Eva's Gastroparedic Adventure

Happy Passover to all who celebrate or take interest in such things. David and I had a lovely seder together and it was the best since The Before Times. We thought about trying to host a seder since we now have the outdoor space, but we do not have the furniture, the dishes are only partially unpacked (not for lack of effort–David has been an unpacking machine) and honestly, neither of us had the spoons to do anything big this year. But next year, watch out!

In other news, I am really liking our new primary care doctor. She is a concierge doc, so she doesn’t come cheap, but she gets it done. I was having some stoma pain (my stoma is the hole where the feeding tube goes into my stomach) and I asked her for some topical lidocaine ointment. She not only gave me a script, but she found me an ostomy clinic where nurses deal with nothing but stomas of all kinds.

I had my appointment at the ostomy clinic this week. The nurses were wonderful (I got two for the entire appointment) and they were excited to get to work with a relatively healthy patient. We had a good conversation about stoma care, they introduced me to some local resources (including an independent pharmacy) and they sent me on my way with a goodie bag.

Next week, David and I both have our extensive, two hour physicals with the new doctor. She has already ordered extensive lab work and David and I dutifully offered up our veins. I am not expecting any surprises, but it will be nice to talk to a doctor who is focusing on more than just my broken digestive tract.

I am continuing to increase my feed and I am now at 48ml per hour. Last year at this time I was at 54ml hour. I was able to read silly novels and knit. I am not there yet, but I am definitely seeing an increase in my energy. Even David commented that I turned a corner in the past week. It has been a long time coming. Next week it will have been a year since my hospitalization and the precipitous drop in my feed down to 25ml per hour. That is a year that I am glad to have left behind me.

It has been waaaay too long since I posted last, but I have been flat out. I get small bursts of energy that I have been expending on being sociable or helping David with the unpacking and then collapsing in exhaustion again.

Nutritionally-speaking, I was stuck on 39ml of formula an hour because we had made the decision to pause the formula increases when the move started. But this is no ordinary move. This has been the extended version. I hadn’t increased my feed in over a month.

Fast forward to last week, when David and I discussed it and I decided that since my current state seems to be some kind of new status quo for me, there was no reason not to resume increasing my feed. I am on 43ml hour as I type this, and it seems to be working since I found the energy to write this post after sorting through a laundry basket full of unmatched socks, trying on some clothes and sorting through a mound of clean t-shirts and deciding what goes out of rotation, what comes in to rotation and the harshest category of all: which get put on the donation pile (bwahahahah).

Assuming today continues apace, then tomorrow morning I will increase to 44ml hour for the day. It is still taking me several days to acclimate to a single milliliter per hour increase. First day, the increase is just from when I get up at around 7:30am to flush* until my last flush shortly before bed time, at around 9:30 or 10. The second day I let the increase run for the full 20 hours of my feed. The third day is the same as the second day. It is a recovery day before the next assault on my extremely hypersensitive jejunum. Then day one again.

I have so much more that I would like to write about our cross-country move. But I doubt that I will have the energy to maintain both forwards and backwards momentum. I intend to keep my eyes looking forward into what is ahead of us. I also truly hope to have the energy to write posts more frequently now that we are actively in the settling in phase of the move.

* My time is defined by flushes. I have to flush 5 times a day. Those flushes are not evenly spaced out. None of those flushes can take place between 3pm and 7pm. Those are the hours that I am disconnected from my feed and my jejunum gets to completely rest. It is not all bad. Flushes give structure to what are usually completely unstructured days.

While David is on his long anticipated cross country trip (he started dreaming of this trip long before we decided to move back west), the cats and I are at home. We are watching his adventure unfold with the rest of you.

Fortunately, life at home is not much of an adventure. There are regular lectures from our Nommie and Xena Malka is being a little extra clingy. On the other hand, she has an itchy ear and is getting ear drops twice a day, so she has more than one reason to be a bit out of sorts.

I am doing better than I had feared/anticipated. I haven’t ventured out of the apartment yet, but I did have an excursion planned for today that got rescheduled for Thursday. I will also need to go visit our friendly pharmacist in the next day or two to pick up a refill. So I have adequate motivation to get out of the apartment. It does absolutely blow my mind that bu the end of next week, I will be living in California.

But first, some absolute road warrior machinations by David. He and our car are scheduled to arrive in Marin in time to meet up with our new landlord, do a walkthrough of the house and get the keys on March 1st. That is a Friday, so he is staying the weekend to get some things set and he will need Monday to do things like get our free P.O. Box because we are going so rural that we won’t even get regular mail deliveries (UPS and Fed Ex both come to the house).

My job in David’s absence is to get things like utilities and the internet set up so we can live like civilized people. We already had to change our phone provider from Ting (whom we had for over a decade and loved, but their wireless calling is tied to a mobile network and we don’t have cell service at the house either) which literally was a multi-day process, and not because of anything technical. Today I dealt with getting our propane deliveries set up. I am dreading PGE., so I am pushing that one off for last.

David flies home on the 5th to help me and the cats get ready for us all to fly out on March 8th. The cats have been to the vet, have had their rabies shots (and have their requisite certificates) and we have gabapentin for both of them to make the trauma of a cross country flight more bearable. And an anti-emetic for our Xena Malka who gets motion sick.

Once we get settled, David heads back to the airport to meet the movers on Astoria on March 15th. After a few extra days for our cleaner to come do a deep clean, returning keys, etc., he finally flies back to Marin where we can start settling in. Well, as much settling in as we can do until our crap–including all of the crap that has been in storage for almost two years–arrives at some date to be magically determined by the mover.

The thing about chronic pain is that when it goes away, everything feels so much lighter.

When I am in pain, it feels like weights have been attached to my body. It is just so hard to move. Today is my first (relatively) pain free day in a month and I feel like I have suddenly been set free. I can do and be again. At least as much as my current malnourished state allows.

How do I know that it has been a month? Funny story, that*.

You know how generic drugs are supposed to be bio-identical and work as well as each other and the name brand? Well, that’s not quite the case. In fact, it has been fairly well documented that some generics are just different, despite looking bio-identical to the generics that work. But it hasn’t gotten much press. I have seen maybe two articles ever. And one goes back so far that I read it while we were still living in Portland.

A bit more than a month ago, the pharmacy sourced the duloxetine I take to convince my confused brain that gut motility does not equal pain, from a different manufacturer.

Maybe it was a bit cheaper, maybe it was just what was available, who knows. but it happens all of the time at most pharmacies. No ill intent. Just how the generic wholesale pharmaceutical market works (as I understand it from those two articles I mentioned. I am in no way an expert on such things).

Anyway, over this past month, I have certainly noticed that the pain that the duloxetine had been managing was back. So much so that I am in conversations with my doctors about weaning me off the duloxetine and trying a new antidepressant. It has been a very bad month, pain-wise.

A couple of days ago, I refilled my duloxetine prescription and I immediately noticed that it was from a previous manufacturer. A previous manufacturer whose product had worked for me. So I was optimistic when I took the first dose of the refill last night. And today I feel amazing!

I am completely overdoing it today, and I know it. But I couldn’t help myself. It has just been so long since I felt this pain-free. I know that I will pay for it tomorrow, but I have no regrets. I am thinking about it as the very occasional decision one makes in middle age to screw your bedtime and hang out with your friends until late. You know you will be paying for it for the next few days, but are enjoying yourself too much to care about future you. And even future you agrees that it was well worth the cost**.

I have to give full credit to my friend Jemiah for aiding in the solving of this mystery. She recently went through the exact same issue and it definitely helped the penny drop.

*We have been rewatching Lucifer and I seem to have picked up some of his verbal quirks.

**Clearly, I am getting excited at the prospect of getting to hang out with friends again once we move!

Want to know what life with a chronic illness is like? We have big news. Like huge. But instead of excitedly announcing it to the world, I am spending my days in bed laying stiff as a board, because curling up in a fetal position, no matter how much I desperately want to, is just too painful.

To make matters worse, my presumably more communicative GI didn’t respond to calls over two days. he did respond over the portal (which I didn’t use initially because it says it is only for non-urgent issues and can take 2 days to respond). He told me what to do, but that was all. There is no indication that he called in the necessary Rx changes and he has failed to respond to my follow-up question for 24 hours and counting. I am considering myself ghosted.

This is where the big news comes in. We are moving to Woodacre, California in March. It is in west Marin County and is the most rural that I have ever lived. There is no mail delivery. We have to get a P.O. Box. Even the goat farm had mail delivery.

But it is not as isolated as it sounds. It is 45 minutes from San Francisco where there are world class medical facilities. It is also, where we can socialize outdoors 3+ seasons of the year. And the house we are renting has beautiful decks and a bathroom that we can isolate from the rest of the house. Guests can use it unmasked without putting anyone’s health at risk. Most importantly, there are lots of friends and family nearby to socialize with, those 3+ seasons of the year.

My point? Maybe my new doctors will be more responsive. I already have one doctor in place. He is a Naturopath with extensive experience with gastroparesis. He is located in Oregon, but he is licensed in California so we can do televisits. Worst case scenario? I have to make a trip up to Portland to see him. I am sure my friends will be crushed.

We have been back from the west coast for a week and I feel like…something bad. That is how badly I am feeling. I have lost my metaphorical skills. At least temporarily.

Seriously, the nerve pain that the cymbalta is supposed to be managing is back, and has been plaguing me for days now. This could be blowback from the travel or it could be a random flare. Doesn’t actually matter because either way, it is disrupting my sleep.

I have a call into my doctor (the new, more responsive GI) and am waiting to hear back. My guess/hope is that we change anti-depressants and the magic starts working again. And hopefully soon , because my tube is scheduled for replacing on Friday.

I know I have been particularly quiet lately. Part of that is the impact of travel on me. We went to the West Coast for a week and that wiped me out for the following week too.

Then things were nice and quiet so I started increasing my feed. This involves anywhere from 2-3 days when I am in pain and out of it, followed by a day or two of feeling ok before starting the process all over again. But it is paying off. I am now at 38 mls per hour.

As a reminder, the highest I have ever been was 54ml per hour and that was nearly 7 months ago. And it was not my goal nutrition rate. It was just as far as I had gotten in my upward titration.

In fact, my GI doesn’t even know what my target rate is because I have just never reached it. The target she ultimately chooses in consultation with her nutritionist will include allowing me to drop down from feeding 20 hours a day to feeding 18 hours a day. Which my jejunum will appreciate. But I probably won’t learn that number until I see her next given the speed at which I am going.

Speaking of my GI, Etisarap is getting a new look. On February 2nd, I am getting my tube replaced with one that will need regular changes every 4-6 months. My current iteration will reach a year in February and that is its general lifespan.

Going forward, with this new style of tube, my tube changes will be able to be done without anesthesia by the interventional radiation department. Nope, I didn’t know such a thing existed either. And yes, I am damn grateful that I have Mary to navigate how to get those swaps done.

In other news, we went to visit my in-laws in Boston over Christmas where we tested my limits and, well, wiped me out for the following week. Next week, we are heading off to the Bay Area to see family and friends. But we are getting to be more strategic and extended the trip to give me some recovery time in the middle. We will see how that works out.

My brain is ever-so-slowly beginning to catch up with the additional nutrition, but instead of doing something useful like allowing me read or knit, I am just getting emotional waterfalls that I am not yet equipped to deal with. So I have periodic meltdowns about things over which I have no control. Not the funnest way to spend an afternoon.

That is the short and the sweet of it. I am planning/hoping to start posting more regularly again, even if they are just short posts. But I know that will be a struggle even as I write this. Travel just truly takes it out of me. You probably won’t hear much out of me until I have recovered from the Bay Area trip, but I will try.

This has been a busy week. I broke up with the uncommunicative GI because I now have a new motility doctor whom I see next week. It was a mutual parting, as I got the sense that he was not unhappy to see me go. Regardless, it is done.

I finally had a follow-up with the neurologist about my MRIs and he deemed me fine, but with an aging neck. Fair enough. Since we had the car out, we drove to our favorite kosher bakery and got sufganiot (jelly donuts) for Chanukah, as well as enough treats to literally last us a month!

And if that wasn’t enough of a day, that evening, we went to a Chanukah candle lighting at Athens Park, surrounded by statuary. Please take a moment to appreciate the irony.

Anyway, I also walked a fair amount (for me) that day, going to and from the garage and I walked part of the way home from the park. I was exhausted the next day, but seriously, Go Me!

I have also started walking stairs on the days that I don’t go outside, unless I feel really crappy, then I listen to my body.

In some ways, it feels counterproductive to me to expend calories on exercise when I am barely just beginning to scrape by with something nearing a sustainable daily caloric intake. I wonder what I am trading off. But I think the movement is important and after two years of this shit, my muscles have definitely atrophied a fair amount. So I walk what feels comfortable that day. Sometimes more, sometimes less. But always trying to push myself just a little, but not too much.

The big news of the week was that my niecelettes turned 16!!!!!!!!!! I have so many Feelings about that. The important thing is that they are impressive young women (eeek!) who have so freaking much to offer the world. I am super proud of them and love them so much.

The following day, Facebook, in its infinite wisdom, showed me a memory from 16 years ago, of Natalie on the day she was born. Exactly my thought. What a journey from such a tiny newborn to the woman she is today. This Sunrise Sunset Moment has been brought to you by Facebook.

I haven’t been up to posting in a while. First I was recovering from our trip. That took a while. Then I really started seeing the benefit from the Nerva hypnotherapy and the Cymbalta.

The pain that has been a constant presence for the previous 6 months had quietly moved into the background until it just faded away. If you have even mild IBS (what it is labeled for) or gastroparesis (what I used it for), I cannot recommend Nerva enough. Available on both the Apple and Google app stores. Worth the $149 and the 15 minutes a day. Truly.

With the motility pain gone, it was finally time to see if I could start increasing the speed on my pump. In just a few weeks, I have gone from being stuck at 25 ml per hour, where I had been for months. I am now up to 33ml per hour. And based on how I am feeling today, we will stay here for another day or two before I am ready to increase to 34ml per hour. It is slow going. But, it is progress.

My body is responding by storing all of those new calories because I am gaining weight again. I don’t know for sure that this is the case, but I think it is the cymbalta. I gained a whole bunch of weight when I went on it the first time.

I am almost up to 1,000 calories a day. Sadly, since so much is going into storage, I am not getting the benefit of those new calories. I remain stuck in limbo where I can only knit a couple of rows on really good days. I want more functionality. But wanting is not enough to make it happen, so I will just have to go back to radically accepting my reality and go back to being patient.

December is a month of GI visits, as I have appointments with 3 of them. Including my tube GI. I am planning on asking her again about when I am due for a tube swap. I am not eager to get rid of the one I have. We have a working understanding and it doesn’t cause me undue pain. But it feels like it may be getting a bit worn out. I would rather plan a tube swap than wait until the tube flips or there is some other emergency. We will se what she has to say.

…and jetlagged. So today’s post will be comprised of a bulleted list of facts in no order whatsoever.

• It was beautiful.
• The PNW will always feel like home to me.
• There were many birds. Notably Buffleheads and Bald Eagles.
• We saw a sea lion taunting birds with a fish in its mouth. Presumably trying to upgrade its meal from seafood to fowl.
• Their trees had better colors than ours right now.
• It was exhausting.
• Not so exhausting that we aren’t already discussing our next trip.
• Our friends harvested delicious Eva-sized apples from their trees.
• We were sent home with apples in many forms, including sauce and chutney.
• It was really nice to get to hang out with good friends for a week .
• It was a relief to be able to hang out indoors without having to mask up (we followed agreed-upon covid safety protocols prior to and during our visit).
• We had an amazing time.
• Xena Malka is making me end this list now because I abandoned her for a week and she needs her scratchies now please and thank you.