Consultant Letters

A few weeks ago I requested all my consultant letters from 2015 onwards. I like to have copies of things as it keeps me straight, doctors are human beings and things get missed. However I wasn’t quite prepared for the amount of untruths, information about my health that had never been passed onto me and test results that had needed urgent action that had never been acted upon. I spent around 30 minutes just having a quick read through, as you can imagine there were probably  100 of pages of information – most of it irrelevant just showing what prescriptions I had ordered and when. But if I found all this in 30 minutes what else is lurking in my notes that hasn’t been acted upon, is a major untruth or I have never been told?

 

I want to state for the record I have no problem at all with my gp surgery, the things i have spoken about should have been relayed to me by my various hospital consultants. I can understand why my gp didn’t bother telling me about the arsehole I saw in 2015 whose letter is so full of mistruths that I wonder if it was actually my appointment he was reporting on, my gp at the time was probably concerned for my mental health. Although we did have an appointment quite soon after seeing this doctor and I made my feelings about him quite clear. Usually my old gp would rush to the defence of other medical professionals if I was voicing a negative opinion, his silence on the matter should have alerted me to the fact he wasn’t that impressed by this so – called – expert.

 

So what did I learn from this quick perusal of my consultant letters? Well I have never been naive enough to believe that I or any patient ever receives the same version of a letter your consultant cc’s you in on – actually tell I lie I know one of my consultant always sends me the same version as he never changes who it is addressed to – never me but my gp. I have seen this in the past with the version I received from one doctor telling me that he was going to do a trial of plasmapheresis to rule out Myasthenia Gravis, only for me to read the letter he sent the consultant where he categorically states I do not have MG and he thinks that all treatment for MG should be stopped. It made me look like a liar when I tried to discuss this letter with my local hospital consultant. At the time I was devastated by the duplicity. Why be one thing to a patient’s face and yet treat them so appallingly behind their back? It reeks of arrogance, that they feel they are a breed apart from their patients.

 

Firstly I learnt I have a fibroid on the anterior wall of my uterus. When I attended the hospital for my trans-vaginal ultra sound in 2015, I was told during the appointment I had an ovarian cyst of around 2cm in size on my right ovary. I was also told that this wouldn’t be monitored as it was under 4cm. At no point was I told I had a fibroid, this was complete news to me.  I was shocked that at no point had anyone suggested that I the patient be given a copy of the report after the ultrasound. Ok it’s not a huge fibroid but surely I had the right to know? Especially when there is no mention of an ovarian cyst.

 

In the same year I had a lot of bloods drawn one of the blood tests performed was a cortisol level. It was taken at 1015am in the morning when cortisol levels would be beginning to slowly drop away naturally. However my cortisol level was 107, as you can see from this abstract – https://www.ncbi.nlm.nih.gov/pubmed/12636203 a level of less that 110nmol/L shows that the patient has adrenal insufficiency. This has the potential to be life threatening as it could indicate I have Addison’s disease. Yet nothing at all has been done about this result. The hospital consultant that wrote to my gp said that he would be admitting me into hospital for further testing. It never happened. What annoyed me more was this was the doctor who accused me of spending too much time on the internet looking up syndromes to have…..yet my blood tests he reluctantly performed showed massively raised prolactin levels and this cortisol level of 107. I’ve had low cortisol before and had further tests in 2010  however my results then were not as low as they were in 2015. So now I will copy the letter and go and see my gp to point out I had low cortisol levels three years ago and possibly it would be a good idea to get it tested again?

 

The winner of best work of fiction – letter from a consultant goes to an arsehole I had to travel nearly 200 miles to see. When I met this tit I knew he was going to be of zero use, especially when as an EDS expert he told me that Ehlers Danlos Syndrome didn’t cause CSF Leaks. When you sat across from someone who is supposed to be an expert in their field and you know more than they do on a subject, that’s the time to start worrying. Hubby and I should have left at this point – research shows that 90% ( it could be 80%) of people with a spontaneous spinal fluid leak have a connective tissue disorder, of which EDS is one. So for this expert to sit across the room and tell me that EDS doesn’t cause spontaneous leaks, either meant he was ignorant of the connection between the two – not a good look for an expert or he was just a massive bellend. The choice is yours.

 

My CSF leak was diagnosed by a neurologist who has published papers on CSF leaks, you know an actual expert on the condition. However this doctor states in his letter to my gp that I don’t have a CSF leak and my headache is being caused by PoTs. This is the doctor that doesn’t believe that EDS causes spontaneous leaks and now is telling my gp he knows more than an expert in the field of spinal fluid leaks. The sheer arrogance of the doctor took my breath away, I was absolutely fizzing with rage and used lots of language that I wouldn’t wrote in this blog.

 

However there was even better to come, he wrote that I told him I used a wheelchair due to my headache…….yep read that again……I told him I used my wheelchair because of my headache…… I just laughed at that one. My doctors know I use a wheelchair for two main reasons 1) I get drop attacks where I will semi lose consciousness as I walk along, with no warning. This was the main reason why I had to stop walking my dogs unaccompanied as I had no clue as to where or when I would pass out. I could be mid-sentence and I would hit the deck. 2) I also use my wheelchair because of the various issues I have with my spine and other joints. Walking causes me intense pain, bursitis will flare up in both my hips, I get plantar fasciitis in both feet. Walking any kind of distance is just too painful. I can categorically state that I NEVER SAID I used a wheelchair because of my CSF leak. Because when I started using a wheelchair in 2008 I didn’t have a csf leak. I started using my chair to prevent head injuries from my drop attacks and to allow me to get out and go further than just walking would allow.

 

Now if that had been all the lies / mistruths he had told then I could possibly live with that but his letter was just one lie after another. He claimed I was resistant to coming off opioids despite the fact they don’t work on my pain. His main concern during the whole appointment was to get me off opiates but could offer me nothing in return to kill the pain. I have never said opiates don’t work, I wouldn’t bother taking them if they didn’t work. Opiates were the only medication that reduced my pain enough for me to be able to get out of bed after being bed bound through pain for 12 weeks. Thankfully the gp who this letter went to was the doctor who prescribed me morphine and when I discussed this attitude of the consultant that I had to come off morphine, my gp said no way, there is nothing to give you as an alternate. He said I saw what you were like before morphine, I couldn’t do that to you.

 

Oh and there is more that this cockwomble of a doctor wrote, he said I was resistant like most EDS patients to getting better………………….I’ll let that sink in. Someone at this National Unit thinks that EDS patients don’t want to get better. Now it really doesn’t surprise me as this hospital also uses the Lightning Treatment on pediatric patients with M.E. If they are arrogant enough to believe that they can cure M.E using this bogus treatment no wonder they believe ( or should I say this one doctor believes) that EDS patients can think themselves better.

 

All the doctors that have ever treated me have said what a positive mental attitude I have towards my medical conditions. That I persevere no matter how hard things get. That I can still laugh and make fun of myself when things are truly awful. So to declare in this letter that I was resistant to getting better from a genetic medical condition that has no cure is simply laughable. No wonder the hospital consultant that referred me to this hospital said he wouldn’t waste the hospital trusts money again sending any future patients there.  He couldn’t apologise enough and at that stage he knew I hadn’t seen the gp’s version of the letter, he probably thought I never would.

I would suggest to all patients that they ask for all copies of their consultants letters going back three years. Some surgeries will charge you a fee for this, i was very lucky and didn’t get charged even though I was expecting it. You will have to fill out a load of information as to why you want the information and you’ll need to provide a form of ID. They can refuse to give you these letters using the get out clause of it being detrimental to your mental health. Using the same get out of jail free card they can omit some letters from what they give you. If you have complex health issues it is essential that you have these letters and read them. If you find that tests haven’t been chased up or performed you can advocate for yourself. When you have lots of conditions / consultants it is very easy for things to get lost or lose their priority. At least this way you can be an extra set of eyes and see if things have been missed and bring them up with your consultants or your gp.

 

 

 

You heard it here first folks I’m bloody cured!!

It’s not often I am stunned into silence but yesterday I pretty much was. Unluckily for you, I seem to have found my voice again. So get comfy, get a hot beverage of your choosing and settle in for a bumpy ride. My long-awaited neurology appointment happened and it turned out the way I had dreaded and worse, if that is even possible. I had been stupid and allowed my hopes to rise only for them to be dashed yet again. I am angry, I am hurt but I am trying to be rational and logical in accepting that I haven’t had an MG diagnosis for the last ten years and now is no different.

 

I had really hoped that this new neurologist would approach me with an open mind. That all the medical crap that had followed me around in my notes for years wouldn’t be dredged up during this appointment but looking back now with 24 hours to calm down, I can see the decision that I didn’t have MG had been made long before I entered the consulting room.

 

Yesterday was a long, painful and emotional roller coaster of a day. There is so much to say but so little of it of any real use. The nerve conduction study was painful. The doctor that conducted it tested my hand, wrist, arm, neck and face. I am in a lot of pain from the tests done on my neck. I really wouldn’t have thought that they would have conducted such a test on someone who has only just recovered from a spontaneous CSF leak. Last night with my head throbbing I feared that the leak has started up again. I can only hope that it’s not the case.

 

The nerve conduction study checks to see if the nerves are carrying messages to the muscles. My test was done using an implement that looked about the size and shape of an old-fashioned electric razor. On the very end of it, it had two prongs, it felt very much like I imagine being poked by a cattle prod would. When the doctor was testing my hand it was jumping around so violently he actually had to hold my hand still. I knew as the test was being done by the way my muscles were twitching that yet again this test would be negative. When he tested the side of my neck, my head jerked uncontrollably from side to side, I also had a searing pain up the side of my face. My neck is very unstable due to EDS and this hasn’t helped one bit. I guess I will only know if any damage has been done over the coming days and weeks. I am hoping the pain I have at the base of my skull and in my neck improves. All I know at the moment is that painkillers aren’t touching it.

 

My face was also tested but he used a two small needles to do this. One needle was inserted close to my hairline in line with my eyebrow and the other was inserted midway between my eyebrow and my fringe (bangs for those in the USA). This wasn’t as painful but it was exhausting. Both sites bled quite a bit afterwards and where the needle was inserted at the side of my eye still hurts (24 hours later).

 

The test was all over within 20-30 minutes, although since speaking to people in the know a proper full sfemg looking for MG should take an hour or more. An sfemg / emg is only as good as the person performing it, MG is not common it is considered rare, so the operator also has to have a vast experience of performing this test on those with MG. It is not the gold standard test it is claimed to be and many neurologists around the world are starting to realise this.

 

After these tests I made my way down to the unit that I was meeting the neurologist in. I needed bloods to be done as the neuro wanted the basic MG blood tests carried out again. No doubt in a few weeks time I will learn that they are negative too. My veins were having none of it as usual, the healthcare assistant made three attempts and couldn’t get a drop despite being in a vein on all three occasions. It wasn’t that surprising to me, it was now gone 2pm and I hadn’t drunk anything since about 9.30am as I didn’t want to constantly need the toilet on the drive to the hospital.

 

It was decided that I would go in to see the neuro and someone else would do battle with my veins after. On the face of it the neuro seemed nice, polite etc but it became clear within minutes of the consultation starting that with the nerve conduction tests coming back negative that they wouldn’t be entertaining the idea of MG. There was no neurological exam, in all my years of being a professional sick person, I have never met a neurologist, student or otherwise who hasn’t performed a basic neurological examination. Clearly as a patient I wasn’t worth the effort.

 

Whenever I have seen neurologists in the past they have examined my eyes or the muscles around them. Usually they would get me to do a sustained upwards gaze which would give me ptosis. They would check also for Cogans lid twitch as you can see demonstrated in this video on YouTube https://www.youtube.com/watch?v=X8DNc-q12lY. Again that would have been positive for me. There is a whole host of other tests they could have done but chose not to because being positive on them would have left a bit of a conundrum as I am always positive on these. To not even bother with any sort of neurological examination made me feel worthless. It seems with a negative nerve conduction study the patient is simply wasting the neurologists time and effort.

 

I was told repeatedly with the nerve conduction study coming back normal, I couldn’t possibly have MG. It was suggested at one point I was in the grip of a hemiplegic migraine………..which was dismissed when I pointed out I hadn’t had a migraine in several years. In fact it had been so long since I have had a migraine that I have stopped taking the medication I took daily to prevent them. Obviously now I have said that out loud I am expecting one any day. I haven’t actually had a hemiplegic migraine since the age of 15, when I did have them my face was never involved, I didn’t have ptosis, I was basically paralysed down one side of my body when they happened. Other than that they had no clue what was causing the ptosis and apparently it doesn’t merit any further investigation. They will kindly review me every now and again when I am at the same hospital seeing my PoTs consultant.

 

Around half way through the appointment they let slip that they had been digging through my notes from ten years ago. They were the same ones that suggested somatization disorder as the root cause of all my problems including the ptosis. So now after being brave enough to stick my head above the parapet and mention MG again I have inadvertently put myself in danger of being written off with that psychological label again. I also found out that they worship at the altar of an idiot doctor I have seen at another hospital. No doubt they’ve had a great laugh at my expense, silly woman convincing herself she has MG. Although I keep telling them I don’t care what it is I just want a name and a treatment plan, it seems that they believe that I am just a patient hellbent on getting a rare diagnosis. Rather than understanding the very human desire of needing answers.

 

There was no explanation as to why mestinon / pyridostigmine resolves my ptosis, other than it increases everyone’s muscle strength even if they don’t have MG. How true that is I don’t know. But even that contradicts the earlier statement that there was nothing wrong with my muscles. The fact that applying ice to my eye resolves the ptosis was also ignored, because to accept that would mean having to acknowledge that there is a problem at the neuromuscular junction. Anyone without a neuromuscular problem that has ptosis doesn’t get those results. I even took a freezer block with me to demonstrate but that was dismissed out of hand. There was no need they assured me.

 

I spent the whole time thinking that they just weren’t listening to anything that I said. Which in turn made the fight leave me, I am savvy enough with doctors now to realise when I am on a hiding to nothing. I just wanted to leave, get home, have a cup of tea and a cigarette. I had explained numerous times that I couldn’t see properly when I had ptosis out of the eye that didn’t have ptosis. The suggestion, which has to be one of the all time greats was and I am paraphrasing “that because it upset me the way I look when I have ptosis, to just use the mestinon when I leave the house”. Those of you who know me or follow this blog know I basically leave the house for medical appointments, that’s it. If I did as suggested I would never take it. It also ignores the fact it would leave me with very little sight for hours every day whilst alone for up to 12 hours a day whilst hubby works.

 

I asked why it was that my oxygen levels plummet why at times I struggle to breathe, why my legs refuse to work on occasion and was met with a shoulder shrug. It was suggested I speak to my gp and have more up to date breathing tests done. My gp isn’t going to do that when MG has been taken off the table. I have had them before and whilst they showed marked desaturation when I was up and moving around, I was accused by the doctor who organised the test (which was basically a pulse oximeter taped to my finger for 24 hours that recorded everything) that I was holding my breath. If I held my breath for as long as I had been accused of doing it, I would be a world champion free diver or dead. However I know now that due to PoTs pulse oximeters aren’t very accurate due to our circulatory issues, at the time of those tests I hadn’t been diagnosed with PoTs.

 

There is nothing quite like the kick in the teeth you get with a doctor that has already made their mind up about you before meeting them. I can only hope that my PoTs consultant goes on the patient he has met and not the neurologist’s opinion of the patient. I really hope that this hasn’t put our working relationship in jeopardy.

 

The only upside of yesterday was that I bumped into my PoTs consultant, who came over and had a quick chat with me. He was taking the mickey out of the healthcare assistant that couldn’t get my veins to relinquish any blood. I told him off as he has never once tried to cannulate me. I have made student nurse and doctors cry due to my veins being such bastards. He did find that very funny. Thankfully the second person to attempt taking blood did hit the jackpot first time.

 

I am allowed to continue taking mestinon as “it makes me feel better” – yep completely ignoring the fact that it resolves my ptosis and I can see. Had I been able to just get straight to the car and be alone I would have sobbed and sobbed. They made me feel utterly worthless, not worthy of further investigation because there is nothing wrong with me. You heard it here first folks I’m bloody cured!!!

 

* * *

 

Thankfully after a shitty day I came home to these beauties, two baby mugs with the puppies (although they will be 11 this year) names on. To go with their mums mug (Mollie) and their uncles mug (Travis).

Stressed

This week has been fraught with activity, on the day last week’s blog post was published I had a telephone call offering me an appointment this Friday for nerve conduction studies and to see the neurologist who specialises in movement disorders. Stressful doesn’t seem to cover it. Even though I have been through all of this before, on numerous occasions it never gets any easier.

 

This isn’t my first rodeo where MG (myasthenia gravis) is concerned. I have had at least 4 nerve conduction studies previously, all came back negative. I will be honest, I really don’t hold out any hope for this one being any different. I have seen several neurologists who on first sight are utterly convinced that I have Myasthenia Gravis but when the tests all come back negative, shrug their shoulders and look no further. I have demonstrated my positive reaction to the ice pack test on more occasions than I have fingers. Yet with all the other tests coming back negative it is ignored despite the fact it conclusively shows I have an issue at the neuromuscular junction.

 

The fact that I respond to mestinon (pyridostigmine bromide) is also ignored once the tests come back negative. With one doctor suggesting it was merely the placebo effect. It is difficult to feel positive about hospital appointments when you know that you will be ignored if the tests don’t come back with a positive result. There is also the danger that you will be labeled with a having a psychological illness such as somatization disorder and all the medical care you currently have will disappear. The stakes are high, I know how much I stand to lose.

 

I have spent the last week slowly working through my pre-hospital appointment checklist. As I am seeing two different departments on Friday, I need to have two sets of prescription medication lists and the medication allergy list (as there are quite a few that will provoke a nasty reaction). These both needed updated as some of the medication I take is not on my repeat prescription list, some of it on the repeats list I haven’t taken for over a year and I have developed more allergies since last year. At the same time I have put together an Emergency envelope that will sit by the front door. This contains my latest hospital letters (copies of), lists of medication allergies, prescribed medication list and contact numbers for next of kin. I think if you have a chronic illness that may require an emergency hospital admission it is good to have an envelope or file with your relevant medical information in. In an emergency blind panic can set in and you can forget stuff. This way all that I have to do or hubby has to do is handover an envelope and the paramedics have everything pertinent to hand. Plus as my health care is overseen by two different hospitals in two different areas, the electronic notes don’t link up.

 

I tend to also carry a copy of  the list my prescription medications and medication allergies in my purse, along with a short list of my medical conditions when I leave the house. So that should anything happen car accident, faint etc I have all the information to hand. I know it sounds over prepared but I am horribly allergic to CT contrast dye, I really wouldn’t want to be injected with the stuff unless it was absolutely necessary.

 

I have lost count of the number of times I have read and re-read the appointment letters from the hospital, my memory is shocking, I wanted to ensure that I have all the correct information with me and that I know where I am supposed to be going. Also with the nerve conduction studies they have asked that I don’t use body lotion etc before the tests as it can interfere with them.

 

I would normally wear make up for a hospital appointment, so that they can’t toss me into the “depressed” file, I also try to avoid wearing black again to avoid being written off as depressed. Yes they really do use what colour clothes you are wearing and if you are wearing makeup to suggest that you are depressed (if you are a woman). I always ensure if I am wearing black (even if it’s just a top or a pair of trousers) I have bright colours somewhere on my outfit. So a great deal of thought has had to go into my hospital outfit, as the neurophysiology appointment asks that you wear a top that can be rolled up above the elbows and with trousers that they can be rolled up above the knee. I need to also add in something that is comfortable and preferably with layers, I have so many problems regulating my temperature, where I can go from cold to way too hot in a matter of seconds, so layers for me are essential.

 

Then comes personal grooming, something that can fall by the wayside when you feel like shit! I think the last time my legs saw a razor was the end of June, for my last hospital appointment. I am lucky I am not very hairy and it is slow-growing so I can get away with it for the most part. However despite being sick I am incredibly vain and would die of embarrassment should I need to roll up my trouser leg for the nerve conduction studies only to reveal really hairy legs!

 

I have also included two photographs in my hospital paperwork of my ptosis should sods law strike and I don’t get it that day. It is usually the case when you have a fluctuating condition that it is never at it’s worst when you see the hospital consultant. Over the years I have learnt the hard way, so now I take evidence with me. So if I am complaining of lower than normal blood pressure I take my omron BP monitor with me as it stores the readings. Now with ptosis I take good clear photographs that I have downloaded from my phone. That way it can’t be disputed that it happens. It does pay to be organised as if you are like me, you can get a little flustered when seeing a new doctor. Knowing that I have prepared in advance helps keep me slightly calmer.

 

I’m still debating on whether or not to take a freezer block with me, in case I should need to demonstrate the ice pack test for the neurologist. I have a nice small cool bag in which to keep it cold, it’s just a case of whether I should or not. In the neurologists letter they have advised me not to take pyridostigmine bromide before the nerve conduction studies but to take it when I have finished the tests. Again I am wondering if I should wait until I am actually in front of the neurologist to take it, so that they can see the extent of my ptosis and muscle weakness. At the moment I think I shall take the meds with me but not take them until after both appointments. What’s the point in assessing my muscle weakness if I have taken a medication that will improve my muscle strength?

 

You can probably tell I am a little wound up about this up and coming appointment. It is already affecting my sleep, as I am waking up at all hours and the immediate thing on my mind is this appointment. So much hangs in the balance. I am honestly not bothered if its MG or not, I just want to know why I am having ptosis / muscle weakness and what can be done about it. Over the last ten years all I have wanted are answers, which I don’t think is too much to ask?

2015 was not last year

We are now six months into 2017 but my brain is still failing to catch up after last year. I am still catching myself thinking that 2015 was last year or writing the date as 2016. It’s almost as if 2016 didn’t happen at all and throughout all the years of chronic illness this has never happened to me before.

 

Last year holds very few memories for me, much of it is a vague blur. When you look at what occurred last year it’s hardly a surprise. From the start of the year I started to experience what I believed to be migraines several times a week. Over the course of three months they became daily and at the end of March 2016 I collapsed in the shower due to the pain. It was immediately diagnosed (correctly) by my gp during a home visit to be a low pressure headache caused by a CSF leak. My gp spoke to my PoTs / EDS consultant who advised increasing my salt tablets (salt can increase CSF production). I spent much of April in bed, three weeks after I collapsed I was referred to a neurologist who specialised in CSF Leaks. First hurdle jumped through or so I thought.

 

Despite my referral being marked as urgent, my referral was refused. This is not uncommon these days as many hospitals now employ admin staff (not medically trained staff) to sift through referral requests to see which ones they can deny and which ones they will approve. At the hospital the consultant was based, insider knowledge from an anonymous source informed me 60% of referrals to neurology were being denied for spurious reasons. When I still hadn’t heard anything back from the hospital by mid May (and now in daily agony) my referral was submitted again. By the end of the week I had an appointment for 22nd June, the day before the EU referendum vote hence why I can never forget date, as it was discussed in my appointment. Now cynical me would say what a devious  strategy for hospitals to keep their waiting lists down by refusing to accept 60% of referrals. But with the UK at the polls today for the General Election you’ve probably been all politicked out, I know I won’t be sleeping tonight whilst I wait for the results to come in.

 

A week after my hospital appointment in June I was admitted to hospital for various tests and the hope that I would get an epidural blood patch done. Those of you who regularly follow my blog will know that I didn’t get an EBP done but instead started monthly caffeine infusions and occipital nerve block injections. With the introduction of the infusions and injections things did improve a little but I was still pretty much incapacitated every day to varying degrees.

 

On the worst days I would be in bed for 20-24 hours, unable to lift my head up off the pillow whilst violently throwing up. My bedside bin (lined) became an impromptu sick bucket and I became an expert at throwing up whilst lying on my side. My world really began to shrink, much of the time I couldn’t watch TV or use a computer / phone as the light emitted was too bright even with sunglasses on. I ended up listening to audiobooks or the radio to pass the time. The back of my head and neck were permanently red from lying on hot water bottles. Days, weeks and months merged into one, something I am not surprised about as this is the worst medical condition I have had to deal with.

 

I look back now and I am surprised that I got through this at all. I was lucky as I had the support of my husband, parents and friends. Someone without that support network would have really struggled. When I was able I could also get support from a Facebook group for those who have a CSF Leak, they helped me in so many ways. I now realise that I have probably been leaking on and off since I had a lumbar puncture in 2009. Although it’s not completely gone away, I still have days where by 2-3pm I have a headache start that will only go away if I lie down, I have quality of life back. Lying in a darkened room, completely alone for much of the time is no way to live. I have to be honest I don’t know how I would have coped if the pain hadn’t suddenly dramatically reduced just before Christmas last year. You don’t realise how much you have even when chronically sick before, until it’s gone. It really shocked me how quickly life as I had known it had been taken away.

 

Even though I know 2016 happened and have snapshot memories of things that happened, it does feel like life completely passed me by. It is a really bizarre situation. Obviously it’s quite normal at the start of the year to think the wrong year was last year, for example in January 2017 you were still probably thinking 2015 was last year (or maybe that’s just me?) However it’s June now and I am still struggling to accept that 2016 has been and gone, that 2015 wasn’t last year its two years ago now. It a really hard thing to describe unless you’ve been through a similar situation.

 

I realised just how caught up I was in still thinking that 2015 was last year when I had to correct myself when speaking to my hairdresser this week – again something I rarely had done last year was my hair! I explained that I was caught up in this brain trap due to losing much of last year to being so ill and she totally got it. Some people I have spoken to about it don’t or can’t understand how you can lose a year but realistically it must happen to many people for a variety of reasons. 2017 just seems so alien to me it takes a conscious effort to remind myself it is this year. One mantra I am repeating constantly is 2015 was not last year. I have six months left to recognise this year is 2017, let’s hope it’s sorted by 2018!

Eventful

On Thursday 1st December I had my 6th Caffeine infusion. To say it was eventful would be an understatement. What has previously gone ahead pretty smoothly other than being unable to cannulate me without multiple attempts was littered with potentially dangerous errors. I am still in shock to be honest.

Over the few days leading up to the infusion my head was letting me know it was long overdue. By the time Thursday came around my head pain (from a csf leak) was reaching a 7 out of 10 on the pain scale within seconds of getting upright. By the time I reached the ward I was dry heaving, which happens when the pain gets to a certain level. I had felt sick before leaving the house and had taken my anti-sickness medication hours earlier but they had done nothing. All I was relying on to prevent me from blowing chunks were deep breaths and they were becoming ineffective.

On arriving at the unit I advised them of the fact I wanted to be sick, several times. My request for anti sickness medications went unanswered so I demanded a bowl as I didn’t want to puke all over myself when I didn’t have a change of clothes with me. In every other hospital situation I have been in when I have told staff I needed to be sick they have sprung into action. Here I was asked by one member of staff if I had a hangover, I don’t drink, well it’s easier to say I rarely drink. I had drunk two bottles of Budweiser the night before as my head was bad and it was a last resort but it wasn’t enough to give me a hangover. I calmly explained to the member of staff, the same member of staff I have been seeing since June (every month) that when my head is bad I will be sick. He knows who I am as he then asked me how my birthday had gone and laughed about the fact Mr Morris had booked me a dentist appointment on my birthday. So he could remember that but not the issue that I come in and see them for every month.

This time it was on my notes that I had to have an ECG, whilst wiring me up I was given a sick bowl. The battery was out on the machine so the nurse had to get a new one. Whilst she was gone I dry heaved into the bowl, bringing up no more than a couple of teaspoons worth of saliva. The dry heaving was automatic, I had no control over it, yet when the nurse came back she demanded I lie still so that she could do the ECG. Believe me it gets worse. Anyone with a modicum of common sense would have sorted out anti-sickness medication so that I didn’t want to dry heave during the ECG but no she was getting the ECG done and I wasn’t to interrupt with anything so petty as throwing up.

Finally after what seemed like an eternity I was presented with two tablets in a paper cup. I looked at them and I don’t know what happened but I asked the nurse what it was. A lot of the time I wouldn’t do this, many patients don’t and just assume what they are being given is correct. So let this be a lesson to you, accept no medication without asking what it is. Nurses / doctors are only human and make mistakes. The nurse told me it was ondansetron, a medication that I have suffered a hideous allergic reaction to when given via IV in 2014. Now this nurse (same one as the ECG nurse) had just put my red wrist band on, the one that alerts staff to the fact the patient has allergies so they must check their notes before issuing medication.

Red wrist band

Red wrist band

 

I carry with me at all times a mini medical file which contains the latest letters from my consultants, my prescription list (I can print off from the doctor’s surgery) and a list of my drug allergies as I have quite a few. Every time I arrive at this unit they ask if I have allergies, I give them the list, they scan it and the same receptionist tells me every time that I won’t need to bring it with me next time. On Thursday she just asked if I had allergies and printed off a red wrist band. I assumed that the allergy list was in my notes. After I pointed out I couldn’t be given ondansetron she checked my notes and surprise, surprise my allergy list wasn’t contained within the file. So my hospital buddy Sharon found it in my bag and gave it to her. Sharon was sat in shock that potentially this nurse had nearly just killed me. Sharon is a veteran of hospitals and said “I never ask what they are giving me, I just assume it’s right”. I told her over the months of me coming to the unit I had heard them give patients ondansetron as the anti-sickness medication of choice. It is probably the cheapest and I don’t blame them for that but not everyone can take them and before issuing a patient wearing a red wristband it might be an idea to check their allergies. If they don’t ask you demand to know what medication they are trying to give you. I don’t want to sound melodramatic but I might not be alive today if I hadn’t have asked the question on Thursday.

As I couldn’t take ondansetron, I was given cyclizine a medication I have taken numerous times before with no issue. In their wisdom they gave it to me in tablet form despite me telling them I wouldn’t keep it down. I had stopped drinking at this point despite my tongue sticking to the roof of my mouth as I was so dry. When I tell you that I am not going to be able to keep a medication down I am not pissing about or trying to be difficult. They ignored me, so I took the tablet and promptly threw it up much to the nursing staffs surprise.

I won’t lie I had come into hospital on Thursday fully expecting a fight with a nurse I shall refer to as Dick. Dick seems to have a problem with my wheelchair and will move it away from my bed and put it in the next room claiming it’s in the way. As my chair will cost £2,500 to replace I have an issue with it being left unattended. He even has a problem with my old wheelchair insisting it is folded up and moved away from the bed. He also won’t provide my hospital buddy with a chair let alone my husband so they always use my wheelchair.

Sharon had witnessed this nurse’s behaviour during my last caffeine infusion. She knew from our conversations over the last month that I wasn’t going to accept this from him this time. To me it seemed to be disability discrimination, he also has a problem with the walking stick I bring to help me transfer from my wheelchair to the bed. I was fully ready to get PALs involved if he kicked off this time. Much to our disappointment  Dick wasn’t on the ward when Sharon moved me through into the unit so by the time he came back from his break, she was fully ensconced in it, at the foot of my bed using it as a chair. We were pissing ourselves as we could see he was seething that we had got it past him. This entertained us greatly whilst we were there and the junior doctor we spoke to who managed to cannulate me first time whilst I was waiting for the cyclizine to come. Although he didn’t say it in so many words he also thought Dick was being a dick about the wheelchair.

The room in which I receive the infusions is pretty small, it has six beds and then a desk by the door where the nurses and doctors do their admin work. I don’t know which doctor it was that had to do the prescription for IV cyclizine but he was kicking off that they hadn’t done it IV to begin with when I was telling them I wouldn’t keep the tablet form down. So someone in there does have some common sense. I also heard the same doctor getting excited about my ECG asking the nurses who was in with sinus tachycardia, the nurse dealing with me told him “she’s always like that and we aren’t treating her for that”. Poor lamb had only wanted to help and was asking the question as to why my heart was racing whilst I was lying down still during an ECG, now we will never know as PoTs is only supposed to occur with changes of posture, I hadn’t moved for ages at the time the ECG was done.

Finally after what seemed like forever I was given IV Cyclizine. Within a few seconds of the injection being finished I really didn’t feel very well. I must’ve turned a funny colour too as Sharon told me I wasn’t looking very well. I suddenly felt very panicky and was worried that the nurse had just given me Iv Ondansetron. I just about managed to tell Sharon that my chest was tight and I felt woozy. Within seconds I was battling to remain conscious, my eyes were rolling in their sockets, unfortunately no one could see this as I had my large very dark glasses on as I become very light-sensitive when my head pain is bad. I felt myself falling as I slumped to the right hand side of the chair. For the briefest of moments I blacked out only coming around as Sharon was screaming my name and shaking my leg trying to rouse me. I couldn’t respond as I was still fighting to stay awake, I couldn’t focus on anything as my eyes just kept wanting to disappear into the back of my head.

Eventually the nurse realised something was wrong and whacked the bed back so that I was flat and then took my blood pressure. By the time she got her reading 109/73 I was feeling more or less with it again. She was trying to excuse herself for not noticing the fact I had passed out by telling Sharon and I it was because I was wearing makeup and sunglasses. I think the biggest clue was I wasn’t responding to Sharon and had slumped to one side. She did tell us that Cyclizine can crash your blood pressure which was obviously what it had just done. What she failed to tell me was that it would repeatedly crash my blood pressure for the remainder of my time in the unit. You’d think that she would have monitored me regularly after that episode but she only took my vitals once more and that was just before I left, nearly three hours after the faint.

I have faced some scary times when in hospital but that has to be one of the most frightening because I was shit scared the nurse had killed me by giving me IV Ondansetron and who can blame me with her laissez-faire attitude towards protocol.

I spent the rest of the infusion time trying very hard not to faint. Throughout the infusion despite the extra fluids going in, I kept feeling like I was going to pass out. I kept feeling like I was having an out-of-body experience. I knew if I fainted again there was a high probability of me not being allowed home, so I drank loads and kept being completely upright to an absolute minimum.

I only let Sharon know how bad I was feeling so that she could place herself in front of me should I try to face plant.

Despite how awful I felt I did have a good time during the infusion, it’s always great to catch up with Sharon, we always have something to say. Plus I got to catch up with a doctor who I thought I had lost forever to the acute stroke ward. He knew I had been to Bath the week before (it wasn’t a great appointment and all they will do for me is write a strongly worded letter to tell the hospital to get on with the blood patch as there is no increased medical risk) and we talked about the clinical trial that he wants me to be a part of. Its called a Sphenopalatine ganglion Block, it’s basically a small catheter type device placed up your nose, which they then use to squirt a dose of local anesthetic up. It works on a group of nerves at the back of the nose and has good results in conditions like chronic migraines, trigeminal neuralgia and facial pain. This doctor and my neurologist want to trial it to see if it is effective for pain caused by a CSF Leak and I am more than happy to give it a go if it has a chance of stopping my pain completely.

I let this doctor know that last month’s occipital neuralgia nerve block injections had been ineffective. I told him although the nurse that does them maybe highly qualified she doesn’t do it the same way he does, which is multiple small injections along the occipital nerve. He agreed due to the fact the last lot hadn’t worked he would repeat them for me, if he came back from his meeting before I left the unit. Thankfully I was still there on his return and the injections he gave me have worked beautifully.

I have very little memory of the rest of Thursday, Friday and most of Saturday as my blood pressure wouldn’t settle and kept crashing after the cyclizine injection. I have had to piece the events together from Sharon and my husband. I don’t think I have ever been made so sick from a trip to hospital.

Due to the incident with the nurse ignoring my red wrist band and attempting to give me a medication I am allergic to, I have had to report the incident to the hospital. I have wrestled my conscience and I wouldn’t be able to live with myself if another patient ended up being given the wrong medication due to protocols not being adhered to. It could make things very difficult for me in the unit but I couldn’t live with the thought that  by not making a complaint it contributed to someone else coming to harm.

So last week’s Caffeine infusion was eventful to say the least.

#5 a comedy of errors

On 31st October I made yet another trek to the hospital for caffeine infusion number 5. They do work and give me a little relief from the awful pain that is being caused by the cerebrospinal fluid leak. The results of each infusion is different, sometimes I get complete relief from pain for several days other times it is just a few hours. This time it was just hours, with the pain knocked down the pain scale for the following few days. Alas it is starting to increase again.

Although the infusion had been planned meaning I didn’t have to make numerous phone calls to get it booked in, the word disaster would cover it quite aptly. We arrived early, hubby, Sharon (my hospital buddy) and I at 9:30am, my appointment was 10am, so when the nurse ushered me straight through to get the cannula set up I was pleased as punch believing the infusion would be under way quickly and we would be able to get home soon. How silly of me.

We were greeted by the nurse that had an issue with my wheelchair (he claimed it took up too much space) last time, which made me uncomfortable as we had brought my new chair, which doesn’t fold down but is much more comfortable if I have to sit in it for a protracted amount of time. On getting me settled on my usual chair / bed thing he immediately told me that my wheelchair would have to go back into the waiting room, leaving me stuck if I needed a wee. I presumed that the offending wheelchair would be allowed back in with me once Sharon and Jay were allowed to join me on the unit. Yes this nurse also demanded my husband and friend stay in the waiting area until my cannula was in. Why I have no idea but as I was going to be in his care for several hours I thought it best not to antagonise him.

Before any cannula attempts were made, the nurse filled out a medical record form. Every time I am in this unit something different is done, this time I was asked for next of kin and what I was being treated for. The nurse had put low-grade headache, to which I nearly exploded but instead  contained my simmering rage and informed him that I had the same CSF Leak that I have had every four weeks since the end of June. I know they have lots of people to remember who go in and out of the unit but they all remember I am the caffeine lady and that I have shit veins to cannulate. So much so that some of the nursing staff actively avoid having me as a patient because my veins are such a nightmare.

Twenty minutes later with one attempt at a cannula made, Sharon came into the unit. The nurse made a face, as to let her know she wasn’t welcome and she stood up to him by telling him something along the lines of “I have come to spend time with Rachel, I am not staying in the waiting room. And can you get me a chair please.” I loved it, as I could see how pissed of he was. She told me Jay had told her to come on in and that there would be nothing they could do. Jay was going to stay with my wheelchair out in reception, as he doesn’t do needles.

Thankfully cannula attempt number three worked (after twenty minutes of having a surgical glove filled with hot water placed on my arm) but I was now waiting for the caffeine to come from the pharmacy. The reason offered was that the pharmacy wouldn’t have processed the prescription that had been completed (4 weeks ago) if it had been sent in on Friday (28th Oct), so they had given it to them today. That was a little concerning as caffeine is such a rarely used drug that I was now at the mercy of the pharmacy having it in stock.

Cannula attempt number 3

Cannula attempt number 3

 

I had seen my neurologist the week before and had asked him if it would be possible to have my occipital nerve block injections. I was unaware at the time that he was the duty neurologist , so he popped by and saw me. He also introduced me to the “headache” nurse who would be able to perform the injections today. I was so grateful I shook his hand as the occipital neuralgia pain had been getting much worse since my last lot of injections ten weeks prior. Again I shouldn’t have got excited as the experience was brutal. 

Thirty minutes later (now an hour after I have arrived) the caffeine infusion still hadn’t been started as the caffeine hadn’t been dispensed from the pharmacy, the “headache” nurse came back and asked if I wanted to have them done, to which I agreed. She then produced a consent form, I told her I had never had to sign a consent form before to which she replied “nothing surprises me”.  The consent form then had to be corrected as where it stated what my medical condition was it said “chronic migraine”. As she hadn’t seen my notes she had presumed what was wrong with me. That wasn’t the only mistake to be made on the form, after I had signed my name I had to print it underneath. I managed to print my maiden name, that hasn’t happened in years. I can only guess that having Sharon there reminded me of the days before I was married.

This nurse had a totally different approach to the occipital nerve block injections than the doctor who had been doing them previously. The doctor would inject the local anesthetic in 4 different locations, this nurse just did two injections at the base of my skull and rammed them in. It hurt like hell and it was all over in seconds. Sharon was in a state of stunned silence, when the nurse left she said “that was f**king brutal Rach” and she wasn’t wrong. Needless to say I wasn’t impressed, I have been left with pain from the injection site and I still have occipital neuralgia. I have been using my Tens machine placed on my neck and the base of my skull to combat the pain. This is the first time these injections have failed to work, I am guessing it is something to do with the way they were performed.

Jay had now been sat in the waiting room for 90 minutes and was not best pleased that the caffeine infusion hadn’t yet been started. Nor was he happy that a wheelchair that would cost over £2,500 to buy new was having to be left unattended in the waiting room whenever he wanted to come and see me. I could sense he was getting tense so told him to go and pop into his parents, as he doesn’t get to see them very often. I also told him to take the wheelchair with him as I didn’t want my chair to be left in the waiting room with no one keeping an eye on it. He took me up on the offer deciding it was the best thing to do because at this point we had no clue how long it was going to take to get the medication from the pharmacy.

At midday, 2.5 hours after arriving the caffeine infusion still hadn’t been started. Sharon went and got us some lunch as we were both starving. She brought back a delicious pile of goodies so we got stuck in. I was so happy to avoid the hospital sandwiches which are totally vile but I usually end up eating because I couldn’t face breakfast. I have to say that was probably the highlight of the day, the cookies she bought for dessert were divine. Good old Marks & Spencer’s, even the crisps were out of this world.

As I was stuffing my face another nurse came over to start the infusion. She flushed the cannula that had been in situ for around 90 minutes but the vein had collapsed and it felt like someone was pouring battery acid down it. I would now need another cannula inserted. Knowing that he had been defeated by my shitty veins and no one offering to have a try, the original nurse went off to get someone else to have a go None of the nurses in the unit wanted to try, as all of them have at some point and know how difficult it is. I was starting to get concerned that they would abandon the infusion if they couldn’t get a line in, leaving me with ever-increasing head pain and no end in sight.

The ward manager was brought in to attempt to get a cannula in, he was cocky which bothered me as those types don’t listen when you tell them not to dig around if they fail to get a vein. He did however ask me where was good for a vein on my right arm, my left arm was now covered in horrendous bruises that had huge lumps under the skin.

The first attempt failed after looking promising initially by providing a flash of blood, which then stopped. My veins like to tease people by doing this on a regular basis. When it stopped working, I wasn’t surprised and nor were the rest of the staff in the unit. All of them at some point have been conned by my veins. Only two people so far have got a vein on their first attempt and both of those were junior doctors but they were only brought in after several other attempts had failed. He then went for the back of my hand which up until now had been a good place to try as on more than one occasion it has been successful. That one failed, so the tourniquet was applied tightly to my upper arm and I was asked to make a fist.

It seemed that I was doing this for ages when all of a sudden the nurse jumped back, as he did that I lifted my hand up from the table only to realise the back of my hand was soaking wet. When the attempt on the back of my hand had been aborted, there had been no blood at all so the nurse hadn’t bothered to put anything on it. Now blood was oozing out all over the table and dripping onto the floor. The nurse had jumped because he thought he had cut himself when he saw the blood and hadn’t realised it was coming from me. It took a while to stop the bleeding with firm pressure applied. Finally on his third attempt he got a cannula in and the caffeine infusion was started without delay.

About an hour after the infusion had been started Jay came back onto the unit with my wheelchair.  The nurse who seems to have an issue with mobility aids was on his lunch, so I told Jay to sit in it whilst we waited for the infusion to finish. None of the other medical staff on the unit have a problem with my wheelchair, there is more than enough room for it, it’s just this nurse seems to make it his mission to make me feel uncomfortable about its presence. Due to the fact I don’t want to have to make a formal complaint about him I have held my tongue however should he start on my next scheduled visit I will speak up. It’s bad enough having to come to terms with the fact I need to use a wheelchair, without some idiot making me feel uncomfortable about its presence in a hospital unit.

Five hours after we arrived at the hospital we left, with the next infusion date booked. This time I have booked it for a Thursday, as the nurse who I have seen since June has told me he will be able to put the prescription in on the Wednesday, so that we should be in and out in three hours if my veins play ball.

Bruise 24 hours after left arm

Bruise 24 hours after left arm

rightarmfollowingday

Right arm 24 hours later

Left arm 48 hours later

Left arm 48 hours later

 

Left arm 8 days after hospital

Left arm 8 days after hospital

My birthday on Tuesday (1st Nov) was a sedate affair as I was completely worn out after the hospital debacle. Jays birthday the following day was mainly spent in bed. We both had really lovely presents given to us and lots of messages on social media. On Sunday 6th November it was Mollie’s 12th birthday. So here is a photo of the old girl, who was thoroughly spoilt.

mollie-12

The most un-birthday-ish ever

Next Tuesday (1st November) or last Tuesday by the time you read this, is my birthday and this year I am feeling the most un-birthday-ish, I have in years. I just can’t get excited about it, nor my husband’s the following day. I have bought and wrapped all his presents, I am looking forward to giving him his presents but if we could just gloss over mine I would be more than happy.

Saying that though I have been incredibly irritated when hubby has tried to open my cards (that have arrived by post) at the same time as his. I have also banned the cards that have arrived being put up on display before the day. Hubby has a dreadful habit of opening everything on the lead up to our birthdays and this year this has got on my very last nerve. I have so little this year to look forward to, that I have decided none of my cards will be opened until the day. I have no problem with him opening the post the rest of the year but my birthday cards are just that mine.

There are a lot of things happening on the lead up to the big day, at the weekend hubby is going out with his friends, so I have a really good friend coming to spend Sunday into Monday with me. Up until now I have been pretty excited by it, we have been planning it for months but now I am filled with anxiety that she won’t enjoy herself or that I will be ill (well sicker than normal) and she will end up changing her role from great friend to carer. Something I hate because it will mean yet again chronic illness has taken over a day that should be fun.

On the 31st October I am heading to Plymouth for my caffeine infusion and meeting up with my oldest friend Sharon, who I have known since we were 8 years old. I can’t thank her enough for spending her free time with me in hospital (a place we both loathe) so that we can catch up. I am looking forward to seeing her as I haven’t seen her for about ten weeks. We have gone years and years before without seeing each other but now because I have seen her on a more regular basis, the hospital visits just aren’t the same when she isn’t there. I also have to thank her for being my photographer when I had my occipital nerve block injections back in September. She admitted to me afterwards that she had almost passed out when she saw how far the needle went in!

Maybe I have my husband to thank for me not feeling particularly birthday -ish after all the muppet did book me in for my first dentist appointment in 3 years on my birthday…..Even the receptionist questioned his wisdom at the time of him doing this. I have been quietly seething ever since as I have a rabid fear of dentists and I know my teeth are quite a mess thanks to EDS.

Most people (other than Dentists) have no clue about the damage EDS can do to the teeth. I am rapidly losing the enamel from my two front teeth, so the base of them is very thin and over the last three years bits of them have chipped off. Also the braces I wore as a teenager have left pits in my teeth, I was lucky enough to wear the old train track style braces top and bottom. Where the brace was cemented to my teeth it has left holes that rapidly became gaping pits in 2013. My dentist at the time filled the holes and they looked great for a while but now, due to copious amounts of coffee (due to my CSF leak, caffeine increases cerebrospinal fluid production) and fags (I seem to smoke more when I am in a lot of pain, when I can get out of bed to smoke at the back door) these “fillings” have become stained and I hate looking at my teeth.

I know I am going to be in for a painful session and will probably have to return quite quickly for more work. I think I need a couple of fillings too which will be an adventure as due to dysautonomia I need adrenaline free injections or I will pass out on standing. I also need a Dentist who works quickly as due to EDS affecting the local anesthetic. I tend to burn through the stuff very quickly and due to my extremely low pain threshold when it comes to my mouth (everywhere else it’s high). So as you can probably imagine I am less than thrilled with the prospect of attending one of my least favourite places on my birthday!

In my husbands defence I did say to him accept the first appointment they have…………maybe I should have given it a bit more thought.

The 1st of November would have been used by me as a crash day. Not that I book them in but I know from experience the day after the trip to Plymouth for a caffeine infusion I am fit for nothing and can barely move. The trip to Tavistock for my neurology appointment landed me in bed from the minute we returned until the Friday (28th October). I was just so tired that I couldn’t function, I kept dropping things, my eyesight was blurred and I had double vision. The pain in my legs and spine from sitting for so long meant all I could do was lie down as my normal painkillers weren’t touching it. I am expecting all of this on Tuesday along with a trip to the dentist. Wednesday 2nd November hubby’s birthday is going to be a total washout. It’s just as well hubby is on holiday that week, as my capabilities are going to be severely restricted.

I don’t know if my lack of birthday excitement is also being caused by the fact for the first time in years we won’t be holding a party. Since our 40th birthday we have held two parties a year. This year however we have had to cancel them all, as I am just no longer well enough to have 15 plus people in the house and all the stress that goes along with putting on a do. I hate what this CSF Leak has done to me. It has robbed me of everything this year and what hurts more are those who fail to understand how bloody restrictive it is.

My life is ruled by my head pain, yes on a good day if I am lucky I can have a few hours sat up. So when friends come over I deliberately lie down for hours before they arrive so that I can be sat up for their visits. However even those have become few and far between. I know that people have their own lives to lead and I don’t begrudge them of that, it’s just this year has become particularly isolating. I have to thank Imogen and Sharon for always being there for me. Imogen for coming every two weeks to see me and looking after our mutts on a moment’s notice and Sharon for accompanying me on my frequent trips to hospital. Without you both I really would have been lost this year. If anything this year has taught me a lot about friendship. There have been others too who have kept in regular contact via text and for that I am grateful.

This birthday is the 9th birthday I have faced being chronically sick. In a normal world I would have gone out for dinner and had a few drinks with my closest friends. Yet again the day will probably be spent lying on the sofa / bed wishing I was anywhere but here. Birthdays were always so exciting when growing up, now they mark another year of failing. Failing to celebrate like the rest of the human race and doing it the chronic illness way. Grabbing what pleasure you can while you can. In an ideal world I would love to go pony trekking for the day or go on a day trip or see a film or play. Those days are long gone and a birthday is now a bitter reminder of stuff I can no longer do.

I should be grateful many people aren’t lucky enough to see their 43rd birthday and I am grateful for the things I have. I just wish that it would be vastly different.

Too much of this year has been spent lying in a darkened room due to head pain, which in turn has left me with far much time to think. I am even anxious about Christmas and whether I will be well enough to supervise the cooking of our Christmas dinner. I have never worried like I am worrying at the moment as I have no control over when a bad day will happen and there are no takeaways open on Christmas day should I find myself incapacitated.

I wish I could get myself into the swing of things and look forward to this birthday but I just can’t. I haven’t felt this un-birthday-ish ever. Hopefully next week I will be able to tell you that I had a fab day….even if some of it was spent in the dentist’s chair!