Archive for The wolf

settling in

The long-awaited haircut unfortunately did not come to pass. Alas, they were all booked up until next Saturday. But I did get to eat a delicious bowl of ramen (with pork belly!) and a green tea ice cream crepe so all was not lost.

My hair though, is still ridiculously long, untamebly tangled, riddled with split ends and has the tendency to fall over my shoulder into T’s face when I’m nursing him. So it still has to go. I’m thinking somewhere cheap and close, it doesn’t have to be a stylish haircut, just one that ends with all my dead ends in a pile on the floor and my hair short enough (but not too short, no “mom” haircut for me thank you!) that I can pull it into a pony tail without having to comb through miles of tangles for half an hour first.

All in all, though, I had a pretty great weekend. On Friday, Paul and I braved happy hour at a trendy, high-end Japanese restaurant in SoMa. I was craving nigiri like nobody’s business and we knew this place had tables with big bench seats that could easily accommodate a car seat so we headed over as early as we could and luckily there were still plenty of those tables left in the bar area when we arrived! T slept quietly the whole time like the little cherub that he is (and yes we did get a comment from the waitress – “Your baby is so good!”) while we chowed down on happy hour snacks, rolls, nigiri and drinks. Since I knew I had some time til I needed to nurse him again I ordered something called the Giddy Geisha – lychee and passionfruit vodka concoction – and it was everything I hoped it would be.

Yesterday we made our way to J-town. Once again at a restaurant (albeit at a totally off-peak hour – 3pm – to minimize the crowd we would have to deal with) and once again we got a comment, this time from a fellow diner, about how good and quiet our baby is.

Today we finally went to this farmer’s market we used to go to literally every weekend. We met up with our friend’s T & V and their new little one, Baby O who is two weeks younger than Titus, but was supposed to be one day older based on their due dates. Except they both decided to come early! Titus just came the earliest so he gets to be the oldest now. It was a gorgeous sunny day and it was so much fun talking to V about what life is like now for us as new mommies. The only downside is that we ended up sitting in the sun for a few hours and even though I was busy shielding T from the sun, I didn’t even think at all about how it would affect me until I got home and realized I’m totally sunburned.

Crap.

I hope those couple hours of carefree fun in the sun don’t result in a crappy lupus flare.

Please, please, please…just be a sunburn and nothing more. I don’t have the luxury of getting really sick right now.

Speaking of which, I finally did a load of my own laundry tonight and am unreasonably excited about the prospect of wearing clothes tomorrow that are not covered in a fine layer of dried breast milk and spit up. And maybe a little pee or something.

under pressure

My blood pressure has been creeping up over the past week or so. I’m hoping that I’m just fighting a virus (that raises bp right? right??) but I’d be lying if I said I wasn’t pretty worried. I have an appointment with my MFM tomorrow so obviously I’ll bring it up to him then. It just sucks that my home cuff is 10pts higher on the diastolic (lower) reading. I may have to spring for a new (hopefully more accurate) cuff once my FSA for the new year kicks in because seeing the higher number, even knowing that it’s wrong, still freaks me out.

Bleh.

lazy or lupus?

I decided to stay home from work today, still feeling malaise and it is raining out which means my arthritis is acting up.  Or maybe it’s just the fact that I have been sleeping terribly.  I had a nice stretch of sleeping 5hrs at a time but am now back to just about two before I wake up for the inevitable pee break.

I dropped Paul off at work because the poor boy has been quite ill with stomach flu the past few days and I didn’t want him walking to work in the cold/rain, and on the way home I started to feel…well…bad.  Of the emotional/mental sort in addition to my physical ailments.

Maybe it’s just that time of year.  My post-Thanksgiving, pre-Christmas blues.  Driving by my office I felt bad.  Should I really be staying home when I’m not sick as a dog sick?  Somehow my mind wandered to setting a bad example for the baby and then to whether or not I will be a good/worthy mother.

But lupus has really thrown a wrench in my assessment of how guilty I should feel about things like this.

The truth of the matter is, I no longer know how much I should be pushing myself, how much I can physically handle.  How wise it is to power through the small physical discomforts that everyone occassionally faces.  I used to chalk it up to my lazy ass nature, which let’s face it, I’m pretty damn lazy.  I don’t like to push myself and when I was in school I usually didn’t.  And that was all pre-lupus so it was easy for me to scold myself for being a bum.

In my professional career though, which pretty much has run concurrent with my lupus diagnosis, it’s no longer so clear.  I’ve certainly pushed myself, gone to work many times when I probably shouldn’t have.  Put work ahead of doctors appointments that, in hindsight, could have bordered on life/death importance.  Agreed to be in situations that could have had serious long-term consequences for my health in order to be a “team player.”

This year though, as I became serious about putting my health first and then got pregnant, I’ve taken off a lot of days that have felt questionable to me.  And I haven’t known, what is the right thing to do?  I’m terrified that if I “push through” and end up REALLY sick and somehow hurt my longterm health or the baby, I will never forgive myself.  But on the other hand, I still have my work ethic which sometimes yells at me and calls me lazy.

It’s hard to know which is which anymore.  It’s hard to know where to draw the line.  I guess I’m afraid that if I err to far on the side of caution my lazy nature will let me keep drawing it further and further back and I’ll just become that fat, bon-bon eating, creature on the couch caricature of a mom that my kids will be embarrassed for their friends to see.

Sigh.

RIP Sasha McHale

As a pretty avid NBA fan in general, and a Jeremy Lin fan even before Linsanity, I was well aware of Coach Kevin McHale’s leave of absence from the Rockets due to his daughter being sick. I was very sad to read this afternoon that his daughter Sasha passed away yesterday at the age of 23 (some articles say she was 22).

But I was surprised to read that she apparently died of complications from her battle with lupus. I don’t think the McHale family has ever made it known previous to this that she suffered from lupus. As someone who has kept my lupus diagnosis pretty close to the vest, I can understand not wanting to publicize it to allow her to maintain some semblance of normalcy as she went through school and as I’m sure they hoped she would go on to have a successful career in whatever her chosen profession was to be. Sadly, but somewhat understandably, there will always be a level of prejudice in the workplace against those of us who suffer from chronic illness that has the potential to be quite debilitating.

I feel awful for the McHale family and am praying for them tonight. I can’t imagine how hard it must be to bury a child and it must be especially difficult in some ways that Sasha was at the age where her adult life was really just about to begin. I hope that they will become advocates against this awful disease that robbed them of their beautiful daughter long before her time. It’s sad but the fact is that diseases tend to remain relatively obscure until enough celebrity voices, usually those who have been personally affected, bring attention to them. Kevin McHale is in a unique position, with access to many NBA superstars and he could do a lot to bring awareness to the struggles that those of us with lupus face on a daily basis.

Part 4: New normal

Part 1: Introducing lupus – my unwanted life companion
Part 2: Surprise! Your kidneys are broken.
Part 3: Struggling with arthritis

***

As I mentioned at the end of the last post, my recovery was not a miraculous overnight healing but rather a slow and steady process. According to my old blog archives it took about three weeks for me to settle into my new state of wellness.

Looking back through my archives it also becomes apparent that my memory wasn’t exactly accurate about the timing of the worst of my arthritis and a lot of it happened before and just after my biopsy (so January-Febuary) and steadily decreased after starting medication post-biopsy.

Once the meds were working their magic, I felt amazing. I felt healthy for the first time in ages, I actually felt my age instead of fifty years older. The prednisone made me voracious but once I started tapering my dose even that side effect faded away. I tried hard to watch what I ate though, knowing that long term use of steroids could cause high blood pressure, diabetes, and all kinds of other fun diseases. I found a book called The Lupus Diet which recommended veganism and what was essentially a celiac diet but I just couldn’t do it! I love meat and wheat too much!

After the biopsy Dr. Miller recommended that I pay a visit to another doctor he often consulted with named Dr. Peng Fan. Dr. Fan was another highly respected rheumatologist in the area (my cousin the UCLA medical resident had heard good things about him) and Dr. Miller felt it might be a good idea to have another set of eyes look over my case to make sure we weren’t missing anything.

Looking back, an important lesson I learned about dealing with chronic illness is just how important it is to get in with a difficult-to-get-in-with doctor for your treatment. Even though seeing Dr. Miller was a complete fluke, being referred through him was the only way I was able to get appointments with a lot of other highly respected specialists who never would have seen me otherwise (or it would have taken a lot longer). Sad to say, but medicine like everything else is partly about who you know, in this case who you know is your doctor.

I was twenty-two years old when I met with Dr. Fan and it was the first time it really hit me that having lupus could affect my ability to have children one day. My nephrologist had mentioned it when he was explaining his rationale for choosing to put me on the Cellcept, but in that aspect of my treatment, I felt like I had dodged a bullet, that my fertility would be preserved and I had nothing to worry about.

You see, prior to Cellcept, they likely would have put me on something called cytoxan which was used to treat nephrotic syndrome but also powerful enough that it is used to treat a number of cancers. As it’s name suggests, cytoxan is a highly toxic medication and one that can basically destroy a person’s fertility. Egg freezing is recommended for young female patients prior to starting treatment because it is that detrimental to egg quality/supply.

Luckily by 2005, there had been several major studies showing the efficacy of Cellcept in treating lupus nephritis patients and so my doctor decided that given my age it made sense to start with Cellcept and only move onto cytoxan if necessary. The Cellcept worked and cytoxan has never been brought up again.

When I met with Dr. Fan he reassured me that Dr. Miller and Dr. Mittleman were taking excellent care of me and that he couldn’t think of anything he would do differently if I were his patient. I remember sitting in his office, he was behind a big desk scattered with papers and thick files (like Dr. Miller he was old school – no computers!) as he flipped through my test results. I didn’t even know all the tests that Dr. Miller had run as I wasn’t used to being an active part of my own healthcare at that point in my disease. So I was a little bit shocked when Dr. Fan brought up something called lupus anticoagulant and exclaimed that it was great news that I had tested negative for it since it meant I wouldn’t be at higher risk for miscarriage. He mentioned that the results could change with time though, so I’d need to be tested again prior to TTC but that so far at least it looked like good news.

Perhaps it was naive of me to think otherwise, but no one had mentioned that lupus itself could cause issues with getting pregnant or carrying to term. But there it was. The first seed of doubt planted in my mind. The first bit of knowledge that made me realize, the path to parenthood might not be so easy for me. Soon after I started reading adoption blogs which led me into the world of infertility blogs.

Life went on after that. I managed my disease. I had regular visits with my doctors. For the most part I did pretty well.

In April 2005 I quit my job at the fundraising company and began working as an assistant property manager. A few months later I would change jobs and industries once again, working as a recruiter for an outside recruiting company, and three months after that I was laid off at the end of my three-month trial period. The job was just not a fit for me, I was not comfortable “selling” people when it came to a crappy job/company, which seemed to be the case for most of the positions we were trying to fill. I think I would have enjoyed it a lot more if it was really about matching people to the best possible position instead of simply merely trying to make commission but as I was reminded many times, we weren’t social workers. But I digress…

After I was laid off in October 2005, I decided I wanted to go back to school. I thought I would be going back for a MA or PhD in Political Science/International Relations but I was contacted by the head of MSBA International Finance program that was just too interesting to pass up. I never thought of myself as a finance person but since Paul had been working in that industry I had, had some exposure to it and felt it was worth pursuing.

It was a one year program, one semester at a CSU in the central valley and the other semester in France! I took the time between October and when the program began in August 2006 to take some pre-reqs at the local community college, my GMAT and really just relax. I caught up on doctors appointments I had had to put off due to my work schedule, I slept a ton, I generally focused on being healthy and reducing my stress. Oh and I also got engaged in March 2006 so I started doing some wedding planning before school started.

Because I would be in France from January 2007-June 2007 my doctors decided they did not want to reduce my meds since they felt like being in France could be a stressful situation and they were not sure how much medical attention I would be able to get there (even though as a student I would be covered by their national healthcare). I was disappointed because I was feeling so good and healthy but I understood their apprehension.

I landed in Paris a few days after 2007 began. It was a pretty tough trip that took almost 24 hours and by the time I was going through my re-check-in at Heathrow I told the airline to please have a wheelchair ready for me when we landed at CDG. I hadn’t slept at all since leaving LAX and knew I didn’t want to start my Parisian adventure sick with a bad flare in a foreign country, far away from my specialists. Luckily I was able to take it easy for a few days and managed to stay in pretty good health despite about a week’s worth of bad jet lag.

Life in Paris was incredible. When I wasn’t in class or doing homework, I was wandering the city, sometimes by foot, sometimes on the metro. I was eating delicious food at restaurants and from street vendors and bakeries. I was taking in the amazing sights and museums, I even got a student pass to the Louvre so that I never had to rush through the exhibits. I lived a very european lifestyle, never rushing, always enjoying, rarely stressing and always drinking plenty of red wine.

So when the three-month supply of meds my mom sent to me in February got stuck in customs and I promptly ran out of Cellcept, I decided maybe it was a sign and I stopped taking all my meds as they ran out.

And I did great. I was healthy and energetic. I didn’t live a crazy lifestyle, I was mostly in bed at a reasonable hour and I was never sleep deprived. I walked a lot (I didn’t really have a choice to be honest) and I ate well. I got my blood checked once in April and my numbers looked completely stable after two months being off the meds.

In May, my sister came to visit and we went on a whirlwind tour of Europe. I got sunburned in Greece which terrified me but I seemed to get over it without flaring and breathed a deep sigh of relief. I managed to lug my own luggage around four different countries without too much arthritis pain!

Eventually though, it was time to come home. Paul had gotten a job near San Francisco while I was in Paris and so much to my delight, I would be moving back to Northern California instead of Los Angeles. Unfortunately, our wedding had already been planned for Malibu a month after my return so we had to do about a month’s worth of long-distance, last-minute wedding planning. All while I tried to find job. And stayed off all meds – I was not even on any kind of “insurance doses” of anything.

Before the wedding there were a lot of sleepless nights spent trying to figure out last minute details (most of which still ended up needing to be salvaged by my awesome bridesmaids!) and I admit, I ran myself ragged. That on top of interviewing as much as I possibly could, and finally being extended an offer for the firm I’m currently with a few days before I was supposed to head south for the wedding.

I knew I was stretched too thin but I had been so well, for so long that I guess I forgot that, that could no longer be the way I lived life. At least not without consequences.

Part 3: Struggling with arthritis

Part 1: Introducing lupus – my unwanted life companion
Part 2: Surprise! Your kidneys are broken.

***

I remember feeling this sense of relief as I was being wheeled out of the hospital the morning after my biopsy. I was hopeful that the worst was over, that now I would have answers, and that maybe I would finally have some relief from the pain.

Unfortunately things would have to get worse before they could get better. I spent most of the first week in bed with a low fever, never really getting much above 100 degrees but never really going away either. My doctors felt it was inflammation from the lupus and not an infection. Given that my arthritis seemed to be getting worse by the minute, this seemed like a fair assessment.

And oh, the arthritis. I’m not sure if my perception now almost eight years later is accurate, but for whatever reason I don’t really remember it being so debilitating until after my biopsy. Although the truth probably is that a lot of what I’m about to recount happened between the night I woke up immobilized by pain through a couple weeks after I started meds about a month later.

I remember pain and random swelling (sometimes where I didn’t even know a joint existed until I woke up with it swollen) and I definitely remember the pain when I woke up crying in the middle of that fateful night, but I don’t remember feeling so completely and utterly crippled.

After the biopsy I was consumed by the helplessness and frustration of not being able to do the simplest things. Brushing my teeth was virtually impossible when I could barely even grasp the toothbrush. Same with brushing my hair or trying to put it in a ponytail to get it out of my face (trying to raise my arms so that they could reach behind my head? ouch! and also my arms just wouldn’t bend that way). Opening a door became a feat of epic proportions (doorknobs = enemy of arthritis). Walking five steps to the restroom? How bad did I really need to go? Could it wait? Could I combine it with another task? And how could I forget the indignity of barely being able to wipe my own ass after using the restroom?

There were times when I would be reduced to tears trying to do any of these simple tasks because I just couldn’t do them and I felt so incredibly broken.

A week after my biopsy my results came back and my diagnosis was officially amended to class III lupus nephritis or “focal proliferative nephritis.” (Click here for more info). Basically this meant that my kidneys were being damaged but only in “focal” areas and luckily it was not class IV nephritis which is the worst type to have because it means the damage is all over. But I was warned that it could easily progress into class IV if it wasn’t treated immediately and aggressively. Class IV nephritis can often result in the need for a kidney transplant if it cannot be brought under control.

It may seem strange but I actually felt incredibly grateful upon reflection of the diagnosis. The news was bad but in my heart I knew it could have been so much worse. If my arthritis hadn’t flared to the point where I was no longer able to function, maybe I would have put off visiting a doctor a little longer, or maybe I would have seen a PCP who would have puttered around for months, not knowing the right tests to run and not seeing all the warning signs that Dr. Miller saw immediately. I’ll never know how long my kidneys would have had because the story played out in my favor. I got the help I needed and I got it in time to make a difference.

Immediately following my official diagnosis, the prescriptions started rolling in. I was put on a high dose of prednisone (40mg) which controls inflammation quickly and is often referred to as a “miracle drug.” It is miraculous in how incredibly fast it can start to work it’s magic but what is not miraculous is the plethora of side effects that can come with it (more on this later). For this reason patients are usually prescribed a very high dose initially and then tapered down as quickly as possible.

On the flip side of that, I was put on Cellcept, starting with a low dose that would be tapered up once it was clear I was tolerating it (gastrointestinal side effects are common). Cellcept is actually a drug given to kidney transplant patients, it suppresses the immune system in order to prevent rejection of the transplanted kidney, but was also found to be effective in treating lupus nephritis patients. Here again, I was quite lucky. When I was diagnosed in 2005 the use of Cellcept in lupus patients was fairly new. Years later when I moved back to the bay area my new doctor commented that my nephrologist must have been quite up to date to have prescribed Cellcept to me back then.

So anyway, I was put on the fast-acting prednisone to control my symptoms in the near term, in order to give the Cellcept time to build up in my system and hopefully keep things under control in the long run. I was also given something called plaquenil which is an anti-malarial drug but for some reason seems to work as an “insurance policy” for lupus patients (that is actually how it was explained to me). It seems to keep people in remission but I guess they’re not really sure how or why.

When I first started on all these meds I experienced relatively few side effects. The prednisone made me want to eat everything in sight, but I really didn’t even gain all that much weight. At least not compared to the horror stories I read about people gaining 50lbs in a matter of weeks. I did put on about 15-20lbs though over the next few years which was a lot given my small previously 100lb, 5’3″ frame. But since I managed to escape this round of medication with relatively few side effects, I’ll discuss the hell of side effects in another post about another flare when I was not so fortunate.

To recap, my biopsy was on a Friday and the following Friday I was given a diagnosis and a bunch of pills to start taking. My parents had to leave but they asked me to come to church with them that Sunday before they were to drive up and I agreed. It had been years since I’d gone to church, I’d drifted so far away from my previous life as a devoted Christian girl that I no longer felt remotely comfortable around “church people” as I referred to them. But for some reason in the middle of all of this, it felt like something I not only wanted to do, but needed to do. So I went.

I don’t really remember the sermon that day. But what I do remember is one of the worship songs they sang during praise.

When the Tears Fall – Newsboys

I’ve had questions, without answers
I’ve known sorrow, I have known pain
But there’s one thing, that I’ll cling to
You are faithful, Jesus You’re true

When hope is lost, I’ll call You Savior
When pain surrounds, I’ll call You Healer
When silence falls, You’ll be the song within my heart

In the lone hour, of my sorrow
Through the darkest night of my soul
You surround me, and sustain me
My defender forever more

When hope is lost, I’ll call You Savior
When pain surrounds, I’ll call You Healer
When silence falls, You’ll be the song within my heart

And I will praise You, I will praise You
When the tears fall, still I will sing to You
I will praise you, Jesus praise You
Through the suffering, still I will sing

Oh You’re so good to me
You’ve always been good to me
So trustworthy

You are faithful and true
Sustain me through and through
You are hope and truth
You’re my spring of living water
You’re my spring of living water
Oh in the lone hour, You’re there
Lord in my sorrow, You’re there
Oh You’re my healer
Oh I need You so
Jesus

Like a well watered garden
Who’s springs never fail
You’re faithful and true
Like a well watered garden
Like a spring that never fails
You’re my spring that never fails

I was pretty much in tears throughout the entire song, in fact it was all I could do to keep myself from openly sobbing as I sang and drank in these amazing words. These words that were my reality. Everytime the congregation sang that chorus (which was a lot of times – I left some of the times out to avoid repetition) I cried a little harder. When pain surrounds…oh those words could not have been anymore apt. But suddenly I knew it in my heart to be true, that God had been with me through it all, that God still loved me despite my turning away from Him, that in the end God had protected me when I needed it and brought me home to Him like the prodigal son that I was – before it was too late for me. Before my kidneys failed.

After the service the pastor approached us. My sister and several of my cousins were active members of the church and he knew what was going on with me and he asked if he could pray with my family and anoint me with oil. Part of me felt a little awkward about it, I guess maybe it was a bit much for a wayward Christian who hadn’t been in a church for almost four years, but I was grateful for his caring and agreed. As he prayed over me and blessed me and touched my forehead with the oil, I felt oddly comforted though. I felt loved and cared for. I felt like God’s presence was indeed there with us.

I didn’t miraculously recover after that day. In fact, although my mom seemed to be hoping the prednisone would act within a day, it took me several weeks to really feel like I was on the road to normal. The joint pain did start to slowly fade away, but not before I experienced many more days of debilitating pain. My fevers became more infrequent as the weeks passed and eventually I was able to start driving again (this probably took longer because back in those days I drove a stick-shift which takes a lot more joints to operate than an automatic!) and then I finally felt well enough to return to work.

Paul and I kept attending my sister’s church even though it was a good 40 minute drive away from our apartment. As Pastor David liked to say, “A church alive is worth the drive!” and we both definitely felt that way.

I’d love to be able to say, “And that was the last time lupus ever got the best of me” but unfortunately, as you probably already know, that isn’t how the story ends…

Part 2: Surprise! Your kidneys are broken.

Part 1: Introducing lupus – my unwanted life companion

***

So it was now the end of January 2005, I was 22 years old and had just been diagnosed with lupus. My rheumatologist strongly suspected kidney involvement because, well, my pee was apparently filled with blood and protein but no bacteria (which would have been present with a bad UTI). He didn’t want to start me on any medications until a) he knew for sure the kidneys were being attacked and b) if they were, the extent of the damage.

***

Maybe it’s time to pause the story for a moment and explain exactly what lupus is for anyone who might be unfamiliar. Lupus.org is a great place to get more information but I’ll give you the quick and dirty here. Basically, lupus is an autoimmune disorder in which your immune system begins attacking your healthy tissue. So far no one really knows why this happens and there is no cure, only treatments that keep symptoms at bay. Most of these involve destroying the immune system so they aren’t exactly pleasant, but they seem to work so it is what it is. Since the definition of lupus is pretty broad, it can affect each person differently. Some people only have arthritis and skin issues, others, like me, have organ involvement. It can affect just one organ or several, and what is affected can also change over time. Recently Toni Braxton has announced that she has lupus affecting her heart and Nick Cannon (Mariah Carey’s husband) has lupus nephritis (kidney involvement). 90% of lupus patients are women and it also disproportionately afflicts minorities.

***

But coming back to my own story, my rheumatologist Dr. Miller immediately referred to me to Dr. Joel Mittleman of Cedars Sinai. I found out many years later that he was the nephrologist that did Nat King Cole’s daughter’s (Natalie King Cole’s sister) kidney transplant (maybe there is something to the whole six degrees of separation thing!). He was a busy doctor but since I was referred as an urgent case I was able to see him within a few days.

Dr. Miller had mentioned to me that it was possible Dr. Mittleman might recommend a kidney biopsy be done. I still couldn’t believe there was something wrong with me beyond the arthritis, it had just never occurred to me that there might be something else beyond what I could actually feel. I couldn’t wrap my mind around the fact that my kidneys might slowly be failing no matter what my labs were saying.

When I met with Dr. Mittleman, he had spoken with Dr. Miller and gone over my records and he said he really did think it would be best if I had a kidney biopsy as soon as possible. He explained that while there are urine and blood tests that can be run, because the kidneys are very good at compensating for damage (i.e. if some filters are destroyed, others just work harder until too much has been destroyed and the kidneys fail. This is why someone can suddenly present with kidney failure despite very few warning signs) the only way to know for sure how badly damaged they were was to study the tissue itself. For that they would need to insert a needle into my back (under local anesthesia) in order to remove a tiny piece of kidney. This would be done twice and both samples would be studied for damage and based on how damaged the samples were they could extrapolate how much damage had been done to the kidneys overall.

As shocked as I was by the lupus diagnosis I was even more in shock hearing that I would need to have this procedure done, one which involved an overnight hospital stay. I had never had to stay in the hospital before, I had never had any kind of procedure done in the hospital, I had always been a fairly healthy kid and never so much as broken a bone before.

My doctors proceeded with a sense of urgency so I didn’t exactly have time to absorb everything. The biopsy was scheduled for a week later so I had time to tell work what was going on, that I would need to be out, maybe for awhile. My boss at the time was known to be a bit of a tyrant but she had suffered health problems herself and was very understanding, they told me to take all the time I needed. My parents wanted to be with me for the procedure so both of them drove down and stayed with me for the week following the biopsy. This was the first time I could remember my dad taking time off work with no notice.

I was scared of the procedure itself. I have always hated needles and blood and believed myself to have a really low tolerance for pain so everything about this terrified me. The idea of being awake for the procedure didn’t help things but I was told general wasn’t necessary for something like this.

We went to the hospital early in the morning, I filled out a million forms and was eventually asked to change into hospital gown and had an IV placed (again as someone who hates needles, this was a ton of fun – NOT). I was led back to the procedure room where my doctor and a few other people in scrubs and gowns were waiting for me. I can’t remember if I was given any sort of sedative or not but I was told to lie face down and given the local. Eventually it was time to start the biopsy and Dr. Mittleman walked me through what would happen. I was told to hold very still (I was so scared I was going to accidentally flinch or move) and I felt pressure when the needle was inserted. He told me he had gotten one piece and was going to be going in again for the second. It was all over pretty quickly and then I was wheeled to a hospital room.

After this my concept of time is pretty fuzzy. Cedars Sinai only has private rooms and I remember it was not an unpleasant room. They said they would bring in a fold-out bed later on because my mom had asked to stay with me overnight. I was told they needed me to stay in bed for about 24 hours to reduce the risk of internal bleeding. I wasn’t even allowed to use the bathroom – I had to call the nurse for a bedpan. Luckily I managed not to go #2 during my stay!

At some point my family and Paul left to go to the cafeteria and they came back saying the food was amazing. I don’t remember anything about the food I was given, I don’t think I had much of an appetite and I was pretty out of it because I think they were giving me painkillers at that point. A nurse would come every few hours (including in the middle of the night) to take some blood. More needles, ugh.

Finally it was nighttime and I was given something to help me sleep. My nephrologist had come earlier in the day I think, but my rheumatologist came after I had been given the sleeping pill so it must have been past 9 or 10pm (he was a workaholic!). I remember being so appreciative that he had come to see how I was. I didn’t sleep all that well because of being woke up every couple hours for a blood draw (sidenote: how are you supposed to recover when they don’t let you sleep?).

By the morning I was completely ready to be out of there but had to wait for my nephrologist to come and release me. He finally came around 9 or 10am and I was asked to sit up for the first time in almost 24 hours. I was allowed to get up and use the restroom but when I got back to my bed I was dizzy and my blood pressure was too low. They decided to give me an IV of saline solution to help raise my blood pressure and I remember feeling secretly relieved that at least I didn’t get the IV put in for nothing! I was told to rest for another hour after which my doctor came back and I was finally released.

I was told what to watch out for, signs of infection or internal bleeding and that I needed to take it really, really easy and was not allowed to do anything remotely strenuous.

For my part, I was just glad that it was over and I was going home. I was hoping we’d have some answers soon and that the worst was over, unfortunately as far as my symptoms went, things were only about to get worse…

Part 1: Introducing lupus – my unwanted life companion

Despite all evidence to the contrary, this is not a pregnancy blog.

It’s just that, for a variety of reasons, I actually don’t get to talk about the baby and pregnancy very much in real life and so this blog becomes my space for that. There are only a few people in my life I have been able to just blab and blab to about all my thoughts and fears about pregnancy, or just things that I find downright interesting and am surprised I never learned in sex ed or bio class!

But as much as I will inevitably talk about pregnancy over the next six months, followed by baby updates, I think it’s also time for me to talk more in detail about my past and how exactly I got here.

It’s interesting that despite having kept this blog pretty religiously over the past twelve years of my life, huge chunks of my life are glaringly absent from this space. Things that I never wrote about at all or wrote about in very cryptic ways to avoid people knowing what I was really talking about or going through. A lot of this was due to not really knowing who was reading, being afraid of how it could someday affect my career path, and of feeling judged but not knowing who was judging me.

I’m not completely over any of those fears, and the idea of my parents finding this place still freaks the bejeezus out of me, but now that I am basically “out” at work, I do think it’s time to share more about my experience with lupus and how it has affected every facet of my life.

In a way I feel like I owe it to the 1.5 million fellow Americans who suffer along with me, mostly in silence. There is so little attention given to this disease that affects so many, this largely invisible disease that has only recently started to have any big name advocates to bring the spotlight on those of us who have to live with pain and illness every day. My story probably won’t change much in the grand scheme of things, but I know that every time I come across the blog of someone else writing about their lupus and how it affects them, it is comforting to realize that there are others out there who get it. Others out there who want more research, more answers, and hopefully someday a cure, every bit as badly as I do. Sometimes it’s enough just to know I’m not alone.

***

I’m not really sure where the story truly begins, but I guess the best place to start would be my senior year of college, the first time when looking back, I had clear and unmistakable signs of a lupus flare.

My boyfriend at the time, The Marine, had just returned from Iraq and our relationship was falling apart like a band-aid being peeled ever so slowly off raw skin. It’s a post for another day (one I really do plan on writing) but the gist of it is that he wanted to return to the “normal” life of a college sophomore (where he had left off before the war) and I was about to graduate and truly believed he was The One. I think on some level he did really love me and on another level he might have felt guilty that I had waited for him and so he couldn’t bring himself to break-up with me right away when he returned and knew that he didn’t want the responsibility of a long-term girlfriend who had her sights set on marriage.

Anyway, it was a tumultuous year. I was jealous, insufferable and clingy. He was emotionally distant. And we were trying to maintain a long-distance relationship since I was still in LA and he was attending UC Santa Cruz.

On top of relationship stress I was worried about finding a job after graduation. I found myself about to graduate from college and still had very little idea of what I wanted to be when I grew up. Except I was about to be a grown up. Oops.

Obviously my problems were all what you would call “first world problems” but they were my problems nonetheless and they did stress me out. And as I now know, stress can contribute greatly to lupus flares.

It started small. The joint in my right elbow would lock up. I attributed it to too many computer games. I even saw a TCM practitioner about it, as well as a PCP at Ka.iser and was told it was a dislocated thumb (TCM) and tendonitis (PCP). This was during Thanksgiving 2003.

The pain in my elbow would come and go, worse somedays, better others. The ex finally put me out of my misery during Spring Break of my senior year. I was devastated but also determined not to show it. I partied, I worked long hours at my internship, and I finished my last quarter of college.

Edited to add: I forgot to mention the small but, I think, important detail that after the breakup I started tanning. I had always been pale but living in LA the pressure to have at least some color on my pasty body finally got to me when I was back in “attract a man” mode. Given that I was already having signs of mild arthritis, tanning was about the dumbest thing I could have done (UV rays are HORRIBLE for lupus) but I’ll cut myself a break since I had no idea what I was risking beyond skin cancer (which admittedly was already pretty dumb of me. But I was 21 and heartbroken, so again, cutting myself a break).

I noticed after nights of clubbing in heels that I would have a hard time walking the next day. I would get up out of my chair and my ankle or knee would lock in pain out of nowhere. Sometimes it happened so suddenly that I would nearly collapse onto the floor. I didn’t think much of it, except that maybe I should quit wearing heels. It honestly never occurred to me that something could be seriously wrong with me.

I graduated college in June 2004 and met my future husband on the day I graduated. I also started working full-time at the fundraising firm for which I did my internship. The hours were long, the environment was stressful, the pay was for shit. They didn’t offer health insurance when I first started and I didn’t realize that I was still covered by my parent’s insurance (it’s changed with Obamacare but at the time you were covered until the end of the calendar year of the year you graduated from college) – but as it turns out I was very lucky that I thought I didn’t have insurance because I never saw a doctor. I say I was lucky because my company started offering health insurance as of January 2005 but had I been seen by a doctor in the interim my new insurance probably would not have paid for my treatments since they could have classified it as a pre-existing condition.

As 2004 passed, my symptoms began to ramp up. When I woke up in the morning, I never knew what joint would be aching or swelling. I remember being home for the holidays (I think it was Thanksgiving again) and my knees swelled up out of nowhere. My family wanted me to see a doctor but I was convinced I didn’t have health insurance and so I didn’t. I honestly wasn’t all that concerned, I still didn’t believe there was anything seriously wrong.

My parents bought me a new Sleep Number mattress for Christmas that year (I thought maybe it was my crappy futon causing all my morning aches and pains) and I didn’t have a frame for it so I put it directly on the ground and I remember somedays it was such a struggle to get up out of bed because various joints hurt so badly I couldn’t push myself up. I was like an arthritic grandma at the age of 22.

And then finally, on a Thursday night in early January 2005, a mere handful of days after my new health insurance kicked in, I woke up in the middle of the night with searing pain shooting across my upper back and both shoulders. That was the first time I had ever had pain there and it was completely unbearable. I couldn’t move without pain, I had to use the bathroom but I just literally could not move. I started crying and Paul woke up. I told him I couldn’t move, that my whole body felt like it was on fire and I finally admitted to myself that something was seriously wrong with me.

The next morning, Friday, I called in sick to work and Paul and I immediately set out looking for a doctor for me to see. I called my cousin who was a family medicine resident at UCLA and told him what had happened. Since I had a PPO he advised that I go directly to see a rheumatologist. Paul looked up rheumatologists that took my insurance and decided that I should call someone named Dr. Bruce Miller. Why? Because he had a strong sounding name and an office in Beverly Hills. Yes, that is seriously how Paul picked the best doctor I have ever met.

So I called Dr. Miller’s office and his assistant Delia answered the call. She told me that unfortunately he was completely booked but I guess she heard the desperation in my voice and she said she would take my information down and see if the doctor would call me on his lunch break. I firmly believe she was one of the angels God sent down to help me when I needed it the most.

Dr. Miller? He was undoubtedly an angel in my life. In fact, if our little one is indeed a boy, his middle name will be Bruce.

He did in fact call me back during his lunch break that day. He spoke with me for awhile, listened to my story while he could have been having a nice sandwich. And then he said that he was completely booked for the day but he did think I needed to be seen right away. He asked if I could come at the end of the day, his nurse could draw my blood and take a urine sample before she left and he would see me after his last appointment. Keep in mind this was all taking place on a Friday, when most doctors want nothing more than to get home and enjoy their weekend.

Months later as I sat in his waiting room (he was almost always running behind but I never minded because I knew it was because he never rushed an appointment and wanted to give each patient personalized and thorough care) another patient began to chat with me. I always got a lot of stares in the waiting room because I was usually the youngest one there by a good 40-50 years. People wondered what I was doing there. The woman asked how I had found Dr. Miller (clearly prying but I didn’t mind, she was very nice) and I told her that I had just called out of the blue one day. She was shocked. She told me that there was a four-month waiting list for new patients, that she had been trying to get a friend in to see him for awhile without success. She told me that he was considered one of the best in LA and that she knew of quite a few other doctors who came to him for their own care.

It was my own Footprints in the Sand moment, realizing that the only thing that made any sense was that God had led me step by step to this very doctor, the one who would diagnose my lupus within two weeks of my first visit with him. A disease that often takes years to diagnose. I guess I was “lucky” in the sense that a) I presented quite clearly with lupus nephritis (arthritis, protein/blood in urine, positive dsDNA, low C3 and C4, anemia, etc.) and b) I had an incredibly thorough doctor who knew exactly what to look for and which tests to run.

I’ll never forget the day he called me to come into his office after he’d gotten all my tests back. I couldn’t even drive myself at that point and Paul was in class over an hour away so I had to ask a friend to take me the office. I was terrified, I couldn’t deny it anymore, something was really wrong with me but I had no idea what he was going to say it was. I was sitting on the exam table and he told me he was pretty sure I had lupus.

I remember him telling me that I wasn’t going to die, that the treatments had improved a lot and that death was quite rare nowadays. I know he thought he was being comforting but the fact was I had no clue what lupus was and it never even crossed my mind that I could die from it until he said I wasn’t going to die from it. He told me I needed to see a nephrologist because it was attacking my kidneys, and I realized that’s why his nurse kept asking me if I had a UTI everytime I gave urine – because there was blood in my samples. He was incredibly compassionate and gentle, and other than the death comment quite comforting about the fact that I was going to be okay.

Still, I left the appointment in shock.

I called Paul and told him what the doctor had said. He had class the next day but an hour later he was knocking on my door. He had gotten in the car immediately and stayed on the phone with me without telling me he was coming because he knew I would tell him not to. I already knew I wanted to marry him before that, but after that I was a little more sure.

I don’t remember at what point the shock broke and the tears started, but it happened sometime that night. I don’t remember telling my parents. I don’t really remember much else about that night besides what I just wrote.

***

And….now it’s late so I think I’m going to have to finish this another time. Up next…meeting the nephrologist and my kidney biopsy.

specialists vs normal people doctors

First, the good news, my beta at 4w5d was 5,043!  The nurse seemed quite happy with it so I’m going to take that and run with it for now.  She even said that they’d be able to prove to me soon that there really is a baby growing in there hehe.

And now the annoying stuff.  I’ve been on a quest to find a regular OB and I’m so frustrated by dealing with office staff that is only used to dealing with “normal” people.  They don’t seem to understand what “high risk” means and since this is my first pregnancy, I really don’t know what it means either, but I do know it means that I should not be getting my first u/s at 12 weeks.

I was specifically told by my high risk ob that I should be getting u/s quite frequently, if not at every visit.  I was also told there would be more labs done and more frequent visits than in a “normal” pregnancy.

Well the staff at all these “normal” people offices don’t seem to get that at all.  They keep telling me that as long as there are no obvious complications (i.e. bleeding, cramping, etc.) that they believe I’ll be treated the same and on the same schedule as any other patient.

Um, no.

That is not going to fly.

Then they ask me things like why I’m high risk and clearly have zero clue what lupus nephritis is and why it would make me a high risk patient.

I just don’t want to deal with these doctors for “normal” people.  I like the safety of my specialists who actually know what lupus is and what the risks are.  I don’t know if I can trust a “normal” OB who I will probably have to educate on my condition.  I mean, seriously?  What is the point of seeing a doctor who you have to teach about your medical condition?

I love my high risk ob so much and am so upset that he can’t be my sole provider through this.  I have a feeling that every visit with the “normal” OB is going to be needlessly stressful and frustrating.

I hope I’m wrong, but I just can’t see this going any differently.

procrastinating

Look at me posting two days in a row!

I am supposed to go get some labs done but for some reason I’m really dreading it today.  Maybe it’s because the draws at this lab almost always hurt.  Or maybe I just enjoyed the past few weeks of not having my veins molested.  All I know is I really, really don’t feel like being poked right now.

Unfortunately for me, at last check my liver enzymes were stable but still higher than normal so that needs to be monitored.  And even though my rheumy did not seem concerned that my complement levels were low (low C3 and C4 are a sign of active lupus), I know from looking at my past labs that they were on the low side even given my always low numbers.  So for my own peace of mind I’d kind of like to see them again before we have to really start factoring pregnancy into the equation.  I’m assuming that since I’m only 5dpo right now that even if there is something fertilized and swimming around in there it shouldn’t be affecting my numbers yet.  Or if it is…well…that would be a really bad sign wouldn’t it?

Speaking of 5dpo, I tried so hard today to just forget about the “two week wait” (2ww), but then came lunch time and the suggestion of Japanese food just reminded me, wait a minute I can’t eat raw fish (my favorite)!  And then I grabbed some chocolates from the box where our admin keeps snacks and had to think twice about whether or not I should eat it (I did).  How am I supposed to forget when I’m also supposed to be vigilant about what I’m eating/drinking?

Hoping that the next six days fly by…