Autoimmune updates, because there are some. (+ a random food pic)

Why hello there, weekenders.

Well!

I only do autoimmune disease updates when there’s something to report for those of you who follow my autoimmune adventures. Adventures, we are having! All kinds of adventures! I’ve been navigating a flare these last few weeks. This time, the joints under attack are those in my left thumb… mainly its middle joint and the large joint at its base.

My rheumatologist ventured that she could put me on prednisone, but she’s in favor of my rejection of that option. I also want to avoid going back on methotrexate, because with my work hours, monthly visits to the V.A. hospital for labs won’t be possible… at least not right now. I’m still too new at work; I don’t accrue sick time yet. I wouldn’t enjoy having to ask for time off every four weeks, regardless. Not to mention, methotrexate nausea at work would really suck.

Instead, we’re doing a trial of topical gel medication (your basic diclofenac sodium) three times a day and a restriction splint that she ordered for me from the prosthetics department. I only wear the splint at night. It helps. Without it, the pain in my left thumb is excruciating in the morning, and the joints are locked up, and my hand is so weak, I can’t hold anything with it. Thankfully, I’m right-handed!

So far, I’m doing okay on this treatment plan. It’s alleviating the pain somewhat, and it’s helping to keep my left hand in working condition. My thumb is still weak, though, and its middle joint still locks up and pops. Its natural state is bent, and I have to pop it to straighten it out. When it’s locked up in a straightened-out position (the most painful circumstance in the flare… it just now happened, in fact), I have to pop it. Pop it to unlock it. That’s when the pain is the worst: when my thumb is straightened out and frozen.

Eh.

These things happen from time to time even if you take your daily dose of hydroxychloroquine without fail. If you know, you know. The medication is effective, but like many, its superpowers aren’t 100% all of the time. Flares will still hit. I’m hoping that the topical and the splint and the Advil will end the flare, because I cannot be going around at work with a methotrexate throw-up bucket.

On that note, I’ll leave you with a pic of the food I devoured for dinner tonight, because why not? It was simple and amazing. I was craving kimchee. This hit the spot:

 

Broccoli, vegan chicken from Gardein’s Mandarin orange crispy chick’n kit (without the orange chicken sauce), vegan kimchee, and brown rice.

 

The vegan chicken from Gardein’s Mandarin orange crispy chick’n kit, though! Highly recommend, my friends. Throw it on a baking sheet and stick it in the oven and call it good, because it is.

Happiest of weekend vibes going out to you!

 

 

Summer solstice with a side of water.

According to people who study the sky, today’s the longest day of the year. In my world, it was yesterday.

I’ve hit the two-month mark on my new (autoimmune disease) treatment plan. If I had to draw a diagram of the side effects and their weekly patterns, it would look like the “The Big Zipper” constellation, which hasn’t been discovered yet because it’s too snaggy to be plotted out. It gets caught on loose threads and puffy linings. You never know what or when. There are no reliable conditions, so it can’t be predicted.

There used to be a sort of pattern, but now it’s all over the map.

I almost got away with no severe side effects this week, and then a series of them hit yesterday out of nowhere: intense nausea, confusion/disorientation, headache, stomach pain, and thirst off the charts.

Everyone is different. No one has the same side effects, or the same configuration of them. Some people can’t take this medication even at its lowest dose, because they can’t tolerate it.

Daily folic acid tablets have kept my side effects to a minimum. You’re supposed to drink a lot of water, which I’m doing… even more than before, if that could be possible. I was already long into the habit of drinking water from the minute I wake up to the minute before I go to bed, and now I’m drinking even more water.

“Excess thirst” doesn’t seem to be a documented side effect, but there has to be a connection between this medication and my increased thirst! The first effect I noticed was the weird sensation of being thirsty while drinking water. It’s weird when water stops being quenching.

 

Water all day.

 

Things are going well, overall. I’ve only had one pain attack since starting the medication, so that is wonderful. My first round of liver and kidney labs came back fine, so we know that the medication’s not damaging them.

I check back in with my doctor in a few weeks… we’ll see what we see from there!

The End.

Possible mid-life crisis sighting: new glasses?! (+ 1st cardio class on new meds!)

I stepped on my glasses yesterday. They were laying on the ground, on the brick pavement part of our back patio, because I’m a brilliant genius. That’s right. Not just any kind of genius. A brilliant genius. Luckily, I was wearing cloth house slippers. The damage could’ve been worse. My expensive progressive lens sat perfectly unharmed – not even scratched – within frames that were bent like a flimsy wire hanger from the dry cleaner’s.

A few hours later, I headed to my optometrist with hopes that the frames could be fixed. While I was there, I did what people naturally do when they’re in a room surrounded by glasses frames: I checked out the glasses frames.

To my dismay, I found a pair that I really, really liked. The entire room, I lamented to Callaghan, is like the cash register lane where they stock things they know you’ll consider buying just because you’re stuck in line with nothing to do but look at them.

I do not need an additional pair of glasses. I just felt like I needed them. My replacement frames were on order (100% covered by the warranty), and I was still sitting there staring wistfully at the unnecessary glasses frames. Callaghan coaxed me away so we could leave. “Allez, allez! On y va!” He said as he walked away from me, leaving me no choice but to follow him. (Classic French husband move.)

So here’s what I’m thinking: I’ve been waiting for and wondering about and anticipating my well-earned mid-life crisis so much that now, every time I get a wild hair up my ass, I think, could this be it?

Maybe this glasses thing is my mid-life crisis, since it fits the cliché: I have this sudden, strong desire to blow a stupid amount of money on something I don’t need. (“Stupid amount of money on something I don’t need ” converted to U.S. currency = anything more than $25.00, maybe $30.00 if you include shipping and tax.)

If this is it, I’m disappointed. The object of my irrational desire should be something more mid-life-crisis-ish. If this isn’t it, then what will it be, and when? Will I reach the end of my natural lifespan and finally realize that I need a Maybach? I do tend to be a late bloomer.

Totally unrelated because I wanted to post a pic and didn’t know what and I wanted to share this small victory with you, anyway: I have a selfie I took yesterday evening when I came back from Body Combat, significant because it marks the first cardio I’ve done in while.

I mean, okay, it’d only been two weeks since my last Combat class, but it seemed longer. Yesterday was the first time in a long time I could get through class without feeling like it was an exercise in dragging myself through wet cement.

Probably not coincidentally, it was my first cardio workout since starting my new medication. It seems that my new treatment plan is working! Despite side effects, I felt much better in class yesterday, and not just because I held back a little on the hardcore. Before the new medication, each Combat class felt successively more impossible; the last one was a disaster.

 

(02 May 2018 – commemorating my first cardio class since the addition of my new medication! It seems to be working.)

 

This wraps up my eventful day yesterday. Here’s to a year with improved physical condition… and only one pair of glasses.

Medical first-world problem. (Ft. See’s)

My rheumatologist added a med to my treatment plan, and I’ve been having some side effects, mainly on-and-off dizziness and lightedness, muscle fatigue, and mild nausea. I’m also experiencing THIRST, which makes no sense when you guzzle water all day. I drink a glass of water and five minutes later I’m hit with a crazy pang of thirst like I need water NOW and if I don’t get water NOW I’m going to die, as if I hadn’t had water for hours. What else… my appetite is somewhat different. I crave sweet things (which I normally don’t) and salty things (which I normally do) while having no appetite.

If this is it for side effects, I said to myself after a week, then this is nothing. This is easy. I can handle this for a year!

Then Callaghan came home from work yesterday.

A client brought me a gift, he said. I’m giving it to you, he said. He opened his backpack and removed a bag I knew very well. My reaction at the sight of it was instantaneous and visceral. I backed away while yelling: “OH MY GOD NO!!! GET IT AWAY FROM ME!!!!”

As if the bag contained roaches, right? Plot twist: the bag contained a half-pound box of See’s Candies. Furthermore, since I tend to assume the worst when I’m down, I knew that the box would contain mixed nuts and chews, my favorites… AND IT DID. To this, my reaction was: “AAARGH NO I’M DOOMED.”

At least the worst of worst-case scenarios didn’t happen. There were no scotchmallows in the box. Our neighbors would not have to hear me screaming in the street.

Callaghan’s response: “Hahahahahaha!!!! But they’re your fav – ”

“No no no no no!! Thank you, but no.”

“You mean you’re not going to eat them? Haha!”

But he knew that I wouldn’t. I was starting to see the whole thing as a prank.

 

Why. Are these. In the house.

 

I’d lost my taste for sugary sweets ages ago, since I quit eating them. I don’t want to start eating them again. I wasn’t a sugar person in the first place, but there were a few sweets that I’d crave, and the number one thing on that short list was See’s Candies. The dark chocolate scotchmallows were my downfall, as some of you may remember.

So I’m alone in the house with the box of See’s Candies in the kitchen. No, they’re not vegan. This never mattered, because I’d eat them pretending that I didn’t know. My See’s Candies weakness was that bad. 

Since I quit eating sugar, I’ve had no problem avoiding it once it was out of my system. It’s been a non-issue. I don’t even “resist” sugary things. I just don’t want them. Now, THIS. And by the way… See’s Candies aside… it’s just weird to crave something without having an appetite. For me it is, anyway.

Truly, though, I’m very grateful. A lot of people suffer horrible side effects from the medication I’m taking, even at the low dose that I take, and I’m feeling mostly fine in comparison. This See’s Candies “problem” is a new one for me. It’s a medical first-world problem.

 

Getting personal: autoimmune disease. (Sjögren’s syndrome)

Though I’ve mentioned it in recent posts, my current medical situation has been a big enough part of my life that it warrants a post of its own, I guess, for anyone who might be interested. I’ve spent most of my adult life dealing with autoimmunity, working around various symptoms until receiving my diagnoses with Sjögren’s syndrome and autoimmune thyroiditis (hypothyroidism). I used to write about my Sjögren’s syndrome a lot. I haven’t written about it at length in years.

I felt fine when I left the country in 2011 and stopped taking my medication (hydroxichloroquine – Plaquenil, in my case), and I assumed that I was in remission. A few years later, I came back to the Land of AZ and went to my optometrist for a routine vision check. He informed me that as far as my eyes were concerned, I never went into remission. (Telling myself that I was in remission sure helped me to feel like I was in remission, though!)

Musculoskeletal symptoms started up again toward the end of 2016, along with worsening “brain fog.” I’d entered an autoimmune disease “flare,” and it left no room for denial. Weird things started to happen, as they do with autoimmunity. When the middle of one finger turned blue one night (“Idiopathic Blue Finger,” diagnosed the E.R. doctor – not Raynaud’s, which I also have), I returned to the rheumatologist, who put me back on hydroxichloroquine (again, Plaquenil). I shrugged my shoulders and pressed forward. I had a rough draft to finish! It was the thing that was causing my stress, but it had to get done.

Toward the end of 2017, my immune system went into overdrive again, even as I diligently took my daily dose of hydroxichloroquine.

2018’s been more difficult, yet. The last three months have revolved around some of the most painful attacks on my joints I can remember, some of it incapacitating. My agenda jammed up with medical appointments and testing of various sorts, as my rheumatologist wanted to rule out the development of other autoimmune disorders before deciding on our next course of action. Let me just say that my rheumatologist at the Phoenix V.A. has been the best I’ve ever had! She’s fantastic. Autoimmunity is something that can gather steam with time and generate additional disorders, so it’s good to re-check everything when things go awry.

Genetics likely play a role here, by the way, and I think I know the source of mine: when we met, my bio-mom told me that I physically take after my father’s mother’s family (the Ashcrofts, in England). I would love to meet them and find out who’s had what autoimmune disease. I’m assuming there’d be something to learn.

It’s pretty easy for me to dismiss my symptoms. I’ve had dry eyes for so long that I forget that it’s a part of my disease. A lot of people have dry eye syndrome without having Sjögren’s. It’s “my normal” to be unable to open my eyes in the morning until I put in artificial tears. (I might have stopped taking the hydroxichloroquine when I moved to France, but I’ve never stopped with the eye drops.) Since I push myself in the gym, it’s easy to assign blame to my workouts when I experience bouts of musculoskeletal pain. I focus when I work out. I don’t consider that I’m dealing with Sjögren’s symptoms. I don’t want to go there in my mind.

I don’t feel sick, for the most part. There’s a general malaise sometimes. My energy levels are mostly good, but fatigue sets in more quickly during my workouts now, and I can feel that it’s Sjögren’s-level fatigue. I have occasional abdominal pain and nausea. The brain fog has led me into some embarrassing conversational exchanges. All of this is minor enough.

Since 2016, my white blood cells have mainly attacked my joints and my eyes. My vision in my right eye has worsened slightly over the course of a year, and there’s more scarring on my corneas. My optometrist applied a temporary contact lens bandage to the cornea of my right eye (the more affected one, the one that hurts) and sent me to a corneal specialist.

My last musculoskeletal attack started at a party a week ago Saturday. In typical autoimmune fashion, it struck all of a sudden and out of nowhere. My left hand seized up with intense pain, starting at the large joints on the outside of the hand and radiating inward. For the rest of the night and into the next day, I couldn’t open or close that hand all the way. It swelled up a little bit and changed colors, and it felt like a mild constriction was happening. It was excruciating. Thankfully, the episode lasted less than 24 hours. Some of my recent attacks have lasted for almost two weeks.

I’m grateful that so far, Sjögren’s syndrome has left my internal organs alone.

Meanwhile, my plant-based lifestyle helps me to function at a physically high level with Sjögren’s syndrome.  I’m trying to keep processed foods to a minimum. I’m trying to get more sleep. I’m continuing to drink water all day long, including water spiked with organic, raw apple cider vinegar. I really believe in that stuff!

Now that my test results have come back, my rheumatologist is adding methotrexate to my hydroxichloroquine. On the alternative side and courtesy of my amazing parents, I’m also adding Manuka honey (Comvita brand, from New Zealand) and Ukon (tumeric) to my daily supplement cocktail. I’m hoping for the best, but expecting life to continue as it is, with good days (as in, I can go to the gym) and bad days (as in, I can’t go to the gym). No, it’s not all or nothing – there are days that are bad because I’m in pain, but I can still do something, so I go to work out and I do whatever I can.

I went to the gym this morning. I took this selfie about an hour ago, in the late afternoon. I’m still feeling fine.

 

Autoimmune, don’t care. Today is a good day.

 

With my new treatment plan, I hope to see the end of this flare. The attacks on my joints should stop. My head should clear up so I can remember things like, say, the first thing about a prominent politician, and that a person who’s ridden in my car on many an occasion does, indeed, know what my car looks like, and that a friend’s get-together was in April, not in March. About that last: I’ve never missed an occasion by a whole month before. It just happened, and it sucks, because the friend who invited me lives out of town, and it might be years before I can see her again… not to mention, I’d accepted her invitation. I accepted, and I didn’t show up, and I regret that very much.

That’s the story. I know that many of you also live with chronic illness. HUGS to you all. Let’s keeping fighting the good fight!

 

The silver lining of a bad day is the day after.

This has been a week. I’m sure you can all relate to this: there is no day as good as the day after a really bad day. The great thing about today is that yesterday was a day of epic fuckery such that today can only be better. For one thing, I was able to get to the gym this morning. I couldn’t go on Tuesday or yesterday, so you can bet that today’s workout made an immense difference.

For me, everything about working out makes everything better, even an aspect as simple as setting up whatever area I use. I took this pic weeks ago when a friend pointed out how I always organize my area, with my backpack and water bottle to the left:

 

Organized crime.

 

I took this picture jokingly, but it’s soothing to see it because I see habit, and habit can be a balm. It’s a way of feeling in control; in this case, it’s a healthy way.

This post comes from a place of gratitude. Yesterday is over. Today is a new day. I have yet another doctor’s appointment this afternoon (my third this week) – one of my medical specialists – but this is a good thing. Today’s doctor will be different, and I’m very optimistic that whatever he does, the experience will be the opposite of the one I had on Tuesday. I’m talking about ophthalmology, the only medical specialty not available at our V.A., by the way.

Yesterday, man. There was just something about it. Callaghan had a Very Bad Day yesterday, too, for reasons different than mine. It was awesome that we didn’t get into it despite our equally bad moods!

I’ll try to remember to repeat this mantra on future bad days: tomorrow is a new day. Some sayings make profound sense, and there’s nothing like experience to appreciate a tired old adage as something more than a tired old adage. Everyone is different. It’s good to hone in on adages that help get us through. For me, “things can always be worse” is a good reminder, but it isn’t as reassuring as “tomorrow is a new day.”

 

Back in the gym! (Autoimmune B.S. notwithstanding.)

Today, I feel the need to report that I went to the gym this morning. It felt momentous and amazing, even though I haven’t missed that much… I just missed last week Thursday and this week’s Tuesday and Wednesday. Today felt momentous even though I did what I could in the garage last week, and even though I did make it to the gym on Saturday. There are lulls in the doldrums of agony, and you can bet I’m racing to the gym when they occur!

It just felt like a long time. The thing is, as I was realizing this morning while talking to my BodyPump instructor, I have a lot of physical energy, so I feel like I’m literally jumping out of my skin when I’m grounded by stress-induced autoimmune flares such as the one I’ve been dealing with lately. My body is full of energy at the same time that it’s grounding me with joint pain. It’s like a librarian surrounding me with all the books I want to read, then setting a ring of fire between me and them so I can’t get to them. That would be a sadistic librarian. Autoimmunity makes for a sadistic body.

Maybe I’ll post more in-depth about my current autoimmune situation in a future blog post. Right now, I’m enjoying this almost-100% feeling. Things aren’t completely settled down yet; I have more appointments lined up, and lab-work pending review. I’m taking each day as it comes, doing what I can, when I can. I have a lot of writing catch-up to do, too, as a result of all of this.

I’m just so grateful for the V.A. hospital, which has been treating me very well, and for my rheumatologist there, who’s the best I’ve ever had.

And BodyPump this morning was awesome, as usual! I love seeing my people there as much as I love the workout!

 

So happy to be at the gym this morning! I took this before-workout locker-room selfie thinking “BodyPump in 15!!”

 

The rest of the week’s looking fabulous, too. Callaghan’s birthday is on Saturday, so there’ll be shenanegans of some sort in honor of that. He would love to know what’s involved. He’s not going to know until then. Heheh.

Happy Friday Eve, everyone!

“The Beast in the Belly.” (My favorite medical mystery.)

Have you ever read an essay or a magazine article that’s stayed with you?

24 years ago, a surgeon in New Haven, CT wrote a narrative essay about one of his patients, a young woman whose mysterious ailment led him to investigate a medical condition the likes of which he’d never seen before. His essay appeared as an article in the February 1995 issue of Discover Magazine, which I found lying on a table somewhere – probably in an office at ASU, as I was in college at the time.

I opened the magazine to the most interesting and horrifying medical story I’ve ever read. I say this without a shred of hyperbole.

Real-life mysteries fascinate me.

I’ve never forgotten this particular medical mystery; I’ve sought out the article several times in the 20+ years since. It’s the only magazine article I’ve wanted to re-read over and over, and it’s the only article whose title I’ve never forgotten. Granted, its title is somewhat sensational: “The Beast in the Belly.” Sensational, yet apt.

The first time I wanted to revisit the article, I had to go to the media library in the campus’ main library’s basement to hunt through the archived magazines. I Xerox’d the article so I wouldn’t have to repeat the effort in the future. I re-read the article several times over the passing years, and I also shared it with friends and family, like you do when your fascination borders on obsession. At some point, I lost my copy of the article, but by then we were far enough into the Digital Age that I was able to find the article online. (I remember how amazed I was at the idea of someone putting archived magazine articles on the internet!)

Perhaps the medical mystery in question may not be as much of a mystery today as it was 20+ years ago. It’d been mysterious enough back then, though, that this surgeon encountered it for the first time and learned about it as he frantically worked with a team to save the young woman’s life (which they did). Even if the ailment is less of a mystery now, it’s still rare in western countries, I believe.

The ailment is not common in western countries, and that is why this surgeon and his medical team in New Haven didn’t know what they were dealing with when this patient landed on their table with her guts rapidly necrotizing.

I’ll now leave you to read this essay – “The Beast in the Belly” – for yourselves, if you’re so inclined. (I spent the morning at the hospital, and this story occupied my thoughts while I was there, in case you were wondering why the medical mystery came back to mind this time.)

Grab the beverage of your choice and enjoy!

 

Wrangling with B.O.B. (Garage Gym workout!)

A minor stress-related autoimmune flare has kept me out of the gym these last two days, but the garage saved me from inactivity in the meanwhile. The ironic thing is that working out is my therapy to help reduce stress, but if stress gets to me anyway, I’m sometimes unable to do my normal workouts! I know that those of you with autoimmunity issues know exactly what I’m talking about.

In the garage yesterday late afternoon, I wanted to challenge myself in ways that wouldn’t aggravate my right shoulder. I set B.O.B. to a greater height than usual, thinking I’d try to work with the height differential.

A sampling of screen shots from my workout with a 6-foot, 290 lb. dummy:

 

1). I started with a jump-rope cardio blast to get warm, jumping rope in 3-minute rounds to music from Disturbed’s The Sickness album.

 

Cardio: jumping rope

 

As usual, there’s nothing to see here, really. You can’t see the rope when it’s in motion.

 

The rope.

 

Moving on! Here’s the height differential I had before me:

 

Me vs B.O.B. (height differential)

 

I’m 5′, 4″ and 115 lbs. In this case, B.O.B. is 6′ and 290 lbs (fully filled with water)

 

Me vs B.O.B. (height differential)

 

2). I threw some kicks to see where they’d land on someone who’s six feet tall.

 

Side kick (placed and held)

 

I have short legs and I’m not flexible, so this is as high as it’d get. This is not what would happen in reality. If you’re taller than me, I’m much more likely to blow out your knee or your family jewels.

 

3). I tested my left back fist (leaving my right arm out of it). It was indeed a reach to get 6-foot B.O.B. in the face. In actuality, a person of this height would get throat-punched.

 

Back fist

 

4). I tried out some knee strikes on 6-foot B.O.B.

 

Pulling B.O.B. down for a knee strike

 

Knee strike

 

In my current condition with my right side, I can pull all day long, but pushing overhead or straight-arm lifting/extending are a problem. I did a lot of pulling in this work-out.

For these knee strikes, I jumped in to grab B.O.B. by the base of his skull, jumped back in my stance to pull him down toward me, and then came up to land a rear knee. Unfortunately, it only got to his chest. Haha. Again, in actuality in a street situation, my knee would end up lower. That’s fine. A hard knee to your solar plexus will knock the air out of you.

 

5). I found out right away that a standing rear naked choke was not going to happen on 6-foot B.O.B., so I just grappled him as best as I could, really testing my strength more than anything. In real life, I’d have to get him to the ground in order to choke him.

 

Using B.O.B.’s base to step up and get my arm around his throat

 

Even stepping up, I couldn’t twist my arm around to get a proper grip, so I just did this. (My right shoulder was fine with this.)

 

Pulling him back by the throat from the other side (sorry we went out of frame)

 

This kind of wrangling with B.O.B. made for a pretty good strength-training, pulling workout (so back and biceps, I guess).

I did a little more in the way of conditioning exercises…

 

6). Speed punches for muscle endurance:

 

Speed punches

 

Again, you can’t really see anything, but there was some speed happening in these rounds of speed punches. The goal is to stand close and hit fast, not hard. This is like sprinting in place with your upper body.

 

7). Jumping-in planks:

 

Plank

 

I kept a little bend in my elbows to avoid stressing my right shoulder.

 

Jumping in (then back out, repeat)

 

(I suppose all of this counts as knuckle-conditioning, too, since I’m always on my knuckles.)

 

8). For abs, I just did some crunches.

 

Lying on the floor (doing crunches), ha

 

9). I finished up with some stretching.

 

A few stretches at the end

 

I forgot to take a post-workout selfie, so here’s a screen-shot of one of the times I turned to face the phone:

 

(you get the idea)

 

That was it! This was a fun garage gym session. I got to sweat a little, and the whole thing was pretty instructive, too. I’m not done working with B.O.B. set to this height.

Phoenix Forgotten. (Failed non-review movie review!) (+PTSD diagnosis story)

We went to watch Phoenix Forgotten, which brought back the year of 1997.

As I sat there, it occurred to me for the first time that the beginning of my PTSD coincided with the Phoenix Lights.

[NOTE: The link function to open the linked page in a new window is down at the moment, so you’ll have to back-arrow to get back here]

 

 

Probably many of us living here in Phoenix metro in 1997 remember the lights that moved over the Valley in March. For me, 1997 was also eventful because it involved numerous doctors throughout the year. 1997 was the year I was diagnosed with PTSD. Yes – six years post-main event.

I wasn’t in school in 1997. I was taking a year off, the year after college and before grad school. There were only two things on my agenda for 1997: write poems and train for my black belt in Tae Kwan Do. I was also working.

So I was doing all of that, just minding my own business, like you do, and then, one night, I went to bed feeling sick to my stomach. As soon as I closed my eyes, my heart jumped in and crashed the party, like, Hey! I’m here too! Whheeeeeee! Cannonball!!!… and I couldn’t breathe, and I thought I was going to die of a cardiac event.

Then I was waking up. It was morning. What the hell just happened?

It happened again the next night, and the next and the next. It got to a point where I was too gun-shy to go bed. Going to bed had become a horrifying prospect, so every night, I put it off until I was passing-out tired. I don’t know why I didn’t go to the doctor sooner.

Eventually, I did go to the doctor, because I had an episode that was different than the others, and that was the proverbial last straw.

In that episode, I was trapped in another dimension and I was going to die for sure. Somewhere between awake and sleep, something happened. If I was completely asleep, it would’ve been a nightmare. Whatever this was, it was psychedelic and real, like, 3D real… and that was on top of the physical Armageddon that was my new normal. After I survived that night, I finally went to the doctor.

*****

1997 became a year of medical mystery. I went back and forth between different internists and specialists, cardiology and gastroenterology and cardiology again, everyone referring me to everyone else. I was deemed healthy – good news! – but I was still having these ridiculous episodes.

Then my baffled first internist started asking me questions about my background. When it came out that I was a combat vet, she referred me to a shrink. The shrink explained that panic attacks mimic heart conditions and other physical issues, which was why no one thought of the PTSD possibility.

He explained that the first episode was a panic attack. After it recurred nightly for a period of time, it became a panic disorder (PTSD, in my case). And the next-level attacks, he said, were “night terrors.”

Why did it take so long for the PTSD to manifest? He said it wasn’t unusual for vets to come home fine and then experience a trigger years later. The trigger could be anything, he said. So what was my trigger? We’ll never know, and it doesn’t matter.

All we know is that my PTSD was triggered by something in the spring of 1997. Coincidentally, I’m sure, the Phoenix Lights also happened in the spring of 1997.

*****

I sat in the movie theater remembering and pondering all of this, and that is how my non-review movie review became a post about my PTSD diagnosis.

I can’t be objective about this movie, but I can say that in my opinion, it wasn’t bad.

Phoenix Forgotten begins on a robust note, then bleeds out into the Found Footage horror movie sub-genre. In my experience, Found Footage movies made after the first Blair Witch Project are doomed to the basement where Bad Horror Flicks live. I often really enjoy Bad Horror Flicks, but I can’t even say whether this movie was bad enough to qualify as that bad.

If you’re intrigued by the Phoenix Lights and/or you’re a fan of Found Footage horror movies, you may dig this one.

 

 

What you never read about the V.A. Health Care System.

Yesterday morning, I went to the V.A. medical center, where I’ve spent a lot of time over the last few years… especially over the last few months. I’ve received wonderful care there. I’m a lucky veteran in that I have access to non-V.A. health care, too; I choose the V.A. over non-V.A. as my primary health care resource because I’ve found it to be a better system. In my experience, V.A. health care is superior to non-V.A. health care.

I know why you might be surprised. The media only wants you to know about the bad stuff pertaining to the V.A. health care system. Believe me, if the entire V.A. health care system was BAD, I wouldn’t be going there.

In brief, my experience at the Phoenix V.A. Medical Center has been superb.

In more detail, I prefer the V.A. health care system for the following reasons:

  • The time I have to wait to get in to see the doctor is significantly less.
  • The time I have to spend sitting in the waiting room waiting to be seen for my appointment is also significantly less.
  • The time that I spend sitting with the doctor during my appointment is considerably greater. I get more personal, thorough attention at the V.A. than I’ve ever received at non-V.A. medical facilities.
  • The quality of the care that I receive from doctors (including specialists), nurse practitioners, lab technicians, and administrative staff at the V.A. is better than what I’ve experienced at non-V.A. health care facilities.
  • V.A. doctors order labs and X-rays readily and on the spot. Since the orders are put into the computer system and the labs and radiology are right there under the same roof, I can leave the doctor’s office and go immediately to have the testing done.
  • If other testing needs to be done, the clinic in question contacts me promptly to schedule my appointment.
  • If I prefer an open MRI due to claustrophobia, the V.A. sends me to a non-V.A. clinic that does open-MRIs.
  • Doctors at the V.A. take a precautionary approach; they send orders for in-depth testing if they think there’s even a remote possibility that something of concern is going on.
  • The pharmacy, too, is housed in the same facility. I can procure my new medication in the same visit and go home with it in hand.
  • Lab and radiology test results come back in a fraction of the time it takes to get results and analyses done in non-V.A. clinics.
  • The V.A. has an online portal system that allows vets to access all of their medical records, notes, and lab results. Vets can also contact their doctors and other health care practitioners online via the My Health-E Vet system.
  • The V.A. is merciless in sending appointment reminders in the mail and calling with reminders. (This is a good thing.)
  • If I have to cancel an appointment, the clinic will call to re-schedule – repeatedly, until I’ve been re-scheduled.
  • The V.A. has a seamless phone-in system for pharmacy refills. Refills show up in my mailbox within 8-10 days.
  • The V.A. always asks me whether I’m safe and whether I have a place to live.
  • The V.A. always points me to available resources, should I need them.
  • The V.A. reimburses vets for their travel costs in getting to and from the medical center.
  • The V.A. ensures that vets have the suicide prevention lifeline phone number.

 

 

I could go on with this list, if I had time. I could offer specific personal examples, if I wanted to share details of my medical picture. Suffice it to say that I’m speaking from experience. It’s not just me, either… I don’t know (or know of) any vets using the Phoenix V.A. health care system who have a bad word to say about the health care that they receive within that system.

I’m impressed anew after the outstanding experience I had with my new rheumatologist at the Phoenix V.A. yesterday. (Previously, I’d gone to my former non-V.A. rheumatologist, who’s nevertheless also good.)

Now, at the Phoenix V.A. medical center, I have my primary care physician, my shrink, my doctor at the women’s clinic, and my rheumatologist. They’re all first-rate.

Yes. The best medical care I’ve ever received is at the infamous PHOENIX V.A.

Do non-V.A. health care systems have problems? Yes. Corruption at the highest levels occurs at non-V.A. health care systems, and patients’ risks on the ground can include negligence, poor conditions, poor treatment, scheduling hold-ups and issues, and all manner of malpractice.

I remember a case I’d read about a diabetic man who had the wrong leg amputated. It didn’t happen at the V.A.

I’ve heard about patients contracting varieties of strep and Methicillin-resistant Staphylococcus aureus (MRSA) infections in hospitals to disastrous effect, but all such cases that reached my attention have happened at non-V.A. medical facilities.

The thing is, non-V.A. health care systems aren’t scrutinized under the glaring political spotlights that blow up the V.A. health care system.

That’s actually another good thing about the V.A. health care system, though: since the system IS scrutinized, problems are addressed with highest priority. When corruption is discovered at the V.A., a gigantic national scandal ensues. The V.A. health care system is suddenly the worst thing that ever happened to veterans… mistreated veterans, poorly treated veterans, and veterans who aren’t treated at all. Action is taken.

Whereas non-V.A. health care system corruption and problems can go unnoticed and unresolved for years.

I’m in no way denying, discounting, or trivializing the horrendous or non-existent treatment veterans have suffered at the hands of the V.A. health care system; I’m not trying to detract from the real problems veterans have experienced with the V.A. I’m pointing out the fact that similar problems exist at non-V.A. hospitals, too, and they aren’t magnified x10,000 in the media. We hear about the V.A. because the V.A. is inextricable from politics. But from what I’ve seen, more veterans are pleased with the V.A. care they receive than not.

Speaking of medical matters, I’m happy to report that I had a great workout this morning. Here’s my gratuitous post-workout gym selfie:

 

Post-workout on a good physical day! I’ve been on a roll. I had five good workouts last week, and I hope to get in five more this week.

 

I am so grateful for my health and for the care I’m receiving at the Phoenix V.A. medical center.

Reiterating just to be clear: I’m not disillusioned about the V.A. health care system and its problems. I wanted to write this post so that somewhere, in some minuscule corner of the interwebs, there’s something positive to be found and read about the V.A. health care system, because it really is, despite its shortcomings, an excellent system.

It’s a shame that although there are many positives, only the negatives are reported. The public eye has been blinded to anything that could be positive about the V.A., which is a lot.

Thank you for reading, if you’ve made it this far.

A little levity, literally. (Height doesn’t work that way!)

If we’re friends on Facebook, you might already know that I went to the doctor recently and found out that I’d lost over an inch in height. Almost two inches, actually.

My whole worldview was shattered.

I’d gone to my mid-day appointment and stepped onto the height-measuring apparatus without thinking about it, because I had no reason to. There was no suspense. My height’s never changed: I’m 65 inches tall. That’s 5′,5″.

But the guy in the blue scrubs said, “Looks like you’re 5′,3″ and just about…” He looked closer at the number lines. “A quarter.”

I shook my head in surprise. “No, I’m 5′,5″.”

“Sorry. It says 5′,3” and a maybe a quarter.”

“There must be something wrong with it,” I said, referring to the apparatus. “I’ve always been 5′,5″.”

He chuckled. “Okay. Here… let’s try it one more time.”

I stepped onto the apparatus again (is there a name for that thing?) and stood as tall as I could.

“Five three and a quarter,” he said. “For sure.”

I thought, This is fake news. 

“Everyone loses height as they age, I’m afraid,” he said, still grinning and chuckling.

I stalked after him to the examination room. His cheerfulness was out of line. It could be that his height-measuring apparatus needed to be recalibrated, but he wasn’t questioning it!

I thought, how could I lose almost two inches?  I was measured at the V.A. – where I usually go – just weeks ago, and their result was the same as always: 65 inches. 5′,5″.

It wasn’t a big deal in the grand scheme of things, but it was wrong.

Later, a friend told me on Facebook that most people tend to measure, on average, half an inch shorter during the day, then spring back to their normal height overnight while they sleep. My appointment had been in the middle of the day, so I thought, that could be it. But still! Almost two inches?

I asked Callaghan to measure me first thing the morning. The result was exactly 65 inches, as it should be. Ha! Then he measured me again in the afternoon, and GUESS WHAT. Still 65 inches. Ha! Ha! Not only am I 65 inches tall, but I’m 65 inches tall all day. My driver’s license is still correct: 5′-05″.

 

65 inches.

 

“His apparatus does need to be recalibrated,” I said to Callaghan. I was annoyed. “The guy was totally condescending. He didn’t even consider that his equipment might be faulty. He probably just thought, ‘She’s old, so she’s shrinking, and I’m young, and I’m wearing blue scrubs, so I’m right, and I’m not going to listen to her, ha ha ha’.”

How would this be characterized in the parlance of our times? Did he mansplain my own height to me, or did he youngsplain it? (If he -splained anything by way of not questioning the apparatus.)

“It’s true, two inches is too big of a difference, especially all at once. It doesn’t matter anyway, though,” Callaghan said. “He’s going to die of a moltnoma!!”

“What’s a moltnoma?”

“I can’t believe you still don’t know what a moltnoma is. Over the last seven years you’ve asked me five times what is a moltnoma, and you never remember it when I say that someone will die of it.”

“I don’t know why I can’t remember it. So what is a moltnoma?”

“It’s a county in Portland, Oregon.”

Typical Callaghan.

“…when I was working in California, we worked with this person who lived in Portland,” he explained. “And then I learned that the county was “moltnoma.” That’s where Portland is.”

I was already cracking up when he concluded, “So I was like, it sounds like a disease like “melanoma” so now I just say that someone will die of a moltnoma as a general cause of death.”

I looked it up. “Multnomah County.” Cool.

Anyway, I’m going back to that doctor on Wednesday, and I’m going to inform the guy in the blue scrubs that his machine is off. People probably do shrink a little over time as they age, but I’m not there yet, and I’m probably not going to lose almost two inches all at once, either. Ha.

Thoughts while reading “Night School” by Lee Child. (REACHER!)

Good morning. Due to medical-type shenanigans that extended late into last night, I wasn’t able to prepare for today’s post. But I’m sitting here drinking coffee with Lee Child’s 2016 Jack Reacher novel next to my laptop, and it’s been on my mind to talk about it, so I thought, why not today!

(Side note: when I’m asked the classic question, “If you could have coffee with anyone, dead or alive, who would it be?” My answer is Lee Child. It would’ve been a tough call between Lee Child, Stephen King, and J.K. Rowling if the latter two weren’t already demystified by countless interviews, public appearances of various sorts, and Twitter. Child remains somewhat of a mystery.)

So here’s my copy of Night School, exactly where it is at the moment:

 

2016's Reacher: "Night School" (Lee Child)

2016’s Reacher: “Night School” (Lee Child)

 

Night School takes us back in time: Reacher is younger and still in the army. I knew this before picking up the book, so I was already intrigued when I started reading. Of Child’s 20-odd Reacher stories, Night School is the third (I believe) to take place during Reacher’s active-duty years.

Some things I learned, things that stood out, and thoughts I had as I read Night School:

1). It was fun going back in time again to read about Reacher operating within an organized military unit.

2). How does active-duty army Reacher differ from present-day Reacher? It turns out not at all. Veteran Reacher does the same thing that active-duty Reacher did. When Reacher ETS’d out (left the army), he continued doing the same work… as a freelancer.

3). “Freelancer” being a euphemism for “vigilante” in his line of work.

4). Reacher is a thug, but being one part math genius and somewhat progressive intellectual (who speaks French) and one part pure thug with superpower fighting capabilities, Reacher is a thinking person’s thug. This has been the case from the beginning of Reacher time. This may explain how Reacher always attracts the women he desires, even though he’s notably not good-looking. Apparently, a rough-around-the-edges contradictory enigma of a vigilante is difficult for these women to resist. (Almost all of Reacher’s women are intelligent, powerful, and in positions of authority; Reacher has great admiration and respect for them.)

5). Also from the beginning of Reacher time, Reacher has had his characteristic threshold beyond which he has to go rogue to some degree or another, striking out on his own. In the army, he had no qualms about disobeying orders to follow his instincts.

6). Reacher’s part in group dynamics: in Night School, we can observe lone-wolf Reacher and his behavior when working with the people brought together by the case at hand, and how Reacher balances working together and going rogue.

7). Reacher chooses Sergeant Frances Neagley (always his number-one pick of enlisted soldiers) to help him in Night School, so we can see that his respect for Neagley and her considerable sharp work and badassery goes way back. Of the three experts tasked to take on the case, Reacher is the only one to choose a woman.

8). We also understand more about Neagley and her quirks, now, and about Reacher’s friendship and liaison with her.

9). Jalalabad, Afghanistan is “a hot desert climate, like Arizona.” (Not news to me; I just enjoyed that simile.)

10). Lots of Muay Thai techniques feature in Night School’s fight scenes. Reacher throws elbow strikes as efficiently as a professional Muay Thai fighter (i.e. what goes up must come down… as in a downward elbow chop taking out one guy after his up elbow took out another guy. Two bad guys with the same elbow on its arc saves time). And side elbows. And Neagley’s use of knee strikes, among other techniques. This comes as a surprise to no one who knows Reacher and Neagley, but still fun to read.

As always, I started looking forward to the next Reacher novel the second I turned the last page!

That’s all I’ve got for today. Happy Tuesday!

I went to a big-ass party and this is what happened. (PTSD post.)

We went to a party on Sunday. It was Callaghan’s company’s “holiday soiree.”

 

thatasianlookingchick-com-holidaysoiree2016

 

(I concealed the names of the company and the party’s hosts.)

If the colors on the invitation seem unusual for such an event, it’s because the party’s theme was “early Mardi Gras.” If you didn’t know, Mardi Gras colors are purple, green, and gold. I’m not sure why it was decided to celebrate the holidays as another holiday that takes place in February, but that’s irrelevant. Well… mostly irrelevant.

We donned the requested semi-formal “festive attire” (I wore a red dress because I was feeling the current season… I wasn’t alone in this), and we ordered an Uber.

The Uber took us to BFE (far away from us, in the middle of nowhere) with no discernible civilization around. We were dropped off in a big-ass parking lot. To enter a big-ass tent. Which led us into a big-ass warehouse. In which there was a big-ass party with roughly 800 people, pretty much in the dark, save for spot lighting here and there.

No part of which agreed with my big-ass case of PTSD.

Not only that, but when we walked into the warehouse, the first thing that happened was a few metallic strings suddenly dropped from the air, straight down, and landed with a clatter on the concrete floor, right in front of my feet. Because, you know, Mardi Gras. It was someone’s role to stand on a second-floor balcony and throw beads down in front of people walking in. This surprise INCOMING situation set me more on edge, though I didn’t show it. I smiled and laughed and talked to people, and I enjoyed the excellent band. I enjoyed meeting some of Callaghan’s co-workers and their wives. I did have a good time in some sense. I focused on that. We stayed for four hours, and I was fine.

Here’s the thing: Like everyone with PTSD, I have some known triggers, and I have some random triggers that can come out of nowhere. I went into the party thinking that my introversion would be the issue, but my panic disorder overrode that completely. It would’ve been great if being an introvert was my biggest challenge.

In response to all of this, I’ve decided to book myself an hour in a sensory deprivation tank.

Yes, you read that right. I’m going to strenuously push my limits in the tank – claustrophobia is one of my issues – and that is the point.

I may never be able to enter a room without immediately looking for the exits and other avenues of escape. I may never be able to sit in a room with my back to the door. But that’s okay. That’s my normal, and those behaviors are valuable, so I have no problems there. Meanwhile, though, I would like to work on lessening the impact of some of my known triggers. Coming out of the party with this realization was the gift of the whole thing. I will act on it! I’ll let you know how it goes.

An aside: I have no pics of us or of the party, I’m sorry to say. There were roaming photographers and co-workers who wanted to take pics, so there are some images floating around somewhere… if I get my hands on one and get the permission of the people in them, I’ll post them at that time.

Let’s resist talking about each other just for one minute.

Overheard in line at the V.A. pharmacy the other day (for real, not metaphor):

Man’s voice: She looks too healthy and young to be here.

Woman’s voice (sounding snide): She’s probably just picking up for someone else.

I thought: They’re so close, and so loud. They can’t be talking about me…?

[::looks behind::]

[::sees no one but the two people making the remarks::]

And I realized that it really does suck to be talked about literally behind your back within close earshot, regardless of what the people are saying. I would have preferred that they address me directly, if they were so curious. I wouldn’t find that to be rude in the slightest.

When I turned to look at them, they were staring at me. I stared back. The woman’s eyes were cold. In fact, she was glaring. Like I didn’t have the right to be there.

Then the man said, to my face this time, that I looked too healthy to be picking up meds for myself at the V.A. pharmacy.

To which I replied, actually, yes, I’m picking up for myself. (I held up my veteran’s I.D. card, which I had in my hand. It’s required to pick up meds.)

Yes, I’m a card-carrying vet. You don’t believe me? Look. Holding up my I.D. as if I was a cop pulling someone over.

The man said, Whoa! You don’t say!!

A brief conversation about my combat service in the 1990-1991 Gulf War ensued before the pharmacist called my name.

NOTE: I was not offended. I was annoyed that I felt like I had to justify my presence there.

No one should feel that they have to validate their illness to strangers in line at the pharmacy.

No one should have to owe anyone an explanation to correct a record made because of an appearance-based judgment.

No one is safe from scrutiny.

It happens that “too healthy and young” are not hurtful words. I know that. But it was still a judgment based on appearance, and it was dismissive. It carried the insinuation that I was trespassing on sacred ground that belonged to others. Context is important. If you’re in line because you were ambushed during a ground war, it sucks to be dismissed because of how you look.

More often than not, though, people hear outright mean things when they overhear someone talking about them. People say hurtful things about others without caring. I’ve witnessed this kind of assholery; it’s awful.

The thing is, we’re constantly making judgments about others based on appearance. If that’s unavoidable because “it’s human nature”? At least don’t be an asshole.

 

lifecoach

 

When I had active Sjogren’s Syndrome, people actually did say to me, “But you don’t look sick!”

When someone found out that I have Hashimoto’s – autoimmune hypothyroidism – they actually said, “OH but you don’t LOOK like you have underactive thyroid disease.” (This has happened more than once.)

You’ve heard it all before. Invisible illness, blah, blah, blah.

Appearance: young/healthy = CAN’T BE A VET

Appearance: healthy = MUST BE HEALTHY

Appearance: heavier than average = MUST BE A LAZY OVER-EATER WITH NO SELF-CONTROL

Appearance: thinner than average = MUST HAVE AN EATING DISORDER OR A METH ADDICTION

Appearance: not white = MUST BE (insert stereotype associated with the applicable ethnicity)

Appearance: a cop = MUST BE A RACIST, BLOOD-THIRSTY PSYCHOPATH

Appearance: tattoos/piercings/other body modifications = MUST BE A DEGENERATE

Appearance: clean-cut = MUST BE AN UPSTANDING CITIZEN

Et cetera, ad nauseum. And we’re often wrong. We can get in trouble because of it. Remember Ted Bundy?

Most of us hear “Don’t judge a book by its cover” from the time we’re old enough to write a sentence. We know better, and yet we still do it! We are fallible human beings, all of us, by nature. In my opinion, since we’re born with the propensity to f*ck things up, we can at least try to be kind, decent, and respectful human beings.

(I’m sorry to come back to you with another ranty post. I prefer being positive here, but sometimes, there are things I need to say.)

Thank you for reading, as always!

How I manage my mental illness.

I’ve touched on some of this in various posts in the past, but I’ve been asked to share an actual list of tactics I use to maintain my mental health.

First of all, I accept that PTSD and clinical depression are a part of who I am. Mental illness and the management of it are “my normal,” and this acceptance helps a lot.

It also helps to accept the fact that just as there are great days, there are horrible days, and days ranging between the two. Sometimes, all the meds and talk therapy and things on the list below just aren’t enough. When this happens, I try to recognize that “this, too, shall pass,” keeping it all in perspective. (I know that this is so much easier said than done. I can say it easily now, when I’m not at the bottom of the abyss of hopelessness and despair. All we can do is try.)

That being said, here’s my list… things I do to manage my mental illness:

1). I avoid alcohol (with few exceptions).

Alcohol is a depressant. It also counters or otherwise negatively interacts with medications taken for mental illness. Consuming alcohol on a regular basis is never advisable for the mentally ill.

2). I take medication and talk to my therapist on a regular basis.

Meds and talk therapy are basic, first-line tactics of controlling mental illness. It’s critically important to adhere to such a routine and to have my external resources at hand. I regularly visit my doctor at the V.A. hospital, and I know that I always have access to emergency help at a national veterans’ crisis line.

3). I work out and try to eat well (within reason, making sure to maintain a healthy balance).

Exercise heightens our mood by way of its effect on our brain chemistry. It leads to improved physical fitness, which improves our physical health. (For this reason, more and more companies are including gym membership coverage fees in their employees’ benefits packages.) Improved physical health reduces stress and makes us feel more energetic and better about ourselves, in general. Choosing healthier food options most of the time comprises the other half of this picture.

4). I have routines, and I stick to them.

Routines are underestimated and even sneered upon. We like to say that spontaneity is critical to quality of life, and there is certainly something to that, but the fact is that routine can provide us with mental health benefits, too. Routines are valuable. They can be soothing when everything else is chaos. Routines can give us a sense of control and accomplishment.

5). I eliminate toxic factors in my life (to the best of my ability).

The word “toxic” is overused in our current vocabulary (instigated, I suspect, by self-help gurus, but that’s beside the point) – and yet, it captures this point well. In a nutshell, a toxic factor is that which makes us feel badly about ourselves. It’s a negative and destructive force and presence in our lives.

Toxic factors can include situations, places, and/or people and relationships. It’s not always possible to eliminate such factors; when we can’t, we can seek out ways to lessen their negative impact. I recently liberated myself from an utterly demoralizing situation, and that leap hugely improved my mental health and quality of life.

6). I engage my creative energy to the fullest extent possible.

If you have creative juices, let them flow. If you have hobbies, indulge in them. If you don’t have a hobby, get one. Losing ourselves in the physical act of doing something we enjoy goes beyond mere escapism. It often involves honing talents with which we’ve been blessed. The act of doing something physical that requires the creative part of our brains is beneficial to our mental health. There’s a reason why occupational therapy is a part of an in-patient mental illness patient’s prescribed agenda.

7). I have cats.

Connecting with animals on an emotional level and caring for them has proven to be a powerful stress reducer, improving our mental and physical health. Our relationships with our pets can actually extend our lives, improve the quality of our lives, and even save our lives. I can’t think of anything that can compare to cultivating the love and trust of an animal. (I say “animal,” but this applies to birds and fish, too.)

 

Nounours: Please to not underestimate the healing powers of my purrs.

Nounours: Please to not underestimate the healing powers of my purrs.

 

8). I actively express my compassion for others in one way or another, however small.

Example: I don’t have time to physically go and volunteer at homeless shelters, so I choose to do my part by providing with water. I make sure to have one or two small bottles of cold water with me when I leave the house, especially in the hot months.

We buy generic water in bulk, keep the bottles in the refrigerator, and give them to the homeless when we see them on the street or at a red light. (Admittedly, I try to identify those homeless who are vets, though I’ll give water to any homeless person, of course.) Every time, without fail, the person takes the bottle of cold water with visible – sometimes overwhelming – gratitude and joy, which they express in such an open and heartfelt manner that I’m instantly put in empathetic touch with their plight. Water is never an unwelcome thing. The person usually opens it and chugs it immediately.

Kindness is invaluable for the human spirit.

Giving water to drink means and accomplishes much more than giving change or a dollar. Giving water with a smile is an act that says, “I recognize that you’re a human being and deserving of this basic, life-saving thing. Someone cares about you and your well-being.” I don’t think it’s necessary to explain how showing compassion to the needy can be anything but beneficial to all involved.

9). I set goals for myself and plan things to anticipate.

I believe I devoted an entire blog post to this. Having agenda items to look forward to is a pleasurable thing. It can also, in the worst of times, give us a reason to keep on keeping on.

10). I try to get 7-8 hours of sleep every night. (Still trying. Still mostly failing. But still trying).

This can’t be stressed enough: Adequate sleep and quality sleep are important for optimal physical and mental health and well-being.

11). I count my blessings and nurture my relationships with loved ones.

One word: Gratitude.

Being grateful for what we have – and who we have – is an incredibly powerful reminder that things could always be worse.

 

Keeping it real.

Keeping it real.

 

That sums it up: In addition to acceptance, meds, and professional talk therapy, I manage my mental illness by working on physical health, stress reduction, and gratitude. I try.

Sjögren’s syndrome and target training (Garage gym post!)

This is a garage gym post, but first I have to tell the backstory of my eyes/vision, since they’re the impetus for this workout.

I returned to my former eye doctor, the one I saw regularly for years. Thanks to him, I now have glasses with the correct prescription. I got single-lens glasses, mainly for driving and watching movies; progressive lenses were overkill since I don’t need to wear glasses all the time.

The disappointing part of the exam was when he told me that my Sjögren’s syndrome is not in remission, as I’d thought it was. I’d stopped seeing my rheumatologist and taking my meds in 2010, and I’ve been feeling better by my own standards, so this came as a surprise. But this eye doctor is the one who’d managed my case insofar as my eye health, so he’s the man where this is concerned.

I’m not going back to my rheumatologist at this time, because I do feel good compared to how I felt before; I’m just following Dr. C’s orders, which are “Prescription use of lubricating eye drops several times a day and before sleeping and after waking up.” (I already do the latter. I can’t keep my eyes open or see anything until I put in the drops. “There you go,” said Dr. C when I told him that. “You still have Sjögren’s. It’s just not as bad now as it used to be.”)

Dr. C’s whole point is that now I have permanent cornea damage because of the Sjögren’s. Turns out that the distortion in my vision is mostly the reason my last prescription seemed so off (though it was indeed slightly off). Dr. C explained that my vision will always be distorted, even with the correct lens prescription. Glasses can help with blurred vision, but not distortion.

The distortion isn’t severe at all, but it’s enough to mean that a). My night vision will always suck, i.e. when driving at night, I’m wont to turn into driveways that aren’t there, b). My depth perception will always suck, i.e. in hand-to-hand combat situations, I’m wont to miss my target and have trouble finding my distance, and c). At the firing range, I’ll have to learn to operate as a cross-dominant shooter (I’m right-handed, but I’ll have to use my left eye as my dominant eye, which it’s not.)

The only point of the above that really matters is the first one, because, you know, it’s useful to be able to drive at night and see what’s where. What’s most disappointing to me is the second point. The distortion in my vision makes it tricky to gauge where I am and where to strike in combat situations, something I’d already noticed in training, but I’d disregarded as “I’m rusty.”

ALL OF THIS TO SAY that I’ve now taped targets onto the punching bag so I can practice for accuracy. I need to train to compensate for my handicap. And that brings me to today’s garage gym workout post.

(The ideal course of action would be to get some target mitts and have someone hold them for me, but I don’t know who I’d ask for that assistance, so tape on the bag, it is.)

I used masking tape to create X targets in three columns around the bag at low, mid, and high levels. I threw combinations and single shots for power and speed, but mainly for accuracy.

 

Let's get into it!

Let’s get into it!

 

Uppercut

Uppercut

 

Spinning back fist

Spinning back fist

 

I had difficulty hitting the targets with my spinning back fists, so I need to work on those a lot more.

 

(Stalking the bag)

(Stalking the bag)

 

Superman punch on the high target

Superman punch on the high target

 

Jab

Jab

 

(Going for angles)

(Going for angles)

 

Backfist transition

Backfist transition

 

Walking back.

Walking back.

 

Anyway, Sjögren’s syndrome is a mere nuisance at this point. I really thought I was done with that crap, but other than my eyes being uncomfortable and red most of the time, I feel just fine. The vision distortion thing is the most annoying aspect in the practical sense, but I’m not complaining. Things used to be a whole lot worse. I’m not going to the rheumy to get put back on Plaquenil, Salagen, and Tramadol. I’m just over here training for accuracy with targets on the punching bag… and spending more money than usual on lubricating eye drops.

“Do not go gentle into that good night” (Thoughts on trolls, suicide, Robin Williams)

In any given human interaction scenario, there’s that proverbial line. Once you cross the line, you’ve entered the land of excess. You’re beyond. I think that as humans, for the sake of decency, we make efforts to not go there. We don’t want to offend.

Conversely, there’s a sub-species of human who regularly and deliberately crosses the line, a sub-species that evolved out of the masses somewhere in the mid-90’s when the World Wide Web opened for business and ushered us into a new dimension of existence. Suddenly, we could hang out in the ether. No one could see us, but we were there. And we had keyboards. They had keyboards… they of the sub-species whose raison d’être is to go there, into the beyond. Those with a propensity to offend could now do it in the most cowardly fashion: Invisibly. At some point, someone started calling them “trolls.” The name stuck, and the verb form quickly followed. Trolling is now a behavior that’s as common-place online as annoying ad pop-ups you have to “click to close” before you can read what’s on the page.

Trolls are everywhere. It’s just a fact of the internet that nothing is sacred to them. I know this, but still, I was aghast at their comments on articles about Robin Williams’ death (if I may use that event as an example). As a reader, I saw that as crossing the line of all lines. When trolls unleash their misdirected anger in the comments section of an article about someone’s death, they’re so far beyond that I can’t begin to comprehend it.

Maybe it’s naïve of me to expect nothing less from trolls who spend their days seething under the bridges of the interwebs, but really? Robin Williams committed suicide in an apparent state of confusion and despair. He was a fellow human being, an artist who devoted his career to making us laugh and using his acting gifts to enrich our collective human experience with the depth of his dramatic performances.

We now know that Robin Williams suffered with Lewy Body Dementia and a couple of other, related neurological diseases. His depression was likely a by-product of LBD, but what if he didn’t have LBT? What if he was simply, clinically depressed, as everyone assumed at the time of his suicide?

Disdain for those who commit suicide* confounds me.

Within our legal system, we have a mechanism by which murderers are shuttled away from incarceration. We informally call it the “insanity plea,” and those who use it can take up residence in a medical facility instead of in prison… because to be determined to be too mentally unfit to stand trial is to be recognized as suffering with a medical condition.

Given this, I often wonder why the murderer of one’s self doesn’t deserve that same consideration. Why do we judge the deceased who took their own lives? Why does the church refuse to bless a soul that died deliberately? The act of suicide comes from a place of inner chaos, whether from clinical depression or from neurological disorders such as those that Williams experienced. Regardless, to be in this state of despair is to be mentally unfit. If a criminal can escape prison due to being mentally unfit, why can’t a person who committed suicide also be spared? Why can’t we acknowledge the fact of mental illness and let the dead rest in peace?

 

Works of two of my favorite poets (of the many who've committed suicide).

Works of two of my favorite poets (of the many who’ve committed suicide).

 

You can’t explain such concepts to trolls. They can’t be reasoned with, but you can reason with others. You can explain how it’s offensive to speak of the deceased as being selfish, pathetic, immature, “a loser,” etc. Many of us say such things. “Suicide is cowardly and selfish. It’s the easy way out that only hurts those left behind.” In my opinion, if we’re into Political Correctness, we should deem it un-P.C. to speak unkindly of those who commit suicide.

Suicide is only tragic. 22 veterans commit suicide every day, and do we speak of them with disdain? No. For the most part, we understand that P.T.S.D. (whether from military experience or from other traumatic events) and depression go together. We reserve our disdain for civilians… but suicide is suicide. No one who commits suicide is mentally fit at the time of the act.

Trolls who emerge to spew their vitriol in the comments section of article about people who committed suicide – such as Robin Williams – are the worst, as far as I’m concerned. They’re gleeful to have this excuse to rant about politics, religion, etc. They want their hatred to be heard, and they’ll use any occasion to achieve that.

The fact is that trolls are the cowardly ones… not the victims of suicide. (This is not at all to say that those who judge suicide victims are trolls.)

People who commit suicide can no longer avoid “going gently into that good night.” Let’s honor their bravery in fighting it, rather than looking down on them for dying.

 

*****

*Please note that I don’t include extremists in my definition of suicides.

Dust mites. (So the house in France wasn’t possessed, after all.)

As I was making the bed yesterday morning, I thought of an article I’d read last week about how beds contain dust mites that eat dead human skin cells. Before you go imagining harmless balls of fluff that collect on the floor under your bed, like I mistakenly did at first, let me clarify that dust mites are alive, outfitted with multiple legs and a mouth that looks like a vagina, and not to be confused with dust bunnies. The article is called “Scientists Tell You Why Making Your Bed Is Disgusting – And Bad for Your Health,” and it was helpfully posted to my Facebook feed by one of my many helpful friends. I wish I could remember who it was. If it was you, thank you.

I read the article and it stuck with me because it’s all about how making your bed enables these vile little beasts to do their dirty work. The article reveals, as indicated in its title, that making your bed may not be the healthiest thing to do.

In her article, Ms. Harper reports that “each bed contains more than a million Dermatophagoides pteronyssinus – the scientific name for dust mites.”

Somehow this surprised me, but I guess everything alive has to have a scientific name.

“…feeding off of your dead skin cells and pooping (yes, pooping) out an allergen that can trigger asthma-like symptoms.”

 

Dermatophagoides pteronyssinus, aka dust mite.

Dermatophagoides pteronyssinus, aka dust mite.

 

Apparently, dust mites can’t do their things in an unmade bed because an unmade bed is exposed to daylight and circulating air, which are lethal for dust mites.

Dust mites are basically microscopic vampires who can only thrive in the dark. Exposure to daylight kills them. A bed that’s made is their coffin. At night, they feed on your biological matter.

(Okay, they’re not pure vampires, since vampires feed on living blood while dust mites prefer dead skin cells. They’re more of a hiding, creeping vampire-vulture hybrid.)

These findings aren’t new. Ms. Harper explains that the research she references was published in 2006. Then she recounts other research findings that suggest a correlation between making the bed and better mental health, including benefits such as lower stress and higher productivity. She points out that we have to decide which is more important to us: the mental well-being that comes with making the bed, or the knowledge that by not making the bed, we’re destroying the carnivorous creatures who feed on our dead, discarded skin cells at night.

So yesterday morning I was making the bed while re-thinking what I was doing, hesitating for the first time. After some serious consideration, I decided that for me, the benefits of making the bed outweigh the benefits of not making the bed.

See, I was hardwired to make my bed every day before I joined the Army. When you join the Army, if you’re not already hardwired to make your bed every day, you come out programmed to do so, and I’m talking bounce-a-quarter-off-the bed kind of programming. For me, the consequences of not making the bed would be more disquieting than the consequences of turning the bed into a hovel for skin-devouring dust mites, but it’s not a sense of threat that propels me to continue making the bed. It’s more of a reflex, more like how it feels wrong to put on your right sock first if you’ve always put your left one on first. It’s a deeply ingrained habit. To stop making the bed would mean putting forth effort to break the habit, and it would challenge my mental health to see the bed all messy and unmade every day. (Not to mention that our unmade bed would end up covered in cat fur.)

It wouldn’t be worth it, especially since we live in the hot, dry desert, where our dust mite problem is minimal compared to other places we’ve lived. As stated in this other article I found, “…if the humidity is under forty percent dust mites don’t live well so that is why parts of the southwest don’t suffer from this problem.”

I now know that the raging skin problems I’d endured while living in France were probably due to dust mites. That second article also states: “Some people will have an allergic rash reaction of eczema. This is similar to the situation with food allergies: Some people get respiratory types of reactions and others will deal with the problem via their skin by having a rash response.”

Mystery solved.

In France, I suffered constantly with horrible, rash-like outbreaks all over my body, front and back, from my feet to my legs to my torso to my arms. Callaghan never had anything. It was an infuriating mystery, and we couldn’t solve it. While the problem persisted on the French Riviera (when we were there, it was more often overcast and rainy than bright and sunny, and being on the coast, it was never dry), it was much worse when we were up in la Région Rhône-Alpes.

We figured I was having a reaction to some kind of insect. I’m severely allergic to insect bites; they wreak 10+ times the havoc on my skin than on Callaghan’s, so it would make sense that if we had dust mites in our always-made bed in the perpetually dark, damp wilderness of our little mountain abode, I would have this reaction, and Callaghan would not. I’d often wake up with one or several itchy bumps that would erupt into a horrible rash that would burn and itch uncontrollably. If I’d scratch the slightest little bit – even lightly – bruises would form.

All of it vanished once we moved back to the States and the sunny, arid Southwest.

I was going to supply a photo here (one of many) of the strange bumps, scabs and bruises that I constantly had all over my body, but I decided to spare your eyeballs because “what has been seen cannot be unseen,” as we all know. (You’re welcome.)

Accidental O.D. (or, I am an airhead). Let’s learn from it.

One day about two weeks ago, I accidentally took too much of my antidepressant. It was a very mild overdose, and nothing horrible happened. I didn’t go to the E.R. or anything like that. I just felt messed up, a little shaken, and maybe just a tad embarrassed when the incident passed.

Everything was fine the next day, but the experience was enough to startle me into the realization of how stupidly easy it is to take an overdose of a prescription medication by accident.

I’ve been thinking about this a lot since then. Often, when it’s reported that someone died from an “accidental overdose of prescription medication,” or “toxicology reports show the presence of prescription drugs in his/her system,” the jaded public’s reaction is largely, “‘Accidental’… right.” There’s a tendency to immediately categorize the death as either a substance abuse-related accident, or as a suicide. We aren’t so inclined to accept “accidental” without any negative connotation attached. We’re cynical. We assume an underlying moral abberation on the part of the deceased, or, at least, questionable character. We sum up the death as “just another senseless tragedy.”

After my experience, I totally understand how someone can simply, accidentally take too much of a prescription drug. What happened was I screwed up my dosage. I made a mistake.

There was some confusion that led to an oversight that led to the mistake, all on my part. My shrink increased my daily antidepressant dosage to 400 mg. Talking about how he’d send in a new prescription, he explained that I’d take two pills in the morning, and two in the afternoon. Either I mixed up parts of the information, or I just altogether missed the part about the prescription strength being different. I went home and took another pill, adding to the one I’d taken a few hours earlier.

Later that day, I took two more for my newly increased afternoon dose, instead of the one pill I’d normally take in the afternoon.

Two to three hours after that, I wasn’t feeling too well. The discomfort was vague and nondescript at first, so I figured, just ignore it… but once it started, I felt increasingly worse, and pretty rapidly. I remember trying to work and being unable to focus. I remember the inside of my head feeling like pins and needles, the same physical sensation you get when your foot falls asleep. There was nothing I could do to alleviate it, and the sensation didn’t dissipate the way it does when it happens to your foot. At the same time, my head felt like it was being constricted from the outside, like there was a band around my skull being pulled tight.

Then it was evening, and the pins and needles sensation inside my head worsened. My heart raced, which was further disconcerting. I felt strangely out of control under my skin. I couldn’t think. Still, I tried to ignore it all. I called Mom at the usual time, but I had trouble focusing on what she was saying, and when I tried to talk, I felt like I was underwater. Everything was a struggle. My head was a maddening ball of tingling, stinging little points, and I felt like I was lost in the middle of it. My mouth was dry. I did have the mental wherewithal to suppose that I was having a reaction to the increased dosage of my antidepressant. But I only took four pills, I thought. That’s what he prescribed, and it’s not enough to kill me.

I remember trying to pay attention to my breathing, and I remember taking my anti-anxiety medication with a big glass of water. Then I was waking up. I woke up to my alarm, which I’d apparently set. I felt fine! I had no recollection of going to sleep, but I remembered how I’d felt before that. I went to get my medication, and that was when I checked the label and saw that the pills in my current prescription were 150 mg, not 100 mg. It was the new prescription that would be 100 mg! Those were the ones I’d take two of twice a day.

 

This was me when Armageddon was happening inside my head, only it's not, because that happened a couple of weeks ago, and this picture was taken in the middle of the night last night. So this is a reenactment of the inside of my head from a couple of weeks before. But at least there's candlelight.

This was me when Armageddon was happening inside my head, only it’s not, because that happened a couple of weeks ago, and this picture was taken in the middle of the night last night. So this is a reenactment of the inside of my head from a couple of weeks before. But at least there’s candlelight.

 

In this most inopportune moment of airheadedness, I jumped from 300 mg to 600 mg when I was told to increase to 400 mg. I took four 150 mg pills in a 12-hour period because I neglected to read the label to verify the prescription strength (the irony of this being that I diligently read the labels on everything else I consider for consumption), and I did it suddenly, which I now know you’re not supposed to do… any changes made to psych drug dosages should be made gradually. In the case of my particular drug, making abrupt increases can cause seizures, so I’m lucky that this didn’t happen. I’m lucky that the overdose was mild, and I only felt like my brain was scrambled until I fell asleep. I was able to wake up in a normal state, go to work, and function well, as if nothing had happened.

Somehow, Callaghan didn’t notice anything unusual about me or my behavior that evening. He only knew something was wrong because I told him that I wasn’t feeling well. Apparently, I talked about calling my shrink the next day to tell him that the new dosage wasn’t working out for me, which I never did… because, of course, once I realized my mistake, I fixed it. I went back down to 300 mg, then increased in increments over the next two weeks. I’ve been taking the prescribed 400 mg per day for a few days now, and all has been well. I haven’t had any further issues.

My point is that anyone can make this kind of mistake.

To translate my experience into something that might be useful to someone, I just want to throw out a reminder that prescription drugs are a serious matter, no matter what they are. It’s always better to err on the side of caution. It’s always better to double-check the details of our medications, to educate ourselves about what we’re taking and how we’re taking it, and to be aware of any drug interaction risks, including mixing medication(s) with alcohol. Depending on the drug, the individual, and external factors, human error plus one glass of wine could be deadly; it’s safest to avoid alcohol entirely when taking psych meds or pain meds (especially the opioids – the narcotics).

Just one oversight could result in a terrible, potentially irreparable circumstance. In some cases, it doesn’t take much. It would be horrible to accidentally die and leave people shaking their heads, wondering where you went wrong, or where they went wrong, or where your parents went wrong… right? Prescription drug-related tragedies can be avoided. It never hurts to be over-cautious.

Typical Food.

Several friends have been asking me what I typically eat, and I find it difficult to answer on the spot, because, I guess, I don’t put all that much thought into food… so the last time I was asked, I decided to do a food journal over the next two days, which happened to be Sunday and Monday (yesterday). The timing was great for the experiment because my documentation captured a weekend day and a weekday that also happened to be a gym day. It covers a pretty good idea of the average food picture in my life. I’m sharing the results here this morning, for anyone who may be curious.

Since this was a spontaneous decision, I didn’t premeditate it or go shopping for it or anything. That’s my excuse for not exhibiting dishes prepared from scratch. Some weekends, I cook food to feed us for a few days, if not for the week, and some weekends, I don’t… and this last weekend, I didn’t.

Here are a few generalities:

1). Water is key to starting my day right. First thing in the morning, I drink three big glasses of chilled water, and I continue drinking water all day long. I have a little idiosyncrasy about water: I prefer very cold water, except I like to drink room-temperature water when I’m eating.

Water is the only thing I drink besides coffee and the occasional cup of tea or iced tea. (I stopped drinking grapefruit juice last year… I used to have it with breakfast.) I’ll sometimes squeeze fresh lemon juice into my water when I’m at home. I’m hyper-vigilant about keeping myself hydrated – I also drink a big glass of water right before going to sleep. I’m just really into water. Fun fact!

2). You’ll notice a lot of carbs on both days, since that’s my favorite food group. I prefer complex carbs and actually avoid simple carbs (white bread, white pasta, white rice, white potatoes, refined sugar, and alcohol… I think my last glass of wine was back in either October or November). (Oh wait, did I have champagne with my in-laws when they were here visiting from France for New Year’s? Yes, I believe did! December 31 was the last time I drank alcohol, then.)

3). I’m in the habit of waiting until 9:00am to eat breakfast, even though my alarm goes off at 5:00-5:30am in the morning five days a week. I get up and drink the three glasses of water with my thyroid medication, and then I wait 30 minutes before consuming anything else, because that’s how thyroid medication works. (I have Hashimoto’s disease – hypothyroidism. In my case, it’s autoimmune thyroiditis.) When the 30 minutes has passed, I take my other morning meds, and I have my first of two mugs of coffee.

4). I take supplements twice a day (different ones with my morning and evening meals).

5). I tend to cycle through certain foods. For instance, for a few weeks recently, I was having a Trader Joe’s blueberry-bran muffin for breakfast every weekday. Then I moved on to waffles and berries. I change it up every two to three weeks.

6). While there’s almost always some overlap in the things we eat (like salads, guacamole, fruit, etc.), Callaghan and I eat different meals about half of the time, I’d say. He’ll incorporate non-vegan elements into his.

7). Have I mentioned that as of about a month and a half ago, I’m back to 100% vegan, 100% of the time? It feels good. I’m my old self again.

So all that said, let’s jump in! Here’s what I ate over the last two days:

Sunday

Breakfast: Bear Naked Honey Almond Granola (10g protein!) with plain, unsweetened almond milk, blueberries and raspberries; coffee with stevia and the same almond milk; whole wheat toast with Earth Balance buttery spread.

 

Granola with a generous topping of fresh berries and almond milk, and whole wheat toast - and Sumatra coffee, of course (my favorite)!

Granola with a generous topping of fresh berries and almond milk, and whole wheat toast – and Sumatra coffee, of course (my favorite)!

 

Lunch: Sandwich with vegan lunch slices in turkey and ham flavor with fresh spinach, Roma tomato, Dijon mustard (that Callaghan brought back from France!) and grapeseed-oil Veganaise on whole wheat bread; a nectarine.

 

I usually default to sandwiches for lunch, which is fine, because I love them. I usually have fruit, too.

I usually default to sandwiches for lunch, which is fine, because I love them. I usually have fruit, too.

 

Snack: Kind Healthy Grains Maple Quinoa Clusters with Chia Seeds (1/3 cup), dry.

 

A handful of dry granola for a crunchy, sweet afternoon snack - one of my favorites! This is Kind Healthy Grains Maple Quinoa Clusters with Chia Seeds. YUM.

A handful of dry granola for a crunchy, sweet afternoon snack – one of my favorites! This is Kind Healthy Grains Maple Quinoa Clusters with Chia Seeds. YUM.

 

Dinner: Black beans and brown rice with HOT salsa; sliced avocado; a side salad of mixed baby spring greens and tomato with olive oil, balsamic vinegar, sea salt, coarsely ground black pepper and oregano.

 

This was a quick and easy dinner of brown rice, black beans, salsa, and avocado, with a salad on the side.

This was a quick and easy dinner of brown rice, black beans, salsa, and avocado, with a salad on the side.

 

Dessert: Justin’s organic dark chocolate peanut butter cups.

 

Justin's organic dark chocolate peanut butter cups are my favorite vegan treat!

Justin’s organic dark chocolate peanut butter cups are my favorite vegan treat!

 

Monday

(The standard two mugs of coffee with stevia and plain, unsweetened almond milk)

Breakfast: Two of Van’s Multigrain 8 Whole Grains waffles with Earth Balance buttery spread; blueberries and raspberries.

 

I toast and "butter" (it's Earth Balance) the waffles at home and bring them to work loosely wrapped in foil. Van’s Multigrain 8 Whole Grains waffles, blueberries and raspberries.

I toast and “butter” (it’s Earth Balance) the waffles at home and bring them to work loosely wrapped in foil. Van’s Multigrain 8 Whole Grains waffles, blueberries and raspberries.

 

Lunch: Sandwich with Trader Joe’s Mediterranean hummus, fresh spinach and Roma tomato on whole wheat bread; a nectarine.

(On gym days, I’ll usually have peanut butter and jelly for lunch, but lately I’ve been alternating with hummus for the savory goodness of it. It’s still a great high protein/healthy fat sandwich spread.)

 

I ate lunch at my desk yesterday: Sandwich with Trader Joe’s Mediterranean hummus, fresh spinach and Roma tomato on whole wheat bread... and a heavenly nectarine for dessert!

I ate lunch at my desk yesterday: Sandwich with Trader Joe’s Mediterranean hummus, fresh spinach and Roma tomato on whole wheat bread… and a heavenly nectarine for dessert!

 

Snack: Small handful of roasted, unsalted almonds; a mini chocolate chip Clif bar.

(Workout fuel! I like a combination of protein, healthy fats, carbs, and a little unrefined sugar an hour or two before going to Body Combat.)

 

A small handful of roasted, unsalted almonds and a mini chocolate chip Clif bar fueled my workout after work. That mini Clif bar is so tiny! It's exactly the right size.

A small handful of roasted, unsalted almonds and a mini chocolate chip Clif bar fueled my workout after work. That mini Clif bar is so tiny! It’s exactly the right size.

 

Dinner: Homemade guacamole and an Amy’s Sonoma veggie burger (organic vegetables, quinoa and walnuts) on whole wheat toast; side salad of spinach, mixed baby spring greens and tomato with olive oil, balsamic vinegar, sea salt, coarsely ground black pepper and oregano.

(Post-workout delicious combination of complex carbs, plant-based protein and healthy fats.)

 

Callaghan made his guacamole to go with our dinner, and it was fabulous, as usual! Homemade guacamole and an Amy’s Sonoma veggie burger on whole wheat toast, plus a side salad.

Callaghan made his guacamole to go with our dinner, and it was fabulous, as usual! Homemade guacamole and an Amy’s Sonoma veggie burger on whole wheat toast, plus a side salad.

 

Dessert: Fresh strawberries.

 

Fresh strawberries for dessert.

Fresh strawberries for dessert.

 

The strawberries look kind of weird in the picture, somehow, but they were wonderful.

Not pictured: I had a cup of Celestial Seasoning’s Honey Vanilla Chamomile tea last night before bed. It’s my favorite nighttime tea.

Et voilà! Two typical days.

My favorite thing to eat besides carbs is seasonal produce. The nectarines are fantastic right now. You know they’re a June favorite!

The Wrah-Wrah is Forever.

Ronnie James will have been gone for five days tonight, and it’s still so hard to walk through the house seeing all the places and things he loved… seeing where he should be or would be, were he still here with us in his furry gray suit, and thinking of what he would be doing. This house without him in it just isn’t right. Callaghan, Nounours and I hope you know how much we appreciate your caring, compassion and concern for the loss of our little lovebug.

Here are the words I wanted to say on Friday, but couldn’t. I just wanted to share with you the events of the week leading up to Ronnie James’ death. I also wanted to write a little tribute to the Wrah-Wrah.

 

Ronnie James the night we brought him home (Monday). Wide-eyed and content.

Ronnie James the night we brought him home (Monday). Wide-eyed and content.

 

We brought Ronnie James home from the hospital on Monday night last week, and the next day, he had an exceptionally good day. With his chest freshly tapped, he was his usual happy and active little self. I took the day off from work to be with him. He ate and drank well, also as usual, and he kept himself close to my side all day… and I do mean even closer than usual. Everywhere I went, he went. Every time I settled on the couch or on the bed, he climbed up on me to snuggle, or he curled up next to me. Callaghan was mostly not here, as he spent much of last week working on-site, but later, when I told him about the day, he was encouraged. We ended the day with the tiniest bit of hope.

On Wednesday, I stayed home with the Wrah-Wrah again – I’d asked for those two days off in advance, as soon as we knew that we were bringing him home on Monday evening – and again, he was happy.

But he also told us that he did not wish to keep his appointment for Thursday’s x-ray/fluid re-check. As heartbreaking as this was to us, it made sense, and it wasn’t unexpected.

I thought I’d seen hints of maybe a miracle the day before. He’s eating so enthusiastically! I thought. Maybe if he eats a lot, he’ll get strong enough for his body to be able to absorb the fluid accumulating in his pleural cavity! Maybe he can be one of those lucky cats who survives chylothorax!

Maybe, maybe, maybe.

Deep down, I knew I was kidding myself. They don’t call it “end stage” when it’s not. There’s no turning back from the complication of pleural fibrosis. That was the problem… the pleural fibrosis. And that was what I was afraid of all along.

I called Dr. M., anyway, to talk about the Thursday follow-up appointment. He explained that if Ronnie James had accumulated enough fluid to be tapped, the radiologist would have to insert the needle into each pocket in order to aspirate enough of it to relieve the pressure around the lungs. This would create even more pockets for fluid to fill in the pleural cavity. At the rate Ronnie James had been accumulating fluid in the hospital up until the moment he was released, the likelihood of finding a tappable volume of fluid on Thursday was 99.9%.

Did we want to put him through that again for those kinds of odds? Certainly not… and Ronnie James didn’t want to go back there again, either.

We didn’t want a single minute of Ronnie James’ short time left to involve anything but pleasantness and contentment for him, and getting stuffed into his carrier and carted back to the hospital wouldn’t qualify as pleasant. We didn’t want to “buy him time” for selfish reasons. The reality at that point was that nothing we could do would change the outcome, so we canceled his appointment in order to spare him the ordeal.

I spoke with Dr. M. a second time, and also with his primary care doctor at our main clinic, who referred me to someone she knew who made house calls. Then, with my heart crumpled into something unrecognizable in my own chest, I made the phone call. The house-calling vet had room in her schedule for us for the next evening… Thursday night.

Thursday morning, I woke up planning to go to work, but as soon as I got out of bed, I knew that I had to be with Ronnie James on his last day in this world. His favorite thing had always been me being home with him. That was when he was the happiest, and I didn’t want to deny him that at the end, if I could help it. I asked my supervisor if I could take one more day. I’m incredibly grateful to have been able to spend Ronnie James’ last three days at home with him. That time with him was invaluable.

So on Thursday, May 14, Ronnie James got 100,000 more kisses. I got to press my face against his, feel his whiskers on my cheeks, and breathe in the adorable, sweet smell of his kitty breath (a scent that only a cat mom can love, I know). I got to feel his purring on my heart as he stretched out and slept on my chest.

One of the most frustrating things about chylothorax is that it doesn’t lead to a typical, end-of-life decline… a decline that you can see. A decline that makes you feel better about the euthanasia. Ronnie James continued to eat, drink, and use his litter box normally until the very end. Not only that, but he was excited about his meal times and his treats throughout the day. He loved drinking from his water fountain. He loved hanging out in his toy corner. Psychologically, all of this made the decision to euthanize even more difficult. We never observed a diminishing quality of life, so we felt like we were killing him unnecessarily. We had to keep reminding ourselves that the fluid filling up his little chest would soon suffocate him.

With chylothorax, cats and dogs are just fine, until they’re not… and when you can see that they’re not, they’re suffering. You see them struggling to breathe. We didn’t want to take that chance. We didn’t want to end up at the E.R. with him in the middle of the night again. That was not how we wanted his death to happen; that was not what we wanted his last experience to be. When we brought him home from the hospital on Monday night, we promised him that we wouldn’t let him suffer, and honoring that promise became our mission in life for those few days we had left with him.

All day Thursday, the most painful thing was to see Ronnie James being so totally normal. He acted like a normal cat on a normal day. He scarfed up his food and drank water from his water fountain. He came running for his treats. He sat at the window and watched his birdies, chattering at them. He roamed around the house, checking everything out with his usual curiosity, and the only odd thing there was that he did this looking kind of detached, as if he was exploring a house that he’d never seen before. It was like he was patrolling, or doing a military re-con exercise. He investigated the whole place thoroughly and purposefully. It was like he was making sure that everything was okay.

As on the previous two days, he spent lots of time snuggling with me. He spent lots of time snuggling with his beloved Nounours. When Callaghan was home, he spent quality time with him, as well.

The vet arrived that night, and Callaghan, Nounours and I were as ready as we were going to be. Ronnie James was ready, too. He was still behaving normally, but his breathing had started to grow faster in the last few hours, so we knew that our timing was good. Chylothorax parents at the end of the struggle know the nuances to watch for very well. We know how to count our baby’s breaths every four hours to gauge when some kind of action should be taken. We were confident in our decision regarding what action to take this time. At 9:59pm, from the comfort of his own home, Ronnie James entered into a better dimension, leaving his embattled body behind in this world. He died in my arms, with his head in his Daddy’s hands, as he loved that so much, and with his brother Nounours nearby.

My heart was destroyed.

I’m going to reiterate, because I can’t say it enough… it was agonizing to put a perfectly normal-looking and behaving cat to sleep. It wasn’t at all like when I had to put my Frankie kitty to sleep because of kidney failure. Frankie did all of the typical things. He stopped eating. At the end, he pretty much stopped moving. It was visibly clear that he was near death. Looking at the Wrah-Wrah being so normal, we just had to keep reminding ourselves of the Armageddon happening inside his chest. We had to remember that in a very short period of time, he would have started to suffer. Liberating Ronnie James from his earthly body was the only humane thing we could do.

The venomous caterpillar that set off this disastrous chain of events won. We did everything we could to save Ronnie James; the damage was just too extensive. But if we hadn’t rescued him from that woman in Montélimar, he would have continued living in misery before dying horribly on his own, slowly suffocating to death from the inside. That is how Dr. M. described a natural death from chylothorax.

I categorized all of my posts about the Wrah-Wrah’s experience and put the category as a link in my blog’s sidebar to make it easier for people to find. There’s a paucity of information about this disease online, and I hope that my documentation here can be helpful to cat and dog parents who find themselves confronted with this terrible diagnosis for their fur-babies.

The Wrah-Wrah was extraordinarily brave and so strong and so full of life until the very end. His love of cuddles and kisses never abated. He never lost his taste for his favorite treats. His beautiful gray fur stayed velvety soft. He continued vocalizing his conversations with us, and he continued saying “I love you” with long, slow blinks of his wide eyes. No one gave kitty eye-blink kisses the way he did, by the way. He would find our gaze, hold our eye contact, and initiate the gesture, keeping his eyes closed for a few seconds before slowly opening them again, making sure that we didn’t miss it.

Ronnie James was my little soul mate from Day One. As I said to a friend the other day, he was my angel kitty who came and saved me when I was grieving the loss of Detta, my kitty who went missing in the French Alpes. I love Nounours dearly, but the Wrah-Wrah and I immediately formed a bond of a depth and strength I’ve never experienced with any other being. It was only in mid-October 2012 that we brought the two little guys home. When I start to dissolve in anguish over having had such a short time with Ronnie James, I remind myself that I should be grateful for every day that I had with him. And I am. I’m so very grateful for every day that I had with the Wrah-Wrah in the two years and seven months he was with us.

Sometime last fall, when we thought we were just dealing with asthma, I started to feel panicky about Ronnie James. I had an ominous feeling. We would be administering his inhaler asthma medications, and I would suddenly tear up and ask Callaghan, desperately, Can the Wrah-Wrah be Forever? I wanted to hear someone say, Yes, the Wrah-Wrah is Forever.

And you know what? He is. The Wrah-Wrah is Forever.

Like his namesake, Ronnie James was a little rock star. Throughout it all, no one could believe how brave he was, how alive he was. Everyone who knew him adored him. He was just such a smart, sweet, and most personable and loving little kitty. Ronnie James will always be my Rainbow in the Dark.

Here is a sampling of some of the pics I took of the Wrah-Wrah in his last three days. I especially wanted to capture his snuggly moments.

On Tuesday the 12th:

 

Curled up on my robe on the couch.

Curled up on my robe on the couch.

 

Curled up against me....

Curled up against me….

 

Laying on my belly, hugging me.

Laying on my belly, hugging me.

 

I couldn't resist taking a picture of it reflected in my laptop screen.

I couldn’t resist taking a picture of it reflected in my laptop screen.

 

Stretched out on my legs, looking at pictures of himself.

Stretched out on my legs, looking at pictures of himself.

 

On my legs, on the bed. I ruffled his fur to demonstrate his new mohawk.

On my legs, on the bed. I ruffled his fur to demonstrate his new mohawk.

 

On Wednesday the 13th:

 

Sleeping, hugging my legs.

Sleeping, hugging my legs.

 

He jumped up to sit on his favorite bar-stool even the day before he died.

He jumped up to sit on his favorite bar-stool even the day before he died.

 

On Thursday the 14th:

 

He kept eating up until the very end, too.

He kept eating up until the very end, too.

 

Ronnie James fully enjoyed loving on his Daddy, too, when he was there.

Ronnie James fully enjoyed loving on his Daddy, too, when he was there.

 

On Friday, I have a story of Nounours’ to tell, as we’ve been witness to a true phenomenon in his grieving process for his brother.

Thank you again for reading, and for being here with us.

Operation: Spoil Wrah-Wrah Wrotten

Ronnie James stayed in the hospital for three more days after I last updated here. We brought him home yesterday, after work.

It was a long weekend of worry and wait. We continued to visit the little guy twice a day, and we called the hospital every four hours to ask about the status of his pleural effusion. The volume of the fluid in his chest did decrease significantly from where it’d been earlier in the week, but hovering around the 8-10 ml range (down from 20-30!), it was still too much to warrant removing his chest tube.

So yesterday afternoon, Ronnie James underwent anesthesia again, and Dr. M. and the radiologist performed a lymphangiography. This procedure allowed Dr. M. to see whether we’d have a shot at the one last surgical option available for chylothorax: cisterna chyli ablation. The study results showed that the surgery would be irrelevant, since the problem was not leakage from the thoracic duct. The thoracic duct ligation surgery had been effective. The fluids were coming from somewhere else, likely from the pleura, as a result of pleural fibrosis. We are out of options.

The good thing about being out of options, though, is that the Wrah-Wrah is now home with us. He’s home, and we’re enjoying him, loving him and spoiling him with attention while we’re waiting for the next thing to happen.

Ronnie James is just the toughest little guy! His spirits are high. He’s happy and active, eating and drinking. But his little body is showing signs of wearing down. For one thing, despite eating well, he’s losing weight. We’ve stopped feeding him the prescribed low-fat diet. We’ve halted attempts to force him to take the loathed rutin. There’s no longer any point to these chylothorax medical management strategies. We’ve more or less entered a hospice phase here at home, and in this phase, we’re going to give him anything and everything he wants.

Dr. M. sent Ronnie James home with us last night so we could spend a good few days with him while he’s happy and alert. Freshly tapped, it will take maybe 48-72 hours for the increasing volume of fluid in his chest to slow him down again. I’m staying home with him today and tomorrow, because it’s out of the question that I’m not here to spend his last few days with him.

On Thursday, we’ll take him back to Dr. M. for an x-ray to see where we are with the fluids. We’ll probably have to make The Decision at that time… for real, this time.

Of course, I’ve got a slew of pics from the weekend.

From Friday:

 

Ronnie James got all the cuddles!

Ronnie James got all the cuddles!

 

Sleepy Wrah-Wrah.

Sleepy Wrah-Wrah.

 

"I can't even with this long underwear!" ~Ronnie James

“I can’t even with this long underwear!” ~Ronnie James

 

Ronnie James, our little dragon.

Ronnie James, our little dragon.

 

The Wrah-Wrah can chill with the best of them.

The Wrah-Wrah can chill with the best of them.

 

The Dude Abides.

The Dude Abides.

 

Here’s me on Saturday wearing my paw earrings just for the Wrah-Wrah:

 

Going to see my baby! Paw earrings required.

Going to see my baby! Paw earrings required.

 

On Sunday, many pictures were taken:

 

Mother's Day at the hospital!

Mother’s Day at the hospital!

 

"Happy Mother's Day, Mommy!" ~Ronnie James

“Happy Mother’s Day, Mommy!” ~Ronnie James

 

Ronnie James moved into a larger kennel on Saturday. More room for rolling around!

Ronnie James moved into a larger kennel on Saturday. More room for rolling around!

 

I got to hold him!

I got to hold him!

 

Daddy scritches are the best.

Daddy scritches are the best.

 

And on Sunday night, we got to spend an hour with him in a private room.

 

Wrah-Wrah cuddles in progress!

Wrah-Wrah cuddles in progress!

 

"I can spend forever in Daddy's arms." ~Ronnie James

“I can spend forever in Daddy’s arms.” ~Ronnie James

 

Snuggling with my baby on Mother's Day. Gratitude.

Snuggling with my baby on Mother’s Day. Gratitude.

 

A miracle could still happen, right? A miracle, an inexplicable turn-around, whatever you want to call it… it could still happen. But Ronnie James will tell us. He’ll tell us what he wants to do, and when he wants to do it. Our job is to listen. At the moment, I’m only hearing his happy “I see birdies!!” sounds as he watches the front yard through the living room window, and I’ve never heard anything more precious.

Ronnie James’ complicated case.

Ronnie James did not come home yesterday, as planned. He’s still in the hospital.

 

Ronnie James recovering in the oxygen chamber the evening of his surgery. (Thoracic duct ligation and pericardectomy)

Ronnie James recovering in the oxygen chamber the evening of his surgery.
(Thoracic duct ligation and pericardectomy)

 

His surgery went well, and he did well, like last time. Dr. M. said that once again, he came through it “like a champion”! The chylothorax seems to be resolved – there’s no more chyle leaking where it doesn’t belong. The Wrah-Wrah is happy and alert, loving all the cuddles and pets he’s getting. He’s eating with good appetite. His disposition and attitude are fantastic!

So what’s the problem?

His chest cavity just keeps filling up with fluid.

As I said, it’s not chyle. Rather, we’re looking at some sort of nondescript, inflammatory-ish fluid, and at this point, no one can say with certainty what it’s all about. A little bit of such fluid could be normal following a surgery. It could be caused by the chest tube, itself, even. But the amount of fluid we’re talking about here is well out of range. Ronnie James’ case is a complicated one, and it’s tough. We’re still battling the ripple effect of his contact with that venomous Pine Processionary caterpillar.

This current iteration of pleural effusion could be a fluke, as in, maybe a “pocket” of fluid resulting from the surgery just released all at once over the night (that was Wednesday night). Or, it could be something scarier, such as his pleura lingering in a self-perpetuating cycle of emitting fluid. Whatever the case, we can’t bring him home until the pleural effusion stops, since his chest tube needs to stay in place in order to drain the excessive fluids.

On his part, Ronnie James is totally oblivious to the danger he’s in, as he’s been busy in pursuit of Dr. M.’s heart (which he successfully captured, might I add). During morning rounds yesterday, Dr. M. found himself engaged in a Wrah-Wrah love fest. The Wrah-Wrah had been rolling around, asking for belly rubs, until he ended up on his back in Dr. M.’s arms, purring furiously as he got his belly rubs with two hands.

“Isn’t he cute?!” I asked Dr. M. when he told me about this.

“Oh, he’s adorable!” he answered the same second the question was out of my mouth. Exact words. Then, later, he said, “He HAS stolen my heart!”

Dr. M. has been Wrah-Wrahed. It happens.

Several other doctors and some of the technicians and staff have also fallen in love with the little guy. This is what the Wrah-Wrah does best, just being himself… his affectionate, smart, happy, interactive, funny, sweet, sweet self. Everyone who spends any time with him at all loves him!

Because Ronnie James’ two-part modus operandi in life is:

  1. Find all the hearts.
  2. Stealz them.

 

Ronnie James the day after surgery, off oxygen and resting in a kennel in the ICU.

Ronnie James the day after surgery, off oxygen and resting in a kennel in the ICU.

 

As I write this, we don’t know what today will bring. I’m going to work, as usual. But will Ronnie James come home tonight? We can’t say. We don’t know. We hope so. We miss him, and so does his Nounours.

 

Poor Nounours! He misses his brother.

Poor Nounours! He misses his brother.

 

I’ll keep you posted. Thank you for reading, and for keeping Ronnie James in your thoughts and prayers.

Happy Friday, All! =)

The Wrah-Wrah Wrollercoaster (or, the WrahWrahCoaster).

Ronnie James goes in for another surgery today. We’re dropping him off in about two hours, at 7:30am.

This development resulted from yesterday’s trip to the vet, when it was found that fluid has filled his pleural cavity again. His chylothorax persists with an aggression that’s frightening. A chylothorax-specific surgery might be able to stop the process; it’s actually a combination of procedures: Thoracic duct ligation plus pericardectomy. This is our next step, and it’s our last.

We were told that the success rate for this surgery is 80% for cats, which is encouraging… but we’re not sure if the Wrah-Wrah will have a chance to try for those odds. We won’t know until Dr. M. opens him up today and examines him. If the developing pleural fibrosis (a complication of chylothorax) is still mild enough to be survivable, Dr. M. will move forward with the surgery. If the pleural fibrosis turns out to be beyond-hope bad, on the other hand, he’ll drain Ronnie James’ chest for the last time and close him up. We’ll have the “end of life” discussion. It will be time to address the details of The End.

 

Callaghan with Ronnie James at yesterday's appointment.

Callaghan with Ronnie James at yesterday’s appointment.

 

Thing is, Ronnie James has been doing so well outside of his bizarre, catastrophic emergencies. You literally only know half of it, because I haven’t yet written about the other half. I will, at some point soon. It’s just… the other day, I joked to Callaghan that “Wrah-Wrah is going to outlive us both long after he sends us into cardiac arrest with his near-death episodes.”

We’ve been on the WrahWrahCoaster going 500 miles per hour for months, and sometimes, it’s like we’re barely strapped in. The relentless and extreme ups and downs have been exhausting.

 

With the Wrah-Wrah at home, after our appointment.

With the Wrah-Wrah at home, after our appointment.

 

So today, we’re trying for this final possible solution.

We’re glad that Ronnie James had such a good weekend this last weekend. He looked better and seemed to feel better than we’d seen him since, well, maybe ever. All weekend, we enjoyed an unusually alert and active Wrah-Wrah, who was everything a healthy Wrah-Wrah should be – he was hungry and thirsty, playful and talkative, and just as flirty and affectionate as ever. He stayed close to us, wherever we were. He’s our bright little lovebug, and we’re going to give him every chance at survival we’re able to give him… and we’re so grateful that we’re able to give him these chances.

Here are some pics from the weekend:

 

The Wrah-Wrah looking so alert! You can see the wheels turning in his head, too.

The Wrah-Wrah looking so alert! You can see the wheels turning in his head, too.

 

The Wrah-Wrah's poodle-like cut is growing out. When the fur on his back is ruffled, it looks like a mohawk from this angle.

The Wrah-Wrah’s poodle-like cut is growing out. When the fur on his back is ruffled, it looks like a mohawk from this angle.

 

Now that his fur is growing out from his last surgery, he’s cultivating kind of a faux-hawk on his left side. Depending on where they shave him this time, we might bring him home with a full-blown ‘hawk!

The Wrah-Wrah and the Rutin. (Help!)

Hmm… I’m thinking it might be a good idea to create a “Cat Mom Blog” category so I can file these Ronnie James posts in one place….

Today, I have a question that I hope someone can answer: How do you get a cat to eat something he loathes?

This is a life-or-death problem we’ve been having, and we’re feeling like we’re out of options.

Ronnie James needs to take rutin. Rutin is not a medication. It’s a dietary supplement, and it’s evidently the only thing that cats can take with any degree of effectiveness for chylothorax. It can potentially stop or at least slow down the flow of chyle into the pleural cavity. It also tastes horrible, and Ronnie James will have none of it.

 

It smells like paint thinner.

It smells like paint thinner.

 

We’ve tried everything. We had Diamondback Drugs, our compounding pharmacy, formulate it into a liquid flavored with chicken. They warned us that he probably still wouldn’t like it, but we might have more luck mixing it into his food that way.

We mixed the chicken-flavored rutin into the Wrah-Wrah’s favorite wet foods, including his current most favorite of all (which, oddly, is one that was prescribed by his primary care physician), and he refused to eat it.

After his surgery, we tried again, to no avail. Finally, in desperation, we returned to the direct approach and injected the rutin into his mouth with the plastic syringe. He threw it up, along with his antibiotics and everything he’d eaten. He was abjectly miserable. We felt awful. We stopped trying and went back Dr. M. in defeat when it came time to remove Ronnie James’ stiches.

The following week brought us to Thursday night and our harrowing trip to the E.R. No one could understand how so much fluid had filled up Ronnie James’ little chest cavity so quickly. He HAD to take his rutin. While there was no guarantee that it would work, it would at least give him a chance at survival if it did. We had to try to give him that chance, and we had to somehow do it without stressing him.

Another order for rutin had been called in to Diamondback Drugs – tuna-flavored, this time. We were hoping we’d have better luck with the tuna, since Ronnie James loves tuna; we figured that strong-smelling fish might mask the rutin flavor well enough if we mixed them together.

Diamondback Drugs was closed on Sunday, so yesterday, Monday, Callaghan picked up the rutin. He stopped by my office on his way back to pick me up for lunch. We got home and went straight for the can of herring waiting on the kitchen counter. Operation Rutin was back in effect!

Two little plates of herring were prepared for the kitties’ lunch: Ronnie James’ contained the rutin. He tentatively sniffed his plate of herring, and then he walked away.

I knew that walk. It was the “I know there’s rutin in that food and I’m outta here” walk. It wasn’t that he didn’t like herring, or that he just wasn’t hungry, either. He went to Nounours’ plate and ate some of his herring. Nounours’ rutin-free herring.

We were beside ourselves. What was it going to take to get Ronnie James to eat the rutin?

Meanwhile, he needed something for lunch, so I fixed a clean plate of his normal, favorite food. (The other issue we’re having is that he’s not drinking enough water, so we’re giving him his favorite wet food at every opportunity.) I set the good stuff down in front of Ronnie James. He looked at it askance, then walked away again.

This time, it was the “I strongly suspect you snuck rutin into that food and I’m outta here” walk. He hadn’t even gotten close enough to smell it thoroughly! He was just convinced that the rutin was in there. We were now having trust issues.

I thought for a minute, then looked over at Ronnie James. He was sitting in the hallway at the kitchen entrance, watching me. Exaggerating my motions and holding his gaze with my eyes, I took an unopened can of his favorite food, waved it before me, and said, “Let’s open a brand-new can!” I reached for another fresh kitty plate, took a clean fork from the drawer, and brought everything to the kitchen entrance where he was sitting.

He kept his eyes on me as I made a big production of holding up the can and opening it, garnishing my actions with a little dramatic flair. He watched attentively as I scooped out a generous forkful, tapped it onto his plate, and set it down in front of him.

He started eating immediately.

He didn’t even sniff it first. He just knew that there wasn’t any rutin in it, because why? Because this cat is a brilliant genius. And we are screwed.

After the rutin-laced fish failure, Ronnie James had looked warily at the clean plate of his untainted favorite food and refused to touch it. But when he witnessed me opening a new can of the same food and filling his plate, he dug right in. He saw that the can was unopened, he saw that I transferred food directly from it to the plate that he saw was clean, and he saw that I put it down without adding anything to it… and the neurons in his brain made all the connections and arrived at the conclusion – food is safe – instantly. Callaghan was as astonished as I was. We’d known that we had an exceptionally smart kitty on our hands, but still, we were floored by this display of cognitive agility and capacity for comprehension.

 

Ronnie James is on to you!

Ronnie James is on to you!

 

It might seem like I’m just letting my proud cat mom colors show here, but really, I’m more just very concerned that there’s no way we’re ever going to get Ronnie James to eat his rutin. Even if we get it down his throat, he throws it up. We can’t outsmart him. Actually, we sniffed the rutin in its bottle, ourselves, and it doesn’t even smell like tuna. It smells like an industrial chemical! It’s atrocious. It literally smells like poison. I’d think that any sane, smart cat would instinctively reject it.

Isn’t there a better way? Has anyone ever had to give rutin to a cat?

We would greatly appreciate any suggestions or advice you could offer. Meanwhile, I’m going to call Diamondback Drugs again to ask if there’s any other way they could compound this stuff….

The Wrah-Wrah goes to the E.R. (and proves once again that he has more lives than the average cat.)

Well, that was a night.

Ronnie James is back in the hospital. After a few days of observing him, calling the hospital, making appointments and then canceling them as he’d seem not-fine one minute and then much better the next, not knowing what his new “normal” is supposed to look like after his surgery (like all cats, Ronnie James is incredibly skilled at hiding the extent of his discomfort), we knew last night that he needed to go to the E.R.

A technician triaged Ronnie James the minute we got there, then immediately took him to the ICU and put him on oxygen. It was scary – scary enough for the doctor to come in and warn us that the Wrah-Wrah might not survive the thoracentesis that had to be done – but the little guy made it through. He was looking much better when we kissed him goodnight before coming home. He was alert and active in his oxygen chamber, being his usual flirty, affectionate self. He’s unbelievable! We were cautioned that he’s not “out of the woods” yet, but he’s looking just as spry as ever!

We shouldn’t have been surprised by this development, as Dr. M. had clearly warned us that Ronnie James would likely require one or two more thoracentesis (chest tap/draining) procedures following his surgery. We were prepared for this likelihood. We just weren’t prepared for the situation to arise in such a dramatic and scary way. I mean, we truly almost lost him last night.

The E.R. doctor, who was wonderful, showed us Ronnie James’ x-rays and said, “Look at this… I don’t know how he was still alive!”

The Wrah-Wrah is a miracle kitty, that’s how.

His x-rays showed nothing but white. On a normal chest x-ray, dark areas of a healthy size and shape would be visible. Those would be the lungs with air in them.

In this one view of Ronnie James’ chest, there’s no dark area to be seen at all:

 

Thursday, 4/23/2015 - Wrah-Wrah's chest cavity is completely filled with fluid. No lung is visible.

Thursday, 4/23/2015 – Wrah-Wrah’s chest cavity is completely filled with fluid. No lung is visible.

 

And in this view, the side view, you can see a small, grayish area with rounded edges “just kind of floating there.” That’s the Wrah-Wrah’s lung. It was surrounded by so much fluid that it was barely functioning. It’s like a ghost lung.

 

Thursday, 4/23/2015 - That faint, ghostly dark roundish area in the center, just below his spine? That's his "lung." That's all he has left, and with all the fluid crowding it, it was barely working.

Thursday, 4/23/2015 – That faint, darker gray area in the center, just below his spine? That’s his lung.

 

The doctor talked to us carefully and made sure that we understood the precariousness of the situation before he performed the thoracentesis. The procedure was extremely high-risk because Ronnie James’ condition was life-threatening. But everything went well. 300 ml of chyle was aspirated, and that wasn’t even all of it!

 

Thursday, 4/23/2015 - This is the fluid that was taken from Ronnie James' chest cavity. It's 300 ml (a cup and a quarter), and it's not even all that was in there. The doctor didn't want to try to drain all of it, because it would have been too risky. The fluid is chyle (chyle can either be cloudy or pink).

Thursday, 4/23/2015 – This is the fluid that was taken from Ronnie James’ chest cavity. It’s 300 ml (a cup and a quarter), and that was just some of it. The fluid is chyle (chyle can either be cloudy or pink).

 

There’s still “quite a bit” of chyle left in the Wrah-Wrah’s pleural cavity. The doctor said that it was too dangerous to try to get it all, but enough was removed to allow for more normal breathing. They might try to remove a little more sometime this morning.

Now, we wait to hear from Dr. M. when he comes in, examines Ronnie James, and reviews the whole situation. We don’t know what’s going to happen next. It’s at least comforting to know that what has happened so far had been anticipated… and the E.R. doctor said that he’s hopeful. Also, most importantly, the Wrah-Wrah isn’t suffering continuously.

 

Thursday, 4/23/2015 - Ronnie James felt better after his thorocentesis. He was wide-eyed, active and heart-meltingly lovey-dovey when we went to visit him in his oxygen chamber before we left.

Thursday, 4/23/2015 – Ronnie James felt better after his thoracentesis. He was wide-eyed, active and heart-meltingly lovey when we went to visit him in his oxygen chamber before we left.

 

Look at those wide, bright eyes!

We’re keeping our thoughts positive.

Ronnie James has a new nickname: Cat Squared (he has 81 lives, apparently)

I wanted to thank you all again for thinking of us and taking part in our journey to better health for Ronnie James with your kind well-wishes and interest in his story. I didn’t mean to tease in my last post. I just didn’t have much time for writing last week! Also, I wanted to talk to our doctor again before I sat down to scribble this out.

This is the short story:  Ronnie James was sick and gradually dying when we rescued him in the fall of 2012, but we didn’t know anything was wrong until he started coughing about 11 months ago. We now know that he’s been evading death for years, somehow surviving a thing that would have killed most mammals. We are in awe of him.

 

Ronnie James, Sunday night, 4/12/2015. Angel kitty with his halo of lights!

Ronnie James, Sunday night, 4/12/2015. Angel kitty with his halo of lights!

 

The detailed story goes like this:

In the operating room on Friday, April 3, Dr. M, our surgeon, opened up Ronnie James and found his left cranial lung lobe in a state of semi-decay; he said it almost looked like it was “rotting” in his chest. The mysterious mass seen on the CT scan turned out to be a mushroom-shaped (“pedunculated”) object that oozed a “weird, thick mucus-like material” when the stem broke off.

Dr. M tried to describe what he saw in the center of the mass, but he couldn’t quite find the words. I got the impression that he’d never seen anything like it before.

He told me, “It looks like it might be something of an infectious nature,” but he seemed to be baffled. He suggested that the mass might be a remnant of an old infection that Ronnie James’ body had tried to wall off. As he spoke, I envisioned an oyster protecting itself from grains of sand by coating the foreign material with its own bodily secretions.

But the bulbous, sickly pearl inside Ronnie James almost killed him. At first, its point of origin wasn’t obvious; it appeared to be attached to the bottom of the left cranial lung lobe. Actually, it seems to have grown off of one of the bronchi, clogging it and causing the lobe to collapse and consolidate. It’s possible that the mass ultimately caused blockage of Ronnie James’ thoracic duct, either directly or indirectly, as it was on the same (left) side. We’re hoping that this was the case, because if it was, then it answers the question of “What caused his chylothorax?”

Chylothorax, the filling up of the chest cavity with chyle, was the chronic issue we were aiming to fix, the problem we had to solve in order to save Ronnie James’ life. If the mass was causing it, well, problem solved! The mass is gone now.

Our surgeon said, “Until the labs come back, we can’t rule out cancer. I’ll tell you what, though… this doesn’t look like any cancer I’ve ever seen. I don’t know what this is.”

All along, Ronnie James’ labs have consistently tested negative for cancer. Dr. M had to say that he couldn’t rule out cancer until the labs came back, but the fact was, no one really thought that it was cancer.

Whatever it was, it was weird.

The weirdest thing was that standing before our kitty’s exposed insides, Dr. M and his team were still more or less flummoxed. Nothing was adding up or making sense, but he went ahead with the planned lung lobectomy, which was absolutely what had to be done, and removed “the entire mass and left cranial lung lobe as well as a small amount of an adherent adjacent lung lobe.” Samples of everything were sent to the lab for analyses and cultures.

While Dr. M was working in Ronnie James’ chest cavity, he also did an ultrasound on the second, smaller mass the CT scan had detected in Ronnie James’ neck.

 

Ronnie James' left cranial lung lobe, part of an adjacent lobe, and the mass were removed. The mass seemed to stem from one of his bronchi.

Ronnie James’ left cranial lung lobe, part of an adjacent lobe, and the mass were removed. The mass seemed to stem from one of his bronchi.

 

When the lab results came back a few days later, they showed that the inside of the lung mass was comprised of fat necrosis (dead fat). Necrotizing tissues and edema were also found throughout the lung lobe. There was “scattered mineralization.” We were indeed looking at decaying organic matter and an old infection, an infection with a history… and it was chronic.

Considering all of this, it’s miraculous that we didn’t lose Ronnie James to something like sepsis or cardiac arrest. Other than his intermittent episodes of coughing and his more recent bouts of prolonged lethargy, he had seemed just fine. He’d initially been diagnosed with asthma, which he may or may not actually have.

But what could have caused Ronnie James’ ancient infection? He’d tested negative for Valley Fever. He’s been an indoor cat since we’ve had him, anyway. We couldn’t stop thinking about it… we were faced with a medical mystery that had to be solved so we could take the best next steps toward complete recovery. It was maddening. What could have wreaked all this havoc in Ronnie James’ pleural cavity?

Then we thought back to the first time we ever took Ronnie James to the vet, when we were still living in France, and we remembered the cause of that problem. It was the Chenille Processionnaire, and it explains everything.

 

Chenille Processionnaire, or Pine Processionary.

Chenille Processionnaire, or Pine Processionary.

 

In October 2012, soon after we adopted 8-year-old Ronnie James from an impoverished woman in Montélimar in southeastern France, we noticed that he was having trouble eating. We took him to the veterinary clinic closest to us, which was down in Bourg de Péage. (In France, our home-base was in the Alpes, about 100 miles from the recent plane crash. I’m sorry to be able to use the location of that awful event as a point of reference, but there it is.) We thought that dental problems might be causing him pain, but when the vet opened his mouth, he simply remarked that Ronnie James had experienced some sort of contact with a Chenille Processionnaire (“Pine Processionary” in English), a venomous caterpillar common in southern France. The tip of Ronnie James’ tongue had been “burnt off,” and it was this disability that impeded his eating. Our vet immediately recognized the characteristic chenille processionnaire damage to Ronnie James’ tongue; there was no question about it.

I’d never heard of anything like it. The Pine Processionary doesn’t exist in the United States. According to Wikipedia, it’s only found in southern Europe and in parts of Asia and Africa.

From what we can understand, animals such as dogs and cats are harmed by this caterpillar either because of poisoning from its venom, or because of an allergic reaction to it, or both, in any case being potentially – even often – fatal. Incidentally, I found some disturbing images of dog and cat tongues either burned, like Ronnie James’ tongue, or amputated at the tip (due to contact with this caterpillar).

 

Les Chenilles Processionnaires (Pine Processionary caterpillars) are often seen traveling end-to-end. They're common where we lived in the Alpes and all over the French Riviera.

Les Chenilles Processionnaires (Pine Processionary caterpillars) are often seen traveling end-to-end. They’re common where we lived in the Alpes and all over the French Riviera.

 

The caterpillar’s venom is released when its tiny hairs break off, or when the caterpillar ejects the hairs in self-defense. The toxins are in the hairs. Dogs and cats suffer when they have direct interaction with the caterpillar, or when they come into contact with pine needles or other organic matter on which the caterpillar’s hairs had fallen. Ronnie James could have licked the caterpillar, or he could have stepped on the hairs while walking around outside, or, more likely, knowing him, he might have played with the caterpillar with his paws, batting it around. Whether he walked on the hairs or played with the caterpillar, the toxic hairs would have stuck to his paws (they stick to whatever they touch), and Ronnie James’ tongue would have been burned when he went to lick his paws, as cats do.

At the same time, a venomous hair or two could have traveled down into Ronnie James’ lungs.

It happens. It happens to dogs and cats who roam outside in areas infested with the Pine Processionary.

Dr. M, who had (along with the rest of his surgical team) noticed the unusual damage to Ronnie James’ tongue when they were prepping him for surgery, agrees that more than likely, this is what happened to him. Though we didn’t witness the caterpillar encounter, we can all look at the evidence before us and do the math. In this case, 2 + 2 = Pine Processionary caterpillar damage in the Wrah-Wrah’s lungs. It would also account for the smaller mass found in his neck, lodged in his throat area, as the way that was presenting also matched the type of damage that could be done by the Pine Processionary.

Everything we can see points to this caterpillar.

Two things are for sure: Ronnie James survived an inordinately long time after his encounter with the caterpillar, and he was certainly dying by the time the surgeon removed the dead lung and surrounding infected areas. And we’re not finished yet. One of his lab cultures came back positive; the infection is alive.

 

thatasianlookingchick.com-pineprocessionarycaterpillar

 

One for the “WTF, Nature?” archives, if you ask me.

We’re so proud of Ronnie James. He’s been such a good sport throughout this ordeal, and he did extremely well in surgery. Everyone was surprised when he didn’t need oxygen therapy to transition out of anesthesia, as dogs and cats typically do after surgery. He started breathing on his own again as soon as they unhooked him! We credit this bit of badassery to the fact that the Wrah-Wrah had long since learned to get along without that nasty old lung.

So that’s what happened. Years ago, Ronnie James inhaled or ingested toxins from a caterpillar. And to think that I’d blamed myself for bringing him here, back when we thought he’d developed asthma from being in the dusty desert! The whole time, he’d been suffering the effects of an environmental hazard that doesn’t even exist in North America. I can’t believe we brought this demon caterpillar venom back from France with us, embedded in the Wrah-Wrah’s lungs. That was more baggage from France than we’d bargained for.

Now that we know the root of the problem, we have a better idea of what to do for Ronnie James. We’re going after the remaining infection with an aggressive, extended course of antibiotics. We’re also continuing him on his asthma treatments, as he’d shown slight improvement on them (the steroid inhaler was helping to hold the infection at bay, and the bronchial dilator inhaler was helping to open up his airways).

Tomorrow, the Wrah-Wrah goes back to Dr. M to have his stitches removed, and he’ll be checked for need of further thoracentesis (chest tapping/draining). We were cautioned that it wouldn’t be unusual for him to need to have his chest drained one or two more times following the surgery. Our hope is that after a month or so, he’ll no longer have to deal with chylothorax and all the treatments it necessitates.

We’ve had a couple of scary episodes with coughing and vomiting in the last few days, but he checked out fine at the hospital; the episodes aren’t surprising given that his insides are adjusting to the changes, and he’s still recovering. Overall, the Wrah-Wrah continues to do much better. He’s happy and more active now than we’ve ever seen him. He is exponentially better, in fact. He’s next-level Wrah-Wrah!

A happy kitty is a kitty without dead lung tissue rotting in his chest with a weird, bulbous, rotting-fat-filled mass. We still have a long road ahead of us; Ronnie James’ long-term prognosis depends on how he responds to treatment from this point on. Anything can happen, but we’re optimistic!

 

Sleepy Ronnie James. He just woke up from his evening nap. (4/13/15)

Sleepy Ronnie James. He just woke up from his evening nap. (4/13/15)

Frankenkitty Comes Home!

Or, shall we say, the FrankenWrahWrah.

Ronnie James, one week post-op. (4/10/2015)

Ronnie James, one week post-op. (4/10/2015)

The results of Ronnie James’ surgery are unbelievable, better than anyone thought possible.

Friday, 4/3/2015, Day Zero: Our first sight of Ronnie James after his surgery, about five hours post-op. Still coming out of anesthesia, heavily medicated.

Friday, 4/3/2015, Day Zero: Our first sight of Ronnie James after his surgery, about five hours post-op… still coming out of anesthesia, heavily medicated.

Hello, Wrah-Wrah!

Hello, Wrah-Wrah!

He’s half hairless. He’s got a five-inch-long incision with about 20 stitches, plus a few stitches closing up the hole where his chest tube had been. He’s minus his left cranial lung lobe, part of an adjacent lung lobe, and a mysterious mass, and he’s breathing much easier now!

Poor Nounours missed his brother so much, he literally waited at the door for him to come home (when he wasn't wandering around the house crying).

Poor Nounours missed his brother so much, he literally waited at the door for him to come home (when he wasn’t wandering around the house crying).

We were all kind of confused going in, but the truest story of the Wrah-Wrah could be seen when our surgeon opened him up and looked inside. The phone call I received at work after the surgery was bizarre because what the surgeon found was bizarre. It fact, it was so bizarre, I have to save the story for the next post.

Meanwhile, here are some pics of our little warrior!

Saturday, 4/4/2015, Day One: The day after his surgery, we went from the gym directly to the hospital to visit Ronnie James. We were allowed to hold him. He was so out of it and scared!

Saturday, 4/4/2015, Day One: The day after his surgery, we went from the gym directly to the hospital to visit Ronnie James. We were allowed to hold him. He was so out of it and scared!

Sunday, 4/5/2015, Day Two: When we brought him home on Sunday night, Wrah-Wrah went straight to my office to rest, relaxed on his pain meds.

Sunday, 4/5/2015, Day Two: When we brought him home on Sunday night, Wrah-Wrah went straight to my office to rest, relaxed on his pain meds.

His fur had been shaved so precisely for the surgery, it looks like he's wearing half a coat! That spot in the center is where his chest tube had been.

His fur had been shaved so precisely for the surgery, it looks like he’s wearing half a coat! That spot in the center is where his chest tube (for drainage) had been.

That is quite an incision there, little guy.

That is quite an incision there, little guy.

Monday, 4/6/2015, Day Three: Pain-killers in full effect! The kitties' toy area in the living-room has been one of Ronnie James' favorite hang-out spots since he's been home.

Monday, 4/6/2015, Day Three: Pain-killers in full effect! The kitties’ toy area in the living-room has been one of Ronnie James’ favorite hang-out spots since he’s been home.

So many toys! Too many decisions.

So many toys! Too many decisions.

Tuesday, 4/7/2015, Day Four: We had a rhythm going with Ronnie James' after-care. Between his different meds and his compress treatments, there's something to be done six times each day. He's doing so well!

Tuesday, 4/7/2015, Day Four: We had a rhythm going with Ronnie James’ after-care. Between his different meds and compress treatments, there’s something to be done six times each day.

He's spent a lot of time snuggling up to me in my office at home.

He’s spent a lot of time snuggling up to me in my office at home.

Thursday, 4/9/2015, Day Six: Breathing so much easier now!

Thursday, 4/9/2015, Day Six: Breathing so much easier now!

We’re so grateful to everyone involved in the Wrah-Wrah’s medical journey (which isn’t quite over, but we’re certainly off to a great start!) and well-being, from the doctors and staff at our two clinics to all of you who’ve been keeping him in your thoughts and prayers. Next week I’ll fill you in on What the Heck the Surgeon Found. 

Happy Friday, All!