Last post was April 6, one day before my 43rd birthday.  Today is August 15th.  In the blogging world, that’s a lifetime.

The photo above is the best hint I can give for what I hope is in our near future.  Writing the post in April began a long period of introspection (as if I don’t live in my head enough as it is) and some very blunt conversations with my spouse.

Changes are coming, though I don’t have dates and don’t know how they will be accomplished and where the money will come from.  Faith for finances has always been a weak spot for me, but I choose faith each day and we should know more next Thursday.

Listen, folks.  When it gets so bad your native humor runs away and you smile only with your lips, it’s time to do something.  Do what it takes, in faith, to change your life in a way that will accommodate your physical changes as well as your emotional needs.  I thought it was selfish.  Turns out martyrdom is not something we choose for ourselves without serious consequences for those we love.  You will be a better parent, partner, friend, and employee if you take care of your basic needs for rest and health.

You’ll smile more.  Your sense of humor will find its way home.

I’m banking on it.  I have our whole future riding on it.

I remember how it started:  One or two names applied like a Kick-Me sign such as drama queen or hypochondriac; a worried daughter who didn’t understand I wouldn’t get better; a spouse who mirrored my symptoms and said he knew how I felt.  Slowly I spoke less, related less, and retreated behind a mask.

I don’t remember when it took over.  It could have been the realization that my employer feared lame ducks.  It could have been too much sympathy.  Regardless, one day I realized I was unconsciously hiding pain – at almost any cost.  I woke to a feeling similar to the childhood certainty that the monster under your bed was after you, or discovering a betrayal so deep it would forever alter your world.

I did what I always do.  I ran straight to my heavenly Father, gibbering prayer as fast as I could write or speak.  You work so hard for so long to ignore it because that’s what good, unselfish people do.  Push it down, shove it away, and tell yourself it isn’t that bad or somehow you earned it.  If that doesn’t work, you fall back on theology.  The rain falls on the just and the unjust alike.  There must be something you are meant to learn.

I poured all these things out in prayer, and then I continued to hide.  My very personality changed as my natural buoyancy and good humor was channeled into hiding pain – even eventually from myself.  I was no longer concealing the condition of my body.  I was concealing my soul.

The harder you work to ignore the pain the more you believe your own lies.  People are used to seeing you stumble so you tense every muscle and steady your gait.  The winces, jerks, tremors and gasps are blamed on your cerebellum, or vertigo, which seem more acceptable than pain.  Over time the body stops bruising and you learn to widen your eyes just right to keep the tears inside.

You choke it down, pretend your concentration isn’t raggedly messy, and keep moving.  Painkillers are bad for two reasons.  Any cessation of pain just makes life harder when it returns.  And by now your body will put you to sleep with anything stronger than Aleve.  Can’t sleep on the clock if you want to eat.  Aspirin and ibuprofen are forbidden if you don’t want to vomit blood.  Tylenol might as well be a sugar pill.  Two Aleve a day becomes four and then multiplies to six.  It isn’t enough but sometimes it takes the edge off long enough to get something done.

Time passes.  The groans that used to slip out in solitude now sometimes slip out in public.  Taking a shower is an hour-long process filled with danger and frightful near-misses because your balance is really that bad.  You try to talk about it, but you’ve hidden too long and convince no one.  You miss more work.  Your wall develops cracks that allow the pain to swell your blood pressure.  You can’t hide that, though treatment is confined to a return-to-work slip and temporary medication.

You redouble your efforts to hide but your body refuses to work.  You build the wall higher with bricks of responsibility and mortar mixed from shame and fear.  Sometimes you wonder what will happen if you are jobless, dependent, helpless or immobile.  You fail at some big things simply because you couldn’t remember to do them.  You fail at a lot of small things for the same reason.

More effort and concentration poured into concealment saps your strength and love of life.  You hide it well and learn to smile, joke, and even listen.  You can’t slow down.  You can’t rest.  People will be disappointed, bills will go unpaid.  There is no chance to stop, assess, figure things out.  Keep moving.

You succeed so well that you lose access to your emotions.  You end up in the ER on a morphine drip, gasping for breath, unable to articulate how you feel or what hurts.  You fool your own doctors and close the last door to help.  The next time your neck goes out, you are offered a nerve conduction study instead of steroids or traction.

You lie in bed twisting and peddling to prevent acknowledging your limbs, your joints, and a neck that feels like a cork between enthusiastic thumbs.  You cry in your sleep and remind yourself that others have it worse…it’s not that bad.

God forbid a chink appears to allow that pain to swamp you in a flood of reality.  Go back to the ER or go back to bed, but set your alarm because tomorrow is another 14 hour day that must be endured lest you let down your family or the bill collectors.

Life becomes a tiny box as your wall rises all around.  No emotions, no one to see your soul.  Just you and the pain locked away together behind a Mona Lisa mask.

And no one knows.  If they know, surely something would be done.  Some form of rescue would be attempted.  Instead you cry silent inside tears, knowing no one will save you, restore you to something beyond simple endurance, or tell you “enough.”  Not even the one closest to you.  Your hope and salvation is that your wall — your box, is open to heaven above.  Suffering is earthly.  There will be no pain in heaven.  Forty or fifty more years, perhaps, but an eternity with no pain.  You cling to that.  Some days that’s all you have.

First, I got my handicapped parking placard.  I’m dealing with the usual jokes such as getting told I can drive everywhere and how much would I charge to rent it out.  My husband was glad, not just for my sake, but his as well.  I was stoic until later, in the privacy of some anonymous bathroom stall, when the tears came.  I’m disabled, I know that.  I have the medical files to prove it because, by the grace of God, I currently have insurance.  Still, to be labeled handicapped…  I can’t describe the ambivalent emotions involved.

My rheumatologist said, in my presence, that it was unlikely for someone with PsA to have Lupus also.  That’s been the big fear for two years, and while it isn’t impossible, I find I can think about it much less now that he’s said so.  I have enough names for how I feel.

The treatment of choice, for now, is Humira; a very expensive drug delivered by injection.  Expensive as in $1100 per month without insurance.  Even with insurance it will run $250 plus $200 per month after that.  Abbott Lab will pick up most of that for six months.  That really bothers me.  We can’t afford it now, I have no reasonable expectation that we can afford it next year.

However, Humira has some side effects, chief of which is to suppress the immune system.  I will have to be faithful about immunizations, careful about getting sick.  Any tumors will be uninhibited while on these injections.  For that reason, the tumor behind my jaw is coming out next month.  One less worry.

And one new worry.  The discs in my neck continue to deteriorate.  It seems one has begun to leak, causing additional neck pain and radiating pain to my left arm (which is worse than the neck, actually).  The Vertigo is also getting worse.

More good than bad.  That makes it a good month.  I can barely move, but still holding a job (which makes the symptoms worse) and still with a spouse who quit looking for a job more than a year ago.

I’d love your prayers.

I have to say thanks to the RhodesTer for a recent post.  He describes his wife’s autoimmune diseases well, and his love for her certainly shines through every word.  He also brings up some serious concerns for people in our economic situation (the working poor).  It’s a good post that I recommend highly.

He also suggested following The Deal with Disability.  This lady is absolutely wonderful, and that’s another thanks from me to Dave.

I’ve sat on this article from USA Today since July 8.  I guess I was kind of hoping it would go away.  As one of those chronic pain patients who can’t take narcotics and still hold a job, I am dependent on over the counter meds to take the edge off or at least let me get through the day.

I will state up front that I don’t take a lot of straight Tylenol because it doesn’t even touch pain.  I might to reduce a fever, but for pain?  Nope.  However, I really like Excedrin for pain control and take much more than the recommended dosage of Aleve each day.  My liver already hates me and my stomach is already ruined.

So here’s an article in USA Today’s Life section (Wednesday, July 8, 2009, page 6D) advising readers that acetaminophen has a high rate of liver failure attached to it.

The Food and Drug Administration joint advisory committee spent two days in discussion of the safety questions.  Their recommendations were to lower the maximum daily dosage, strengthen labeling and remove it as an ingredient from some prescription drugs.  They have yet to take action.

Acetaminophen is an ingredient in Vicodin, Percocet, Darvocet, NyQuil, Exedrin, and several cold and flu medications.

The FDA reports an estimated 110,000 emergency room visits a year are related to the drug and linked cases of acute liver failure are also reported.

This is the medicine most of us give to our children!

I think I’m glad it doesn’t work that well for me, but now I have to watch everything else I might take to make sure it doesn’t creep in.  My liver isn’t in great shape as it is.

In related news (as in prescription drugs used for pain control being dangerous), propoxyphene painkillers are being phased out of all European markets.  Darvocet, Darvon and other painkillers that contain the narcotic propoxyphene will, however, be staying on the US Market with stronger warning labels.

The European Medicines Agency concluded that the risks of propoxyphen medicines, particularly for the potentially fatal overdose, outweigh their benefits and recommend the European Union gradually withdraw them.

This drug, apparently, kills, though the article doesn’t give specifics.  It does quote Sidney Wolfe, Public Citizens’ Health Research Group’s acting director to say “I have never seen a drug with a more unfavorable ratio of risk to benefit.”

I’ve been prescribed Darvon several times throughout my young adulthood before percodan and percocet became more available.  This short article cleared up part of my curiosity over what happened to a drug that seemed to work well on pain.

So I’m stuck with Aleve for daytime and my standing prescriptions for Tramadol (Ultram) or Demoral for nights I just can’t take it.  I’m half afraid the FDA is going to come out with something bad for Aleve, also, in which case I’ll be sitting on a street corner promising a song or poem for food.

4. Create a new measuring stick.

Our self-esteem lies in the standards with which we measure ourselves as we go through life. To thrive with chronic illness, throw out the old and rethink your standards. If you are used to defining yourself by your 50-hour workweek, for instance, you may feel lousy about yourself because now you can’t manage it.

Finding a new standard can be tough. One technique I use with patients is to have them ask themselves what is reasonable? Is it reasonable to do it all yourself or is it more reasonable to delegate? Is it reasonable to register the kids in travel hockey or is it more reasonable to stay local? This is where a lot of courage is needed. Courage to address old pressures to be a certain way and to imagine value in doing things differently. In my own life and in my work I find that those who thrive despite chronic illness creatively find opportunity in their new reality.

So I finally started with the CPAP two nights ago.  The mask doesn’t fit well and I had it so tight it practically drilled a hole in my forehead, but I’m doing it.  Mark at Broadcasting Brain said he saw benefit quickly.  In fact, his post made me feel so much better. DLG (commentor here and my mom) said others saw a change in her in a week, and she did in a couple weeks.

The mask is hellish only in one way (besides the hole drilling thing).  I wake up coughing in the wee hours, and the minute I open my mouth and the passage from nasal to throat, I feel I’m suffocating in a terrible wind.  Waking up enough to not panic isn’t always easy.  This mask is so tight I can’t temporarily lift it away so I can wake up and calm the panic.  I ripped it off the first night and stuck both thumbs under it the second night.  I just need enough time to wake up, cough or whatever, and rest the mask.  I’ll get there, right?

I’m using the mask shown in profile in the image at the top of this post.  I need to find the money for one of the nasal pillow masks or the one on the lower right of that image.  You know…before that hole gets all the way through my skull.  I’d rather save up the money for this one though.  It looks awesome on their website.

I looked for an image.  I did.  I didn’t find any I was willing for anyone to see near a mealtime.  I’ll just say this.  From the front fold of my arm (arm pit) to the back fold, I have a zipper of staples.  Both sides.  Four days out and I’m doing very well.  Even sitting here typing for a few minutes.  I take my pain meds, so end up sleeping a lot.  My arms are not much use yet.

And still, I’d rather do this than abdominal any day.  I can sit up to roll over, I can walk, bend over and prop a book on my belly…all things I couldn’t do even with laprascopic.  And then there’s the up side of not developing additional hernias (I have four) in my ab wall.

So, I’m here but I’m not.   When my arms work better, I’ll be on more.  All is well and the staples will come out in another ten days.

Our hospital recently went to digital mammography, so I wasn’t surprised and knew a callback was a good possibility.  What I wasn’t prepared for was the phrase “we need a different angle to see if  it is real.”  Hmm.  Interesting turn of phrase.  It didn’t help that I had glanced my images when I left and saw a white streak I didn’t understand.

Now, I understand logically that this callback is simply part of the new baseline needed when switching to digital.  I  understand logically that the odds are pretty low.  I got this call in the midst of being very ill with cellulitis and infection.  I wasn’t in a position to be very logical, though I succeeded in keeping it down to a low grade anxiety.

I dutifully went back for the extra films.  I asked questions.  I saw what they were looking at.  And I got the news that they wanted to recheck it in six months, but did not have cause for alarm right now.

I have two things to say.  The first is that week of anxiety was my own fault because I had more faith in the films than I did in God at that moment.  The second is that digital mammography is incredible.  Something that might not even have been visible on  the old kind was clear on this one and is now under observation.

Please, if you are “at that age,” at high risk, o r have a concern, get a mammogram.  Get the peace of mind, or get the peace of mind of fast treatment.  Do it for your loved ones.

I have a lot to talk about, but rather than lumping into one long post, give me a few days to sort things by topic and get some things ironed out.  Amongst topics that might come up:  the stress of mammogram callbacks, surgery prep, being PC2 disabled, what to do about Barbara, coping with mirror people, the necessity of withdrawl, the wonders of Zoloft, and how recovering from illnesses never seems to happen for some patients.

There’s good stuff, too. There’s also much to laugh about and at.  Life is never so bad that we can’t find reason to smile.