Four

Last week marked my fourth hospital visit this year. I noticed changes in my urine, and felt out of it, and had an abnormal temp. Called my doctor early Monday morning in hopes of getting an office visit with him, but instead was politely told by the nurse to go to the ED, which is in the same healthcare system as my doc. My doc and the colleagues from his practice do daily rounds at that hospital, so with any visit, if need be, they can consult almost immediately.

Lucky for me, it's new resident season, and I had the joys of having a brand new shiny doctor, who confused autoimmune hepatitis with hepatitis C more than once. Don't get me wrong, I have many friends and colleagues that are physician, and typically have the utmost respect, but if you want to work in an ED, be sure to know the difference between viral and autoimmune diseases.

She ordered an ultrasound, for gallstones, even though I told her numerous times I had my gallbladder removed, and imaging done to ensure I had no stones in bile ducts previously. The ultrasound, showed an enlarged heterozygous liver, indicative of liver disease. No surprise there. She ordered only a basic hepatic panel and CBC and let me go after filling me 2000ml of fluid.

Unfortunately, I had missed the rounds of the liver team at this point, and was told that I was merely dehydrated and to follow up with my liver doc as scheduled, and get blood work again this week. My LFTs are still climbing back up, even with the increase of azathioprine. I'm anxious to see the results this week. I also was frustrated at her telling me that I need to drink more water. I have Crohn's disease. I can drink a gallon of water a day and still be dehydrated and it's so incredibly difficult to stay hydrated. I left upset, and frustrated and just done.

This incident is why I hate going to the ED/ the hospital. I spent over 8 hours in a gown in an uncomfortable bed, only to be told, follow up with your main doc. Back in March, while in severe pain, when my gallbladder wasn't functioning- I was told to follow up with my primary doc. I feel that having such a rare combo of diseases, or hell having either one, is typically way more complicated than what a typical ED doc can handle. It's why we see specialists in the first place. The ED is one of the worst places to get care for chronic diseases, yet any times we are forced to go there when our docs are not available. My friends and family sometimes insist for me to go when I don't feel well, or symptoms are amiss. I wish it was as simple as walking into the ED and having a medical problem solved, but unfortunately, it's rarely the case. It's frustrating, painful and wasteful in my opinion, and it really reiterates my dislike of rushing to the ED to get checked out.

Waiting

Lately I've been thinking more and more about dating. Sadly, almost every person I talk to, whether male or female has told me to not think about it right now- wait until you're healthy. 

I get that it's not something I should be focusing on. At the same time, I do not know when I will be healthy. To be realistic, I will never fit into the "perfectly healthy" category. I'm just so frustrated in general with the whole "wait until you're healthy" mentality. Wait until you're healthy to go back to school for your PhD. Wait until you're healthy to buy a house. Wait until you're healthy to go on vacation. Would the same people tell a cancer patient... Wait until you're healthy to live/enjoy your life? 

Having a chronic illness, or in my case, a couple, means that there may never be a "healthy enough" time. There is no cure, there is no "I Beat Crohn's" Medal of Honor, there is no " You're Crohn's free"(in most cases). 

I feel like the past two years of my life have been spent in a holding pattern, waiting until I'm healthy enough. I know it will be difficult, but with compromise, I think things will work. In terms of housing, I'm settling for a townhouse/condo, that can be easily rented out, if anything should happen. I have shelved my dreams of owning a cute little single family house for the time being, knowing that it will be difficult to keep up on, alone. I have also have compromised on my vacation plans, staying more locally, and buying travel insurance as needed. The only real area of my life that I haven't found the right balance of compromise on is dating. I'm not sure on what the right compromise is for it, but I do know that I'm not waiting until I'm "healthy" for anything else in life. 

The past week has been brutal. The increase of azathioprine has not helped whatsoever. My liver is ridiculously swollen, I've gained about 10 pounds in water weight, my fever is higher, I have lost my appetite and my urine is as dark as it was when I was admitted for liver failure two months ago. Figures it's a weekend, and cannot get in touch with my docs.

I just feel run down, but still function-able. I don't feel all that sick. I just know that inside my body is waging a war against itself. On Monday, I will get in touch with my liver doc. I had a few family members tell me to go to the ED, but frankly, I know I can wait the two days till Monday. I don't want to sit and be there for hours. They ultimately would have to consult with my liver doc/his partner who  also don't do rounds in the hospital on weekends. So I would most likely be admitted until they could track them down to do a consult. It's a hard place to be in. I know I'm in liver failure again. I'm not quite sure what the next step would be, since initially I responded so well to the treatment. I also live 45 minutes from the hospital(s) that both my GI/liver man are a part of. I have five hospitals that are much closer, not to mention cleaner, nicer and in better locations. It's a tough call. I don't feel like this is an emergency. I'm obviously surviving day to day. I will not let it go past Monday, or if something drastic changes, but I will try to enjoy my weekend as best as possible.

The past couple of days have been rough. I feel as if I am going through the motions. Get up, try to eat something so I don't throw my guts up by 8am. Get to work, struggle to find a comfortable position sitting, because my liver is so incredibly swollen, it hurts to sit for an extended period of time. Fight off nausea. Take a few phone calls, write a few emails, and try to stretch out the morning, before having to take another dose of medicine. Take second dose of meds, try to once again shove food down my throat before the nausea sets in. Avoid the lunch room, because smells make the nausea so much worse. Go back to my desk, struggle to find another comfortable position. Try to keep my eyes open. Do some more work, and rejoice when the clock hits 4pm. Get home, immediately change and lay down. Typically nap two hours. Try to find something to eat that doesn't upset my stomach. Read for an hour or so before bed, and then am asleep between 9-10pm each night.

It is SO incredibly difficult not to let illness overtake your life, but when you can barely make it through a day, the battle is almost over before it starts. 

Depending upon the next few weeks, I may try to see if I can work something out with my job, about working from home a day or two a week. I am hoping with the changes in medication that this will be completely unnecessary, but if my disease progresses, it may be one of the only choices I have left. I am hoping and praying and doing everything in my power, in order to aid in my recovery. What makes this difficult, is that in someways I am my own worst enemy. In order to ask for help, in order to ask for accomendations, in order to admit some form of defeat, in order to admit that I am not the person I once was, I have to overcome myself. I think the stark realization of the seriousness of my illnesses has been a slap in the face. I had such overwhelming success coming back from a severe traumatic brain injury, that I went in full force with my Crohn's diagnosis, being so incredibly confident, okay so albeit a bit cocky in that I had this battle in the bag. For the first couple of years, I did, and was even able to be medication free for a time. This most recent flare up and the additional diagnosis of AIH, has brought me back to reality, and shoved my cocky attitude in my face. I am not perfect. I am not a failure, and I cannot do everything alone. Which has been so incredibly difficult to admit. I hate asking for help. I hate feeling like a failure. 

The past three months have scared me. I now see that I cannot ignore my issues, and that even if I attempt to do the best job ever, that sometimes, life is out of my hands, out of my control. It has been one of the most incredibly difficult things I have had to do this far in life. I don't consider it admitting to defeat, but that I need help in going at this. It is going to be a long, life long battle, with sometimes no end in sight. I just know I cannot do this alone any longer. 

Got to visit my lovely liver team and GI doc today. The verdict is in- my liver function is failing again, and  things are getting serious. Bumping up my azathioprine to the highest dose, increasing my Humira to weekly and trying to stay on 10mg of Prednisone so I can at least hold on to some form on sanity through this.

My white (blood cell) counts were also abnormal, which is another thing to really keep an eye on as well. Could be from my autoimmune diseases, could be from the medications, either way, I'm much more prone to infection and getting sick.

I'm still processing this all. I'm frustrated, angry, and a bit emotional. Honestly, I'm worried. I hope that within the next three weeks my liver works overtime to heal, to get on the right track. I hope that my Crohn's will behave nicely, once I up my Humira dose. I just need time to process everything.

Breaking Point

The past three months have been hell. Looking back, I spent a decent part of 2013 in remission. Since  October 2013, I've been in one long flare up. I did have a month where I was feeling okay (mid February to early March), but besides that, my health has been shit (obviously). 

Constant pain and feeling like crap ages you. It wears you down, and sucks the life out of you. For the past three months, I've run a constant 99-101 degree fever. I feel always on the verge on getting sick, that my body is fighting a cold. In truth, it's simply fighting itself. I really hate complaining, but this is a miserable way to live. I've had my favorite foods, drinks, and activities (running, working out) taken away from me. Eating has become a chore, and almost fear inducing. Throughout the past ten years, post TBI, I have been so optimistic, so positive with whatever life handed me. At this point, I'm struggling. I hate living doctors appointment to appointment, hoping that the next treatment will lead to remission, or at least some form of relief. 

Most of all, I want my life back. I want to be able to go out and run 5 miles, and celebrate with an ice cold beer. I want to have the energy to go out with friends, to be able to eat out without fear of having an accident or end up in the bathroom all night. Again, I HATE complaining, but we all reach our breaking points eventually. 

kids.

Something that has been weighing on my mind a lot lately, has been the subject of children. As a child, I had zero interest in playing house, playing mommy or babysitting small children. I was more interested in playing outside or reading books. Even throughout my teen years, I refused to babysit and the thought of being around small children made me anxious, and want to run.

I haven't really shared this with many people, but this topic has been in my mind the past few days...

Around the age of 21, my feelings did a 180. Call it the early rumblings of a biological clock, or maybe my fear subsiding, children became a lot less frightening and perhaps even cute at this point in my life. At this time, I was in a serious relationship, and close to 22, had an unplanned pregnancy. At the time, I was overjoyed, and extremely excited. I was fascinated with motherhood, and my fears quickly fell away. Though not expected, I was in the middle of grad school, and was in a stable relationship, and would be able to fully financially and emotionally support a child. I was extremely ill through out the pregnancy, ending up in the ER biweekly for dehydration. At 16 weeks, I felt much more ill, and proceeded to once again go to the ER for what I thought was dehydration. I found out that I had had a miscarriage, which was earth shattering.

The next few weeks were a blur, and the months following were so emotionally taxing. My relationship fragile as it was, before the pregnancy, ended, and resulted in me moving back home with my mother, and trying to struggle through the spring semester of grad school. It was during this time, that I was initially diagnosed with Crohn's. So many thoughts consumed me- if I had been diagnosed earlier would my baby survived? Why wasn't this caught earlier? Can I even have children? This was one of my darkest times emotionally and the thoughts still occasionally haunt me.

With each passing year, I find myself wanting children, to be a mother, more and more. I know I'm young to start thinking this way, but at the same time, I realize that it will be quite the undertaking for me to have children. Even with the AIH diagnosis, I still will be able to have children. I will have to have an extremely planned pregnancy, with close and careful monitoring. I also will have to make sure I'm healthy enough myself in order to sustain a pregnancy (in remission from both diseases).

 I have asked my medical team if my illnesses would prohibit me from having my own genetic children, and there should not be an issue, but if there is, there are many many other options. There is so little research on Crohn's and pregnancy, and even less on AIH and pregnancy. I have yet to find a single study/case report/ anything on Crohn's, AIH and pregnancy, and my GI kindly informed me that he would gladly write a case study on me one day, to be the first of its kind. 


I'm not looking to have children tomorrow, or even next year. It may even be ten or fifteen years down the road.  There is no time line, no magic age, no impending doom. I also know while extremely unlikely, I may not be able to physically have children. This will not stop me from having children, biologic or otherwise. I want to be able to half the mother the mom has been for me. I want to love, teach, provide for and nurture. For someone who once gagged at the thought of playing mom, I find myself in awe of watching dads and moms playing with their kids on the beach, squealing at pictures of my coworkers children, and occasionally daydreaming of one day experiencing parenthood. I know that I have such a long way to go, and that's fine with me. Plus this girl has got to get herself healthy, finish school, buy a house and ya know, maybe find a significant other and have a stable and loving relationship before the thoughts of actual parenthood cross my mind...

25

Tomorrow, I turn 26. Needless to say, 25 has been far from what I expected. I expected to run my fifth Broad Street Run, complete a full marathon, run 3 half marathons, and a handful of 5ks. I expected for my health and job to stay the same, which was fine with me. On the bright side, I got an awesome promotion at work, one I wasn't expecting. I finally, after three years, walked in graduation for my Master's. I've worked on two published studies, and have learned so much in my short time in my new position.

25 started off with a partially torn Achilles, and severely inflammed tendons and ligaments in both feet and ankles. Three months of physical therapy later, I was back to new. A month or so later, I noticed that my Crohn's was becoming more active. For most of 2013, I was not in total remission, but feeling pretty decent. Around November, when things started to drastically change, knew it was time to tackle this full force.

By February, I was able to start Humira, and thought it was smooth sailing. Late March I ended up in the hospital with a non-functioning gallbladder, with surgery in April. May brought another surgery, acute liver failure, and a third life changing diagnosis (the first being my TBI, second Crohn's) of Autoimmune Hepatitis.

Life has sure kept me on my toes, and I can say that without a doubt, 25 was my best year yet. Yes, it's been crazy, and yes I've spent way too much time in doctors' offices, and one too many nights in the hospital. In return, I've gained so much appreciation for my life, for the opportunities I have been given. I finally am feeling comfortable in my own skin, and appreciative of myself, and that in itself has been more than worth the past years pains.

The joys of Prednisone

Out of the 50-plus medications I have taken over my life time, prednisone tops the list of being the absolute worst. Between my TBI, Crohn's and AIH, I've become no stranger to relying on medications to survive.

Prednisone, is one of the simplest medications, with hundreds of uses. It often tops lists of most essential drugs, and is life saving at times. Unfortunately, out of any drug I have taken, it has the worst side effects. It leeches calcium from bones, can raise blood sugar, blood pressure, increase or decrease heart rate and can even cause seizures. It can increase bruising (the past couple of weeks, I constantly look like I got into a bar fight), can cause depression, unusual thoughts, feelings or behaviors (more on this later), muscle pain or weakness, numbness, tingling of burning pain, and one of my favorites, rapid weight gain, swelling in your hands, ankles or feet.

Sure many other my other medications have much more scary potential side effects, like increased risk of melanoma, increased risk of cancer overall, but the incidence of these side effects are under 1%. Prednisone's side effects happen much more frequently, and have much higher incidence rates.

In other words, while taking high doses of prednisone, I become a rotund, raging bitch covered in bruises. Soooo totally sexy. The weight gain, bruising, numbness, heck I even broke a bone on my last course of long term prednisone, I can deal with those side effects. It's the mental effects I cannot deal with. Having suffered from generalized anxiety disorder, OCD, PTSD and depression for the past ten years, I am no stranger to mental health issues. Through years of therapy, and finding the right cocktail of medications, 95% of the time I feel fantastic. Though I have a safety supply of Xanax as needed, before prednisone, I had not had to take one in over six months. Like with my previous course of long-term prednisone within the first week, I noticed my anxiety come out with a vengeance. I am short with people, have mood swings (hello crying for no reason at all), and the persistent anxious thoughts. I turn into a Jekyll Hyde, and feel like I have no control of my thoughts or emotions, I feel grateful that at this point, I know what to expect. I know that I can get through this, and these are not my thoughts, that it's not who I am. It is so incredibly scary though, to know that one simple, life saving pill can cause so many issues.

Unfortunately prednisone is the drug of choice for almost all autoimmune conditions. It simple, in that it works. It's cheap, effective and easily obtained. Unlike the alternative steroid used in UC/Crohn's, Entocort (a steroid that less system and targets the GI tract) costs about $1500 per month supply. Many insurances do not cover it (for prednisone is available at a much cheaper cost) and even when they do, the co-pays can still run up to $800. The side effects are that of Prednisone though not to the same magnitude. The efficacy of Entocort is also sometimes not as great as Prednisone, so that's another deterrent for its use.

When I see both my GI and liver doc 7/15, and depending on my blood work, I'm going to ask to be taken off. My mental health, has what kept me sane through the physical pains and ills of Crohn's, and AIH. It has what kept me going, kept me positive, kept me sane. Now that it's altered, I feel worse physically as well. I just can't do it any longer, and I know that as a patient, I have a choice. Fingers crossed I'm healthy enough to get off and that my liver plays nice.

Nashville

Sorry for the lack of updates, I'm at a conference for work in Nashville until Thursday. I'm exhausted, but trying my best to maintain. Since starting Humira again on 6/16, I've noticed almost no improvement. I'm disappointed. While on Humira the first time, I noticed a drastic improvement within a few days of the loading dose. Maybe it's because I did not have a loading dose this time around, or that my disease has progressed. I have appointments to follow up with my GI and liver doctor July 15th. I will be able to get in two more doses of Humira during that time, and will also be getting blood work done to see how my liver is tolerating it.

The heat and humidity have also made this trip a bit torturous. Each night, my ankles and knees are grapefruit sized, along with my hands being extremely swollen. Enough complaining for now... It's time to fit in a short nap before more presentations!