Life is a Chronic Illness

A friend was recently diagnosed with breast cancer for the second time. Although her lump, which was pre-cancerous, was successfully removed, she has to have radiation therapy as a precaution, to reduce the likelihood of the cancer returning in a more aggressive form. Her oncologist told her “Breast cancer is no longer a death sentence. Breast cancer is a chronic illness.” I was there to support my friend, and it occurred to me that life is a chronic illness. While not immediately life-threatening (if that's not n oxymoron), it does kill us in the end. The trick is learning to live with this chronic condition, to take each day as it comes and make the most of it, not knowing when the end will come.

Now, I know this thought isn’t original. I’m not sure which philosopher put it into words first – probably not Marcus Aurelius, who I'm currently re-reading, although he had some helpful things to say. Do not act as if thou wert going to live ten thousand years. Death hangs over thee. While thou livest, while it is in thy power, be good. (From Meditations.) So why am I meditating on life and death? Because I’ve hit another little bad patch in my journey, and I need to remind myself that being ill is not the be-all and end-all of my life.

Low energy, shakiness, weepiness – so what’s new?

The most annoying thing about this chronic condition is the way a relapse takes me unawares. It’s a pain! I can go along feeling fine, full of energy, brain working almost as well as it always has (maybe a little slower, if I’m honest), and wham, suddenly I have a day when I’m feeling shaky, weepy, and an intense desire to lie on couch and feel sorry for myself.

The reason is I have been ignoring the little warning signs that this is creeping up on me. At some level, I have been believing that I well. Fixed. Cured. 100 per cent better. And behaving like I’m as fit or fitter than I was at 25. Exercising at the gym 3 or 4 times a week. Working hard editing, writing. Going out with friends. Filling every day with activity. When, to be honest again, I should know – and accept ­– that at best I’m only ever going to be 90 per cent or 80 per cent, and I can’t behave like I have the drive and energy of my younger and healthier self.

Low iodine and slow adrenals

In my last post, I mentioned the possibility of mild hypothyroidism. My most recent blood test reinforced that possibility. My blood iodine levels were mid-range at 48 – moderate iodine deficiency, so now I’m taking one drop of iodine tincture in a glass of water once a day.

Iodine is one of the micronutrients the body requires to produce the thyroid hormones. Although it is found in fish and seafood, the best natural sources of iodine are seaweed and kelp, which not many people eat, except as wrappers for sushi rolls. Japanese people, whose diet is high in seafoods and seaweeds, seldom suffer from iodine deficiencies, but many Australians unknowingly have a mild lack, and this is a concern with maternal and infant health. Other sources are eggs, yoghurt, milk, strawberries and some cheeses, but their iodine is dependent on the soil in which the grass or the crops was grown.

Worldwide, 139 countries have soil deficient in or entirely lacking iodine. Australia is one of them – particularly Tasmania, where I spent my childhood. Severe iodine deficiency, especially in pregnant and lactating women, causes horrific brain development problems in the foetus and young babies. Growing up in the 1950s, I saw many cases of cretinism and goitre, terrifying to a small child. By 1960, the cause had been discovered and we were given iodine supplements. The best sources of iodine in Australia are actually bread and salt, which have iodine added. (Milk used to be a good source, when iodates were used as part of the sterilising process in dairies, but this no longer happens.)

Adrenal exhaustion – not again!

Eighteen months ago, I was totally weak, limp and useless, as I was suffering from adrenal exhaustion. I was afraid this latest set-back would be the same, but I was over-reacting. Sure, I have a bit of adrenal fatigue, thanks to the low iodine, slight anaemia, having migraines on hot and humid days, and just doing too much, but I am 75/75 – ie – 75 percent well, 75 percent of the time. I just have to get it through my stubborn mind that I MUST rest more and do less, and keep taking my daily supplements of B12, folinic acid, vitamin C, iodine, and the Chinese herb, cordyceps. Find a balance between action and repose, to make the most of my chronic life.

Reasons to be cheerful

• Music on my laptop, for when I have to lie on my couch.
• Poetry cds, poems read by their British or American authors for couch time
• Good books and a local library that gets all the latest ones
• Walking through the Botanic Gardens or my favourite parks when I have the energy
• Work that uses my brain and provides disposable income to buy concert tickets, books, cds, occasional new clothes,
• Time with friends and family – either in the flesh or on Skype

Poor genes, poor health – but not poor me!

I’m approaching the 2nd anniversary of my diagnosis with ITP. I feel stronger and happier than I did this time last year, but it’s been a strange journey, and along the way there have been far more questions than answers!

Every three weeks I have a blood test, and my GP and I analyse the data and come up with a new or extended hypothesis of the underlying causes of my low platelet count and my prognosis over the next few weeks. As well as the all-important platelet count, we have a cycle of other markers we monitor – cortisol, haemoglobin, red cells, white cells, lymphocytes, monocytes, basophils, eosinophils, calcium, vitamin D and vitamin B12, plus a string of blood chemicals and hormones identified only by initials – most of which I only have the very vaguest understanding of what they do.

No simple answer for thrombocytopenia

Two years on and the one thing that is clear is that there is no simple, straightforward answer as to why I have thrombocytopenia. Why my platelets bounce up and down, and struggle to reach 100. Why 50 or 60 is an OK level for me, though it would be a tremendous psychological boost if they would sit on 100 for while.

On 50, or better still, 60, I function pretty well most days, with maybe one dodgy day a week or 10 days. By ‘dodgy’ I mean slow moving in the morning, or shaky for the first couple of hours, so my bad days are nowhere near as horrible and debilitating as they have been, and are, currently, less frequent.

Over the months, we’ve looked at various possible causes or contributing factors, such as H pylori ,gut parasites, and low-grade Lyme disease. Plus we have identified some of my genetic deficiencies – being gluten-intolerant and also unable to metabolise folate from food. Now we have another one – low level hypothyroidism.

Hypothyroidism a possible villain?

In the latest blood test, we checked my Vitamin B12 level, something we do every three months, together with homocysteine. As usual, the B12 was lowish – still within the very broad range of 145-637, but this time right at the bottom. And the homocysteine was way up, almost double what it should be. Both the high homocysteine levels and the inability to metabolise folate are linked to the MFTHR gene and can occur together with low levels of thyroid hormones, and could indicate very borderline hypothyroidism.

That my presumed hypothyroidism is very marginal is shown by the fact that I exhibit none of its most noticeable symptoms: tendency to gain weight and inability to lose it; slow thinking; thin hair and hair loss; puffy eyes; oily skin; and other more delicate comparisons – such as constipation vs irritable bowel.

What it appears I have is ‘secondary hypothyroidism’, thanks to the last year’s adrenal fatigue and my ongoing adrenal insufficiency. So possibly the borderline hypothyroidism is not so much a cause as what the medicos call a co-morbidity – connected, but not necessarily cause and effect.

Chronic condition from long-term problems

To sum it up, here’s my equation:
a lifetime of less than optimal health (as a result of choosing my parents badly), compounded by environmental factors* + an unknown viral or environmental stress in 2009 = ITP.

Not a clear cause and effect, or diagnosis and cure, but good enough to be going on with, now that what was life-threatening two years ago is pretty much under control.

Reasons to be cheerful

• My weight is pretty steady at an appropriate weight for height and build: 60kg to my 160cms and thin bones;
• I have good energy (most days)
• I enjoy going to the gym 2 or 3 times a week
• I have enough freelance work that I can manage
• I love doing coffee or going to a play, concert, discussion group or art gallery with family and friends
• I have time to write my short stories
• The jacarandas are flowering
• I feel good!

* Tasmania, my home state, has very low iodine levels in the soil, causing many people to develop gross hypothyroidism and goitres. This connection was not recognised until I was about 10, so I would not have had an optimal iodine intake during my early growing years.

A Beautiful Number

When former Australian Federal Labor Treasurer, Paul Keating was what he described as “the Placido Domingo of Australian politics”, he would often speak lyrically of “beautiful numbers”. Yesterday, I had a beautiful number of my own.

I’d had an absolutely crap 10 days, with each successive day seeming worse. I’d developed a heavy cold the day after taking part in the Walk Against Warming, and was already aware from my previous visit with my haematologist that my thrombocytes were disappearing again. On December 11 they had dropped to 119,000, and the professor warned that if they kept dropping, he would have to put me back into hospital to administer more IV immunoglobulin, and probably do a bone marrow test to see what was going on.

So by yesterday, December 23, I was feeling so wretched – absolutely no energy most days and no brain power either – that I was convinced they must have dropped to 60,000 or less. I even put myself under “house arrest” for the last 3 days, (apart from friends taking me downstairs to the coffee shop in my apartment building), terrified that if I went out on the street during the Christmas shopping frenzy I’d get knocked over and start bleeding internally.

Not only had I convinced myself, but also my family and close friends, all of whom were very worried for me.

When I saw the professor after my blood test, and he asked how I was feeling, I replied, gloomily, “I’ve felt better.”

“No.” he replied, “You’ve felt a lot worse. Your platelets are up to 193,000. You’re almost back to normal.”

So I poured out my sad story as he sat there, grinning broadly. He had the decency to acknowledge that I had indeed suffered, and explained that most of the misery would have been from the cold, exacerbated by the still-annoying steroid side-effects – most especially the lack of sleep.

The Good Things About Taking Steroids

So, in acknowledgement of the very real benefits I’ve received from my daily prednisolone this past couple of weeks, I’ve decided to list the positives:

• My thrombocyte count is almost back to normal
• I don’t have to spend Christmas in hospital, eating incredibly bland food & having daily blood tests and IV transfusions
• I'm up so early, I can watch the daily miracle of the dawn from my balcony, really conscious of the earth rolling from east to west as the sun rises over the tall gum trees behind the university
• Being up so early, I have time to do some stretches & gentle exercises before breakfast
• My eczema is temporarily suppressed - I can eat foods from the nightshade group- tomatoes, capsicums and chillis, that would normally bring me out in a rash within half an hour.
  At last my homegrown basil can combine as it should with fresh tomatoes for the perfect vitamin-rich summer salad!

A Christmas Break

Since my haematologist thinks I’m safe until I see him again mid-January, (so long as I’m sensible), and has given me permission to travel, I’m able to accept my friends’ invitation to spend a few days with them and their cats over Christmas in the beautiful Blue Mountains town of Katoomba.