Friday, 19 December 2014

Update

I've been meaning to update for a while, but just haven't got round to it, so sorry about that!

Things are going fairly well really. I'm actually on the train to home-home from uni-home at the moment. Excited to have made it through my first ever uni term major-relapse-free! I've barely missed anything (*proud face*), but admittedly I have been part-time this term. I'm even more excited by the prospect of time-off though. It's certainly needed!!!

The beginning of my first term back after medical leave was undeniably incredibly difficult and pushed me absolutely to the limits of (and at times way beyond) what I could cope with physically. I survived though, my ability to flare without massively relapsing reassured me somewhat, and I was incredibly lucky that my body managed to make some improvements and over time fought back less, which is an absolute first! The middle of the term things seemed manageable, and I'd even got marginally beyond prefixing manageable with 'only just'. Just as things were starting to feel doable and I was feeling a bit more reassured and a bit less fearful of a relapse (and less haunted by the memories of how bad relapses can get), things started getting harder.

Towards the end of term, I had a really challenging few weeks, feeling like my body was flagging significantly, and feeling in need of a break! My speech in particular has been really difficult at times, and I've had days where basically every sentence has been a struggle. I find that pretty difficult, because I used to be relatively eloquent and prided myself on my ability to argue a point well; now I get people who see me stammering excessively and fighting with my words who presume I'm mentally incompetent and that's very difficult when the words are in there trying hard to get out! I'm using hand gestures and non-verbal communication a lot recently to try to get me through. I've never been so grateful for my ability to nod, shake my head, point and do a thumbs up and thumbs down, my heart absolutely drops less often now, because I know I will find a way to communicate even if it's not neatly, efficiently and the way I'd like. My second (most recent) speech therapy session was really helpful and I've learnt a few techniques to help me speak a bit more fluently and they do help, but they don't yet come at all naturally. I do feel a bit more in control though and less panicked now that I have some techniques to turn to as needed. People are generally fairly understanding/considerate about my speech difficulties, but unfortunately not everyone is. Some outright laugh, some smile in an amused way, some presume you're totally thick (particularly as I'm visibly physically disabled), some look panicked and/or perplexed, but most people are more concerned about reassuring me that it's ok (which it might be ok for them, but I'm not ok with it) and are patient and encouraging. Negative reactions are difficult, but mostly people have been great- my friends have been amazing with it, not batting an eyelid at all (I do have pretty awesome friends).

The other thing I've been having massive problems with very recently is headaches. They have been utterly awful, practically unbearable at times. I've spent the last few days speaking with various people trying to get them sorted and under control before leaving the area for a couple of weeks. I was quick to blame my newest medication- Fludrocortisone- and stopped that [edit to add: I did check with my doctor that it was safe to do so, and it was as I have only recently started on it]. 3 and a half days after stopping it the pain has lessened somewhat. I do still have a headache though and my facial pain is not as well controlled as usual. It's hard to prise things apart when things get so complicated. They thought the new medication might have caused my blood pressure to sky-rocket and that was the cause of the headache, but when tested it was still only 108/45, so on the low side if anything. The next suggestion was that I might have had a change in my glasses prescription, so I went for an eye test today (on my birthday!) to rule that out- there has been a change in my prescription but not significant enough to be causing severe headaches, thankfully all looking healthy except dry eyes though. So the mystery still isn't yet solved really. I'm thinking it's either the medication and it's taking a while to get completely out of my system, or it's my facial pain. I had already been considering changing my facial pain medication again, but I'd been hoping to not have to go through that too soon, but if it doesn't settle I think that'll have to be the next line of action.

The medication I mentioned stopping- Fludrocortisone- was intended to help my Neurally Mediated Hypotension and stop me going faint; it was hoped that this would help my other symptoms too. It possibly did help with my lightheadedness, but it has also made me feel more rough and tired than normal I think. I certainly haven't felt significantly better on it, so it wasn't overly disappointing to have to stop it, apart from in the respect that I had expected great things from it, which didn't happen.. Maybe there will be other things to try which will suit me better.

I've also started melatonin since last updating on here, and that was a really, really good decision. It helped massively with my sleep, shifting my sleep pattern significantly in the right direction. It also helped me feel a bit better during the day (because I've actually had some sleep), nights are less frustrating and days are longer and more productive, so all good! I wish I had tried it sooner, but it wasn't one of my top priorities to discuss with my consultant until I was wanting to get back into lectures, and that wasn't going to happen without a shift in my sleep pattern. I haven't had any real side effects from it at all (it's naturally occurring in the body anyway, so it's less likely to cause side effects than most meds to help with sleep); the only slight side effect I had was feeling a bit overheated after taking it- even that has settled down though.

I'm feeling in a good place mentally right now, a bit weird about the passing of time with it being my sixth birthday and Christmas ill, my fifth of each with a diagnosis, but mostly I'm just enjoying and looking forward to spending the time with friends and family. I'm delighted with how far I've come and feeling quite at ease with life really. Yes, I still have constant symptoms, some of them are out of control at the moment, and life is quite a challenge, but I'm so lucky to have amazing people around me, and I'm incredibly lucky to have clawed my way back from the depths of severe illness (even if I have only got as far as moderate- next stop mild please!).

As we reach the end of the year, I'm not sure what to make of 2014. It's been a year of absolute highs and lows. I've had months of illness of a severity I could never have accurately imagined until it happened. I've faced devastation when I had to take time out from uni, further devastation when I relapsed even further soon after, months where I was challenged continuously physically and emotionally, but also the absolute high of starting back at uni, being back with my friends and returning to some vague sort of 'normality' (if there is such a thing), and other happy, enjoyable events throughout the year. This time last year I knew I was in for a very difficult year as my body was an absolute wreck; this year I'm not sure what to expect- I'm hoping things will go smoothly as I transition from part-time back to full-time studies, but I'm also aware that I'm still very ill and things could fall apart at any point. I know that full-time studying may not be very compatible with my state of (lack of) health, but I won't know without giving it a good try. I will be very glad to put 2014, along with its difficult memories, behind me, and I'm looking forward to a fun-filled and rest-filled festive season!

Wishing everyone a fantastic Christmas time and hoping 2015 is a great year for you all!

Wednesday, 22 October 2014

I stutter../ International Stuttering Awareness Day

It's not something I have discussed with many people face-to-face, but I now have a stutter. I hate the stammer that has entered my life uninvited, I hate the fact I no longer trust that my speech will be fluent, I hate that I get nervous that I will get stuck and the fact that that makes me not want to speak at times.

It has complicated life, and my life was frankly complicated enough already,

I first noticed problems with my speech quite a few months ago now. To start with the problem was very infrequent, and I was the only one who was at all aware of it. Even now, it's far more obvious to me than whoever I'm talking to, but it's now bad, at times, to the extent that it hampers communication. In my particular case, prolonged sounds appear in my speech- I will get to a word/sound and then be unable to get past the first letter/sound. I often try to re-start the word, the phrase or the sentence to try to get past where I am stuck, but it can be challenging; if those attempts fail, then often if I take a breath and try again it all flows (e.g. I often try to re-ssssss ss re-sss try to re-sss *breath* I often try to re-start the...). If I get stuck and then panic about being stuck, getting past the sound I'm stuck on can be very difficult. At times like these, I actually like people to step in and try to finish my word for me, because otherwise the situation seems increasingly horrific, and the rest of what I need to say is likely to be negatively affected if I get stressed about being stuck. Getting stuck once can quickly escalate to getting stuck repeatedly if I stress about it, particularly if I am tired (when my speech is worse anyway).

Struggling with speech can cause real problems. An example- when checking in at hospital or collecting a prescription, a standard question is to confirm the first line of your address. When you reply ffff fff ff, due to your inability to say 'Five', it's kind of tricky. This has happened to me a couple of times now and I tend to just laugh it off, I do get there in the end!

When talking to people who stutter, my general advice would be:
1) Maintain a normal amount of eye contact, don't look away or turn away when it's obvious someone is struggling (I realise this can be a natural reaction if it feels awkward). Eye contact shows that you're still listening and are still interested to hear what they have to say. The stutterer may look away if they feel awkward, but that doesn't mean you should.
2) Try to make the situation as relaxed as possible. They're likely to be far more comfortable about their stuttering, and may actually stutter less, if you don't make them feel under any pressure and keep the atmosphere chilled.
3) Unless you know that the person is definitely ok with it, don't try to finish off their sentences, as tempting as it may be. People with stutters often get frustrated that they don't feel heard because people are forever deciding what they're going to say for them. Give these people an opportunity to speak and be heard.
4) Don't assume someone is nervous simply because they are stuttering. I have speech difficulties when talking to my closest friends and family, in situations where I am completely relaxed and comfortable. The stutter is just as likely to be causing any anxiety as it to be caused by anxiety. People can be totally confident and relaxed and still stutter.
5) Try not to laugh or make fun of someone for the way they say things. Be aware that people can feel very differently towards their speech difficulties. Some people accept and embrace them and are completely comfortable stuttering openly. Others will try to hide it or will feel awfully self-conscious or will avoid speaking for fear of stuttering. Some may be ok with you making a joke about it, but many will not. Think before you speak- it could be a sensitive subject.. That said, if someone laughs about their inability to say something or makes a joke about it, it's ok to laugh!
6) Be patient! I understand it must be frustrating when someone is not managing to get across what they're wanting to say and you're busy and it's taking a long time, but please just take the extra time to listen. Sometimes it may be a bit harder to pick out what is being said, but please do make the extra effort. You may only come across one person in your day with whom communication is difficult, but that person will likely have a number of frustrating interactions struggling to communicate with a number of different people- please show that person that there are good people who are willing to wait and listen to them.

Speech dysfluencies vary massively in severity and affect people differently. My speech problems are relatively mild, yet I find it quite difficult to live with and accept. There are other people who get stuck on every syllable but are used to their speech being the way it is and are largely unbothered by it.

I hope my speech problems will resolve with time. I have been referred for a speech therapy opinion so I'm hopeful they will be able to help. If not, I hope I will learn to live with my stammer and it will bother me less over time. I hope I will reach a point where I don't fear situations in which I am put on the spot and have to speak for myself.

Communication is vital, and struggling with something as basic as speech has made me appreciate the importance of communication so much more. It is important to remind ourselves that what is being said is far more important than the way in which it is said!




Tuesday, 7 October 2014

Trigeminal Neuralgia/facial pain Awareness

Today, October 7th, is the awareness day for trigeminal neuralgia and other facial pain conditions. I have had facial pain for several years now and I don't think I can begin to explain how severe the pain can get at times. I get very sharp, electric-shock-like pains, particularly in my temples and along my jaw, in addition to vice-like aches in my forehead and cheeks.

Soon after the pain started, I was started on Gabapentin and referred to a Maxillofacial surgeon, with a tentative provisional diagnosis of Trigeminal Neuralgia.

Once seen by the Maxillofacial surgeon I was sent for an MRI scan to rule out a cerebellopontine angle tumour and look for compression of the trigeminal nerves. It came back clear.

The conclusion was reached that my facial pain and related symptoms are, in fact, likely to be as a result of my ME/CFS, which makes sense as I get nerve pain elsewhere.

Around the same time I was developing increasing problems with the sensation in my face, in particular problems with crawling sensations and tingling in my lips and tongue.

My dose of gabapentin was adjusted up and down a few times. Higher doses sedated me and caused horrible overwhelming exhaustion, low doses didn't really work sufficiently.

Eventually (about 6 months ago) I decided to take the plunge and change medications, both because my pain wasn't managed brilliantly, and because I had concerns that the gabapentin could be contributing to my abdominal pain.

I changed to Pregabalin (Lyrica) and eventually got up to the maximum dose (lower doses didn't work sufficiently, but each increase was vile, sending me into a very ill, semi-comatose state for a week each time). My pain seemed to be under control for a short while.

Recently though, my pain has flared up again and I suffer with headaches, stabbing pains and tooth pain on a daily basis. I have had a few occasions where I've been absolutely writhing in agony, it's awful.

I think people would think my facial pain is a minor inconvenience compared to my other problems, but when it's bad, it's far more than that. It affects my quality of life significantly and the severity during shock-like episodes is certainly as severe as any pain I get resulting from my other conditions. The pain is all-encompassing and simply cannot be ignored. I quite often literally gasp with the sudden intensity of the pain. And then it goes as quickly as it came.

I'm on epilepsy medications to dampen down my nervous system to try to control the facial pain. I wouldn't risk the side effects and interactions with other meds if the pain was bearable without, but it simply isn't.

Many people have lengthy, unpleasant (unnecessary) dental treatment prior to diagnosis. Most sufferers are on daily medications. People go through deep brain surgery or have treatments to damage the nerves involved to try to relieve the pain. If you look up Trigeminal Neuralgia, you soon come across the fact that it's sometimes known as 'the suicide disease' due to the high rates of suicide in this patient population (mainly before effective medications were available, but some even now) due to the pain's severity and the condition's unpredictability. These conditions are not trivial. It's not a case of a bit of a headache or a bit of toothache. The conditions are, without doubt, often life-altering.

Thanks for reading and please do help spread the word about these conditions.





Saturday, 4 October 2014

Return to Uni following medical leave

Returning to University following medical leave has been a roller-coaster of emotions.

Firstly, I'm elated to be back. When I suspended studies and left, I was terrified I would never be well enough to manage to return. When you get the opportunity to return to what you want to do, rather than living 'the sick life', it's awesome. I couldn't wait to see my friends, and was keen to feel part of things again. I thought things would feel more normal..

And then you get back and realise 'normal' really doesn't apply to you these days. I'm part-time, doing a phased return at the moment = abnormal. I use a mobility scooter = abnormal. I'm seriously chronically ill = abnormal. I'm in a new year group with all new people = abnormal. I can't physically do what I want, when I want = abnormal. You see where I'm going.. I realised just how abnormal my situation was when I had returned to Uni and was surrounded by healthy people my own age- they have SO. MUCH. ENERGY!

I, on the other hand, am severely lacking in energy. Living away from home, I'm now very reliant on friends- they have been utterly amazing, but it's frustrating not being able to do things for myself. I'd forgotten the amount of time I spend in a typical day staring at things just out of reach, wishing they would jump into my hand. Sitting in bed at the end of the day contemplating getting changed into pyjamas is horrific- you know you're about to flare your pain up to an extent that will make it difficult to sleep for hours... Not easy.

Being chronically ill is beyond hard. You are exhausted and it's exhausting- there is so much hassle trying to sort everything and juggle things. And then the more you think about it all, the more exhausted you get, and the more difficult it becomes.. Ugh.

Being back with all the normal life stresses reminds me how incompatible stress and chronic illness are. Stress really, really flares up my symptoms. But keeping calm and relaxed is easier said than done while facing huge challenges. I consider washing and dressing huge challenges, but returning to Uni means facing challenges much greater.

It's difficult being new to a year group. It's almost tempting to creep in, hide, quietly get on with things, then creep out (although creeping quietly on a whirring mobility scooter is fairly impossible). It's particularly hard when other people already know one another. It's yet harder still when you don't trust your speech not to play up, remembering names and faces is practically impossible, and you're feeling decidedly 'different'. You feel exposed and alone.

Thankfully, my group have been lovely, and I'm lucky in that I have support workers, which means I always have someone with me, so even from day 1 I was never really actually alone- perfect!

My symptoms, on the other hand, have been far from perfect. I always knew my symptoms would increase on starting back, so it hasn't come as a huge surprise, but it's hard. Pain, fatigue and nausea, among others, have all been severe at times, and it's difficult when you know that it's something you're choosing to do that's the cause of the increase in symptoms. I don't want to cause myself more pain, but I have to accept that doing what I want to do is going to cause my symptoms to be at an even higher level than they were when I was doing very little and resting a lot. It's just the way it is. My facial pain has flared up again (despite being on maximum dose Lyrica) and I now have tinnitus- oh, the joys.

I wanted to be much healthier when I started back than I have ended up being, but you have to hope for 1 thing, expect less and accept much less quite frequently with chronic illness, in my experience. My pain and fatigue levels are still fairly nasty, I still get dizzy and nearly faint a lot, and I still feel utterly rough. On a positive note, I (briefly) met my weight target a few weeks before starting back!!! It's only taken 3.5 years, haha. I've since lost around half a stone, but at least I had got up to where I wanted, so I'm away from the danger zone! The threats of tube feeding seem like a distant memory which is rather nice!

The other fairly recent improvements were in my speech and balance. My speech got a lot less glitchy when I started wearing my compression tights following my NMH diagnosis, and I started losing my balance less often. I had also been practicing my balance too, so would like to think that also helped a bit. Both have become significantly more problematic again since starting back at Uni and getting extra-exhausted, but hopefully will improve again once my body is freaking out less- fingers crossed. Difficulty communicating because of my stutter is really frustrating and embarrassing..

Having reached a severity I can't even bare to discuss while I was on medical leave, I'm scared about ending up back there. In fact, terrified may be more accurate. An experience like that stays with you, whether you want it to or not. I faced limitations only a minority of people my age have faced, and I can tell you that it's frightening, undignified and soul-destroying. I hope no-one reading this ever ends up in that state, and if you're currently severely affected, I really honestly hope things pick up for you and wish you all the best.

Everybody has been really lovely since I started back- staff, students, everyone. I couldn't have wished for people to be kinder or more accepting. I have, however, been asked 'what happened?!' multiple times; I didn't understand what the question was getting at the first time, before eventually catching on that people were assuming I was using my scooter having had some sort of accident. It's then a bit tricky explaining that you're long-term ill and can't really stand/walk anymore as a result. Not quite as exciting an explanation as they were anticipating..

It's all awkward really. How much do I tell people about where I've been? I'm more than happy to be honest with them, but I appreciate that chronic illness is sometimes an awkward thing to talk about. I don't want to sound moany, but I also don't want to make light of what was, and continues to be, a seriously difficult period of my life.

I'm also, understandably, getting people asking how things are going since starting back. The truth is, I'm not really sure. I'm doing very little yet it's really hard, symptoms are pretty vile, new/recurring symptoms are a concern, I'm having to medicate my pain more regularly due to the severity, and I'm struggling. But I expected that. The thing I don't know is whether it is sustainable. I honestly don't know whether my body can cope with this long-term.

I don't know whether things are likely to get easier or get harder. If things get easier I'll be able to increase what I'm doing and possibly get back to full-time by January, which is what I'm hoping; if things get much harder, I'll be left with no option but to suspend studies again, and then questions would have to be asked about whether getting through my course is a realistic aim. I've had a few appointments that have made me wonder whether I'm being a bit overly-optimistic about my chances of the return to uni working out, but we'll just have to see how things go. At the moment, things do, unfortunately, seem to be getting worse. The last week or so, I've been managing less and my symptoms have been getting significantly worse. It's really worrying and disappointing. I'm clinging onto the hope that it's just a flare and things will pick up again, but I'm honestly not sure..

So yes, that's the truth, although that's not necessarily the response that people are likely to get in person. I'm happy to admit that it's hard, but I like to give the impression that I'm coping, which I am- sort of. I don't know whether a relapse is imminent or not. I was asked in an appointment recently whether I could see crashes coming and the honest answer, even after 5 years, is still no, really. Sometimes, they just happen. I'm not ready- physically or emotionally, to face a serious crash, so I seriously hope it's a while before the next one inevitably happens!

To anybody who reads this because they are planning a return to uni following medical leave, my advice would be:
1) accept that it will be hard. Really hard. Get that firmly accepted before starting back.
2) have whatever you would normally use to get through flares to hand (painkillers, heat pack, easy meals etc), and be prepared to use them to help you through the first few weeks.
3) don't panic if symptoms are worse initially when you first start back, it's bound to be a shock to the system. 'If symptoms persist consult your doctor' or consider reducing your workload a bit.
4) prepare for your return in advance (if you've got time). Get your brain back to speed again by doing a bit of reading. Read over things that you will need to know. If you're well enough, build up your physical strength and stamina, even if that's just practising being sat up long enough to get through lectures. If it's all rather last minute, don't panic, just get yourself as prepared as you can be given your circumstances.
5) make sure those who will be supporting you- at home and at uni- are aware of where you're at physically and the challenges you're going to face physically, mentally and emotionally. They're going to need to be your cheerleaders, supporting you through when things get tough.
6) agree on a suitable timetable. Consider part-time options if you're not well enough for full-time.
7) get appropriate support agreed and in place. Think about DSAs, support workers etc. Disability advisors are absolute stars when it comes to sorting out all this stuff.
8) keep your fingers crossed (not literally- don't wreck your hands before you've started!). You can't control how your body will react, so it's all partly down to luck. Give yourself the best chance you can of things working out and then simply hope for the best- it's all you can do!
9) look after yourself best you can. It goes without saying that you don't want to risk ending up back on medical leave again.. It's not a sprint, it's a marathon- take things steady. Monitor how you're getting on and let people know early if alarm bells should be ringing. Stop and rest as necessary- missing a lecture is far less disastrous than relapsing from attending a lecture when not well enough. 
10) enjoy it!!! You're starting back because you want to be there- appreciate being back, remember how much you longed to be there while you were off (and remind yourself of this repeatedly when you're trudging your way through a difficult assignment..)!

I certainly don't regret starting back. It's great, I love immersing myself in my work and almost forgetting about the challenges of life for a while. It's amazing to feel like I have a sort-of purpose and a proper place in society and the outside world again. It's a relief to finally look in my calendar and see something other than medical appointments. 

It's hard (understatement), but of course that's the case! I only just improved enough to start back so I was hardly likely to be frolicking around doing a full-time timetable and finding it all a doddle. I'm doing a very reduced timetable and it's very much challenging my limits. But that's fine-ish, it's my choice, I want to be working at the maximum I can manage. I'm managing to study a little, and I'm enjoying it, which is great! Obviously I'd love to think I'll start to improve and will get back up to a full-time timetable and manage it comfortably, but that feels a world away from where I'm at at the moment, so whether that will happen remains to be seen!

I'm starting to realise that returning to uni is all well and good, but remaining at uni is the real challenge... Fingers crossed!!!

To everyone else with a chronic illness returning to studies or starting uni for the first time, I wish you SO much luck and hope it all works out for you!

Tuesday, 29 July 2014

Lots of updates! Various appointments plus last few weeks

I promised an update on my other appointments, so here goes... (There's also a general update at the bottom)

Maxillofacial unit
My facial pain is bearable at the moment, having increased my pregabalin fairly recently, so we're leaving things as they are for now.

Asthma review
Peak flow was 390, which is really good for me. Agreed to keep medications the same.

GP (PCP)
Appointment went well. Among other things we discussed my rib pain and he thinks it's my intercostal muscles. I am trying some ibuprofen (alongside my other pain meds) to see if the anti-inflammatory properties help; he said it was what he'd use for 'normal' patients so it was worth a try. I said I wasn't keen to try anything stronger than tramadol and he agreed that they would flatten me.

Immunology/CFS Consultant
Appointment was really constructive.

I said my balance had got even worse, and he suggested I got a wobble board to practise my balance.

I said my temperature was all over the place and he said it is a common problem with CFS but nothing can be done.

I mentioned that I was concerned that my hands have been shaking at times, normally in the evening, and asked whether it was likely to be due to weakness. He agreed that it was, and suggested I squeeze a stress ball and/or use a gyroscope exercise ball to strengthen my hands and wrists.

I said that I've been having some speech problems. He says stuttering is common and he wasn't concerned but if it starts causing major problems I can be referred to speech and language pathologist for vocal exercises. He said that he felt there were other things more important to focus on at the moment.

I mentioned that a GI consultant had said that he thought it was possible I have gastroparesis, but said that my nausea etc hadn't been so bad recently so I wasn't keen to go ahead with testing at the moment. He said that if it flares up again, there is someone in a nearby city who looks into neurological GI problems that I can be referred to.

I mentioned my rib pain so my vitamin D is being checked and I've been on folic acid a while so my folate levels are being checked.

Most importantly we discussed my plans for returning to Uni and he agreed that a return in September can go ahead but that I should only do 3 afternoons per week to start with. I was VERY happy to get the thumbs up to start back, even if it is only part-time to begin with - yay!

Update
I coped remarkably well living with friends for a week at my university city while I went to appointments. We had some lovely days and evenings out. I feel a bit more at ease with the idea of going back having managed relatively ok while I was there.

I wasn't managing to help out with anything really, and I feel bad relying on friends so much but I'm sure we'll work something out. I felt very aware that I need a lot more help than I did a year ago, and I also (ideally) need help that I'm not willing to accept. I muddled along ok though- I managed to keep my hair washed regularly and everything like that, which was an achievement. I've had a shower stool (for at the sink) and a bath stool (for having showers in the bath) delivered ready for September, and they helped. I was also pleased that I made sure I spent plenty of time resting.

My mobility and balance have deteriorated recently and I felt a bit unsteady getting around the flat- I need to find all the places to grab hold of/lean on and get my confidence back, but hopefully that will come with time.

I then went back to my university city a second time for my tilt test, and two trips so close together in addition to the tilt test itself, knocked me back a bit. The last week has been a bit rough.

I can't believe I've been diagnosed with Neurally Mediated Hypotension for a week already. I've been trying to look up information online but it seems to be sparse and there is real confusion in terms of terminology. I have come to the conclusion that Neurocardiogenic Syncope and Neurally Mediated Syncope are the same as Neurally Mediated Hypotension. I believe that these aren't the same as Orthostatic Hypotension; I think NMH/NMS/NCS involve a drop in heart rate in addition to a drop in blood pressure, whereas OH is only a drop in blood pressure, and it seems OH is generally seen in older people. Orthostatic Intolerance is different again- that's an increase in symptoms when upright, frequently seen in CFS patients, but it's a symptom rather than a condition. Vasovagal Syncope refers to simple faints- NMH makes Vasovagal Syncope more likely/frequent. Postural/Positional (Orthostatic) Tachycardia Syndrome is a condition similar to NMH; it is also a form of dysautonomia, but the heart rate increases by 30 beats per minute on standing- it causes similar symptoms but whereas NMH can lead to fainting, POTS doesn't. Not sure if that clears anything up for anyone and I'm not 100% sure of the accuracy of any of that, but they are the conclusions I have come to. It would seem there are probably some inconsistencies between specialists to be honest.

I've been tired this week. I've had a few nice days regardless, but have had some rough ones too. My rib pain has eased off a little but my facial pain is twinge-ing a bit, so swings and roundabouts really.

Emotionally I haven't particularly struggled to come to terms with my NMH diagnosis. It feels positive to know that I have it, because it opens up more treatment options.

The 2.5 litre per day fluid intake is really difficult. It's still a struggle every day, but I'm doing it. I'm finding it hard to find foods to put salt on, but I'm trying to have at least 1 high-salt thing per day. Tilt training is really tough- it makes me feel really rough and makes my legs really painful, they shake and my knees threaten to give up, but I'm determined to persevere. My tilt training times seemed to be rising quite significantly early on but they're fluctuating a bit now. Considering my first time was 4 seconds, I'm quite pleased to have broken the 10 minute mark a couple of times in the last few days.

I have no idea whether I should have seen an effect from the increased fluids and salt yet (apart from increased trips to the bathroom); I'm still hopeful that these will help, and am (sort-of) looking forward to my compression tights arriving to see whether they help too. At least I know that there are further options to try if these things fail to improve my symptoms.

Tuesday, 22 July 2014

Tilt test and additional diagnoses: Neurally Mediated Hypotension and Vasovagal Syncope

A while ago I was seen by a consultant who suspected that I had Neurally Mediated Hypotension from my symptoms, but she said a tilt test was needed to confirm the diagnosis. An appointment came through and my mum and I headed off for me to have it done yesterday.

I got called through by my consultant and she explained that I would be wired up to monitoring equipment and we would see how things went- I would be stood up for 20minutes and then if I felt able to be stood longer I would be given a spray of GTN (to dilate blood vessels) and then stood for a further 15-20minutes. She asked whether I thought I'd manage the full 40minutes and whether I was happy to go ahead with the test- I said that I would see how things went, I couldn't predict how I would cope with it, but that I was happy to give it a try.

They pulled the curtains round and I lay on the tilt table, which just looked like a bed with a platform at the bottom. My feet were against the platform ready to be stood up. I was wired up to an ECG machine (just 4 leads) and blood pressure monitoring equipment by a lovely nurse. I was then strapped to the bed and a table was put across to rest my arm on once standing.

The nurse said to let her know if anything was digging in or if I was getting pain both because they wanted me to be as comfortable as possible and because pain would decrease the likelihood of the test working because it would cause my blood pressure to increase. She also said that I should let her know if I was experiencing any symptoms and that we wouldn't be able to chat once I was upright because me talking could affect the readings and it could also distract her and she needed to be watching the screen.

They then started monitoring with me lying down. There was some difficulty getting readings on one of the pieces of equipment (because I have poor circulation and cold hands) to start with, but once they were getting reliable readings on the monitor, they stood me up.

It's a peculiar sensation, because you're sort-of standing but you're supported by the bed and the straps. You're almost, but not completely, upright. I felt some symptoms to start with, my heart was pounding and I felt quite light-headed, nauseous and hot-and-cold-prickly, but then things eased off and waxed and waned.  The nurse checked with me that the straps and everything were ok. Once stood up I found it quite difficult to speak and could feel increasing pressure (presumably blood pooling) in my feet and legs. The nurse watched the screen intently throughout and made occasional notes and my consultant popped her head in a few times to check everything was going ok.

20 minutes arrived and the nurse said that she'd give me a spray of GTN under my tongue. She explained that it might feel uncomfortable in the base of my mouth, might make my heart race and there was a 1 in 20 chance of it causing a headache. She explained that it's only in the blood system for about 10 minutes, so it wouldn't have long-lasting effects. I agreed to go ahead and she said it didn't taste very nice and she was right. It's a very strong taste that sort of takes your breath away.. I can't really describe it, but it's not nice.

The nurse said not to be disheartened if we didn't get a positive result this time and that it's difficult to try to get the blood pressure to drop when it's not what it wants to do. But then she asked me a knowing 'are you starting to get an increase in symptoms now?'. I had been feeling pretty rough but wondered why she asked.... And then I knew. She had said previously that she'd probably see my blood pressure dropping before I felt myself going- she was right. Soon all I could manage was a few grunts in agreement that I wasn't feeling well, I'm fairly sure an alarm of some sort went off (though it could have been a tinnitus-type noise), and then I was out.

Passing out is a fairly indescribable feeling, but very familiar to me. The heat and cold washes over me, I feel ridiculously nauseous and acutely unwell and then I normally lose my sight and/or my ability to speak before losing consciousness.

The next thing I knew, I was coming round from a dream that I cannot recall, but remember was strange, to find about 4 people (including my consultant and the nurse) stood over me. I remember someone saying "Jessica, you're in the hospital", a feeling of confused panic, followed by some vague recollection of what was happening. I remember my consultant saying to wiggle my feet around to help me come round quicker, and someone else advising me to move my legs like I was on a bicycle; I remember just trying to work out where my legs were- I twitched around a bit (completely uncontrolled) and they seemed satisfied. I remember someone saying they would put a cold cloth on my head, and then being taken by surprise because I hadn't processed the words yet. I remember feeling totally disorientated and confused. I was offered a drink of water and caught the straw in my mouth but it took me a few seconds to work out how to suck and then a few more to work out how to swallow lying down. I was asked whether I had someone with me and their name, and just about managed to force out some one-syllable answers, but it was hard. I was still just trying to come round.

My mum was brought in to sit with me and I was still wide-eyed and fairly unresponsive, but was getting there. I had some more water which I managed better. I noticed for the first time that I was no longer strapped to the bed, the table for my arms was gone and my legs were raised on a big cushion- all changes made while I was totally out-of-it.

The nurse and my mum chatted briefly while I came round a bit more, and apparently I had looked like a rabbit in the headlights. I have a habit of fainting with my eyes open, it's apparently a bit freaky, but I don't have much choice in the matter.

The consultant came in and said that my blood pressure dropped dramatically which caused me to lose consciousness (and we were shown the traces). She said she was confident that I have Neurally Mediated Hypotension and resultant Vasovagal Syncope (fainting). She said that I'm getting blood pooling in my legs when I'm upright which is causing too little blood to get to my brain, heart and muscles which results in light-headedness and fainting, but is also probably a contributory factor to my fatigue, nausea and other symptoms.

I've been advised to squash the blood out of my muscles before standing up (eg. By crossing my legs), drink 2.5 litres of non-caffeinated fluid per day, increase salt intake, wear compression tights and do tilt training (stand 15cm away from a wall and lean against it until symptoms arise twice every day- the amount of time should increase with time).

None of this is going to exactly be easy, but if it helps to improve my symptoms then it will be totally worth it. There is no cure for Neurally Mediated Hypotension but there is symptomatic treatment. If the above methods don't work, I can be given medications, but they don't fix the underlying problem, they increase the blood pressure so that it drops from a greater level and therefore hopefully doesn't then drop low enough to cause symptoms.

After discussing with the consultant (which basically involved gentle grunts from me in what seemed like the right places- I was still pretty out-of-it), I was disconnected from all the monitoring equipment and started working towards sitting up, managed to get onto my scooter and left once I felt safe to sit up and scoot home.

I got something sugary to eat and a big drink in the hospital cafe and recovered quite well. I was extra-tired and needed to be flat a lot of the rest of the day but didn't feel too bad.

NMH is a form of dysautonomia, which means I've got a problem with my autonomic nervous system which controls everything that happens in the body automatically. The signals between my brain and my heart aren't working correctly.

It hasn't come as a huge surprise but you get so used to things coming back 'normal' with CFS, and you get so used to things being not only incurable but also untreatable, that I almost didn't dare believe someone would find an often-treatable problem that they think could be a significant contributory factor to my condition. I don't think I can come round to the idea that any new diagnosis is exactly 'good' but it sort of is this time because it's something major but potentially treatable, and treatable is most definitely good!!

PS I have had other appointments that I haven't updated about yet, but I will do. They went fine and there were no other new diagnoses, just advice. My main consultant did say he was happy for me to return to Uni for a few hours per week in September though which is exciting. Will explain more soon.


Thursday, 3 July 2014

03/07/14 update: health, Uni, medical leave

It's July. Already?! Eek. Where on earth did June, May, April, March and February go?! Wah! It would seem time in fact flies regardless of whether you are having fun..

I'm heading to my university city for a whole week soon to see a few doctors and sort out prescriptions and have my asthma review.. All exciting stuff. It'll be nice to see some friends who are still there though (some won't be around which is a shame). I'm not quite sure how I'm going to manage everything I've got planned, alongside serious challenges including getting washed and dressed, but I'll give it a go. What's the worst that can happen?! Ok, don't answer that actually..

How have things been since I last properly updated? Well, much the same really. I'm struggling to varying degrees with things I wish I still took for granted. I have been out and about a few times and have seen a friend though which has been nice.

My sleep schedule is still rather.. unique. I recently had to fill in a sleep diary for hospital which basically showed that my sleep is a mess (my analysis, not theirs). On average I got less than 6 and a half hours of sleep (range from 2hrs45 to 9hrs20) and it took an average of 200 mins (3hrs20) to fall asleep after lights out (range 2 hours to 5 hours 10 minutes). Yeah. Normally I sleep from about 2 until about 10, but it varies a lot.

Pain. Well, it hurts. I went to the cinema recently to see A Fault In Our Stars (good film, but tears are inevitable) and I remember them quoting 'pain demands to be felt'. So very true. 50mg Tramadol is now about as effective as swallowing a smartie and hoping it will help. My pregabalin (Lyrica) dose has now been increased to 600mg total per day.. The maximum dose. I'm not totally sure this is safe long-term as I'm only relatively light (and several doctors have pointed out to me that dosages should really be dependent on weight). It seems to be helping to some extent thankfully, but my pain levels are far from ideal. My ribs have been agony in particular- they never used to give me much grief, but the last few months my ribs have given me more grief than most other body parts.

On the subject of only being little, I'm significantly less little than I was- yay! I'm still about half a stone lighter than I was when I was well but I'm quite happy with how things are going. My weight is creeping up nicely. My ribs are still horribly bony yet my tummy is big and swollen (ok, partly IBS-related)- typical- you really should get to choose where the weight goes!

On a closely-related matter, my nausea is still ok. Not going to talk about this any further incase I jinx things ;)

Fatigue is still a nightmare. I still have to lie down a lot. Doing anything vaguely physical is pretty much a no-go. I can go out on my mobility scooter for a day (well, a few hours) and I'll be shattered but I can manage that ok (not every day, but some days). Bathing/showering and dressing and washing my hair (the absolute worst!) are much, much more of a challenge.

Walking is a real challenge. My balance seems even worse than it was..

My mood is variable, but it's been ok. The pain levels have been difficult to endure at times and that wears me down. I've also been stressing a bit at the idea of starting back at Uni, because things are far from how I'd hoped they'd be at this point, but it's exciting to think I'll hopefully be back with my friends and doing what I want to do. The lack of progress is frustrating. Going weeks at a time without seeing anyone your own age is strange. Relying on others and losing any sense of purpose is soul-destroying. But mostly I muddle along ok, and stay relatively happy. I enjoy the little things, and they keep me going.

My brain feels very mushy and I get mentally fatigued as well as physically which is frustrating. I can't always manage (and when I can, I often forget) to reply to long messages (sorry everyone currently waiting for replies) and I can't always manage to update my blog which is why posts are sometimes rather infrequent. This is a bit of a concern considering I'm hoping to return to university in September. I also get stuck on sounds sometimes (sss, lll, rrr, www) and can't remember specific words when I'm talking which is really annoying.

It's become clear to me that Interruption of studies/Medical leave(/being stuck at home chronically ill for any reason) is far from the 'easy option'. The challenges while struggling at Uni are different to those while on medical leave, but neither circumstance is an easier experience than the other. I dream of being back at Uni, but I dream of being back AND well- I don't miss the constant administrative nightmare of juggling everything medical with studying, I don't miss trying to do pieces of work or revision through flares, I don't miss never knowing how I was going to drag myself through the next day, I don't miss trying to get my screaming body through to the end of the week and spending the weekends recovering enough to face the same onslaught the next week. When I was struggling at Uni time off certainly appealed, but I definitely didn't hope for this reality- time out from Uni, with little you are able to do, too ill to go out regularly, and few friends around to visit, is isolating, depressing, mind-numbing and incredibly frustrating; nobody would 'wish they got to lie around all day like me' if they took into consideration the amount of pain I'm in, the lack of choice I have in the matter, the fact most daily tasks are a huge challenge or impossible for me most days or how horribly ill I constantly feel. When I was at Uni I wanted a holiday- but from Uni AND my illness, primarily the latter. Basically, I just want rid of this illness, then even the holiday wouldn't be necessary, although it would still be nice!

I had no choice in swapping from struggling at Uni to going on medical leave because I was too ill to stay studying, but I have a choice (to some extent) about swapping back and I still want to try and study again, despite the challenges. I'm going in with my eyes wide open- I know it's going to be hard- but it'll be worth it. I can't do the job I want without getting through my course first, so although it would be great to enjoy every second of my course, right now just getting through it is the aim. I love my course, and I just hope it doesn't feel like an ordeal this time round. I'm not a lot better than I was when I left, but I want to give it a try. I'm paying rent anyway, so I may as well try and live there! I won't do anything stupid though, there's lots that needs to be taken into consideration. If I don't feel able to meet the demands of my course, or my condition relapses, I will have to retreat.

This is all presuming I get the go-ahead from my consultant to resume my studies.. I think it's going to be a close call to be honest. I could obviously influence the decision hugely if I wanted to, but I want him to be able to make an accurate assessment of the situation and advise me accordingly. Balancing my health and my ambition isn't easy, so in a way I'd like someone else to be making the decision.

Going back would risk aggravating things, and could possibly trigger a further decline in my condition. I'm not sure I feel able to cope with an even greater level of illness and disability. Obviously that would be worst case scenario but it's perfectly possible..

Living with a chronic illness seems to involve constantly walking fine lines. It's often hard to know what to do and actions always have consequences. You can't always prioritise health, because you could end up mollycoddling your failing health and getting nowhere in life. Sometimes pushing boundaries to some extent is a positive thing. Pushing them too far, however, risks disaster. You do have to know when to step away but at some point you have to try dipping your toe back in the water again, but knowing when it's safe to do so isn't always easy.