Congestive Heart Failure And Me

August 27, 2014 at 11:22 am (Congestive Heart Failure, Hospitalizations, Living With Chronic Illness, Medical, The Journey Towards Diagnosis) (, , , , , , , , , , , , , , )

I have been diagnosed with stage 3, right sided congestive heart failure. Let’s break that down so you understand what that means. Keep in mind, I’m not a doctor and this is by no means meant to be a completely scientific lesson on heart disease. I am sharing the information I feel will help my friends and family understand how this diagnosis affects me and what it means. Feel free to ask your doctor for more information.

I’m going to start with the “congestive heart failure” part. Your heart is a wickedly smart little organ. It knows exactly how much blood each of your organs needs to operate at their maximum. When one or more of the organs needs more blood, the heart is able to increase how fast it beats, pushing blood faster where it’s needed.

The first symptom I had was that my heart was beating pretty fast – upwards of 120bpm. Obviously, that can be caused by a lot of less serious reasons, so although it was something my doctor was aware of, it didn’t cause any alarm all by itself.

Meanwhile, my right ventricle, the one in charge of getting the right amount of blood to my lungs, thought something was up. It wasn’t getting as much fluid back as it was sending out, which is cause for concern when you’re a right ventricle. It assume that there has been some trauma or injury to the lungs wherein there is blood loss, so it wants to pump harder to make sure the wound doesn’t drain the blood the lungs still need to function.

But in my case, it was not a wound that was causing the lack of fluid return. My body was soaking it up, in the form of edema. That’s the reason my feet and ankles, and then eventually my abdomen, got really swollen. The reason my heart thoughts my lungs were in trouble is because my lungs were really struggling with keeping my oxygen levels high enough to function. The struggle was primarily caused by my sleep apnea – I was using a CPAP setting from 2005, and a lot has changed since then. I need a BiPAP in order to get the right amount of oxygen at night, and the more oxygen and the less carbon dioxide in my system, the less the demand on the right ventricle.

CPAP? BiPAP? Is this like a Pap smear?
No, thank goodness. Continuous Positive Airway Pressure is one way to make sure someone’s airway is open and functioning while they are asleep. If you’ve ever shared a bed with someone who snored terribly, that snore was likely caused because it was the only way to get the passages open enough to maintain enough oxygen. With a CPAP, it gently blows air into your nose (and mouth if necessary) to help keep the airway open.

With CPAP, there’s one number: the amount of air pressure the person needs to keep their passage open all night. However, if the person needs a very high amount of pressure, it becomes difficult to exhale without feeling like you have to use your exhale to push against it. What makes sense is to have two pressure settings: the higher one when you breathe in, and the lower one for when you breathe out. Thus: BiPAP. Bilevel positive airway pressure. BiPAP comes with a second usage, which is that it can also stand in as an external ventilator should someone have significant trouble breathing night *or* day.

I knew I needed a BiPAP for a few months, but I was dealing with a lot of doctor office monkeyshines and did not get it. But I will have one when I get home, as the hospital has taken care of that.

The Right Side of Heart Failure

Like I’ve said earlier, the right ventricle is specifically tasked with keeping the lungs happy. Because I was having severe O2 deprivation due to the apnea, my poor little right ventricle did all it could do. Now it is damaged from being overclocked for so long. Part of the reason it took so long to figure out what was going on is that the symptoms of heart failure are easily attributed to being fat, even if you aren’t really fat to begin with. CHF makes you feel tired all the time, it robs you of your stamina, you lose your breath even when you aren’t doing anything, and then the swelling comes. The edema is made worse when it gets to the abdomen, because then it is putting extra undue pressure on the diaphragm and lungs, making it even more difficult to breathe.

Although I am still a little angry about it, I have come to accept that even though I was clear with many doctors about these symptoms as soon as I noticed them, many of them dismissed me and told me it was because I was fat and I should reconsider weight loss surgery. (In case you weren’t a reader when I wrote my many rants on WLS, look at the tags on the side of this page for more info). I mean, my weight is a contributing factor (but not the only factor!) to my apnea, so in a way it is also a factor in my heart failure. But lots of people get CHF, and getting it at my age is getting more and more common.

What does this mean? Are you going to have to stop traveling/teaching?

Well, Del is going to have to get used to a daily regimen. Not only am I increasing the amount of prescriptions I need, but there are other changes I need to track carefully. I will have to weigh myself every single day (whee!) and do it in kilograms because metric! If I gain even a little bit of weight, I have to call my doctors ASAP to see if it’s related.

I am also going to have to learn how to live with strict fluid intake rules. I am only allowed to have 2000mg a day of any kind of fluid – that’s 2 liters. I have a plan on how to measure this, so hopefully that will work. I’m just from a world where drinking fluids was a good thing, and there was no such thing as too much water.

The reason I have to restrict my fluid intake is because should my body have extra fluid, it is likely going to shunt it into edema, because the right ventricle will be all like, “Hey feet, I got some extra fluid here, so I’m a hook you up!” and my feet will be like, “No, dude, we’re already super full! I’m sure your fluid is tasty but I can’t even imagine another…oh. Thanks.”

The last part I’ll tackle is the Stage 3. There are 4 stages, with 1 being asymptomatic and 4 being severely damaged and in need of interventions like surgical implants, surgery, or transplant if the patient is young enough to recover. 3 means that I have significant symptoms, but we’re hoping that with a minimum of intervention I should be okay for a while. But I’m going to give it to you straight – this is not a thing you take a pill, you stop eating salt, and everything gets better. This will degenerate and become more bothersome as time moves on. At some point, I plan on writing about how this diagnosis takes some of the vagueness out of “Del is sick”. The monster in the closet (or at least one of them) has a name, a face, a sense of reality.

Please feel free to ask questions in the comments below. Just please don’t break my rule of offering treatment options unless you are a professional. I don’t want to know what your Uncle Tommy did to recover from CHF, nor do I want to read that article you saw on how CHF is a made-up disease to sell cardio meds. But at the same time, I want to make sure everyone has a clear understanding of what’s going on with me and how it affects things moving forward.

*BONUS ROUND*

My blood sugar numbers were also wacky out on control when I got here, and I had a great endocrinologist who helped get me back to a normal-ish level. When talking about follow-up and finding the endo, I took a chance and mentioned that I was hoping to find an endo who would manage my diabetes *and* administer T. Without hesitation, he made me a recommendation to a Hopkins endo who does T for lots of different people. Even got me the number of the pysch I need to see for clearance before we can talk about T. He keeps reminding me that this is a maybe, not a yes, because I am so complicated; but he also said it may come down to an informed consent situation, where we go over the pros and the cons and then I choose what I think is best.

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The Magic Number

August 8, 2014 at 2:26 pm (Death and Dying, Hospitalizations, Medical, Mental Health, The Journey Towards Diagnosis) (, , , , , , , , , , , , , , , , , , , , , , , )

Hey there, dear readers. Before I begin, I want to apologize. When I started this blog, one of the main reasons was so I could share information about my health in a timely manner from a centralized location – so I didn’t have to post to every single social medium and then answer comments from them as well – but this time I didn’t feel ready to blog about coming to Johns Hopkins ER or why I came in. I’m still not ready to write about all of it. But here is a little information, a little navel gazing, and a little update. -Del

A while ago, back in March, I started taking on some serious edemitous weight (what we non-medical types call “water weight”, “edema”, or “swelling”) – one doctor guestimated I had gained 50-70lbs of swelling (and he was pretty close to exactly right). I began seeing a long and complicated list of specialists, each of whom happily pointed to one another as the doctor who could help me tackle this once and for all. I was bounced from cardiologist to infectious disease to primary care to nephrology and around again. I got put on several different combinations of drugs, kept on using the pneumatics when I could, tried to limit my fluid intake, etc, etc, etc.

I will admit, I was feeling pretty defeated. Not only did each doctor think it was definitely a SEP (Someone Else’s Problem), but none of them treated it like a big deal. When I had to buy new shoes 3 sizes larger, I barely got a shrug. To me, my Non-Violet Beauregard impression felt like something pretty hazardous but even when doctors was using scary words like “organ failure” and “amputation” they did it with a resignation usually used about troublesome boys.

After all, the list of symptoms I had –

  • Extreme Fatigue
  • Shortness of Breath
  • Apparent Weight Gain (Swelling)
  • Lack of Appetite/Nausea
  • Sleep Disturbance

– could all (and were) attributed to being obese/sedentary. When I showed my primary doc that I was losing my breath just from standing up and buttoning my pants, we had a ten minute conversation/debate; she was forceful with her opinion that I was decompensating. (Basically, the opposite of ‘getting in shape’.) I kept arguing that even if I was truly decompensating, I was pretty sure it wouldn’t happen that fast and that dramatically.

But all along, everything that popped up she immediately tried to relate to my weight. In fact, when I came back to her after getting the diagnosis “Volume Overload” (Totally my Del Tashlin cover band), she weighed me to confirm that I’ve had a radical weight change – 60ish pounds in 3 months.

But to me, that wasn’t the shock. It was the magic number. I think we all have one. It may not be the same statistic, but there’s a number somewhere in your life that fits the category.

  • “If I ever have to buy my pants at Lane Bryant, just shoot me.” (number implied)
  • The day my scale says 300lbs is the day I lose my shit.”
  • “When I can no longer buy clothes at the mall because I am too big/short/tall/etc, I will have to kill myself.”
  • My cousin’s bra size is a 44G. I’d rob a bank to get a reduction before I would live like that.

There I am, standing on the scale looking at the highest weight I’ve ever been. I’m not seeing the magic number, but I’m very close to it. I take a deep breath and start reminding myself that it is edematous weight, swelling, something that will go away once they figure out what is causing it. Maybe a few tears roll down the side of my face, because it’s a number I wasn’t ready for that day.

As we go back into the exam room, my doc makes a comment about possibly revisiting the weight loss surgery conversation. Anyone who has followed my story from the beginning can probably guess how that conversation went. She’s trying to assure me that just because I had ONE bad experience with ONE doctor should not mean I reject the possibility forever. I am trying to clarify to her that this weight is not “Del ate some extra cheetos and skipped aqua aerobics” weight, but “something is physically wrong with Del that is causing water retention at a ridiculous level”.

I left the appointment feeling pretty sure that my GP wasn’t going to be any further help in this situation. Once again, I’m thinking I might have to go looking for someone new – especially in light of what has happened. In the most obvious application of the metaphor, I came to her with a list of symptoms of a serious medical problem of immediate need of treatment, and what she saw was a fat, lazy person who wasn’t taking care of themselves.

I got so disheartened, I stopped giving a shit. I still took my meds and the like, but I stopped making doctor’s appointments. I lost my fire. Inside I knew that something serious was going on, but it was as if I ran around the village telling everyone the Monsters are Coming and the village reacted with affected apathy. It wasn’t until Rave and I noticed that the swelling was getting markedly worse, and now was happening faster than before, that we decided something had to be done.

Now I am inpatient at Johns Hopkins and I know for certain what all my symptoms were caused by and what the short term plans are to get me going home, at the very least. As I discussed things with Winter last night, he asked me what he and the Clan could do to support me in this time, and I paraphrase for you, dear reader, as well:

I feel like I need some time to wander in the dark, bump into the walls, wack my toe on the moulding. I need permission to let this filter in slowly, rather than jump to branding it on social media for the 140 characters times worth of edification faded into the next cute cat meme. I don’t want to have to educate each and every person I talk to about what it is, how I got it, and how we’re treating it. I just want to sit with this for a while, think about it, run my fingers around the edges and see if there’s a contingency envelope hidden somewhere.

When I’m ready, I will share everything on the blog and you will all know what’s going on. Until then, for now, it’s just mine to feel in all the ways I want to feel it.

(And the good news is, I’ve already lost 15 lbs away from the magic number, so that’s reassuring.)

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Surgery Tomorrow

April 23, 2013 at 11:06 am (Death and Dying, Hospitalizations, Living, Medical, Spiritual, The Panniculectomy) (, , , , , , , , , , , , , , , , , , , , , )

12 days after being admitted through the ER and the decision has finally been made: I am having surgery tomorrow.

In a way I guess it’s a good thing we waited, as I have a very clear understanding that we have tried every other option before jumping to surgery, and in fact the lead team on my case, Plastics, has been dragging their feet for several days after the other teams (Infectious Disease, General Surgery, Acute Pain Management, etc) all decided that surgery was the best option left.

Yesterday was the final straw. As I’ve written before, they have put several drains into my abscess in hopes it would deflate on its own, and for the 11 days I’ve been here we haven’t seen any fluid come out at all. Interventional Radiology, the team that deals with the drains directly, informed my surgeon that the fluid inside of my collection(s)  was too thick to drain this way, but my surgeon was stubborn and wanted to try one last time before he gave up for good. They poked a new, wider hole into the collection and then even went so far as to attach it to suction, and still nothing came out.

The surgery is not exactly the same as the one in December in a couple of ways. The December surgery did entail removing an infected abscess but there was a lot more infected tissue that wasn’t incorporated into a collection, enough to require a panniculectomy. When they finished the surgery, they removed some excess skin and pulled my belly up, making it much smaller (technically, a “tummy tuck”), and I had a very large surgical scar that went from one hip to the other. I also had two small grenade-shaped drains (JP drains) that helped suck out excess fluid produced from the surgery.

This time, they will be removing an infected abscess, but the focus is on trying to keep this from happening over and over again. They’re going to re-open a small portion of the scar from December (about a third, or 9-15cm) over the collection, remove the abscess and all the other bad stuff around there, including physically washing the space out. Then, instead of sewing or suturing up the wound (which will be “the size and shape of a small loaf of bread”) like you’d expect, they’re going to “pack” the hole with a special kind of vacuum-bandage. The idea is that if they just sew the hole closed, the hole will sit there empty, and nature abhors an empty space. By packing the wound, it is forced to heal from the inside out, and the scar tissue created will keep it from reforming a new and/or different abscess in the future. By using the motorized system, any fluid that is created from the wound or left behind by the surgeons during the operation will be sucked out in a more efficient method than the drains we used last time. (I have a bad history of having drains “fall out” before they’re done doing their job, no matter how many precautions are used to keep that from happening, and that could very well be contributing to the problem.)

I will likely be in JH for another week or so in recovery, and then sent home with a home-care-nurse visiting three times a week. They’re telling me I should be able to work (including teach classes and stuff), so I haven’t cancelled any of my upcoming gigs. I will have at least one, maybe two, small motors I will have to port around with me, but I’m inventive and will figure out some fashionable way to do it and not look bad.

I haven’t had much more time to ruminate on the spiritual meaning of all of this beyond what I’ve already posted. I’m trying very hard to see this situation as not being all about me, but at the same time not allowing others to use me/my medical situation against me in some way. It’s been difficult, especially lately, but I just keep holding my head high and be the man I want to be and let everything fall as it will.

I asked Alex if he could think of some witty vacuum joke or reference I could turn into the title of this entry, but joking about it would inaccurately convey my emotional state. I’m not depressed or amused; I’m pissed. I’m angry that it took 12 days for the doctors to do what they told me was going to happen 12 days ago. I’m angry that last time I was given all this lead time to prepare, and this time we have practically none. I had a very clear image as to what it all meant, why it was happening both physically and spiritually, and what I was supposed to get out of it. I understood it.

This time I have no idea. I have some guesses as to what it means, but they’re really just shots in the dark – and I’m also willing to accept that maybe it just doesn’t have a bigger meaning to it at all. I understood that the abscesses were something that happened because Dr WLS fucked up my ventral hernia repair that April, but this one doesn’t seem to be directly related to that, either. Last time I was able to garner support not just because of the health crisis, but because it coincided with my husband ending our marriage. Instead, this time, it all just feels like it’s landed on my lap and I have no idea why, or what I’m supposed to learn, or why this would have any meaning at all, other than to make me miserable and in pain and reinforce my fears that I can’t live a normal life ever again.

It reinforces a lot of the fears I was able to squelch last time, stuff about my divorce and my living situation and trying to figure out who really cares about me and who doesn’t. It makes me look really hard at the prediction I received three years ago, that said in year three the game would change dramatically. As my STBX basically disallowed me to talk about the prediction at all, I learned how to put it out of my mind, but these days it is feeling more and more relevant and yet harder to accept as being real. It’s dredging up a lot of inner stuff I was able to bury and/or hide for a long time and making it impossible to ignore. It’s forcing me to really and truly think about the word family, what it means, what the qualifications are, and what to do when someone who used to be an important member of your family makes it clear that they don’t feel the same way anymore. I am thinking about what honesty is, and where honesty is important, and yet where honesty can be hurtful and/or cruel at the same time. I’m thinking about a lot of things.

But at least now you all know that the surgery is for real, it’s happening tomorrow at some point, and you’ll all know one or another that I got out of it safely (or not). I will be spending some time this afternoon updating my will and advanced directives to make sure they reflect my most current realities.

Please feel free to pray for me, to ask your Gods (and mine as well) to look out for me, to guide me through this process, and to bless the doctors with clear heads and deft hands. Please do not send energy or Reiki of any kind; although I do have an anti-Reiki amulet to wear, it just makes things easier if you don’t send it for starters.

Love you all, and see you on the other side.

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The Three Sided Coin

April 16, 2013 at 7:21 am (Hospitalizations, Living, Living With Chronic Illness, Medical, Mental Health, The Journey Towards Diagnosis, The Panniculectomy, Tuberculosis (Inactive)) (, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , )

If you just want the short version, you can skim/scroll down to the “Here is the TL:DR Bookmark”, and start there. You’re welcome.

As you all know, I had a panniculectomy in late December, from which I healed much faster than expected. The surgeon had predicted a much more dire situation, but in the end other than a little breathing issues on the table everything seemed to be going fine. By February, the surgeon was ready to start scheduling my follow-up appointments six weeks apart; we had agreed before the surgery that we would be following up for at least a year if not longer, because there was a really high chance of post-op complications. Six weeks was the maximum time between follow up appointments, so that’s how well I was doing only two months after the knife.

In the middle of March, I noticed that there was some very slight swelling around the right-of-center part of my abdomen, around part of the surgical scar. The doctor has warned me that there might be odd swelling up to a year afterward, so at first I dismissed it. Also, I had just spend two and a half months “healing from surgery”, so I wasn’t keen to go running back to the doctor right away; I wanted to spend that time and energy getting back into the swing of things post-separation, booking some gigs and finishing the book. Every week I’d say to myself or Rave, “I should call Dr Sacks about this swelling in my belly; it looks a little worse.” And then I’d get distracted doing other stuff and wouldn’t. I kept assuring myself I had the six-week checkup already planned and if nothing else, I’d be seeing him then.

Six weeks finally passed, and I went to see him for the appointment. As soon as he walked in the room, my guilt jumped out at him and said, “Don’t be mad at me; there’s been some swelling. I kept thinking I should call you, but I was busy with other stuff and was afraid I’d have to go on hiatus again to deal with it.” He laughed; he reminded me that this is my body, not his, and if I want to ignore something I had the right to do so. He’d eat those words a few weeks later.

This is an interesting thought, and something worth going on a bit of a tangent on, if you’ll indulge me. (Again, if you want to skip ahead to the part where I get to the point, feel free.) Between having friends who deeply care and sometimes feel invested in my well-being, and being a blogger who shares their medical journey with the general Internet public, it can sometimes be overlooked that we’re talking about my body, and that everyone has made decisions that did not put their body or their health at the top of the priority list. Whether it’s extreme sports or eating a triple bacon cheeseburger with hamburger patties for buns, we accept that sometimes the experience is worth the risk. But when one is both public and chronically ill, people tend to want to bundle us in soft cotton and keep us from any extra suffering. It’s actually something I’ve read quite a bit about when reading disability advocacy and activism papers; that part of fighting for body autonomy is fighting for the right to do unhealthy or risky things with one’s body regardless of one’s state of health/ability when they make that decision.

In writing this blog for over a year, I frequently get emails, comments, or find myself in conversations, in which people basically inform me that they know more about how to treat my body than I do. That’s not what they say, but it’s what they mean. When someone sees me eating something delicious, but not the most healthy (or these days, merely something I’ve previously stated is a food or drink I am avoiding) they feel they not only have automatic permission to point this out to me, but in some cases, they physically take the food away or publicly shame me for making that choice.

During this hospital stay, people have been bringing me slushies from Sonic, which is a total Del comfort food. They’re basically fruit, simple syrup, and frozen water (and I get the ones that Sonic claims are made from “real fruit”, rather than just a flavored syrup), but it doesn’t take a food scientist to know that they’re full of simple sugars. My blood sugar numbers have been pretty shitty lately, and most of that is due to stress/pain. However, I’ve noticed a behavior among the nurses here that I really wish the rest of the world would take a cue from: they don’t care. When I get “caught” – when a nurse comes in to take my blood sugar only to see a half-empty Sonic slushy on my table next to my laptop – the nurse doesn’t actually say or do anything at all. It’s me, responding to years of programmed fat-and-sugar-shaming, that immediately jumps and says, “You caught me. I was having a slushy.” And it is Pavlovian, this response, because my experience from the last few days has shown me that the nurses don’t give a damn. It’s the people visiting me who make the judgement statements or even just a joke about how terrible it is that I’m drinking this thing.

It’s as if disabled/chronically ill bodies no longer belong to the person using them. We are community property, open to scrutiny and judgement by anybody, but most often by people who think they know better. However, I will assert that when a person feels entitled to judge another based solely on what they see/hear/know in the moment, or solely on what that person shares on the Internet, frequently their judgements say more about them than they do about us. Someone may attempt to shame me for my choices, as some sort of dodge or deflection about their unhealthy choices.

There’s more I want to say about this, but this tangent is getting really long and you’re more interested in what’s going to happen next in my hospital story, so remind me to come back to this sometime.

He didn’t think the swelling was anything particularly surprising or negative, but he sent me to get a CT scan right away to see if it was a new fluid collection or abscess. It turned out I had a much smaller (9mm) fluid collection, but that it was not infected. I got another drain installed via Interventional Radiology (IR), but there was (oddly) very little fluid coming out. What did come out was serrous fluid, or basically white blood cells. I only had the drain in for a week and a bit, as it mysteriously fell out of it’s own accord on that Sunday when I was at Charm City Fetish Fair.

The day before that happened, Saturday April 6th, was a very bad day. Even though I knew I needed to be up very early (for Dels) in order to go to Charm City and register, I could not for the life of me get any sleep the night before, mostly because I felt pain and nausea. It was bad, really bad. Probably the worst chronic illness day I’ve had in the last two years. We got to the hotel and I went right to sleep, woke up, did my class/panel, went right back to sleep, woke up for my volunteer shift, and then sleep. I couldn’t really eat or even drink fluids because I was so sick to my stomach. I emailed my surgeon and his PA to tell them how bad I was feeling and asking for their advice. Dr Sacks felt it was no big deal and to be expected, whereas his assistant thought going to the ER there and then was the better choice. As I was not feeling inclined to go to the hospital, and Dr. Sacks was assuring me it didn’t have anything to do with my abdomen, I decided to stay at the event.

As part of my earlier tangent, I wanted to add another point here. Again, feel free to skip this part.

Another way in which people outside of my immediate circle judge me and my choices is when they criticize me for leaving the house. I have lost count of how many times someone has suggested that if I only stayed home more often, or rested more, or did less work, or some other way confined my life to my bedroom, I would miraculously feel better and/or have taken better care of my body. They also feel entitled to make those comments because I openly write about financial struggles and have received donations from people in the past to help cover medical costs; and yet, I also write about going to parties or events or in some other way spending money on a social life that, in their opinion, would be better spent on medical costs.

I can’t stress enough how backwards this is. If I never go out and never do fun things, then my entire life becomes restricted to “being sick”. The only people I know – and I do know them – who want their lives to completely revolve around being ill/having medical emergencies, are mentally unstable. They thrive off of the attention people who suffer are given, and they are immediately jealous if someone else gets one iota of attention because that other person is also suffering. It’s as if there is nothing redeeming about them, nothing worth paying attention to or engaging with them over, except their illness.

I, and I like to think saner people, fight that perception with every bone in our body. I begged Baphomet to allow me a second blog specifically because my online presence had become completely focused on me being sick, and it’s not the only, or even most important part of my identity. But in order to do that, writing about my adventures is not enough; I actually have to go have them. Now, this doesn’t mean that I spend the grocery money (or the prescription money) on sex toys and roller coasters, but it does mean that – gasp – I choose to cut back on one thing in order to have fun, and also that – gasp – I frequently go out and do fun things when I “should” be home resting. Anyone who tries to shame me for leaving my house twice this month, putting off seeing the doc by a week or two, doesn’t understand or support the concept of people living full, complete, joyous lives. And that’s just sad, because it means that their life is so boring, so empty, that their idea of fun is to criticize and ridicule some random person on the Internet for doing something fun.

Sunday morning came, and our plan was to get dressed, eat some breakfast, take a look at the vendor mart, and go home. A friend of mine was in charge of vendors and was telling me that no one was buying stuff and the vendors were feeling kinda desperate. As I was getting dressed, I turned at one point and realized my drain was on the bed, and it was too far away from me to still be attached. Sure enough, upon closer inspection, I could clearly see the end of the tube that goes inside of the abscess lying on the bed like it was just another piece of my outfit. I emailed Dr Sacks and his PA again, and this time they both stressed that I should only go to the ER if I felt I had to, because there was really nothing the ER could do to assist me. I bandaged up the wound and left the hotel for home, spending most of the next two days asleep.

I was looking something up online about Isoniazid, my TB drug, when I remembered about liver-toxicity, which is a well known and documented side effect that hits those who get ill a lot. I brought up a page on the med and lo and behold, there’s a list of all of my current symptoms under the heading, “Seek out medical attention immediately if you experience…”

I had been waffling about calling a new PCP or going to see the old one. My PCP is no spring chicken, but at least I’ve been with him for long enough that I feel like he knows what’s going on and how to look at the bigger picture. However, I couldn’t get in to see him specifically, but another doctor in his practice. My ride shows up to take me to the appointment, and even she suggests we skip it and go directly to the ER instead. At this point, however, I’ve created this narrative in my head that says “If you go to the ER, it will be an emergency. If you go to the doctor, it will be no big deal.” I even reaffirm my decision when we reach the point in the journey where we could still peel off and go straight to the ER.

Well, we know how that played out. The PCP listened to what I had to say, and immediately knew she was out of her depth and I should go to, not just the ER in general, but the ER at Johns Hopkins, since I’ve been working with them and my files are all integrated. So my patient driver and I hop back in the car and reverse our trip to JHER.

It is quickly realized that I do not have a liver problem, but whatever is ailing me is fucking serious. I get admitted fairly quickly, even though it takes hours upon hours to get a bed. I start to feel much more ill as they park me in a tiny waiting room (which they now swear is a “staging area”) for two hours with no supervision, no one checking in to see how I’m doing, and a gaggle of very angry sick people who have also be relegated to this purgatory. Finally, Rave and I make enough of a stink combined that they move me back into the ER proper but we have to continue waiting for a “real bed”.

We learn that the new fluid collection has grown larger. It now has a “skin”, a membrane that holds it all together, which makes it really difficult to kill with antibiotics alone. They take cultures and try to determine exactly what is in there and what way is best to treat it. I end up losing the fight over getting a PICC line or central line when they start running Vancomyacin through my veins, and I blow three or four veins that first night alone.

The next few days are kinda blurry for me. See, at the same time, I started suffering from very short bouts of amnesia. I would forget where I was, or what I was doing at Johns Hopkins (I kept thinking I was back in High School). I got a neuro consult and although they’re testing just to make sure I didn’t have a mini stroke or temporal lobe seizures or anything like that, they think it might be a side effect of long term use of narcotic pain meds. I don’t know if I agree, but I do admire them for at least making an effort to make sure it’s not something more serious. They chided me a bit for not chasing the neuro stuff more aggressively (like going to get all the test my neuro ordered or going to see him more often) and I explained that I have been putting out fires since August and am doing my best.

Anyway, now you know enough of the backstory to get to the point.


Here is the TL:DR Bookmark

The Infectious Disease Doctors, The Plastic Surgeons, and The General Surgeons all agree.
The reason I am getting these infected abscesses in my abdomen is because of the mesh that was used during my ventral hernia repair back in 2009. Yes, that was Dr. WLS’s doing.
They used mesh to hold up and strengthen my abdominal wall, and in the process the mesh grew a “biofilm”, basically, a wonderful fertilized area for bacterial infections to grow and flourish.

Option One: “The Big Deal”

I will continue to have these infections while I still have the mesh inside of me. Removing the mesh, however, would be a big deal surgery wise. The mesh is covered in adhesions, and may very well be attached to my intestines, and it was put there for a reason. So this surgery, which I’ve nicknamed The Big Deal, would be a team of surgeons going in, finding said mesh (it doesn’t image well on CT or Xray), carefully removing all the adhesions, removing it from my bowels (which could get complicated very quickly, and include such favorites as “Bowl Resection”).

The surgeons are giving me all the exact same doom and gloom songs that they did about the surgery in December; that I will definitely be in the hospital for close to a month if not longer, that there is a really good chance I won’t make it through the surgery (especially now that I had a hiccup in the Dec one), and it will be a very long and difficult recovery with lots of creative agony and embarrassment. But this time, none of the surgeons want to do this surgery. They all feel this is something we should wait, and plan, and know the area super well beforehand, for the reasons we all know and have discussed.

The only way The Big Deal would happen during this hospitalization is if I spiked an abnormally high fever (like 104), or in some other way showed signs of advanced infection.

Option Two: “History Repeating”

My second option, which is still very much on the table for this hospitalization, is to address this specific abscess. That would entail having much the same surgery that I did in December; it would be much more superficial than The Big Deal, in that it would not entail cutting into the muscle wall or anything like that. It is still as dangerous as it was last time, but we also know that I did very well with the surgery itself and healed fairly well.

Option Three: “No Cuts, Just Infinite Pills”

This is the option most of the doctors (but not all) are currently advocating for, depending on how the next few days go while I’m here. This course would be to put me on really strong “nuclear bomb” home antibiotics, either via a PICC line or oral meds, for six to twelve weeks. After that, I would be given a permanent prescription for whatever antibiotic they feel will fend off more infections in the abdomen. I would still have the mesh, and that would still be fertile soil for growing infections, but the antibiotic would hopefully keep the infections from becoming anything to write home about.

Before you get all excited that there’s a non-surgical option, there are some big drawbacks to both being on a nuclear bomb level antibiotic for six to twelve weeks, and there are some bigger drawbacks to being on a permanent antibiotic prescription. Now, I’m saying “permanent”, but that makes the assumption that we never decide to try to correct the problem surgically.

Now, this makes it sound like I have a decision to make, right? Not really. I need to be informed about each of the options, and have a general understanding of how I feel about them and how seriously I want to pursue them. But how things like this usually play out is that the doctors will look at all the test results and data and make the best decision based on their knowledge and experience, and then recommend that choice heavily to me. It doesn’t mean I couldn’t chose to advocate the fuck out of a different choice if I really wanted it (like in Dec, when Dr Sacks kept suggesting reasons why we’d postpone the surgery another six weeks), but I’m the type of guy who trusts but verifies.

If we lived in a world where I could make a free and conscious choice, I would probably choose History Repeating for the right now, and then spend the summer preparing for The Big Deal. I’ve already reached out to Dr. Awesome and asked her if she might be willing to look at my current records and give me a consult over what she thinks is the best choice; but I did this with the covert agenda of asking her to be my surgeon for the Big Deal. Dr. Sacks would handle History Repeating, but I know from past discussions that he would feel uncomfortable doing The Big Deal all by himself. He and Dr. Awesome have worked together in the OR before, so it’s possible to get them to team up for The Big Deal.

Right now, they’re still trying to get a very accurate understanding of what types of infection I have growing in my abdomen, and also digging up information about the mesh that was installed – when, what type, where, etc. If I had to take a wild guess as to how much longer I am going to be here, I’d say at the minimum three more days, at reasonable maximum (barring surgery) I’d say a week or a week plus a day or two. If History Repeats, I would bump that up to two to three weeks.

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Don’t Panic

April 14, 2013 at 2:06 am (Death and Dying, Hospitalizations, Medical, Mental Health, Spiritual, The Panniculectomy) (, , , , , , , , , )

The theme of this hospital stay seems to be “Don’t Panic”, like the large friendly words they put on the cover of the Hitchhiker’s Guide to the Galaxy. Except in my case, I keep being told not to panic over things that I feel pretty strongly are totally panic-worthy.

I come into the ER thinking I had liver toxicity, and it turns out that I have another serious infected pocket of tissue, and yet I am supposed to somehow be relieved by this news.

Then I find out that this new pocket, although smaller than the one that was removed surgically in December, has a “skin membrane” and also has “air pockets”, both signs that it will likely have to be surgically removed rather than treated via antibiotics. Yet the fact that it’s smaller is somehow supposed to make me feel less worried.

The fact that this time, they put a drain in and practically nothing is coming out, whereas the last few times it was so productive they had to use two or three bags at the moment of insertion to contain all the output, is supposed to be reassuring. Even when the nurses keep saying, “This probably means it’s not in the right spot.”

I almost never manifest a fever or other stereotypical signs of infection until it’s at “going to kill you if you don’t get to an ER” level of infection. Yet, the fact that I don’t have these stereotypical signs is supposed to make me feel good. In addition, since nausea is not a typical sign of infection (and yet every time I get an infection my nausea gets markedly worse), I shouldn’t be worried about my inability to eat (yay weight loss, says the nurse) or that the nausea is so strong I scared my nurse into giving me a EKG because of my symptoms.

Even though I’ve already blown three veins, when I start to feel the signs that the antibiotic they won’t be sure I need until Monday is burning through my IV line, I should sit tight and suffer until the line actually blows, because it’s really important. If I ask the doctor to wait to give me the antibiotic that burns my veins out until they can use a PICC line to infuse it, I am going against medical advice. (Yes, for asking.) I am being irrational about blowing out my veins, because using a caustic med before we know if it will actually treat me is rational.

When my pain quality and location changes drastically in the span of two hours, getting bad enough to wake me up after less than a hour’s consecutive sleep in four days, I’m supposed to be reassured that since none of my vitals changed, that everything is totally okay. I don’t know about you, but knowing something got much worse and there’s no apparent reason, scares me way worse.

I don’t know. I used to love Johns Hopkins, but now it’s just turning into another shitty hospital with nurses who don’t give a shit and doctors who hate you because you’re on pain meds. It’s another ER where I get shunted from room to room for 36 hours. I’m expecting Dr WLS to walk through the door any moment now.

And this hospitalization came at a really fucking terrible moment in my personal life. Yes, including the time I was hospitalized two weeks after my husband dumped me. I really needed, psychologically among other reasons, to have a few weeks where my health was not center fucking stage. I needed to spoons to have some big conversations, and instead the things I could have fixed three days ago are starting to fall apart. I’m losing my ability to be rational and objective, and just want people to stop being stupid jackasses, rather than have to spend an hour finding a nice way of saying, “Cut out your stupid selfish behavior you twat”. I need to get the work I’m doing, done. I need to be have the ability to answer emails. I was ready for this shit in December, but not now.

Things really, really suck. A lot. I am very depressed, and very disheartened. You may see me or talk to me and I’m all smiles and jokes, but inside I feel like I did all this fighting for a life that sucks, that I tried to save something that will just continually disappoint me. In a fucked up way, I feel the same way about my life as I did about my marriage in those two weeks before my STBX dumped me; like staying and fighting is the only decision I’m allowedto make, because of what I believe, but my intuition says RUN RUN RUN.

I don’t get it. I could probably handle this if it was something different, new, interesting. Hearing that I may have the same problem over and over again over the next few years is not comforting in the least.

Oh, and PS? They’re talking about more surgery. Possibly in the next few months.

Don’t panic, my ass.

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Three Doc Monty, Shame, and Speaking Up

November 7, 2012 at 12:18 pm (Living With Chronic Illness, Medical, The Journey Towards Diagnosis, Tuberculosis (Inactive)) (, , , , , , , , , , , , , , , )

Before I begin the whole story of my recent adventures in dermatology and infectious disease, I want to address one of the reasons it has taken me this long to write this entry. I have written about all sorts of medical problems and procedures – from abdominal surgery to uterine ablation – and although sometimes I get a little pang of “Maybe I should just keep this part to myself”, I never feel ashamed by the fact that I am chronically ill and/or need treatment. Maybe I feel like I wish I had a little more privacy, or that I could pick and choose who reads about what’s happening in my uterus, but never really shame.

When I started to write this entry, I found myself avoiding it. I’d find just about every reason in the book to do something else. It probably helped that I’ve found myself with a little bit of email drama that has been emotionally challenging, so every time I wanted to get out of writing this entry, I went back into my email and re-read some of the posts. But why? Why was I slacking from writing about an experience that was, in turns, funny and serious?

So I posted to Twitter about this odd feeling of shame I was having that I couldn’t figure out. It was my friend Stephanie who said that we are taught as children/teenagers that you can avoid all dermatological problems if you just keep yourself “clean”, and therefore someone who has a skin problem is “dirty”. And that hit the nail on the head for me; for some reason, I felt like I held blame for developing a skin condition, whereas I don’t feel I am responsible for needing a hernia surgery.

With that being said, and me being clear that I haven’t stopped being ashamed about it, but am blasting through it instead, here’s the wacky story of dermatological adventures.

You might remember back a few months ago when I wrote about seeing a great dermatologist named Dr. Lee. It’s worth noting that even in that entry, I mention that his office is in Damascus. I really liked him a lot, and so when I had an odd wound on my back that wasn’t healing right (and had been dismissed by another doctor, but more on that later), I decided I would go see him again to figure out what was going on.

Rave makes the majority of my doctor’s appointments. It’s one of those things I really hate about being chronically ill, the constant scheduling and paperwork and other inconveniences that come with seeing yet another doctor, so when I’m left to my own devices I walk around the house for months saying, “I really need to call and make an appointment.” To keep me from walking around my house to death, Rave helps me out by making appointments for me that magically just show up on my google calendar. It’s nice to have someone in my life who is actually willing to help with the parts of being chronically ill I hate the most.

So I told Rave to call Dr. Lee and see if we couldn’t get an emergency appointment.

Keep in mind, that I have seen (no exaggeration) more than 20 medical practitioners in the last five months or so, and that they’ve been located all over the area, from Washington DC to Baltimore, from Rockville to Frederick. So at times, it can be hard for anyone to keep track of which doctor has which specialty and where their offices are located. Add upon that, that several of my doctors have more than one office in the the area and so I’ve been seen in two locations for the same doctor, and it gets even more complicated.

Rave recalled that I was seen at a place that had Dermatology in the name, like “The Dermatology Center” or “The Center for Dermatology”. She also knew that when I saw him, it was pretty close to my house in Germantown. So she searched for “Dr. Lee, dermatology, Germantown” and got a hit for The Dermatology Center. However, that Dr. Lee is Dr. Joseph Lee, who doesn’t practice in the Germantown office. The Dr. Lee I had seen and loved back in June was Dr. David Lee, who practices at Dermatology and Surgery Skin Center in Damascus, which is about a fifteen minute drive from Germantown.

She called the Germantown office and told them about the situation and asked for an emergency appointment. They gave her one, in Bethesda, at 9am. As I am now living in Hagerstown, Google Maps mocks me with it’s estimated “1 hour and 10 minutes”; at rush hour going in the direction of rush, I’d have to leave here at somewhere around 6 or 7am to make sure I got there on time. Not to mention that the friend who was taking me was driving up from Sterling, VA, so she’d have to leave at something like 4. I thanked Rave but told her to cancel the appointment, as 9am in Bethesda is not doable.

She calls the next day and they tell her I can be seen that day at 3pm. Rave calls my friend Rebecca (who was a trooper!), who jumps in the car and heads in my direction. The first hiccup is that lately, between having a cold and being on 50-80% bed rest means that I usually sleep pretty late. What happened on my end is that I woke up, looked at the huge number of missed calls and text messages, and pieced together that I had about ten minutes to get my ass in gear and be downstairs waiting for Rebecca. This is somewhat difficult for Dels, but somehow I pulled it off.

We start to exit Hagerstown, which has a preponderance of very narrow streets. As we were trying to navigate our way out of town, someone opens their door into our lane and clips the side mirror. Luckily, no one was hurt and the other car didn’t have any noticeable damage, and the other driver was much more concerned with our well being than trying to pick a fight.

I honestly don’t remember when I realized we were going to Germantown and that Dr. Lee’s office was…somewhere else. I couldn’t, for the life of me, remember what town it was in. My best guess was Olney, as I remembered it being in a town I don’t visit often. Maybe it was Frederick? I think in my head I assumed that maybe Dr. Lee had another office in Germantown I didn’t know about, so I didn’t think too hard about it.

When we arrived at the office, they had no record of me at all. No patient records, no appointment. I take several deep breaths, and tell them repeatedly that I had seen Dr. Lee in…Frederick? Olney? The receptionist tells me he doesn’t have offices there. I’m trying to rack my brain to figure out where it was, and at the same time plead with the receptionist that we had gone to great trouble to be here, so could I please be seen? They finally agree to let me see the doctor, and I had to quickly fill out all the new patient information stuff I hate so much.

So now, a little background on why I needed to see a dermatologist at all. About a month or maybe a little longer ago, a strange wound showed up on my back. At first, it just looked like a red, raised stripe. It didn’t bother me at all, so I basically wrote it off to a scratch or pressure wound or something else that would heal on it’s own. It got bigger, and deeper, and more infected looking, until I found myself in a great amount of pain when I tried to sleep on my side or back, and I am a dedicated side sleeper.

I had an appointment coming up with an infectious disease nurse, to take out my PICC line. While I was there, I mentioned I had this wound on my back that was becoming much more bothersome, and she took a look. As it happens, ID and Derm share space at this clinic, so she brought two dermatologists over to take a look. Almost immediately, they agree it looks like HSV or shingles. They take a sample to test and send me on my way.

I go back for a follow up, and this time they have me being seen by a doctor (I needed clearance from ID to proceed with my plans for surgery). She was the queen bitch of all bitchy doctors I have ever been to, bar none. I mean, Dr. WLS was an asshole, but at least most of the time he was trying to appear nice. She didn’t want to be there, she didn’t want to see me, she wanted to spend the least amount of time possible around me, and she made that all readily apparent.

She informs me that the tests were negative. I tell her it’s gotten deeper, more painful, and more productive. She takes a glance – and I really mean a glance – and says, “Well, it looks like it’s healing now, so nothing to be done.”

I go home and I know she’s full of shit, but I decide to wait a week or two and see if she’s right. Absolutely not. At this point it has become so painful I cannot lay down unless I have a lidoderm patch on it, and now there is a big ulcer at the top of the stripe and the stripe is widening and more red/productive.

So this is where the Dr. Lee/Dr. Lee circus joins the story. In fact, I see Dr. Yu, and he is very concerned that this could be MRSA. He takes a culture and prescribes both an anti-fungal and an antibiotic cream that I have to put on twice a day. (Luckily, I can reach where it is so I can do this without help.) Rave and I notice that within two or three days on the creams, it is looking much better. It’s still red and productive, but less so.

Finally, after no less than six rounds of phone tag, I finally got to talk to the nurse at Dr. Yu’s office (in Germantown, for those playing the home game) and she informs me that it’s Streptococcus, and that he’s adding an oral antibiotic for ten days, and to call him if it doesn’t get better.

My research with Dr. Wikipedia has me confused, though. Although strep can produce several different kinds of skin lesions (including Necrotizing Fasciitis, which is otherwise known as “flesh eating bacteria”, but my thing doesn’t look like that at all) I can’t seem to find one that looks or acts like what I have. The closest I’ve come is possibly Ecthyma, although I don’t think my lesion is quite that deep. Although Impetigo is also caused by strep, and the grouchy old man in me would love to whine about his impetigo, it looks and acts nothing like that either.

So I’ve decided to stop playing Dr. Wikipedia and just take my meds like a good patient and see what happens. However, now that I knew that I had an infection when I saw that ID doc at Johns Hopkins, I wrote the following letter to the head of her department.

I apologize if this is the incorrect email address to use for this purpose, but I would humbly ask for your help in getting this message to the right recipient.

My legal name is [not yet Del Tashlin]. My DOB is [numbers].

I was seen by Geeta Sood in the ID clinic at Bayview on October 4, 2012 at 2pm. This was a follow up appointment after being seen by Karen Daniels.

It was clear from the moment she walked in the room that Dr. Sood had not read my chart and did not know why I was there. She was rude, curt, and completely unhelpful. She finally acquiesced and left the room for over 20 minutes to read my chart, and when she returned she was incredibly short with me and dismissive.

She actually said, upon her ending the appointment, “I hope I never see you again.” while shaking my hand and the hand of the person I brought with me.

She made medical mistakes that have created further issues for me. I had a wound tested for hsv and varicella. Those tests were negative, and although I reported the wound had grown, and was incredibly painful, she took one short look at it and declared, “Well, it looks like it’s healing, so nothing to be done there.” I have since been diagnosed with a strep infection, which if it had been caught earlier would have meant less aggressive and easier treatment. But since it was clear that Dr. Sood wanted to spend the bare minimum amount of time with me, it was completely overlooked.

Also, she prescribed a course of Ioniazid for my inactive TB, with absolutely no plans to follow me to monitor for liver issues. She was rude when I asked what symptoms should worry me/send me to the ER, and was completely dismissive of my concern that since I manifest many of those symptoms already I wouldn’t know the difference between my everyday experience and hepatits or other liver infections. She just retorted, “You’d know.” As she had never seen me before, she dismissed me trying to explain that I suffer from chronic nausea, vomiting, and lack of appetite (which, if she had read my chart and seen that I had lost 40 lbs in less than three months, she would have known), and also have dark urine and muscle/joint pain on a regular basis. It was only when I filled the prescription and read the materials did I realize that I need to contact a doctor for monthly liver panels. This was not even mentioned to me by Dr. Sood at all.

Overall, I had an incredibly negative experience with her, and now that I know that I have had an infection for over a month that she could have treated if she had just shown any interest in my welfare at all, I feel strongly that I need to report her negligence to someone in a position to see that she reads this, and at least it be added to her HR file.

If I don’t hear back from someone at Johns Hopkins in one month’s time, I will have no other option than to file a complaint with the Maryland Board of Physicians. This is not my intent, but I feel very strongly that her conduct was more than unprofessional and rude, but negligent. I would rather see her be dealt with inside of the structure of Johns Hopkins (which I have had stellar experiences with, save the ID department) than have to go to such measures.

Thank for your time reading this, and helping me to find the correct place for this to go. Please feel free to respond to me via this email address.

Thanks again,
[Del, who has stopped taking shit from shitty doctors]

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Cutting Away the Heart of the Matter

September 20, 2012 at 5:25 pm (Hospitalizations, Mental Health) (, , , , , , , , , , , )

I’ve been spending the last few days weighing back and forth on how much, if anything, I was going to talk about the upcoming surgery I face. It’s high risk, and a big deal, and it’s messing with my head in a number of ways. I’ve had several divinations done about it, and the situations surrounding it, and one point of view came out during a session that I hadn’t thought about.

The fact of the matter is that they are cutting away a good portion of my panniculus, sometimes called a pannus, or an “apron”, or in more direct terms, the hanging part of my belly. The doctors estimate that I will lose 50lbs of tissue during the surgery. And for some reason, when I heard about this, I had a very nuanced reaction, but one of the major emotions was shame.

I can’t say with a straight face that I do a lot of work in the fat acceptance community, but I do support it both by being an outspoken voice for it, and sometimes financially. I have come a long way, personally, from hating the fact that my genetics dictate the size and shape of my body, to accepting and even loving the unusual nature of the habitus I’ve been given. I even teach classes aimed at people who need ideas on how to better explore and use their bigger bodies to express themselves sexually. I do not, and have never seen, my size as a disability. It is a thing to be celebrated and appreciated, not abused, jeered at, and hated.

I, like many others, went through periods where I decided that I needed to change this – and I’ve approached it from all matter of healthy and unhealthy ways. I was labeled anorexic when I was in psychiactric care, which may be hard to believe when you think of the public images of that disease, but one need not be 70 lbs to starve oneself, to deny oneself bodily necessities as some sort of punishment. In fact, many survivors of eating disorders are not thin at all, but who started down that path due to the public and private shame that comes from being overweight. Most who know me also know that five years ago, Dr. WLS put me on a protein-shake-only diet in which I lost a significant amount of weight – near 140 lbs – in seven months. This is now been identified as one of the causes of my neurological condition.

I have come to accept that this is my body, and I am not what people think. I do not eat piles of fried food, potato chips, and ice cream. In fact, I frequently get told I do not eat enough. I do have certain culinary weaknesses, and I won’t profess that every single thing that passes my lips would meet muster with whomever the diet cult leader is at the moment. I have done the atkins thing, and the south beach thing, and the paleo thing, and the cabbage thing, and the slim fast thing, and the vegetarian thing, and the macrobiotic thing, and the low fat thing, and even that really popular “points” thing. (I will admit I’ve never done the “ship processed foods to my house and that’s all I eat” thing, but mostly because that thing is wacky expensive.)

And here I sit, somewhere around 400lbs.

The reason that I have to have my belly excised is complicated. Part of the reason is because my intestines are in there, and they don’t get proper abdominal wall support, which has been the cause of all of my hernia issues. Another concern is that there is now a buildup of infected and necrotic tissue, possible due to the several surgeries having this pannus has caused. I am currently draining a very large absess that grew to large proportions unnoticed in my belly because of its size. And finally, it does hinder my mobility to a certain degree. So it has to go.

It amuses me that, technically, the surgery I’m facing is a “tummy tuck”. Of course, it’s a much bigger undertaking that some afternoon vanity procedure for a supermodel who ate one too many pieces of pizza. My “tummy” is quite large, and has organs in it, and cannot be supported by something like a binder or a girdle. (Those items just end up compressing my pannus against me, or falling off due to lack of support. Believe you me, it’s been tried over and over again by several doctors.)

So why am I ashamed of this? Why does this seem to be the kind of procedure to have in secret, when no one knows? Why do I have a hard time articulating what is just another medical procedure, when I’ve been so candid up until this point with every little other thing?

I hold my belly in my hands for a moment. I don’t want to be a part of the pressing media shame machine that tells fat people that being fat is a medical disaster waiting to happen. I don’t want to be counted among their statistics of overweight-related surgical and medical procedures. Even the lead surgeon who is performing my panniculectomy said, “It happens to people who weight 145, and who weigh 400lbs. It’s not about how much weight, but how it’s distributed.” I just happened to be descended from the “Eggs on Sticks” tribe, where all of our weight is in our trunk and abdomen. Luck of the draw, I guess.

I also can’t, for the life of me, imagine what my body will look like when the procedure is over. I had a similar surgery a few years ago, but it still left me with a significant apron; this time, they’re going to take as much as they can without putting my body into shock. The reason the surgery is high risk is because I’ll be under for up to 12 hours or longer, between removing the tissue, making sure the infected stuff doesn’t cross contaminate and is completely removed, making sure my intenstines are secure and supported by a strong muscular wall, and that the absesses won’t reoccur. Most of the images I’ve found of people who have had similar procedures end up looking like they have a beer belly. I guess that will help with making me look slightly more masculine?

But yes, I don’t want my personal medical procedure to be proof positive that being fat will lead to these sorts of things. It’s important to remember that other factors contributed to this as well – I won’t talk about whether or not Dr. WLS’s past work on my belly lead to this, because I’m still investigating legal recourse, but from that statement alone you should figure out my stance on the matter. I keep repeating to myself, “It’s about the belly, not the fat”, but it isn’t getting through.

So there’s one of the several trains of thought that I’ve been processing. Maybe you, too, have had to face the dubious line between fat acceptance and medical intervention? How do you reconcile what you were born with, with what the medical industry says is “healthy”? And how do you approach a surgery you’re ashamed to admit you need?

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Sometimes It Feels Like a Three Ring Circus

August 27, 2012 at 1:22 pm (Medical, The Journey Towards Diagnosis, Tuberculosis (Inactive)) (, , , , , , )

I will admit, I’ve been shying away from posting some of the medical stuff I’ve been going through online; it’s kind of a silly reason so I’m not going to explain it. But today was full of such medical fuckery that it would be a disservice to humankind not to share at least parts of it.

In my last medical update, I was scurried off for emergency testing because they saw some sort of cystic lesions around my surgical site. This test was supposed to be an abdominal CT. I went to Johns Hopkins the next day and got that taken care of.

Then I waited. And waited. There were symptoms I was told to look out for, and when they occurred I called my GP. And waited. Finally, I called the office and asked for the practice manager; she promptly informed me that they had not yet received the results of my “STAT” CT, but that she was going to call JH and get them right away. She called back about an hour later and told me they had seen a small nodule, but nothing to be alarmed about, and I should re-test in 3-6 months.

You’d think this would be good news, but I informed her that my symptoms were increasing, and getting pretty uncomfortable, and what was I supposed to do now? She informed me that she is not a doctor, so the best bet would be to come back in and see my GP again. We made an appointment for the following Monday (today).

Please remember in this story, that I’m not living in my former home in Germantown. I’m about an hour and a half away, and most of the journey is on commuter highways. So we had to leave at the crack of dawn (literally) to make our morning appointment. I had a very bad emotional night, so I had only gotten about two hours of sleep. We pulled into the parking lot with only moments to spare and was seen pretty much right away.

I then find out that my appointment is not with the GP I’ve been seeing for years (who at least pretends to have a grip on my whole medical situation) but a new doctor to the practice. I ask if it would be possible to see my GP instead, since I saw him in the office while I was waiting. I was told that no, he was not available and my choices were to see New Doctor now, or make another appointment to see GP. Since we had traveled a while and gotten up early, I went with New Doctor, which is always the bad choice.

She comes in, and she’s this diminutive Indian-looking woman (I don’t know her actual heritage). I have to admit to a little bias here: I try to stay away from doctors with heavy accents, as I have a hard time understanding doctors without them, and it only makes communication more difficult. As she introduces herself, I realize that she has a accent, but I do my best and ask a lot of questions.

I give her the short story of what’s been going on with the emergency surgery in April, and more recently, and she pulls up my file on the computer. However, she can’t seem to locate my CT. Finally, she gets the practice manager to come in, who remembers my story, and finds it immediately. The doctor comments, “But this is a chest CT, not an abdominal one.” My heart sinks, somewhat appropriately from my chest into my abdomen.

Turns out, the GP’s office wrote a script for the wrong CT. (Even though I knew the answer, I specifically asked her, “So was the screw-up that the wrong script was written, or that the techs did the wrong test?” and after hemming and hawing, admits that the screw-up was on them.)

I will admit, I almost lost my shit. I mean, I’ve been having a pretty difficult emotional time, what with the separation and my friend dying and my car not turning over last night, so I came in a little loaded to bear. But this sure felt like a camel-breaking straw. I did my best to swallow my seething frustration and decided to ask about the “nodule” they found.

She says it’s pretty small (6mm), which is probably nothing to worry about, but that I’ll need another chest CT in 3 months. I inform her that I’m seropositive for TB, and that changes her tune. She gives me a referral for a pulmonologist (in that area, rather than near where I’m currently living, which is basically useless to me) and urges me to follow up with him to make sure it’s not TB. Hurray!

Then we get back to the matter at hand. She does a quick exam of my belly, and immediately feels the difference between the rigid parts and the softer parts. She also sees that pushing on certain areas cause me pain. She looks at my surgical scar, and then she tells me to get dressed again.

She informs me that it’s probably a “seratoma” (Dr. Google couldn’t find much by that, but I think she meant seroma, but it we need the CT to be certain. (The funny part is that Dr. Google says that seromas are almost always due to surgical error, but I don’t even have the mental spoons to go there.) It could also be an abscess, which is pretty dangerous, especially in someone like me who gets infections easily. The normal course of action is to go see the surgeon who performed the procedure, and I make it very clear to her that I am basically unwilling to do that unless it’s my last and only option.

She explains that I could ask for a second opinion, and if that second doctor found something noteworthy, they would be the one to correct it, not the original surgeon. I ask her if it’s at all possible to skip the part where I go to Dr. WLS at all, and she comes up with an idea. She calls Dr. WLS office and leaves a voicemail asking if he’d be willing to make a second opinion referral right away. Unfortunately, because nobody answered, I have to wait a few days to find out the end of that tale.

I end the appointment by asking her my stock questions in these sorts of situations: is there anything I can do for the symptoms? Nope. You’re already on heavy painkillers. (Uh huh. Like they will do anything.) All right, I say, so what symptoms do I look for that say “Go to the ER?” She lists a few, but they’re all symptoms I experience pretty much daily. The only one that stood out was “7 out of 10 pain”, to which I replied, “Well, then, I should have gone to the ER last Wednesday, because I was in a fair amount of pain for hours then.” She lists the rest, and again, nothing that would alert me any more than usual.

So here I sit. Now I have to go back into emergency mode, because if these things are seromas, they could be mildly dangerous; if they are abscesses or, y’know, just about anything else, it can be pretty fucking serious. And unless something earthshattering happens, I’m likely to overlook symptoms that might mean GO NOW, because I can’t discern them from everyday stuff. My best bet is to get the tests done right away, and try to keep my head about me, which is a little hard seeing as all the stress I’m under. I also already had two other appointments this week that I can’t reschedule, both in DC, which is an even further commute than my GP. (Did you see the part about my car not working?)

Really and honestly, I’m at wits end. I just don’t have the brain or body spoons to deal with this in any kind of rational manner. All I can do to keep functioning is only deal with what is right in front of me in the exact moment it exists in my field of view, and try very hard not to look at my life in any sort of detail. Life would be, oh, six hundred times less stressful if I could somehow be back in Germantown, so all these doctor visits would be half an hour rather than two, but that doesn’t seem to be a negotiable point right now.

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Pushing the Limits

May 9, 2012 at 10:35 am (Chronic Pain, Disability, Living, Living With Chronic Illness, Mental Health) (, , , , , , , , , , , )

I am, at heart, a pusher of limits. If you tell me I (or you) can’t do something, I am literally obsessed with finding a way to make it possible. This may sound like a mostly positive thing, but as one may expect there are times when pushing a limit means falling off the cliff hidden behind it.

I did an image search for “pusher of limits” and this was one of the first images in the results. I’m not sure my Pusher of Limits looks like Grover, but I just couldn’t resist.

Things have been a little challenging for me lately, as evidenced by the fact that I haven’t updated the blog since April 18th. I’m very sorry about that; I am trying very hard to make at least one post a week, but as the warmer weather defrosts my schedule, my responsibilities as a traveling educator start to eat up what little post-surgical spoons I may have had lying around. Not only was I teaching classes at the event, I facilitated a very intense ordeal. So intense, in fact, that several of those close to me pulled me aside beforehand and very seriously asked me if I was physically up for the demands of what I knew (and didn’t know) would be expected of my corpus habitus.

Pusher-of-Limits said, “I can do this. I will make it work.” Saner-Voice took steps to try to reduce the impact on my body.

Now that the event is over, and the season of events has begun in earnest, I’m seriously taking stock of where my health and my desires intersect. Pusher-of-Limits keeps telling me that nothing has to change, that I can continue to travel and go to camping events forever. Saner-Voice and Corpus Habitus disagree.

I turned to Ninja the first night I was at Ramblewood (a campground that hosts several alt sex/spirituality events during the summer) and said, “I shouldn’t be here. I can’t hack this. I need to rethink some stuff.”

I won’t lie. Even with having a personal golf cart, and two service people plus my spouse and friends who don’t mind lending a hand, it was fucking hard. I was frequently in pain, even if I didn’t show it. My incision, which is still healing (but doing nicely) hurt like a mo’fo most of the time. I didn’t get to do or see as much as I would have liked, spending heaps of time in bed with my Nook banking spoons for my obligations. I did get to have a little fun, but it was short and sweet and sporadic.

Wanna know a secret? I am scared to death that I can’t do this anymore. I was scared every moment that I was there that something would go wrong, that I’d be rushed to the emergency room in a strange place and have to find a way to explain why I was at a campground three weeks after surgery. I am terrified that the level of ability I have now is dwindling, and each event I attend I have a moment of “This may be the last time I can do this event.”

Doing these events for me is “being with the people”. I spend so, so much time in isolation, sometimes only seeing my spouse and my slave for weeks at a time. Other than doctor’s appointments, I rarely go out just for fun, and three times out of four I have to cancel because I feel like crap. The artifice of “obligation” that comes with being a presenter for events helps motivate me when really, if it were just another social outlet, I’d likely cancel. Even while at the event, there are times that twenty minutes before class time, I’m in my bed desperately summoning spoons so I can just get through the next ninety.

So it was with great trepidation that I saw Dr. WLS yesterday. I knew my drain had been very active while I was away, and my scar was aching at a pretty intense level. I honestly don’t know if he’s just so focused on ending our relationship that he wasn’t concerned, or if I’m really doing better than I think, but he “advanced” my drain (moved the tubing out about three inches) which is a step towards having it removed. He looked at my scar and said it was healing very well and didn’t look infected at all.

Today, the limit pushing is a different one. Now that I’ve realized Dying for A Diagnosis, and have a general feel for the difference between blogging and journalling, I’m seriously thinking about starting a second project, where I can talk about spirit work/shamanism and ordeal/kink, which only sometimes is appropriate for what this blog is for. I need to figure out if I have enough writing spoons to take on this new blog without neglecting this one. Baphomet is skeptical; if it were up to Hir, this would be my focus and I’d write in here every day, pumping out as much content on chronic illness and spirituality as I possibly can before I die.

I am aware, as I ponder this, that DfaD is more than a blog. It’s a devotional act, a very important vehicle of communication for those who feel vested in my health, and a meaningful tome for those who suffer from chronic illness and need to hear our stories told in honesty and truth. I need to evaluate my reasons for wanting this other blog, and what commitments I can make to it while still striving to post here at least once a week as health provides. There are a plethora of blogs about shamanism and ordeal/kink, but not as many about the spiritual experience of dying.

Can I push my limits a little further? Or is it time for Saner Voice to rule?

I made a promise, and sealed it with death. I will live up to my promise first and foremost, and will not shake the responsibility You have put on my shoulders and in my heart. Hail Baphomet! Rex Mundi!

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Breathing in, Breathing Out: Tonglen

April 18, 2012 at 1:32 pm (Chronic Pain, Disability, Living, Living With Chronic Illness, Mental Health, Tuberculosis (Inactive)) (, , , , , , , , , , , , , )

There are two topics that have been vying for blog post-dom, and then I realized that maybe they can coexist in a single post. One is how I use the meditative practice of tonglen to help deal with my health issues, and the other is how I struggle with well-meaning people who think I don’t know how to google. I know, it doesn’t sound like they can be the same post, and it may take some literary magic on my part, but let’s give it a try.

First, I should explain what tonglen is. Most Pagans, when utilizing meditation as a way to deal with stressful things, visualize that the in-breath is the inhalation of that which is good/useful/healing for the situation, and the out breath is the exhalation of that which is unwanted/bad/hurtful for the situation. Breathe in relaxation, breathe out stress. Sound familiar?

Tonglen, a Buddhist practice, looks at this practice and sees that it’s kinda backwards. Sure, it works in the visual sense, but not in the physical sense. When someone is inhaling, their muscles are tensing as their body adjusts to the action of the intake. Breathing in, in this fashion, is an action. In comparison, when someone is exhaling, their muscles are relaxing as their body returns to a base state. Breathing out is a reaction to breathing in. Do it now – take a deep breath in, and then let it out. After which one do you feel more relaxed, more at peace, in general, better?

So when practicing tonglen, on the in breath you think about all the people, places, and things that have experienced the same frustration, pain, or stress that you are dealing with. I breathe in, and I think about all the people who are at home right now trying to recover from surgery but real life keeps getting in the way. I hold the breath for a moment, to give myself the freedom to really feel the frustration and pain not only of my own situation, but multiplied by all the other people on the planet who feel the same way. Then, on the out breath, I send love and patience and healing to everyone I am sharing this experience with, including myself. After all, I am a subsect of “all the people struggling with recovering from surgery”.

I find this helps me in a lot of ways. It reminds me that there is no human experience that is not shared. No matter how much I feel isolated because of my complicated medical situation, I know that it’s statistically impossible that I am the only person on the whole planet who is as medically complicated as I am, and I bet there are many who are worse off. So before I even begin the actual practice, just the thinking that leads to it is useful. I am not alone, and people have survived this situation before.

Then I breathe in, and I really allow that sensation of frustration to tense my muscles, to contort my body in whatever way will give me the most focus on how yucky it feels, and how terrible it must feel to all the other people who are suffering in the same way I am. I give myself permission to feel bad about it, to feel a little sorry for myself, to fully engage in my emotions.

And then I let go.

My body relaxes. I cultivate love and patience for other people (which is usually much easier than doing so for one’s self), and then slowly apply that same love and patience inward. The more I breathe, the more relaxation I feel. The less tension I feel on the in breath. The more I feel like I am connected with a band of strong, inspiring people who struggle in the same way I do.

I practiced a lot of tonglen in the hospital. In – I think about all the people who are waiting in this ER, who have been here as long or longer than I have . Out – I send them patience and ease as they get the best possible outcome for their emergency. In – Many people are frustrated at their nurse, who is slow to respond and has her own agenda. Out – I send love to both those who lie in wait for care, and to the nurses who are having a bad day due to inpatient patients.

It is invaluable to me when I get totally overwhelmed by all the medical shit that’s been going on for me. I was just telling a friend that if you had told me six months ago that I was in the calm before the storm, I would have laughed at you. You mean having inactive TB and dealing with a new neurologist is the “calm” time? Right. Now things have grown so exponentially more difficult and complex, I can barely make it through the day without crying.

When I get frustrated, I frequently post to Facebook, or to my blog. As I’ve discussed before, my friends and readers want desperately to feel of use, to do or say something that might help the situation. The current favorite is to tell me to report Dr. WLS to “the medical boards”. They post links that take a few minutes of googling to find. I breathe in, because I, too, have google and have looked at those same pages, usually before you post them. I breathe out, because I know that they did that because they love me and want me to be happy and well. But what I can’t seem to communicate effectively is that my medical situation is a big tangled web, and the only person who really knows how it all works is me. I’m willing to share it with someone who really wants in, but being in means a lot more than reading my blog and trading a few emails. It means going with me to the doctor’s appointments to hear what they’re saying. It means personally understanding what it’s like to have doctor’s appointments three days a week when you don’t drive, and most of them would cost more than $50 by taxi. It means understanding that I, too, have Google, and do actually spend time researching things like where to effectively complain about Dr. WLS.

You'd think this is an exaggeration, but replace Blondie here with a fuzzy haired Del and it's about accurate, books and all.

I breathe in for all those who hate Dr. WLS for what he’s done to me, and I breathe out patience. Yes, technically I could probably seek out another surgeon to take over my aftercare. But they aren’t the surgeon who performed the surgery, and therefore they’d be relying on whatever Dr. WLS tells them (and not me, because I am not a surgeon). This is what I was told when I cold-called another general surgeon about possibly being seen as a ‘second opinion’. Starting from scratch with a brand new doctor in any situation is difficult, and I know this because I’ve seen five different neurologists, two different infectious disease doctors, two different primary care physicians, etc. So in the end, I choose to get frustrated and abused by Dr. WLS then go through the rigamarole of seeking out a different surgeon. If this means you’d like me to stop complaining about him, because it’s my choice to see him, then I will.

I try to illustrate my current medical situation this way: Imagine a Del. Now imagine over the Del’s head are a series of balloons. Each one represents one of the medical situations I’m currently facing. One balloon says, “Emergency ab surgery/recovery/scar in a place on the body under a lot of stress/too much edema”. Another balloon says, “Unexplained chronic pain”. Another says, “Needs a D&C and ablation or could get cancer.” Another one is labeled “Has inactive TB, which could go active at any moment, and really the only organ we know how to help if it gets attacked is the lungs. Also, you have a history of infection, so it’s likely to go active.”

Kinda like this.

For any one person, this balloon (pick one) would be their entire existence. They would be focusing all of their free time on researching what to do, contacting doctors, going to doctor’s appointments, taking whatever treatments are prescribed, and changing their lifestyle to accommodate this balloon. I don’t have that luxury. I have too many balloons, so many that they’re threatening to carry me away to a place called Death. I’m doing as much as I can to keep up, without forgetting that I’m also a human being that needs to eat and sleep and spend time with friends and watch Glee and feel normal from time to time.

Maybe you’d handle it differently. Maybe you’d go all gangbusters and spend every waking minute doing whatever it takes. I can’t, because I feel like crap and I’m tired all the time and I’m in a lot of pain and there’s only so many kinds of effort I can give before I can’t anymore. In the end, it’s my body and my life and I have to do with it what I think is right, and many times I choose the “feel like a normal human being” over the “holy crap balloons”. On average, I have at least one doctor’s appointment a week (these days, it’s closer to two or three). I make at least six phone calls, emails, or other forms of contact dealing with my medical situation a day. I spend an hour or two with Google, looking related tI hings up (everything from who to send the complaint letter to about Dr. WLS that will actually matter, to how other people dealing with chronic pain cope with the added discomfort of surgical pain, to how long I can put off that D&C until I’m really risking cancer).

But for now, I will breathe in all of your frustrations, all of your desires to be of use, and to be helpful, and the feeling I know intimately of seeing someone you care about suffer and know there is nothing you can do. I breathe out love, and patience, and compassion, and understanding. I do love all of you, even when you drive me a little bonkers.

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