Thursday, October 12, 2017

Hundred People Search

We have added a new HPSer to the patient registry. This puts us at 86 to go on this year's Hundred People Search (HPS). Keep up the outreach! 

Wednesday, September 27, 2017

Worried for Puerto Rico

Living with a rare and chronic illness is never easy, but try doing it in the face of an epic natural disaster – no water, no power, no fuel – forget easy access to medical care, medical equipment or medications.

My family connection to Puerto Rico is distant. My great grandfather was from the northwest part of the island. He came to the mainland United States to go to college, and eventually became a professor at the University of Oklahoma. He was a linguist. While I inherited an HPS gene from him, sadly I didn’t get the language gene.

Living in Europe, I learned a lot about the history and culture of the other aspects of my heritage, but I never knew much about Puerto Rico. My grandmother would tell us stories about visiting the family plantation when she was a child, but that was about all I knew of the place.

When I was diagnosed with HPS, one of the blessings (instead of curses) that came with the diagnosis was a sudden intimate connection to the island. Suddenly I knew tons of people from Puerto Rico, and they were more than casual acquaintances – they became family! I was also blessed to get to visit the island several times to attend HPS conferences and work on HPS outreach. That was interesting, but it was also very satisfying to travel through parts of the island I knew my great grandfather and his family must have known. It was a connection to learn more about the culture and the food and the feel of the place.

My family here lost connection with the extended family in Puerto Rico when my grandmother’s last cousin (that she kept in touch with for years and years) finally passed away. I’ve always wanted to find extended family there, and make sure they knew about HPS, but I’ve never been able to do it. Every time I’ve attended an HPS event in Puerto Rico, I look at the crowd and wonder what the odds are that someone there is related to me, albeit distantly.

Unlike my many, many, Puerto Rican friends, I am not waiting to hear about the welfare of a relative. Still, waiting for news and watching for updates has had me very anxious this past week.

I worry for anyone in Puerto Rico who might have HPS and be on oxygen. Their oxygen concentrators won’t be working and I have no idea how they will get fresh oxygen tanks delivered anytime soon! I worry about whether anyone with HPS has been injured and may be bleeding and need medical attention. I worry about the health implications for anyone with HPS going forward as the island tries to recover. Are their lungs being exposed to mildew or mold that could affect their long-term prognosis? Are they out in the sun and unable to get the sunscreen that could prevent skin cancers? Are they getting exposed to bacteria in flood waters that could make them sick and further complicate their medical lives?

On the news I’ve heard about people unable to get kidney dialysis or insulin. When you have a chronic health issue, you are so vulnerable when things go wrong. It is scary!

I’ve felt so frustrated by the scant attention given to the plight of Puerto Rico in the media. I know the challenges of a natural disaster on an island are different than those in an area on the mainland. People can’t load up their cars and drive there to bring supplies etc. Still, I can’t help but feel that if this were happening elsewhere in the US, more would be done faster. It is sad that every news story has to emphasize that Puerto Ricans are American citizens. I guess I’m glad they are making the point, but it says something that they have to make it at all. Puerto Rico has the highest per capita participation rate in the Armed Forces. They have fought and died for the US for generations, yet according to surveys, more than half of Americans don’t even know Puerto Ricans are citizens.

I can’t imagine how all this must frustrate my friends with closer ties to the island.

For now, we are trying to figure out what we can do to help those with HPS recover. What needs might they have that are unique, and what is the most effective way to help?

Thursday, September 21, 2017

Health Update:

It has been a rough few weeks here, but could be much worse. I’ve had a cold for a week and a half. Thankfully, (knocking on wood) it hasn’t impacted the amount of oxygen I need, and so far, hasn’t become a respiratory infection. Yet, just having a cold these days makes me so anxious! I don’t have any reserve at this point. One bad infection, and I’m going to be in the hospital until I get lungs, or I don’t. I just don’t have too far to go before I won’t be able to get enough oxygen at home.

So, you might say, I’m paranoid. I’m paranoid about germs and when I get sick, it’s so much more than just having a little cold. Thankfully, only one day of a fever etc. The trouble is I get better and I think I’m recovered, and then it seems to come back.

The medicine the transplant center gave me to help with the cough is helping. I still cough a lot though. I’m so tired all the time because I rarely sleep well. But, with the medicine, my coughing fits aren’t quite as long. I haven’t coughed so hard I’ve thrown up since starting them, so that’s something. I did cough so hard yesterday I pulled a muscle in my neck…whine, whine, whine…..

I get very frustrated because I get tired so easy. I have so much to do, but I can never keep up with it all. I have so many friends I want to stay in better touch with, but by the time I do what I have to do medically every day, and work a few hours, I’m so tired it is hard to call people and just chit chat. It makes me cough more, and it is hard to be very conversational when you are so tired.

I hope everyone can forgive me for not being in touch better.

Wednesday, September 06, 2017

Hundred People Search - H.P.S.

We added another new HPSer to the HPS patient registry. This puts us at 87 to go on the Hundred People Search - H.P.S. Keep up the outreach! 

Tuesday, September 05, 2017

Hundred People Search

We have added a new member to the HPS registry. This puts us at 88 to go on this year's Hundred People Search - H.P.S. 

Friday, August 18, 2017

A Rude Awakening

This past Monday I was on the HPS Conference Planning Committee video conference and my phone rang. It was Inova Fairfax Hospital. Every time I see that number my heart falls into my feet. It isn’t that I don’t want a transplant. It isn’t that I wouldn’t be thrilled to get the call. But, when that call comes, I know we will be embarking on a whole new medical saga and the road can be rocky. Surgery isn’t the only scary thing. Getting a transplant isn’t a cure. It’s trading one lung disease for another in hopes that, at least for a while, you get to be healthy enough to have a somewhat normal life. But, we are not replacing auto parts here. It isn’t a sure thing. It might not work. So, getting that call is exciting, but super scary too.

When you first get listed, you may know it is unlikely to get a call, but still, you are on constant alert for the ring of the phone. Nine months in, life goes on. You do your day to day things and try not to think about it too much. At any moment this call could come that will turn your life upside down, but you sort of adjust into this weird normal until it does.

So, when I saw who it was on the caller ID, I immediately picked up the phone. It was my transplant coordinator and one of the doctors. My stomach did a flip flop. But, it wasn’t the call. It was just as much of a stomach turner though.

They were calling to tell me that the transplant committee had met and discussed my case. They think it is time to list for a single or a double lung transplant, and not just a double. They think my disease progression is speeding up, and by doing this, I might get more chances. There are pros and cons, and whether for me a single or a double would be better, is a debate. A single might not last as long as a double. But, the surgery isn’t as hard on you, and if you manage not to get cancer or develop some other health problem from the anti-rejection drugs, it gives you some options if you should have to go for a second try at a transplant. Can you imagine that? We might have to go through all of this again! No wonder I don’t have any finger nails left!

The call caught me totally off guard. At every transplant appointment we’ve had this discussion about whether it is time to list for a single or a double, and so far, we’ve held to sticking it out for a double. While I’ve had progression, it’s been a kind of creeping progression. The call was jarring both because I had to consider listing for a single, and because it is a sign that I’m not doing as well as I thought.

That might seem crazy to someone else, but it’s my way. The day I was admitted to the hospital with severe bowel disease, a hemoglobin of 6 and ended up having an emergency ileostomy days later, I’d had no idea how ill I really was. Sure, I was sick. No doubt about it. I was chronically anemic from internal bleeding. I was living on Ensure, jello, ramen and baby food because I couldn’t eat. I had lost tons and tons of weight. My stomach cramped a lot. I went to the bathroom 15 to 20 times a day and it was very painful every time. But, I felt I was managing a chronic condition for which there was nothing else to do. I just had to get through it. So, I did. That very day I had taken a midterm exam that I blew out of the water, babysat for one of my professors and tutored football players in English. The idea that the doctor’s office wouldn’t even let me walk across the street to be admitted to the hospital seemed utterly crazy to me that day.

Perhaps it is the same way now. I’ve got things to do. I can’t focus on how bad things are. I have to focus on how to get the job done. Learning that my docs had met about me, and were concerned enough about a changing picture to want to change the plan was just as jarring as the whole one vs. two debate.

It took me 24 hours to process things. I talked to my friends in the HPS community, family etc. I looked through and reread journal articles. Ultimately the decision wasn’t as much about science as it was about faith. What decision would I regret more? What decision would give me the best chance of accomplishing some of the things that make this fight worth doing? How much control over this do I really have anyway? So, I decided to leave it up to God. If the plan is to get two lungs, then I will still get two lungs. But, if that is not the plan, then this makes the way for other plans.

It’s been a tough week to be honest. My anxiety levels have been super high, even after making this decision.

Monday, August 14, 2017

August Transplant Appointment

I had my most recent transplant clinic appointment Aug. 3rd. As always, I’m never really sure whether to say it was a good appointment or a bad appointment. It had aspects of both, depending on how you look at it. I try to look at the up side these days. Grin!

My numbers were down again, but this time, they were down enough to give me more points on my lung allocation score. The higher the score, the more likely you are to get a call. So, not sure if it is bad that my numbers progressed again, or good that at least this time, I got some points for the advancement. Last time everything was down, but not down enough.

I brought them the CT scan from NIH. No need to get an extra dose of radiation, even if only a small one, for no reason. Let’s save that for when it really matters! And, the CT was done two weeks before the transplant appointment, so it was very current. Again, advancement, but no surprises there.

I have developed what is called Bronchiectasis. Essentially, as my lungs get increasingly fibrotic, the tissue gets harder, can’t expand and contract, and eventually atrophies, or shrinks up. This is making my airways pulled apart in places. It was a new one for me in terms of pulmonary fibrosis, but it sort of makes sense I guess. It is something I’ve heard associated more with COPD, or Cystic Fibrosis. I’ve probably had it developing for some time, but it is now very visible on the CT. Or, at least it was the first time it was notable enough that it showed up in the report.

It also explains why my cough (which I have had for almost a decade now) is now so much worse. They are trying a treatment regimen to help, and so far I think it is helping. Some of you have asked what it is, and I’m happy to share, but with this disclaimer. I’m always a bit hesitant to share details of my treatment regimen when it is not in the context of a direct conversation. The reason is we are all different. Our PF can even be different. I don’t want HPSers reading this, and then going to their pulmonogists and saying, HPSers do this…as it might not be effective or necessary for everyone. That being said, they have prescribed abuderol nebulizer treatments several times a day, and a drug called gabapentin. This drug, like all of our drugs, is off label for us. Some have been using it with some success to treat the cough of IPF, and so, given how debilitating this cough has become, my doctor and I decided to give it a shot. The drug is on label to treat seizures and neurological pain. I’m not sure why it would help with the cough, but I think it may have to do with the spasms that happen when I have a big coughing fit. Since starting the drug, I am coughing a bit less, but still coughing. It is easier to bring up the mucus I am coughing up now. When I do have a big coughing fit, it doesn’t last as long. They had gotten to run about 30 minutes,, which is incredibly disruptive and exhausting, especially when they are several times a day! I have also noticed my O2 sats a bit better. Don’t get me wrong. I still need a LOT of oxygen, but for example, I can get up and walk to my bathroom without my oxygen on and am still okay. My apartment is super small, so that’s maybe 11 to 20 steps. For the last month, however, just that would make my 02 go into the basement, so this is a minor improvement. It hasn’t made any difference in the 02 I need for exercise or walking around, but every little bit helps.

The gabapentin is a challenge for me to adjust to, for whatever reason. It has given me hand tremors, made me nauseous and made me so sleepy I have literally done nose plants on my computer screen trying to work. It makes my affect very bla. Sometimes I am talking and the words are clear in my head, but I can’t get them out my mouth. This is improving though, so I hope as I adjust to it, these continue to lessen. My ab muscles are appreciating a bit of a break from chronic severe coughing. Really, with all the coughing I do, I should have abs of steel!

After I do the abuderol nebulizer, I am doing three sets of ten with a device called an acapella. It makes your airways vibrate so it is easier to get the mucus out. Getting this crap out is important as it is a perfect breeding ground for bacteria, and thus, respiratory infections. As I said in my last post, getting this sort of infection is a big deal problem for me these days. It isn’t just a matter of getting some antibiotics and getting through a cold. It could cause an acceleration of my fibrosis. That might up my lung allocation score, but there’s no garuntee that just because my score rises, that lungs will be available. You just don’t know. I think of all my friends who have passed waiting for lungs, and I know that as positive as I am, as much as I say when I get my lungs (not if) that it may very well not happen.

So, I just keep working to give myself the best odds.

The other big worry to me at the transplant appointment is that I couldn’t complete the six minute walk on eight liters of oxygen. I had done so at NIH just a few weeks before, and done pretty well actually. At Inova, however, they used the pendant cannula I use on a day-to-day basis. This is a conserving device to try to help the tanks last a bit longer. They go so fast when you are using a lot of oxygen and it can be very life limiting. But, I know from rehab, that it isn’t ideal for full on exercise. It just can’t keep up as well. At NIH, they didn’t have a high flow cannula so they used a regular oxygen mask. I asked my respiratory therapists at rehab about it because it really worried me, but they said the different was likely due to the mask vs. pendant cannula and not me. Also, when I do that six minute walk, I walk faster than I do in every day life.

The other reason I couldn’t finish the six minute walk is that they changed their protocol for how they do them. It used to be they would bump the oxygen up if you went too low. Now, if you go under 80 they just make you stop and they conclude the test. If they had bumped it for the last minute of the test, I would have covered as much, if not more, ground than I had at NIH. So much really depends on the speed you are walking, and the type of oxygen delivery device you are using. I was very worried when they wouldn’t let me finish the test because years ago an HPS friend who was needing so much oxygen she had to be in the hospital, had to be able to complete the six minute walk to stay on the transplant list. I could have finished the walk if I walked slower, or used more liters of oxygen. But, I guess that isn’t the rule here as I am still listed.

I’m still not entirely sure if it is better to walk as fast as you can without running, even if it means your oxygen goes too low, or if it is better to walk at a slower pace and finish the test. The rules of the game, sort of speak, seem a bit murky.

The last thing that came out of the transplant appointment is that they want to do another echo. I had one just a few months ago. They are keeping an eye on whether I am developing pulmonary hypertension. I am at high risk for it. If I had it, it would give me a big bump on the lung allocation score. Treating it might also mean I might use less oxygen. So far, however, I haven’t developed it. Knock on wood! Long term strain on your lungs can start to impact your heart. So far, that hasn’t happened to me. But, if this goes on long enough, it probably will.

Sunday, August 13, 2017

Visit to NIH

Last month I made another visit to the National Institutes of Health (NIH) as part of the natural history study on Hermansky-Pudlak Syndrome or HPS. It was the first time that, to be honest, I wasn’t really excited about going. Don’t get me wrong. I was happy to go, but for me, it was different this time.

I’m at a point with my HPS where there is nothing left to do. I am taking all of the medications I am able to take to help. I am on the transplant list, doing my rehab, and continuing to try to eat healthy and lose more weight. The only thing I was going to learn from the trip is that my lung disease is worse. I know that. In fact, I was pretty sure I wouldn’t learn it was stable because I get seen by a pulmonogist about every month and a half. My numbers are steadly tracking downward, and my oxygen needs continue to creep upwards. So, progression wasn’t exactly a news flash.

But then going to NIH isn’t about yourself. They tell you that participating in research has no benefit for you. I’d disagree. I think it has benefits – they just aren’t monetary, and they may not be clinical exactly. Participating in research, however, has been very personally meaningful. It is therapeutic for me to know that someone else can benefit from what I am experiencing now. It is therapeutic to be able to create hope for a different future, even if it won’t benefit you directly. And, that is why I went back this time, even though it wasn’t easy and even though I wasn’t thrilled to be doing more tests. It isn’t about me. It never was supposed to be about me.

Sure enough, my numbers were worse. No surprise there. I was just happy that they weren’t very different than the numbers I recently had at the transplant center. In fact, they were just about the same.

The respiratory therapist who did my pulmonary function tests was a saint! It was my last test, the end of the working day, and it took an hour and a half to finish my pulmonary function tests. Normally they take about a half hour, maybe a tad more, depending on what tests you are doing. The problem was my hellish cough. When I would take a deep breath to try to do the tests, I would start coughing and coughing and coughing. I’d pause for a bit, take a sip of water even though I know it doesn’t really help, and then try again. I was trying again perhaps too soon. If I try to talk or move around too soon after a coughing fit, even after it ends, it just starts the spasms up all over again. I was worried, however, that this poor guy had to get home. It was six in the evening before we finished, and the clinic was supposed to close at five. He was a real trooper!

I was grateful that not too much was made of my wrap up. In the past I wanted to know everything about everything. I had zillions of questions to ask and I liked getting to see my CT scan. Now, I really didn’t want to dwell too much on the results because there was nothing I could really do with them. After years of attending lectures on pulmonary medicine, I know what the typical prognosis is for someone with my numbers, and I try not to think about it too much. I’ve already outlived predictions made about my life expectancy several times.

The NIH had compressed three days of testing into one day for me. They cut out anything that wasn’t absolutely necessary for their understanding and research. This way I didn’t have to spend the night. With the oxygen needs I now have, that would have meant probably staying in the hospital. Not only is that an extra expense for the research budget, but it runs the risk of exposing me to more germs. At this point in my disease, catching any kind of a bug, especially a respiratory one, could drastically accelerate disease progression. I have to be super careful. I was so grateful that they were able to do that for me.

I can no longer fly, (even if I didn’t have to be close to my transplant center) so if I didn’t live locally, I don’t think I would have been able to go to NIH. I hope that this gave them a look at someone with advanced disease that they might not see all the time.

I can never put into words adequately how important it is that we participate in research. It is easy to say someone else can be inconvenienced. Someone else will do it. But, at the end of the day, someone has to actually do it. With a rare disease, every person counts so much! Without volunteers, there will be no treatments and no cures. We can’t afford to think it is up to someone else.

Saturday, August 05, 2017

Hundred People Search Update

We've added a new member to the Hermansky-Pudlak Syndrome registry. This puts us at 89 to go on this year's Hundred People Search. (H.P.S.) 

Thursday, July 20, 2017

Hundred People Search update

We've added another member to the registry. This puts us at 90 to go on the Hundred People Search H.P.S.