The Minutaie

There are a million little things you can do for yourself every second of every day. You don’t need to ask; you simply get up and do it. But what if there were times you couldn’t get up or if you were disabled and dependent on someone else? How long is it okay to wait? I mean, think of a baby. They are as helpless as I am, and most people come to their aid quickly. But when you are an adult with a paralyzing disease like ALS, it feels to me as if I can wait for any amount of time. After all, they know that my disease is incurable and fatal. So why spend time and money on something that progresses onward to my death? It’s pennies on the dollar in healthcare.

There are times when my caregiver is right in front of me and I cannot even make a sound to let them know that I am in pain or if they themselves are hurting me. So a reasonable adult waits in pain. Babies can cry for some of the same reasons I do. It might be my only form of communication at the time.

I do have a question I would like to ask though. If we protect babies at all costs, what about adults? I have good respiratory numbers to keep me alive. So the next move is to slowly decrease my food and to give me intravenous liquids. Does it sound like I am being replaced by an infant? I mean, we are all going to die. I just didn’t realize that I would be dying by an involuntary food strike or I could have joined the IRA years ago (OK, that is the author’s interpretation of what I heard from a hospice representative.)

At what point do we decide a person’s value and who makes the decision? What makes a person worth saving? Is it the number of years they live? Is it because they do not have a rare disease and more money can be earned on their illness (WWJD)?

On April 1, 2018, I wrote a letter to the President of Duke Hospital. I didn’t ask for, nor did I receive a reply, not even a form letter. But all the surveys I get from Duke have had his name on them. Do you really think he cares about an individual response, or just tallies up the responses his survey company gets? I bet I know the answer. After all isn’t Duke a for-profit hospital?

Got onto my soapbox again and off topic – the minutiae. So who scratches your itches? Who drives your power wheelchair when you can no longer move your hands?

Who opens the door when there is no handicap button, or you can’t push it? Who moves the trash can so conveniently placed in front of that button?

Do you care? Do you notice? The Americans with Disabilities Act has been a law for more than 25 years. Do you know any part of the law? I bet you know about driving with a cell phone, though.

Minutaie…

 

(This blog  was  written  with eye-tracking)

The Truth

 

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Photo by Pixabay on Pexels.com

I receive a lot of compliments from people who say that I inspire them even though I have ALS, a progressive, incurable, untreatable, and fatal disease. The truth is, I don’t know how to inspire anyone, not even myself.

Come find me on a day when I am angry or my PBA is in full swing. I am not very inspiring on those days. There are days when I just give up or give in because I cannot communicate. Today I gave up trying to communicate to my caregiver that I felt uncomfortable with the way I was positioned in my wheelchair. Someone who can move and wriggle their butt into a comfortable position may not recognize how painful it is to be sitting lopsided with all of your body weight on one side.

I often sit silent because it is too much effort to type with my eyes. Sure there are phrases stored in my device that can quickly allow me to say something, but is it witty, thoughtful, or inspiring? It takes time to get a thoughtful statement typed out correctly with your eyes. Or maybe I am just not proficient in eye-gaze yet. When I am revved up and halfway through my comments, the conversation has usually moved on. If I decide I want to get my voice heard any way, I’m usually interrupting a conversation that has progressed to a different topic.

Truth be told, I am really irked by being asked questions that require more than a yes or no response when I don’t have my speech device. I cannot grasp a pen to write, and I cannot hold my cell phone or type on the tiny keyboard. My husband is hard of hearing and hearing aids do not help him to understand my garbled speech. No one can understand it, but that doesn’t stop me from trying. When I am really frustrated, I do what babies do, I cry. The only difference is no one picks me up, pats me on the back, and cuddles me. Which is probably a good thing because I would probably cry more.

Worst of all is that everyone else sucks at charades. They may get a clue to one word I am saying which I acknowledge, but then the rest of the their guesses are completely disconnected and off the wall. The truth is that this annoys the crap out of me. It shouldn’t, but it does. I mean after all, I know what I am saying, why not everyone else? Okay I am kidding, but it is so very frustrating. It’s like watching Judge Judy, being sworn to tell the truth, and then not being allowed to tell your story.

It’s true that I hate that I cannot get others to understand the idiosyncrasies of the disease, the itching, the burning, the feeling that bugs are crawling on my skin, and the constant need for assistance. I really can’t deal with losing the use of my hands and arms. My right arm is practically useless. It is becoming difficult to operate my wheelchair because I cannot move my hand onto the controls. I wish I could clean my own eyes and scratch my own itches, brush my teeth, comb my hair, put on my eyeglasses and earrings, and wear my wedding ring again.

The truth is that that I have come to hate ALS more than I ever thought I would. Naively, I thought it was something I could deal with. I handled not being able to walk. I got a pimped out pink power wheelchair to raise ALS awareness. I handled the eating and swallowing problem with a feeding tube. I don’t really have cravings for particular foods, and the government buys me my meals. They are like MREs (meals ready to eat). After all, I am in combat against a formidable enemy. But the fact is that ALS is stealing my life. It is hitting hard at my steely exterior. Truthfully, there are days that ALS sneaks in through its friend PBA to ruin a perfectly good day. Distractions can help keep it at bay.

I will keep on telling you the truth about this disease. I only ask that you listen, learn, and educate others. Every 90 seconds someone is diagnosed with ALS while another PALS dies. Spread the truth and help cure ALS.

Bitching & Complaining

bitchingYes, you read that right. This blog is about bitching and complaining. It is mostly about ALS, the bitch in my life, but a few other things may slip in. I am after all a born and bred New Yorker, so it’s a given that I am going to complain. If you don’t like complaining, don’t read any further. I am not about to change now. There are lots of things to complain about with ALS, and I’m taking the opportunity to put it all out there.

Disclaimer: These complaints are not directed toward any specific person, but even so, names will be changed to protect the guilty.

Communication
This is a big one. It may actually be the only real issue because not being able to express even the smallest desire is a huge frustration.

I live with my husband who has hearing loss and wears hearing aids, most of the time. So communication has always been an issue. I was always being reprimanded for talking to him from another room instead of face to face. That was a difficult thing for me to get used to since he was the first hearing impaired person I really knew. Heck, in my childhood home we would yell to each other from one floor to another. So, of course, it’s Murphy’s Law that I should lose the ability to speak and make our communication even more difficult. I spent about six weeks reading 1600 nonsensical phrases so I could have a synthetic voice that would sound like me. I now have a speech device that Medicare paid $16,000 for, and guess what? He can’t understand my synthetic voice on it. Murphy, again.

We used to say that as we got older, we could learn sign language to add to our ability to speak to one another. Damn you, Murphy. I can’t use my arms and hands very well.

I have my speech device which is a Tobii Dynavox. I just call it my Toby. I took it with me to the hospital where no one had the time to wait for me to type my responses. So I was essentially voiceless. I take the effort to practice so I can be faster at communicating and there is always something to annoy me. For example:

1) Toby quits in the middle of a sentence I have been painstakingly writing;
2) People are on to another discussion before I can fully respond;
3) As I type sometimes people will read the screen and try to anticipate what I am saying (sometimes this is OK, but it takes away privacy of prior conversations because of its predictivity function. I really don’t want people to see “I need the bed pan” when I was writing “I need some help.”)
4) I attempt to use the dwell-free keyboard which is faster and doesn’t appear on the screen until I want it to, but if I make an eyegaze mistake, it takes longer to correct and, therefore, longer to speak;
5) People don’t really understand what Toby said, but don’t bother to ask for clarification. To me this seems like they are not interested in communicating.

The worst times for me are when I am asked questions that require more than the nod of my head, which I can still do right now, and Toby is packed away or out of my sight. If I notice something important or need something, I am helpless. These instances occur frequently during bathing and dressing.

Sensations
Constantly feeling itchy is an extreme annoyance.  I cannot reach very far so lots of these feelings must be ignored. Mind over matter, or in this case itches, does not always work. I can feel loose hairs on my skin like bugs crawling on me. My pleas to remove them bring snickers from Barney. A real annoyance.

Burning sensations from pressure occur at times. I feel the burning in my feet at least once again daily. I used to experience burning in the heels of my feet almost every night. Fortunately, this situation seems to be under control with the use of many, many pillows. In fact, our bedroom has become overrun by pillows.

PBA
PBA or pseudo-bulbar affect is the nemesis of my relationships. I know many people are put off by it. It is hard on me and hard on people who are witness to it. I was never an emotional person and now I start crying at the drop of a hat. Sometimes it’s because I’m upset or frustrated. At other times I’m just overwhelmed by the emotion of the moment. Thankfully, medication has helped control it a lot, but a little bit lingers behind. It makes it hard to breathe. I hate it!

Relationships
Where have some of those old relationships gone? I’m dying and you can’t say you’re sorry? Did I piss you off? Let me know if you want to reconnect. I can apologize too. I will be dead a long time and I won’t be back.

Hospice
I have now signed up for hospice. It should begin this week, right in time for my trip to Washington, DC, for ALS Advocacy Day. Hospice isn’t a prison. They actually expect me to live my life before it’s over. How long I will be on hospice will depend on my respiratory system. While on hospice (which is at home by the way) I will get a weekly visit from a hospice nurse and 2-3 CNA visits a week. I will also have a case manager. Medications will be monitored and provided through hospice as well. When I travel, I get information on a local hospice to contact, if necessary. If you have ALS, look into palliative care or hospice, and find out when it is appropriate and how it works with the insurance you have. It can give your caregiver some help.

Getting hospice on a predictable schedule seems like that will be my next complaint. Can’t things be planned in advance? Don’t call at 3 pm to come give me a shower. I like to plan things ahead. Most of my funeral plans are finalized. There’s just one date I can’t schedule. So get with the program, already! Please and dammit!

The Transformers

300px-PrimeBeeAs time goes by I feel more and more as if my daily existence is machine dependent.  I am not talking about the usual home appliances.  I am referring to the multitude of equipment that an ALS patient relies on to make their life comfortable and livable.

Since my last post two weeks ago, I have been inundated with appointments.  One of the first was with EMS who arrived to help get me off the floor when I slid out of my lift chair.  I know, not exactly a planned appointment.  I had a new aide filling in for the day who wasn’t familiar with my routine.  I wasn’t hurt, but it did take quite a while for EMS to arrive which was disconcerting.  I was very surprised to learn that the paramedics are not trained on how to use a Hoyer lift.  My aide, however, was able to instruct them and they all worked together.

This incident has made me even more impatient waiting for occupational therapy (OT) to arrive.  You see, it’s time to give the hospital bed another try.  We’ve already dismantled our guest room to accommodate some furniture that will need to be moved out of the master bedroom.  The electric hospital bed is coming back into my life because I have become weaker.  The electric Hoyer will help get me into bed and the occupational therapist will be our instructor.  Then the battle to get comfortable will begin anew.  It’s a real challenge keeping ahead of the constant changes that are the life of a person living with ALS (PALS).

So, in addition to the electric hospital bed and lift, I had a visit from my durable medical equipment supplier who brought me a Trilogy machine and a cough assist machine.  You may be familiar with the terms CPAP and BiPAP.  Trilogy is similar to a BiPAP machine.  It helps with respiratory issues.  In my case it will help inflate my lungs and perhaps increase my lung capacity, but it will also help me get rid of the carbon dioxide that I cannot expel on my own.  It is difficult to expel carbon dioxide when the respiratory system is compromised by ALS.  Too much carbon dioxide can kill me.  It is also one reason why I keep an ALS alert sheet hanging in my kitchen.  It alerts EMS not to give me 100% oxygen.  I found this information at the site www.alsemergency.info and ran it by my doctor before posting.  Now both my husband and I are masked sleepers.

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The end of the month brought the much-awaited speech device, a Tobii Dynavox.  The Tobii uses eye-tracking so I can type and surf the internet hands free.  There were a few hiccups with the delivery like missing mounting poles for my wheelchair and several attempts to retrieve via email the information to unlock Windows.  But all is good and the sales rep is affixing the mounting bracket as I type this.

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I will be spending a lot of time getting up to speed typing by eye and learning Windows again.  Ugh!  All I need now is an appointment-free day, week or month.

In the days that followed Tobii’s arrival, I saw a palliative care nurse practitioner and had a physical therapy (PT) intake visit.  I’m already scheduled for PT twice this week.  My life and home are in shambles.  I have boxes everywhere (empty device boxes, liquid formula boxes), an empty guest room, dust bunnies.  Well, you get the idea.  OT where are you?  I need you so that decisions can be made about where to put everything.  It was very difficult to move to a smaller home just to accommodate ALS.  Adding more stuff to the mix does not help.  Being a little bit of a neat freak (which I didn’t think I was, but have been accused of being), all of this drives me nuts.

The transformation to a machine-filled ALS life began with a power wheelchair.  Now it has expanded to include the Amazon Alexa to turn on and off lights and other cool stuff, a Ring doorbell, cough assist and Trilogy machines, a suction machine, an electric Hoyer lift, electric hospital bed, and my speech device, the Tobii Dynavox.  Half of these machines I am not able to operate alone or unaided.  I thank God every day for the assistance of able and caring people who transform my life into a comfortable existence.

On the Road Again

imagesI’m on the road again, literally and figuratively. I’m on the road to vacation and stuck in traffic on I-95. Then last week we hit a roadblock when it was announced that two ALS drug trials had failed. One of them I had taken part in for more than a year. So after some time being stalled at the gate, I’ll hit the road again looking for another trial to take part in.

The past few weeks have been pretty well trafficked with people, appointments, and just things to do.

At my last clinic visit I was diagnosed with a probable case of thrush. Another bump in the road. Thrush is a problem usually found in infants who are bottle feeding. So it fits right in with my scenario of wearing bibs, eating toddler food as snacks, and requesting to be taken to the bathroom to tinkle. The instructions on the medication say to gargle and swish four times a day. Um, that’s not happening. Swishing, gargling, and even spitting have gone by the wayside.

On a Tuesday early in the month I had a massage. My massage therapist comes to my home. After moving the furniture around in the bedroom, my aide skillfully gets me into that hospital bed I never use. I get a full body massage even though I cannot roll over. It is a relaxing hour and one that my immobile muscles appreciate. I only wish it was a covered medical expense and could be twice as long and more frequent. If anyone out there has a foot fetish, I have two feet you can massage whenever you want.

Later that afternoon I had an appointment for a telephone conference with researchers wanting to learn more about a PALS’ point of view of their disease. Now, if you’ve been following my blog, you know that I have come to dislike talking on the phone. It takes up a lot of energy and the majority of people I talk to don’t understand what I’ve said anyway. It’s very frustrating for me.

I planned the call late in the afternoon so that my husband would be home to act as my interpreter. As it turned out, he was stuck in a meeting and would not be home in time. As the clock ticked past the arranged time, I realized that the researchers had called but my phone was still set on do not disturb for my massage earlier in the day. Another road bump. I called back and managed it with some repetition necessary on my part. The call was tiring but worthwhile. Anything that drives research along is, in my opinion, worth the time.

The next day I had a wonderful visit with two friends who flew down from New York for the day. We all worked together in Intellectual Property in New York City. Ironically, I worked in the Life Sciences end.

That week wore me out and then it started all over again with a mammogram on Monday where the biggest impression I made was with my power wheelchair. Did you know you can have a mammogram in a wheelchair? And it doesn’t have to be the Rolls Royce of wheelchairs, as the ladies dubbed mine.

Wednesday evening I had a follow-up visit by neighbors who are members of our community outreach, Woodlake Cares. They are researching ways to help Joe and me. Together with my neighbors and my church family collaborating it will all get figured out. Love abounds!

And now the time has finally arrived to get on the road to another new adventure — learning how to use an eye tracking system. The system will be my voice. It will replace my computer and if I get good enough at it, I may be back to talking on the phone.

ALS is sucky and makes life difficult. It plays with our bodies and tries to make us give up. I have many frustrations that don’t always make it into this blog. But it’s important that we find the right road and cram as much as we can handle into the pit stop of our lives.

Trick-or-Treat

IMG_6625Happy Halloween!  Tuesday was Halloween and the day I chose to follow-up at the ALS clinic.  I had also requested a speech evaluation and it wound up being that morning.  It was a full and exhausting day.  It was also fun and sobering as far as my journey with ALS is concerned.

I was up at a bleary-eyed 6 A.M.  After being helped with showering, dressing, and breakfast, we were off.  We were well aware that the ALS clinic would be filled with costumed medical personnel so we packed our costumes in the back of the van in anticipation of our afternoon appointment there.

First up was my 9:30 A.M. appointment at the Duke Speech Pathology Clinic.  We waited in reception for my name to be called along with costumed kids who were trick-or-treating while also waiting for their own appointments.  After a short wait, I was summoned to a small room in the back of the clinic to meet with the IT technician and speech pathologist along with their respective interns.  I handed over my email from Team Gleason¹ whom I had previously contacted for advice on speech technology.  The technician politely handed it over to his intern.  A minute or two into my evaluation it was apparent that this Duke team did not need any advice.

I practiced using eye tracking on three different devices.  Eye tracking measures the activity of your eyes and allows data to be collected from a computer screen allowing you to type hands free (eyetracking.com, 2011).  I found the different eyetracking devices easy to understand and use.  I guess I have my 30+ years working as an intellectual property legal assistant to thank for that.  I will be getting a speech device that will use a synthetic voice to speak for me.  Right now, I can still use my arms and hands but they want me to be proactive in learning how to use the eye tracking technology.  It will be 2-3 months before I get my own equipment.

At home, I have a MacBook Pro and I use the track pad.  I was told to practice using a mouse and an on-screen keyboard in advance of an in-home trial on the three devices.  (Of course, I just realized I am not following that advice as I type this.)  It seems that everything is about saving energy.  Using my fingers to type and edit takes energy that I need to save in order to avoid fatigue.  I can also learn how to use the technology to talk on the phone.  Unfortunately, I will most likely have to give up my iPhone.

IMG_6630Next up was a trip to the ALS clinic to meet with the research nurse prior to my quarterly follow-up visit.  On arrival at the ALS Clinic, my husband and I quickly donned our Mr. and Mrs. Potato Head apparel in the parking lot.  The friendly witch at the reception desk checked me in.  While the costume fun was just about to begin, the sobering wake-up call to the reality of ALS was hiding somewhere amongst the gaiety.

 

The ALS Clinic is multidisciplinary.  This means I don’t have to travel around to see the various members of the ALS team every time I need a follow-up.  They are all located at the clinic, and I have the convenience of having them come to see me and not the other way around.  I see so many people it’s hard to remember who I saw and what we did.  Thankfully, I have the benefit of an excellent caregiver who pays attention and knows what is going on.  Electronic medical records also help.  I can go home and log into Duke MyChart to download a copy of my visit summary.

The sobering part of the visit meant I left with information on a chopped diet and pureed foods along with information on feeding tubes.  Because my ability to chew and swallow food is becoming more difficult and my forced vital capacity (having to do with lung capacity and breathing level) is slowly decreasing, it is time to consider a feeding tube.  The tube is a proactive move and does not mean that I am dying.  It means that while I can still eat a lot of foods by mouth, it takes a long time and a lot of energy.  Ironically, the energy I get from the food is already burned while I’m eating.  That means I have no caloric intake.  The tube is meant to supplement meals.  The best part is I can save my energy with tube feedings and later eat fun stuff like ice cream or Italian food.

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Staff at the ALS Multidisciplinary Clinic dressed to mimic the clinic’s director, Dr. Richard Bedlack (front center)

So in between visits by various costumed (Halloween vs. medical) garbed personnel, I also earned about oral hygiene (another problem), got my wheelchair adjusted, and discussed physical therapy.  There was probably some other important stuff I missed.  I can only thank God that between my doctor and my husband, someone is looking out for my well-being.  I’m too busy living to dwell on dying.  The trick is on you, ALS.

¹Steve Gleason played professional football for The New Orleans Saints from 2000-2008.  He was diagnosed with ALS in 2011.  His foundation is a charitable 501(c)(3) non-profit corporation.

References

eyetracking.com (2011).  About Us: What is Eyetracking?  Retrieved November 4, 2017 from http://www.eyetracking.com/About-Us/What-Is-Eye-Tracking