Best GP Appointment!

I had a really great appointment with my GP last week. I have only been seeing her for a short while so we are still getting to know each other, and it was great to feel that my hunch that she is really great seems to be ringing true.

She spent a long time with me, and she does not rush me when I am trying to explain things which really helps me to concentrate and not forget important things, as well as it being less exhausting. She really listens and her response to things I suggest is usually positive, such as “yes, that is certainly something we can try” or “I will speak to a colleague/look that up and get back to you”. It really is a breath of fresh air after my last GP surgery.

This time was really a drug review and a review of symptoms to find what combinations might work best. I have come away with plans to make several changes in my own time, one at a time and to experiment with what works best for me. She really treats me like and intelligent adult and is not patronising at all. It is so great.

(Has anyone tried Clonazepam and do you take it in the day for muscle tension/pain or sensory overload/neurological symptoms? I have started taking it at night and sleep better but my symptoms remain…)

I also asked her about stretching and gentle exercise to maintain what function I have over the long-term. This was also related to the risk of osteoporosis of being indoors so much and not being physically active. She said that any movement is better than none, however small. I have been told before that stretching is pointless unless you can hold it for 20 seconds, and that doing exercises is also pointless unless you keep increasing the amount you do (like graded exercise therapy). My GP says she will ask a physio friend of hers about the best way to stretch very weak and trembly muscles, and how to build strength gently. She said I won’t be able to tell any difference for a long time as things will be so slow, which is a good attitude I think, rather than the pressured approach of people I have met before. I am willing to give it a try. I told her that I have a heart rate monitor and would wear it to be sure I was not stressing my body too much, and in order to keep my heart rate low I will have to do most of it lying down. She said that was excellent. I have dug out the exercise sheets given to me in the past by physios and the CFS management team, which I failed to do regularly before as the approach was not tailored to my severity. I just need to work out what I can actually do and also which things it is most important to focus my energy on, as I won’t be able to do anything on days where I am in recovery from doing something, or having a flare up: I need to choose wisely which stretches/movements will have most all-round benefit. She did say that even stretching would probably cause increased pain initially but not to worry about it if being very gentle. I hope that longer term I can reduce my pain levels through being a bit stronger and my muscles being less tense. I do think that there are various causes for muscle problems in ME and that it is just not possible to exercise all the issues away, especially nerve related issues. I can only see how my body reacts. I don’t think anyone should try to exercise unless they feel up to it, and I certainly will only be doing a little bit during my best time of day and on better days… I use the word “exercise” very loosely!

It’s worth a try, even though there are other things I would rather be doing with my time and energy! I will be starting with just a few minutes so will just have to discipline myself… again. Maybe some stretching then a treat!

Busy busy

Well, hello again, this is a long overdue update but much will have been forgotten as so much time has passed…

I have been to see the POTS specialist again who changed the dosage of both drugs I am on, but the second one did not seem to agree with me so I have reverted to the original dosage for now and might try again when I am not so busy and can tell perhaps more easily if it is really the drug or just that I am not doing so well for other reasons… I don’t want to dismiss it too readily as I know the options are limited and the lower dose has really helped. Maybe less is more, but my concern is that if this dose is the best for me with this drug, where do I go from here? Can a third drug be added to the mix (the more drugs, the more chance of interactions and negative effects) or do I have to forego the benefits of this one in order to see if something else suits me better? Tricky.

The weekend before last a friend came to visit, and I had a really lovely and relaxed weekend with her. I felt more able to chat and interact than I expected as had had a bad lead up, so it was good. We even did some creative stuff together! I have had over a week to recuperate and tomorrow another friend is coming for a week! Soon after that we are going away to Edinburgh for a week, so the rest of the month is very busy. All with fun things, so I hope I will be up to enjoying them.

I have been waking up really early recently, and sleeping less hours in total due to this. In general I am still functional as I was but am having a lot of symptoms/pain generally, which feels a bit strange. It may just be that I feel I am functional because I am not really trying to do anything big and my activity is limited to the mornings. By evening I feel pretty bad, despite my afternoon nap and I am going to bed earlier and earlier, though not getting to sleep any earlier in general. This early waking may just be the effect of summer or a new phase.

I do need to go to the GP and talk about my pain issues, but that won’t happen until September now. I had a bit of a scare when I forgot my Gabapentin one night, but did not realise I had missed the dose. My nerve pain was terrible and I barely slept. It seems to be in new places and felt worse than I remembered. There was no position to lie in without triggering it, whereas I used to be able to lie on my back with my legs up. I was so relieved when I discovered that I had forgotten to take my tablets and that I did not need to rush to the GP to find something new to help me. I am finding the drug less effective than it was and I wish there was something that would help with the nerve pain as well as the other types. I am not living in constantly bad pain, but certainly constant discomfort and there are periods of the day that are worse than others. It is good to know how much Gabapentin is working, even if it is not perfect.

I have not felt able to write blog posts, nor read many blogs by other people either, which I do miss. I like to keep up with how people are and what is going on but it just feels like there is not enough time/energy available for it all. My best hours in the morning can disappear very quickly doing essentials. I am going to have an internet break during this coming visit and also when away. I am spending a lot of time on facebook (as I can access it on my phone) which I get a lot from as it is my social life, and I don’t want to lose touch with everyone but I feel I need a bit of a break, especially from the more political stuff and news of Wessley that seems unavoidable recently. I would like to see what space a break will open up in my life, and seeing as I will be doing fun/sociable things in real life it seems a good time to try.

Speaking of Wessley, I wrote to The Times newspaper in response to an article they wrote about him and the death threats he has been getting. This is one of several media articles covering this story over the past week and I finally had enough and felt I had to do something in response. I won’t dignify them with a link, suffice to say they are very one-sided and another story about ME that does not address any of the really important issues, instead just focussing on the actions of a very small number of people with ME in order to undermine us and the validity of our voices. The reasons for these threats were not represented and the article itself admitted they were very few in number. I don’t know if my letter will be published, but I hope they do publish some decent responses as I know of other people who have written in.

Oh, I nearly forgot! I must mention the new International Consensus Criteria, published in the Journal of Internal Medicine. It gives a very clear definition of ME, as opposed to CFS. I really hope it will be adopted and used by doctors around the world and in research to move things along more swiftly.

I have just read The Sound of a Wild Snail Eating by Elisabeth Tova Bailey. I really enjoyed it and recommend it to people with ME who sometimes find reading difficult – it is short, simply written and in small chapters. It is really lovely and has nice illustrations too, even in the Kindle version.

I have had a few nice trips to the beach over the last few months. It has been really nice to get out a bit this summer. I saw some great waves!

I will stop here, though I am sure there is much more I could say. Will be back in the Autumn, no doubt. All the best til then to my friends.

Too many time constraints!

This is a quick post, not the one on leaky gut syndrome that I promised you! That is not finished yet. This is just to show how ridiculous the lives of chronically ill people can be! It is no wonder I get so little done in a day and am mentally exhausted! This stuff takes a lot of concentration…

 I have started taking digestive enzymes recently as described in my previous post. I have added a high protease (systemic) enzyme to take between meals (to allegedly reduce bodily inflammation and pain among other things). I have also started taking L-Glutamine (though I suspect it has caused diarrhea so I have paused for now to test that, but let’s assume I am taking it. I also read that drinking fluids should be avoided so as not to dilute the enzymes in their very important work, and that if you have low stomach acid the dilution is not good (I don’t know if this applies to me but it could and seems likely) so I should not drink for an hour before meals or two hours afterwards. The protease enzyme is the same rules, but only half an hour before meals is ok. I also take an anti-spasmodic and other medications not related to my digestive issues. I also have in the fridge two probiotics which I plan to start taking soon. I generally need to drink about 4 litres of fluids per day (that’s up to 4x what people usually drink unless it’s hot weather) to help with POTS symptoms.

So let’s see what a day looks like if I do this properly:

8.30am wake up and take my usual medications with water (most of my glasses of water and cups of tea are 1/3 litre).

9am Get up and have a cup of tea. Take vitamins including zinc (good for digestive/gut health). I really should take more vitamin C too – note to self – it apparently helps kill bad bugs in the gut.

Also put Alpha Stim electrodes on my upper back as I do every day (my pain relief machine).

9.30am take antispasmodic and L-Glutamine

9.45 take digestive enzyme (as it is a veggie capsule I read it needs time to dissolve so to take it a bit before eating, but other places say to take at the same time as food, so I am confused about this one. Let’s say 15 mins is ok for now.

10am take probiotic (type one) and eat breakfast

Also move electrodes on Alpha Stim to anywhere else that hurts or just to another position for upper back/shoulders.

11am change setting on Alpha Stim to CES and put earclips on

12 midday take systemic enzyme and wait half an hour for it to get into my system (think this way round makes sense or I would drink then have to wait an hour?)

Alpha Stim done.

12.30 take usual medications and push fluids for half an hour, perhaps 1 litre.

1pm stop drinking and wait an hour before food

1.30 take antispasmodic and L-Glutamine

1.45 take digestive enzyme assuming it takes time to dissolve 

2 – 2.30pm take probiotic (type one) and eat lunch

Go to bed and rest/nap

4.30 wake up and take systemic enzyme

5-5.30pm take usual medications and drink fluids – 1 litre

6pm take antispasmodic and L-Glutamine

6.15 take digestive enzyme

6.30-7pm take probiotic (type one) and eat

9pm drink – not much as getting late and don’t want to be up all night – 1/3 litre

10pm – take usual medications and probiotic (type two). Make way to bed.

So I have only managed to fit in 3 litres of fluids, plus a bit with tablets. I could take a jug and drink more before getting up. This regime also prevents me eating little and often as I prefer and forces me to make sure I have eaten enough in one sitting to last me 4 1/2 hours. This goes against advice for managing IBS and POTS symptoms. I also really like to finish a meal with a cup of tea, but I have known for a long time this is not meant to be good if you have digestive issues.

I have tried the systemic enzyme for a few days and that was fine although my stomach seemed to be getting more sore each morning so I am resting it before starting again as is advised. I am unsure about the L-Glutamine but will try it again in a few days. My plan is to do this properly in a couple of weeks and go sugar-free for that time to see if I get any symptoms of die-off to test for a yeast overgrowth. If I feel fine (normal for me!) than it suggests that yeast is not a big issue for me. The more I read about Leaky Gut Syndrome I suspect it may be an issue, despite being quite skeptical, but I think not too extreme for me. I hope so anyway. Even if I cut out all sugars I will still have to eat the diet that I can currently digest which is not very low GI so there will be sugars present (rice/potato) but it will be reduced and that should trigger some reaction. I think taking the probiotics at this time will maximise their efficacy as the bad bugs will be dying anyway –  ha ha evil laugh.

Someone had generously given me some Stevia to use during my sugar-free fortnight. My plan is to make some chocolate biscotti (I have found a recipe) so that I can end meals with something sweet and also sweeten my breakfast as I will have to switch to unsweetened soya milk (yuk!).

Sorry for the lack of links in this post – I really have no energy/time for it. Please leave a comment if anything is unclear – my next post on Leaky Gut Syndrome (coming in a week or two) should clarify it all anyway!

*I do not advise anyone to undertake this strange regmen, I know not how useful it will be, only using myself as a guinea pig, as usual…

Medical Appointments

Yes, I have been to more medical appointments and have more on the horizon.

Last week I saw my new GP for the second time and am pleased to report that she is still as good the second time around and I will be sticking with her. She was running very late though and we were there two hours in total so it was quite a struggle. I get the impression she always runs late as is the type of doctor who is more concerned with doing a good job than sticking rigidly to the time constraints imposed upon her. I don’t mind waiting really if I will get a good appointment where I will be listened to and taken seriously, though it is not great when you are unwell and it took some getting over. She did look quite frazzled though and my partner did comment that if she carries on doing such a good job she may get burn-out! I really hope not. Outcome of the appointment is that I am on a higher dose of Gabapentin for my nerve pain and have started Mebeverine for my IBS.

I have not taken any drugs for my IBS for many years (just relying on dietary changes, as well as having tried lots of probiotics but with no real change) but after more than two years of a restricted diet it is still flaring up and painful there is no more I can do on that front, so thought I would try again with the drugs. About ten years ago I tried them all and had no improvement, but I think there is a slight improvement already after just three days this time! I need longer to really know but I think there is less pain at night-time and perhaps things are a bit calmer as I have not been playing it especially safe food-wise. The GP did suggest that I could try Amitryptaline at a low dose to help with IBS but to ask the POTS specialist if it’s ok.

So this week I have been to see the POTS specialist. She says Amitryptaline not a great idea unless absolutely desperate as it can lower blood pressure and increase heart rate – two things I do not need.

We also discussed the drug (Dilzem) that she started me on last visit. I think it has helped my stamina and also my recovery time after doing things, enough to be a trend but not in a really dramatic way. It is better than nothing. She did not change my medications this time, only the timing of one tablet and I will be wearing a blood pressure monitor for 24 hours soon to check how I am doing. Based on the results of that she will know if I can tolerate higher doses of drugs or not and adjust as required. I hope I will get to try higher doses as I know POTS symptoms are still affecting me daily and where would we go from here if not? I am not sure!

So that is it, two pleasant appointments which makes a nice change.

On a vaguely related note, my trigeminal neuralgia has been bad the last few days. Gabapentin is a listed treatment for this condition, though not the main reason I am taking it, but still it keeps flaring up. I am concerned, as reading about it, it seems that it is something that gets worse and worse over time and can become very bad. I wonder how bad it would be now if I was not taking Gabapentin? I am seeing the ME/CFS specialist in a few weeks and want to talk to him about my neuropathic pain in general and also the trigeminal neuralgia. I would like to understand how these conditions fit into my ME/CFS (if they do) and what I can expect long-term with them. They are quite concerning and debilitating on top of everything else. I also want to ask him about Low Dose Naltrexone (LDN). This is taken by some people with similar itch/nerve pains as me as well as people with ME/CFS so I think it might be worth trying. I hope he will be open to letting me try it without having to fight for it.

I have just received an appointment for the Pain Clinic at my new GP surgery. It is for next week. I have already had an initial telephone call and also filled in an assessment form for them. The doctor I will be seeing seems very intelligent and not patronising and keen to help me understand my pain issues. He did talk a lot during our phone call about Fibromyalgia and pain sensitization (or something similar to that) which is good but I don’t think the whole picture. I do not have a Fibromyalgia diagnosis and may have to take some info with me about pain mechanisms and ME/CFS as they do seem to be distinct entities and there is often much pain in ME/CFS in it’s own right… At least he is willing to talk about biological processes though, and did not sound too much like he was just going to teach me breathing exercises. I doubt he will have much to say to help me understand the nerve pains though. It will be interesting. The appointment will be an hour long, which will be a challenge in itself.

It would be nice not to have all these medical appointments. I know various people with ME/CFS who rarely bother to go (or know there is no point with their existing doctor) but I seem to have various issues that I really cannot ignore and that for which there does seem some hope of management/improvement with medical treatment. It would be so freeing to not use all my energy up in this way and just to be able to focus on going out to do things that are pleasurable or useful but it seems it is not to be. There are things I have never even brought up with a doctor for many years, or not at all, and I feel with this new GP that it might just be worth it to discuss all these minor loose ends sometime. How nice to feel that I can, even if there is nothing to be done. I am so glad I left that last GP surgery – all I ever got was a lecture and the impression that I was wasting their time or I got the distinct impression that they did not know enough to make it worth bringing anything up in the first place! Oh for the day when ME is universally understood and treated seriously… and treated effectively! It should not be a lottery just to get a GP who listens and has a “let’s try” and a “can do” attitude regardless of any actual effective treatments…

A New Year begins…

Hello all,

I am not sure what to write about today, or how much to say. I am bored of writing how I am, which symptoms are bad and so on, though I know it serves a purpose for me in terms of tracking my symptoms and health, which is one of the reasons I do blog. I am bored with it though, and so it seems is my partner, understandably. We want to escape the never-ending discussions of how I am, which parts hurt and so on. But how? I honestly do not think it is possible.

I do not need to tell you readers who are also ill and living with other people the difficulties of being in any relationship when there is an unwanted entity (the illness) hovering around affecting everything we do, or more usually cannot do. Things are ok, and we are coping but I am just feeling a bit emotional at the start of this year.

As well as wanting me and more especially my partner to have a break from it all, I am deeply worried about a friend of mine who is in hospital. I have heard from her dad that she has had an emergency operation and is very unwell, but nothing for a few days and I cannot help but think about her and her start to 2011. She has not even been able to open her Christmas presents yet. She is on my mind a lot.

I think I am also just in recovery from going away at Christmas. I feel a sense of achievement and adventure at having gone away – I spent a few days with my partner’s family. It was good and I am very glad I went in many ways. I was made to feel really welcome and they tried really hard to accommodate my needs and it was nice to feel part of something but it was also pretty hard for me at times.

The main issues were the travel (which took 4 hours on the way there and 3 on the way back; even as a passenger that is really a lot for my poor brain to cope with. I find it very challenging neurologically to be in motion and to have such a lot of visual stimuli rushing past at the same time); the heating, which despite other people saying they felt cold was on really high and it was the hottest house I have been in for a long time (which obviously is really bad for me in terms of POTS as it means my blood pools more easily and less gets to my brain which makes me feel worse and have lower stamina and more neurological symptoms, like tolerance of noise…); and also the noise!

When there is noise my stamina is very limited and the combination of Xmas music on a loop and/or a tv turned up loud for some of the family who can no longer hear very well (and refuse a hearing aid) as well as the conversation of up to twelve people on top was at times hard to bear. Added to this was the noise of a house full of people when I was trying to rest, especially when a few drinks had been had, despite my ear plugs! People really did try so I am not blaming them, it’s just that normal festive behaviour and this illness do not mix. It is not like everyone should sit and shiver in several jumpers in silence just so that I can “do” Xmas!! It would not be fun for me or anyone else that way.

Overall it was a successful visit and I would take on the journey again when things would be quieter and hope that perhaps I could be able to leave the house when there next time to explore the city a little. It did feel strange to just be in the house all the time and not be able to situate it or explore; which seems ridiculous as I rarely go out to explore my own city, but when you go somewhere new I suppose you feel it more keenly that it is the normal thing to do. I know there were art galleries within a ten minute radius, and that hurt!

I have been feeling a bit stir-crazy actually and the trip away almost added to it for the reason given above. It gave me a sense of adventure if anything! I have not left the house much for a long time, other than for appointments, and the weather has been a big part of this. It has been just freezing with snow and ice everywhere – hardly wheelchair-friendly. I did go over to see a friend before Xmas and that was really nice, though it felt so surreal and I realised it was nearly a year since I had visited her home. She has had to visit me most of the time in the last year. Another reason is that my partner is just so busy and there is no-one else to take me out. I really find it hard to go anywhere without my wheelchair and that means being accompanied. I need to perhaps just take a taxi sometimes and sit somewhere interesting and comfortable for a while, but finding somewhere comfortable (in terms of chair, but also noise etc) is quite tricky.

Good things already planned for this year are a lecture about printmaking at a local university at the end of March. It is just an hour so I am going to give that a try if I can. Also we have booked tickets to see Iron and Wine in concert, which is also not for a while, but something to look forward to. Some of the most memorable and best things I did in 2011 were going to concerts, which has become easier now that I can sit in my wheelchair, so I hope to keep finding good people to see this year. It is great to go out with my partner and share such experiences with her. We don’t do enough fun things together.

It is my birthday this month and some time has been kept clear to do “something”. It is not yet clear what I will be up to doing, or what the options are but I am looking into it!

I hope to continue with my art immersion at home (see blog post on my creative blog) and finish the painting I am working on and move on to the other many creative things I want to work on. So many ideas, so little energy and ability! Never mind, art is a good distraction from illness. I also want to read more. I have got a Kindle for Xmas, though I had it early, and I am really loving it and how much easier it is for me to read with than a real book.

Feeling Better, Doing More

In the last few weeks I have noticed a gradual improvement in my stamina. I think there are a number of things that are potentially contributing to this improvement, which is great whatever the reason, though I would like to know what exactly is helping so that I can continue with it!

About six weeks ago I went to see the POTS specialist and had a list as long as my arm of current and pressing issues – she (rightly) could not deal with them all and it was not a successful appointment (for that and other reasons) and it upset me, but I could not pick and choose between all these issues as I was just overwhelmed by various issues which were all severe. These included: Sleep, Neuropathy and Trigeminal Neuralgia, Muscular Pain and Tension as well as other pain issues, POTS (this was low down the list so you can see how bad the other stuff was!), as well as medication issues.

She gave me a new medication to try for POTS (Diltiazem). I did not start it for the first few days as other outcomes from the appointment were that I should stop taking my sleeping tablet (eszopiclone) to see how I am without it, and also I had only just increased my dosage of Gabapentin (for Neuropathy) over the previous few days, so I did not want to confuse things by doing it all at once.

Also around this time I was having massages of my back, neck shoulders and head which were pretty intensive as the pain and tension there was really getting unbearable. My head felt so tight and painful and my scalp was really tender to touch in places (always is a bit, but was getting very bad and more widespread). My neck felt very painful and weak and was clicking in a very disturbing way low down my cervical spine. Shoulders and upper back, well, the usual. A couple of days after the third massage I felt the tension really lifted and I no longer was taking painkillers every single day. The clicking was also much less frequent – I think the muscles were not clamped so tight around the joints.  This was also the time that I started taking the Diltiazem, but I did not think it would do anything and apart from the pain/tension improvement I did not feel any different. A few days later I had my first acupuncture appointment.

It was another couple of weeks before I had the second appointment and did the Tai Chi (and “broke” my back). Then another week until the third, when I started to use the Alpha Stim (see previous post).

During the last few weeks I have noticed a gradual increase in what I can do in the day. I am certainly more active, particularly mentally. I am also sleeping much better and dreaming vividly all the time! I have taken the sleeping tablet again briefly when my mum was here and it confirmed what I thought. It does help me get to sleep but once it wears off in the early hours I feel more awake than I would have done without it. Very odd. As it is I am sleeping much more deeply than I have for a long time with no drugs at all. I am still getting up several times for the toilet but am just getting back into bed and back to sleep easily. I am also sleeping deeply most days and later in the day than I was. It is working for me despite being bad in theory to sleep late in the day (sleep hygiene blah blah). I think the higher dose of Gabapentin is helping to control my nerve related pain and discomfort which used to flare up every time I got out of bed (or in!). It is still there but milder and as long as the bedding is smooth and flat underneath me (a constant battle) it is usually ok. I think with me Gabapentin takes a few weeks to reach it’s maximum efficacy. When I first took it, although there was some improvement it was not for a few weeks that it really felt more consistent, and the same has happened with the higher dosage.

I think perhaps the added activity is also helping the sleep. I am being careful not to overdo it, though some days it is hard to stop pottering about with little things, as they all add up. I have at times got that “wired” feeling of having over-stimulated myself, but I am also recovering more quickly. I have had the odd bad day but overall it’s a very positive trend.

I even went out into town (being pushed in wheelchair). We went to three shops one evening and I did practically all my Christmas shopping. Then we went for an Indian meal before returning home! It was really great to have a meal out and I felt pretty good throughout.

I hate department stores (it was only them that opened late) but I did not get over-hot and being in the wheelchair made it much better for obvious reasons (like being able to go fifty times further!) but also in terms of navigation, which I am rubbish at in shops. It is so nice to allow someone much better at it than me to push me around: she knows where the lifts are, where the exits are, how to best get from one shop to another etc. So much more relaxing!

I also find the decision-making hard but as the shop was not too busy or noisy and I had a list of people to buy for, I just stayed calm and focussed and got through it in no time. Such a relief and great to avoid lots of deliveries coming to the door at random times when I am in bed in the day.

The most amazing thing – yes I am getting there, waffle waffle – was the payback… or should I say LACK OF PAYBACK!!! I rested the following days, but was still pottering around more than I felt I should following such a big trip out. Day three I really felt it would hit, but it didn’t really. This is unheard of in my world. I was only saying to someone more moderately affected than me a few days before that unlike her, I am rarely surprised by how ill I feel, as it is predictable: do something slightly more than usual, second day, bam – feel awful. I take a few more days to rest, then carry on with the usual routines. Even my IBS did not flare up too much after the meal out, which again, it usually does even if I am careful about what I eat.

So I was on cloud nine about that. It really made me feel that the improvements are solid, even if I have not felt quite so strong since then. I feel an upward trend again at last. I am kind of hoping that most of the improvement is down to the new POTS drug. It has been about a year since I felt any real improvement in function from Midodrine, the other drug I take for POTS, which has plateaued really, despite some dosage increase. I also tried Ivabradine which I was not sure about in terms of improvement as I had such severe neuropathy at the time I was in a lot of pain and not sleeping well at all, so I could not tell. I could not get a prescription for that in the end anyway.

If the acupuncture is helping too, then all to the good. If I can get a decent improvement in pain through that then that will help me hopefully to move and relax my muscles more and increase my function again. I like to think so anyway. I feel a little hope creeping in…

Another doctor’s appointment – a good one!

Went to the new GP surgery today to meet a second GP from the practice. I was told to see this one about the progesterone pill that I take long-term to stop my periods. I was a bit worried that she would not be understanding and want me to change what I take or even stop me taking anything. This would be very bad for me as it has really changed my life not having the awful effects of my hormonal cycles to deal with all the time. It had a huge effect on my functioning and energy levels for almost the whole month.

She was lovely though. She spent lots of time with me even though she was running very late already, and said that although she would contact the specialist I originally saw who put me on the pill just to check that it was ok for really long-term use, she could see how much good it was doing me and that changing it would potentially cause me a lot of disruption and problems managing my condition.

Seeing as she was so nice I took the opportunity to ask her about referring me to a pain clinic, while making clear it was not urgent and I did not want to make her run even more behind. She seemed happy to deal with it and genuinely wanted to do all she could for me today.

She firstly suggested that the CFS specialist who I have been referred back to might be able to help me and he could decide if I really needed to see the pain clinic or if his team would help. I said that firstly that would make the timescale very long as there is always a three-month wait to see him. Also I had not had any help with specific pain issues from them in the past, even the physio gave me advice that was not tailored to my needs and severity.

She listened to me and the kinds of pain that I experience and said she did think the pain clinic would be best. She said she needed to get more information and look at my notes more before deciding where to refer me to, adding that there was a pain clinic held at the GP surgery which has short waiting times and that I may get to go there. She is going to ring me soon to let me know. I was very impressed with her attentive approach and willingness to commit even more time to me outside of the appointment.

When we discussed the pain issues that I have, including bladder discomfort, I said that I felt that everything was more sensitive and more painful due to neurological problems, rather than the bladder (or other body part) itself, and she said “yes, you are right, processes of central sensitization (can’t remember the actual sentence, but something like that). I nearly fell off my chair. A doctor who is knowledgeable enough about the mechanisms of ME/CFS to engage in a conversation about such things and is also happy when I express some knowledge about my own condition! Very rare in my experience.

She also knew what POTS was and did not assume my partner was my mother – bonus points all around!

I feel like I have struck gold, but am also aware that she is not easy to get an appointment with. She specialises in reproductive stuff, which is why I was sent to her for the pill issue so I may not be able to see her regularly. Also she is very popular from the impression I get. I hope that if I have anything complex to discuss I will be able to see her though, if not all the time. I do think she would be a good person to ask to do the DLA form evidence – she seemed very thorough and I think would treat it with due importance. I would gladly go in for a 7am appointment (if they did them) or wait a month to have another appointment like this one!

I feel today that the leap into the unknown I took in changing GP surgeries has paid off. The first GP I saw was nice, but this one really seems a cut above anything I have experienced in a decade or so.

Happy day!

Review of How To Be Sick by Toni Bernhard

I was planning on writing a thorough review of the book How To Be Sick by Toni Bernhard, but I am taking advice and guidance from Michael Nobbs in his new ebook Sustainable Creativity and I am keeping my tasks simple and manageable. If I write a short review I can get it done today and have a sense of achievement, rather than not finding the energy for days/weeks and having the task hanging over me. He also encourages us to not care if something is not perfect, allowing us to get on with our day. This review will not be well honed but I hope it will be good enough. I am not even going upstairs to find the book to refresh my memory before I start!

In How To Be Sick, Toni combines the experiences and challenges that chronically ill people face day-to-day with Buddhist teachings in a very effective and seemingly effortless way. It does not feel like the chronic life is being forced to fit into a paradigm, it is as if these two things were meant to be thought about together.

I found that I did resist buying this book, despite the good reviews. As someone with very longstanding ME/CFS  I have become wary of self-help advice. Often it is forced onto us, inappropriate, claiming to cure, patronising, making assumptions about us and so on. Or we seek it out ourselves and get “self-help fatigue” on top of the illness itself as we work so hard to challenge ourselves, examine ourselves and change ourselves and just end up twisted in knots feeling no better, calmer, stronger or healthier. We then feel a failure and I for one no longer take part in these activities. I suspect I am not alone. Who, when chronically ill, has the energy to keep constantly looking at themselves in such an intense manner?

So against this backdrop, Toni has bravely approached the problem in a new way. It really does feel so refreshing and when I actually picked up the book and started reading I felt no resistance. It is written in an easy to understand, absorbing, humourous way (I laughed out loud at a bit about Sarah Palin!). Most importantly she takes us on her personal journey and explains how difficult she still finds some of the practices, rather than saying she has reached some level of perfection (enlightenment!) and therefore effortlessly copes with all day-to-day stresses and restrictions on her freedom. Of course she doesn’t, she is only human, and that approach allows us all to have a go, Buddhist or not.

It is really refreshing to read the examples she gives as I had also found myself in these exact same situations. Perhaps it is because Toni has ME/CFS and POTS as I do, that our experiences are so similar, but I expect that actually the experiences of chronically ill people are more universal, regardless of our specific conditions, than we realise. Which begs the question: Why is our experience so marginalised and misunderstood, even by people whose job it is so see us regularly, ie medical professionals? (See previous posts for where this issue is coming from for me!)

I have occasionally done Mindfulness of Breathing meditations over the years, in phases. I first started before I became ill when a monk came onto campus once a week when I was at university to do a guided meditation. I found very powerful and energising at the time. While it is harder to do in a body which is constantly uncomfortable and without your own monk to guide you (!), I have found that being guided by a recording is also good. The book made me see this practice in a new way and I feel encouraged to keep doing it and getting more and more from it.

Lastly I would like to say that even if you know nothing about Buddhism, this book is very accessible. It has sparked an interest in me to look at it further, especially the specific concepts that Toni works with in the book. (Michael Nobbs actually posted a link on his website to Audio Dharma and a talk about Embracing Imperfection, which echoed some ideas from Toni’s book. I just went to find the link to post here and see that Toni has done her own recording on the site! Small world.) 

What really felt encouraging for me was that although I had not heard of many of the Buddhist ideas in the book, I found that I could relate to the practices. I realised I have been doing some of them by myself. For example, I do enjoy the joy of others more than I perhaps did at the start of my illness, even when I cannot participate in the source of that joy (although there are some people with which this is easier to do, than with others who make no acknowledgement of your own situation! I still have work to be done.). It is nice to feel that you have made some progress yourself inadvertently just by living with illness so long.

All change!

The last couple of week I have changed some medications:

I have upped my dose of Gabapentin, which I am taking for nerve pains. These are mostly occurring on my lower legs, but also affect thighs, arms and other places on occasion.

I have recently (re) developed Trigeminal Neuralgia despite being on this drug, which is listed as one which helps. I had it about four years ago, in conjunction with forehead paralysis which meant one eyebrow did not rise (!) though it felt like it was doing so… a bit odd. This time my eyebrow is thankfully mobile but the nerve pains, while not severe, are quite persistent and annoying. I cannot lie on one side of my face much which limits the already limited positions I can lie in in bed due to other pain.

I have stopped taking Eszopiclone, a sleeping tablet. I am stopping for a month on doctor’s advice to evaluate how I am without it as I have been taking it for several weeks with mixed results. I have had two stern warnings from GPs about the risks of addiction and they say it is usually only prescribed for a two-week period. Well, I have not experienced any issues with stopping it which is a relief and good to know. I think I will just take it when I am having stressful times or when I have things planned that I need to be functional for, like holidays/Christmas or visitors.

It has helped me to sleep in some ways. I was getting to sleep earlier on it, getting up for the toilet only about 2-3 times as opposed to many more previously. I was still waking in the early hours and sometimes having trouble getting back to sleep, though it was perhaps easier than it is without sleep medication which was less stressful. The real issue for me was that I did not feel much better in myself in the daytime for supposedly getting more sleep. Why pollute my body and risk addiction/withdrawal in that case? I will see how things go. It is useful to have something to fall back on if things get really difficult for short periods.

I have also started Diltiazem for my POTS symptoms. It is a calcium channel blocker, though I do not know much about it. It is listed as a drug that can make Orthostatic Intolerance worse (!) but I am only on day two and it’s too early to say either way if it will help me.

I also asked the specialist at the hospital about my increasing pain levels and painkillers, as I am taking more and more these days, though still being fairly restrained. She says to focus on paracetamol and she suggested going to a Pain Management Clinic. I don’t know what they will be able to help me with, but I am willing to give it a chance.

The most exciting thing for me today is that I have just made an appointment with an Acupuncture practitioner. I saw him when I previously had Trigeminal Neuralgia and he sorted that and made my frozen eyebrow move again as normal in just 5 sessions. It moved a tiny bit more each time!

After my disappointing appointment with the specialist earlier in the week I am looking forward to his calming, attentive and holistic approach to my health. He is very well-regarded and very skilled as well as quite a character! I really enjoyed seeing him before and hope he will have a healing and de-stressing effect on me. I primarily would like him to focus on my trigeminal neuralgia and headaches/tension in neck & shoulders as I think they are all connected. I hope he will be able to help with neuropathy and other pains too. He also used to try to help me with temperature fluctuations and I think there is plenty for him to tackle in the long run but that perhaps it may be worth taking a set of symptoms at a time as it is easier to track progress that way. I will see what he thinks.

I have had a few massages recently as the pain and tension in my head, neck and back has been getting really bad. I have avoided them due to my nerve pain for a long time – just lying on my front was impossible even in soft clothes but better now that I am taking Gabapentin. I still would not be able to have a full-body massage (do NOT touch my legs!) but my back is possible. I have tolerated the massages pretty well and they have helped, but only in a very temporary way. I hope the acupuncture will be a little more long-lasting in effect.

mundane update

The title is to warn you all that this is not important stuff, only I feel I should make a record of certain symptoms fluctuations and patterns regarding medications so that I can make some sense of it (potentially) along the line. It is a giant ramble so unless these issues apply to you, don’t bother reading! I have bolded key themes, for easy skimming 😉

(There is a good link to a webinar about POTS and Orthostatic Intolerance at the end if you want to understand it better.)

~~~~~~~~~

Since my holiday my IBS has been in a general flare – main symptoms being my usual issues of increased wind and bloating/abdominal pain and more frequent “happenings” (shall we call them?). I have also had a bad bout of diarrhea (though i did eat more veg beforehand which did not help) and also an evening of very bad nausea (though i did narrowly avoid being sick) and this is rare for me.

While on holiday things were actually pretty good in this department, but things have got gradually worse. The only thing that has changed is that I started to take Eszopiclone – a sleeping tablet – every night from the start of the holiday. The reaction was obviously not immediate or dramatic, but I wonder if this medication is irritating my digestive system. It does say on the packet that it contains wheat starch and lactose – but surely i cannot be so sensitive that half or sometimes one whole (small!) tablet a night can do this? I think I am more susceptible to starches. Dairy products do not do me much good but I do eat some cheese, so that amount of lactose really should not be an issue. Or, of course, it could be the drug itself or just a random flare-up. I have not changed my diet in any significant way (the chance would be a fine thing!).

So, while not a major problem at this stage, it is a significant change and not one I am happy about.

That said, my nerve pain/itching has been generally improved since the holiday and I wonder if sleeping better has helped this. This Neuropathy, as it is most recently diagnosed, was very bad in the weeks before the holiday, and during the holiday itself. I have not yet heard back from the specialist about upping my dose of Gabapentin, which i take for this, but it has calmed down a lot anyway. I would still like to take a higher dose as it is still a big issue for me and I have to stick to certain rituals to avoid it which i would like to relax on, but it has been nice to have a general reduction in symptoms. Also perhaps the slightly less hot and humid weather may be helping.

So, my plan of action is to stop taking the sleeping tablet (did not take last night) and see if after 10 days or so anything has improved “down below”. I may have to start it again and re-stop to confirm the link as life is never that simple with these illnesses. Also I am going to research and see if there is a brand that does not contain the wheat starch, though that is a long-shot.

I have also stopped taking my antihistamines since the holiday, in a gradual fashion, on advice from the dermatologist and POTS specialist, who both agree the Gabapentin is the best drug for the symptoms. I can still take an anti-histamine if i get a bad attack of itching/pain but am not taking them on a regular basis. I have been very surprised that this reduction has not caused a flare-up in symptoms as when I started to take them I did experience an improvement. I have wondered if that improvement was due to the soporific effect of the night-time antihistamines, as I slept better in the first weeks of taking them that I had done for literally years. I think better sleep could easily account for reduced nerve pain, and I wonder if that has happened over the last few weeks on the new sleeping tablet also, as the gabapentin alone did help but things improved again with better sleep.

Another thing to note is that I do not think my days are dramatically better since taking the sleeping tablet. I think i assumed I would feel much better and have more stamina if I slept better. This has not really happened, but I would say my mood and stress/anxiety levels are improved. Being awake in the early hours of every night usually with neuropathy and other discomfort (bladder/back pain), as well as getting up much more for the toilet every night was hard to cope with. I have enjoyed getting up less and usually getting right back to sleep even if I do. I had hoped to phase out my daily nap when sleeping better, this has also not been as easy as I would have hoped. Some days I feel I have really slept well and when I go to lie down I do not sleep properly, just rest. This is good for “sleep hygiene” though I have come to realise there is only a certain amount of control I can have over that. I have tried to do everything right for years and my sleep has not been good quality. Most days I still need a nap, only an hour of actual sleep, though I do lie there for longer in total. In an ideal paced world maybe I could avoid it but in reality there is always something to recover from, rest for etc.

My cognitive function has been quite low at times and I wonder if this is a side effect of the medication. I don’t always wake up with a hangover feeling as such, or no more than is quite usual. I would expect better sleep would make me more mentally alert but I have not found that at all! When I have taken the drug I do find that I do not remember things that have happened in the night and cannot speak/think clearly if I try to have a conversation if I wake up in the middle of the night… but I was like that last night without the drug so maybe it is just a symptom of being really asleep!

One other thing to note is my neck – it is literally a pain in the… neck! It has been very weak for a long time and the muscles on top of my shoulders where it joins my neck (an anatomist I am not!) are constantly tight and painful. The smallest thing seems to trigger it into pain. This is not a new problem but it has got worse. I find the positions that I can hold my neck in comfortably are limited to about one, sitting with my chin tucked in, basically (lying down on my back is also good). Any activity where I have to hold my head in any other position, or move about too much can trigger it off. It also clicks in a nasty cracking way which cannot be good but feels necessary. I cannot think that it is just deconditioning of my muscles as if there are any muscles that are constantly in use it is the ones holding up my head! I do not lie in bed more than 12-13 hours out of 24 so they are being used quite a lot.

Regular readers will know that I have tried an osteopath and that did not work out, so I do not know what to do apart from mention it (again) to the ME/POTS specialist on my next visit. Upper back/spinal issues have been a constant issue for me for the duration of my illness, and yet are given no attention by the medical profession (I did get a useless physio referral once or twice). Hmm. I cannot help but think that spinal health is important for those with neurological problems, seeing as all the signals/messages have to go that way, but as we are always being told: chronic pain is not necessarily a sign of injury or anything being wrong… Hmm, double hmm.

Lastly, just to note that I have now run out of Ivabradine, the drug that the specialist wanted to try me on to slow my heart rate down to help with POTS symptoms. I am trying to challenge the decision of my GP (this is a family doctor, “general practitioner” for those not in the UK) not to prescribe and have asked the specialist to talk to the GP to see if they can agree something but I have yet to hear anything. I think it did help my heart be a bit calmer in response to standing and I think it made it easier. I have noticed that I have had a few more quite bad and surprising turns from doing quite small things in the house which may be due to stopping that drug. I have noticed my legs are often quite purple when I sitting, though it could just be the warmer weather making things sluggish or that I am noticing more (I tend not to look!). As always, hard to tell.

If you want to know more about POTS and Orthostatic Intolerance for people with ME/CFS in general, I recommend this webinar from the CFIDS Association: http://www.youtube.com/watch?v=5iF30TVLaRE . As well as explaining what is going on in the body there is a lot of info about research that has been done, what can help and details about different drugs. Very comprehensive and perhaps useful to take to your doctor (there is an information sheet to go with it: http://www.cfids.org/webinar/cfsinfo2010.pdf) if they do not know much.