groups.

She has food allergies – restricted from dairy, gluten and soy.  And seasonal allergies to all things pollen.

None of this includes normal things.  Like dentist and orthodontist visits, or even haircuts.

It is easy to get isolated.

She has a strong sense of what is right and wrong, and can be rigid in her perceptions.  But, life has shown her things most adults, let alone people her age, have ever seen.   Just as that strong mindedness flusters me, I refuse to try to break it down.  It is that same will that has gotten us where we are.

And where we are, is in TRIAGE.

My iphone calendar is with me everywhere.  I prioritize swim and theater over doctors when I can.  Physical Therapy is a high on the list right now for pain management and strengthening.

Vocal lessons keep her going, as she can sing herself through a lot of stress.  Theater is just a fun group of children, and I am not willing to sacrifice that.

I have a list by my desk of “next up” appointments, and because our availability is so limited, I am often booking months out.  We travel to most – NYC or LI.  Short on miles – but up to 2 hours each way – often.

We stack them when we can.  Two appointments are a bonus, three is a banner day.

And every year about this time I dream of a summer light on appointments.  I’ve yet to see it come true.  Truth be told, almost every school holiday and every vacation is cluttered with things we need to do, but would rather not.

There is a blessing in knowing what we are fighting.  There is blessing in having a warning system in place.  But, there are still some days when I’m totally overwhelmed that I wish I didn’t know so much.

Triage.

Triage means that right now the physical and emotional health of my teenager trumps all.

So she swims 5 days.  We do PT 1-2 nights after swim. We see “other” doctors midweek on the one day there is no swim.  We do voice, and theater on Saturday.

I make my appointments on weekends when my husband can drive.  I make my appointments a year out so I can stack three in one day in the summer and on February break.  I schedule our surgeries for February of Easter vacation when I can.

I plan our fundraiser now for October, so as not to give it up, but in hopes of finding an easier time.

I research at night.  There is always a need to learn what most of our doctors do not know.

I write, when I can.  I love it and I miss it, but time just doesn’t seem to allow.

Hair, nails, eyebrows, and things I used to enjoy are forced into holes in the calendar, every once in a while.

Dust builds in places I never used to allow it.

Friends, well I have to trust they get it and they’ll be around when there is a change in the current status of things.  I miss them.

Triage.

It starts early in the morning, waking up a teen who just hasn’t slept well.

It continues through the day – my job and her school.

After school is all about making it work.  Swim, PT, or whatever therapy the night brings.

There are often phone calls, requests for lab reports, or battles about IEP needs…  Emails go through the iphone.

Usually we are out of the house about 13 hours.

At night we pack everything so that we can be ready to begin again.

Triage.

Most critical right now is allowing my teenager to find her way, in school, in sports, and in her life.  Most critical is giving her very real scenarios where her disease does not define her, and she is able to achieve in spite of her challenges, not because of them.

In order to make this happen, everything revolves around her schedule.  There are opinions about that in all directions.  There are people who would tell me I am creating an entitled, self-absorbed human.  I don’t pay them much mind, because they haven’t met her.

When I signed in to be a parent I knew I’d be all in.  I just never saw THIS coming.

Balance needs to always be in place, where the physical needs of either of us are never overlooked.  However, non-essential appointments CAN, and WILL be scheduled around our availability.  She will be a happier, and more tolerant patient when she didn’t miss something she loved with three hours in traffic and two in the waiting room.

Triage is meant to be something you experience briefly in times of crisis.

The “fight or flight” response is not always supposed to be on.

But it is.

At this time in our lives we may not always make for stellar company, although ironically, we’d love to have more of it.

At this time, we may say no constantly, to the point where you stop inviting.  Trust me.  We’d rather go.  We actually enjoy your company.

At this time, we are so busy surviving, and taking care of the most critical needs, that anything not immediately essential gets passed by.

We are constantly evaluating order of events, but TRIAGE is fluid by definition.  Unfortunately there are so many situations and scenarios, it is hard to see through them all.

Even at our toughest times.  Even at our most overwhelmed days.  We can look around and find our blessings.  They exist in big things, like being able to physically attend 5 practices a week, and little things, like being able to WALK around the school without hesitation or assistance.

We are aware of those suffering illnesses far beyond our grasp.  We are aware and we are grateful for the health we do have.

We are also tired.  And lonely.  And often overwhelmed.  We also know this is the way the plan must go for now.  And one day it may change.

Triage is fluid.

Life is fluid.

We all do the best we can with what we have where we are.

And we remain steadfast

#beatingcowdens.

 

 

Invisible Illness

For the last 6 nights my soon to be 10 year- old has slept in between her father and I.

Now I will pause to give you time to gasp, as wave your fingers at me.

I will give you time to self-righteously proclaim that you “know better” than to put your child in your bed, because once you start “that habit” you will never be able to break it.

Go ahead.  Tell me its my own fault that I don’t sleep as comfortably as I could with my 5 foot tall 85 pound child bouncing between clinging to my husband and I.

Tell me I should just send her back to her own bed.

And then – when you are done.  Come over.  Please.  I will even make you some coffee – but you will have to settle for fake milk.  No need to keep any in a house where a child has a dairy allergy.

When you come over you can watch her for a few minutes.  I will let you watch as she winces in pain, and cries out as she bounces around.  And that, that is after she actually gets to sleep.

invisible illness

See before she gets to sleep, there is pain.  Always some pain.  Always.  But some nights, or weeks like this one, it is worse than normal.

There are nights, and plenty of them that she sleeps in her own bed.  Right through until as late as we will let her.  Those are the nights the pain is at its best.

Then there are the nights she needs one of us to rub her in her bed.  A knee, a calf, and ankle, an elbow, a shoulder, a wrist, or even a head is keeping her up.  Sure, you could say she is exaggerating.  Maybe she is acting like any kid who doesn’t want to go to sleep.  But Meghan is above many things, a really rotten liar.  So, when she hurts – she lets us know.  And when she doesn’t it never comes up – end of story.

The worst nights are the ones like this week.  The ones where she can’t even get herself comfortable in her own bed.  These are the nights she cries not only for the pain, but also for the raw fatigue that keeps her awake when she would rather sleep.

This week there has been pain.  Pain in the legs as she adjusts to swim practice, or plays with a friend or two at a play date.  There has been pain in the wrist, the pesky wrist injured now since early June.  The one that has to have a problem – we just don’t know what it is – yet.  The wrist in line for an MRI/MRA has a pulse to it that is reminiscent of the AVM  in her knee.  But we are trying not to jump the gun.

If you ever do stop by my house in the middle of the night, to see why none of us have any semblance of a normal sleeping pattern, maybe you can bring a warm compress, or strong hands, and help as we massage cramping, painful body parts.

Even on the days we fall hard!

No one knows the Meghan of 2 AM.

Everyone sees the bright smiley face.

Everyone sees the interpersonal child who talks with everyone – who makes them laugh.

Everyone sees the reader, the friend, the kid who likes quiet, and order, and rules, and helping people in need.

The Meghan of 2, or 3 AM disappears with the morning light.  She washes her face, brushes her teeth, and puts on the best smile she can to prepare to face the world.

This is the story of life with chronic, invisible illness.

energy to be normal

No one knows about the growths on her thyroid, or the insufferable hot flashes she has.

No one knows about the effort it takes her to walk up the stairs, or to sit and play with friends.

No one knows she is slated for 2 more MRIs, a pituitary function test and a pelvic sonogram – and that’s just the next 2 weeks.

No one knows because she doesn’t “look sick.”

And she wouldn’t have it any other way.

She wears her denim ribbon necklace, the one crafted after the Global Genes Project logo – every single day.  And she dreams of the day she will look across a room at another little girl wearing one too.

The denim ribbon is the symbol for rare and genetic disorders, and since identifying her own need to have a “symbol” to wear, like my pink ribbon, she saw to it that one was created to be worn around her neck.  She chose to have it modeled off the Global Genes Project- an organization that spoke to her heart soon after our Cowden’s Syndrome diagnosis.

We wear them now, my husband, and Meghan, and I – united in our battle.  And we hope that one day there will be more.

circle of three

A denim cause ribbon, crafted after the Global Genes Project's slogan, "Hope it's in our Genes!"
A denim cause ribbon, crafted after the Global Genes Project’s slogan, “Hope it’s in our Genes!”

Next month we will travel to Disney World, as we have for the last 6 years.  While we are there Meghan will use a wheelchair.

Recently, when the controversy hit about the misuse of Guest Assistance Passes at Disney, I was sick to my stomach.

You see I have a child with a virtually invisible disability.  She can walk, by the grace of God.  She can swim.  She can function throughout a day – often with insufferable pain at night.

But what she can not do is walk for long distances.  Ever.  Regardless of the footwear – no matter how hard we try to prepare.  She just can’t.

We took her out of soccer because of the impact.  We took her out of dance for the same reason.  Now she swims, and even with that sometimes the muscle pain is difficult to bear.

So it is especially tricky for us at a park that necessitates walking and standing.  Sometimes she can stretch her legs.  Usually she can cover about a half mile on foot.  Then she needs to rest.  If she pushes too  hard on day 1, by day 4 we might as well be back home.

She spent her birthday one year in tears, pleading with me – in the middle of EPCOT that she would go home “RIGHT NOW IF YOU COULD MAKE THE PAIN STOP.”  That was the day after we let her walk 50% of the day before.

She hates being confined.  She would rather walk.  She looks like she should be walking.  But she can’t be.  Bottom line.

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So as I said earlier, those of you who want to judge me for rubbing my child’s sore and aching body so she can rest – feel free.  As long as we breathe she will be able to seek comfort in the arms of her mother and father.

And when you see me pushing her around Walt Disney World, I know there are the lowlives out there who abuse the policy, but before you assume that my “normal looking” child is one of them, ask yourself if you have ever met anyone with an invisible illness.

Ask yourself how many children, when given the opportunity, would rather navigate the happiest place on earth from the confines of a chair.  Sure we all need a rest some time.  But she’d rather have it on a bench.  And while we are at it – she would rather be having an ice cream cone like the other kids too.

Just because I teach my child to go through life with her head held high.  Just because I teach her to push through pain.  Just because I teach her to smile at adversity and to be kind to judgmental strangers- that doesn’t mean she doesn’t hurt.  None of that invalidates the 4 surgeries for the AVM in her knee, the thyroid biopsies, the constant scans, the issues yet to be uncovered.

My child knows patience.  She knows how to wait.  And she does it all year at countless doctors, and invasive lab tests, with grace, and poise and dignity.

So, before you forget what invisible illness looks like- look here.  We are too busy BEATING COWDEN’S to acknowledge the judgmental.  We teach our daughter to love and forgive.  She has too much stress in her life to harbor any anger.  We learn our best qualities from her.

you were given this life

“What are you celebrating?”

I am awake earlier than the rest of my family.  My big dog took a container of Meghan’s gluten, dairy, soy free chocolate chip cookies off the counter last night while we were out.  I think she will be fine.  She just had her second dose of activated charcoal, and she seems to be resting comfortably.  But. EVERYONE knows who the Mom is when they are sick – so she and I BOTH had a long night. (and I am sending her Daddy out to clean the yard! :-))

Allie - The Cookie Monster
Allie – The Cookie Monster

Last night we headed to Manhattan where we celebrated Felix’s sister’s 50th birthday.  It was a crowded room, and although the food was quite good, I had a tough time being so cramped in.  My little girl, as usual amazed me with her calm, patience, and poise.  I asked her before we left of she wanted me to ask the restaurant to cook for her.  She said she wanted me to pack her dinner.  She doesn’t trust very many places to “get it right,” and she did not want a belly ache.

So.  she put on her fancy dress.  The one she is so EXCITED to wear to the Father/Daughter dance hosted by her school Monday night.  I put her hair up and stepped back. This child has always been mature beyond her years, but when did her body start to catch up?

My little girl?
My little girl?

We sat, for a few hours.  There was minimal time to walk around, but when she did get to talk she vibrantly retold the story of how she lost her last baby tooth, and the Tooth Fairy left her $20 and a Tigger pin!  Way to clean up on the last tooth,  None of the others were worth that much!

tigger

Magic.  She brings it back into our lives.  She rounds out her father and I.  She is a princess.  Yes, she has just about everything she has ever asked us for, but she has a whole lot more.  She has compassion, patience, maturity, and wisdom.  She has kindness and generosity.  She takes pleasure out of making people happy.

My mother always said, “Children should be spoiled, just not spoiled rotten.”  Doing our best Mom.  It seems to be working out ok.

Before I started writing this, I was searching the Disney website.  I was playing around with prices for a summer trip.  We have taken Meghan to Disney in August (usually for her birthday) every year since she turned 5.  My house has photos in every room that remind us of our adventures.  We have had the happiest of times at Disney.  We enjoy each other.  And, I have to say, the year my parents joined us, was one of the best vacations.

Family fun
Family fun

We started going to Disney because of their accommodations for allergies.  It  is almost impossible to maintain a gluten, dairy, and soy free diet for a week without staff trained to take every allergy very seriously.  And while we struggled a bit last year to find “quick service” food for her, on the whole we have had only positive things to say about our Disney dining experiences.  When you have a child with allergies, you plan your trips a little differently.  Everything else falls into place, AFTER you know they will be well fed.

Disney also accommodates her chronic joint pain.  Even with the Celebrex she could not endure the miles of walking we do each day.  She travels Disney – walking some, but spending the majority of her day in a portable wheelchair.  We always get a room on the first floor to avoid extra steps, and in the event those knees give out, every park has everything from Advil to heating pads to help with the pain.

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Not to mention the Magic.  I believe in the wonders of Disney.  I believe in the smiles of hugging Chip and Dale, and Mickey and Minnie, and all their friends.  I believe in the smiles on my girl’s face.  I believe in the memories we are making – that no one can ever take from us.

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So, this morning when I ran the prices of the trip through the computer I choked a little.  It, like everything else, has gone up a good deal since last year.  And, for a brief second the thought of not going crossed my mind.

I mean, the deck needs major work, we still haven’t finished the upstairs.  There are plans for the basement to be redone, and the backyard needs help.  What about that awning for the blistering sun in our back yard.  Plus, this year forced us into a new car, braces….

Then I saw the question in the corner of their website.  It said, quite simply, “What are you celebrating?”

Well, that did it.  We are celebrating all right.  We are celebrating Meghan’s negative biopsy.  We are celebrating the knowledge we have gained from our Cowden’s Syndrome diagnoses, and the ability to “strike first.”  We are celebrating that after a long stretch of studying, they offered the Electrical licensing Exam, and Felix passed part one on his first try.  We are celebrating the love of friends, the kindness of stangers, and the compassionate heart of my little girl.  We are celebrating the power of God and the Holy Spirit to lead us to a place we worship together as a family each Sunday. We are celebrating “more birthdays” as Meghan will turn 10 and Felix 40 during that hot August vacation.  And I could go on and on with the thoughts that flooded my head in reply to that simple question.

Disney 2012
Disney 2012

So today I will finalize our trip.  I will be sure to get “trip insurance” in case life tosses us any more curve balls between now and then.  We may not finish all the projects around the house this year either.  But we have lived here for 12 years now, and its a pretty nice place to be.  The projects, the bills – they will get paid for and finished.

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The magic may not last forever.  We have learned as a family to stop and enjoy the ride.  We are celebrating our countless blessings.  God is good.  Life is good.  Family vacations are worth celebrating.

celebrate