Road Trip! or Exhausting Yourself Getting Somewhere so you Don’t Have the Energy to BE There.

Roosevelt Site

Standing at the visitor center of the Roosevelt Historical Site in cute, lightweight shoes

I just celebrated a milestone birthday and I embraced it like a child. I had three birthday cakes, a birthday pie, and a birthday helmet full of ice cream with rainbow sprinkles. I ran into the sunshine and the baseball games, and road trips, and hosting guests with reckless abandon–emphasis on the running and the reckless. It was wonderful.

There were only two days in the month of July that we did not have house guests to celebrate with.  It is so nice to wake up to friendly faces around your breakfast table. But those faces want to eat breakfast, which does not make itself, and they want to get out and make the most of their stay and getting out often means expending lots of energy, climbing flights of stairs, and facing the sun. All of this combined made it so that at the mid-point of the month I was flaring. My legs were swelling up (first time I have experienced this). It took me a little while to figure out how to enjoy a busy summer without my health suffering. I made some good decisions and some really bad ones in July. Here is what I came up with.

With summer comes sunshine. Getting out into the world in the summer time means coming face to face with my nemesis—the sun. If you look online, you can find me at a baseball game in the middle of the summer wearing jeans and a black shirt. This is insane right?  I can hear you saying: Why would you wear black?! The answer is simple: vanity. My brother and I planned to go to a  baseball game. My normal Lupus hack for baseball games is to simply go to them at night. A 7:05 p.m. start guarantees a cooler, UV-free experience. Unfortunately, the game time on the only day we could go was 4:05 p.m. I tried on four outfits to deal with this situation. A skirt went on and then off because I was afraid my legs would get too much sun. Jeans, I thought, would fix that. I needed a really light shirt to go with them so I didn’t over heat. I tried on one and then another. The lightest one was black, so on it went. And then I noticed that shirt didn’t quite cover the scars on my arm and I couldn’t have that. So I put on a light cardigan and cute necklace and hunted down my sandals. By that point, it was past time to leave. There was no time to consider that I was dressed for a brisk fall day, not five hours in the beat-down sun. Mid way through the game I went to the ladies room to assess the damage. My legs were bright red even under my jeans. I knew I had gone too far and it wasn’t the first time that week. Even under coats and coats of sunscreen, I spent more time in the sun the first week of July than I had the rest of the year up to that point.

Damage was done, but did I stop there? Nope. I also spent an hour or two paddle boating the next day.

By week two, I was sleeping in until 10:30 every day and falling dead asleep for the night by 9:00 p.m. I didn’t do anything active because I couldn’t. The stairs between my bedroom and kitchen were a trial. I was secretly relieved when our guest left a day early. I slept the entire day and in the evening, I changed sheets in the guest room and got ready for my mom’s arrival.

Stairway to Exhaustion. Week three was full of activity. My mom came to visit and to pet sit my puppy while I hit the road bright and early on a trip my sweet boyfriend planned. Every stop was a surprise. We stopped at a snack factory in PA, and then continued on to Greenwich, Connecticut, where we boarded a train for Yankee Stadium night game!

I was so excited…until I reached the first of many stony obstacles. The train station is flight after flight after flight of steep concrete stairs. I wanted to cry. This was probably more because my energy level was already low, but I knew I would be useless if I had to climb all of those stairs and then climb them again on the way home. I am not tall. Even if I didn’t have lupus, I would still have to walk faster than the people I am with to keep up, now add Lupus. In the moment I was too tired to deconstruct why this was so overwhelming. My knees hurt. Stairs and knees are not friends–at least not my knees. I couldn’t walk and dread and be rushed to meet the train and formulate words to say why I was…sad? tired? Lupus-y? I couldn’t even think. It’s so frustrating when you exhaust yourself getting somewhere, and then you don’t have the energy to BE there.  Mid way through I stomped my feet and made T stop and consider my plight. I can’t rush and climb the stairs and still participate in the destination. I can do one of those. We took ten minutes and found the elevators and we still made the trains. The game was a lot of fun. The weather was cool and breezy as we watched my favorite team win and my personalized “happy birthday” on the jumbo tron.

We had one more stop on this road trip; Hyde Park and the Franklin Roosevelt Presidential Library. This is a historical site that I always wanted to visit. It was an enlightening, empowering stop – and it completely had to do with moving through the world with different abilities. I will be sharing more about this in another post. For now, here is what helped me really enjoy my trip.

Here is a list of the things I needed to enjoy a summer trip:

SunscreenSunscreen. I am tired of reading about the value of sunscreen for managing Lupus and I bet you are too. So I will leave it at this: Use it. Reapply often. I use this solid sunscreen from Neutrogena to make absolutely sure I cover the rash on my face and the scars on my arm.

Hats. Oh the hats. There was a baseball hat at Yankee stadium, a straw hat with a bow (a la Anne of Green Gables), a cream hat with red and blue stripes for Independence Day, and a pretty red number that makes me feel like a sexy spy on vacation. There was also a garish leopard print hat with wide brim that I bought for $2 at a craft store on the way to a winery after I forgot and left all of these hats behind. For this reason I have now added a hat to my emergency car stuff (you know the stuff–jumper cables, windshield washer fluid, flares, sunscreen and now a permanent hat).

Long Dresses, Sleeves, and Pants. Not jeans and a black sweater, but long sleeve linen shirts and pants. Cool cotton dresses that sweep the floor. It helps.

Closer Parking Spaces and Fewer Staircases. File this under obvious tips and tricks for living like you don’t have an autoimmune disease. When you are driving, you can choose to park close to where you need to go and take the elevator rather than the stairs. With that you can reserve more energy to do what you intended to do, rather than spending all of your energy getting where you are going. When you are not the driver or the decider, stand strong and be vocal. Even when the crowd is taking the stairs, even when it takes a few extra minutes to find a closer parking spot.  It is a pain sometimes, but it benefits the whole group—do these things and you can enjoy the outing like everyone else.

Vitamin D. It makes a difference. My brilliant dermatologist has explained how vitamin D makes a difference for those with Lupus. For everyone, cells die and turn over all constantly (even more die when we do silly things like getting sunburned). As a rule, Lupus makes it so our bodies don’t efficiently get rid of dead cells. Vitamin D helps us more efficiently clean out the dead cells. When taken in appropriately high doses, it makes a major difference in how I feel—it is worth discussing with your doctor.

The Right Shoes. Finding the right shoes is critical—they have to be light and offer the right support for the activity, but they also have to be cute. I am not ready to give up the cuteness. That would be admitting defeat to Lupus. I am never going to be that sick, unless I am actively dying.

Madden Girl Kissesss Flat Sandal

Madden Girl Kissesss Sandal. Yes, that is really the name. 

The shoes that fit the bill this trip were pink Steve Madden flat sandals and super lightweight black leather ankle strap sandals from a company called Spring Step. Both pairs weigh nothing, they stay on even when you are moving fast and they are adorable. The black ones make my heart sing. The inside is a pale gold and the perforated leather keeps you cool even when it is 100 degrees outside. Note: they run a tiny bit big. Here is a link to where I got mine: Spring Step Lada Wedge. Both companies reliably make lightweight comfortable, cute shoes.

Spring Step Lada Sandal

The perfect shoe for the trip: Spring Step’s Lada Sandal

It helps to have the right places to visit.  Add these to the totally Lupus-Friendly Places to Visit on the East Coast of the U.S (click the name of the site for more information):

Herr’s Snack Factory. The tour is free, but you need to make a reservation. The best part was seeing thousands of perfect pretzels roll by. It looked like snack food wallpaper. Take the tour, taste chips right off the line, see little kids mystified by the hoppers and conveyors and workers. King of Prussia, Pennsylvania. 

 Hershey Park Chocolate World. The noise level will deafen you. I also recommend avoiding the whole retail area; it was pure chaos on a sugar high. But it is one level and there are lots of activities that anyone can easily take part in—from history tours on buses with UV shielded glass to making a chocolate bar in air-conditioned comfort. PLUS you get to see your friends and family in hair and beard nets. Hershey World is separate from the amusement park. It has its own easy to access, free parking. Hershey, PA 

The Home of Franklin D. Roosevelt.  Appreciate how a man who was paralyzed in adulthood moved through the world and commanded a country during its darkest days. Park at the visitors center. Walk the short distance to the Presidential Library (it is so big you can take a whole day there). Take the tram to Springwood, the president’s family estate, or Val-Kil, his wife’s retreat.  Plan to spend some time reflecting at Top Cottage–a small space FDR designed so he could be completely self-sufficient from his wheelchair. Before ADA, he made doors open in both directions, eliminated floor seams in doorways, and had a toaster in the living room so he could serve tea and toast to guests on the porch (when it was too early to serve martinis). Hyde Park, NY

 

Tracking Lupus from Both Sides of the Stethoscope

I was surfing Facebook this morning and I came upon a posted video from Lupus Foundation of America (LFA) called:

LFA-Real(tm) System is First-of-its-Kind Tool to Monitor Disease Activity

This caught my attention because this is more than a tool for physicians. The system has two parts:

  • A doctor’s assessment of a patient’s lupus disease activity.
  • A patient’s assessment of their lupus disease activity.

The idea is that the assessment on both sides of the stethoscope can be done quickly–and it can track disease over time.

I have had two experiences with tracking and assessment, and to be honest friends, they have kept me from going to the doctor for a couple of months now.

When I discovered a symptom tracker called Symple, which allowed me to track my daily symptoms and also the factors that might cause them (lack of sleep, vitamins, stress, etc.) I was elated. I tracked faithfully every day for more than a month. When I met with my rheumatologist, I showed her my data, explained the app in three sentences or less and offered to email the report Symple created from my tracking. She could not have cared less. She barely glanced at the screen. That was the end of the story. I was crestfallen because I thought this was awesome. In my 20 minute office visit, I can’t convey all of the pain and suffering over a month, three months, six months. And if I could I am CERTAIN it would sound worse than I want it to. The app, however is an honest, accurate assessment over the course of many days. This body of data takes into account the good and the bad days, and what is influencing them.My doctor didn’t see it that way. I don’t feel understood. I feel prescribed to. You can check out Symple by clicking here. And by the way, it is free.

Not too long ago I got really sick in a weird, Lupus sort of way. I had stomach problems, I was achy and miserable. I knew I didn’t have the flu. I suffered for a while and then out of nowhere I got hives. This is my Lupus nemesis. I spent years suffering from hives and sinus infections before I was diagnosed. It was awful. Once I was diagnosed and I started taking Plaquenil, the hives went away completely–for years and years. Until that day. I decided to go to see my primary care physician–in case it was the flu or something. I got a doctor filling in for mine and she was great. She listened. She was informative, she ordered a TON of blood work. A week later, when it all came back normal. I talked with her about it. I was still feeling miserable and my legs were covered in hives and here she was saying: all your blood work is normal.

As a lupus patient, this is something I struggle with. I want an actionable answer at all times. And you know what, there isn’t always an action to take.

Oh I'm sorry. Did it look like I zoned out?  I was just picking out a wall to bang my head on.

Oh I’m sorry. Did it look like I zoned out? I was just picking out a wall to bang my head on.

I said thank you to the doctor and said, “I guess there is nothing left to say–I feel miserable, but according to my blood work, I am totally fine.” She stopped me there by saying: “No. You have Lupus. It doesn’t mean you aren’t experiencing symptoms.”  I am sure I sat there staring at her for a moment as I imagined repeatedly banging my head against a wall. That was my last visit. I have no plan to go back to either doctor unless something awful befalls me, because seriously, what is the point?  What is to be gained? Other than massive medical bills and more frustration (which leads to more symptoms).

Maybe LFA-Real will make a difference in this. If they can track what is a flare and what is a chronic symptom from a patient and match that with a physician’s observations and the test data?  I am skeptical, but hopeful.

This is in the beginning stages, like just about everything with Lupus, but the system is free and open to use for everyone (Thanks, LFA).  This System, which includes the development of the tools used to assess, and lots of input from patients and professionals alike, will be unveiled this year and you can watch the video by clicking here.

What Does a Lupus Flare Feel Like?

Someone just asked what a Lupus Flare feels like and I answered:

 

It Feels Pretty Damn Bad.

 

Here is what the tiny print says:

Imagine having the flu and then falling down a flight of stairs. Now imagine that the medicine you are taking to feel better makes your heart race, head ache and your emotions rage. Now imagine your doctor can’t help you and some people don’t believe you don’t feel well. Now add the responsibilities of life, the frustration of limitations on what you want to do and the guilt of having to have everyone in your life make concessions for you. Lupus is the worst..

 

What does it feel like for you? Post a comment or follow on Facebook and talk to me there!

Stand Up for Yourself.

I don’t know what it is about me, but when I feel like the masses are being slighted, I feel compelled to take up their cause and fight. I call this my inner Norma Rae. Have you seen that movie from the late 70s? The one where Sally Field starts a revolution of the textile industry by standing up holding a big, bold sign that says “UNION” on it?

It was hard. It was unpopular. It causes trouble at home and at work. But it’s the right thing to do, so up she goes. Sign over her head. And that leads to a revolution. Or at least that is how it goes in the movies.

Standing up. We all have to do it.

Standing up. We all have to do it.

The last few days have been Norma Rae days for me. I am sure I didn’t start a revolution, but I am also sure that the doctor who got me so wound up will at least think of my face and hopefully my words the next time someone shows up swollen, aching, and desperate in the name of Lupus. I have heard of people having amazing relationships with their rheumatologists. The kind of doctors who head up collaborative care among doctors to get patients well and thriving. But hearing about it is where it ends for me. I have a stand out primary care doctor and the kind of dermatologist that you could trust your life to, but I have never had a rheumatologist to write home about. The one I started seeing recently though, simply takes the cake.

I started seeing my new rheumatologist a few months ago when I got a new health insurer. We didn’t totally hit it off, but it wasn’t too bad. She was stand offish and she made a sour face when I showed her the vasculitis on my arm, but I am sensitive about that, so I chalked it up to my thin skin (ha!). When I left her office that first day, she sent me for blood work. Fifteen vials of bloodwork that took four sticks, the last one in my hand (ouch) to get ahold of. I thought I was going to pass out from sheer exhaustion. After that, there was a host of small things (mis-dosed medication, another wasn’t available, I had a reaction to a new generic, and so on) that fell like disease dominos and landed me smack in the middle of a flare–the most painful one I have had to date.

I suffered for a few days before emailing my doctor. She put me on a TON of prednisone and said to keep in touch. I took the ton of prednisone and it was like a beast was unleashed. In addition to a racing heart, I was so dizzy I was losing my balance, I was exhausted but couldn’t sleep. AND I WAS A MEANIE. At the prompting of my poor, suffering boyfriend, I went back into see the doctor face to face.

This is where the UNION sign comes in.You see, I had already had low expectations for this doctor caring for me. But when she met my sick, sad self with a pile of pain pills, and “Well, that’s Lupus. Eventually the flare will be over and you’ll feel fine.” I kind of lost it. I asked her to consider that people are more than the sum of their symptoms and test results. I told her we weren’t working out (like we were dating or something), and I did all of this while hysterically crying. In my experience doctors aren’t huge fans of tears. They are a more tightly laced lot. My rheumatologist looked horrified, but all I could think to myself was, finally I am getting through to her.  I eventually pulled myself together enough to finish the visit and head down for more blood work. I wasn’t done though because all of that went badly too.

I just finished my follow up email to her (this is how she prefers to communicate) and it reads like a ranty break up letter. Whether or not she even reads the damn thing, I had to say it all. I had to say it for every person who ever has to sit in a phlebotomy lab and get told, “You are a slow bleeder. I am going to have to stick you again.” I had to say it for every person who has had to sit down to dry their hair because showering took just about all of their energy. I wanted to say it for every person who didn’t have the strength to say it for themselves. I had to say it for everyone who has Lupus. 

God save the world when my hands don’t hurt too much to type.

PS: From the “well ain’t that a kick in the head” files, I just found this article from a few years ago: Real ‘Norma Rae’ dies of cancer after insurer delayed treatment

“The North Carolina union organizer who was the inspiration for the movie “Norma Rae” died on Friday of brain cancer after a battle with her insurance company, which delayed her treatment.”
Health Insurance. That is another post for another day.