Stage 3: Bargaining.

I've officially hit the 3rd stage of grief, bargaining. I've caught myself doing this for the past week or so.

Bargaining the "third stage involves the hope that the individual can somehow undo or avoid a cause of grief. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Other times, they will use anything valuable as a bargaining chip against another human agency to extend or prolong the life they live. "

I often say hey, it sucks, but at least I have great insurance, or at least I have a great job. I find myself saying and thinking about bargaining multiple times a day. I have a minor in psychology, and have taken numerous psych courses, but it still surprises me how innate the stages of grief really are. They unfold without cognition, without thought, and often without plan. Some may get stuck in anger, while others depression. I'm scared to death to hit the depression stage.

People question the Kubler-Ross model of stages of grief, especially applied to things other than death or dying, not to mention diagnosis of a chronic disease, with no cure. With my Crohn's diagnosis, I had known for months what was coming. I had had bowel issues for quite sometime, so it wasn't surprising when I was diagnosed, especially with my family history. I had months to think research and plan. With the Autoimmune Hepatitis, I feel like I was slapped in the face. I had been told about a year ago that I had mild Nonalcholic Steatohepatitis, but that it wasn't off too much concern. This past April, when I was having gallbladder issues, I was told that my liver problems were due to my gallbladder not functioning and that after surgery, my liver would normalize.

Much to my surprise, instead of my liver healing, I went into acute liver failure. I was told that I had a disease, that left untreated, 90% of patients die within the first year. A disease that, 60-70% of patients will require liver transplant within 10 years of diagnosis. I know these are just statistics. I have an advanced degree in the study of diseases, and calculate attack rates, case fatality rates, odds ratios and biostatistics daily. Adding in Crohn's, I'm at a much greater risk of complications, and frankly, death. Does it scare me? Absolutely. Will it stop my life? No, it won't stop my life. It will take time, and maybe a decent amount of it, to cycle through all five stages of grief. I will try my best.

el jefe del hígado

Or in English, the boss of the liver. So had my last biweekly date with my hepatologist, we are now graduating to monthly appointments!

So, like as I expected from my liver biopsy pathology report, my liver is SCREWED. The biopsy has confirmed, that I've had long term, severe inflammation caused by Autoimmune Hepatitis. I'm so so incredibly lucky that my GI saw my lovely cup o' urine the day of my colonoscopy. It's what caused me to get an immediate appointment with the liver doc, and we were able to catch the early stages of acute liver failure. If I had waited even a week or so longer, I would mostly likely progressed into total liver failure, and required a transplant.

I love my liver man for his bluntness, and openness. Within ten years, I most likely will need a transplant. I have at least one full year of monthly visits, blood work, follow up and heavy duty medication to send this puppy into remission. I'm happy because I was able to taper down to 10mgs of prednisone, but it also means I have to double my dose of azathioprine... Killing my immune system further (and increasing nausea and hair loss). I am meeting with my GI Monday, and will be coming up with a treatment protocol for my Crohn's.

My saving grace, is that my LFTs continue to come down. Even when they reach the normal range, I will still have to continue meds for at least a year. I can live with it. My brain has just been so over whelmed with everything going on.

dating.

I've been wanting to write about this subject for the past few weeks. Since my initial Crohn's diagnosis, in April 2011, I have yet to have a serious relationship. From the time I was 14, throughout college, I was the girl that always had a boyfriend. In my senior year of college, I had met and started to date a guy who I thought was "the one". We had talked marriage, and were planning for our future together. We had gotten a lab puppy together, and things were pretty decent.

Unfortunately, after moving in with him, I started to realize that he was a completely different person, that the past year of our relationship was more or less a charade. Part of me believes that the stress during the period (December 2010ish), and our volatile breakup had brought about my Crohn's or at least brought upon my first flare up which led to my diagnosis four months later.

The past few years have been difficult, trying to finish my Master's, working full time, and trying to keep my health under control. The first two years I was adamant about not dating, primarily because I had never been single for a decent amount of time before, and secondly, because I was determined to not to get distracted. Another year passed, and though I went on a hand full of dates, nothing ever worked out.

At this point, I feel like I'm in a crappy situation. Part of me wishes I had someone to be there for me throughout the past few months. I want someone to be able to vent to, to be apart of my support system, to pick me up when I fall down, and to hold me, when I can't hold myself together. I realize this is fully selfish though. I look at myself, and I know I would not be able to be a decent girlfriend at this time, or hell, even a decent friend. I cannot guarantee that I could be there for someone in times of need. Right now, living day to day. I feel like I cannot plan, and cannot think ahead. Instead of planning ahead, I'm focused on getting out of bed each morning. I'm focused on being able to stomach breakfast, and what could I make for lunch that would be safe. I'm focused on making it to the bathroom, hoping to God I don't have an accident before I make it in to work. It takes so much energy just to survive, that even thinking about living is draining.

How would this be fair to another person? It's not. I often get told that I'm in the prime of my life, that if I don't meet someone now, I never will, and that I will be single forever. At this point, I can't focus on that. I need to focus on getting and staying healthy, to survive this next year of aggressive treatment, even if it is alone. Would I love to have someone to come home to at night? To sit with me on my bad days, to take care of me? Absolutely, but I realize at the same time, those are not the reasons to start a relationship/get involved with someone for the sake of being with someone.

This has been one of the most difficult posts to write. I am so torn.

running

In high school, I started running track freshman year. It was mostly to stay in shape for soccer, but after my TBI sophomore year, it became my year round obsession. The only issue, was that I refused to run anything longer than 2 miles. I was a sprinter, queen of the 200m. Somewhere in senior year, I started to run the 400m hurdles after it was noticed that I some sort of endurance. I still skated my way through, somehow always managing to get out of the 3 and 5 miler days.

Somewhere in college, I started used to use the treadmill. I went to college in West Philadelphia. At the time, I was a naive beach girl, who didn't exactly feel safe running through the streets of West Philly at 10pm (I loveeeed going to the gym late). I realized that I could run 3 miles. Heck I even did 15 miles a couple of times. I soon began running longer distances, and finished my first half marathon my senior year of college.

Running, is my therapy. After five years of neuropsychological therapy, and talking to my fair share of psychologists, psychiatrists, neuropsychologists, I was therapied out. I still see a psychiatrist for my anxiety medications, but I get nothing out of seeing a therapist/psychologist. My anxiety, PTSD, and depression are here to stay. For the most part, they are under control. The past few weeks I've had a resurgence due to the AIH and Crohn's flares, but I've been managing. When I was  first diagnosed with Crohn's three years ago, I found running to be so therapeutic. I can lose myself in the music, in the miles (I have a terrible habit of not realizing how far I've run), and have a total mental vacation.

Unfortunately Crohn's and now AIH have interfered with my running. I have lost track of how many races I've had to pull out of. I've broken my leg after being on steroids long term, from running, and my joints lately have been screaming in pain once I hit 3 miles. I've pulled out of runs due to surgery (this year, the Broad Street Ten Miler, the Nike Woman's Half Marathon in DC, the Odyssey Half Marathon in Philly), due to being so dehydrated, and just plain sick.

It's hard finding the right balance. My mind needs me to run. My body, on the other hand, does not want me to run whatsoever. While I love classes at the gym, such as Yoga, or Body Pump or spinning, I do not get the same relief, or "runner's high". The only thing that can come semi-close has been swimming. Unfortunately my current gym does not have a pool, and at this point, I really don't want to switch for numerous reasons. I have been doing my best to listen to my body. After my gallbladder surgery, I could not run for 6 weeks, and I'm at week 7. I have been running this past week, but have limited it to maximum three days a week, and three to five miles each run. I'm going to try to keep to that schedule, and add in other workouts.

My body is not what is used to be. Though I'm 25, well a month from 26, my body is far from that of a healthy 25 year old. I have to remember this, and try my best not to overdo it, since I'm fantastic at being overly ambitious. I have the tendency to over do it, to push my body to its limits and then some. I'm going to try my best..

happy dance!

Just received my blood work results from my LabCorp Patient Beacon. I think I would be insane without it. In most states, as a patient you can register with LabCorp to access your Patient Beacon, an online portal with your lab test results. After your doctor views the results, they are released into the Beacon. For me, this has been a life saver, with having to switch doctors numerous times, and also for the sake of my sanity.

As of June 2nd, my LFTs are significantly lowered, meaning I am responding to treatment!!!!! Unfortunately, I will most likely have two more years of azathioprine (the typical regiment, after induction of remission). At this point, my GI should feel comfortably enough to start treatment (hopefully Humira again) for my Crohn's, since that has been rearing it's ugly head this past week. I should also be able to taper my prednisone again, to 10mg this Wednesday. I'll know more Tuesday after my appointment with my hepatologist, and know even more next Monday, after I follow up with my GI.

This has been the first time I have not gained weight while on prednisone. Heck, I'm loosing weight but that is due to the Crohn's and crazy nausea from the azathioprine. I have been suffering from insomnia every night, and my anxiety is out of control, so I haven't escaped the side effects of prednisone completely. I'm just so relieved my numbers are coming down!

Liver Biopsy Results and Feeling Angry

Not good. So not good.

So my hepatologist and I were waiting for specialty staining to be completed on my liver biopsy done on 5/13. Preliminary results showed Autoimmune Hepatitis, which along with my clinical signs and symptoms landed me my diagnosis. I received a copy of my pathology results because my hospital has a nifty patient portal.

I had an original liver biopsy done 4/16, when I had my gallbladder removed laparoscopically. I had received a copy of those pathology results from my surgeon and brought that to my new GI, and then to my hepatologist. The results were limited to two sentences, noticing severe inflammation, but that was about it. The report I received today, is a massive paragraph. Previously, we thought that I had mild fibrosis, and moderate hepatitis (inflammation of the liver).

It's way worse then I imagined, but want to wait until I speak to my hepatologist next Tuesday about it. I also had blood work done yesterday, and I'm anxious to see how my LFTs have been, now that I tapered down to 20mgs of prednisone. Things that worry me: low grade fever is still hanging around, my urine is getting darker, I have lost my appetite again, and so sore.  My body is in the midst of a war at this point... I don't necessarily know if I am imagining my liver get worse, or if  I'm being overly aware of my symptoms. It's also been difficult since my Crohn's is really misbehaving, and some of the symptoms overlap, like loss of appetite, pain and fever. The urine thing has me a bit worried, for it hasn't been this dark since my hospital stay. So gross, I realize, but in terms of liver and gastro diseases, I'm used to being overly aware of what my body excretes.

I'm 25 years old. Seeing phrases like severe hepatitis and cell necrosis are not exactly comforting. Again, besides feeling a bit deflated, I also feel quite angry. I guess I'm fully at Stage 2 of Grief: Anger. This is a pretty decent explanation I found:
-As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family.  Rationally, we know the person is not to be blamed. We feel guilty for being angry, and this makes us more angry.

I haven't reached Stage 3 yet, which is Bargaining. I'm not done being angry yet.

Counting geese instead of sheep

Started off today with four hours of sleep. Next week when I see my hepatologist/GI team, I'm going to ask to be be put back on a real sleeping med. From my TBI, I have disordered sleeping, and do not naturally go into the same sleep cycles as most people. I had tried Ambien, Sonata, Lunesta, trazodone, gabepentin, and Soma all at different times. I found that while Ambien worked best, I would sleepwalk/sleep eat/sleep try to leave my house. The others worked miserably and had even more side effects. For the past few years, I've been taking Remeron at night, and it's been fantastic until the past week or so. Now, I feel lucky to get four hours of sleep. When I was previously on long term Prednisone, and even on Entocort (another steroid), I suffered from terrible insomnia. It's gotten to the point I cannot function at work, and I know that, temporarily I need help sleeping.

I also managed to hit and kill a goose crossing the street on my way into work, just realized how thin my hair has gotten, nausea has come out in full force, new bruises covering my body, and finally if all that wasn't enough, I have a nasty sinus infection on top of everything else. Oh and I won't have hot water for another couple of days (my hot water heater broke on Friday).

Hopefully the week only goes up from here. Going for my biweekly blood work tomorrow, and should have the results by Friday. Hopefully my LFTs have come down far enough that I can go back on Humira, and taper further off the prednisone. I also am semi-excited to get my hair done tomorrow night, and to try to do something with it to hide the hair loss. I really should call my docs about this infection, but want to try to hold off to see if I can fight it on my own.

My victory of the day was getting to the gym before work. Since I was up at the crack of dawn, and bored I went to the gym, and managed to somehow run three miles, and do a modified leg day. I probably pushed my body way too hard but it felt so good, and therapeutic. I may pay for it tomorrow but I needed the hour workout to clear my mind.  Here's to hoping that tomorrow is way better than today.

Woke up yesterday feeling pretty crappy. Severely swollen lymph nodes, mild fever, sore throat, achey and out of sorts. Looks like I need to give my GI a call tomorrow morning, since he was already concerned that after only a week on azathioprine my blood tests came back funky. My hepatologist did not order the TPMT blood test (which shows your body's ability to metabolize azathioprine/6mp. My GI has written me a script to get it done, along with a CBC, and of course my LFTs. I was planning to hold off until next weekend to go, but after this will be moving that up to hopefully Tuesday. 

It's never ending. I just want a break. I want my life back. 

How are you?

I feel like a monster. Mentally the past couple of weeks have taken a toll on me. I am so incredibly tired of people asking how I am, and how I am feeling. I am sick of having to lie, or even worse, my most common reply, “hanging in there”. I want to say I feel like f-ing crap. I want to say, I feel lonely, I feel agitated and frustrated. I want to say I feel pissed as shit today.

I’m tired of going into work with a smile on my face every day, pretending to hold on to some semblance of normality. I am also beyond tired of hearing- “You poor thing”, “You’re so young!”, “It’s so sad”. One of my absolute favorites is “Haven’t you’ve been through enough?”

I get that I should be thankful that people genuinely care and are concerned. I am just so frustrated. I am frustrated because, yes, I am young. Yes, I had a traumatic brain injury ten years ago, was diagnosed with Crohn’s Disease two years ago, and now diagnosed with Autoimmune Hepatitis. Yes, it is sad, because my health has been ripped away from me, my foundation crumbling, while I should be enjoying life. Instead I am worried about next week’s blood work. I am worried that I have run out of treatment options for my Crohn’s, and that my body is no longer responding to medication. I am worried that I may never be able to have children.  I am worried that within ten years, there is a strong likelihood I will need a liver transplant. I am worried because my joints are already damaged from chronic inflammation, and I am only 25. With all these worries, it is hard to just answer “I am okay.”

With the feeling of worry, also comes the feeling of being pissed. Why should I be worrying about things only those in their 70s worry about? Why should I have more worries about my body than my grandparents in their 80s do? I am pissed as shit that my hepatitis and scaring of my liver is worse than those people who have been alcoholics for fifty years, or those that have viral hepatitis from engaging in high risk activities. I ran half marathons, ate paleo, and totally organic. I indulged in the occasional bottle of wine, but never used an illicit drug. Being a public health fanatic, I have always had safe, protected sex. How fair is it that my liver is in worse shape than many people who have Hepatitis C or Hepatitis B or were raging alcoholics for decades? How is it fair that crack addicts and heroin junkies have less health issues than I do? I have worked my ass off to stay healthy, and to live a productive life, yet at this point, I can’t seem to help myself.

I haven’t figured out the right answer to “How are you?” I may never. For now though, I am going to be honest. If others cannot handle my response, or it makes them feel uncomfortable, so be it.

Hepatitis?!

According to my great friends at the Mayo Clinic, Autoimmune Hepatitis is

"inflammation in your liver that occurs when your body's immune system attacks your liver. Although the cause of autoimmune hepatitis isn't entirely clear, some diseases, toxins and drugs may trigger autoimmune hepatitis in susceptible people, especially women.

Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system.

A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or when liver disease is advanced."

What AIH is NOT...

- It is not viral

- It is not labeled A, B or C

-It is not communicable... I did not get this from someone, nor can I give it to anyone

-curable

AIH is most common in women, those with other autoimmune conditions, and younger people. Lucky for me, I get not just one autoimmune disease, but now two. AIH is more commonly seen in those with Ulcerative Colitis over those with Crohn's, but since I love being an anomaly, it fits. Speaking of fantastic news... I also received the results of the biopsies from my colonoscopy on May 8th. Previously, my Crohn's was strictly located in my terminal ileum. Like in my previous scopes, my doctor took 20 plus biopsies from my ileum through rectum. Unlike in other scopes, every single specimen was abnormal, including specimens from my colon. I now have ileocolonic disease, and it is spreading.

Fortunately similar drugs are used to treat both AIH and Crohn's. Treatment for AIH is limited to prednisone and Azathioprine. Crohn's has many more treatment options for inflammation (even if I have exhausted many of them). I have been off of Humira for almost two months, after stopping it before my gallbladder surgery. Right now, I am taking strictly prednisone and azathioprine waiting for my LFTs to normalize. I will be starting to taper the Prednisone, and may have to adjust the azathioprine to make up for it. I also will hopefully be able to start back on Humira once my LFTs stabilize. For the bare minimum, I will have to take azathioprine for two years, for the AIH. I am thrilled that both of my doctors hate prednisone, and already have a plan for tapering. I do not do well whatsoever on prednisone, mentally or physically and I am happy that we are on the same page for that. I also get to follow up with my doctors every 3-4 weeks, along with concurring blood work.

When it rains, it pours. Lucky for me, I put on my wellies and jump in...