April 22, 2009 at 1:43 am (Uncategorized)

I’m still in Rochester, Minnesota, in a hotel across the street from at the Mayo Clinic. Tomorrow afternoon my husband Jay and I get to go home after nine days of me being poked, prodded, scanned, scoped, and questioned. It’s been worth it, though. For once, after making a pilgrimage to a major medical site, I am leaving with news. Now before you–or I, for that matter–think that I have definitive information on all fronts, don’t get your hopes up. We are, after all, still dealing with sarcoidosis, which can be maddeningly mysterious in its presentation.

Still, I am thrilled–and, dare I say, hopeful?–with what I’ve learned. I’ll start with my heart, one of the two critical organs involved in my latest sarcoidosis adventures. As some of you might remember, my local physicians in Helena were growing concerned that, after a three-year hiatus, the disease might have become active again in my heart. This was a terrifying prospect given the battery of drugs that I’ve been on trying to beat back the disease and the fact that it doesn’t seem like there’s a whole lot more out there to throw at this thing. Indeed, I’ve been worried about keeling over from a heart attack, or having some weird sort of heart failure kill me more slowly, all while the doctors remain powerless to do anything to help me. So the Mayo doctors ran a cardiac MRI and an echocardiogram to see if there’d been a recurrence of the conduction issues that had been my original cardiac problem in 2004 or if the right side of my heart had started to enlarge again after stabilizing for a few years. Turns out I can stop with the nail biting. The Mayo cardiologists found both my latest cardiac MRI and echo unchanged from 2006, when I had learned that the cardiac sarcoidosis was inactive. I am now exhaling.

I breathed another enormous sigh of relief after getting back the results from the MRI of my brain, with its special focus on my pituitary gland. For those of you new to my blog, I’ve been suffering (and I use that word deliberately) from neurosarcoidosis since the fall of 2007. After months of vertigo, debilitating headaches, and weird neurological episodes where I don’t speak entirely like myself and lose feeling on the left side of my face, I began to work with a sarcoidosis specialist in Cincinnati who started me on Cytoxan, a chemotherapy drug, to treat the disease in my head. I’ve been getting Cytoxan intravenously for several months, and the side effects are what you’d expect from chemo—nausea, vomiting, and chronic fatigue—though I’ve been lucky to keep my hair. While I haven’t felt cured or well since starting the chemo, I have had fewer headaches and much less vertigo. The Mayo brain scans confirmed my sense of improvement: the swelling in the area surrounding my pituitary is better. It’s nice to know that we can document the efficacy of my semi-monthly doses of poison. I was also relieved to learn that the pulmonary function tests done here show that my lungs remain virtually untouched by sarcoidosis. I’ve always found it a bit ironic that I’ve never actually had pulmonary problems from what is generally considered a lung disease—but I’m not complaining.

The results from the various cultures, biopsies, and scans performed on my digestive track were also encouraging. No evidence of celiac disease, Krohn’s disease, Whipple’s disease, or any sort of bizarre or random fungus, parasite or infection. Though here’s where things get a little fuzzy. Because I’ve been on prednisone for so long (and at high doses so recently), the biopsies aren’t entirely reliable, since the steroids can skew the biopsies. There’s also the question of whether this still might be GI sarcoidosis, since negative biopsy results can simply mean that you didn’t happen to snag a microscopic spot of granuloma from amid all the feet of intestine in which it could hide. Still, since the disease appears to be slammed into submission elsewhere in my body, the gastroenterologist thought it was much more likely that all the varied and strong drugs I’ve made my stomach and intestines endure over the past five years have caused a bad-ass case of irritable bowel disease. But, the gastroenterologist countered himself, that conclusion still doesn’t explain why the massive doses of corticosteroids I received during my last hospitalization has been the only attempted remedy that actually helped my stomach problem. However, I feel fortunate that none of the stomach testing showed anything nasty, like the cancer I had convinced myself I had. In any event, if it’s sarcoidosis in my intestines, there’s not much else I can take. Assuming it’s IBD (which is now the working theory), I’ll need to begin thoroughly tracking what I eat and finding any possible triggers for the pain and debilitating episodes of diarrhea.

Even if Mayo hadn’t given me good news (with a dash of nebulousness thrown in, just to make sure I remember what disease I’m dealing with), I’d still like the place. I’ve visited several medical centers in an effort to find the best possible treatment for my sarcoidosis. I don’t mind flying for good care. Hell, I’d fly to another country to seek advice if I thought that would help. (Actually, I’d love an excuse to fly to another country, but that’s a whole different issue.) While I’ve encountered brilliant individual doctors at different facilities (and I even followed one when she left National Jewish Hospital in Denver—one of the forerunners in sarcoidosis treatment and research—to another big medical center on the East Coast), I have yet to meet a team of physicians of the caliber I’ve encountered here. Even more impressive than their education and expertise in their respective fields is the fact that this team communicates among itself. Unlike many other doctors I’ve met (and boy, have I dealt with a platoon’s worth of white coats in the past five years), the Mayo “ethic” seems to stress communication and cooperation with each other (and, God forbid, the patient—unless you are that first cardiologist I saw here) rather than solo-ing it. In terms of medical models, Mayo conjures up images of a well-run mid-Western town, with every individual (from the lowly phlebotomist to the neurosurgeon) having their role. It’s a refreshing change from the totalitarian fiefdoms I’ve encountered in the past.

Jay and I can’t wait to get home and hug our five-year old boy, Andrew, who might evince a flicker of interest in our arrival. He has, after all, been spending the past ten days on his grandparents’ ranch, where he is spoiled in the best sense of that word (though I do think sometimes, “I never got to put canned whipped cream on my pancakes along with maple syrup when I was in their charge”). I can’t wait to share the good medical news I’ve received with Andrew, with our extended families, and with our friends. I’m a little scared about my stomach. But I’ll rest a little easier knowing the pain I’m experiencing isn’t coming from something ghastly. And the Mayo GI doctor was quite clear that if I worsen, if I can’t get control of this cycle of pain and diarrhea, I can—and should—come back and see him and get re-tested and re-evaluated. The best news, though, is that is appears that the sarcoidosis is in retreat. The last eight months of hellish chemo, combined with monthly infusions of Remicade, daily doses of prednisone, and, until last month, daily doses of Thalidomide have paid off. Every single marker for the disease points to it being inactive, being kicked in its granulomatous teeth by the medications and by my own body, which is actually fighting this disease. I am excited that the various specialists here, including the oncologist I saw today to get my biweekly dose of chemo, recommend that I eliminate one of the three big immune suppressants I am still on. I hope that Remicade can follow the Thalidomide.

I’m not planning on ending my relationship with my sarcoidosis guru in Ohio. I feel like I owe him my life. When I first saw him, I couldn’t walk across the room without feeling I was aboard one of Andrew’ imaginary pirate ships on choppy seas. While the regimen he put together is extremely difficult, it is working. Now I’m almost always certain I’m on dry ground. Plus, I am writing this, and I won’t suffer from motion-sickness after five minutes of looking at the words; I haven’t had a brutal headache in the past few days; and once I get the chemo out of my system, I know I’ll have the mental energy and capacity to play with Andrew. No amount of cooperation and collaboration can make me break a bond with someone who has helped me feel alive again. However, receiving Mayo’s confirmation of this is nothing short of amazing, given the five years of hell I feel like I’ve endured.

I plan to return to Mayo in June or July. I’d like to work with their pain management program; I’d like to meet their neurosarcoidosis specialist (there aren’t too many of those in the world); and I’d like to establish a patient relationship with their pulmonary department. If I have another gastrointestinal crisis, I will seriously consider flying here, rather than endure ever again the total chaos of our local hospital, where excellent local physicians can’t make contact with far-away specialists, and sometimes with each other. But that’s another story in itself. For today, I’m happy to know that, for once, all is as well as it can be with my body. That’s not saying I wouldn’t mind a little whipped cream on my pancakes.

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Greetings from Mayoville

April 15, 2009 at 5:20 pm (Uncategorized)

From outside my hotel window, I can see the looming granite edifice of one of the four main buildings that comprise the Mayo Clinic.  Because my digestive system and heart continue to be troublesome, my doctors in Montana arranged for me see a gastroenterologist, a cardiologist, and any other –ologists deemed necessary here in Rochester, Minnesota.

My view of Mayo’s facade is impressive, as is the facility’s efficiency.  I’m used to making medical pilgrimages to hospitals that aren’t set up for out of town customers.  I’m used to having to fuss to get tests scheduled, to see appropriate specialists after seeing the main “expert” I’ve gone to see. It is quite the opposite at Mayo. I feel almost like a high school freshman, stumbling my around unfamiliar buildings with a horde of other new students. We clutch the helpful schedules that Mayo prints up for us. But instead of finding our way to lockers and the room for Algebra I, we make our way to Gonda Building, Ninth Floor, Desk 9 South or to the Hilton Building, Court Level, Desk C, also known as “Venipuncture Specimen Collection.” At the latter site, a helpful receptionist gives me what looks like a shopping bag from an upscale department store, inside which she places a labeled “specimen container” and proceeds to list all the “specimen” carts throughout the buildings where I can leave the bag when I’ve done my business. “Talk about discrete and well-planned,” my husband Jay said. He was right. The beige bag was totally opaque. If I didn’t have my own, I’d assume that the five hundred other people toting identical bags around with them had just gone shopping rather than being prepared to drop off warm loads of crap.

Mayo’s commitment to efficiency and to accommodating medical travelers is on display everywhere. My schedule of doctors’ visits and tests includes instructions on how to try to make appointments earlier, just in case the “first available” one they give you is after your flight home. As in airline travel, there is a procedure and a protocol. The printed schedule tells you what desk to appear at and how to make your request. It’s the medical equivalent of flying standby—looking for a cancellation instead of an open seat. Come to think of it, after dealing with surly flight attendants and chaotic airplane boarding, the airlines could learn a thing or two from Mayo—the inventors of the pneumatic tube system, we’ve learned. Rather than having to wait at one of Mayo’s desks, for instance, for a patient not to show up, the clinic will ring you on your cell phone if you pledge to make it there when told. (Of course that system won’t work if you camp out in the waiting room – Mayo’s commitment to efficiency is such that they simply block all interior cell phone traffic rather than having to go through the hassle of posting “Please Turn Off Your Phone” signs.) You can see the same type of organizational brain that conjured up the concept of sending tubes arcing through buildings behind Mayo’s giving you a pager when you check in to see the doctor; rather than bellow your name across a room and chance that you’ve wandered out of hearing to get a sip of water or use the restroom, you are paged.

The reality, though—no matter how many bells and whistles Mayo adds, no matter how easily they schedule me for tests and procedures ranging from a biopsy of my small bowel to a cardiac MRI to a simple EKG, no matter how thoroughly their managerial minds have streamlined every process—is that I am still seeing White Coats and still having my physical self violated in ways miniscule and significant. I am still a bit doctored out and tested out from my most recent stay in the hospital in Montana. I am tired of having cameras put in places unimaginable, tired of reciting the litany of events related to the past five years of sarcoidosis, tired of being cheerful and good-natured about stripping to be examined, rolling up my sleeve to have blood drawn, carting around my crap in a beige bag, and, later today, about swallowing a capsule endoscope and some other tools. I am, in short, simply tired.

I’m not stupid enough to think that I’m not lucky to be able to be seen here, or to not recognize that things could be a lot worse—hence my efforts to be cheerful and good-natured. But I’m also not stupid enough to be placated by the medical equivalent of bling. Even though the blood pressure machine in the cardiologist’s office was automated and fancy and took my blood pressure six times in a row to provide a more accurate, averaged reading, I still had to deal with the cardiologist—who was, quite frankly, an arrogant asshole who expected patients to be seen and not heard, unless and until he stared down from his metaphorical mountain where the doctor gods live and deigned to ask me a question. He is well-qualified and extremely competent, I am sure. I don’t doubt that he has ordered the proper tests and will read them accurately and make an accurate diagnosis of my heart. But I don’t like him. Equally well-qualified is the gastroenterologist, I am certain, who has a personality almost exactly the opposite of the cardiologist and who I liked a lot.

I have a week more of tests and appointments inside the well-oiled machine that is the Mayo Clinic. I know I will be all right, no matter if I have to spend more time with the jerk of a cardiologist, no matter if he or his colleagues order additional unpleasant testing, no matter if they discover something terrible, or discover nothing new at all (which will make me wonder if this whole adventure in Minnesota was a colossal waste of money and time, even if that time was finely managed). Having lived in Chronic Town for five years has prepared me well for Mayoville. Now, if you’ll excuse me, I need to consult my schedule and see what desk to show up at for my next appointment.

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