When diagnoses are a bit like buses

My journey to diagnosis was a long and frustrating slog, to say the least. Partly because it’s a very difficult thing to diagnose and partly because no one would bloody listen.  I often felt tempted to just give up trying to find out what was wrong. On a regular basis, I lost all faith in the medical profession.  Lupus Bus

Bus stop sign Looking back I now know that my Lupus kicked in years ago. The first sign was the terrible pains in my legs and hips;  some days they got so bad I could hardly stand up.  I went to our local doctor in Australia (where we were living at the time) but he didn’t have a clue.  He sent me off for x-rays but nothing showed up.  He didn’t really bother to investigate beyond that, even though the pain continued.

Eventually, I found myself a chiropractor, who told me I had one leg shorter than the other. Diagnosis completed, as far as she was concerned.  I was then sent to a podiatrist who made me a heel lift to wear in all my shoes.

What a proud Forest Gump moment that turned out to be.

Of course, no one wears shoes in Australia, they wear thongs (that’s flip-flops to you and me), so it doesn’t take a genius to work out you can’t wear a heel lift on a Croc. So painful hips, one leg longer than the other and then limited to trainers in the 40-degree heat.  Oh, how I laughed.

Of course, the heel lift did nothing to help the underlying issue that was Lupus.  Funny that seeing as being a bit stumpy in the limb department has absolutely no bearing on one’s immune system.

Adding to the drama further I then suffered a very miserable 3-month bout of vertigo. The full on type where the world spins around you, not the fear heights.  Heel lifts no longer become such a concern as I could barely stand up without falling down.

This was later followed by a night where breathing became tricky and I lost feeling in both my legs.  An ambulance was called and I was whisked off to the local A&E.  The doctors were once again clueless. They tried to put it down to me overexerting myself at the time. The fact that at the time it happened I was calming sitting down, eating a yogurt and watching Greys Anatomy.  So nothing ever came of that episode either, except of course an $800 bill in the post for the pleasure of my ambulance ride.  Australia sure isn’t the cheapest place in the world to be sick.

Fast forward a year and I’m back in the UK.  Out of nowhere my fingers suddenly started to go numb at the drop of a hat.  One minute totally normally, the next I’d have a full set of bloodless digits; they looked like the hands of a corpse that’s been washed up after several weeks at sea.  Not pleasant at all, but BINGO, suddenly I had my first diagnosis: Raynaud’s phenomenon.

Dodgy hips, random pains and unexplained bouts of tiredness continued, and then fast forward another year and my eyes were now dry and burning and my mouth felt like a forgotten flip-flop in the Sahara Desert.  BINGO again. It’s Diagnosis Number 2:  Sjögren’s Syndrome.  Bit like buses these damn diagnoses.

I honestly can’t even remember how, why or when they reached my final diagnosis of SLE.  For some reason, my GP failed to tell me she was even testing my blood for other things.  So I suppose it stands to reason that she would also forget to tell me what they had found out.

The first I knew of it was during a nurses appointment at the hospital.  Just a simple check up I thought, after having my numb, wrinkled fingers x-rayed and my dry, itchy eyes scanned.

So why am I seeing you today? I enquired of the lovely lady in blue.
I’m your Lupus care nurse, she said.
Why do I need one of those? (sometimes it takes a while for the penny to drop)
Because you were diagnosed with Lupus a month ago, she said.
Oh. Right. Good to know. 

Queue much crying by the time I’d reached the car.

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Day 60: it was all going so well

The last five weeks have all been a bit up and down;  some days I’ve felt great and other weeks have been a total disaster.  The last couple of weeks have been particularly bad, however, but until today I just couldn’t work out why.  I knew I hadn’t been ‘pushing’ myself (no base jumping or tiger wrestling) yet the brain fog well and truly descended upon me and I’ve had the energy levels of a snail.

The reason for this became clear, following my third blood test on Monday.  I had a call this morning to say my GP needed to speak to me about my results. I admit I freaked out, just a little.  In my experience, doctors rarely call you at home to tell you anything you’d actually want to hear.  The last such home call I received was from a different doctor, telling me I had to see a neurologist immediately as my life was in danger.  But that’s a whole other story.

A flurry of phone calls ensued between my GP, the rheumatology nurses, the rheumatologist and myself.  Apparently, my white cell count and my neutrophils were crazy low, and this put me at a much greater risk of infection.  I swear I could feel my chest tightening and a tickle in my throat as soon as she told me.

If you so much as cough or sneeze or feel slightly hot or unwell you must come into the surgery straight away, my GP warned me.  But I’ll never get an appointment, I pointed out. Consider this a fast past to get in whenever you need, she assured me, just say you have to be seen as a matter of urgency.

Hmmm, look forward to trying that one out on the bull dogs receptionists who man the surgery phones.  They seem to regard every enquiry for a same-day appointment as a completely unreasonable and unnecessary request.  I once had to throw myself, weeping and wailing across the counter top before they reluctantly ‘allowed’ me to see a doctor.

To cut a long story short, my azathioprine dosage has now been cut by 50mg to see if this will bring my bloods in line.  I’m also back to vetting all my visiting friends in case they or their offspring are infectious or sick.  My melodramatic self is now picturing having to live in a vacuum packed bubble for the rest of my life.  Yes I know, I’ve already told myself to get a grip on reality and calm down.

Rewind to Day 20.

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Why is Lupus so difficult to diagnose?

Lupus is a chronic and complex disease that can throw up many different and often bizarre symptoms – symptoms that can vary greatly from person to person and often randomly come and go over weeks and months.

It’s known as ‘the great imitator’ as many of these symptoms mirror those of other, far more common conditions.  This makes the little bugger that much more difficult to diagnose.  To make things trickier still, there is no single laboratory test that can determine if a person has Lupus, and a test result may be positive one time and negative another time.

It’s safe to say that this certainly isn’t the most helpful or cooperative disease to have!

Before you can be branded with that great, big, ugly, Lupus stick, the doctors will have to look at your current symptoms (there are plenty of these for your body to pick and choose from), your blood test results, your full medical history and the medical history of your close family members.

The blood tests are used to assess your general state of health, check if you have an infection, see how well certain organs, such as the liver and kidneys, are working and screen for certain genetic conditions.

The first test off the starting block is the erythrocyte sedimentation rate (ESR) test, to determine whether there is any inflammation in your body.  This is quite a useful little indicator as Lupus has a habit of making various joints and organs swollen and inflamed.

Next up is the anti-nuclear antibody test (referred to as the ANA test)  the test you will probably hear about the most.  This test is to check whether there is a certain type of antibody cell in your blood, known as the anti-nuclear antibody.  Approximately 95% of people with SLE have this antibody, but it’s also possible to have the anti-nuclear antibody without having SLE.  In other words, this test needs even more tests to back it up. Useful!

Following in hot pursuit is the anti-DNA test, which also checks for a certain type of antibody in your blood, known as the anti-DNA antibody.  Sadly having this antibody means chances are you do indeed have SLE.  Of course, the level of anti-DNA antibodies increases if you’re having a flare-up, so that can be pretty changeable too. Oh yes, and the antibody is only found in around 70% of people with the condition. Even more useful still.

Finally, there’s the complement level test.  Complement is a chemical in the blood that forms part of your immune system. The level of this chemical may be tested to check how active your SLE is. The levels decrease when your SLR  is more active.

All test results will probably be sent directly to your GP and your rheumatologist to mull over.  In all these years no one has ever bothered to tell me what the results have been, possibly because I’m only the patient on a need-to-know basis,  more likely  because I wouldn’t have a clue what any of them actually mean.

I’m just a humble little patient, not a doctor, so to read more in-depth info about the different laboratory tests required, you might want to have a nosey here.

Of course, the tests don’t stop once you’ve been diagnosed.  Once you have SLE it is possible to develop other conditions, such as kidney problems, so regular monitoring will be necessary to check for any changes or complications.  Certain medications also require regular testing to make sure everything still working as it should do.

You may also need to have scans, such as an X-ray, ultrasound scan, magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check whether SLE is affecting your internal organs.

All-in-all it can often take years for a Lupus diagnosis to be made.  To hurry up the whole painful ordeal it certainly helps to find yourself a sympathetic, empathetic and medically clued-up doctor who will take your symptoms seriously, and then move heaven and earth to get you treated.

Happy hunting and good luck!

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Day 20: light at the end of the tunnel

Twenty days in and things are definitely looking up.  Not only am I feeling almost human again, I no longer look like an extra from Thriller.  

I’ve gone up to my final daily dose of 150 mg and I had my first blood test on Monday. Thank heavens my local nurse is better with the needles than the last one, as I’m going to be seeing an awful lot more of her going forward.

The best news so far is that (fingers crossed, wood touched) some of the excruciating pain from my hands and arms seems to have calmed down a little. This in itself is a monumental moment as I’m now able to push doors open, pick up a cup of tea and hold my husband’s hand without wincing and grimacing. Understandably that last one was starting to give him something of a complex!

My energy levels are still on par with a hibernating bear, but baby steps and all.  I’m reminding myself that first and foremost I was put onto the Azathioprine to help with the pain, so anything else that improves is a bonus.

Rewind to Day 10. Fast forward to Day 60.

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Day 10: feeling bleurgh

A week and a half into these meds and I’m feeling absolutely bloody awful.

Skin tone for today is at least fifty shades of grey, with a dash of sickly green thrown in for good measure.  If Farrow & Ball were to name the colour, I’d say it would probably be a toss-up between ‘Deathly Pallor, ‘Decaying Corpse’ or ‘Watery Vomit’.  To make matters worse, my skin is also purging a year’s worth of impurities.  This ain’t good and it sure ain’t pretty.

Things don’t improve much from the neck down.  All four limbs feel like they’ve been encased in concrete and my bones continually ache.  Random sharp pains are jabbing me in the back.  My hands are sore and all scrunched up like arthritic old claws.  Body temperature wise I’m fluctuating between early menopausal flushes and Arctic chill.

I think my brain has short-circuited;  it’s spluttering along on just the one cell. The most it can deal with today is TOWIE, and even that’s proving a struggle.  God help me, I am in trouble.

Yup, it definitely feels like I’m grinding to a halt here. What the hell is happening in there?  And how much worse does it get before it starts to get better?

Rewind to Day 7.  Fast Forward to Day 20.

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Day 7: troublesome hormones & tardy tooth fairies

It’s now a week since starting the Azathioprine and there’s still no sign of the green scaly skin, tail or special powers.  More importantly, there’s still no sign of nausea either.  The dosage does however double today, so there’s still the chance I’ll be inhaling ginger biscuits by bedtime.

I had yet more interrupted REM sleep last night, though this time is was down to a 2am tooth fairy panic.  Mid-dream I suddenly remembered that the bloodied offering from my son was still sat awaiting collection at the end of his bed.  Tempting as it was to blame this on a tardy Tinkerbell, I staggered downstairs to fetch a coin and write a fairy thank you note.  Admittedly I could have skipped the note (this bit involved bright lights and a hunt for a pen) but tiredness is never an excuse for bad manners.  By the time I swapped the canine for cash and returned to bed I was wide awake.

So here I am, still feeling dog tired and looking rough. Of course, there’s nothing unusual about that.  It’s a Lupus + chronic fatigue + monthly hormone thing. Obviously I didn’t (but probably should have) calculate exactly what time of the month it was before starting these new pills.  This being the week I normally sleepwalk through the day and neck painkillers like smarties for the pain in my hip.  Incidentally, I’m still waiting for a doctor to explain to me why my overactive monthly hormones cause me to flare up in this way.

Normal tiredness aside, my body has felt extra rung out this week;  more battered around than usual.  My head has also felt a little extra woozy and a lot foggier in the brain department.  But all-in-all, physically speaking, everything seems to be going OK so far.

Perhaps the hardest bit to deal with has been knowing I’m on this stuff. It’s the unnerving knowledge that my immune system will now be ‘suppressed’ and my body is much more vulnerable to attack.  I’m already eyeing up everyone who coughs and sneezes within a 100-metre radius; to me, they’re a potential threat.

Being this tired every day means you spend rather a lot of time horizontal, dreaming up one possible undesirable scenario after the other. I am currently picturing my already traitorous blood cells (who throw all of their energies into attacking their host body), now picking up their placards and going on a strike.  And without them, my body becomes an unmanned, unprotected hotspot for every passing bacteria, germ, and virus looking to invade.

How can this scenario possibly end well?! Now, where did I put that face mask?

Rewind to Day 3. Fast forward to Day 10.

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Day 3: looking like death

What a difference 50mg of something horrible can make.

Last night I woke up at too bloody early o’clock.  From 4am to at least  5.30am, I lay there, panicking because I couldn’t get back to sleep.  It didn’t help  that my husband had hijacked half my pillow and the dog was talking in his sleep.

Unsurprisingly I woke up this morning looking and feeling like absolute shit.  Death warmed up, I think would the appropriate terminology.  Actually, make that death warmed up, reheated, eaten and then regurgitated all over the floor.

Had someone come to my front door today they would have been greeted by a yawning, pale and clammy looking individual with puffy hamster cheeks (my husband’s words, not mine) and eyelids that drooped below my eyelashes. Definitely not a day for selfies, that’s for sure.

Having felt pretty good since starting the Azathioprine on Monday,  I’m hoping today was a result of sleep deprivation, not a sign of things to come.  On a positive note, there’s still no sign of the nausea I was dreading.  I’ve already put in 8 collective months of morning sickness over the years so I can well do without any more of that, thank you very much.

Rewind to Day 1. Fast forward to Day 7.

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