Here. We. Go.

It’s just after midnight on Sunday, January 17th. I should be sound asleep, but instead I’m propped up in my bed with my iPad in hand. There are suitcases in the living room and a cooler of food and other supplies set to go. In about 6 hours Meghan and I will embark on a 12 hour journey to Indianapolis.

The story of how we got here anxiously waiting to get there began years ago and is intricately interwoven within the journey that is #beatingcowdens.

I have written a great deal through the years about Meghan’s physical struggles. I have been more guarded about the emotional toll this disease has taken. There is too much to the journey to pretend I can create a linear summary of how we ended up here.

The contract for the service dog was signed in November of 2017. A good few months of soul searching came directly prior. Meghan, like always, seemed to know what she needed. I had begun to learn by that point that she was more often than not, correct.

She was a high school freshman, and in between panic attacks that left her calling me from stairwells and bathrooms in the middle of both of our school days, she researched service dogs. She was most impressed by Medical Mutts, a facility in Indiana that rescues dogs and trains them for service. This was a fit on so many levels. We are a dog rescuing family, believing strongly in the beautiful bonds of adoption. We hold nothing against breed to train facilities, but for Meghan, the one who always felt like she was just outside the circles of life, watching as others participated; the idea of not only working with a service dog, but working with one from a shelter, who was left there because they needed someone to love them, well that was pretty much perfection.

The interview took place in my car. we were outside of her high school during her freshman swim season. The interview went well and it was agreed that Meghan could be placed on their list for a dog. A deposit was made. And then we were left to wait.

But, even as we waited, her depression and anxiety did not. She met with a doctor at NYU who was willing to put a name on the PTSD – Post Traumatic Stress Disorder, that Meghan was living with. There were specific triggers in her medical history that stayed right at the heart of her soul and her psyche, despite a years long relationship with counselors. And it was messy to try to understand how all that medical trauma, alongside some emotionally damaging classmates left her feeling as though she was free falling without a parachute.

When chaos is your norm, and “fight or flight” is not a passing stage, it can make it hard for people to be around you. It seemed there was always something new on the horizon – whether a new diagnosis or a test or a pending surgery, it was ALWAYS something. The amount of hours spent at medical appointments, testing, surgery, recovery were at times all consuming. These are simply facts.

I think the idea of the service dog solidified in the nights. Meghan is adept at pushing through the day. With Cowden’s on your mind, and Ehler’s Danlos playing cruel games with your body, there is scarcely any way for your mind to focus on more than surviving. But at night, it was a whole different world. Settling down in a dark room, falling asleep, reminiscent of countless trips to operating rooms where you wondered if you’d ever awaken, was not an easy task. I spent many nights on a couch in her room. Many nights settling one of our dogs onto her bed so their rhythmic breathing would soothe her to sleep. Many nights watching the nightmares and the hours of restlessness that circled itself into fatigue that rarely quit. And by the time she settled into a restful sleep, there was no waking her. To this day, alarms blaring do little to even cause her to stir.

The medication helped the depression some. But that energy has to go somewhere, and soon after, she began picking at her arms in such a way that they became scarred and red all the time. No area of her body was off limits, and still to this day I see the self harm that I’m grateful isn’t worse. The most severe anxiety attacks come at home now, although they are still unpredictable. She hides them too. So much so that most who meet her would see nothing other than confidence. She is a living, breathing example that things are not always what they seem.

I don’t know if people choose not to see these ramifications of living with two rare diseases because it makes them uncomfortable, or if she is just adept at hiding it so that they don’t get to see the full extent of how hard she fights to stay above water. Maybe it’s both. I come from a family, who, while they love us a great deal, tend to believe some things should just be kept private, and handled by bottling them up. Asking for help, seeking help, and getting help that would potentially indicate to the world that you struggle can sometimes times be perceived as a weakness. The thought of a service dog for a young lady who is “doing well” through the uninformed accounts of others is appalling to many. We’ve been cautioned that she “won’t fit in.” Or that others will “judge her.” Yep. She knows all about being judged, and belittled, and maligned for being herself. She decided a long time ago she was not going to bend to the will of the world. She was going to rise above. And she did. And she does.

In fact, she soars.

Her friends list is short and neat, as any adult would tell you, it should be. Her grades are exemplary. She has chosen to spend this pandemic becoming a better version of herself. She is attending classes to be confirmed at a church where my brother-in-law is the pastor in May. She is learning and embracing a God who loves her. She has reconnected with her father in ways that are heartwarming. College choices are plentiful, and there is a bright future in her chosen field of study, Physician Assistant.

There is no harm in asking for help. There is no shame in saying, this is a lot, and I need someone to talk it through. There is nothing at all wrong with someone who needs help becoming the best version of themselves. When you desire to change the world, or simply to enjoy mundane tasks, there is actually beauty in saying “I need help.”

I see people hide from themselves and others. Then I see Meghan. She lives what we all know to be the truth, the hard truth, that the only way out is through. She is doing the difficult work so that her childhood traumas are not a weight to hold her down, but rather a valuable part of the background medical professional she will become.

Tonight we will sleep in Indianapolis. Monday Meghan will meet her partner for the next leg of her life journey. Ella will join the family as Meghan’s service dog.

And I will remind my girl again, that those who say it can’t be done, should never interrupt those that are doing it. Meghan I am so proud of who you are. Stay true to that. The rest will all work out. Sleep tonight dreaming if your new companion.

We are forever

#beatingcowdens

Ella, Meghan has been waiting for you since before you were born!

Show Up

It was three MRIs in two days that week in November.  That’s too many, in case you were wondering.

One was an extension of an August MRI, which had been a knee follow up.  If you’ve been following – you know that long story.  If you’re new, the AVM (Arteriovenous Malformation) she was likely born with in her right knee, has cost her 8 trips to the OR so far.  It requires frequent attention.

By frequent I mean we see the orthopedist more often than we see most family.  And this time the whole muscle band up her thigh had been acting odd.  So we reached out to the orthopedist who asked for an MRI of the right thigh before we saw him at 1 PM that Tuesday.

By “odd” I actually mean really painful.  Pretty much all the time.  Painful enough that walking long distances or kicking swim practice got hard to maintain.  But there is so much that hurts it’s hard to sort out where something stops and other things start.  The hip had been “out” more than in, and even the chiropractor could not sort out why.  The knee pain was persistent enough to leave her wondering if something was wrong again.  The shooting pain, tingling and occasional numbness left her wondering if a nerve was somehow damaged.

Turns out, in typical form, she was right pretty much all around.  This kid has an uncanny awareness of her body.

The doctor’s student came in first not far past 1PM.  The MRI results were up, and he mentioned the AVM.  We said, “In her knee?”  When he said no, and mentioned one higher up in her leg, I pulled the plug on his practicing and sent for her actual doctor.  Turns out the thigh MRI showed a vascular malformation in the back of her right thigh.  It was somewhere in between the muscle and the bone, and adjacent to the sciatic nerve. When the images changed you could actually see the proximity to the nerve.

Hip issues – check

Knee pain- check

Shooting (nerve) pain-check

So he asked for an MRI with contrast of the pelvis.  “Sooner rather than later.”

But then he had to address the issue that had been of greatest concern walking in the door.

The right shoulder had been presenting an escalating problem all during the fall swim season.  She is a powerhouse my kid.  She pushes through because she knows nothing else. The awareness that the Hypermobile Ehlers Danlos diagnosis added on in July could at least explain the frequent partial dislocations was little comfort to the body that was living with them.  A thorough examination of a shoulder with extremely limited range of motion left us with orders for an MRI arthogram of the right shoulder.  It was time to rule out a rotator cuff tear.  We left with both MRI orders, and scripts for muscle relaxant and pain meds.  We were told to try to get it done by Thursday.  Yep 48 hours.

Thankfully Meghan’s insurance, which is the same as my husbands, (insurance coverage and coordination of benefits could take another post, so just trust me) does not require prior authorization for MRI testing.

So I got on the phone with scheduling and secured an appointment at the same facility we had been at at 11 AM for 3:30 PM.  That ended up being the pelvic MRI with contrast, something we avoid until we are confident something is there.  IV in place, back in the tube for another 45 minutes.

We were able to schedule the arthogram for 8AM the next morning in Brooklyn. But, not before learning that an arthogram was a pretty awful test.  As I had tried to barter for a time that would not take her out of school three days in a row, I was told that the doctor had to be on site.  I was asking for a quick schedule and I had to take what was available.  I was wondering why a doctor had to be on site, but my girl found the answers first.

And as we contemplated the test we sat in two hours of traffic to make the 32 mile trip home.

The next morning we were met by a well meaning tech in a Brooklyn office who thought my girl was going to have the catheter placed without me. You can say all the rational things you want about her being almost an adult. But PTSD is very real.  No matter how smart and articulate she is.  It is flat out real.  And that was about as huge a trigger as there is.  So I got a vest, signed consent for whatever I was about to be exposed to and held her hand while she screamed in pain.  The catheter was placed.  The contrast was injected, and we were back to another 45 minuted in the tube.

The appointment at 1 the next day was overwhelming to say the least.  The pain, the anxiety and the exhaustion were palpable.  The news that there was no rotator cuff tear was met with simultaneous relief and exasperation.  And if you don’t quite understand that it is probably because you have not lived with daily pain so intense you would give just about anything to hear that it was fixable.

Our orthopedist is nothing short of amazing, and he was able to explain to her that it was likely that repetitive partial subluxations caused muscle spasms that left the shoulder sitting just out of place enough that it was incredibly painful.  And because the muscles were in almost a constant spasm she couldn’t get it back “in.”  He explained the strength of her back and how some muscles are overpowering others.  He broke down the directions for PT.  He pulled her from the water for 7 days.  He started a muscle relaxant 3 times a day.

Then, he had to explain to her that we should head back to Lennox Hill Hospital to see the interventional radiologist who dealt with her prior AVM.  It had been three years since we had seen him, in hopes we were done for good.  The placement of this “small” AVM (and think relative here, does a splinter hurt?  Yep.  So a grape hanging out somewhere in between the bone, muscle and nerve probably would too.) was difficult from an ortho standpoint.  He felt that embolization, closing off the blood supply to the malformation, would give a quicker recovery than trying to dig it out.

We had an appointment on December 2nd at Lennox Hill.  Just enough time to let the muscle relaxants start to kick in, PT to begin, and the shoulder to start moving slowly and painfully.

The doctor looked at the scans, did his own ultrasound and told us to schedule the procedure.  We left with a date of Tuesday, December 17th for an outpatient procedure.

The date was carefully chosen by my girl.  The 17th meant she’d miss only 4 days of school, and for a junior with a rigorous schedule and a 4.0 that mattered.

Also, the 17th meant she could go to Lancaster, PA the weekend prior to compete in a qualifying swim meet she had worked for years to make.  She had been looking at this meet since she began swimming years prior.  When she made her first, second, and third cuts over the months leading up to it, she was ecstatic.  Now, she was facing this meet with a different set of eyes.  The training interruptions caused by her shoulder meant she was unlikely to attain any best times.  However her gentle giant of a coach reassured her she should go for the experience.

And it certainly was an experience!   We left for home Sunday the 15th with the coach’s approval of three good swims.  She knew it was the last time she’d be in the water for a bit.

We left home Tuesday the 17th for at 8 for a 10 AM arrival.  This was surgery 19.  We knew the routine.  She had had nothing to eat or drink since 9 the night before.  The wait was long.  It was after 2 when we were waiting to leave her in the OR.  And as we were leaving the team made a last minute change that they would do the procedure on her stomach.  That meant a more aggressive anesthesia and an overnight stay which we were not prepared for.

We were placed in luxury accommodations, better than most hotels I’ve stayed in, because pediatrics was overbooked.  We ended up in the executive suite.  With nothing we needed.  Felix headed home on the bus to gather supplies.  He then drove back to the city and met me at the door to the hospital before heading home for the night.

I was glad we stayed.  The pain needed hospital level management.  The pain medication allowed for some brief silly time.  She was discharged around noon the next day.

As I went to gather the car from the lot I was prepared for the hefty overnight fee, but not for the giant scrapes along my right rear panel. Clearly my car had been hit, hard.  The bumper clip was broken.  I had just enough time to file a claim with the garage before she let me know the transporter had her in the main lobby.

I settled her into the car in terror because she could not get a seatbelt on.  I prayed so hard during that white knuckle drive down the FDR and through the tunnel.  We arrived safely home 45 minutes later where a neighbor saw us struggling and helped her up the stairs into the house.

As I write, it is the afternoon of 12/22.  If you’ve read this far you know it’s been a long month.  But the longest days came after we arrived home.

This kid is busy.  All the time.  She is at school.  She is at swim.  She is at lessons.  She is at the doctor.  She is at PT.  She is NOT used to being home.

Because I think most of us can relate that when you are still there is time to think.  And thinking is hard.  When you are still there is time to feel.  And often feeling is hard.

My girl is used to being just on the outside in most social situations.   I do not know why.  I can theorize for days, but it doesn’t matter really.  It just is.  So when you are on the edge, you get your interactions with people when you are there. When you are not there you get the often difficult to process feeling that you are not missed or your absence isn’t noteworthy.

There were some cards, and some well intentioned messages from well meaning family and friends.  They lit up her whole being.

If I’ve learned anything from watching her recover and rehab time and time again, it’s this.  When you’re not sure what to do, show up.

I don’t mean in person necessarily.  Although those visits can bring brief humor and relaxation.  The irony of this technologically connected world is that we are more distant than ever, when it is so easy to show up.

When in doubt, send a text.  There is no need for gifts or grand gestures.  Offer a face time call.  Let someone know you care, especially in the first 4 days when then pain is often the worst.  It’s ok to reach out because these phones are all on mute.  And you won’t bother someone sleeping, you will only make them smile when they wake.

Whether it’s one surgery or 31, the chronically ill patient appreciates it.

There are so many super-convenient ways to show up.

So many that we are practicing showing up more for others.  Because the world is round.  And you may not ever repay the kindness sent to you, but showing up for someone else can change everything.

#beatingcowdens and#hEDS

Don’t give up on a (limping) Zebra

You know that person in your life.  The one who always has a dramatic tale of woe?  The one who you tire of hearing from because all they do is talk about their health?  Because honestly all that doctor talk is quite depressing.  And I mean, you hate going to the doctor.  You just went last week and they made you wait 30 minutes past your appointment.  But, you gave them a piece of your mind, and you’re just not going back.  You are way too busy anyway.  You have other things to do, and a LIFE.  So you’ll get to it when you get to it.

So, it might be a little hard for you to process that your friend doesn’t have the ability to make the same choices.  And that one doctor visit, with the 30 minute delay, they do that several times a month. A 30 minute wait is a rarity.  Typical time round trip, including traffic and wait – often 5 hours. 

And over time you might have less and less to talk about with them.  Because, they missed the party, or cancelled on dinner.  They are so dramatic.  You’ve had that wrong with you.  Sometimes you have to get up and keep moving.  They spend too much time being sad.  What “trauma” could they possibly know?

While the Zebra is the Symbol for Ehler’s Danlos Syndrome- a group of inherited connective tissue disorders- it also speaks symbolically and metaphorically to the Rare Disease Patients we encounter daily.  In our house it is PTEN Hamartoma Tumor Syndrome, or Cowden’s Syndrome, and Hypermobile Ehlers-Danlos Syndrome, for now. With over 7,000 Rare Diseases, it is not “rare” to have one.  It is rare for them to be properly diagnosed, managed, and understood.

From National Geographic  (BLUE PRINT IS CUT FROM THE ARTICLE)

https://www.nationalgeographic.com/animals/mammals/p/plains-zebra/

ABOUT THE PLAINS ZEBRA

No animal has a more distinctive coat than the zebra. Each animal’s stripes are as unique as fingerprints—no two are exactly alike—although each of the three species has its own general pattern.

No two are exactly alike…

Zebra Stripes

Why do zebras have stripes at all? Scientists aren’t sure, but many theories center on their utility as some form of camouflage. The patterns may make it difficult for predators to identify a single animal from a running herd and distort distance at dawn and dusk. Or they may dissuade insects that recognize only large areas of single-colored fur or act as a kind of natural sunscreen. Because of their uniqueness, stripes may also help zebras recognize one another.

Stripes may help them recognize each other….

Population and Herd Behavior

Zebras are social animals that spend time in herds. They graze together, primarily on grass, and even groom one another.

Plains zebras are the most common species. They live in small family groups consisting of a male (stallion), several females, and their young. These units may combine with others to form awe-inspiring herds thousands of head strong, but family members will remain close within the herd.

They can combine to form a herd, or a small group called a “dazzle.”  Seems fitting though…

I used to be social.  I mean not overly social.  I never traveled in large groups, but I used to dine out.  I used to see friends.  At least sometimes.

I learned of the old concept taught in medical school many years ago when we were starting to live this overwhelming life full time.  It goes “When you hear hoofbeats, think horses, not zebras.”  The professionals we look to have been trained to explain us away.

Our medical system is so deeply broken, that our best and brightest are in debt they can barely see past, and in shackles to the facilities they must work for, who are often managed on bottom lines and drug companies pockets as they overbook them and take away the time to look at the whole patient.  These doctors are often cognitively capable of doping their job.  They are just not allowed.

Some theories on the progression of that quote can be found clicking this link.

When You Hear Hoofbeats Look for Horses Not Zebras

But the reality is this.  We are Zebras.  In this rare disease community at large, we are a herd of them, as many as 10% of the world’s population.

( And other Rare Facts here… https://globalgenes.org/rare-facts/)

RARE Facts

And we are trying to get treated by many doctors who have been trained, for whatever the reason, to categorically deny the existence of zebras!

It’s easier to diagnose and treat a horse I suppose.  It is easier to open the text book, or the app and find the segment on their current malady, remedy it, and send them on their way.

I rarely meet a zebra who doesn’t WISH they could be a horse.  We don’t want to be hard to diagnose and treat.  But, we are.

I am currently in my 11th month treating a foot injury.

I fell at work and it was handled to the letter of the law there.

My insurance company denied the MRI I needed for my pain.  I waited and walked on it for 2 months.  When I could stand the pain no longer I received a diagnosis of a partial lisfranc tear, a zebra type of foot injury if you will.  I was put in a boot, taken out of work and rested.  Then I was taken out of the boot, not because there was proof of healing, but because I’d been in it too long.

A second opinion told me to be patient.

My local podiatrist running point on the case has been wonderful.

I have seen him every other week since March.

It hurts. Still.

I tried Physical Therapy and was sent away after 5 visits because he felt something else was wrong.

I tried ignoring the pain and walking through it.  It got so much worse.

Another visit back to the second orthopedist left me feeling like a fool as he told me it was all good.

An MRI 2 days later showed stress changes in the cuboid bone, another “zebra” foot injury.

Unfortunately, those results came my way after 6 days in Orlando.

The boot was on again.  This time with a scooter.

Another opinion and another MRI in September progressed the fracture to “non-discplaced” cuboid fracture and sentences me to another 10 weeks in the boot.

My original podiatrist, a stand up guy, suggested Hospital for Special Surgery.  He could not get another MRI approved.  My insurance had tired of me trying to get better.  He thought HSS had a better shot.

In the mean time I had to come out of the boot.  Not because the pain was better, but because there is only so long you can stay in before you have other risks.

Countless hours trying to schedule, I ended up with an appointment 10/31.  His diagnosis was made without ever having me take a step.  “You have too much pain in too many places.”  Go see pain management.  My husband strong armed him into ordering another MRI, which he did.  Except for reasons I’ll never know he ordered only the forefoot…

The results of that MRI showed swelling, chronic fracture of the sesamoid, and a neuroma(that one is fairly common) among other things.  He backpedaled a great deal when he called with those results.

My foot is in no shape to return to teaching – yet.

I went to neurology locally.  Prior to me getting my sneakers off he diagnosed me with a pain syndrome, because “it has to be.”  I did a nerve function test, was told to take a “tri-phase bone scan” and seek pain management. Again, no exam.

So, I scheduled the bone scan and started looking at pain management.  Except no one at Hospital for Special Surgery will treat me, even though their doctor was also sending me.  And the one specialist I was referred to locally does not take my insurance.  I am awaiting an answer for another suggestion.  My second call to the local office was at 9 this morning.

 

I have a ‘hail Mary’ pass going to a PT tonight who I PRAY will think he can help.

It sounds luxurious to be a zebra, right?  Spa treatments all day.  HA! Because what else would you do when you’re not at work?

It is easier to think someone is being lazy.  It is easier to think they don’t care, or they aren’t trying.  It is easier to find the green grass in someone else’s yard.

It is easy to judge.  To say someone is “taking advantage.”  It is so much easier than hearing the truth.  Often the truth is hard.  And just not as interesting.

I can assure you I have been schooled once again in the value of the lesson “Everyone has something.”

When you are rare, you are left on your own.  A lot.  Doctors will not, or can not, or are unable to troubleshoot an abnormal/multidisciplinary diagnosis.

I will wait.  I will continue to seek answers.  I will pray that all the bones in my foot stay in one piece.  Because this, this was supposed to be the “normal” injury in the house.  It was “just a fall.”

But, apparently as I’m learning, when you’re a zebra, you are a zebra through and through.

Thankful for my “dazzle…”  You know who you are.

And some days I feel like its even a little more unique…

#beatingcowdens

#hEDS