When I saw the doctor yesterday at noon, he was concerned about my noticeable emotional state. He listened to my withdrawal symptoms and agreed that the psychiatrist shouldn’t have dropped my dosage so quickly. Having him confirm this made me feel like I wasn’t going crazy or overreacting. He immediately asked how the bloody noses and spontaneous bruises were.  Once I said they had dramatically improved, he exhibited a mix of excitement and disappointment.  Excitement because his theory was right and he finally got my bleeding and bruising to stop, but disappointment because he could see how hard the withdrawal has been on me.  He said if the bleeding and bruising hadn’t vastly improved he would have hiked my Sertraline dose back up, but since they improved I’m going to have to power through the withdrawal.

As for my appointment, my hemoglobin was up to 12.8 and my platelets rose from 80 to 87. I don’t know which I was more excited about!  I was excited about the platelet rise because, though it was small, I drank this past weekend when I was home visiting my parents and my platelets still went up!  Don’t get me wrong, I certainly can’t get wasted or drink excessively, but it’s nice to know I can have a few drinks or go to the bar without feeling guilty. It makes me feel like I’m on the right track finally. Plus, my social life feels much less limited now. It’s definitely a huge improvement over the last time I tried drinking back in June and my platelets dropped to an all-time low of 13.

I’m also really excited about my hemoglobin. It’s been going up consistently for weeks now and 12.8 is an all-time high!  I don’t think the doctors in the hospital thought I would even hit double digits.  The range for normal is 12-16 and I’m at 12.8. 12.8!

When the hematologist told me my platelet count yesterday he mentioned that last week’s differential (a manual platelet count under a microscope) showed my platelets were really at 92, not 80!  How can the numbers be different?  I asked the same thing. Apparently the machine in the hematology office can only read the “normal” platelets. If there are any larger (“giant”) platelets, the machine weeds them out. In this case, there were 12.

Earlier today his reception staff called to tell me the differential from yesterday’s blood draw. The differential still showed that my platelets were at 92.  Basically, this means my platelets didn’t actually go up this week – they stayed the same. Regardless, I’m just thrilled they didn’t go down!

The hematologist was just as excited as I was!  He said since my counts have been consistently going up he doesn’t need to see me again for ten days, instead of seven!  Also, after some mild complaining on my part, he agreed to drop my Prednisone from 50mg a day to 40!  I see him again on Monday, August 22nd to see how the Prednisone drop affected my counts.

It’s been a week since I started lowering my Sertraline dose and it’s been a little rocky. The three days in which I took 150 mg were easy. I had no noticeable side effects from the decrease and I felt like my normal self. The first couple of days of 100 mg dosages were fine, as well. This is likely due to the buildup of Sertraline in my system over the last seven years. Things are now starting to get a little trickier, though. I feel apathetic and exhausted and sad for no reason. Don’t get me wrong, its only a fraction of what I used to feel before medication, but I still hate the feeling. Thankfully, for the moment, I feel in control of my emotions, but that could change as the buildup of Sertraline in my system decreases.

I think tapering from 200 mg to 150 mg was a good first step, but I think only having me on 150 mg for THREE days was a mistake. I think my psychiatrist made a bad judgement call. Compared to seven years, three days is nothing. He essentially had me cut my dose in half almost immediately. I assumed I’d be on 150 mg for about two weeks or so (at a minimum) before dropping to 100 mg. These next couple of weeks will be tough, but after that, I should hopefully be used to the lower dose.

On the plus side, I’ve only had one mystery bruise and one bloody nose in the last week!  Either this is all psychological or the lower dose of Sertraline is making a difference!

I’ll know more once I talk to my hematologist about it. My appointment was supposed to be today, but his receptionist called about an hour before my appointment to say he went home sick. She rescheduled me for tomorrow at noon. Fingers crossed that all goes well!

I woke up to an email from my psychiatrist. He said he spoke with my hematologist and thinks that an adjustment to my Sertraline may be a good idea. He wants me to take 150 mg today, tomorrow, & Friday (for three days) and then drop to 100 mg a day until further notice. I think his plan is to see if the 100 mg drop (from 200 mg) is enough to improve the bleeding and bruising. If this adjustment proves the correlation between the medication and the side effects I’ve been experiencing, he may consider switching my medication or taking me off of it completely.

Luckily, I’ve been told that tapering off of Sertraline, even after long term use, creates no physical health risks at all. The only risk is to one’s emotional wellbeing. There are certain withdrawal side effects commonly associated with such a large decrease in dosage, such as depression, anxiety, suicidal thoughts or actions, etc. Essentially, the symptoms that caused me to need Sertraline are the same symptoms that can resurface as I wean off of it. Hopefully my circumstances are different enough and my general wellbeing has improved enough that I can fight off any potential side effects. Here goes nothing!

I’m at the point where I am only meeting with the doctor once a week for a platelet check so there isn’t much to say between appointments. It’s a waiting game. With that being said, this post will serve as my update for the last week or so.

On Friday, July 29th I had two bloody noses. Saturday was even worse. I had three in total. Sunday I had another one and Monday morning, yet another. That is seven bloody noses in a four-day span. I think Saturday’s bloody noses were due in part to having a stuffy nose. Every time I blew my nose on one side, the other side started bleeding. I’m not sure if this was due to the pressure of blowing my nose or what.

This morning while I was in the shower I noticed that my right shoulder was bleeding.  I hadn’t scratched at it or scrubbed it, but there was blood running down my arm.  At first I thought maybe I had another bloody nose that was dripping, but when I washed away the blood it immediately started up again.  I could barely even see the tiny little cut/hole on my shoulder.  By the time I dried off from my shower, I didn’t even remember where on my shoulder it had been.  Regardless, between the seven bloody noses the spontaneous shoulder bleed, I was assuming the worst at today’s appointment.  I thought for sure my platelets had gone down.

Despite the symptoms and warning signs telling me otherwise, my platelets didn’t go down!  In fact, they went way up!  My count jumped from 54 to 80!  My hematologist said that the Prednisone is finally working on my platelets.  Because of that, he held off on tapering my dose again.  I protested but he said to give him one more week. Depending on my numbers next Tuesday he may finally taper it again.

I thought he’d have an update about my Sertraline today but the psychiatrist never returned his call. We tried calling him again while I was in the office today but he didn’t pick up. I gave the hematologist his email address so hopefully he can finally get a response.

In the meantime, he consulted a psychiatrist in the building and briefly explained my situation and the psychiatrist agreed that it could definitely be the Sertraline causing the easy bruising and increased bleeding. Today’s platelet count served as further proof. Since my platelets went up but the bleeding got worse, it’s definitely a problem with the Sertraline damaging the platelets. The doctor explained it to me like his – Sertraline releases seratonin and is meant to balance these levels. Platelets contain small bits of seratonin that interact with the medication. He said he found multiple studies and papers linking Sertraline to platelet problems. As for why it was never a problem before, I didn’t have ITP before. Circumstances changed, so my side effects changed.

I just get nervous because I’ve only been taken off of one long term antidepressant before and it did not go well. It felt like an out of body experience.  I felt helpless and out of control, which was terrifying.

I’m really nervous about having the same experience this time around. I almost started crying in the doctor’s office. I had to hold back tears. As I sit here writing this I’m trying to figure out what I’m really so afraid of though. I know that I’m in a much better place emotionally than I was back then and I have a strong support system, a great job, and a loving husband. What am I so afraid of?!  Perhaps I’m not afraid so much as annoyed. Annoyed the hospital didn’t immediately point out the potential interaction with my meds and ITP?  Maybe. Annoyed that I still don’t have a long term game plan or any end of the Prednisone in sight?  More likely this.

One of the worst things is waiting – waiting in any form is a trigger. It increases my anxiety and frustration and makes me feel as if I have no control over a situation. I feel like I can’t move on or go back to “normal” until this is all over. I never know what my week is going to look like. As a planner, the unpredictability of this illness and my current state is sheer terror. I hate not having a plan in place. I hate that things keep getting pushed off. Don’t get me wrong, I’m thrilled that my platelets went up and I don’t have to worry about further treatments at this time, but it’s all a false sense of security because I’m still on the Prednisone. I won’t know the real status of my AIHA or ITP until I’m completely off the steroids, so it’s hard to get excited in the meantime.

My mother says I should be celebrating the little victories, such as a rise in my platelets, but it’s hard to celebrate until/unless I know it’s over.

It has taken me a while to get to this point, but I am not embarrassed to say that I am on antidepressants. Each morning I take two 100 mg Sertraline pills and one 150 mg Bupropion XL pill. These were prescribed to me by a psychiatrist to treat my anxiety, depression, and panic disorder.

I was first prescribed Sertraline (the generic for Zoloft) in January 2009.  Over time my dose was increased until I eventually reached 200 mg a day, which is the maximum allowed. When this still wasn’t enough my doctor started trying other medications in addition to the Zoloft. After a few months, she settled on Bupropion XL (the generic for Wellbutrin). This certainly helped control my depression, but my anxiety was still a looming problem. Clonazepam (the generic of Klonopin) was added on a “take as needed” basis. I try not to use these often. I only take one if I’m in the middle of a panic attack. It is nice knowing I have them if I need them, though. They are sort of like a safety net to fall back on.

I am not sure exactly how long I have been on this precise combination of pills and dosages, but I know these are the three medications I was on when I studied abroad in the summer of 2011 (as a frame of reference). I’m not even sure I know who I was before the antidepressants. Some people say the pills change you or dull your personality, but I don’t think that has been my experience at all. The medication makes me feel calm and better equipped to handle life and the challenges of daily living.

I was originally strongly against the idea of taking medication to deal with emotional problems, but I am so glad I changed my viewpoint. I don’t know how I would have made it through the last seven and a half years without the pills. When I started the medication I was practically lifeless. I didn’t care about myself, my success, my passions, or, sometimes even, my existence. Getting out of bed in the mornings was a struggle and I completely lost interest in maintaining friendships and communications with the outside world. I would shut myself in. I had become a shell of my former self, but the antidepressants changed all of that. Things these last seven and a half years have by NO means been easy, but they have been manageable. I no longer feel like the world is collapsing every time I leave my bed.

Why is all of this relevant?  I wanted to paint a picture of how much I believe antidepressants changed my life for the better. I’d like to be completely weaned off of them some day, but not anytime soon. I am terrified of falling back into the rut I was in when I started. I was in a really dark place back then and I have no interest in working backwards.

Today I received a voicemail from the hematology center asking me to call ASAP because my doctor had been trying to get ahold of me. I called on my way home from work and the receptionist put me on hold and went to get the doctor. The doctor picked up the phone and told me that he needed the contact information for my psychiatrist. He went on to say that spontaneous bruising and bloody noses can happen when an ITP patient is at less than 30,000 platelets, but shouldn’t be happening at 54,000. He said the sheer quantity of bloody noses perplexed him, which is why he needed to do the bone marrow biopsy last week and rule out other causes. Now that those results showed no abnormalities, he was back at square one, so he reread my charts and labs. This is when he realized I was on Sertraline. I don’t know all of the logistics yet, but the hematologist told me that Sertraline has been known to make platelets “sensitive”.  He now believes my spontaneous bruising and bloody noses are due, in part, to my antidepressants. I am not sure exactly what my hematologist is going to ask my psychiatrist or what my psychiatrist is going to say.

Will I be tapered to a lower dose of Sertraline?  Is my Bupropion XL also a problem?  Am I going to need to wean off of Sertraline completely?  How will this medication change affect my overall mental state and wellbeing?  Are there any common side effects to weaning off of long-term Sertraline usage?

Did this medication affect my platelets?  Will coming off of this medication increase my platelets?  Are they linked at all?  Or is Sertraline solely linked to “platelet sensitivity” and not destruction?

I am really nervous that the two doctors are going to talk amongst themselves and agree to wean me off of the Sertraline.  I am terrified of not being on it. I barely remember who I was before it, but the parts I do remember are less than ideal. I can’t go back to that place mentally – it took me years to completely claw my way out.  Granted, I feel much better equipped at this point in my life to handle whatever challenges may come my way, but I’m afraid to find out if that is me or the medication talking.

The title says it all!  Today was chuck full of good news – so much so that I’m still a little afraid I’m dreaming.

I spoke with my company’s HR Director and the insurance company has agreed to waive the huge $4,500 lab fee I incurred due to the negligence of my original hematologist. I am not sure about all of the reasons/details yet that influenced their decision, but I am so glad they are on my side (especially since the problem could have easily been avoided and was completely out of my control).

I had a platelet check today at 1:00 and then met with the hematologist. This visit to the hematology center was the best one yet and here is why:

1. My platelets, which were at 38 on Wednesday, went up to 54 today!  This is the first time that they have ever gone up on their own!  This is a VERY good sign. The doctor was so pleased that he decided no further treatment is necessary unless I develop new symptoms (bleeding or bruising) or my count drops below 30.
2. The results of the echo were completely normal!  The cardiology report showed that everything looked and sounded right and my heart was doing its job. Conclusion: the heart palpitations are purely a side effect of the Prednisone and should hopefully end once I’m off the steroids.
3. The preliminary bone marrow biopsy results came back normal, as well!  My bone marrow is still producing platelets, which is a huge relief. I spent most of yesterday a little worried because I found out if my marrow had stopped producing platelets I would need to have a bone marrow transplant. Luckily, this isn’t an issue!  Also, the fact that the bone marrow sample was normal means I tested negative for cancer. The testing that takes two weeks is the genetic testing. A lab physically looks at my DNA to see if there are any rare diseases I am a carrier for. The doctor said that he can usually tell from the prelim results if the lab is likely to find something. He is confident that the genetic testing will come back negative.

It’s safe to say I had a pretty great day!  I see him again next Tuesday afternoon for my weekly platelet check. Hopefully he lowers my Prednisone dose soon. He still has me on 50mg. He was too hesitant to reduce it today – not sure why.

The bone marrow biopsy hurt like a bitch (pardon my language but there is no other word emphatic enough to describe it). The nurse took me into an exam room where a biopsy kit was laid out – think slides, tubes, and containers – a little overwhelming to look at. Originally the nurse positioned me on my left hand side for the biopsy but it was too tricky – I had to keep my left leg completely straight, my right leg bent up towards my chest like I was doing a cannonball, and my torso tilted down towards the table hugging the side. It wasn’t comfortable. After trying to maneuver me at an angle that would work the doctor and nurse decided it would be easier for me to just lay on my stomach. I laid down on my stomach with my legs extended and my face turned to the side for the entirety of the procedure.

Before I get into the logistics of the procedure, I think some background knowledge would be useful. I have two very different, very effective, ways of dealing with pain.

When the pain is emotional in nature (i.e. feeling anxious, overwhelmed, scared, depressed, etc.) I cry. A good, long cry is so therapeutic. It makes me feel like the pain is washing away. When that doesn’t work, listening to sad music does the trick. It seems counter-intuitive, but for me, listening to happy music when I’m sad is never the answer. When I’m sad I want to wallow and be sad for a little bit. I don’t want to try to force myself to skip over the grieving/healing.

When the pain is physical in nature I tend to swear, make weird noises/sound effects, threaten those around me, and use sarcasm and humor as a shield. I also react the same way when I’m stressed or really angry. Just to help drill my point home, here are a few examples of phrases I have been known to utter in times of physical pain or extreme stress and during fits of rage:

“I hate you and everything you stand for”
“I’ll kill you”
“You’re the devil”
“You’re dead to me”
“I’m gonna punch you in the face”
“I’m dead inside”
“I’m gonna cut off your face and wear it as a mask” (okay, so this one is more of an inside joke than anything else, but I did get mad enough to say it once)

Now back to the procedure! The nurse had ocean sounds playing on a sound machine and held my hand during the painful parts. In a way it reminded me of when I got my ears pierced when I was younger because the nurse and doctor asked if I’d rather have a countdown or be surprised and I had the same response I had years ago at a mall kiosk – I would rather just have a casual conversation – it is a nice distraction. The nurse and I talked about my husband and about my parents’ dog while the doctor injected the local anesthetic. He said it would feel like a slight pinch as the needle went in and then a burning sensation. He wasn’t kidding. It felt a lot like the Cortisone shots I used to get in the heels of my feet for my plantar fasciitis. My lower hip started to go numb and the doctor got ready for the biopsy. I spent the next ten minutes or so resisting the urge to swear and rotating between “I hate you” and “I’m dead inside”. Luckily the doctor and I have a pretty good rapport and he knows I was just kidding around.

I was unable to control the noises I was making as a subconscious response to the pain and the doctor started to get nervous that he was hurting me. The pressure of the needle was intense since it has to break through skin, tissue, & bone to extract marrow. Though the skin was numbed, there is no way to numb the bone. As he was pushing I kept grunting “ahhh” and he kept stopping because he was afraid the anesthetic wasn’t strong enough or that I needed more. I kept telling him “no, no pain – just pressure” but he asked all three times I made a noise. The noise was involuntary. I make strange noises all the time. Every time my husband drives through Manhattan he makes me nap because otherwise I gasp anytime he gets close to another car. It freaks him out every time. I understand why the doctor was concerned but by the third time, no need to ask! Every time he asked he paused and then had to reapply the pressure. It made it worse somehow. I even told him “if it hurts, I will tell you”, but he continued to ask anyways. I think he just cares SO much that he wanted to make sure he wasn’t causing me any pain. I suppose that’s not such a bad thing!

I don’t know how to describe the pain of the biopsy without analogies. It left like someone was pogoing on my lower back. Whatever tool/needle/corkscrew he was using just kept pushing on my bone repeatedly and felt springloaded. Though the skin was numbed, I could feel when the needle penetrated the bone – a super strange and terrifying feeling. I hope I never have to get another bone marrow biopsy. The sheer level of pressure and discomfort was awful. The good news is the doctor said he got a great sample and it was one of his best he’s ever obtained. Whew!

He made up a bunch of slides and packaged the kit to be sent out for testing. In the meantime the nurse applied pressure to the biopsy site to stop the bleeding. She then used a 4×4 gauze square and medical tape to patch it up and said to leave that on until tomorrow. She brought me an apple juice and helped me flip over and button my pants back up. I was then instructed to remain lying down for 20 mins.

During the biopsy I had mentioned to the nurse and doctor that I noticed a handful of little bruises on my chest (all very small, about six of them, varying stages of yellow/purple) when I woke up this morning. The doctor asked the nurse to take a finger prick after the biopsy was done and run the blood to check my platelets. Since he just checked them yesterday he didn’t expect much of a change. While I was lying on my back for 20 minutes, she did the finger prick and ran the numbers. When she returned to the exam room she had an empty vial with her and a needle. She said that my platelets were at 42 and she wanted to run it again with a better sample. The second sample showed my platelets at 38, meaning they dropped 21,000 overnight.

The doctor wants me to come back on Monday for a platelet check again. He originally was going to have me come in later next week to ensure he had the echo results and the preliminary biopsy results before meeting with me, but the low platelet count caused him to move up my appointment time.

Now that I’m home I’m just sore. It’s been 8 hrs since the procedure and I haven’t needed any Oxycodone or Percocet, just Tylenol! It’s a little uncomfortable, but it doesn’t hurt. I was afraid it would be more of a sharp pain, but it’s dull and achy if anything. The thing that has been the biggest problem is that I keep vividly picturing/reliving the pain of the procedure for no apparent reason. I can’t seem to distract myself long enough to forget what it felt like to feel something move around inside of my bone. Hopefully the flashbacks end soon. I’m not trying to sound dramatic – it was literally that awful.

I have to first start this post by thanking my mother in law and sister in law for coming to my rescue. My husband has been missing too much work with all of my appointments and treatments and wasn’t going to be able to go to my Echocardiagram or hematology appointments with me today. I was scared to go alone, so I told my mother in law about it last week and asked if her offer to come visit was still valid. She rearranged her schedule so she could be with me today and I am SO grateful.

My mother in law and sister in law arrived at my apartment around 11:30 AM. We left shortly after to go to my 12:30 PM echo appointment. I checked in with the front desk and then waited to be called into an exam room. In the exam room, I was asked to remove all clothing from the waist up and put on a paper gown with the opening in the front. The technician had me lie down on my side facing the machine. She squeezed cold gel onto the end of the ultrasound wand and then, with the wand, began applying pressure to my chest. She moved the wand slowly and meticulously isolating various images, sounds, and movements. It was cool to hear and see my heart on the computer screen. She mapped out all chambers and measured each ventricle. In addition, she analyzed the beat, rhythm, motion, and speed of my heartbeat. At one point, she had my lie on my back so she could look at my heart from the side. The entire process took about 25 minutes.

When the technician finished, I asked her if she saw anything alarming or tragic on the screen. She said she’s not allowed to discuss the results or tell me anything, but if there was any sort of emergency, she wouldn’t have told me I could leave. That put my mind at ease. Since she didn’t call a doctor in to immediately see or hear something, I am not going to let myself worry about it. I should have the results by the end of the week or early next week.

Hopefully insurance covers the echo. I never got a definitive “yes, you’re all set” from the doctor or the imaging center. When I called insurance they were unable to tell me if it was covered or not by name alone. They needed the echo’s five digit code, which I didn’t have. In reading my coverage documentation though it seems only large scale imaging needs to be pre authorized – PET scan, CT scan, MRI, etc. I should be okay.

I left the imaging center around 1:15 PM and my mother in law, sister in law, and I headed to Hoboken for lunch. We had pizza from a small little place in the center of town and then walked to Carlo’s Bake Shop for dessert and to grab some cannolis for later.

Shortly after it was time to head to the hematology center for my platelet check. It was really busy there today and I had to wait far longer than usual to be seen by the doctor or even taken back for vitals and blood work. Eventually, a nurse drew my blood and ran it through the machine. My platelets last week were at 96 and today they had dropped to 59. It’s not ideal, but I suppose it could have been worse. A little part of me was expecting worse because of all of the nose bleeds (six in the last week, four of which were all on Sunday).

While I was waiting in an exam room for my turn with my doctor, my nose started to bleed. I stuck my head out into the hall and asked a nurse that was walking by for tissues. She called over another nurse who twisted up two tissues and put one in each nostril. She had me lie down on the table and she held the tissues in place for me until the bleeding slowed. The door was open and the doctor happened to walk by. He suggested an ice pack to stop the bleeding faster, so the nurse held an ice pack against my nose. That seemed to do the trick!

As soon as the doctor came in to speak with me, he immediately asked about the bloody nose. He seemed curious more than anything. Once I told him it was my seventh this week, though, the curiosity turned to genuine concern. I thought that bloody noses were common in people with ITP, but he said that isn’t necessarily the case. My hematologist said that spontaneous nose bleeds only happen in about 10% of ITP patients. He said one or two would have had him a little worried, but not too concerned, but that seven was a red flag. The more common problem in ITP patients is trying to get a bloody nose to stop. In addition to the bloody noses, the doctor didn’t like the fact that my bruise from my June 23rd infusion site still hasn’t faded or healed much at all. Between the spontaneous bloody noses and the long-lasting and sometimes spontaneous bruising, the hematologist is highly recommending I agree to further testing. But what does this “further testing” entail? A bone marrow biopsy.

The doctor said that a bone marrow sample can be tested for over 50 conditions, including rare genetic conditions/disorders and cancers. Also, he wants to see if my bone marrow is still producing platelets at all. Thankfully, he assured me that he is expecting everything to come back negative. Since the percent of people who have the random bleeding and bruising is low he needs to be sure there is no other explanation or underlying cause for the platelet destruction before he can formulate an accurate treatment plan.

The biopsy is tomorrow at 11:15, so my husband is taking me on his lunch break. Preliminary results will take 4-5 days and full results will take about two weeks. The doctor said once he has the full results he will be able to plan my future treatments. He said I will almost definitely need some sort of infusion again since my numbers are low. As opposed to recommending I try IVIG again, he suggested Rituxan because of the awful headaches IVIG gave me.  I know Rituxan can mess with your reproductive system, though, and I haven’t had kids yet, so I’m thinking I’d rather just deal with the headaches. Luckily, this isn’t something I need to decide or, frankly, even think about for a couple weeks still.

My hematologist briefly explained the biopsy process to me so that I won’t feel blindsided tomorrow. I will be in a sterile room with him and a nurse and the procedure should take a total of about 20 minutes. Local anesthetic is used to numb the area (usually the hip bone). Unfortunately, only the skin and tissues can be numbed, not the bone. The doctor claims that the procedure shouldn’t be painful, but rather, uncomfortable. He says it feels like a lot of pressure pushing on your side/back. This is normally the point in time where I would Google the procedure and read about risks and look at photos/videos of the biopsy being performed, but I am trying to resist. The hematologist went out of his way to specifically say, “whatever you do, don’t Google it”. Somehow that made me even more nervous – is he hiding some sort of painful or disgusting secret?

I am reminded though that things could always be worse. The doctor brought a woman into the room next to mine and closed the door. He told her she had cancer and she burst into tears. I can’t imagine hearing that news and hearing it alone nonetheless.

After my appointment we went back to the apartment where my mother in law made dinner and did the dishes while my sister in law and I colored. Having my in laws here today was the perfect distraction. From the bottom of my heart, thank you!

Friday night after work my husband and I went to IKEA and bought some long-awaited furniture for our apartment. We are now the proud owners of a queen-sized futon. Also, as a thank you for being so great these last seven weeks, I bought my husband his dream desk. I have to admit I’m pretty jealous of it. It is electric and with the push of a button can move up/down to adjust to the perfect height. He sits at it when he’s typing but changes it into a standing desk when he’s working on projects. Since my husband has the new desk now, we moved his old metal desk from the living room to the guest bedroom for me to set up as a home office.  Since I’ve been working from home so often, it just made sense.  More importantly, though, when I start grad school this fall, I will need a quiet space in which to study and write papers and the guest room was the obvious choice.

We spent Saturday rearranging the guest room furniture, putting together the futon, and setting up the desks.  I took my husband’s advice and ordered myself a second monitor.  The setup looks great now – dual monitors, a keyboard, & a mouse that all work with my laptop.  Also, he made it so that my MacBook can run on iOS or Windows 10! This will certainly make grad school easier – some of the courses require the use of programs that are mostly meant for PCs.

Yesterday morning around 4:30 AM I woke up with a bloody nose.  I hadn’t had once since Tuesday so I wasn’t too concerned.  I waited for it to stop bleeding and then went back to sleep.  My husband and I spent the day cleaning the apartment – mainly the kitchen and bathrooms.  Around 2:00 PM my nose started bleeding again.  Twice in one day?  That can’t be a good sign… At least it stopped fairly quickly!  As 3:30 PM rolled around, I could feel my nose dripping again.  UGH!  A third bloody nose?!  Now I know this is DEFINITELY not good.  I started to panic, but took solace in the fact that the worst was over.  False.  Around 12:30 AM as I was getting ready for bed the nose bleed came on strong.  It still wasn’t tragic, but it took twice as long to stop as the previous three.  If I didn’t already have an appointment scheduled for tomorrow with the hematologist, I would have called his office today asking to be seen.  He previously mentioned that the real concern with bloody noses is if you can’t get them to stop.  I am thinking, though, that the sheer number of incidents warrants cause for concern.

I keep trying to justify the bloody noses and rationalize them.  For instance, my sleep apnea machine (although I always use the humidity setting so I don’t think it dries out my nose much at all) could cause my nose to dry out.  Or the fact that I broke my nose Christmas 2014 could play a part.  But can an injury that old still be a contributing factor to nose bleeds?  Chances are these nose bleeds are solely related to the ITP, but I’ll find out tomorrow.

I got to work early this morning.  The commute in wasn’t too terrible or strenuous.  I had an appointment with my therapist at 1:00 PM and decided it would be easiest to go straight home after that.  I hopped on the train back to NJ and then Ubered home from the PATH Station.  Around 5:30 PM I got yet ANOTHER nose bleed.  Thankfully, this one didn’t last too horribly long.

Enough about nose bleeds, though!  The thing I want to focus on is the advice my therapist gave me today regarding tomorrow’s Echocardiagram.  As I had previously mentioned, I am nervous I will blame myself for the results if they show any sort of weight-related damage or problems.  My therapist pointed out that guilt and shame keep us focused on the past and prevent us from moving forward.  What then followed was the single greatest analogy to date. For some reason after hearing this everything just clicked for me:

There is a cup of coffee spilled all over the kitchen floor.  You have two options – you can try to figure out how it spilled or you can simply clean it up and move on.  If you try to figure out how it spilled, you start wondering “did I leave it too close to the edge of the table?”, “did I accidentally knock it over?”, “should I have put it by the sink?” and you waste time worrying about what you could have or should have done differently to prevent the spill.  All the while, the stain is setting in. Reflecting on how or why the spill happened doesn’t make the spill any better, it doesn’t make it go away any faster, and it certainly doesn’t help the situation.  It is wasted time spent pointing fingers instead of addressing the problem.  I think I need to approach the results of tomorrow’s echo the same way – the results are what they are – beating myself up over what I could have done differently to prevent a problem (assuming there is one) is only going to cause me more hurt.  I need to instead figure out what the next steps are to rectify the problem and prevent future occurrences.  I know myself pretty well, though, and I’m going to have to consciously make the decision to not focus on what role I played in this situation – “if I had eaten better…”, “if I had exercised more…”, etc.

Fingers crossed that all goes well tomorrow!