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Archive for the ‘Intractable’ Category

Migraines, Meds and Making Connections

Migraine Support Group cover photo - courtesy of the U.S. Pain Foundation

Migraine Support Group cover photo – courtesy of the U.S. Pain Foundation

I recently joined a Facebook support group for migraine sufferers. It has been an experience that leaves me with such a variety of emotions. Sadness. Empathy. Frustration. Compassion. Fury. Hope. I read the posts and it is as though I am reading something that younger versions of me might have said. Versions of me in the early stages, with ill-equipped doctors doling out terrible advice and the wrong meds. Giving up on me. Over and over. Versions of me that wondered if anyone else on the planet could possibly be experiencing what I was going through. Non-stop pain. Pain that was crippling. Pain that made me wish I was dead, or at least unconscious until someone invented a cure. Isolation. Judgement. No one could SEE my migraine so many people dismissed it, underestimated it, assumed I was faking or being dramatic. Loss of wages for when I couldn’t get to or stay at work. Loss of income when I was repeatedly let go for absenteeism. Accusation of being a drug-seeker when I wound up in the emergency room. The inability of so many ER staff to distinguish between seeking drugs, and seeking comfort, progress, a few moments, at least, with less pain. Versions of me that could sense when yet another doctor was about to give up on me or simply say that my only option was pain management with narcotics. Versions of me ready to just give up all together.

More than 14 years of living with this condition has left me wiser, more cautious, patient, more discriminating about who I allow on my treatment team, and eager to get the word out that if you are dealing with migraines, or any other chronic condition – know this – YOU ARE NOT ALONE. The first time I actually believed that was when I was being treated in-patient at the Michigan Headpain and Neurological Institute. A team of doctors from various disciplines led by Dr. Joel Saper, world-renowned for his work in migraine treatment, fully dedicated to 22 patients. We did 3-day trials of intense IV protocols. Some helped. Some hurt. Some did nothing…or so it seemed. Some people had miraculous success. Others, like me, waited for weeks with no apparent improvement. We went to classes on the physiology of pain, stress reduction, coping mechanisms, art therapy, yoga. We saw psychologists. But out of all of that, one of the most amazing and life-altering parts of this entire process was the 21 other people who actually got what I was going through. REALLY got it. Not “I can only imagine” got it or “I went through something similar” got it, they actually, really, absolutely got it. That was as powerful as the medicine. It was miraculous. Life-altering. Those relationships are still some of the most important in my life.

Dr. Joel Saper, photo courtesy of MHNI

Dr. Joel Saper, photo courtesy of MHNI

My time at MHNI was also my first experience with a real headache clinic. The results were profound. If you combined all of the improvement from the previous 5 1/2 years, ridiculous number of medications and treatments and countless doctors, it was only a fraction of the relief I got from the protocol the MHNI doctors found for me.

So why am I still a chronic migraine sufferer? Pretty common question. The thing about migraine and all of the other headache disorders is that you are dealing with the most complex thing on the planet – the human brain. Brain chemistry changes CONSTANTLY. So to think that finding something that works for the moment is the same as finding a cure is just naive. What works now will hopefully work for a while. But it is unlikely that it will work indefinitely. For me, it was about two years before the efficacy of my drug protocol started to nose-dive. But when it did, it didn’t take long. It was excruciating. Both physically and emotionally. I just knew that I couldn’t go back to that level of pain every day again. And certainly not with the hours I was working. I was right. Something had to give. I was battling my HMO to allow me to go back to MHNI even though they were out of network while still trying to keep things going at home and at work. NOT sustainable. I started missing work. A lot of work. In fact, I used up all of my FMLA days. I had to take each day I missed without pay. FINALLY I got the go-ahead to go back to MHNI. I went on short-term disability, figured I’d be there for 3-4 weeks and would need another 3-4 to recover before coming back.

If only it were that simple. My second month as a patient at MHNI didn’t yield the incredible results the first one had. In fact, I was not better at all. Short-term turned to long-term disability. My financial situation deteriorated. My emotional state plummeted. I became essentially non-functional. If I got from my bed to the couch downstairs it was a big accomplishment. This went on for a couple of years. I became suicidal. I was treated at a trauma treatment center for three weeks. My emotional state improved while my physical state continued to deteriorate.

Then I moved. There were many factors that brought me from northern Virginia to central Florida, but the biggest thing (healthwise) that I got out of it was a new doctor who profoundly changed my outlook, my options, and delivered (to an extent) on promises of relief. I’ve been with him now for about two years. I’ve had several surgeries. I am better. I am not cured. I am not pain-free. But I am better. And more than that – I have hope. I often get the most amazed response to that statement. After more than 14 years of chronic pain, how can I actually be hopeful? Well here’s the thing…I had a surgery that did not exist when my condition began. And it has helped me. Not in the ways or to the extent that I was led to believe, but it did help. So why would I not assume that this incredibly complex science being explored by some of the most brilliant minds in the world would not continue to advance? It will. And I will continue to reap the benefits of that progress.

So to all of you out there at whatever stage of chronic migraine or cluster headache or whatever other disorder – hold on. Keep going. Find a good specialist and keep your expectations in check. Progress is possible and there is reason for hope. And for all of you out there who are “old hats” at this chronic pain thing – reach out. There are people who need you. None of us is alone. There are others – many others, who are going through the exact same thing as you. We deal with the same challenges, the same questions, the same stigma, the same need to not be alone in this battle.

So here’s to better science, less pain and many new connections!

 

 

Migraine, Fibro and Gratitude.

Anyone who has followed this BLOG or who knows me personally is aware of my battle with intractable migraines. I have not discussed fibromyalgia here in any detail. For a very long time I didn’t feel I should even identify myself as someone with fibro. I have friends with fibro and have read the work of others living with fibro that is so invasive and debilitating that the few symptoms I had that led to my initial diagnosis many years ago felt insignificant. It felt like an insult to those who had “real fibro” for me to claim to be affected by it at all. About six months ago, all of that changed.

Fibromyalgia is a progressive condition (a syndrome rather than a disease) that affects “an estimated 10 million people in the U.S. and an estimated 3-6% of the world population” according to the National Fibromyalgia Association. That’s a lot of people in a lot of pain. But a large portion of those suffering from fibro go undiagnosed or misdiagnosed for years. The symptoms mimic those of many other conditions and there are still many in the medical field who refuse to even recognize fibro as a legitimate or real condition. Thankfully its recognition and thus its treatment has been rising steadily over the last decade.

I have no idea how long I’ve actually had fibro, because there was so much overlap between my fibro symptoms and those of my migraine condition and the side effects of several of my migraine medications. I was diagnosed with it about 7 years ago. At the time my symptoms were relatively inconspicuous. The most bothersome of any was the pain that was caused by even a light touch on my arms. My boyfriend would put his arm around me and rub my arm gently and it felt as though he were digging his fingers in as hard as he could. That seemed like small potatoes. It was nothing compared to what I dealt with from my migraine condition and nothing compared to what I knew others experienced from fibro. If you’ve read Mary Gelpi’s incredible blog, Fibromy-Awesome, you know exactly what I’m talking about.

Illustration of the Reed Procedure

Illustration of the Reed Procedure – yes – I am the real deal bionic woman!

So what changed? Some of the symptoms from my migraine condition eased up after my neurostimulator implant surgeries (the Reed Procedure). I am on fewer medications than I have been at any other time in the last 13 years (only 16 a day! Woo-hoo!), and consequently dealing with far fewer side effects. Seemingly out of nowhere, my body turned alien. I started waking up with my hands so swollen I couldn’t make a fist. My legs and feet swelled so much that from the knees down I was a clone for someone 9 months pregnant and ready to burst. Many mornings my entire body is so stiff that merely getting up out of bed requires a series of countless tiny movements to stretch and ease the tension in every joint and muscle. Days of exhaustion so severe that I cannot do anything that is not an absolute physical necessity have become common. One day the joints in my left thumb were so painful when I awoke that it actually felt broken. My right wrist started intermittently hurting enough that I thought I must have started sleep walking and done something terrible to it. All of these symptoms and more. Apparently out of thin air. Some of them I recognized as fibro right away; others I had no idea could be part of this condition that I had essentially been denying I had at all for nearly a decade.

I was frustrated. I finally made a bit of real progress with my migraine pain for what? To swap it out for increased fibro pain? What in the world had I done to deserve this? It seemed so unfair. Then another thought occurred… what if I had had to deal with all of the fibro pain on top of the worst of my migraine pain? What if this sudden explosion of symptoms had occurred not following the surgeries that alleviated one condition, but had coincided with the onset of my intractable migraine? Could I have survived it all at once? Maybe this wasn’t the least fair thing in the world, but the greatest stroke of luck. Perhaps I should thank God and all my lucky stars that this is happening now, and not years ago when the pain in my head nearly drove me to take my own life.

I have lived by the saying “everything happens for a reason” my whole life. I believe it with every fiber of my being, even when it makes me curse whoever is in charge and when I know there is no way I will ever understand the reason. I do not believe in coincidences. I don’t believe in random chance. I have never been a religious person. My family identifies as Protestant, though we never attended church regularly, and only sometimes on Christmas and Easter. I attended Mass with my best friend as a child periodically. Her family was deeply religious (her father was a former priest). Mostly we giggled and whispered and got in trouble. I have, however, always believed in what some people refer to as God. I have always believed that our souls exist beyond the life of our bodies and that there is something somewhere greater than us all. It has been, at times, an internal battle with the scientist in me. I believe in evolution. No man in the sky created all that is in a week. But I look around the world and I find it impossible to ignore that everything is connected. There is nothing that happens in a vacuum or that does not have an effect that reaches far beyond what we can see.

A few years back on a trip to Grand Bahama Island to visit my father, I stood in a coral cave staring into a pool of fresh water sitting atop salt water. The experience was overwhelming. I found it nearly impossible to leave or resist returning once I had. The way the light came in through the collapsed ceiling where the less dense coral had eroded and eventually given way was amazing. It bounced around beneath the water’s surface making it nearly impossible to tell reflection from surface. The depth was impossible to gauge. The colors were more beautiful than any I had ever seen. It was, and continues to be one of the most awe-inspiring places I have ever been. For me, it was a deeply spiritual experience. My father asked how my trip to the cave was and I told him (after several days of discussion about religion) that the cave was my church. I don’t need a building in which to worship. I don’t need a man to tell me what God says, or to be my messenger. If I want to talk to God I’ll do it myself. I don’t mean that to sound offensive; it’s simply what I believe. My relationship with God does not require any middleman or cathedral.

I know it seems I have gotten off course here with this discussion, but to bring it back around – what I have realized is that I don’t have control over the fact that I have intractable migraines or fibromyalgia. I didn’t have a say in when they started or how significantly they have affected my life. I could allow myself to become bitter and angry that when I started to experience a small amount of relief from one condition, the other flared up with an intensity I had always been grateful not to have experienced. But I choose not to do that. I choose not feel that way. I choose, instead, to be grateful. Grateful that I have not been dealing with fibro at this level for all of my life, or for the first 12 1/2 years that my migraines were completely unabated. I choose to believe that this series of events has unfolded in ways that I might not understand, but are not without reason. I choose to believe that even if I am meant to experience both of these conditions, something greater than us all protected me from experiencing them both at the same time in ways that were more than I could handle.

For those who know me best, much of this discussion will come as a shock. The girl who has studied and worked in the sciences going on about God and spirituality will seem a giant contradiction. I have spent years being critical of those who are deeply religious. Catholics, in particular. The “word of the Lord” as written in the Bible has been at the very heart of many a heated discussion with those who try to use God as an excuse for hatred and bigotry. But we all have a right to our opinions and our faith. That does not, however, excuse any harm we inflict on others in the name of religion or spirituality.

Jesus Calling by Sarah Young

Jesus Calling by Sarah Young

I will conclude with this…a thank you to my mother who gave me a book of daily devotions (Jesus Calling by Sarah Young) that I would never have picked up on my own. She handed me her copy in the midst of a very dark moment when pain and fear and exhaustion were getting the better of me. She didn’t read it to me or insist that I read it. She simply left it by my side. Since then I have read it every day. While some of what is said in this book is at odds with what I believe, the messages, for the most part, have been not only comforting but kept me from falling into weak patterns without purpose or constructive thought. I will leave you with one of my favorite passages that zeros in on something that is both difficult and essential for everyone with a chronic illness;

When you are plagued by a persistent problem – one that goes on and on – view it as a rich opportunity. An ongoing problem is like a tutor who is always by your side. The learning possibilities are limited only by your willingness to be teachable.”  

Bittersweet Victory

I had a big win recently. My request for an expedited hearing before the Social Security Administrative Law Judge was approved. We waived the right to a 20-day notice and were notified on January 21 that my hearing would take place on the 24th since there had been a cancellation. For three days there was a frantic race to get ready. A race to pull together all of the arguments and facts and answers. After years of waiting, suddenly it was a rush to pull it all together before Friday. I met with my lawyer. I spoke to my family. I got letters from friends, family members, previous doctors. And then we went.

I sat in a tiny room with an awkward setup staring up at the man who would decide my fate. He was kind and comforting and patient and reassuring. Nothing like what I had imagined. I think that I’ve just been fighting so hard for so long that it was actually a little unnerving to not feel as though I was facing an opponent in that room. My lawyer gave an opening argument. The judge asked questions. My lawyer asked questions. Then the judge started to move to the “VE,” the vocational expert. These are people whose job it is to find any theoretical job in the national economy for a theoretical job seeker with the limitations of the person applying for disability. My lawyer had explained this before the hearing and said not to get upset or defensive when he or she listed the jobs. “They always find jobs,” he told me. It’s the lawyer’s job to cross examine the VE and challenge the idea that I could do any of the jobs with my limitations.

My mother was with us, waiting outside. She was going to testify if the judge allowed it – not all do. So when the judge started to call on the VE, my lawyer said that she was there and could offer testimony regarding the nature and severity of my condition and the limitations I face. The judge looked back and said “I don’t think that will be necessary.” My heart sank. He continued… “I believe I’ve heard all I need to hear. We’ll just get the VE on the record and then rule in favor.” The world just stopped. Much like I had asked it to a million times. But this time I hadn’t asked. The judge just made it so with three words.

“Rule in favor.”

I kept hearing it. He began questioning the VE. He threw out the set of limitations that I have and asked if there were any jobs for a hypothetical job seeker with such conditions on the light exertion level (social security splits jobs up into exertion levels.) There were none, she told him.

“Rule in favor”

It kept playing in my mind. He removed some of the limitations. There were still none. This went on for a couple of minutes until he finally asked if there was any job at any level that the hypothetical candidate could do. “No, your honor. None.” I knew in my head that those words solidified what the judge had already concluded.

“Rule in favor.”

I had won. But what on earth was going on? I was shocked. That made sense. I was happy. That made sense. I was all kinds of things that made sense. But I was sad, or upset, or….something I couldn’t quite put my finger on that I knew didn’t feel good. And then it hit me. I had just sat in a room answering questions and listening to my lawyer prove beyond a shadow of a doubt that there is not a job anywhere at any level that I can do. It’s funny how living with something, and fighting to get others to recognize it is so completely different from having someone else say it or prove it.

The only analogy I could come up with was this…if you talk badly about someone in your family it’s not a big deal. You love them; you’ll get to each other every now and then. But if someone OUTSIDE of your family says anything bad about that person – WOAH! Step back – now THAT is not cool. Even if all they do is repeat what you have said, it sounds so different when they say it. Feels different when they say it. It’s WORSE when they say it. Well it felt really different to hear that VE and that judge say that I am, in fact, disabled. That I cannot work.

It took me a few days to get things clear in my own head and in my heart. I was happy. And grateful. And the initial sting wore off. I focused on the fact that it won’t always be like this and that now, finally, at least I will be somewhat able to support myself. It’s kind of strange, to be honest. Strange to get up every day and not be waging this war. I’ve been fighting for disability for so long that it still feels a bit like I’m not doing something really important every day.

There is still a lot to figure out. The final decision hasn’t been put on the record. They haven’t sent me the paperwork with my award amount and all the details. It will be a while until my benefits begin. But the judge was very clear. And my lawyer said that the VE not finding ANY jobs – that doesn’t happen. I still have to sort through my decisions about health insurance and what I’ll need on top of medicaid. But the fight is over. And I won.

I put off applying for SSDI for a long time because I refused to believe what was proven in court two weeks ago. I thought it meant I was weak. I thought it meant I had given up. I wanted to believe it was not true. But you can’t hide from the truth. At least not forever, and certainly not without consequence. I hid for a long time. And it cost me all of my money, many nights and even weeks in hospitals, and nearly my life. And it cost my family an enormous amount too. But this decision marks the start of a new reality for me and a new truth. I don’t yet know what it looks like or what it will feel like, but I am, above all things, grateful.

This has not been an easy road, or a comfortable victory. But it is a victory. One that I pray each of you plodding along in the same heavy shoes has the strength to keep moving toward, one step at a time. There are many road blocks and the system is designed to make you give up. But don’t. Keep going. Keep fighting. It is a long road. A hard road. And you are fighting for something you wish with all your heart you did not need. But you do. I do. And though it is somewhat bitter – there is still sweet victory at the end of this journey! So here’s to strength and perseverance, and to someday not needing that for which we have all fought so hard!

Recovering Plan-a-holic

I grew up a planner. I planned everything. Always. I had back up plans. I had backup plans for my backup plans. I did this from the time I was a little kid until I was an adult…sitting amidst the ruins of years worth of failed plans. Then I realized, life simply can’t be planned…at least not in any long-term fashion. (SHOCKER – I know! – well at least now you can’t say I never taught you anything!) One more important matter – it never pays to get attached to our plans.

There is a wonderful Chinese proverb that states that “To enjoy the life we deserve, we must first let go of the one we planned.” I used to read that saying every week while sitting in the waiting room of my therapist’s office. I would recite it over and over until I felt like I could MAYBE start doing it rather than just reading it. That went a little something like this…

“Ok, so I’m not married to my college sweetheart. And we don’t have a cute house in a great neighborhood. Our home isn’t filled with two kids (Jacob and Kiley) and our two dogs – Nala (our German Shepherd) and Tucker (our Golden) – in           addition to Piper and Chloe, of course. Instead, I’m 34, never married, not dating anyone, no kids and no dogs. And never owned a home. Drifting between the homes of friends and family while still waging a war against my own body and fighting desperately for social security disability.”

Eh – no problem – that other life, the one I had planned in absurd detail – it probably wouldn’t have been so great anyway. Ok – so it’s still hard sometimes not to at least wonder about that life. But here’s what’s more important, and more exciting. This life – the actual day-to-day real one that I never planned and often don’t know if I can handle – this one is full of undiscovered potential. Yes, that’s right I said POTENTIAL. And if you think it’s tough to imagine loads of potential while huddled in a painful ball in a dark, silent room…you’re sometimes right. But practice really does make perfect. And I’m getting there. I might not have all the things I imagined I would at this stage of my life. But I have a great deal more strength and resilience and faith than I ever would have if things had just gone according to plan. So I am hopeful and optimistic, and yes, even grateful. Not for losing the man I loved, but for the ways this life has tested me and fortified me. And for all the possibilities that remain.

Speaking of possibilities – this week has brought a firestorm of opportunity (and challenge). I learned that our request for an expedited Social Security Disability Hearing had been approved and that it will take place tomorrow at 2 pm. From the time I learned this until…well, earlier tonight, I have prepared and planned and stressed and planned some more. I have been frustrated with my attorney who, in my estimation has not done nearly enough of any of those things. But I sit here now and I realize – I can’t plan or stress tomorrow into being successful. Yes, preparation is needed. But I went far beyond preparation. I was looking for something that does not exist. I wanted a guarantee. And my hearing tomorrow, as with all things in life – comes with no guarantee. So I will go in as prepared as I can. I will let go of all the planning and the resentment toward my attorney. I must simply accept that he knows how to do his job better than I do.

I will either win the appeal or not. But it will all happen one step at a time. I’ll finish this post. I’ll relax and spend time with my mom and step-dad and cuddle with my cats. I’ll (hopefully) get a good night’s rest. I’ll get up and take tomorrow, similarly, one step at a time. Then, after putting one foot in front of the other through this incredibly important day, my hearing will be over. And both my lawyer and I will have done all we can do until the judge renders a decision. And I am (almost alarmingly so) at peace with that.

I spoke with a friend earlier tonight. He questioned me about what I will do if the judge rules against me. Fighting everything in me that yearns to plan for every contingency….I simply said, “I don’t know. I will cross that bridge when..IF…I come to it.” I smiled, pleased with myself. I must be doing something right. I’ve apparently learned a lesson somewhere along the way. And in this particular moment, it appears that my energy could be put to far better use than planning that which cannot be planned! If you don’t believe me…just as Chloe…

International cat sign for “GET OFF THE COMPUTER AND PAY ATTENTION TO ME!”

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