Showing posts with label rheumatoid arthritis. Show all posts
Showing posts with label rheumatoid arthritis. Show all posts

Friday, July 10, 2015

Watching the mane go bye-bye...thanks methotrexate.

I'm grateful for the medications I take for rheumatoid arthritis that allow me to continue to work and be productive -- and in manageable pain most of the time. And I definitely feel the difference when I skip methotrexate and Orencia. After about 4 days I start to slow down, all my joints hurting, the fatigue is incredible. It's like night and day.

Methotrexate is a drug cancer patients are given, but is taken a much reduced dose for those battling RA. It's pretty toxic and many cannot tolerate it, but it does reduce inflammation. I had terrible trouble with the oral version. Since I moved to injectible, I've had fewer tummy side effects, but both versions did a number on me.

For all the positives in controlling pain, the one side effect that is demoralizing and humiliating is watching my hair thin and fall out. My locs, which I've been growing since 2000, have been a source of comfort and pride, having cultivated them from two-strand twists and locked and maintained them on my own (no, I wasn't going to pay anyone to do what I could learn to do myself!) for all these years.

What I couldn't stop was the horror of locs simply dropping out in the shower, and my hair thinning. I cried numerous times. What is happening to me?

I always liked wearing hats, it was kind of part of my look, but now wearing hats became a necessity. The only time I didn't wear one is if I had my hair up in a pony tail and had a headband on, which helped hide the thinning...a bit.

On the left - you can see how thin it is today; on the right with a hat and single pony.
And in the middle, the lush locs of the past (2011).
But here we are in 2015, and it's just grinding me that the medicine that keeps me able is taking its toll...on my vanity. I'm actually not that self-conscious otherwise, for whatever reason. For instance, I've been on a health regimen that has resulted in a weight loss of over 50 lbs so far (30 more to go!), but I was not shy about being a plus size fashionista at times, lol. The weight loss is obviously something I feel good about, since I feel better and look better overall. But for all that, losing my hair I don't have much control over and it vexes me.

I guess self-acceptance at any size, and with any beauty deficits is something to ponder. Is my hair that important in the scheme of things? Could I shave it all off again? I had a short natural back in the 90s (see the slideshow for a pic from that era), but I would feel naked without my locs. Would I start them over again? Who knows.

I just know it hurts to lose them, and a part of me mourns every day I try to style them knowing what "used to be."

But my health means more.



Slideshow of the various lengths and thicknesses of my hair during its loc phase...



Related:

* My hair journey (all those styles!)

Wednesday, May 7, 2014

My own ableism and thoughts about assistive technologies and productivity

The reality of the need to rely on voice recognition software is setting in. My hands and wrists are going south fast from rheumatoid arthritis. I had a flare-up last week that caused me so much pain that by the end of the day I was literally crying at my desk. It was difficult to drive home because gripping the steering wheel was nearly impossible. I had to sleep in wrist and thumb wraps...when I could sleep at all.

Since I have a job that relies on using a computer and the vast majority of my essential job functions rely on keyboarding (and mousing) and computer multi-tasking, it's a necessity that is forcing me to evaluate just how reliant I am on my physical capabilities to accomplish essential job functions.

It's a good thing in many ways to be humbled by the challenges of losing the abilities that you take for granted in many ways, to embark on more than an intellectual exercise in this area to understand the world from a yet another point of view. So as I think these things out in this digital space, dear readers, I apologize in advance for inadvertent stepping on toes as I confront my own ableist biases "aloud."

Tip-toeing into Voice Recognition Software

Fortunately Chrome and the Android OS allow for easy implementation of it w/o the OS-resource sucking Dragon Naturally Speaking. Configuring my tablet/PC/phone took just a few setting changes. Aside from some web apps, most basic functions are accommodated.

Saying that it saves you from any keyboarding is ludicrous, unless numerous typos and lack of advanced formatting are acceptable in a business context. Correcting is tiresome and tedious.

That speed trade off is huge. It is no surprise that it unfortunately doesn't match up to being able to physically touch type 80 wpm on the fly. Dragon has better accuracy than built-in voice rec, but it has a steep teaching/learning curve. I'm just trying out the built-in functionality and I'm beginning to see the huge productivity hit that will result in real-world circumstances (for me).

Expectations

The more I fiddle with basic voice rec, the more I wonder how those who have limited ability to manually type (or lose it altogether) can use a computer without compromising a lot of former speed and accuracy.

[Of course, if you never had that physical capability to begin with, there isn't that that personal frame of reference to contend with, but there is the comparison to performance expectations in the abled world.]

Efforts that I depended on manual dexterity and speed for - such as moving between apps and windows, copying and pasting, text formatting, etc. are so far a no-go w/o Dragon. Of course my brain is quite biased by personal history. It has been well-trained over the years to execute such tasks effortlessly from thought to my hands to the keyboard to the computer. Now that this "communication chain" is broken, learning to do the same tasks using different tools is daunting.

It would good to see if there are studies/tests to evaluate one's voice rec performance to multi-task, multi-app keyboarding and navigation, not just the metric of straight dictation.

For instance, doing Facebook or Twitter updates using native voice recognition software (OS and Chrome; not Dragon) on my tablet or desktop is impossible to do without some keystroking or manual intervention. Most of my devices do best with straight dictation only. My Samsung phone is best at the latter.

I guess that my main focus now is figuring out how to think about voice recognition software and its place as an assistive technology. Is its primary purpose to simply make certain functions possible? Beyond the possible, what is the expectation regarding performance itself - is the assistive technology's purpose to help that person achieve the same performance levels that exist in the able-biased world as well?

The latter seems like a lofty goal, but being able to accomplish a function is not the same as accomplishing that same function at the same rate of speed as you did before. A logical question then is how expectation of rate of speed of performance falls into the category of essential functions of a job.

The ADA

There are plenty of practical considerations of course; take a read through the voluminous Americans with Disabilities Act (ADA ) site and the Job Accommodation Network (the Dept of Labor site). They are not really bedtime reading, but interesting resources to peruse if you have the time. You realize what a herculean accomplishment it was to pass such a landmark law (1990) given the amount of ableism that existed then and continues to exist today. For instance:
"Under the ADA, when an individual with a disability is qualified to perform the essential functions of a job except for functions that cannot be performed because of related limitations and existing job barriers, an employer must try to find a reasonable accommodation that would enable this person to perform these functions. The reasonable accommodation should reduce or eliminate unnecessary barriers between the individual's abilities and the requirements for performing the essential job functions."
There's a lot packed in the above that has been life-changing for those working with disabilities. The ADA has ensured that they can bring their considerable personal and professional skills to bear to contribute to the economy by giving them access to opportunity.

The wrinkle of course is unless the reasonable ADA accommodation causes an "undue hardship." What constitutes "undue hardship" for an employer in this matter? It has to be:
"Excessively costly, extensive, substantial, or disruptive, or that would fundamentally alter the nature or operation of the business."
Yeah, it's complicated and there's a lot of ink dedicated to unpacking that statement. Just do the bedtime reading, if you are so inclined...

Some history -- the ADA would not have passed without the advocacy of Senator Bob Dole (R-Kansas), whose presence on the Hill among colleagues made a crucial difference.
Senator Dole was a fitting advocate for people with disabilities. In an interview with ABILITY Magazine, Senator Dole described the effect of his war injury: 
"Experiencing a disability yourself, you could almost walk around with a blindfold and pick out the other people with disabilities…. Having a disability changes your whole life, not just your attitude." 
...On July 16, 1990, more than 3,000 people attended the signing ceremony on the White House lawn. As he signed the bill, President George H. W. Bush said: 
"Every man, woman and child with a disability can now pass through once-closed doors into a bright new era of equality, independence and freedom… We will not tolerate discrimination in America." (Read President Bush’s Full Remarks at ADA Signing) 
Bob Dole added: "This historic civil rights legislation seeks to end the unjustified segregation and exclusion of persons with disabilities from the mainstream of American life… the ADA is fair and balanced legislation that carefully blends the rights of people with disabilities… with the legitimate needs of the American business community."
***

BTW, this post took forever using voice rec. In the end I typed about half of it, and corrected a boatload of the input. And the formatting had to be done via keyboard. With that said, it could be done over time and at my own pace. That's certainly not the same as the pressure of composing something on a deadline for work.

Related:
* Life changes -- RA drives me onto the professional off-ramp

Friday, April 25, 2014

What a difference a new pair of glasses makes!

I CAN SEE! I picked up my new glasses today. No big style change for me, as you see. These glasses are plain, black geek frames, a little larger than my last pair, to give my eyes a bit more coverage for sun protection with Transitions lenses. My current insurance allows me one new pair a year, I think.

My horrid nearsightedness improved, as did my reading script. But it's still bad; I needed hi-index 1.67. This is the script for the progressives:

OD Sph: -7.75 Cyl:-0.50 Axis: 180
OS Sph: -7.50 Cyl: -.75 Axis: 165
OD ADD 2.25
OS ADD 2.25

I used to be > -8.00 in both eyes prior to requiring bifocals when I turned 42 (I'm 50 now). I also need a separate single-vision lens for computer work (I just had them replace the lenses in my old glasses to save $). I'm still blind as a bat by most folks' standard:

OD Sph: -6.50 Cyl:-0.50 Axis: 180
OS Sph: -6.25 Cyl: -.75 Axis: 165

***

Blind as a bat without them.
Q: Has anyone ever ordered a pair of prescription glasses online? I didn't know how satisfied people were, particularly if they have a difficult script. I was thinking of getting a pair that is tinted for indoor use, since I have light sensitivity from developing cataracts.

***

On a related front, I can report that my prescription insurance, ExpressScripts, actually covered Restasis (drops for extreme eye dryness caused by RA/Sjogrens and other similar conditions). It's insane how much these meds cost. I paid $100 for 3 months' supply, the insurance covered > $700! Why does this med cost so much? Never mind. I'm sure it's cheaper across either border.

Tuesday, April 22, 2014

Managing a RA flare sick day

Sick day today; my first full-blown RA flare up in months since I switched to Orencia as my biologic vs. Enbrel. I haven't taken an actual sick day like this from work in months, as in: no work email, texts, calls, IMs. I was only online in the AM to "call in" via email and to rearrange all the meetings I had to miss. And even that was a horrible effort since light is really hurting my eyes this time. Flat out on my azz sick. Not working through it to prove that I'm impervious to chronic, life-altering pain. No way to fake it through a flare.

I then slept almost all day. It's annoying to be so wiped and in pain that you have to sit there in a stupor thinking about a plan to get up to make it across the room, but that's the reality of a big time RA flare. It just has to pass.

It was about 80F today, but I was cold when I briefly stepped outside, so my body therm is screwy. Doc gave me a script for prednisone a while back, but I won't take it unless this goes on for days since steroids F up my BGs.

The light sensitivity has abated somewhat this evening (why I can type this), but my muscles and joints are so tight that I'm already showered and coated in my rotating cast of liniments (tonight starring Biofreeze + Sombra + Capsaicin!).

Getting under the fleece and going to fall asleep to mothership L&O (1992 season is on We).

Monday, April 14, 2014

Life changes -- RA drives me onto the professional off-ramp

Last week I officially acknowledged what I can no longer do -- my current job. It was announced in my org that I was stepping down from my position as an IT manager. I'll vacate as soon as they hire a successor.

I did this job for ~15 years. But I am no longer the person I once was because of pretty aggressive rheumatoid arthritis (RA), and I've been telling my boss for a couple of years now that a person is needed in this position that can handle the long hours that come with the job. So the succession plan is being rolled out ASAP.

Actually, my rheumatologist and endocrinologist have said for the last 4 years to "get out of that job," because the stress that comes with the ever-demanding and changing world of IT is wholly incompatible with an autoimmune condition that is profoundly affected by stress, the weather, and random foolishness I never can quite figure out. I'm deteriorating faster than I could have imagined. I guess the docs were right. I was in denial.

But those who know me know that I thrived for a long time on stress and long hours (or so I thought I did).

It's part of my own acceptance process to admit that I am not the person that I once was, chugging away on ungodly over-work up to about 3 years ago (doing this job plus running a full-time, nationally recognized blog, traveling during my vacation time to go to press conferences, the White House, covering all sorts of things as a citizen journalist in digital media). It was tiring, wonderful fun.

Fast forward to now -- rheumatoid arthritis has so destroyed me from the inside out that I:

1) can no longer down a 40 hour job;
2) had to shut down my blog;
3) can no longer travel alone because I can't lift my bags and I suffer from extreme fatigue and threats of flare ups from the barometric pressure changes because of flying;
4) live by the clock for meds, sleep breaks and the like; and
5) give up my weekends, taking my RA biologic med, and methotrexate that make me sick as a dog, and doles out unreal fatigue, all sacrificed so I can work the next week.

My spine is also now affected and one of my disks not only re-herniated (L5-S1), but it is collapsing on the other side, affecting feeling in my left leg and foot.

All in just three years. 

My life now revolves around preserving myself for work -- and nothing else of me is left for life. I am one of only a couple of patients of my rheumatologist that is still able to work. It's estimated that as many as one-third of people with RA are forced to stop working within 10 years of being diagnosed. You can read about others' experiences with RA and the workplace here.

Unlike some RA patients on the professional off-ramp, the organization is crafting an accommodation that may allow me to slide over to a different, hopefully more manageable 30 hr/week job. What's definite is that I will no longer be a senior manager. Does this bother me? Actually, I'm in such a constant state of pain and exhaustion that losing that status isn't something I'm mourning. It remains to seen how much of a demotion this new position represents.

In terms of reactions to the change, it's pretty clear that thinking about disability and my need to step down scares many people into silence (after all, it's natural to think "glad it's not me/that could be me" -- it's a very human reaction). Are you supposed to congratulate the person, have a sense of sorrow that they are stepping down for obvious health reasons? There is no good way to react. It was kind of like the interesting reactions I encountered during the couple of days I lost my voice due to a med change ("People -- I can't speak, but that doesn't mean I can't hear or think..."):
"[T]his temporary situation shows just how ill-prepared the average person is to deal with a disability of this nature. Our ability to speak allows us to convey a lot of information in very few words. Body language (thumbs up, down, OK gesture), is pretty limited when you need to communicate detailed thoughts or nuances.
Those who can communicate vocally assert their privilege/ability to try to force the mute to communicate on their level even when logically they know the other person cannot speak. You can see the frustration on their faces; they'd rather avoid me rather than try to compensate for the communication delay. Well, of course -- a pad and pen is a poor substitute.  I've also had to whisper from time to time because of my frustration in moving conversations along so I can get back to work. They don't want me to break my vocal rest, mind you, they just don't know what to do, so they avoid."
What I cannot avoid

Emotionally, I'm not really able to celebrate anything, since some things are still up in the air. But honestly, I'm still having those feelings of "Dead woman walking" or that I represent "the old dog taken out back and shot in the head." Pick your poison of negativity. It's all normal feelings I've had over the last week, and I just have to work through it. I do take solace in that I know that I'm not alone; this is a story that has played out (with even worse circumstances and resolutions) for most patients with severe RA. It's the netherworld prior to full disability -- too sick to work full time, not sick enough to qualify for disability. It's a high bar to clear. Besides, in my case I, want to work. And just be able to exit with dignity when the time comes. That option usually doesn't happen for most. Many simply have to resign.

It's horrible to know that I have a professional expiration date that isn't long in the future. Even something as simple as writing longhand is excruciating. I have to wrap my hands (and now my thumbs too) each AM, to tolerate typing all day. If I lose that ability, I don't know how I'll adjust. I detested using Dragon Naturally Speaking when I tested it. I think so much faster through my hands; when the day comes and I cannot type, it will be a real crossroads.

Part of me wants to flee and leave it all for someone else to deal with rather than exist being less than whole and involuntarily on a professional off-ramp at 50.

But I live in the real world. I just have to stay healthy enough to make it through the fire of a long list of to-dos to pass the torch to the next IT manager.

And figure out how I'll be able to make it to the next Journey concert when they hit Raleigh (on a weeknight, no less. I'm usually in bed by 7PM these days). I'll really pay dearly in terms of fatigue, but I need something to feel positive about right about now. I'm still holding out on buying tix because of the health circumstances, so I guess I won't get good-for-photos seats now. Sigh. Ah, just think Anything is Possible.


Tuesday, March 18, 2014

Losing the RA battle and it's only Tuesday!

Made it through the usual fire of biologic med side effects that kill my weekends (Fri PM to Sun afternoon) so I can continue to work, but between the impact of a terrible weather front and an insane workload, I came home in searing joint pain everywhere today.

Bed time? 6:15 PM. That's a new record for me.

Anyway, the reason I'm up now is to take some more Aleve to tide me over till I have to get back up at 3:30 AM for the next cocktail of meds so that I'm functional at work tomorrow. Otherwise I'd rather be unconscious to recharge my limited body battery supply before I have to get back on the hamster wheel again.

Even the popular biologic RA drugs (like Enbrel, Humira, or Orencia) can't perform those miracles that Big Pharma portrays in those commercials you see on TV. They seem to air with greater frequency these days. These ads really downplay the serious side effects - the narrators speed through a partial laundry list while showing the sunny, compelling visuals of people opening jars, digging in gardens, tossing a ball with kids, etc.

I guess visuals showing patients writhing with chills, experiencing crippling fatigue, and communing with the potty for 2 days a week after dosing their meds probably wouldn't go over well with focus groups...

The drugs don't stop progressive joint damage for everyone either, or stop the chronic pain entirely. They temporarily relieve some inflammation and, to their credit, for me have reduced sick days to nearly zero, a huge relief. Hell, I worked (though I probably should have been out, but duty called) even while suffering from shingles agony for a couple of weeks. Before biologics, I was probably down and out on average a day a week; that was at first diagnosis in 2011.

BUT, my effective high-functioning ("gee, you don’t look sick") hours per day are continuing to shrink, in the slow, steady decline folks with RA (and similiar autoimmune disorders) are all too familiar with. I look in the mirror and can now easily see the toll of the battle of trying to hold on to "normal" as it fritters away.