Wednesday, May 29, 2013

My Guest Post for The Pulmonary Hypertension Association's Blog


I am honored that The Pulmonary Hypertention Association has posted what I wrote about this monday's upcoming Twitter Event: To get #scleroderma to trend world-wide.  There are many overlapping and associated conditions.


I know that you already knew this about me. This also describes you!

Sunday, May 26, 2013

Memorial Day 2013


What started as a Facebook status for Memorial Day, turned into something that I felt need more that just Facebook "status".
Remember that "Supporting The Troops" means that we remember they are the very strongest of the "We The People". That "WE" never be thought of as a "necessary casualty" without profound consideration of the consequences of putting "We" in harm's way.
Remember that those who serve, take an oath to make the ultimate sacrifice and that by connection, those who risk losing them, silently take that oath as well. Willing or not.
Gravestones with flags planted on them for memorial day.
Remember the chaos when they return home. We must do better than empty promises and talking points.
Remember to never send any of "We", into harm's way without everything they foreseeable need.
Here are some things we can agree to pledge, if we believe this nation is "Under God", or not:
Pledge that before we put those in harms way, that we have resources before they go, that would never force them to fight when they return.
Pledge to never again put those who serve in harm's way, with talking points and patriotic phrases. If any reason to send others can fit on a bumper sticker, we need to get back to work.
Pledge to never forget things that were said, like, "Gas will be practically free, if we invade." ANY country. We cannot forget that. We must remember, so it is never repeated.
This Memorial Day, remember our "Troops" are not just talking points, buzz words and bumper stickers. Let's honor the fallen, by thinking before we act.  Always.

Memorial Day, 2013


What started as a Facebook status for Memorial Day, turned into something that I felt need more that just Facebook "status".
Remember that "Supporting The Troops" means that we remember they are the very strongest of the "We The People". That "WE" never be thought of as a "necessary casualty" without profound consideration of the consequences of putting "We" in harm's way.
Remember that those who serve, take an oath to make the ultimate sacrifice and that by connection, those who risk losing them, silently take that oath as well. Willing or not.
Gravestones with flags planted on them for memorial day.
Remember the chaos when they return home. We must do better than empty promises and talking points.
Remember to never send any of "We", into harm's way without everything they foreseeable need.
Here are some things we can agree to pledge, if we believe this nation is "Under God", or not:
Pledge that before we put those in harms way, that we have resources before they go, that would never force them to fight when they return.
Pledge to never again put those who serve in harm's way, with talking points and patriotic phrases. If any reason to send others can fit on a bumper sticker, we need to get back to work.
Pledge to never forget things that were said, like, "Gas will be practically free, if we invade." ANY country. We cannot forget that. We must remember, so it is never repeated.
This Memorial Day, remember our "Troops" are not just talking points, buzz words and bumper stickers. Let's honor the fallen, by thinking before we act.  Always.

Friday, May 17, 2013

What's The Point?


Will it really make a difference if we get scleroderma to trend June 3?

Let's start with more questions.  Because isn't the journey what it's all about?  No?
Well how about this:  It's what Yoda would do.

Don't worry, Young Jedi.  As always, there is an option to skip to the end.  What is most important, is that you get the point.  I'll never know you didn't read it all.  I just want to relay a message and I hope that you share it.   (Scroll down to where the "Detour" sign was supposed to be.)  
I ask myself this type of question often:  Will it really make a difference if I write about scleroderma or any disease?
I don't have thousands of followers.  If you look at my Twitter numbers, I follow more people, than those who follow me.  I follow patients, doctors, caregivers, foundations and celebrities, and I don't care about my numbers.  I follow because I hope that someone may see something useful, and pass it on to someone else.  Does that make a difference?
If I judged what I do based on my numbers, I would have given up long ago.  Let's face it.  I am not market driven.  And no matter how much I scramble to cover things like education or  travel expenses- or not, depending on what's in the bank- I can't see the rationale behind starting a non-profit.  Why?  So I can create yet another community that probably charges for access to information?  No, there are plenty of online communities that provide free access, information, and doing a wonderful job.  Plus, I like the idea of being able to have access to these communities.  It makes more sense to be a part of what's going on instead of isolating ideas and people.  Plus, if I see a problem with a community, I can support those I know to be legitimate.  People are creating empires based on the suffering of others.  We can all work together, without membership fees, because most patients can't afford them, and there are lots of donors who can.  We just have to get the word out to let them know we are here.

Who are "we"?

Well, we don't have a catchy title like "cancer" after our unrecognizable names.  Yeah, I said it.  We need a cure for cancer.  We need access to care for all patients with cancer.  We have the capabilities, yet people STILL have to walk, raise money and rally around families to be able to afford treatment of cancer.  Does anyone else see the problem with this?  The problem is not only cancer.  The problem is that patients STILL have to fight and raise money to PAY for cancer treatment.  That's the problem.  Cancer has brought the level of care higher for all long term chronic illnesses.  Yes, the problem is there is no cure.  And an even bigger problem is later detection because of financial reasons.  Raise your hand if you know someone who had/has cancer and it was detected at a later stage because of lack of insurance.    We all know someone, don't we?  And with all the walks and bracelets that read "BOOBIES", people are still dying of breast cancer.

Everyone has heard of cancer.

That doesn't mean we should have to fight each other to get research funds, but we do.  We fight with ads, bracelets, publicity, made for TV movies and fundraisers.  Let's face it, it's working.  We have come a long way with cancer research.  And research for cancer has led the way for long term care, hospice care and cosmetic surgery.  Mastectomies and reconstruction is now covered by insurance.  So, if you have insurance, you have a chance.  A fighting chance.

Don't abandon cancer.  Just add awareness of other conditions.

Scleroderma has been referred to as a "niche disease".  Not as many people get scleroderma as cancer.  On the surface, that's true, but there are many different types of cancer.  Scleroderma is an autoimmune disease.  And there are many types of autoimmune diseases.  How many?  Well, that depends on who you ask.  I know of one so-called activist who told me, she has fibromyalgia, but chooses to focus on her lupus because she felt that fibromyalgia wasn't a "real" disease.  But you know what?  What if that's just what I thought she said.  What if I just mentioned that to angry up your blood to move you to activism?  Or what if I had a non-profit and I said that to move you to donate?

Is it a mind game, or is it real?

When I first had the symptoms of scleroderma, I was told I was an "Hysterical female".  And yes, that was real.  Like many patients with a chronic illness with no visible symptoms, I too asked myself: Is this real?
You know what I also wonder?  What if I didn't have veteran's benefits?  If the disease didn't kill me first, I probably would have died in childbirth.    Every day I find a Facebook status about some fighting for their healthcare.  That's right, fighting for care for their own illness.
Not to mention by the time most are diagnosed with a chronic illness, they have lost their income, and are fighting for benefits they paid into because assholes like Rush Limbaugh insist on calling things like Social Security and Medicare, "entitlement programs".  Yes, people like me who have worked since age 15, or raised a family and want to live on the government teet, near poverty.   Look, every system has it's abusers.  There is always a way to cheat the system - any system.  So, let's make it so people won't die because they have to choose between medicine and food.  People do it every day.  I am not one of them and I am one of the lucky ones.  That's because I am a veteran.  If I had been diagnosed with scleroderma before I entered the Navy, I would have been tossed out before boot camp  relying  on Social Security and living with family.  But, you know what, I would have been dead by now.

But Karen, you don't know you would be dead without veteran's benefits.

But I do.  I have the luxury of walking into any Veteran's Hospital ER and getting treated for what I have, because I was given 100% service connected disability rating in 1996.  Not now, while there is a 2 year backlog.  In fact, if I have a grave emergency, I don't have to go all the way to the nearest veteran's hospital.  I can go into any emergency room and get the care I need and bill the VA.  Sure, it's a mess of paperwork, but if I am in grave danger, it's covered.
My initial onset of symptoms was numbness and tingling in my hands.  I was smoker in my early 20's, so I would have written it off and cut down, or quit and then just write it off as normal.  Who knows how long I would have waited to receive care.  You know,I have gone on long enough.  My onset of symptoms is for a whole other post.

Okay, if you skipped to the end:
Why make scleroderma trend?  Let's do something that costs NOTHING.  No membership fees, no advertising costs or Facebook ads.  Let's do what the Kardashians do, and go viral.  Let's make our voices heard by yelling something most people have never even heard of.  Let's make our voices heard without scary pictures, frightening phrases or braclets that cost $1.00 plus shipping and handling.  Let's break all the rules Monday, June 3rd.  If you are at work, you will probably be in front of a computer anyway, or looking to kill some time on your phone.  Let's do this with corny phrases, pictures of walks or those we love who were lost.  Use dirty jokes.  Someone out there has the creativity to use scleroderma in The Aristocrats, I just know it!  Yes, yes I did just link to a Bob Saget Video.  I hate it when guys say there are going to call you, then don't.  It's okay.  I ruin The Aristocrats or piss my pants trying to tell it. (A whole other post)
Scleroderma is not fun.  Awareness is not fun either.  Sure, events around awareness are fun like walks or gatherings, but when I am made acutely aware of scleroderma by a new complication, that is not fun.  Or when I am reminded by my curled hands getting injured, or when someone asks, "What happened to your hand?" I look around the room,  before I realize I have a large bandage on my hand, because I am so "aware", I forget there is something wrong.
I'll add more updates before the big day we make scleroderma trend.  Right now, I need you to help me get the message out so we can do this.  Please share information about June 3rd.  Let's set the trend, all of Us.
For more:
Watch the Bob Saget Video. Watch it to the end.  The eye socket chat is worth it.  Not for the kids!
Want to make a tax deductible donation? Find a non-profit that does patient education and research, or doesn't charge a membership fee to access information.

Wednesday, May 15, 2013

Calling In Sick to Doctor's Appointment


Yes, you read that correctly.  This morning, I have an appointment for a consultation for kineseology, than a driving adaptation test in LA.  That's about 120 miles away.
I have had a sore throat for about two days now, then this morning I woke up with a cough.   Time to go into fight mode, and rest.
Plugging through a cold may result in making it harder for my body to fight it.  Because of my comprised esophagus due to Barrat's, esophageal reflux scarring and open epiglottis, I am even more susceptible to an infection in my lungs.  I cannot let this get worse.  So, if anyone needs me, I will be the couch.  I'll probably occasionally do something online because resting can be boring.  Right now, I'm going back to sleep.
I would love to write more, but I'm resting, so if you could, please read about how we lost the great Bernie Mac to pneumonia.  Bernie Mac had Sarcoidosis.
Also, learn about patients living with sarcoidosis by checking out Caring Hands Sarcoidosis Network of Michigan and Life with Sarcoidosis on twitter and  The Bernie Mac Foundation.
Have a great day everyone, I'll be resting!

Friday, May 3, 2013

Chasing Dragons

Edited October 23, 2013


Keeping up with each organ system effected by the progression of scleroderma is like chasing dragons. Sure, no one has ever seen an actual dragon, but something that "just" appears to be part of the progression,  could be the start of a catastrophic condition that can be managed if caught in time.  These dragons keep the villages of my body on high alert.

I have pulmonary fibrosis.  
Pulmonary fibrosis can exist alone, or as part of an associated condition of a disease like scleroderma, which is the case for me.   Parts of my lungs have scarred and become fibrotic.  I function well, but without medication like Viagra to help my lungs work effectively, my heart could suffer damage and eventually fail.  Another factor that has yet to be determined is whether or not I have pulmonary hypertension.  Sure, Viagra may be helping the my lungs, but is it also helping to maintain a stable pressure in my pulmonary artery.  I still may have undiagnosed pulmonary hypertension and it must be ruled out.  

If this is news to you:
I know there may be friends and family recoiling in horror while reading this, (If this a surprise, I truly am sorry, but it's your own fault for not paying attention.   If you are that far behind you really should follow my turtle page on Facebook.  Keeping up with this is exhausting.  I've had this diagnosis for a long time.  We all know where this is going in about 50 years.  I just might need a lung transplant on the way.  Again, if this is a surprise, we really need to connect on FB. )
I'm the protagonist in a dark comedy.  (Probably a result of my own inflated opinion of myself, but that's a whole other post.) Of all the medical names for things I have had bounced off of me by doctors and people who think they are doctors because they read Web MD, my internal voice sounds like Amy Poehler in a round of "Really?" with Seth Meyers.  The most exhausting thing about all of this, is having to fight for tests to get ahead of the mayhem of scleroderma and its associated conditions.  The test I need to completely rule out pulmonary fibrosis is called a right heart caterization, called the Gold Standard of PH Diagnosis by the Pulmonary Hypertension Association.  

Exercise helps me.  
I move like Jagger, I just dont look as cool.  Mick Jagger's is 69 and he can move around on stage like he does, because he has stayed in shape all these years.   Do you really think he does his signature "chicken dance" because he thinks it looks cool?  I don't, but he makes it look cool.  Placing his hands on the back of his hops with his elbows behind him opens his chest to make room for his lungs to expand with even more air.  (Look, I don't know if he starting doing this move on a dare, but technically, that's what it does, so I;m going to go with it.  Mr. Jagger, your comments are certainly welcome.) When I'm 69, I plan to move that way. Without all that head moving and hands-on-the-hips thing.  I'm cool, but not Mick Jagger-cool.  I said I can move like Jagger, I don't have the moves like Jagger. 
Long story short, if I stay in shape, I have a better chance of a favorable outcome as the diseases progress.

Wench, Bring Me More Viagra Mead! 
I take Viagra four times a day to keep blood flow to my fingers and toes, as well as to normalize the pressure in my lungs.  I know this, because if I skip a dose of Viagra, I get tired faster, and my lungs feel like they aren't opening as much as they could.  I stay as active as possible.  I take long walks, go hiking and do martial arts.  If I don't get some cardio, I feel it the next day.    Maybe it's all in my head, but it's working.   I believe I am somehow staying ahead of the progression, somehow breaking up the fibrosis with my magic exercise.  Abra-freakin-cadabra.  During my exercise I have no distress, except the occasional fall in Krav Maga (Israeli Martial Arts) which all students experience.

The Viagra makes it so I can do these things without causing damage.  Which is fine.  I'm okay with that, but like all treatments, they are no cure.  Eventually, I'm going to need more Viagra or a whole new drug.  But while I'm on Viagra, we should get to know my heart.  Because when lungs have difficulty that gets progressively worse, the heart can be damaged.

Let's Get a Baseline.
Sounds so simple, doesn't it?  We know enough about scleroderma and related conditions like pulmonary fibrosis, an echocardiogram  (1)"...estimate  PASP (Pulmonary Artery Systolic Pressure) in patients with advanced lung disease such as interstitial lung disease and chronic obstructive lung disease can be difficult to obtain"
Okay, so since we have pulmonary fibrosis with scleroderma and tricuspid regurgitation (That is asymptomatic for me.) there is more than one study that calls for a right heart catherization.  (It's just a test, don't freak out.)
So, as I mentioned earlier, getting a baseline seems simple.  We want one so that we know if a condition is progressing.  Let's see what my normal is so that when "shit gets real", we can quantify changes and treat effectively.

Apparently, there are doctors, who believe that a baseline is not necessary.  I would call them idiots, but the truth is, they don't know enough about pulmonary hypertension and variables that can provide a false negative with echo cardiograms.

Educating doctors could be called a challenge.  I call it a day that ends in "Y".
Challenges for tests are nothing new to me.  When this happens, someone is lacking information.  When this happens, it becomes my responsibility to get the practitioner the information.  I made a case to rheumatology, they concur,  some department head will have a come to Jesus moment and maybe there's a hug at the end.  (okay, the hug part never happens.)

When I'm told "no", I find a way to get to yes.  And though I have never even read that book, I know how to get to yes.    I switch to sales mode: What can I do do to get you in to this car, today?

What's with the dragons?
Today was just one of those days. This was the third follow up appointment about a right heart cath, because the Chief of Rheumatology had been out of the country. We needed some seniority to get this heart cath done.  I felt like I was chasing something during my appointment, then I thought:  hey, why not make it a dragon?  Then once we were all in agreement that my test would take place, I felt like I was ready to ride.  Because that's really all this is.  You get the diagnostic tools, the results will dictate the next move.  The test is coming.  I've caught the dragon.  Why not saddle up and go for a ride?  It will be bumpy and scary, but it's just a dragon.   Maybe I should have used an airplane metaphor, because on planes they serve drinks, and on a metaphoric plane, I can drink.  Dragons sounded really good on my drive home from the VA Hospital today.  I'm too tired to redo this.

If You Skipped to the End:
When a doctor tells me a test I need can't be done because the chief of another department where the test is done  doesn't want to play, that chief just needs more information.  I could get mad and pitch a fit, but I have found anger a waste of time.

If you find yourself fighting for tests, please don't give up, keep fighting.  I know it sucks.  It won't get easier, but eventually, you will get used to it.  Of course it sucks.  But life is what you make it and complaining without action will get you nowhere. You wil find ourself walking information to doctors.   There are a lot of crazy diseases no one has heard of, so it;s our job as our own best advocate to get info where needed.   Don't hate the playa, hate the game.  Then, get to work.  


Get More Information
Right Heart Catherizaton, Johns Hopkins Medicine.