Meghan and Ella have been settling in so well together. Jax and Ella are fast friends. April and Ella will be polite acquaintances. Ella is playing, running, eating, and sleeping. She is adjusting to life in our home and seems to be enjoying it.
The most prominent lingering fear surrounded the lump on her side.
We gathered the notes from the vet in Indiana. We put all her paperwork together. The entire Ortega kennel had vet appointments today. So, we headed out for the first time as a party of 6- 18 legs, and 3 tails.
Our veterinarian is thorough. He has treated our dogs well. April needed some lab work for a persistent problem we’re working on. Jax needed to be caught up with some shots. And, Ella, well, that pretty girl needed to get started in her next phase of life.
The vet took her in and did a complete exam. He read the sparse notes we carried with us from Indiana. He looked at the photos of the lump on her side.
He called to tell us that we should start her vaccinations, as he could only verify rabies. He told us he did a heartworm test that was negative for heartworms. He drew blood. That “should be nothing” later this week.
And, since in these Covid times, all news comes via phone from outside the vet’s office, the three of us sat quietly while we waited.
“And the lump?”
“It’s her rib.”
Collective exhaling throughout the car…
“Yes, if you trace along the bone it’ll take you to her spine. Most people never feel it. Ella is very lean.”
Fist pumping and smiling took place for a few minutes.
We live in a worst-case scenario existence. It is so rare that it goes well. And, yet, today, was a win.
Nerves shot for no reason. I have no idea what happened in that office, or why the vet said hernia 750 miles ago. But this is a win. I’ll take it all day every day.
It looks like the rest of life really does start now.
It was a walk. Outside. On the long lead. And it went really well. Not perfect, but so very much better. The distractions are still a little disconcerting, but her focus and response to Meghan is improving all the time.
I am bothered that she doesn’t use the elevator, a problem compounded by our 4th floor room, Meghan’s nine knee surgeries and my very painful, swollen foot. And yet, I am super pleased that she trained today on the floor near the elevators, a floor she wouldn’t walk on days ago.
Her sporadic barking is a bit troublesome. Her trainers have told us it is the hotel, and noises we can’t even hear. I don’t love it, but they’ve been right on so many things this week. This week has been a huge learning experience. Yet another time in life where nothing is quite as you planned or expected, but there is a cautious optimism in the air.
I really expected when we got here that this Ella girl would hop right into bed with Meghan, and wake her up on cue the next morning. I did. I figured the leash would hand off and she’d be ready to do all the things Meghan needed. I expected she’d potty on command, and quietly tuck into small spaces. And I was upset when it didn’t go down that way at all. From learning to walk in sync, to finding the right spots for her to pee, it has been a labor.
I know lots of things. But sometimes it’s hard to accept that I don’t know ALL the things. Preconceived notions can be the undoing of many of us, and I am no exception. I did not realize at all that “Team Training” would mean that the dog and Meghan would be learning everything together. It actually makes sense. Ella is not a machine. Dogs don’t fit into “boxes” anymore than people do. Ella learned to work with Eva, and with Michele. Now, she needs to learn to work with Meghan.
Every time we have changed jobs, or bosses, we have taken with us the skills and work ethic, but had to tweak the way we performed. As the week has gone on it’s become evident that Ella was extremely well trained. She also works hard for really good food. As Meghan and she get to know each other, Ella has begun to transfer her learned behaviors and execute them with Meghan.
I was not totally sold on positive reinforcement training. I mean, I guess I used it to raise my kid, but certainly not with cheese and hot dogs! However, I have watched it work this week. And while I have no desire to train my otherwise happy pets like this, I see it’s value.
Tomorrow they practice, and Meghan gets to ask the rest of the questions. Well, the ones she has thought of already… I do hope they are prepared!
Tuesday she takes her public access test and we get on the road with our “plus one” for the 750 miles back to New York. This team has a lot going for them. Ella makes my girl laugh. The way the dog looks at her warms my soul. It’s like Ella understands she’s got someone really special in Meghan, and Meghan feels the same about Ella.
There are things that aren’t ready yet. We know there are no promises in life. We know it all too well. We are preparing to end the “Team Training” with tons of answers, lots of unknowns, and a giant pile of HOPE. I guess that’s about the best any of us can ask for!
Keep these two in your thoughts as they make “Puppy Steps” forward.
I knew it wasn’t going to be easy. I did. I just didn’t realize it was going to be THIS hard. I mean, maybe I should have. Easy is for amateurs after all. But, I didn’t realize it. And as a direct result I am just coming back to life after a week of anticipation, frustration, exasperation, disappointment and despair, because finally we have settled into HOPE.
There are so many things that are not quite as we expected. Some, because we did not ask the right questions, and some because the questions could not have been anticipated until we arrived. Yet other things were not as we expected because so much time lapsed from contract to “Team Training” that some of the things we were seeking most seemed to have gotten lost in translation.
The trip, all 11 hours and 750 miles was nothing short of exhausting. We ended it with a stop at Whole Foods before parking in the ice covered hotel parking lot. We promptly found someone to help, and paid a generous tip to have our car emptied to our 4th floor room while we waited out of the way of the black ice and the unwelcoming bite in the Indiana air.
We had a hard time resting that night, thinking of the union over three years in the making, that was finally only hours away.
When we arrived at Medical Mutts there was a warm welcome from Eva, and there was Marvin, the friendliest cat I’ve ever met to sit with us through paperwork. Michele, Ella’s primary trainer, came with Ella, and while there was excitement, there was hesitation throughout the room. There were no “fireworks” and no “Here Comes the Sun” playing, as I had anticipated so many different times before. There were casual greetings, and obvious work from everyone, human and canine, to try to figure each other out.
That is the part you don’t think about before hand. Or maybe you do think about it. But, then there is the difference between thinking about it, knowing it, and experiencing it. Ella is not a computer to be programmed. She is a dog. And for all the reasons we love dogs, she is a dog. She is also a highly intelligent, and extremely well trained dog. The former, her intelligence and even her ability to be trained are innate. Her training though was very much a labor of love.
Medical Mutts saw promise in this girl, a stray from the streets of Tennessee. They took her in from the rescue that had taken her off those streets. They brought her to Indiana and loved her. They worked with this beautiful girl knowing that she would one day become someone’s partner for life, and give them just the independence they were so desperately seeking. It is the whole reason this facility, these people, were Meghan’s focus years prior. The beauty of taking the unloved and abandoned and giving them value and purpose, that is the real reason we ended up here, at THIS facility.
I guess I just hoped, that it would be easier. But, easy is for amateurs.
Ella’s primary trainer was Michele, a well-spoken, professional and knowledgeable woman. When she first greeted us I found her a bit aloof. In less than two hours I realized she had put a good deal of energy into Ella and was protecting her best interests. She was trying to figure out if Meghan was going to give Ella the life she deserves. In less than two hours those two understood each other and I watched aloof become focused and driven to ensure she transferred all her knowledge of Ella to Meghan. I watched she and Meghan connect, like minded in many ways, and both were keen on making this union successful.
They worked Monday and the progress was spotty. Ella came with us to the hotel that night and all of us were in for an adjustment. We expected a dog who would hop on the bed and cuddle. But, Ella wasn’t accustomed to touch. My mind was a little blown, as we had sought this dog largely to sleep with Meghan, soothe her through nightmares, and wake her in the morning.
Tuesday they met again, and worked on some behaviors. My mind traveled from confused, to furious as I silently boiled at the thought we had waited this long for a dog that lacked what we had asked for in the first place. Further, she was distracted and needed seemingly constant redirects. When we entered the mall and both trainers seemed stunned at what they saw, I actually took a walk to choke on my tears. How after all this time could this be what was happening?
When I had originally looked at the schedule I was irritated that we had an off day Wednesday. I needed to go back to my life. What was this “off day?”
And then it was Wednesday. And I understood. It was a huge pivot in the journey. Meghan and Ella had some fun time. Ella stayed on the bed, and even let Meghan touch her. Ella played. She rested. Meghan got some confidence. They began to connect. It was so much slower than I had planned in my mind, but so few things ever go according to plan, I knew that often the best things came out of the detours.
There hasn’t been a day that we have not felt the full gamut of emotions. We’ve laughed and cried and screamed and yelled. We’ve giggled and cheered. We’ve passed out from exhaustion.
This morning Meghan and Ella had successful outings to CVS and Barnes and Noble. And I mean, really successful. They did the best team work I have seen so far. We came back to the hotel to playful “zoomies” and another training session with Michele.
And then tonight there was exasperation on a trip outside.
The pendulum is relentless. But every swing seems to leave them closer to being a functional pair. Ella is asking for contact. Meghan is reinforcing at rates that keep her interested and focused. They are growing together.
The weekend is for resting, playing and some informal sessions. Monday we brush up. Tuesday they take their public access test before we begin the journey home.
Tuesday is not the end, but another beginning. There will be so many beginnings in this journey. And maybe that’s the point.
Nothing in Meghan’s life has been as we planned. And not much has been easy or smooth. Yet every single step has brought us to places we’d never imagined possible.
Easy is for amateurs.
Meghan and Ella you’ve got this! Let the journey continue.
Below is the essay my daughter Meghan wrote and is planning to submit with her college applications this week. She is planning to pursue a career in the medical field. She wants to “do better.” Please after reading, click the title you think best suits her essay. We appreciate your help and support for #beatingcowdens.
There is a blaring white light. I feel someone holding me down. A needle pierces my feeble skin. A wail escapes my mouth. I let out a plea. I sob as I writhe on the table. I cry out and beg for the extraction of the needle protruding through my neck. My response garners two more needles. The despair is overwhelming. Dread encompasses me. Then, it all goes black.
That is it. That is all I can recall from November 2, 2011, when I was finally forced to confront the challenges of my new life.
At the ripe age of fifteen months, I underwent my first trip to the foreboding operating room, a place that would soon become as familiar to me as my mother’s smile. Being under the knife, in those bleak rooms where the sterile surgical tools sing in bitter harmony, is all I know.
Life became a whirlwind of many operating room doors, many tearful goodbyes, many nights of my parents patrolling my hospital rooms, and no answers.
Seven surgeries, six hospitalizations, and sixteen procedures later, I finally received a diagnosis. After seeing a geneticist, I was deemed a rare disease patient. I had Cowden’s Syndrome, a rare genetic disorder affecting 1 in 200,000 people. This disorder is specifically characterized by the commonality of both cancerous and benign tumors in patients, as well as vascular abnormalities and hamartomas.
I am seventeen years old. I have had nineteen surgeries. I have been admitted to the hospital thirty-two times. I have fifteen specialists. I have had over sixty scans, and more than one hundred blood draws. I have been poked and prodded so many times that my veins have developed scar tissue. I take over twenty types of medications just to get through the day. My weeks are filled with pain and tears. My months are filled with struggles and determination. However, I will never let the pain or my diagnosis stop me. I will continue to fight with every ounce of energy in my body to keep moving forward.
I have vowed to take everything I learned from each interaction in the medical field and carry those lessons into my activism and healthcare career. The opportunity to be a voice for my community is one of the biggest blessings of my life.
Following my diagnosis, the first organization I connected with was the Global Genes Project. Their symbol is the denim ribbon paired with the slogan “Hope, it’s in our Genes.” After playing an instrumental role in the creation of the first “denim ribbon” jewelry, my first idea for an awareness campaign was born. We started by giving out ribbons like the one I wear on my necklace every day. As the years progressed so did the complexity and efficiency of these events. To the blessing of all of us, the PTEN Foundation was created in 2013 and is a direct connection to patients like me. I have hosted seven events including virtual fundraisers, in-person fundraisers, and awareness campaigns.
Despite all the years of surgeries, setbacks, and mental health struggles, I have accomplished everything no one, even myself at times, believed I could. I have held a 4.0 GPA throughout my entire high school career, my mental health has never been better, and I am being recruited to continue my athletic career in collegiate programs. I have overcome my unfortunate genetics and made the most out of the obstacles placed in my life.
I am not rare because of the diseases I was born with. I am not rare because I happened to lose the genetic lottery or even because of the collection of scars and crutches I have accrued throughout the years. I am rare because of what I have done with what life has handed me. The scars are badges of honor that prove I stood up and faced these battles head-on.
This is not the birthday we planned, but it will be amazing in its own way.
These last few months have been a lesson for the world, that plans are sometimes abruptly interrupted and that life is often unfair. This is not news to us. We’ve been replaying that lesson together for many years; cheering each other on, and holding each other up through surgeries, recoveries, setbacks and all the things that come with our diagnoses.
The difference this year was that everyone else was at it alongside us.
I know you well Meg, but I have learned even more about you these last few months and I could not be prouder of you.
You tend to see the parts where you struggle. Sometimes it weighs you down. I see the parts where you succeed. I see the parts where the struggle is productive and you grow. That’s why we’ll always be good together.
There is no denying that there were times this year where frustration, sadness, isolation and loneliness tried to win. But, as I’ve said to you so many times before, you have a 100% success rate when it comes to overcoming obstacles, and this year proved no different.
You took the “remote learning” for what it had to offer. You missed the classes that had been engaging you and challenging your brain, but you never gave up. You spent the end of your Junior year as you did the beginning, finishing with the same perfect report card while doing a whole lot of “self-teaching.”
Swimming was wiped out in March just days before a meet that was to be your comeback. You were trained. You were ready. It was cancelled.
You mourned a few days. You worried about how to keep in shape. Your body had never allowed you to do much land training. You tried video after video. You addressed your own frustrations. You found a way. Now, when I see you hitting a heavy bag probably in the best overall strength of your life, I can’t help but smile. When I see photos of an 8 mile hike, when a year ago walking .5 was too much, my heart sings. You push your body to always be better. You don’t give up. You inspire me.
You had gotten us to agree to that tattoo months earlier – but you couldn’t be out of the water the required time after it was done. Then suddenly swim practice was no longer. So, you did it. With our blessing you took back a little of your body that day. You took back some control. You started to heal your soul a little more from so much trauma.
Without access to standardized exams, without the ability to tour campuses, without your college office, you knew you had to take matters into your own hands. Focused on your desire to be a Physician’s Assistant you carefully researched Universities. You created a list. You reached out to swim coaches. You set up your own calls. You narrowed things down. You called again. You got connected to admissions offices. You are well on your way to completing applications. You could have sat back and whined. You could have waited. You refuse to let anything stand in the way of your goals and dreams. When college is ready for you in the fall of 2021 you will be well-prepared.
You had a birthday vacation to Disney with your very best friend planned to the day. You were so grateful and so excited to experience your happy place with a great deal of independence, and super fun company too. We watched the numbers. We stalled. We watched some more. Then finally I had to pull the plug. Your birthday is one of my favorite days. It was hard to hand you disappointment like that. You took your time to process and picked your head up again. There will always be 2021…. The magic will still await.
Faced with the unusual situation of being local on your birthday you talked through all the feelings. You wanted to do something to make joy out of disappointment. You decided you were going to use your day to make others happy. You chose Ronald McDonald House, as you remember vividly the treatment you received when we spent a night in 2014 before your thyroid surgery. With a little help from Aunt Lisa, you were connected to the CEO of the RMDH New Hyde Park. I listened as you spoke to him and was just full of pride at your maturity and ability to handle yourself. By the time you finished he was as excited as you were.
You spent hours generating a digital flyer. You texted and posted and shared. You set up a contactless donation option for items on our front porch. Signs were made. People started to reach out.
When people asked what you wanted for your birthday, you sent the flyer.
That level of selflessness causes parents hearts to actually burst with pride.
There are many things this year is not. Many things you wished it was. You are starting your Senior Year of High School in very uncertain times. Your resilience is amazing.
It is not all smooth. It is not all easy. There are COUNTLESS bumps, and pot holes and craters in the road. “The other shoe” drops constantly. Sometimes as a sneaker, and other times as a steel toed boot. Regardless, you dust yourself off and press on.
“Get up. Dress up. Show up. And NEVER give up,” was written for you.
I can not promise you a smooth year. No one can. What I can promise is that if you continue to remain driven, focused, compassionate and loyal, you will succeed in all you do.
My wish for you is that you can spend some time this year learning to love your own strengths. I hope that you can spend less time worried about the struggle, and more appreciating the outcome.
Explore. The world is waiting for you. And the world will be better for it.
You can have hope while being grounded in reality.
Faith doesn’t mean you’re never sad.
Laura Story wrote the song, “Blessings” many years ago. It is a song that has played on repeat during a few of Meghan’s hospital stays.
“Cause what if your blessings come through raindrops? What if Your healing comes through tears? What if a thousand sleepless nights are what it takes to know You’re near? What if trials of this life are Your mercies in disguise?”
Is full of seemingly opposite concepts. Yet so often through our rare disease journey, and our Cowden’s Syndrome mountains, and Ehlers- Danlos obstacles, this song has just made sense.
And now, during this time of pandemic and isolation, and anxiety it resonates even more.
We are freakishly accustomed to isolation. Passing through surgeries and rehabilitation, and hospitalizations and illnesses as if they are as normal as a traffic light on the corner of a city block, means that you look at things a little differently. Any time not spent recovering is seemingly spent traveling to and from appointments that yield little besides new appointments. And yet, their very existence can consume every spare moment.
Cowden’s Syndrome is a constant “flashing yellow,” a caution sign, so to speak. It is a blessing that we are equipped with the knowledge that as a people so susceptible to a variety of cancers that we must pause to aggressively screen,often twice a year, for our most sinister well known risks, (breast, thyroid, uterus, kidney, colon, skin…) and that we must investigate each new bump or lump, because you just never know.
And yet that blessing comes sometimes through raindrops, of plans foiled, and journeys rerouted. All worth it if we have remained as we say, #beatingcowdens.
COVID-19 has rerouted most of the world this spring.
And we have learned.
We feel. We laugh. We cry. We sit still. We take walks. We eat together. We pray. We read. We pet the dogs. We sing. We celebrate. We mourn. We watch TV. We act with caution not terror. We care about others. We read. We learn. We talk to each other.
We “attend” church weekly for the first time in YEARS, as we have a church too many miles from us with a message we deeply need, suddenly available in our living room.
We did not pass a single graduation sign without a moment of empathy for what the graduates missed. We celebrated every birthday drive by with loud honking horns. We sent virtual cards when the store wasn’t an option. We thought about sports events and recitals and parades and everything someone, somewhere had their heart set on.
We talked about everyone missing something. Every house, on every street had plans interrupted, and life rescheduled without warning. “Everyone has something.”
And in the most unusual way, for the first time in a long time, we felt a camaraderie with so many. Everyone’s life was upended. Everyone’s.
Don’t misunderstand, I’m not happy about any of this. I just feel like it is easier to talk to people. That may sound odd. But currently people “get” isolation a bit better than before.
As swim season cut short days before a college showcase she was prepped and ready for, it wasn’t just HER.
As the SAT, and ACT play miserable games with enrollment and dates, she is united with the class of 2021.
Remote learning was… well I’ll just leave that there and say, necessary based on the state of NY in April.
We saw a 20th anniversary celebration derailed. And yet, we had the most incredible evening.
I cancelled tickets to my first solo journey, a PTEN conference that was to be in Boston. But, I celebrated the fact that this time I actually WAS going. I will get to the next one.
I took the refund for the missed Billy Joel concert. It took 2 decades for me to get the nerve to want to attend any concert again. It may take another 2 before I want to be in a crowd that large.
Disney – our August safe zone for 12 summers is cancelled. There is no way I could do it under these conditions. Just none.
There were tears cried for all of the above. But, there was also the awareness of gratitude, for health of family and friends, for two secure paychecks, and extra time with two adorable dogs.
The maintenance appointments are beginning to get caught up. Some have been live, and some virtual. I am undoubtedly excited about keeping some virtual medicine where the visits will allow. So far we are all faring well.
We are staying close to home. We are choosing our interactions wisely. We are choosing not to be crippled with fear, but rather empowered with logic, faith and compassion.
And when we head out into the world we mask.
We look daily at COVID numbers around us, and quite frankly they are disturbing. Locally we are in good shape now. But things change quickly.
We spend these days enjoying sunshine. We are in gratitude for a beautiful yard, and thankful that swim practice has begun again.
I promised to not complain about the 5:45 AM wake ups. And I’m trying to be true to that.
We have real conversations here about a fall schedule, without letting it overwhelm our days. We talk about scenarios. Her sport is a fall sport and it grows increasingly likely that her Senior season is in jeopardy.
We have conversations about school. We know that we want to return. But we do not know if it will come to be, at least not right away.
We have summer goals. They are different this year. And maybe that’s not always a bad thing.
We allow ourselves to feel every emotion here. And for us, it helps.
Whether you’re fighting a rare disease (or two) or wrangling a teenager, now more than ever we are one.
Blessings and sorrows are not mutually exclusive.
Disappointment can exist alongside gratitude.
You can have hope while being grounded in reality.
Faith doesn’t mean you’re never sad.
completing my first post from my iPad on the couch as the FOOT recovers from some pretty extensive, non Cowden’s related surgery.
There are things you could do without ever experiencing. Clearly #COVID19 is one of them.
I live in NYC. I have lived here every one of my 46 years.
I was born and raised here. I graduated from public school, SUNY and then CUNY. I work in the elementary school I graduated from. I have lived in the same zip code pretty much my whole life.
I watched my local community rise up many years ago when my young cousin battled Leukemia. I remember that, even over 30 years later, whenever a neighbor I don’t know is in need.
I watched my local community, many aspects of which were decimated by the horrors of 9/11, rise up in indescribable ways.
I watched my community draw together again after Hurricane Sandy wiped out neighborhoods.
We worked together. We prayed together. We loved on each other. We gathered together. We shared what we had.
I live amongst compassion, bravery, dedication, resilience, tragedy, and grief.
I also live amongst some selfishness, stupidity and inflated senses of self importance.
The greatest city in the world gives you all that and then some.
Despite having a small social circle, I am a mother, a wife, a daughter, a granddaughter, a sister, a niece, a cousin and a friend.
I am a patient with a PTEN mutation called Cowden’s Syndrome.
I am a cancer survivor.
I have a teenager with 2 rare diseases, and a brain that runs 24/7.
We are immune compromised.
I am a NYC Public School Teacher.
My husband is an essential worker.
Daily the news reports are often silenced in my house. I know what’s going on around me. A few numbers across a screen give me what I already know. Hope of blossoming spring has been muted by tales that nightmares are made of.
I spend the days trying to remotely engage young minds in math games. It is, if nothing else, a welcome distraction.
Suddenly, this community that does so much better when we can gather together is isolated.
Our friends are sick and dying quickly. To much of the country and the world they are numbers. To us they are humans with names and families. We can not visit. We can not comfort. We can not gather. We are leaving our loved ones at the emergency room door, praying we will see them again.
We, alongside the whole world, are fighting a virus that seems to have a strangle hold on my home town.
People like to make themselves feel better, but the truth is this virus does not discriminate. We can barely even find it, let alone attack it.
We are chasing it. It clearly has the upper hand.
We have been told to #flattenthecurve but, I fear the sheer numbers of us make this so much harder.
My husband comes from work removes all layers, scrubs, showers, washes all outer garments. He gave up public transportation to reduce his “touch points.”
We are grateful for the home we have. We are grateful for each other, for the internet, for Zoom and FaceTime, and virtual church. We are grateful for washing machines and space, and luxuries never to be taken for granted again.
We are grateful for computers that allow for everything from Advanced Biology to voice lessons and test prep.
We leave for 2 walks a day at off peak hours.
The stores I used to walk in and out of because I could, are saved for when lists accumulate and there is need.
We order food a few times a week, a calculated risk carefully played out because the restaurants that have openly supported our fundraisers through the years, deserve our support now as well.
The schedule has slowed from its chaotic pace. Swim season just isn’t. There is no college search right now. Doctors are cancelling, and rescheduling. Routine check ups are on hold. And honestly I don’t mind. Even this chronically painful foot is waiting its turn while really important things happen at the local hospitals.
We take this call to social isolation really seriously here.
Selfishly, I might even enjoy a little of this forced family time. A year from now my girl will likely have her college chosen and be starting her transition out of our nest.
Having Cowden’s Syndrome has done a lot of work on my perspective through the years. I’ve learned that you can’t keep waiting for it to be over. That’s true of everything in life.
A dear friend has told me often, “You can have it all, just not all at the same time.”
You have to live each day, from beautiful to unspeakable. It is the only way to preserve feelings of compassion, empathy and focus on the greater good. You must laugh and cry, and scream and yell, and feel all the feelings.
I have scanned 3 and a half years of letters Pop wrote to Grandma in the years he was deployed during WWII. Those years preceded a marriage that lasted over 70 years. I think of them all the time, but even extra these days. I think about how hard it would have been to socially distance from them, but also about the lessons they could have taught all of us in patience, resilience and sacrifice for the greater good.
I’ll use some of the next days to read every one of those letters before uploading them to create a hard copy to be shared in my family for generations.
There is a lot to be learned from the “Greatest Generation.”
Sometimes I get angry at flippant or arrogant folks I see, in person or on the news. The people who think they are too good, or exempt from this global pandemic. The people who don’t think they have to do their part.
Then, I decide to focus on the overwhelming number of people who are doing whatever they can to make this better. All those essential workers we learned about in the first grade unit on “Community Helpers” are the ones I focus on with gratitude.
I am not better than this virus. I am just as susceptible as the good people across the globe who are struggling with these infections.
I isolate not out of fear, but out of respect.
I isolate out of respect for those who can’t.
I isolate out of respect for our first responders and essential workers.
I isolate out of respect for those who are living with this virus.
I isolate because maybe one less person will get infected because I did.
I miss the way our city has come together in all other times of tragedy.
I miss hugs, and offering comfort and being comforted.
I will message the people I miss so much, and check in on them.
And, instead of complaining the time away I will spend more of it in prayer for those who need very much not to feel alone, reaching out through the technology I’m blessed to have, with gratitude that if I am forced to isolate I have a comfortable home and a few of my best friends to be with.
World Rare Disease Day is February 28th. People all over the world will work to raise funds and awareness for over 7,000 Rare Diseases worldwide. In our house things are buzzing, as we prepare to teach the world a bit more about Cowden’s Syndrome.
There will be so much time to write. Soon. Right now we are preparing for Rare Disease Day 2017 and “Jeans for Rare Genes 3.” All the preparing brought me back to her video from last year. And then I looked at the year before, and the one before that. And I was struck by how much she has grown, not only in her technological ability, but also as an advocate, and a voice, and a human.
There will be no video this year. It was time for a change of pace. But, I thought it appropriate to post these here, now. She keeps me grounded…
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.
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)
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…
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.
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…