Wednesday, 26 April 2017

RA life - the things that are keeping me sane.

I wrote recently about my general sense of being a bit stuck emotionally and mentally at the moment and about managing depression and the potential fallout, and have been reading a number of blog posts and articles by other people about slumps, losing mojo, self care, etc... Lene Andersen wrote about her current fatigue levels, and how that impacts on so many levels. Clearly, there's something in the water. 

In those posts of mine, I was looking particularly at a mix of personal, some illness related, and circumstantial elements that are impacting me at the moment. In thinking over it since - given that one of the reasons I wrote the post in the first place was to put it out there so I'd have to DO something about it - I've ticked a few things off my list (more on that in a minute), and have given myself an almost daily talking to to try and kickstart each day with a more positive outlook. I've also been looking closely at the things that ARE working for me, because sometimes it's all too easy to get caught up in the negatives, and that's a nasty trap. 

The talking to is having mixed results... One of the things that's getting to me is how stuck we are with the house since the move. Any new place needs that settling in time while you work out where to put things, and what you might need to add to make it work. We got some things done - Rumi proofed the back fence so the little monkey couldn't keep escaping; got Dragon Dad's desk set up in the spare room so he had a place to work; bought and put together some industrial shelving to help solve the storage issues in the kitchen (hardware store chic!) and bought and assembled a skinny cupboard to stick in the back hall for pantry storage. And then it ground to a halt, because money...or lack of. There are no built in wardrobes in this house. We had a pair of IKEA ones that work in the spare room and give Dragon Dad some clothes storage. And two chests of drawers in our room that double as bedside tables for our smalls and socks and so on. But I'm still, eight months in, living out of suitcases and boxes - and have a most impressive chair/floordrobe that would do any teenager proud! It's frustrating, and a bit depressing. So, on the list of things still to do is find the energy to go and do a major sort so I can pack away all the summer stuff into suitcases that can be neatly parked in a corner, and reduce the items that I am using so I can make neat folded piles of them. We also - and Dragon Dad actually said this... - need another bookcase because I've still not sorted and properly shelved the books because there isn't enough space - that's around $100, I think...might be doable soonish, I hope. 

In the meantime though, I have done two tai chi classes now, and am paid up and committed to continuing.  My mother would laugh at me - all those years of her telling me I should do it, and me not doing it because she'd told me I should - perverse... I like it. I really do. I crash afterwards - fell asleep on the couch in front of the TV on Tuesday evening after dinner. But the joy of falling asleep because I'm tired because I did something physical - a 'normal' activity that used energy - THAT was wonderful. I'm not finding it too physically difficult - apart from my feet. In the two classes so far, I've tried two different pairs of shoes - we're on bare board floors, so going without shoes altogether can't happen. I have a third pair to try next week...fingers crossed. Otherwise, as Dragon Dad said, I might just have to live with the fact that they're going to hurt. I hunted online yesterday and found the 'Beijing 12' that we started learning this week - because, try as I might, I could not remember the first movement that we were taught. Damned brain fog and inherent lack of remembering physical routines...

Getting past that emotional block about starting something new with strangers was a good feeling too. Reminded me that, actually, I CAN do it. A salutary reminder to get over myself!

Getting back on track with the blog. This my second post this week.  I'll try and keep to that if I can. It does me good to write. To get the stuff in my head OUT of my head! The trick is finding a point of focus so I don't just ramble on, because no one wants to read that. All the stuff I've read about blogging and being a 'successful' blogger make the same point - that the really important thing is regular posts. It doesn't matter whether they're weekly or daily, or something in between, but they need to be regular. While I'm perfectly capable of writing to a brief - including deadlines - one of the reasons I started blogging was to give myself an avenue to write where there weren't structures like that that create pressure. However, to make the blog WORK, there do need to be some, so I'll try...I may not succeed, but I will try.

I've also done some research, looking for new places to pitch work - it's a jungle out there, folks. I have some paid work that's semi regular, but I need - financially as well as creatively - to find other work to do, other places to publish. So I write stuff and send it out - mostly into a black hole. Typically, I've done this in bursts, having a flurry of busy-ness, and sending things, and getting all worked up in anticipation that perhaps this time I'll have cracked it - only to come crashing down as the persistent lack of responses demonstrate that, yet again, there are no takers. So, I'm looking at diversifying that approach a bit with a more balanced mix of things I'm working on, with a different spread of potential destinations. At least the writing itself will be a bit more mixed, and interesting. 

Fat Mum Slim's Photo a Day challenge. I wrote about this when I first planned to start doing it. It's nearly the end of April, which makes almost four months of posting a photo every day in the Facebook group, and on the Dragon Mother Facebook page. In that post, I wrote about some of the reasons that decided me on committing to doing it, and by and large, they're playing out as I thought they would. As the daily drawing practice did (which I've not managed to pick up again so far), it makes me look at the world around me with much more attention. 

There are specific daily prompts for the photos, so there's a certain amount of daily discipline that comes with getting my head around how I'll approach that - sometimes, it feels really obvious but other days it can be a real challenge - and surprisingly difficult! Some of my results have prompted Dragon Dad to tell me that I've got some potentially serious photographic talent - which was hugely gratifying! And also that at some point when money allows, we must find me a good digital SLR camera. At present, it's all being done with the phone on my iPhone - although, I'm far from alone because there are lots of others in the group in the same position. 

I've also been 'fabbed' three times now - for each prompt, the moderators select a number of photographs that they particularly liked and post a collage of them as the pinned post for the next twenty four hours. I've been ridiculously chuffed each time - again, validation, which is nice. Most importantly, I'm making new friends online. I may never meet many of them in person, but I have to say, it's an extraordinarily positive and supportive group of people, and there's lots of friendly chat on comment threads on the photos when people come to comment on each others' shots. And, the thing that prompted this particular post, there are more than a few people for whom this particular activity is enabling them to have something that they're consistently focused on which is giving their lives structure, for whatever reason - and there's a conversation happening on a particular photo today to that effect. So, to finish on a positive note, I'll upload a few of my favourite photos so far. Those of you who follow the Facebook page may have seen them already, or not, depending on how your newsfeed serves up things! For those who WANT to see them regularly and don't follow the FB page - I invite you to do find it and follow. 

Flat lay
Fave part of my day - fabbed
Off centre
Opposites - fabbed

Sunday, 23 April 2017

Fund raising and awareness of RA and other autoimmune diseases - or the lack of...

I've been stopped twice in the last week, at the same supermarket, by people fundraising for cancer research. Now, before anyone gets up in arms, I totally get the need for cancer awareness and fund raising, and am only too thankful for the good work that's been done in the field to improve diagnosis and treatment protocols. 

BUT...and it's a big, daily but, for me... I have an incurable, chronic disease. It's unlikely to kill me, although, severe RA and its co-morbidities and complications can cause death, and has. Ask yourself though, did you know that? Readers of this blog who have RA or another autoimmune (AI) disease probably do, and perhaps some of their friends and family members. However, it's highly unlikely that the average person on the street does. Because, RA is still, in the minds of many, 'just' arthritis. Like their granny has... the odd sore joint that slows them down a bit, and hurts when the weather gets cold. Not to minimise the potential devastation of osteoarthritis (OA), either, but RA is a systemic disease - unlike OA. As is Lupus, Sjogren's Syndrome, Psoriatic Arthritis, Spondylising Ankylosis, Type 1 Diabetes, and many, many more. And not a single one of them can be cured. 

Before writing more, I'd just like to say that this is a really hard post to write. I don't want to come over all whiney, and 'poor me' - that's not the aim of the exercise at all. I don't want it to sound like there's some kind of competition between cancer and autoimmune diseases, because there's not. I also don't want to offend anyone - that's the last thing I want to do. I just want people to stop for a moment and consider what I'm saying, and try to understand where I'm coming from, because that's what real awareness is about. 

So where the hell are the tables with bright faced young things raising funds for autoimmune diseases? Seriously...where? 

There aren't any... 

I don't donate to cancer research. Not because I don't think it's worthy of my money. But because thousands and thousands of people already do, and there are more foundations for different types of cancer than I can poke a stick at. So many labs devoted to cancer research here and all over the world, doing excellent work and making important breakthroughs regularly. Which is marvelous. And necessary. 

When it comes to autoimmune diseases though, that's just not the case. I honestly don't know why that is. It can't be based on the numbers. The Australian Institute of Health and Welfare report from 2014-2015 reported an estimated 407,900 people in Australia have Rheumatoid Arthritis alone. That's - if my maths are correct - something around 1.76% of our current population. That's NOT a small number.And goodness only know what the current numbers might be.

Is it some sort of twisted kind of 'glamour'? In a world that is being fed by dramatic press headlines, those depicting celebrities fighting cancer appear to be increasingly frequent. And there is that concept of the 'brave fight', particularly when, tragically, someone dies...losing that brave fight. 

More celebrities have been 'coming out' about their autoimmune diseases. At the same time, their experience can look very different - and I've seen comments on forums where people make a point of making that an issue in, those people, regardless of the diagnosis, have more means than the average individual to make life easier despite the diagnosis. The same could be said for celebrities with cancer, I guess. But ultimately, we're still all people, and no fame and/or fortune can change the fact that being sick - whether it's cancer or an AI disease just plain sucks. 

I wrote about this when my dear friend Lizzie died from ovarian cancer. It's her birthday today, along with No.1 son... Lizzie had also been diagnosed with RA some time before the cancer diagnosis. Ironically, I have seen in RA circles online people who have RA and are struggling with the kinds of lack of support and understanding that are common for many making the statement that they 'wish they had cancer' - on the basis that cancer HAS a level of awareness and understanding that autoimmune diseases don't have. There's no way that Lizzie would have subscribed to that particular idea. She was all too aware of the different playing field offered by her cancer diagnoses. Tragically, as is the case for all too many of those diagnosed with ovarian cancer, the diagnosis came far too late to offer her reasonable odds of survival. So, I've never wished I could have cancer instead of RA, just to have more awareness. 

Awareness and fundraising are important though. Incredibly important. Research takes time, and requires money to fund staff and facilities so that it can be done, and done thoroughly. I did a Google search for current research specifically being done for RA in Australia, and found two main places. TWO. Two sites of research for a disease that close to half a million people in this country have. One is the Garvan Institute in Sydney, and the other is the University of Queensland. The latter is working on what they're calling a 'vaccine' for RA. I'm not entirely sure how you vaccinate for an AI disease, to be honest. From what I've read though, they've tackled the research along the lines that I've always thought seemed most logical - figuring out how to turn OFF an autoimmune system that has got stuck on overdrive...because by doing that, effectively, you stop the disease process entirely. Current treatments only slow that process down by inhibiting the overactivity. The UQ model aims at flicking an off switch to stop it.

Garvan, on the other hand, are looking at a treatment that sounds as if it may work similarly to current biologic drugs, but it is targeting cells in the inflammatory process rather than the autoimmune process, in a way that can be effective earlier in the immune response that's attacking the patient's own cells. It could have a similar effect to the UQ model in shutting down the disease activity altogether. 

What isn't clear with either project is whether the proposed treatments are something that the patient then needs to be on long term to maintain the status quo - which, to my way of thinking, puts them into a treatment classification rather than a cure. I don't know if - should they work - you'd then have to remain on that treatment, because coming off it again would allow the disease to start up again.

Overseas, there is work being done with an electronic implant that stimulates the vagus nerve - a project that started when a neurologist (I think - I can't find the original article I read about this) started to wonder if it would be possible to interfere with the inflammatory system via the nervous system. The vagus nerve controls TNF production (tumor necrosis factor, a chemical in the system that is a primary component in the inflammatory response - the first of the biologic drugs on the market, which are still being used, are TNF blockers) so the implanted device sends a signal to the vagus nerve which stimulates a response that interferes with that process - effectively reversing the disease. Early human trials have had some promising results, although they've been relatively small samples. At this stage, the consensus appears to be that it's potentially a treatment that can be offered when a patient has failed to respond adequately to current drug protocols, as it's invasive, and once implanted, rules out future MRI scans (a major diagnostic and monitoring tool), due to it being metal. Again, like the two previous projects, my question is, does that mean that once implanted, the device has to stay put for the rest of the patient's life? Is the 'cure' conditional on the ongoing presence of the device?
Receiving the infusion of the biologic drug that's keeping my RA controlled.
While these projects are all encouraging and indicate to me some logical new approaches in research for RA, given the numbers of people who are affected by the disease, they're disproportionately small. And awareness of the disease and its affects on the daily lives of patients certainly isn't on the increase. On the television last night, the Ride for a Cure was being advertised. It's an annual long distance mass cycling event that people can do to raise money for cancer research. A friend of mine did a similar one last year, riding from Canberra to Sydney over three days. Dragon Dad, being a cyclist, voiced the idea that he'd like to do it one day. He did do a two day ride that was to raise funds for cancer research a few years ago - 100kms each day. I forget how much he raised, but he had to raise a certain amount before he'd even be eligible to ride. When No.1 Son did the Noosa Triathlon last year, he was racing to raise funds for cancer too. 

Then, last year, I stumbled across a cycling event for RA that popped up on Facebook because of the algorithms that govern my newsfeed. I clicked on the page, and there it was - a ride from Canberra to Adelaide to raise funds for RA...only it was nearly over, and I'd heard absolutely nothing about it via any of my channels prior to the event. When I hunted around online, I found a reference to it on the Arthritis Australia website two days before it was due to start...but no active promotion, which I thought was appalling. The event itself was instigated by a cyclist whose partner has RA. In the conversation I had via Messenger on FB, they said it was a one off. MAYBE they'd repeat it, but that wasn't a given. Dragon Dad was really disappointed - he'd have gone and done the ride with them had he known. He'd have promoted it like crazy too, because that's how he rolls. He'd certainly have contacted all the television stations and newspapers to try and get coverage - as there is for the cancer ride. I don't know how much money the cyclists raised - there was no follow up on their FB page or the Arthritis Australia site. Given that that's our mainstream agency in this country, that's just not good enough. 

Both of the times I was accosted at the supermarket last week, I stopped and said that no, I wouldn't be donating, and I told the girls why. The first time, with two girls on the stall, one of them introduced herself and asked my name, then told me she totally understood, as her mother had recently been diagnosed with MS, which has now been classified as an AI disease. She wished me well. The other girl with her tuned out and looked as if she was trying to be anywhere else but there at that moment. Similarly, the second time - one girl on her own - she looked uncomfortable, and clearly didn't know what to say, so said nothing.

Somehow, this status quo has to change. These diseases, collectively, affect millions of people in Australia. There needs to be better research funding, because if cures CAN be found, many of those people will be able to re-enter society healthy and capable of living fuller lives than many currently manage. It will mean many will be able to go back to work - something so many of us can no longer do. It will mean fewer people are living with chronic pain. It will mean so much for so many... So, next time you have an opportunity to donate to medical research, think about the diseases that don't receive so much funding, and maybe pick one of those. 

Saturday, 8 April 2017

Rheumatoid Arthritis - on NOT being a hermit...

I'm a fairly gregarious individual. I like spending time with people, going places, doing things... I belong to the extrovert end of the social scale - not at the extreme end, but I'm definitely not an introvert. Having said that, I am shy. I've always found it difficult to launch into new activities where I don't know anyone - walking into a new situation knowing no one is something I find very challenging. I don't always find it easy to fit myself in socially. Growing up, we mostly associated with family, so there weren't 'events', as such, where I learned how to make small talk and do the social 'thing'... 

One of the more insidious things with chronic illnesses is that it can get very easy to have your world shrink. Pre-2013, I was working, getting together with friends, going to gallery openings (I was doing a reasonable amount of exhibition reviewing), swimming regularly, going to different events as opportunities arose, and so on. A fairly regular, busy, contemporary life. 

Now, a visit to the cinema is a highlight, and the most social I'm being is the odd coffee get together with a friend. We've been going to shul semi-regularly, but haven't really got very involved at the synagogue apart from attending those services. Occasionally, we head to friends down the Mornington Peninsular for a drink or a meal. Mostly, if we go out, we're prowling different areas of Melbourne and finding what might well become familiar haunts - just the two of us. I've found Tai Chi Australia, and have been in touch. The most logical place for me to go to classes is about a 15 minute drive away and the next beginner class starts on the 18th of this month. 

Here's the thing though... I'm dreading getting to that first class - finding the school where it's being held, finding parking, finding the room, and then walking in not knowing anyone. I want to ask Dragon Dad to come, only he doesn't want to do Tai Chi, and I'm aware of just how pathetic that would make me sound. He's asked me a few times why I've not gone to services at the shul on my own, when he's not been able to go... A part of the reason is that the Friday services are at the end of the day when I'm most tired, so I dread the drive back after I've sat for an hour at the end of the day and am really stiff and sore - and that's what I've told him. But also, it's the whole going by myself thing, because I really don't know many people at the shul, and those I know are passing acquaintances, not actual friends. I've still not emailed the cantor about the choirs, which would alleviate that particular situation since once I'm involved, there'll be a core group of people within the community that I will get to know, and I'll have a 'place'... But it's still that initial step.

Why is this...? 

Part of my reticence is our current extremely tight financial situation. There are a number of things I've found that I could do - which would both throw me into getting to know people, as well as getting me out doing things I enjoy, but they cost. And we really can't afford extra expenses at the moment. Tai Chi fits into overall health care, so it's a priority that can be sorted out financially, along with other things that Dragon Dad's doing for his health and fitness. Some of the others, while no doubt good for my mental health don't feel that straightforward.

Another critical element is that new people mean explanations. When it's just Dragon Dad, or friends I have here already that go back some years, I don't have to explain. I can say I'm not well, and they're sympathetic, but don't need me to explain. Strangers are another thing altogether. My old friends have known me before this severe phase of the disease. They're not happy I've got so sick - for my sake. But they know who I am, what I've done, what I can do, etc. They know the whole me, not just the 'sick girl'... There was a time when I could walk into a new situation and it wasn't necessary for anyone to know. I was well enough for it not to show, and for me to rarely need accommodations to be made. If I cancelled something, it was usually for some big and immediately understandable reason - not because I was having a bad day. Because my 'bad day' now is about being too ill to manage something - too much pain, or too much fog, or too many side effects immediately post infusion, and so on. For instance, the Tai Chi class I'm looking at is on a Tuesday. So is my infusion, every fourth Tuesday... So, once every four weeks, I'll need to go to a different class on a different day, because the end of the day on infusion day is definitely not going to be an option. I'll have been sleeping most of the afternoon and I'll have the headache from hell, and a level of drug infused fatigue that's impossible to get past. I won't be capable of driving or being as physical as the class will require. And I'll have to tell them that - and make arrangements for which class I pop up in like a bad penny every four weeks...and tell the teacher of that class too. 

Little by little, all these bits and pieces of emotional baggage start to add up to the point that they can end up looking like an enormous wall of 'stuff' that just can't be scaled. But I don't think I'm alone. I suspect that this is a phenomena that many of us with chronic illnesses know and understand, even if it's not something we articulate for ourselves or anyone else. 

My rational self tells me that it's going to be FINE. That I don't need to get myself into such a state. Because when I do scale that mountain, things usually are OK. The friend I'm seeing most frequently at the moment is a new friend, in physical terms. I met her online in an international RA support group, and invited her to joint the Australian one I'm involved with. Then it turned out she lives in Melbourne so when we knew the move was really happening, I tucked that away in the back of my head for when we finally moved. I didn't do anything about that after we'd made the move though, not immediately. For one, there was that whole 'do I cross the line from online contact to face to face?' thing that's very much part of the online world vs real time. But also, it was that whole thing about taking that first step. Then I had a crisis situation that she became aware about via an online conversation, and in the end we did meet up in the next few days. Because it turns out we don't live very far away from each other, so it's REALLY easy to get together. And it's been lovely - given the context of how we met in the first place, we don't have to explain anything about illness, because we're both sick! 

So, things can work. I know this. But I've had almost three and a half years of my life steadily shrinking and it's really hard to acknowledge that I've got a part to play in that, and if I don't want to end up being completely isolated, I need to put my big girl pants on and just step up. Which is, ultimately, what this blog post is about. I'm putting it out there. Saying it out loud so I have to do something about it, because it's not hiding away in my head any more! Those of you who read this post now know I now - well, once I hit publish - feel like I'm accountable! 

Wish me luck, folks. It's time to crawl out of my shell and start making my life happen again. And if I can do it, so can you, so tell me your stories!