Sunday, February 28, 2010

More anti-anti-depressant stuff

Another interesting article, this one in The New York Times Magazine, about doctors who think depression has an upside. I think they're confusing sadness in response to a recent event with chronic inability to be happy or even feel:

http://www.nytimes.com/2010/02/28/magazine/28depression-t.html?ref=magazine

Friday, February 26, 2010

Pity vs. self-pity

The amount of denial I've been able to sustain over the past year is pretty substantial. Or perhaps it would be kinder to myself to call it the amount of optimism and patience. I watch each new symptom arrive, and I see it as just something new to cope with -- more important, something that can be surmounted, treated or simply tolerated as not that horrible, and, because I refuse to see the bigger picture, not tragic in the scheme of things. (I'm also lucky enough that I am on disability insurance and don't have to work at the same time as I cope with all this stuff.)

In some part of my brain, incrementalism makes me see each new problem in isolation, or at least not such a big deal all by itself. My perspective is probably a result of the anti-depressant to a great degree.

But as things mount up, I'm beginning to accept that I'm on a pretty slippery slope; that the disease is devouring my body in fits and starts and though I still haven't been given a time limit, I am not the person I was four months ago. How does it feel to be me? I can't walk; I'm constantly dizzy; I feel as though I have a metal girdle around my middle; I'm deaf in one ear; I can't speak above a whisper; and I can't swallow food without choking. When I put it like that, it does sound dire, unfair, sad, pitiful, all the things that I know other people think and sometimes say when they hear what I'm dealing with. I recognize their pity (though most people are pretty upbeat around me), and it's always a little shocking to me. For me to admit it's that bad means to admit that I'm dying. That's a very hard thing to do.

I find it interesting that while I was even sicker than this, in the hospital, all I wanted to do was die. All my life, I had watched portrayals of people who were suffering so much they craved death, and the poverty of my imagination made it impossible for me to comprehend that impulse. Suddenly, in the hospital, I understood it deeply. Death seemed a welcome respite, and life had little appeal.

Conversely, as I began to feel better, my energy level rose and my legs gained a little more flexibility (and my anti-depressant was increased), I started to want to live again. But oddly, when I do get sad now, I get really sad. When you feel well, you want to live and you feel happiness, and having a terminal illness is a real downer, so in turn you can get quite blue at the thought of soon losing all you hold so dear. On the other hand, since feeling really sick saps your will to live, and there isn't much left to hold dear, it must make dying much easier than I would have expected. But who knows: maybe when I get really close to it, my attitude will change.

And maybe the fact that I feel somewhat better than I did last month means I'm not at death's door. But my quality of life has deteriorated more than I've been willing to admit.

Those who've taken anti-depressants may recognize how much easier they make it to ignore one's troubles. A friend who has taken them agreed, and said, "Yes, you're just building up to a big, devastating emotional crash, and all of a sudden you say, 'Gee, wasn't I going to make pancakes?' and in an instant you've been completely distracted from your difficulties." You just can't sustain your depression. It's like all your problems are behind a door -- you know they're behind that door, and you know exactly what they are, but the door is allowing you to ignore them.

There was an interesting article by Louis Menand in The New Yorker this week that included a lot of evidence that anti-depressants operate mostly by placebo effect, which I find hard to believe, but the opinion that up to a certain point we should allow ourselves to experience the real highs and lows of our lives rather than medicalize them makes a certain amount of sense to me. In theory. In practice, I can't do it.

Meanwhile, today I saw the ear, nose and throat specialist and had a hearing test. I learned that:
  • There is an injection they can do to try to cure the vocal cord problem with an 80% success rate (though it may be temporary). It's done under general anesthetic and involves some kind of compound related to hyaluronic acid. And it's not covered by Ontario health insurance.
  • The hearing loss is not related to the vocal cord paralysis.
  • The hearing loss in my right ear is pretty much total.
So tomorrow I'll have an MRI of my head, neck and spine, and pretty soon I'll know how much farther this cancer has spread. But I've been saying that for a year now! I guess you just never know until it's almost all over. Hence, the adage "take one day at a time."

In the meantime, I have a ferocious appetite. It's really hard to choke the food down, but all I can think of is food, after a period of having little appetite. It's either the return of my usual emotional-eating pattern (especially since I'm not exactly occupied with pressing things all day), or the drugs I'm taking.

Monday, February 22, 2010

Birthday and rant

It's been a busy week. Mom is here for a week or so, and we've been having belated birthday parties for her; the house is filled with cake and flowers. A bunch of my friends kindly feted her and gave her a beautiful pendant, and my brothers and their families came over for lunch yesterday. So, lots of Pollyanna moments.

Meanwhile, I went to my oncologist, and she is puzzled by the fact that I've lost most of the hearing in my right ear, and was having pretty serious double vision, although the latter has improved considerably in the past couple of days. She says that if a cancerous lesion was causing hearing and vision problems, the problems would be persistent, and in fact the vision thing came and went. Anyway, she is trying to get me an MRI, and I will see the ear, nose and throat doctor on Friday. I hope I'll know soon what's going on, but part of me doesn't want to know, of course.

Completely off topic (I'm so sick of writing about cancer): yesterday I was reminded again of how little I understand society's view of what femininity is. Mom and I went to the dollar store yesterday afternoon -- it was such a glorious day, and I literally had not had a breath of fresh air or been out of my house for a week -- and were looking at greeting cards. The birthday cards were segregated into those for men and those for women, as usual. But what made a card suitable for a man? One had a quirky photo of a dog in an old car, and a perfectly neutral message inside; I seriously considered it for a female friend who loves animals and then noticed it was a card for men. Women don't like dogs? Cars? Birthday cards without hearts and flowers on them?

Meanwhile, the sound system in the store was playing a local radio station, which was broadcasting a Max Webster tune, "Diamonds Diamonds," one of their lighter tracks. Then the DJ started on about how guys used to take their girlfriends to Max Webster or Kim Mitchell concerts on the strength of their poppier songs and then the girlfriends would freak out when the hard rock began. Women don't like hard rock? I love all of Max Webster and Kim Mitchell's stuff and have seen them in concert a gazillion times, along with my sister. It's like those ads from Shoppers Drug Mart that warn men not to give women gifts that aren't womanly, like electric drills. I guess we single women are weird; we don't get romantic gifts, but we still have men in our lives, and some of my favourite gifts were from my father, who gave me, at Christmas and birthdays, my electric drill, my bench vise, a set of screwdrivers. He also gave me furry moccasins and a butterfly house and a huge fishing tackle box intended to hold sewing equipment, an ingenious idea as it turned out (he gave my mom one, too, but had a seamstress friend cover it with beautiful fabric and ruffles; I guess that's the romantic part). Anyway, I get so sick of this image of women still promulgated out there. It's so one-dimensional. Rant over.

Monday, February 15, 2010

What's next??

I no sooner arrived at my house from the hospital than I began to notice a reduction in my ability to hear in my right ear; within a couple of days it was drastic enough that if I put the phone to that ear when someone calls, I can't make out what they're saying. I also have vertigo when I wake up in the mornings, and just slightly throughout the day. Which could also be the result of meds, the paralysis in my buttocks (which means I'm never quite able to balance when sitting), the fact that I don't move while I'm sleeping, etc. Or maybe it's connected to the paralyzed vocal cord, or maybe both are related to the cancer after all. Or maybe I have an ear infection? I've also developed a sore in my mouth and slight sore throat in the past few days. Apart from the odd twinge in my head, I have no headaches. Just a feeling that the room is moving.

What next?

Dr. Noguff told me that the radiologist who read my MRI at Princess Margaret Hospital said he saw something that could be a "leptomeningeal deposit" at L4 and L5, but he wasn't certain. As far as I can determine, this animal is something that can spread to or from the brain. So I guess that's the next thing I have to get checked out.

Meanwhile, I am adjusting to being at home and only being able to get around with the walker. My brother got me a walker that has a little basket with a tray in it, including a cup holder, and that's been making a world of difference. Not being able to walk and carry things in my hands at the same time was a nuisance.

I haven't been upstairs in my own house in six weeks, but with help I can manage the basement stairs, which are shorter. I have a personal support worker coming in from government-paid home care for an hour five days a week, which is just enough to give me the help I need to take a shower in the basement bathroom (sitting on a shower chair), tidy up my living-room couch bed and empty the commode pot.

I'm trying to do exercises each day, but my shoulder blade pain is so bad sometimes that I just want to lie down. Still, there are:

Pollyanna moments:
  • Matt flew out from Alberta to stay with me for five days, which gave my mom some respite, and we've had lots of fun watching movies and having laughs. And of course, Matt has been cooking and cleaning his little heart out. My appetite is much improved, even though my ability to swallow still makes it tough and slow to eat much. Still, when you have an appetite, you try harder. For the first couple of weeks in hospital, before I began taking the digestion drugs and before the radiation side effects calmed down, I could barely eat at all. (My body, when I see it naked, looks like one of those awful photos of refugee children in developing countries; so much muscle wastage because my weight loss was so rapid, a distended belly. But my hair has grown in thick and curly, so I'm not completely hideous.)
  • We went out for dinner to one of my favourite restaurants, Gio Rana's, with a friend last Friday evening. My eyes were bigger than my stomach and we ended up taking home a doggie bag we're still eating from.
  • Yesterday we took in a play, Cloud 9 by Caryl Churchill. To my delight, a seat in the wheelchair section was not only cheap, it was accompanied by a free ticket for Matt, which made up for the cost of getting there and back by taxi with the wheelchair. The play was not the greatest I've seen -- a little dated and uneven -- but it was very good, with superior performances by some very accomplished Canadian actors, such as Megan Follows, Ann-Marie Macdonald and Ben Carlson.

Thursday, February 11, 2010

The food I don't have to put up with anymore....


Or at least for now....

Though the banana was a nice touch -- might have been brought from home, though, now that I think of it.

I'm home!

Well, the deed is done, and I've left Princess Margaret Hospital after a month. So far I am happy to be home, even though I need lots of help. On the way home, my brother took me to some home health-care supply shops and we purchased an indoor walker with a little basket and tray in the front, and a seat with arms to make my basement toilet more useable. The walker is great; it allows me to transport little things around the house and the kitchen, in particular (my kitchen is large and there's a huge distance between one countertop and the opposite one with the sink), and gives me some independence I wouldn't otherwise have. It's amazing how limited you are when you can't carry things in your hands and walk at the same time. The basket even has a little cup holder. I can fix myself something to eat, kind of. My laptop fits in the basket, too, which is handy.

I slept very well last night on my couch, and I can't stress enough what a difference that makes. Back pain plagued me through the night in the hospital bed, but here I have no back pain at all at night (daytime is a different story). Maybe it's psychological, maybe the bed.

I've yet to find out how much home-care support I'm going to get, but it should become clear today. An occupational therapist is coming to the house this morning to assess the situation. I'm really hoping for a daily personal support worker, if only to empty my commode, a chore I don't particularly want to leave to my friends and family, and help me get into the basement for showers, and more important, out again.

Today I'm also going to call a handyman and get some grab bars installed in the shower and elsewhere in the house.

Mom leaves today and Matt arrives tonight for five days, so I'm well looked after for now. Mom will return when Matt leaves, but I'm worried that she's overextending herself, what with having to look in on Dad as much as she can in Kitchener and live her own life there. Still, she insists on wanting to look after me as much as she can -- mother to the end.

Pollyanna moments:
  • My appetite has improved quite a bit, and despite the difficulty swallowing, I'm getting a lot more food down than I was a couple of weeks ago. I ate a whole frozen pasta entree last night.
  • I was scheduled to host my book club tonight, and I'm going ahead with it. Looking forward to seeing my friends in my home.
  • The sun is shining! We got just enough snow yesterday to lighten up the world, so the view from my kitchen is splendid.

Monday, February 08, 2010

Blowing this pop stand?

I had an overnight visit at my own house on the weekend -- what a treat after four weeks locked up in this hospital! Just driving down Dundas Street with my neighbours and my mom felt like an exotic excursion. It was great to be home, surrounded by my things. Getting into the house was tricky. I had practised with the physiotherapist to get myself up steps, but unfortunately we didn't practise what to do when you get to the top step and the railing runs out. I had to have somebody lift my legs up for me. Similarly, I managed to get down into my basement where my office and a bathroom are, but going up again got almost impossible when I got to the top step -- again, my brother had to push my feet up for me.

I needed my mom to do things like cooking and dishes, but I think I could manage a little of that with help. I could walk around the house with a walker, or by grabbing furniture and countertops. And I had a very good sleep on my living room couch. Sleeping in the hospital has been an ordeal, because so many of my roommates have been snorers. My current roommate, a young mother of two who is very ill, doesn't snore, but her husband sleeps on a cot beside her bed at night, and he snores. They're lovely people and very kind to me -- extremely religious; their church friends regularly surround my bed and pray for me. I'm sure the praying won't kill me, but I could do without the noise.

So, I returned to the hospital last night determined that I would simply check myself out and wait at home for the bed in the rehab hospital. It's a big gamble, because as much as I hate being in the hospital, it's a pleasant place with excellent care and terrific nurses, and I feel very safe here. I will feel much more precarious at home. Still, when I talked to the social worker about it this morning, she mentioned that I may be not just weeks away but possibly months away from getting a bed at Bridgepoint, the only place that has agreed to take me. Their waiting list is long.

I certainly can't see languishing in this hospital for weeks and months. So I've put in a request with my doctor to check myself out, possibly as early as Wednesday. I believe I'm prepared to live mostly on my main floor. I have to purchase a couple of items like an extra toilet extension and another walker, and I've yet to find out how much personal home care I can get. My hope is that a support worker can get me into the basement every couple of days to take a shower.

Mom is staying with me until Thursday, when she'll return to Kitchener, and then Matt will arrive to look after me. He leaves on the 16th. After that, it's poor Mom again, until I get confident enough to stay alone, or I organize enough friends to take turns spending a few hours with me.

My brother is horrified that I'll fall or get caught in a fire without working legs. I'm thinking seriously of starting a search for an apartment that's all on one floor, possibly even a retirement residence.

Pollyanna moments:
  • On Saturday night, even though it meant manoeuvring me out of and into my house again, I took my brothers and their families, my mother and Diane out to dinner at a local roadhouse my neighbours and I frequent. It was great to feel like I was doing something normal! Even if I was in a wheelchair again. Of course, I couldn't eat much and had to watch them put away my favourite souvlaki dinner while I satisfied myself with a small Greek salad and a few forkfuls of mashed potatoes and gravy. But it was worth it to get out.
  • The weather has been amazing -- no snow for anybody to shovel, or to get in my way when I'm trying to enter my house. This may change on Wednesday, though.
  • I definitely feel stronger every day and I'm moving about more easily, compared to the sack of potatoes I was in the first couple of weeks I was here. My appetite is better, notwithstanding that the paralyzed vocal cord prevents me from eating much (it took me an hour and 20 minutes to get through a small bowl of shredded wheat on Sunday morning). And the domperidone seems to have quelled the reflux and vomiting. The back pain is the biggest problem, aside from not being able to walk. But that's what drugs are for...

Wednesday, February 03, 2010

Hopeful

The new drug to quell my acid reflux and vomiting seems to be working, and well it should with a name like Domperidone -- sounds like fine champagne. So I'm feeling much better, more mobile, more energetic. I'm doing more reading, and slowly venturing around with the walker. And I can concentrate on watching stuff on my computer -- the other night I watched the movie Up, an episode of Two and a Half Men, and Barack Obama's State of the Union address.

I'd be dishonest if I didn't admit that increasing my dosage of the anti-depressant drug Celexa has helped me greatly. I barely recall the first two weeks in the hospital; I really wanted to die, in a passive sort of way. I know people are hot and cold on the use of anti-depressants, but in my case they have changed my life for the better, and I feel fortunate to have them in my arsenal. And I decry the societal stigma against such drugs and mental illness generally.

Recently I wrote about hope and hopelessness. My friend Liz has a wonderful friend Donna who read my blog and sent me some writing by Jerome Groopman, Harvard professor of medicine and author of books such as The Anatomy of Hope. He talked about hopelessness springing from the notion that we don't deserve something better, and I could relate to that. When it comes right down to it, the things I never got in life, I thought I didn't deserve.

It was comforting to realize that I deserve to get better for a while. I may not get better, but if I don't, it won't be because I didn't deserve it. Why did it take me until the age of 52 to get that through my skull?

I interviewed a young woman for the back page of the last issue of Look Good Feel Better magazine, a recently married student who has an incurable cancer. When I asked her about the future, she said she had decided it was OK to look to the future as long as one didn't get attached to it. Those words have helped me.

So today I am hopeful, but I don't look very far down the road. My next goal is to get a day pass and make a trip to my house.

Pollyanna moments:
  • Cream of tomato soup Robin brought from the George Brown College Chef School store.
  • The lovely little bag Lina crocheted for me is perfect to hold my toothbrushing paraphernalia and hang around my neck so I can get into the bathroom in the wheelchair without spilling things all over.