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.

 

 

Onward…

“Onward Christian Soldiers, marching as to war, with the cross of Jesus going on before…”  That was one of Pop’s favorite hymns growing up in our Lutheran Church.  He sang it loud.  He lived it softly, but meaningfully…

It’s been a long time since I have written and I am sorry.

Writing is my therapy.  It’s free and easy.  When there is a few minutes to do it.

writing

And that, well that has been the problem these last few weeks.

I know it’s hard to imagine life getting so crazy that I wouldn’t have an hour or two a week to get my thoughts together, but it’s true.

Time to catch you all up –

On Sunday, February 21, 2016 the Second Annual “Genes for Rare Genes” fundraiser took place at the Hilton Garden Inn on Staten Island.  We had www.yeehahbob.com  Bob Jackson from Walt Disney World at the piano entertaining the masses.  We had generously donated raffles galore.  We had 178 friends and family with us, raising money and awareness for Rare Diseases.  We had Meghan, hosting, and giving her speech and showing her video.  https://beatingcowdens.com/2016/02/21/meghans-rare-disease-day-video-and-speech-2016/  We had Borough President Oddo stop by to continue to support Meghan in her desire to raise awareness and funds.  We had Charlie Balloons entertaining the children and the adults too.

My Everything
My Everything

 

Bob Jackson - Our Disney Friend
Bob Jackson – Our Disney Friend

It was a perfect day, and a month later I can tell you the total funds raised were $13,045.40 to be exact!  A large portion of that money has been sent to the PTEN Foundation and will have a significant impact on helping people like us with PTEN Mutations.  The balance of the money is soon to be on it’s way to the Global Genes Project They will always be near and dear to Meghan.  We identified first with the denim ribbon, and the logo “Hope, It’s in our Genes.”  And that is the site we learned first about Rare Diseases, and that we in fact are among the lucky ones.  These are lessons we will never forget.

Meghan addressing a crowded room
Meghan addressing a crowded room

 

Just a handful of our many raffles
Just a handful of our many raffles

Finally, I THINK, (and I apologize if we forgot anyone) all the thank you notes have been written or Emailed.  When I finally settled down to do it, there were over 80.  Meg helped, but I just flat out write faster.  Now, we rest on that a bit, while we consider what changes and what remains the same for next year.

But, life did not even pause while we planned this event.  My grandfather, my 96 year old grandfather, who was still living on the second floor of the two family home my mother grew up in, caring for my grandma, his bride of 70 years, fell on January 13th.  This set of a tirade of events of the next few weeks that brought us all through an emotional roller coaster.  My grandparents were the center of my world for much of my life, and even though I am blessed to have had them for 42 years, it is hard to imagine navigating life without them.   Pop visited two hospitals, had mutliple strokes, and ultimately ended up in the nursing home for rehabilitation.  The rehab was not meant to be, and on March 3rd he passed away peacefully, after some tumultuous days.

Pop - So much to so many
Pop – So much to so many

Grandma, now resides in that same nursing home.  Alzheimer’s has robbed her of much of her memory, but she is well cared for by kind, patient people.  She is safe.  She is calmer.  This is a good thing.  And, in one of many ironies, perhaps her disease has been a blessing.  There was no need for her to say goodbye to Pop, as he always seems to be just “across the room” when we visit.  They were never meant to be apart any way.

Always together...
Always together…

We celebrated Pop’s life at a beautiful service on March 12th.  My conscious mind, the rational one, is grateful he is at peace, and thrilled to know he is Home in Heaven.  The little girl in me, the one who adores her grandfather is sad.  Just very sad, and not looking forward to the series of “firsts” in front of us as reality sets in.

I planted the seedlings for my garden, just as my Pop showed me.  I am tending to them on the kitchen table with plenty of sunlight.  They have begun to sprout.

image

And those seedlings, and signs of new life remind me of why Pop loved the garden so.  It is refreshing to see growth, new life, and new promise each day.

We celebrated Kathi’s bridal shower, as she and Jon will marry April 15th.  All things new.

Time keeps passing.

time passes

In the interim there have been regular Mommy things to do, like swim practice, and doctor’s appointments, and household stuff.  Thankfully in this house we have a very, very helpful Daddy, and we do a lot of team work.  Thanks to him, all those weeks I was out of commission cherishing every moment with Pop, he was here, keeping it all going.

Last week we went dress shopping for some of the events coming quickly.

This week it was shoe shopping.  Shopping for shoes is never as much fun, because it is hard to find a shoe that is 12 years old, and supports those feet, knees and legs.  The right knee, the site of 6 surgeries targeting that AVM, has residual damage.  The muscles are not formed as well, obvious only to Meghan when she puts on a pair of jeans.  The foot is over one full size smaller than the other, and it is skinnier too.  So, we buy two pairs of shoes to make one “pair.”  We are careful.  Frugal when we can be as it’s all x2, but focus is always on fit, style and comfort combined.  No easy task.  But, we did it.

Meghan left the store apologizing for the bill.  I told her how grateful I am that we can pay for shoes, and other things.  We had a long talk about the phrase, “I cried because I had no shoes, then I met a man who had no feet.”  It fits nicely with the perspective talks we have all the time.

image

Tonight I was thrilled to find a website that will allow me to donate her “other” shoes to amputees.  She was excited too.  Something that will make us both feel better.

This week I scheduled some more appointments.  I was waiting.

Friday we head to the gyn for the 3 month follow up.  The hormones are a nightmare, but that’s for another post.  The next biopsy is supposed to be in June…

The dermatologist 6 month will be during spring break.  So will the orthopedist.

Cowden’s wasn’t gone.  Heck, it wasn’t even resting.  I was just using a big stick to hold it at bay for a few weeks.  I’m sure I left some stuff out.  It’ll come up if it was all that important.  Just know-

We are still #BEATINGCOWDENS!

Onward…