I’ve Been Told I Need a Bubble….Can I Make that Two?

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After all these years, dear readers, I can safely say I’ve encountered a “first.”

I tore a ligament in my ankle. Sitting still.

Yes, sitting still. Now, I’ve torn, broken, twisted, and battered my knees and ankles many times; I’ve even had the other ankle surgically reconstructed using a tendon from my leg that was strategically drilled into the bone and held in place with pins. But normally, there are reasonable explanations for my injuries: a wrong turn in kickboxing class, a stumble off a sidewalk onto cobble stoned streets while wearing heels, too much wear and tear from figure skating as a child, etc.

Now imagine my sheepishness when I hopped/limped into the ER at 1 am last week and had to answer the inevitable, “So how did this happen?” What else could I do but admit the truth: I am that much of a disaster that even sitting still I somehow manage to injure myself. I mean, I thought I’d reached an all-time low when I broke my finger typing last month (the second time I’ve done it that way), but at least I know I can still surprise myself.

For years, friends and family have half-joked that I need to encase myself in a protective bubble. In fact, even my doctors have said it. Whether it’s a strep infection in my knee, a rare type of bug no one else grows, the time I broke into hives only to be told I’d somehow become allergic to myself (I’m not kidding on that one), or any of the other myriad medical mishaps I’ve encountered, each time the tale borders on the improbable, the response is the same: “You need a bubble.”

Actually, I think I need two.

Allow me to contextualize this most recent escapade. I was sitting on the floor of my parents’ bedroom, legs on the plush rug and back leaning against the bedpost. My dog had her head resting on my left ankle, which was turned outward. After a few minutes, my ankle felt sore but I was reluctant to move it. I remained that way for about an hour and when I finally stood up, I fell over and my eyes smarted with the pain shooting up the side of my ankle, into my heel, and up my leg.

But silly girl, why didn’t you just move your damn foot when it started to hurt?

Ah, but don’t forget, I ordered two bubbles. The other one is for my similarly cursed dog, who was resting her lamp-shaded head on my foot and howling piteously in pain. You see, we’d just gotten back from an emergency animal hospital where she’d had a 4-inch long, 1-inch wide plank of wood removed from her right eye.

Yes, my dog had a plank of wood stuck in her eye. Well, to the side of the eyeball itself, where it sliced through her mucus membranes and sliced all the way back to the bony orbital near her brain, narrowly missing her optic nerve. At one point, we didn’t think she’d even be able to keep the eye, but she did.

It was a hideous sight, opening the back door and finding her sitting there waiting to come in, this huge stick in her eye. It didn’t even look real.

Who was I to move an animal in clear agony? And really, whose feet don’t get uncomfortable in certain positions? Even I couldn’t have guessed I’d actually hurt myself sitting there.

(Side note: she wound up going back to the hospital as an inpatient for four days and is just now starting to make a very slow recovery.) (Side note two: caring for two dogs, one of whom requires constant attention and has more meds than I do, while on crutches and painkillers, is not ideal).

I got a phone call yesterday and the person was surprised to hear me so hoarse.

“Isn’t it your ankle that’s hurt?” she asked.

“Yes, but I’ve been sick with a respiratory infection for five weeks now. I just forgot to mention that with everything else going on,” I said.

I had to laugh a little at the fact that this didn’t surprise her in the least.

So yes, I need two bubbles. One for me since obviously I can’t get out of my own way, and one for my panic-attack prone, anxiety ridden, severe food allergy suffering dog who was doing what she loved best—racing around the fenced-in yard with her best friend—when somehow she practically impaled her own eyeball.

She’s resting her swollen head on a pillow right now, and as I type, I’m elevating my swollen ankle. We definitely deserve each other.

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On Adapting, Evolving, and Why I’m the Perfect Candidate for GPS

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“Head south on Main street,” my husband said.

“That means nothing to me,” I said. Which way was south from where I was? And, more importantly, where was I?

I stumbled across this wonderful Salon article penned by a woman with the exact same problem—not your average “I’m bad with directions” problem, but a very real and very pronounced spatial relations learning disability.

Similar to the author’s experience, I got tested for the disability when the humongous gap between my verbal and non-verbal reasoning standardized test scores was too big to ignore any longer. I could read before I was three, I read on an eighth-grade level when I was five, and used my photographic memory to learn all the answers on every card in Trivial Pursuit so I could beat my older brothers that same year.

Yet when the educational psychologist asked a 14-year-old me to put together a basic 7-piece puzzle of the human face in three minutes, I could not do it.

I know what a face looks like. I know seven pieces—a mouth, a nose, two eyes, etc—is not a hard puzzle. So why, in 180 painstaking seconds, couldn’t I put even two pieces together? Or match up a tree to its shadow, or any of the other basic spatial things most people can do?

Because something really screwy happens in my brain when I look at or try to visualize non-verbal images or concepts—they get flipped, reversed, thrown into chaos, and no matter how hard I focus, I cannot make sense of things.

Like the author, I don’t “do” north, south, east, or west. The only way I know where the sun rises is to remember which window the sunlight used to stream into each morning when I was a kid—since it woke me up, I could remember it.

I can’t read a map. I can’t follow directions. I get lost in my hometown, lost in the city I’ve lived in for five years; I get lost so often that almost everything is beginning to look familiar (“Oh, I know where we are, I’ve been lost here before!”) I routinely build in an extra half-hour for lost time, and my family knows to keep their cell phones on for frantic “Where am I?” calls.

It took me years to tell time on an analog clock. I still can’t do puzzles, get riddled with anxiety when navigating the labyrinthine hallways of my office building, and even though I slogged through honors calculus, I can’t add fractions, can’t reverse things in my head, and the “P” on the pepper shaker often looks like a triangle to me. I can’t asseble things, and despite Scrabble scores of 400, I cannot figure out how to put the letter trays back in their slots in the Travel Scrabble edition. Getting the picture?

And yet, like the Salon author, I’ve learned to adapt. I memorize street signs, store fronts, anything with words, so that my landscape is a guidebook of verbal landmarks. I park in the same place when I return to malls, hospitals, or other sprawling places so I can retrace my exact steps. I rely heavily on my memory to re-create scenes so I know where to go, and when I get lost it my own building and bump into people, I pretend I was going to the copy machine.

I’m so used to seeing the world differently and using my dominant strengths to help balance out the glaring deficits that I don’t even think about it too much. Reading this article made me appreciate just how rote many of my coping mechanisms are—so built into my life that I barely notice them.

It’s the same sort of thing we do with chronic conditions, the changes and adaptations and mechanisms we use to deflect or diffuse symptoms. When I get winded from using the stairs on a “bad” lung day, I duck into the restroom to catch my breath. On a much larger scale, when I lost my adrenaline and my lungs spiraled downwards to boot, I focused on building a career with flexibility. At some point or another, every patient with a chronic disease faces similar strategic thinking and adapting.

Everyone’s got something to compensate for in life, whether it’s a learning disability that makes stepping out of a subway exit a daily adventure in disorientation or a serious illness that makes a simple thing like drawing a breath complicated. I really don’t believe “normal” exists—all we can do is live our lives in such a way that we maximize our strengths and minimize our weaknesses. That’s the ideal, anyway, though getting to that point is the harder part.

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The Tale of How I Got a Clue

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I’m twenty-seven years old. I’m a married woman. I work at a university and write for several publications. I’ve got my life together and the frequent infections and crises that are part of living with illness do not faze me much at this point. And yet when I was sick last week and stuck in my house, my parents insisted on stopping in just to say hello. You know, just to make sure I was still breathing and all. Even though I spend weeks like this every year and I’m always okay in the end.

But I think I’m finally getting it, this whole protective parent thing.

Let me tell you a little story I’m calling “A Tale of Two Dogs.” Fear not, this is not ubiquitous pet-blogging, I am actually going somewhere with this, I promise.

Let’s call Dog #1 Shadow (as in, scared of her own). Shadow didn’t have the easiest start in life. She was bounced from kill shelter to kill shelter as a puppy and was conditioned to think being scared of everything was okay. Even after she found a home, Shadow went through a lot of crises and stress in her young life, and though her owners did everything they could for her, sometimes things happened that were out of their control and they couldn’t make things easier for her. So many things scared her: sounds, things that moved, strangers, voices, even her own darn tail when it hit the French doors by accident. Shadow is a loving, loyal girl. She loves parks and walks, running and chewing bones—that is, when her problems don’t overshadow everything else, when they allow her to do the things she loves.

And then there’s Dog #2, whom we’ll call Bull (as in, in a china shop), despite its gender inaccuracies. Bull is a happy-go-lucky kind of girl. She is fearless and playful, she leaps into life before she’d ever consider looking, and is the rough and tumble sort who enters a room and instantly makes herself at home. She flings herself into pools, she chases balls into walls and bounces off them without skipping a beat, and she wags her tail with such fervor that she knocks herself over in excitement on an hourly basis. It is a nice thing to see, this playful exuberance, this innocence with which she approaches life.

As a friend of mine would say, to boil things down into an executive summary, consider the following example: Bull and Shadow are frolicking in the yard. The sprinkler heads spring to life. Bull bounds toward them with glee, trying to catch the water in her mouth and batting at the spray with her paws. Terrified by the sound and the motion, Shadow lurches herself across the yard and scuttles under the porch, tail between her legs and ears pinned back. On this day, she cannot enjoy the simple acts of living that Bull can.

Bull is the new girl in town. I know that I will love Bull and Shadow equally, that I will appreciate their quirks and talents and funny little ways equally. No question about that. But I will always more about Shadow, will always be that much more protective and alert when it comes to her because we have been through so much and I know that life will always be a little bit harder for her. Bull is a grand girl and will be fine; with love and an endless supply of tennis balls, she’ll find her way in this world. She won’t need me the same way Shadow does. She is lucky in that way.

Maybe it’s a stretch, maybe I spent too much time in rescue shelters this week and the lack of air conditioning and the stench of panting dog and stale urine went to my brain or something, but I can’t help feeling that this must be a tiny little slice of what it’s like to be parents. Parents who have healthy children and sick children, who love them each without limit and love them for the individuals they are—and who will not ever be able to shake that instinctual urge to protect the one they’ve been through the trenches with, the one whose problems (physical or, like Shadow’s, emotional) sometimes make everyday life that much harder. It is not a greater love than they have for anyone else, and it is not a smothering love. But it is a love that speaks of a very different bond, one that cannot be replicated or truncated.

I’m twenty-seven, a married woman with a career and two dogs. And yet my parents flood me with “How are you feeling?” phone calls the minute a fever spikes. You tell me, am I onto something here? If so, maybe I can tone down the exapseration with which I reply, “It’s just an infection. It’s not a big deal.”

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If You Offer It, They Will Come….

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I’m no economist, but simple notions of supply and demand seem to dictate that if you offer a service to a captive market and meet with success, an inevitable increase in demand (and then more supply) will follow.

As logical as this sounds, I have to admit that for awhile I didn’t think the restaurant industry would take notice of what I already knew to be a clear demand for gluten-free dining—or at the very least, increased understanding of what gluten is and how it is incorporated in dishes.

Check out this interesting NYT article on GF dining in NYC. Turns out, savvy GF diners are proving that if restaurants cater to their needs, they will come. In droves, apparently. Long-standing mecca of gluten-free goodness Risotteria is mentioned (I am still dreaming of the breadsticks and chocolate frosting-stuffed cookies from last April), along with other restaurants that offer separate GF menus ripe with two things long absent from the GF dining experience: options and variety.

We’re a loyal lot, this band of celiacs who refuse to give up on eating out, and as the article illustrates, I’m not alone when I say that if I know of a restaurant that caters to my dietary needs, I will go out of my way to try it, and I’ll spread the word. Win-win situation, yes?

This has been a good week for me in terms of GF tolerance. I’m still adjusting to a dairy-free existence (I admit, I am a bit frightened to try the dairy-free, soy-free “cheddar flavored rice product” my well-meaning husband brought home from the grocery store today, but I’ll try it at least once), so knowing the GF horizon is a little less bumpy makes that easier. It can get somewhat daunting to plan a meal or peruse a menu when there are so many ingredients to avoid. I’m energized about the decision to go dairy-free—anything that even marginally reduces the mucus that chokes me is well worth it—but like going GF, it is still an adjustment.

The same day a friend forwarded me the NYT article, I had a more local encounter of the celiac-friendly kind. I think I’ve mentioned The Fireplace before for its gracious, accommodating nature and abundant native produce, but they’ve upped their GF game a bit since I was last there. They now offer a menu for celiacs that lists every item on the “regular” menu with a bold YES or NO next to each entry—yes meaning it is totally safe from cross-contamination and has no gluten, and no meaning it is not an acceptable offering.

The food and the menu were fabulous. And I think offering something like this is just as helpful for the servers, too—after all, if you don’t have celiac disease, it’s hard to keep track of all the things that contain gluten, especially if it’s a crowded night and there’s an extensive menu to check. It takes the pressure of both parties—I could make an informed order without needing to flag down our waiter with questions, and he could spend his time extolling the virtues of the great wine list with us instead.

Of course, at the end of the day it is my responsibility as the consumer to be educated and prepared, whether that means calling restaurants ahead of time, looking over the menu online, or being willing to be flexible when it comes to ordering off of smaller menus. Gluten and dairy will always have a large presence in most mainstream establishments, and it’s up to me to make sure I choose a restaurant where I can eat something.

But I’m not going to lie; when I walk into a restaurant and open up an entire menu where every single item is safe, it translates into one thing: a celiac foodie’s heaven.

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Grand Rounds, Vol. 3, No 44

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Grand Rounds Vol. 3, No 44: It’s All in a Day’s News

As excited as I was to host Grand Rounds for the first time, I had a fair amount of trepidation, too. How was I going to arrange all these posts in an interesting yet logical way, one that did justice to the wide array of topics included and still appealed to all types of readers? The answer arrived on my doorstep in the neatly folded form of my trusty daily newspaper. Of course. I started my career in newspapers, and decided to use elements from my favorite print and online papers for today’s compilation of news, analysis, and debate.

Have at it!

Front Page Stories:
When Blogging Gets You Fired by David Bradley at Sciencebase discusses ways to maintain a blog and still maintain a career, especially pertinent advice if you practice medicine
Why Chernobyl’s Birds Matter by grrlscientist at Living the Scientific Life explores the unequal effects of radiation on bird species twenty years after the catastrophic Chernobyl nuclear reactor disaster—and what this means for humans
For the Love of Strange Medicine by Kim at Emergiblog uses a hypothetical situation to take on what can be a controversial issue of authority in the ER
Making Meaning by Susan at Rickety Contrivances of Doing Good draws a powerful parallel between being a volunteer hospital chaplain and being an English professor

News:
Mirrors Provide New Treatment for Chronic Pain by HowToCopeWithPain discusses an exciting and non-invasive treatment for chronic pain using mirror images
Runaway Costs Can Undermine Health Reform in a Hurry by Health Business Blog looks at a potentially costly flaw in Massachusetts’s health care reform plan
Proof Innovative Thinking in Health Care Exists by Hospital Impact Blog uncovers the proactive approaches one hospital has implemented to improve the patient experience
Suicidal Breast Implants by Shrink Rap provides shownotes for a podcast discussing an increased risk of suicide in women who have cosmetic breast augmentation
Should Rapid HIV Tests Be Mandatory During Pregnancy? by International Network for Ethical Issues in Resource Allocation reviews research that concludes pregnant women shouldn’t be required to undergo rapid HIV infection tests

Op-Ed:
What You’ll Learn in Pre-Med Classes by Dr. Val
& The Voice of Reason tackles the question that plagues all pre-meds at some point: Are you ever going to use any of this stuff?
Is American Health Care Headed Overseas? by Madness: Tales of an Emergency Room Nurse includes thoughts about the emerging trend known as medical tourism
Web 2.0 and Clinical Genetics in Practice by Scienceroll lends support for the significance of technology in diagnosing genetic conditions
Is Mental Illness Adaptive? by Behavioral Ecology Blog debates Nobel Prize winner John Nash’s statements on the subject

Science/Technology:
Exploding Lips and Other Combustible Pursuits by Ian at Impactednurse offers amusing analysis on the use of lip balm during oxygen therapy
Sex, Lies and Anesthesia by Counting Sheep lays bare the common(and comedic) misconceptions that people have about anesthesia
Beyond the Hype: The iPhone and Health by Tech Medicine shows the medical uses of the iPhone, proving it is more than simply the coolest new accessory
How To Do a Pelvic Exam by Women’s Health News offers candid commentary on a video of the procedure every woman dreads: the pelvic exam
A Placebo State of Mind by Christian at Med Journal Watch is a series that explores the power of the human mind when it comes to placebo treatment
Pregnancy and the HSIL Diagnosis by Fruit of the Womb covers the questions and concerns that accompany high-grade cervical dysplasia
An Unusual Cause of High Serum Amylase in the Setting of Normal Serum Lipase by Inside Surgery is a concise, technical explanation of an uncommon cause of this condition

Your Life:
Don’t Give Up by Amy at Diabetes Mine captures the other “low” of living with type 1 diabetes—and all the reasons why she doesn’t give into it
The Disconnect by Kerri at Six Until Me recounts a grateful reunion with her insulin pump after a week away from its many conveniences
Where Would I Be? by Rachel at Tales of My Thirties reveals the surprising ways living with Type 2 diabetes and anxiety has shaped this patient’s life
Why the Dutch Look Down on Us by Parallel Universes provides commentary on the factors that make people taller or shorter
Can Elvis Cure Throat Cancer? by Dr. Bruce Campell explores rationalism versus empiricism in the context of a postage stamp turned panacea—and why rationalism can still be so appealing, even when we know better

Travel/Leisure:
DisAdventure: Advice for World Travelers with Disabilities and Chronic Conditions by Jocelyn at Chronic Babeoffers the keys for smart travel—you won’t need a vacation from this vacation
Strange Occurrences by Lemonade Life details wacky blood sugars, misinformed athletic trainers, and other random events in the life of this diabetic
Tales of a Jellyfish by Medicine for the Outdoors
is a stinging account of a marine encounter gone wrong—and what could have prevented it
Better Exercise on the Stairs by The Fitness Fixer shows how climbing stairs can be painless, not punishing
A Travel Destination of Another Kind by Eye on DNA looks at medical tourism and preimplantation genetic diagnosis (PGD)

Thanks for reading today’s edition!* Many thanks to Nicholas Genes for all his hard work in keeping this fantastic tradition going strong, and thanks again to everyone who submitted. You made my run as temporary editor-in-chief a great one.

Don’t forget to check out next week’s Grand Rounds at another Boston-based blog, Health Business Blog

(*For best results, view this blog in Safari or Internet Explorer)

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What’s the Deal with Dairy?

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I’m turning to you, thoughtful readers of the blogosphere, for some input on a decision that has been slowly building traction in the back of my mind for several days now.

Should I go dairy-free?

I saw my doctor this week, a follow-up appointment to see how I’ve responded to my antibiotics. My respiratory infection has definitely improved, but my bronchiectasis exacerbation from it is still pronounced, so I have a handful of new meds and inhalers to try and quell the chaos rumbling in my airways. I don’t even remember how it happened, but dairy came up in our conversation. Of course, I’ve long known that dairy is a mucus-producer, and if there’s anything I don’t need, it is more phlegm in my life.

“I really don’t consume much dairy,” I told him, sheepishly looking at my cup of coffee on his desk, which clearly contained milk. I don’t even like milk; even as a kid I never drank it on its own, it was merely a conduit to moist cereal, and as an adult, it’s merely a conduit to what I think is better-tasting coffee.

But when I thought about, I do have dairy often enough. I eat cottage cheese a couple of days a week because it’s a great protein source, and while I try to avoid cheese because of its fat content, I do have feta on my Greek salads regularly.

“Well, the less dairy you have, the better,” my doctor said. I nodded.

The seed was planted.

And then I stumbled across this site in the comments section on Kerrie’s blog (ironically, her original post included something I’d written about going gluten-free, so I’m now engaging in an amusing but totally productive game of blog-tag, I think 🙂 ) and I started to think about giving up dairy more seriously.

Enter the back and forth dialogue in my mind: It would certainly be a big sacrifice, lots of labels to read and accommodations to make. Yet so was going gluten-free, and you wouldn’t change that for anything, you know you feel so much better. Yes, but I have celiac disease, so clearly going GF would make me feel better–I am not lactose intolerant and don’t think I feel any worse when I eat dairy, so would I even see results? But don’t forget, you know you get more congested after frozen yogurt, so even if the only change was less phlegm and less exacerbation, wouldn’t that be worth it?

And, finally, the remaining question: But your diet is already so limited. Wouldn’t removing dairy make an already difficult dining situation (remember, one of your hobbies is trying new restaurants!) even harder?

Yes, but if it helped, wouldn’t it be worth it?

Leaving the dialogue in my mind alone for a second, what you do think? Is it worth a try? Is it something worth doing in degrees–eg, removing “big” thinks like milk, cheese, etc but not whey and all those little tiny ingredients that appear on labels? (This reminds me of people who go wheat-free but still eat many other forms of gluten). Would I still get any benefit, or, like going GF for a celiac, is it something that only works when you do it 100 percent?

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It’s time for some GRAND ROUNDS! (Vol. 3, No 44, that is)

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I want your submissions! That’s right, Grand Rounds, that wonderful weekly carnival of wit and wisdom (aka the best of the medical blogosphere), is coming to A Chronic Dose on Tues, July 24th.

Make my first time hosting a sucess and submit, submit, submit! C’mon, you know you want to!

There’s no specific theme for the posts, but the more recent/timely the content, the better.

Please submit your entries by 11 pm on Sunday, July 22, and put “Grand Rounds” in your subject line. Make sure you include your post’s URL and title, the name of your blog, and a brief description of the post.

The “E-mail me here” link is conveniently located on the sidebar to your right, underneath my picture and profile. (It’s also laurieDOTedwardsATgmailDOTcom)

Thanks, and I’m looking forward to reading what you all have to say!

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