Friday, May 27, 2022

Why Spoons?

 


Not too terribly long after I was diagnosed, I came across an essay written by a lady who suffers from lupus.  In the essay she shows in a tangible way what it is like to live with an invisible illness.  I am going to post the essay here with a link back to the original website for credit to the original writer. 


The Spoon Theory

by Christine Miserandino www.butyoudontlooksick.com

My best friend and I were in the diner, talking. As usual, it was very late and we were eating French fries with gravy. Like normal girls our age, we spent a lot of time in the diner while in college, and most of the time we spent talking about boys, music or trivial things, that seemed very important at the time. We never got serious about anything in particular and spent most of our time laughing.

Cartoon image of Christine Miserandino holding a spoon
As I went to take some of my medicine with a snack as I usually did, she watched me with an awkward kind of stare, instead of continuing the conversation. She then asked me out of the blue what it felt like to have Lupus and be sick. I was shocked not only because she asked the random question, but also because I assumed she knew all there was to know about Lupus. She came to doctors with me, she saw me walk with a cane, and throw up in the bathroom. She had seen me cry in pain, what else was there to know?

I started to ramble on about pills, and aches and pains, but she kept pursuing, and didn’t seem satisfied with my answers. I was a little surprised as being my roommate in college and friend for years; I thought she already knew the medical definition of Lupus. Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick.

As I tried to gain my composure, I glanced around the table for help or guidance, or at least stall for time to think. I was trying to find the right words. How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being effected, and give the emotions a sick person goes through with clarity. I could have given up, cracked a joke like I usually do, and changed the subject, but I remember thinking if I don’t try to explain this, how could I ever expect her to understand. If I can’t explain this to my best friend, how could I explain my world to anyone else? I had to at least try.

At that moment, the spoon theory was born. I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said “Here you go, you have Lupus”. She looked at me slightly confused, as anyone would when they are being handed a bouquet of spoons. The cold metal spoons clanked in my hands, as I grouped them together and shoved them into her hands.

I explained that the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to. The healthy have the luxury of a life without choices, a gift most people take for granted.

Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions. So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case Lupus, being in control.

She grabbed the spoons with excitement. She didn’t understand what I was doing, but she is always up for a good time, so I guess she thought I was cracking a joke of some kind like I usually do when talking about touchy topics. Little did she know how serious I would become?

I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of “spoons”. But when you have to now plan your day, you need to know exactly how many “spoons” you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons. She laughed and said she wanted more. I said no, and I knew right away that this little game would work, when she looked disappointed, and we hadn’t even started yet. I’ve wanted more “spoons” for years and haven’t found a way yet to get more, why should she? I also told her to always be conscious of how many she had, and not to drop them because she can never forget she has Lupus.

I asked her to list off the tasks of her day, including the most simple. As, she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon. When she jumped right into getting ready for work as her first task of the morning, I cut her off and took away a spoon. I practically jumped down her throat. I said ” No! You don’t just get up. You have to crack open your eyes, and then realize you are late. You didn’t sleep well the night before. You have to crawl out of bed, and then you have to make your self something to eat before you can do anything else, because if you don’t, you can’t take your medicine, and if you don’t take your medicine you might as well give up all your spoons for today and tomorrow too.” I quickly took away a spoon and she realized she hasn’t even gotten dressed yet. Showering cost her spoon, just for washing her hair and shaving her legs. Reaching high and low that early in the morning could actually cost more than one spoon, but I figured I would give her a break; I didn’t want to scare her right away. Getting dressed was worth another spoon. I stopped her and broke down every task to show her how every little detail needs to be thought about. You cannot simply just throw clothes on when you are sick. I explained that I have to see what clothes I can physically put on, if my hands hurt that day buttons are out of the question. If I have bruises that day, I need to wear long sleeves, and if I have a fever I need a sweater to stay warm and so on. If my hair is falling out I need to spend more time to look presentable, and then you need to factor in another 5 minutes for feeling badly that it took you 2 hours to do all this.

I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your “spoons” are gone, they are gone. Sometimes you can borrow against tomorrow’s “spoons”, but just think how hard tomorrow will be with less “spoons”. I also needed to explain that a person who is sick always lives with the looming thought that tomorrow may be the day that a cold comes, or an infection, or any number of things that could be very dangerous. So you do not want to run low on “spoons”, because you never know when you truly will need them. I didn’t want to depress her, but I needed to be realistic, and unfortunately being prepared for the worst is part of a real day for me.

We went through the rest of the day, and she slowly learned that skipping lunch would cost her a spoon, as well as standing on a train, or even typing at her computer too long. She was forced to make choices and think about things differently. Hypothetically, she had to choose not to run errands, so that she could eat dinner that night.

When we got to the end of her pretend day, she said she was hungry. I summarized that she had to eat dinner but she only had one spoon left. If she cooked, she wouldn’t have enough energy to clean the pots. If she went out for dinner, she might be too tired to drive home safely. Then I also explained, that I didn’t even bother to add into this game, that she was so nauseous, that cooking was probably out of the question anyway. So she decided to make soup, it was easy. I then said it is only 7pm, you have the rest of the night but maybe end up with one spoon, so you can do something fun, or clean your apartment, or do chores, but you can’t do it all.

I rarely see her emotional, so when I saw her upset I knew maybe I was getting through to her. I didn’t want my friend to be upset, but at the same time I was happy to think finally maybe someone understood me a little bit. She had tears in her eyes and asked quietly “Christine, How do you do it? Do you really do this everyday?” I explained that some days were worse then others; some days I have more spoons then most. But I can never make it go away and I can’t forget about it, I always have to think about it. I handed her a spoon I had been holding in reserve. I said simply, “I have learned to live life with an extra spoon in my pocket, in reserve. You need to always be prepared.”

Its hard, the hardest thing I ever had to learn is to slow down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay home, or to not get things done that I want to. I wanted her to feel that frustration. I wanted her to understand, that everything everyone else does comes so easy, but for me it is one hundred little jobs in one. I need to think about the weather, my temperature that day, and the whole day’s plans before I can attack any one given thing. When other people can simply do things, I have to attack it and make a plan like I am strategizing a war. It is in that lifestyle, the difference between being sick and healthy. It is the beautiful ability to not think and just do. I miss that freedom. I miss never having to count “spoons”.

After we were emotional and talked about this for a little while longer, I sensed she was sad. Maybe she finally understood. Maybe she realized that she never could truly and honestly say she understands. But at least now she might not complain so much when I can’t go out for dinner some nights, or when I never seem to make it to her house and she always has to drive to mine. I gave her a hug when we walked out of the diner. I had the one spoon in my hand and I said “Don’t worry. I see this as a blessing. I have been forced to think about everything I do. Do you know how many spoons people waste everyday? I don’t have room for wasted time, or wasted “spoons” and I chose to spend this time with you.”

Ever since this night, I have used the spoon theory to explain my life to many people. In fact, my family and friends refer to spoons all the time. It has been a code word for what I can and cannot do. Once people understand the spoon theory they seem to understand me better, but I also think they live their life a little differently too. I think it isn’t just good for understanding Lupus, but anyone dealing with any disability or illness. Hopefully, they don’t take so much for granted or their life in general. I give a piece of myself, in every sense of the word when I do anything. It has become an inside joke. I have become famous for saying to people jokingly that they should feel special when I spend time with them, because they have one of my “spoons”.

© Christine Miserandino

This essay has explained so well what my life is like.  I might have days where my spoons keep up with my tasks, but if I overdo it, I pay with fewer spoons on the next day.  As Randy Pausch put it so eloquently, "We cannot change the cards we are dealt, just how we play the hand." 

There is a story about a father and daughter saying good bye at an airport, and the father tells his daughter, "I  love you.  I wish you enough. 

I wish you enough sun to keep your attitude bright. I wish you enough rain to appreciate the sun more.  I wish you enough happiness to keep your spirit alive.  I wish you enough pain so that the smallest joys in life appear much bigger.  I wish you enough gain to satisfy your wanting.  I wish you enough loss to appreciate all that you possess. . . ."  [ Original story by Bob Perks, in Chicken Soup For the Grieving Soul ]

I have experienced enough and I know that God's grace is enough to fill all the gaps.  So today, my friends, I wish you enough. Primarily, I wish you enough spoons to get you through the day.  

Tuesday, May 24, 2022

More Adventures of a Zebra


 One of the hardest things people will ever have to do is tell their parents or other loved ones they have cancer.  There is a bit of panic involved, but as time goes by, acceptance finally makes its appearance and a certain peace reigns.  

I chose this graphic because it speaks to the life we all have to live.  We can't live in a microcosm of self without the support of those around us.  We have to have our loved ones and friends hold us up in prayer as well as in tangible ways.  

In late 2009, I was told my mother had a tumor on her brain and the final diagnosis was a very serious brain cancer that would eventually take her life. I spent more than half of her remaining weeks taking care of her and then cleaning out her house.  Soon after I was back home, I heard someone talk about taking care of his/her parents in that parents' waning days.  The attitude the speaker had was, "I was privileged to take care of my parents.  I didn't have to, I GOT to."  That was exactly my feelings on taking care of Mama.  

In 2011, after one of my scans, my oncologist didn't like the looks of one tumor.  She had gone to a seminar put on by Dr. Rodney Pommier, of Oregon Health Sciences University in Portland, and spoke to him afterwards.  He was interested in my case.  So I saw him that spring and he said we could remove the tumor.  I had some things I wanted to do that summer and his schedule wasn't open until September, so it worked out perfectly.  After a six hour surgery, I had been relieved of a six pound, volleyball sized tumor.  

The first post-op scan showed my remaining tumors had grown and Dr. Pommier referred me to an interventional radiologist, Dr. Kolbeck, who might have some solutions.  So, I entered the world of Yttrium-90 treatments (Y-90 is a radioactive agent bound to plastic beads the size of grains of salt).  One of the fellows working with Dr. Kolbeck told me that I had interesting architecture as he was doing the mapping from my femoral artery to my liver.  I'm nothing if not challenging.  Over the next few years, I had four Y-90 treatments, but then my disease stabilized.  Now I'm still stable, but because of the Y-90, I have damage to my liver causing me some other health concerns.  Still, according to my blood work, my liver is still functioning.  

For fear of making this post a novel, I'll close this one for today. but just know that I cherish each and every one of you who reads my posts. 

Friday, May 13, 2022

Random Facts, Random Thoughts on a Random Life


There is a penguin in this picture for a reason--when I was pregnant with my son, a new (at the time) friend told me that if I had a girl, I should name her Pen so she could be Pen Guinn (you are allowed to groan now, if you choose).  When I did have a girl, I didn't name her Pen, because I wanted her to like me when she grew up.  

  • I read--a LOT.  When I was getting ready to start school, I had heard a lot about learning to read and I couldn't wait.  For the first two weeks of school in first grade, I only went half days.  Mama came to pick me up after school the first day and I came to the car in tears.  When she asked me what was wrong, I told her they didn't teach me how to read.  I was devastated. 
  • My tasted in music is quite eclectic.  Mozart is one of my best-loved classical composers (Eine Kleine Nachtmusik is a particular favorite).  Fur Elise is the Beethoven composition I like best.  Peter and the Wolf by Prokofiev will always touch my heart, because I grew up listening to it ALL THE TIME.  But I will listen to the "oldies" of the 1960 to70s, too. 
  • I love listening to singers who can reach the low registers--Bass voices.  Tim Foust from the a capella group Home Free is one I love listening to.
  • The reason I love bass voices is that I imagine that's what the voice of God sounds like.  My favorite Psalm is Psalm 29--The voice of the Lord is over the waters; the God of glory thunders, the Lord, over many waters. The voice of the Lord is powerful; the voice of the Lord is full of majesty.  The voice of the Lord breaks the cedars; the Lord breaks the cedars of Lebanon. He makes Lebanon to skip like a calf, and Sirion like a young wild ox.  The voice of the Lord flashes forth flames of fire. The voice of the Lord shakes the wilderness; the Lord shakes the wilderness of Kadesh. The voice of the Lord makes the deer give birth and strips the forests bare, and in His temple all cry, "Glory!" (verses 3-9 ESV)
  • I love thunderstorms, the deep rumble of the thunder, the cleansing of the rain, and I love bundling up in a blanket with a good book while it is storming outside. 
  • My all-time Christian artists are Buddy Greene, Fernando Ortega, and Michael Card.  I've gotten to see Buddy and Fernando in person and I have even engaged in conversation with Buddy.  I find him to be quite personable.  What these three men do in their music is they sing truth. 
  • I believe Calendar Girls is a movie EVERY cancer patient should see.  The husband of one of the girls is diagnosed with cancer and he "named this evil thing within him Saddam Hussein." It is a freeing thing to think about cancer as a terrorist (in the truest sense of the word).  Because I have multiple tumors, I named mine Al Qaeda--it's a group of terrorists, not just a single extremist.  
  • One quote I love from the movie, Calendar Girls, is meaningful.  "I don't think there's anything on this planet that more trumpets life that the sunflower. For me that's because of the reason behind its name. Not because it looks like the sun but because it follows the sun. During the course of the day, the head tracks the journey of the sun across the sky. A satellite dish for sunshine. Wherever light is, no matter how weak, these flowers will find it. And that's such an admirable thing. And such a lesson in life."
  • Why Zebras?  Every cancer has its ribbon color or its symbol for inspiration. Zebras are the symbol for Carcinoid cancers because they are rare, hard to detect, and not the norm.  In medical school, doctors are told, "When you hear hoofbeats, assume horses." Zebras are the hoofbeats of the rare cancers.  
  • I love questions that make me think, questions that have no right or wrong answers except for the answers that are right for the answerer.  One of those questions I have come across  and held onto for a number of years is this:  If you could choose someone from the Bible to be your prayer partner (other than Jesus Christ, who always lives to intercede for us), whom would you choose and why?  Being the little renegade I am, I chose two--Aaron and Hur from Exodus 17. The Israelites are fighting the Amalekites and Moses is standing at the top of the hill praying with his arms upraised.  As long as his arms are up, the Israelites prevail.  If he lowers his arms, the Amalekites prevail. Aaron and Hur bring a stone for Moses to sit on and each one stands on either side of him to keep his arms upraised until the final victory is won.  That's what I need, Aaron and Hur to stand beside me until the final victory is won. 
  • I have personally known four other people with this disease, one of whom was cured by simply removing the one tumor she had.  
  • One of my cousins says I have a "wicked sense of humor." 
There is my randomness for today.  I thank God for each and every one of my friends who stand by me, and y'all are those!

 

Thursday, May 5, 2022

Time for a Vocabulary Lesson


Whenever a dramatic diagnosis comes your way, you develop a whole new vocabulary that is specific to your situation.  These words are beyond the scope of ordinary, every day life.  So let's jump into the educational portion of this journey.  

Oncologist--a doctor dealing specifically with cancer.  Mine also is a hematologist--a doctor who deals with blood disorders as well. 


Neuroendocrine tumors--tumors that arise from specific cells in the body that are termed "neuroendocrine" cells. These cells are concentrated in the pituitary, in the pancreas, in certain other places of the gastrointestinal system. They're not tumors of nerves or the central nervous system.

Chromogranin-A--blood test to determine the activity of the tumors

5-HIAA--24 hour urine collection to determine serotonin production.  It stands for five hydroxyindoleacetic acid.  One of the dangers of these tumors is excess serotonin--a necessary hormone that is your "feel good" hormone.  A surfeit of serotonin over a long period of time can erode the tri-cuspid valve in the heart.  Not a good thing to have happen.  

Octreo-Scan--is a nuclear medicine test very similar to a bone scan where someone is injected with a very small amount of radioactivity and the tag here localizes to the tumor.  This test takes two days.  The injection of the radioactive agent, followed by a scan five hours later.  Then a second scan is taken twenty-four hours later.  The scans require the body to be totally immobilized for the duration, taking up to two hours for the scans.  Yes, I had one of these done. 

Sandostatin or Octreotide--this is the drug used to treat my tumors.  It helps prevent serotonin production from the tumors.  There is a similar drug called Lanreotide that works in much the same way.  Just for a point of reference, the Sandostatin is given with a 19 gauge needle about two inches long.  Injections for cattle are given with an 18 gauge needle, the smaller the number, the larger bore the needle is.  A blood draw is done with a 22 gauge needle. 

Y-90 or Yttrium-90--a treatment used to inject radiation directly into the tumors through the femoral artery.  The side effect of this is that the Y-90 can cause radiation burns to the liver that will create problems later on, personal experience. This is also called Radio-Embolization.  There is a similar treatment called Chemo-Embolization that injects chemo drugs (doxorubicin) directly into the tumors.  Both of these treatments have dual purposes--to kill tumor cells while creating blockage to the blood supply to the tumors. 

IMRT--Intensity Modulated Radiation Therapy--this is a targeted radiation therapy that doesn't harm other nearby organs.  I had this done to treat one tumor that was the size of a tennis ball located outside my liver.  This was done primarily as a palliative measure because of the discomfort this particular tumor was causing.  It shrank to the size of a golf ball before the treatment was finished, and continued shrinking to the size of a marble.  

SRT--Stereotactic Radiation Therapy (SRT) is a type of external radiation therapy which uses special equipment to precisely position the patient in order to deliver radiation to a well-defined cancerous tumor. With SRT, the total dose of radiation is divided into several smaller doses given over several days.  Instead of five days a week for six weeks, this treatment is given over five days and is done.  This is the treatment I would have had, except for the fact that my insurance company was dumb.  Even though this was less expensive and shorter duration, they decided, in their infinite wisdom, that I needed the longer, more expensive kind of therapy.

Ascites--free floating fluid in the abdomen caused by damage to the liver. 

Paracentesis--mechanically draining the ascites for comfort. It is a tiring procedure that really isn't all that taxing, but it does lay me low for a day. Generally they drain 4 liters of ascites every three to four weeks. That's nearly nine pounds for the non-metric users.

As the days go by, I am gaining new vocabulary with each new development in my situation.  These are just some of the things I've been through.  




 

A Serious Comedy of Errors

  So, a couple of weeks ago, we heard that Kevin's brother fell and broke his hip.  Tuesday, this past week Kevin fell and ruptured his ...