Saturday, May 25, 2019

Navigating a Chronic disease diagnosis: 5 things I wish I would have known when I was diagnosed

I can't believe how many people I know have been diagnosed with a chronic illness - young, seemingly healthy friends who have been handed a diagnosis of psoriatic arthritis, crohn's disease, endometriosis - the list goes on and on. I was diagnosed with a chronic disease at the age of 34 - about 6 years ago. However, it didn't really occur to me that my disease was chronic until just a few years ago when I realized that I was suffering from something that was persisting and reoccurring - hence; chronic.

My diagnosis is quite rare - 1 in 100,000 to be exact, so I don't know anyone personally who also suffers from Osteochrondritis dissecans (OCD - not to be confused with the compulsion disorder). This disease affects the cartilage in my joints (presently both knees and an elbow), and has required 11 surgeries over the past 6 years just to keep me mobile. I am a member of a facebook "support" group (more on that later) who share my diagnosis, so I do frequent that site from time to time. Just a few days ago as a read a new post on the site I felt myself shaking my head and cringing. A 25 year old woman explained that she had recently been diagnosed with OCD in both knees. She was a marathon runner. She expressed her determination to "fight the disease" and continue to compete in marathons, despite her diagnosis and her Orthopedic surgeon's recommendations. The reason that I shook my head and cringed was because that was me. Ok...I wasn't a competitive marathon runner but I fought my diagnosis with determination for at least a solid year...and you know what? I did not do myself any favors.

I understand that my chronic disease is much different than most of the diseases that my friends are facing. OCD specifically affects my mobility. It is a visible disease in that people can see when I am suffering, unlike diseases like crohn's or diabetes where there are no overt signs to signal "Hey! I feel like shit today!" On the other hand, I think that anyone who has been diagnosed with a disease that seemingly has no cure will share similiar experiences and feelings. Although I'm still navigating life with a chronic illness, I have learned a lot over the past 6 years. Therefore, I've compiled a list of 5 things I wish someone would have told me when I was first diagnosed with a chronic disease:

1) You and your body are on the same team


Like the 25 year old woman on the online support group, I immediately went into fight mode when I received my diagnosis. I vividly recall sitting in my Ortho's office, listening (but not "hearing")  his shpiel on life changes associated with OCD, and thinking "F#$% you. You have no idea who you are talking to. I will fight this. I will win." Each time I achieved something that I was told I should no longer do (i.e. jumping), I quietly kept score - Kirstie 1: Knee 0. I recall posting a surfing video of myself and captioning it, "Take that, knee!" I was quickly humbled when I stared at an MRI that indicated that my activities had resulted in significant cartilage damage. Eventually I came to the realization that keeping score implies that my knee and I are on different teams, which is ridiculous. My knee is part of my body and instead of fighting against it, I've learned to keep it happy. You know the saying, "The happier the knee, the happier you will be," No? Okay, I made that up, but you get the point. Follow your Doctor's recommendations, cheer on your body when it is performing well and pamper it when it is struggling. Stop fighting against it.



2) Find a balance between seeking knowledge and living life


With all knowledge available with the click of a mouse, it can be empowering to read, research, and seek out others who share your diagnosis. My online support group has provided me with many useful tips on medication, knee braces, as well as support when I am feeling low.  On the other hand, spending your days studying your disease and interacting with others who share your diagnosis can throw you into a black hole of despair where you become consumed by your disease. If you find yourself searching for the "thing," that magical "thing" that will cure you, it is, unfortunately, likely not going to be found on some online support group. The fact is, people who are consistently posting on your support forum are typically the people who are not doing so well. Think about it, if you are feeling pretty good and positive about your health, you are not spending your days posting on support forums. Therefore, the information that you are getting from your support group can be negative and bleak. Trust me, I've been that person who is laying listless and depressed on the couch and posting daily - misery loves company.  If you find yourself perusing the internet for hours, and feel increasingly hopeless, it's time to get off the computer and get outside of your disease for a few hours.



3) You will experience the grief cycle MANY times and it's Ok. 


Grief is a natural reaction to receiving a diagnosis of a chronic disease. You are essentially grieving your old self. Your life will change. You will never be the same. It's freaking sad. You will experience denial ("Not me. I will fight this!"), anger ("Why is this happening to me? I've always taken care of my body. This is not fair!),  depression ("I can't face the world today"), bargaining ("If I could just run again I swear that I will be a better person"), and acceptance ("I can't run anymore, but I can swim"). I would also add a new and exciting stage to this cycle: Fear/Uncertainty ("Sure my disease is dormant today, but what's going to happen tomorrow?").

I would estimate that since my diagnosis 6 years ago, I have cycled through anger, depression, fear, and acceptance at least 300 times! What's shocking is that I often don't recognize this and am suddenly dismayed that I feel an intense emotion! Just last week as I was recovering from surgery #11 I was out at a social event with my friends, my knee gave out, and I fell on a table. Initially I was mortified, but that was quickly followed by intense anger. Once I returned home, I threw my purse against the wall and screamed. And then I cried.  For about 60 minutes I felt betrayed by my body, I felt sad that I have this stupid disease, and eventually I came to the conclusion that my knee is still recovering, it wasn't a super huge deal, and my friends don't think any less of me. A few years ago that incident would have preoccupied my thoughts for days. I will say that now that I am able to identify why I'm feeling a particular emotion, and allow myself to feel that way, I am able to move through the grief cycle much faster.




4) Help your friends help you


I think that it's really important to educate your friends and family about your disease. Don't beat them over the head with it, but provide them with the basic knowledge and how this disease is affecting you so that they can help. I spent a good few years telling everyone that I was "fine." Like a robot, I generated key phrases like, "Coming along," "Feeling fine," or "Getting there." This was sufficient information for acquaintances, but my friends and family became frustrated by the distance that I was creating between us with my nondescript response. I didn't realize that my friends felt powerless too! They, too, were mourning the loss of their old vibrant and healthy buddy. I eventually divulged that I felt sad, hopeless, and depressed. I'm not going to lie - some friends responded with radio silence. Those peeps were surface friends, and I soon realized that they were my "feel good" friends - those buds with whom you party, but not necessarily the friends who you count on. My close buds, on the other hand, responded with an outpouring of support. Although I struggled to answer the age-old question, "What can I do to help?" (I honestly didn't know!), my friends stepped up by simply being there - sending me a funny text, stopping by with a tea, and making me laugh (there were times when I thought that I would never laugh again!). Let your friends help you.

Although it's important to educate your friends and family, don't assume that they are always aware or conscious of your disease. I remember feeling pissed off when my buds chose a venue with stairs for a social event. "Why wouldn't they realize that these stairs are going to be difficult for me? How selfish!" The fact is, your friends aren't thinking about your disease/disability every second of the day because they don't see you as your disease. And that, my friends, is a good thing!

Disclaimer: If you are feeling depressed to the point where you are thinking about harming yourself and/or you can't see a way out of the black hole, please seek professional help. I worked with a pain psychologist who was instrumental in arming me with the strategies that I needed to keep my head above water during challenging times.



5) Life does, in fact, go on


Ahhh...easier said than done. There were so many times where I really didn't believe that life would go on. I likened myself to my little white dog, sitting at the window and watching the world pass by without me. It's been 6 years since my diagnosis and realizing that life does go on has been the most difficult concept for me to grasp, and there are still days where I feel just the opposite. And you know what? - sometimes we are just not ready to hear that life will go on, and that's fine too. But looking back at the past 6 years I can see that this sucky disease has actually opened up opportunities for me - I was forced to adapt and make changes, changes that have opened up my eyes to a whole new world. For example, the cold weather in Canada was wreaking havoc on my joints, and that was the push I needed to pursue a life in a warmer climate. And here I am - loving life in Grand Cayman! In addition, although receiving this diagnosis initially challenged our marriage,  I know that my husband and I are much stronger as a couple having navigated this disease together. We are a better team because of my OCD. Your disease might prevent you from continuing with your  job or partaking in physical activities that you love. You are allowed to grieve that, but also see it as an opportunity to try something different. Often people become stagnant, locked into the lifestyle they believe they are supposed to live and are scared to veer in a different direction. Sometimes a diagnosis creates the push that you need to make those changes and, essentially,  live a happier life.


Friday, May 3, 2019

Philly trip: Cheesesteaks, baseball....and a little surgery

Hey friends,

Well I can't believe surgery #11 has already come and gone and I'm back on our little island, recovering quite nicely.

I hate to brag, but let me tell ya, after enduring all these freakin' knee surgeries (11 to be exact), I'm pretty damn good at surgery. Is that something to brag about? Despite my fabulous surgery skills (it sounds like I perform my own surgeries πŸ˜‚),  there has always been some type of complication - whether it's pain control or nausea and puking, there has consistently been an issue post surgery. Hence, I'm typically prepared for the worst - compiling pain management strategies and meditation techniques to combat nerves. Surgery #11, however, entailed no preparation whatsoever. None. Zero. I literally wolfed down a ball park hotdog at Citizens Bank Park,  and cheered on a 5-1 Phillies victory without a care in the world a mere 10 hours before I limped into Penn Hospital for my surgery at 5am on Monday morning. Whatevs. Dr. Carey, take the wheel! She's all yours!

Surgery, what surgery? Go Phillies!

My awesome Team!

Any nerves that I did feel dissipated as soon as I ran into all my Penn Med "friends." It was nice to be greeted by the same Nurses, Anesthesiologist, and of course my Surgeon and his fabulous PA, who all remembered me and were keen to see how I was doing while prepping me for surgery. I think one of the most important things to me during the last  6+ years of dealing with this disease is to form personal connections with the medical staff who is caring for me. It's paramount to me that my care providers see me as a real person - plus I'm a social person and it calms my nerves to learn more about the people who are helping me as well! So it was nice to hear that Nurse Tom's daughter is loving 3rd grade and that Dr. Sabrina just had a well deserved spa weekend. I felt a bit like a Penn Med celeb as I overheard another patient in pre-op brag about his "4th knee surgery," to which I heard my Nurse quickly respond, "That's nothing! My patient lives in the Cayman Islands and this is her 11th knee surgery!" haha. Trump that one random knee dude in Preop #8. Funny aside: I overheard random knee dude explain that he was a lawyer. When the Anesthesiologist asked what type of lawyer he was, he responded, "a good one." hehe. Touche. Anyway, by the time I was done catching up with my buds,  I was being wheeled into the operating room. I met a new OR Nurse, Charlie, and just as I was chatting to him about the Phillies win on Sunday, I was out cold.  I woke up a few hours later, and other than the foul taste of anesthetic in my mouth, I felt pretty darn good. On my typical post surgery high, I listened to other patients in recovery moaning in pain, sat up wide eyed in bed and exclaimed, "Ok, I'm ready to get out of here!" (I always feel like I don't belong with the sick people after surgeryπŸ˜‚!!) Once back in my room, I bragged to Mom and Evan about how I awesome I felt and showed my Nurses how talented I was on crutches as they realized I did not require assistance to the bathroom. I was a cocky little shit! but...you know what? It felt good! 

Anyone seen my knee? Anyone? Anyone?


Usually my cockiness fades as the anesthetic wears off, but this time the pain was minimal and I was able to go back to our apartment that day. It's always important to me to stop taking narcotics as quickly as possible, given my history of dependence, and the yucky way that they make me feel. I was quickly able to transition from Dilaudid to Tylenol, and although I felt a little queasy, there was no puke, which was a welcome surprise. Overall, I'd say it was my most successful surgery yet - it only took 11 to find the sweet spot. Whoot whoot.

The results of the surgery were fairly positive. Unfortunately, I've now had a few complications from the big transplant surgery that took place 2 years ago. Dr. Carey explained that the chances of any complications are less than 5% and I've now had 3 complications - which makes me...rare? One of which is that my cartilage overgrew. But is that really a complication? I would say that's overachieving cartilage, no? Anyway, that overgrown cartilage was catching so he gave it a little haircut. In addition, I had a tear in the new meniscus transplant that I was equipped  with 2 years ago. Dr. Carey had to trim that I'm now I'm only left with 75% of my newly acquired meniscus, but I had 0% meniscus for many many years, so 75% seems like a decent number. The meniscus acts as a "first defence" to my cartilage transplants, so it is important, at this point, that it's there in some aspect. I think the daunting information is that my other knee, the right knee, is continuing to deteriorate with the disease.  Luckily, despite these complications in the left, Dr. Carey is optimistic that my prognosis is good, and I am still a candidate to receive the transplant surgery in my right knee. However, I have to be prepared for the fact that my right knee will likely have the same complications as the left knee.  After an informative discussion with my Surgeon (have I mentioned how much he LOVES cartilage?), my goal is to put off the transplant surgery in the right knee for a few more years. I need to continue to strengthen both knees, and just live my life (with no running or jumping, of course). The upcoming transplant surgeries will be intense, and likely require multiple surgeries, but that's a "future Kirstie" problem. I am cautiously optimistic that I can get back, participating in all the activities that I was partaking in last summer, quite quickly. Dr. Carey admitted that he has a successful surgery patient file, which presently contains a picture of me surfing. The type A perfectionist in me really wants to maintain my "success" status. 😜

I am rare like the exquisite rare pink dolphin! πŸ˜‚

I'm already back in Cayman with my Mom and Ev. Philly has become a bit of a second home these past few years, and although I find the people to be really friendly and the food to be delicious, it is sooo nice to be back in the tropical sunshine! Mom is staying to help out for as long as I need it (thank you MOM!), but I'm hopeful that my recovery will be fairly quick this time around. I need to remember that I did just have surgery, and although it's important to get back into physio and regular activity, it's also important to just chill and take a break. So I'm tabling the cocky attitude and taking it easy. My body deserves that.

I really appreciate all of the messages that I've received from each and every one of you. It means a lot knowing that I have an awesome group of friends and family supporting and cheering me on. I've learned from experience that recovery can be lonely, so it's super helpful to surround myself with people who lift me up. Thanks guys! Cheers to you and cheers to the medical researchers who think cartilage is cool.