The Huge Improvement

Today was leaps and bounds better than the past few days. First and foremost, I woke up without a headache for the first time in almost a week. Second, I was able to get up and walk around the apartment. I had spent the last four days almost completely bedridden. Today I woke up, took a shower, ate breakfast at the table with my sister and her roommate, and then helped them get ready and make plans for the day. It was so nice spending time with them!  I finished packing some miscellaneous stuff for the cottage and then my husband and I started the trip upstate. Luckily, I survived the four hour car ride without a hitch!  I never would have made it if we had stuck to the original plan and gone up last night. It was definitely worth waiting.

image

The cottage is relaxing, as always. It doesn’t hurt that we have WiFi here now, too. As I write this I’m sitting by the fire, listening to a live band across the lake, and other lake goers are setting off some fireworks. It’s so nice to be around other people and to be able to relax. It’s nice not having to worry about the noise of the music or sparklers giving me a headache or the bright light of the fire bothering my eyes.  Hell, it’s nice even just sitting up in a chair without feeling shaky. I’ll leave you with a picture of my current view.

image

The Crazy Lab Charge

My insurance company mails me a paper copy of each claim or service rendered once a decision has been made. It always shows the amount/breakdown of what the provider charged, how much of it insurance paid for, and how much I owe. Usually these show up in the mail and I can throw them away because I have already paid the copay in-office and/or I don’t owe anything. I happened to open yesterday’s and it was for the lab work I had done at the original hematologist’s office – the lab work I never even saw, the lab work that was taken by the lady who didn’t wear gloves. Despite the fact that I made it abundantly clear to the hematologist that my vials needed to be sent out to either Quest or LabCorp, she sent them for testing at some random, local lab that isn’t covered by insurance. As a result, the paperwork I got from the insurance company shows they covered none of the cost and I owe almost $4,500!  For lab work?!  She only took five vials of blood!  What in the hell costs $4,500 to test?!  Did she combine my blood with liquid gold?  I don’t understand.

The insurance paperwork says on it “this is not a bill”, but I know that means the bill from the lab is on its way. This could get interesting because there is no way in hell I’m paying a cent of it. I told the hematologist flat out that the blood needed to be sent to Quest or LabCorp because those are the only two labs my insurance covers AND they cover them in full – I shouldn’t even owe a copay for lab work. Somehow, this crazy lady took it upon herself to completely ignore my instructions and send the vials wherever she damn well pleased. I’m not paying $4,500 for lab results I didn’t even receive just because she was too lazy to follow directions. Quest & LabCorp are probably the two largest diagnostic lab chains in the nation – it should have been a very simple request. I’m not sure what happens when I get the bill – do I fight it out with the old hematologist, the laboratory, or insurance?  Do I get my company’s HR Director involved?  I’m already getting anxiety and the bill hasn’t even come yet. I don’t need this added stress right now. UGH.

The Surprise Visitors

My little sister and her roommate were supposed to fly to Denver, CO last night for vacation, but due to flash flooding, all flights from Chicago to Denver were grounded and the airline couldn’t get them on a flight until Saturday night. Since they already had the days off of work and their bags were packed, they decided to take a spontaneous trip to NYC to stay at our apartment while we’re at the cottage. I’m excited that my sister got to see my apartment, but I’m even more excited that we overlap for about a day and a half, meaning that I got to see my sister today!  It doesn’t make up for the Chicago trip I had to miss last weekend, but it’s still ten times better than not seeing her at all!  I knew I missed her, but I forgot how much until I got to hug her.

In terms of my side effects, today was certainly better than the past few days. I still didn’t leave bed much and my appetite this morning and early afternoon was practically non-existent, but by dinner I was able to eat a real meal and sit up in bed for a little bit. For some reason, even though it makes me extremely overheated, laying on my husband’s shoulder makes my headache better. It might just be psychological, but I’ll take it!  Also, the makeshift blackout curtains that my husband hung make a huge difference.  My eyes have been super sensitive to the light.

The one thing that hasn’t improved at all is showering. Last night’s shower was rough. I think I was finally able to pinpoint the exact cause of the shortness of breath, though. The problem is the steam. Since our new apartment’s master bathroom has a small, square, glassed-in standing shower, the steam accumulates fairly quickly. Don’t get me wrong, I love having a glass shower, but I wish it was a little bigger so the steam had somewhere to go. The only way to obtain any relief was to periodically open the shower door to let some steam out and some cold air in. Basically anytime I wasn’t under the water (ex. soaping up or shampooing my hair) I had to leave the glass door open. Again, not ideal, but at least it was a workaround. Hopefully this won’t be a problem forever.

The only other update is that my foot cramps are back. That is definitely due to the Prednisone, though, so hopefully it won’t be a problem within a few weeks. I’ll just have to deal with it until then.

I’m finally all packed for the cottage and we’re hoping to leave tomorrow afternoon. Fingers crossed!  Last time we headed to the cottage was Memorial Day Weekend and that didn’t end well, so here’s to hoping we finally get the relaxing week away that we want/need. My husband has been such a trooper taking care of me and waiting on me for over a month at this point – he deserves the chance to relax!  Hopefully my Percocet/Oxycodone will keep the headache at bay long enough for me to relax this week, as well!  Or at least long enough for me to survive the four hour drive upstate!

The Slight Improvement

The side effects were slightly less intense today. Don’t get me wrong, my headache was still raging and the loss of appetite kept coming and going, but at least I had a two hour window where I was able to get some work done.  Not much else to report.

The Useless Day

So much for working from home… Today was a nightmare. The side effects of the IVIG and Prednisone were non-stop torture. I can’t even think of a time today where I was able to sit up for more than five minutes. Also, my foot cramps returned and I had a total loss of appetite. I had to force myself to eat which, in turn, only angered my belly. Around lunchtime I called my husband crying and begged him to come home from work because I didn’t feel good and I was scared to be alone. Luckily, his boss is very understanding and let him work the afternoon from home.

I don’t know what I would have done this last month if I didn’t have my husband. He has been my saving grace. Today, for instance, he came home and made sure I ate lunch, grabbed me an ice pack for my headache, stroked my hair, and repeatedly kissed my forehead. The forehead kisses this last month have been numerous and much-appreciated. Nothing makes me feel more loved than a forehead kiss.

In general, today’s main issue was the headache. I suppose a better word would be migraine. My husband hung the black-out curtains in the bedroom so I didn’t have to deal with the light making my migraine worse. He also unscrewed a few of the lightbulbs in the bathroom so it wasn’t overwhelmingly bright every time I went in there. Even so, the pain was pounding on the right side of my head and it was pounding ALL day. I sincerely hope tomorrow is better. Laying in bed all day gets old after a while. I have work to do and I have to pack for the cottage.

I read an article online about IVIG that said the side effects only last up to three days after treatment is finished. I hope that’s right because it would mean the side effects should be gone by end of day tomorrow!  I guess that is when I’ll find out how much of this is IVIG-related and how much is due to the Prednisone taper. Fingers crossed that tomorrow is a better day!

The Side Effects

I hope every day isn’t going to be like today. I wish I could at least know how long these IVIG side effects are going to last. Or I wish I could know how much of what I’m feeling is due to Prednisone withdrawal. I’m inclined to believe it is a combination, like the doctor suggested, but I’m praying most of it is just from the IVIG, meaning it will subside and eventually fade away within the next week or so. If these headaches and lack of concentration are mostly due to Prednisone tapering, I’m screwed for at least the next month. UGH!

The plan today, tomorrow, & Thursday is to work from home, but today was a total fail. I logged on around 8AM, had breakfast, took my pills, worked for about an hour and then the intense migraine set in and looking at the computer screen was making me want to claw my eyes out. I had to walk away.  I took a couple of Percocet and then immediately fell asleep for an hour or hour and a half. By the time I woke up, the painkillers had kicked in and I had about 30-45 useful minutes before my headache returned. Anddddddd repeat the same process. All day. I ended up having to cancel/reschedule my graduate school interview that was scheduled for 6PM via Skype because I couldn’t function for more than a few minutes at a time.  I feel bad cancelling and I hope it doesn’t hurt my chances of admission, but there is no way I would have been able to accurately portray myself in a video interview like this.

By the time dinner rolled around, I didn’t have much of an appetite. I made myself eat anyways, especially since I didn’t eat lunch. Then I had to face my newest enemy – the shower.  Once again, my oxygen level dropped and my heart rate shot up.  I don’t know if it is the steam, the enclosed space, or the fact that I’m standing for more than a couple of minutes, but it is extremely frustrating.

I think the thing that is perhaps the most frustrating, though, is how crappy I feel in general. A couple of weeks ago when my platelet count was awful, I felt totally fine. Things were going crazy inside my body, but on the outside, I had almost no symptoms. At the time it was terrifying, but now I miss it. It’s ironic how “getting better” has made me feel so, so much worse. Now that my platelets have reached an acceptable level, I’m all of a sudden completely broken on the outside. How does that make any sense?!  Maybe this IVIG treatment was more intense than I had originally thought.

The Final IVIG Treatment

Today was a disaster of a day.  From the moment I woke up I had an excruciating headache.  By the time I got to the doctor’s office for my 9AM appointment, I was very shaky and sick to my stomach.  They took me in the back a little after 9:15 and I chose the corner recliner again.  I took two Tylenol and then the nurse drew three vials of blood. Luckily, the vein on my right elbow that they used the first day was healed enough to be used again.  That meant no searching for a vein on my forearm and no bruise!  They started me on a bag of fluids and then the Solu-Medrol.  By this point, it had been almost an hour and my symptoms weren’t improving at all.  I was shaking and whimpering in the chair and writhing around in pain.  Then, the hot flashes started.  I was literally dripping sweat while everyone around me had on blankets.  All of a sudden the nausea hit me HARD and I had to ask for a puke bucket.  The nurses asked if I had eaten any breakfast, which I had (blueberry bagel with butter and jelly), and then pricked my finger to check my blood sugar.  My blood sugar was at 76, which they said was low considering what I’d eaten for breakfast, so they brought me juice and asked me to sip on it.

At this point, the nurses were concerned and called my doctor.  He came back and saw the condition I was in and asked the nurses to give me a Zofran drip to help with the upset stomach.  He then told me that the IVIG was working!  He said my hemoglobin was at 10.5 and my platelets had skyrocketed to 159,000 over the weekend!  Unfortunately, the side effects I was experiencing were a combination of the IVIG taking its toll on my body and the lower dose of steroids (withdrawal).  At least it wasn’t all for nothing!  I would hate to have these miserable side effects AND be told the IVIG didn’t work.

After the doctor left the room the nurse started the Zofran drip followed by the Benadryl, which put me to sleep.  By the time I woke up it was 11:30 already and they were JUST starting the first vial of Carimune NF.  Thankfully, the Zofran helped my stomach immensely!  I still had no appetite though.  I didn’t touch any of my snacks except for a PB&J and even that didn’t settle well.

They ran the first drip slowly because I was already in such a weak state.  The vial finished around 1:00 and the second finished by 2:00.  Based on my timelines from my previous three treatments, I had expected to be done and out of there by 2:00, but I was only halfway done.  Halfway?!  That fact sank in and I started to get visibly upset.  Yes, this means I cried. I was in a room full of elderly patients and I was crying and whimpering in the corner while they stared at me.  I don’t even feel bad.  I can’t even begin to explain the amount of pain I was in.

The nurses started the third vial at 2:15, gave me two more Tylenol, and sped up the drip.  By the time the bottle finished at 3:25, I was in even worse shape.  I have never felt so uncomfortable and miserable in my entire life.  I asked the nurse to talk to the doctor about skipping the fourth and final vial.  Another hour in that chair would have been excruciating.  Luckily, he told the nurse it was fine to skip the last vial and that I should head to his office so we can talk about next steps before I head home.

My husband drove over from work and met me in the doctor’s office so I wouldn’t have to be alone.  The doctor answered my questions (below) and gave me a prescription for Percocet (a combination of Oxycodone & Tylenol) to combat the awful headaches.

I slept in the car while my husband ran into the pharmacy to fill my prescription.  As soon as I got home I took two Percocet (instructions say take 1-2 every 4-6 hours for pain) and passed out.  When I woke up a couple of hours later I felt infinitely better, but the relief was short-lived.

Can I go to the cottage?
Yes, absolutely!

Can I swim in the lake?
Of course!

When is my next appointment/blood draw?
One week from today.  Most places will be closed on the fourth, so Tuesday is fine.  I will need to go to a Quest or LabCorp up near the cottage.  He gave me a prescription for bloodwork and the results just need to be faxed to him.  He is also on vacation next week anyways, so it’s not a big deal that I am not in town.

How frequent will they be after that?
Depends on how the numbers looks.  While I’m still on the steroids, blood draws will likely be once a week to make sure my numbers are holding steady on the lower dose of steroids.  My next appointment with the doctor is Monday, July 11th.

Will I ever be able to drink alcohol again?
Luckily, I didn’t even have to bring this up – he addressed it on his own!  He said that I can definitely have a couple drinks each day like a glass of wine or a beer.  He just doesn’t want me doing keg stands.  So looks like I’ll be able to sip on some Moscato or hard cider next week after all!  I’m still going to take it easy, but it’s nice to know I have options.

How much Prednisone should I be taking and when will my next taper be?
He said taking 75 mg over the weekend was perfect – thank goodness!  He wants me to stay on the 75 mg a day until I see him on July 11th.  My assumption is that he will then taper me to 50 mg a day, so long as my counts are holding steady.

The Semi-Productive Sunday

Today was the most productive day I’ve had in a while. I woke up around 7, made myself breakfast and sat down to watch Netflix. After I ate I took my pills, ordered my husband a present off Amazon, added to yesterday’s blog post, and emptied the dishwasher. I laid down for a couple hours and then around 11 folded all of the clean laundry in our apartment – about four baskets full – before making lunch for my husband. We caught up on a few of our shows that we had fallen behind on and then he fell back asleep. I took this opportunity to do some work I hadn’t been able to get to during the week. I don’t like being behind and I finally had a three hour block where my headache was under control and I felt focused. That has been one of my major problems this last month that I didn’t even realize was happening until today – I have been completely unable to focus or concentrate on something for very long and I have been confused a lot more easily than usual.

Anyways, my day was productive and I felt accomplished. The only downfall, besides the massive headaches, is that I couldn’t manage to make it through my shower tonight. It felt like someone was sitting on my lungs. I tried pointing the water off to the side so it hit the wall instead of pummeling me in the chest, I tried making the water colder, and I tried just standing for a minute with my arms at my side, but no matter what I did, I couldn’t get my heart to stop fluttering and I couldn’t catch my breath.  I would normally be afraid I was relapsing already, but the doctor said the Prednisone can cause the jittery/fluttery feeling.

I had to get out of the shower and sit on the bathroom floor until my heart rate returned to normal. I then proceeded to cry for a solid ten minutes.  Why are even the simplest of things so much harder lately?  I don’t want a pity party and I don’t want to whine about how life isn’t fair, because it could always be worse and I’ve been blessed with so much in life, but I just wish I could know what’s normal.  I wish I could know how much longer things are going to feel this way.  I just want answers to questions that have none.  For instance, how does one’s immune system just all of a sudden stop recognizing its own RBCs and platelets?  Is there a cause?  Is there something I could have done to prevent this?  Is there a chance my immune system will ever reverse its decision to hate itself?  I want to know more but ES is so rare that there is little to no research on cause, prognosis, or effective treatments.  Every patient responds differently to the medications and it is essentially a guessing game – trial and error.

At this point, all I care is that I can get something for this headache because the Tylenol isn’t cutting it.

The Overdue Thanks

My husband and I celebrated our one-year wedding anniversary on Tuesday, May 24th.  It was only four days later that I was admitted to the hospital.  My mother has always referred to my husband as “that poor bastard” because he seems to have the worst luck and this was no exception.  Leave it to him to get married and find out one short year later that his wife has a rare chronic disease.  He has been really lighthearted about it, though, and even joked around with my dad in the hospital asking what the return policy was on me or if he could extend his one-year warranty.  Thankfully my husband seems to be taking all of this in stride, which is good because if he was freaking out, I would be a wreck.

delayed thank yous

To my husband, thank you for feeding me, showering me, holding my water cup, fetching towels, swiping snacks from the nurses’ station, sitting with me until I fell asleep each night, and arriving early in the mornings so  I didn’t have to be alone.  You are truly my rock and I wouldn’t want anyone else by my side during this mayhem.  Thank you for your continued support, for carting me around to my numerous appointments, for taking care of dinner and for doing whatever possible to make me feel better when I’m having an off day.  There are a million things I could write here, but none of them would truly capture the gratitude I feel.  You have truly embraced our vows, “in sickness and in health”, in a way I never could have predicted.

To my mother, thank you for dropping everything on a Saturday afternoon, hopping in the car, and driving five hours to Saratoga to be by my side at the hospital.  Thank you for spending the night at the hospital and still having the energy to drive five hours back home on Sunday.  Even more so, thank you for getting in the car with dad Monday morning and making the five hour drive yet again because you found out I needed another blood transfusion.  You sat by my side the next two days offering to get me food, fanning me, tracking down nurses, and making sure I was comfortable.  Another huge thank you for staying an extra night at the hotel after I was discharged so I could relax and spend time with you.  You are truly selfless and would do anything for your children.  I feel blessed to have you as my mother.

To my mother-in-law, where do I even begin?  You 100% treat me like you would your own daughter and I can’t thank you enough for that.  You came with me to the ER and made sure to text my mother with updates so she didn’t have to worry/wonder.  You graciously bought me food, helped me pick my meals each day, and even ran to the store to grab gift cards and thank you notes for the nursing staff.  Every nurse in that hospital was sure to point out to me how lucky I got with my in-laws and they were absolutely right.  Thank you for staying late, showing up early, and relieving others of their shifts.  I only wish there was a phrase stronger than “thank you”.

To my father, thank you for driving up to Saratoga Monday morning with momma.  Thank you for being the perfect distraction while in the hospital – your sense of humor and our endless Canasta games kept me from losing my mind.  Also, thank you for driving to the store to grab me portable fans when my hot flashes started to get the best of me.  Thank you for being you.  I love you!

To my father-in-law, thank you for snagging the big fan from the nurses’ station to cool me down and for holding down the fort back at the cottage so your wife and son could focus on being at the hospital.  It certainly wasn’t the Memorial Day Weekend any of us had planned, but you went above and beyond doing laundry, cleaning the cottage, and making up beds for my mother and aunt to nap in.  Thank you for playing the gracious host and for keeping everything running smoothly behind the scenes.

To my aunt (the Nurse Practitioner), thank you for listening to my symptoms, recognizing their severity, and referring me to the ER.  Thank you for dropping everything and driving the five hours to Saratoga (and back) with my mother to be by my side.  Thank you for asking all of the right questions, explaining the medical terms and lab results to me, helping me freshen up, and chasing down nurses, snacks, and toiletries for me.  Thank you for fixing my hair, painting my toenails, and for FaceTiming me throughout the week, especially during the family Memorial Day Party.  Your constant check ins and advice have kept me sane throughout this last month and I don’t know what I would do without you.

To my coworkers/employer, thank you for helping me understand what it is I love about our company – we’re a family.  The patience, understanding, and support you have all shown me over the last month has absolutely blown me away.  Thank you to my teammates who took over some of my day-to-day responsibilities so I won’t return to a huge buildup, especially my former boss.  Thank you to our Founder & CEO who set aside time to talk to me about my condition and made sure I was getting the best care possible.  Thank you to our HR Director for chasing down IVIG approval and making sure insurance coverage was the last thing on my mind.  Thank you to our CFO who made sure my focus this last month was on healing and recovery.  Thank you for caring about my continued success and for allowing me to work from home in between treatments.  A huge thank you to my boss who checked in with me daily, kept HR/management informed of my treatments and condition, and allowed me to make recovery and rest my top priority without having to worry if I would still have a job when this was over.  And finally, to my coworkers on other teams who have kept in touch and helped wherever/whenever possible, you are the reason I miss coming to work.  You are the reason I can’t wait to get back.

image

A very special thank you to all of my family, friends, and coworkers who sent flowers, get well soon cards, stuffed animals, meals, and presents.  For everyone that reached out to check on me, offered to donate blood, and prayed for my continued recovery, I love you.

The Third Treatment

When I woke up this morning, I immediately noticed that yesterday’s infusion spot was bruised/discolored, warm to the touch, and swollen.  Also, I was short of breath, so I was a little nervous that my hemoglobin levels had dropped again, but this morning’s blood work showed my hemoglobin was back up to 11.0.  I’m almost at a “normal” level!  I showed the bruise to the nurses and told them about the shortness of breath I had been feeling and they determined it was merely a reaction to yesterday’s infusion.

The nurse this morning chose a vein on my left forearm for my blood draw and IV.  She drew three vials in order to run a full CBC, as per the doctor’s instructions.  The results showed that after only two days of the IVIG treatments my platelets were up to 59,000!  That is the highest my platelets have been in months and I’m only halfway through my infusions!!!  After the blood draw, the nurse started the IV fluids and I felt an immediate sharp, stabbing pain in my arm.  It turns out the vein blew up.  It isn’t dangerous, but it means the nurse had to immediately remove the IV and find a new vein for the day.  The blown vein is something I hope to never have to endure again – it continued to throb for a half hour or so.

The nurse chose a vein in my right forearm, so I had to keep my arm facing up most of the day, but it wasn’t so bad.  The Benadryl burned a little when it went through the IV today, but I think I was still just on edge from the blown vein.  Between the swollen green bruise on the back of my forearm from yesterday’s infusion site, the blown vein in my left forearm, and the needle marks and petechiae covering both elbows, I feel like a human pincushion.

image

I just pray that some of these heal by Monday because I am running out of good veins.

The doctor wasn’t in today and I still needed to ask about this weekend’s Prednisone dosage, so I had to speak with the on-call hematologist.  I explained that I’d been on the 100 mg dose for a month and was worried that taking no steroids at all over the weekend would cause withdrawal.  She completely agreed and told me to take 80 mg Saturday and 80 mg on Sunday and then my doctor would likely decrease my dosage to 60 mg on Monday.  Since the pills I have are 50 mg pills, she said I could simply take one and a half each day (75 mg).  Easy-peasy!  I’m not so sure I’ll be ready to decrease to 60 mg on Monday, but I’ll worry about that when the time comes.

Today was a slow day at the hematology center.  For the first time all week, I was surrounded by patients that wanted to talk, but another patient was talking loudly on her phone right next to my face the entire time she was being transfused.  It was extremely rude and frustrating.  Taking a quick phone call is one thing, but talking loudly over a TV and other patients trying to converse is annoying as hell.  SHH. Thankfully, she was just receiving iron so her transfusion only took about a half hour.  It was refreshing to talk to other patients afterwards about their conditions and treatments.  I felt less alone.

Apparently the office closes early on Fridays and the nurses and doctors can leave as soon as their appointments are done.  By 1:30 I was the only patient left for the day, so the nurse had to stay another two hours just for me.  The room felt sad and lonely with me in the corner surrounded by empty recliners, but I was able to watch Netflix on my laptop.  I threw on “House” and curled up with a blankie and some snacks.

10:45 AM – 11:55 AM : Vial 1 : 1 hr, 10 mins
11:55 AM – 1:05 PM : Vial 2 : 1 hr, 10 mins
1:05 PM – 2:10 PM : Vial 3 : 1 hr, 5 mins
2:10 PM – 3:05 PM : Vial 4 : 1 hr, 5 mins
Total time required for IVIG treatment : 4 hrs, 30 mins

My husband picked me up around 3:30 PM and we headed back to our apartment.  I had a little bit of a headache, but nothing like yesterday’s.  The only difference between Wednesday/today and Thursday was the time of day the Solu-Medrol was administered.  I am inclined to believe that yesterday’s side effects were due to receiving the steroids in the afternoon, rather than the morning.  I’ll make sure to ask for them first thing on Monday.