holding on, holding out

I’m increasingly thinking I need to be inpatient, and I don’t say that lightly.  I spent yesterday, day two of the massive hypotension, sucking down juice all day and trying to lay with my feet up to keep my resting BP up.  Nope.  The only things that reliably bring it up are stress/anxiety and being up and moving around, both are temporary and the up and moving also jacks up my heart rate to my high POTSy levels.  So that’s no good.  Plus, I’m dizzy while I’m up.

The two days of juice have taken their toll on my stomach I think.  Well, that’s what my theory is for why I woke up this AM with stomach pain which quickly progressed to nausea.  Took a zofran.  An hour later, I was vomiting.  I swear, all zofran does for me is constipate.

The juice, white grape juice, is less acidic than gatorade, but it still is sharp on my stomach.  I am hoping two days of high acid in my stomach is what it was that set things off today…I’m pretty unhappy that I’m puking now too, on top of all this blood pressure crap.

My husband leaves tomorrow for his conference, which he is already planning to cut short since I’m so sick.  A good friend (out of state) is coming up to hang out with me while he’s gone.  I’m not accustomed to having company while I’m so sick, basically she’s going to have to minimally baby sit me (and possibly take me to the ER and watch my cats until my husband gets home) and I am not looking forward to that.  I had been hoping this would be more of a visit, but the last few days are not looking good.

So my husband’s coming back Sunday night, cutting his conference attendance short, which sucks.  But I’m glad.  Because this sucks too, and it’s scary, and the only reason I’m not pushing the doctors to admit me is that I don’t want to be in the hospital while he’s out of town.

I was supposed to check in with Neuro today, about the mirtazipine.  I’m sure they’re going to be unhappy that I discontinued it, but I really feel I had good reason to do so.  Of course, today’s nausea and vomiting doesn’t help my  case that without mirtazipine, I can at least tolerate a liquid diet.  😦  But up until today, I was doing much better OFF the mirtazipine than on, stomach-wise.

Nope

Looks like the mirtazipine might make the gastroparesis worse.  Yesterday, I felt like nothing I ate left my stomach all day.  Lots of reflux, heartburn, and even some regurgitation of what I ate, and I had a pretty mild diet (smoothies, Carnation shakes, fat free yogurt…I did push it and have some chicken and rice in the afternoon, I was hungry despite feeling so full and sick).  Better when I woke up, including better in terms of sleepiness.  I took the mirtazipine much earlier last night, which meant falling asleep on the couch watching shows in the early evening, but that’s not unheard of for me anyhow.

I’m sad that the mirtazipine might not be working out.  I had high hopes.  I’m trying not to be too disappointed by this, telling myself that the akathesia/anxiety is getting better (it does seem to be, a bit, but I haven’t had a med free day since Thursday, and while Thursday wasn’t the worst day I’ve had this week, it sure wasn’t the best).  I’m sitting here at my computer with my legs working away under my desk like I’m marching double time somewhere.  I can stop it if I want to, but it keeps starting back up again.  This is the pattern, the jigginess first, then some general agitation, then the anxiety.  I’m going to try riding my bike in a few, then it’s time to try to eat something again.  Blurg.  I wish food wasn’t being so unkind to me right now, it’s sucking the energy out of me (and I’m already pretty low on energy to start with) and it’s depressing/alarming in its own right.  One more thing to focus on when I’m feeling anxious.  Like I needed that.

I’ll call Neuro Monday to let them know, in the meantime I think I’m going to skip the dose tonight and see if at least my stomach is better tomorrow.  Fingers crossed.

Trying Mirtazipine, again

Saw Neuro yesterday.  We’re giving Mirtazipine a shot.  It’s worth it, since although the fellow said that he thought that the movements/fidgeting might be more a product of the anxiety than a co-symptom of akathisia, mirtazipine is used for akathisia.

An amusing side note about that, a good friend of mine has been saying “just do whatever they do in Israel, they always seem to get things right” about the akathisia/anxiety/whatever this is.  The  paper where results of using mirtazipine for akathisia were published, the authors are from Israel.  That made me laugh.

So I started the mirtazipine last night.  Because it’s not just for akathisia, but for sleep and appetite (both of which I am sorely lacking in).  I did not sleep well, but I am soooooo sleepy today.  Which is affecting my writing, I’m sure, so apologies to anyone reading this and wondering why it’s so stilted and error-filled.  I’m hopeful that it will help.  I know it’ll take a while for the psych effects to kick in, at least that’s how it usually is with meds for anxiety and depression, so I’m going to try to be patient.  I hope I don’t get any acute anxiety today, because I’ll be on the floor if I take even a half an ativan on top of this mirtazipine induced sleepiness.

Thinking of showering while Hubby is still home this AM.  I’m worried that if I try later, I’ll fall.  Yeah, I’m that sleepy.  Checked my vitals this AM while laying sleepily on the couch after getting up, 80/52, hr 52.  So concerns about falling are not overblown, not with vital signs like that.

And I still have to call the psychiatrist.  I’m not really sure what to say.  “I don’t want to see you again” seems like a good place to start, and end, I suppose.  Minimally, I need to cancel my appointment for Monday.

Terrible weekend, better Monday

This weekend was awful.  Despite taking the ativan, I was really not at all ok.  Some of that is my own fault, on Sunday I thought “I’m going to wait on taking the ativan, I don’t want to keep taking it when I first crack open my eyes….so I’ll get up, have some (decaff) coffee, feed the cats, do stuff online, and then if I start feeling jumpy, then I’ll take it.”

Well it turns out that’s a good way to let it all get on top of you and while the Ativan works (some) to tamp things down if I take it when I first wake up, it does far less good when I take it late, after the agitation and retching and jumpy legs have started, like on Sunday.

Monday was better.  Yesterday was better than the weekend but not as good as Monday.

Monday I called the neurologist and asked for help.  Begged for help is more like it.  No call back Monday, I called again Tuesday AM and got a little attitude from the BATH office (this doc has two offices, one en route to the Irish Riviera as we call it up here; and one at the BATH in the city).  But I persevered, left the message with my doctor’s nurse, Keith.

And resolved that if no one called me back by 4:00, I was calling the BATH to confirm that Keith is not on vacation, and to leave him another message.

At 3:30, the nicer sounding lady from the Irish Riviera office called and told me the doctor can see me on Thursday.

Big sighs of relief.  Still apprehensive, not sure if I should skip the ativan that day.  I feel like it doesn’t work great but it does tamp things down some, and maybe the doc should see me unmedicated.  Also, if this is akathisia, and tardive akathisia at that, I’m not sure there’s much to be done.

Dr. Not Impressed

I called my psychiatrist yesterday to ask him if he would be willing to speak with the neurologist.

See, I figured neurology’s input might make a difference in the approach to my treatment.  Among other things, the covering neurologist had said that the SSRI was not a great idea if this was akathisia, and I wanted the neurologist and the psychiatrist to be able to talk it over rather than to have me in the middle trying to explain the arguments for or against an SSRI here.

Oh but no, that was not in the cards.  The psychiatrist felt there was no need for him to talk to the neurologist, said if he spoke to him it would only be to say that he “respectfully disagreed” that an SSRI can cause or exaccerbate akathisia “if that is the word he used”….

Now see, it’s little things like that.  Little things that say “I don’t believe you” or “I am invalidating what you are telling me”.  Little things like “if that’s the word he used” or the sighing (yes, there were exasperated sounding sighs from my psychiatrist), or the tone of voice that sounds, quite frankly, peeved, fed up, sick of listening to something stupid.  You know the tone.  I’ve heard it from him before, and I figured that maybe I was projecting.  But on top of the sighing, and the phrasing he used in speaking about whether it made sense to talk to the neurologist and about akathisia in general, about whether it made sense for me to stay on the SSRI, it sort of adds up to one ugly percept.

I was pretty upset after talking to him.  I get like that with doctors, when they get like that with me.  So needless to say, yesterday was not a stellar day.

It didn’t help that yesterday, I felt like I was on the verge of fainting or just plain old falling over *all*damned*day*.  It was like I was way too heavily sedated.  I had taken an Ativan yesterday, at about 6 AM, 1 mg, no more than I’d taken in past days.  Because I felt so fogged, I even waited it out and didn’t take any more (another .5 mg) until 5 PM.  Didn’t matter, I spent the day in a sick-flu-like fog.  It sucked.  It made me a little panicky too, on top of the distress after my call with Dr. Not Impressed, which sucked because I didn’t want to take another Ativan to deal with the panic.  So I just sucked it up and dealt with the shaking and retching.

So this AM I tried not taking an Ativan, on account of the fogginess yesterday.  I got to 8:00 with leg shaking and pacing, then finally the retching started.  I need to be able to eat and keep my food down, so I just took an Ativan.  It feels like a failure to do so.  I feel so lost right now.  I wonder if I will ever feel normal again.  For a short period this morning, I did.  Between waking up at 4:30 and laying in bed with my mind racing on stressors, my legs shaking (trying not to, I can consciously stop them from shaking, stop myself from rocking, but as soon as I lose focus, I start again), and getting up at 6:30, I was in a state.  I was ok for a time after getting up.  Taking care of the cats, feeling sad about the cats (that’s just ever present now, that seeping, aching sorrow), looking for jobs online, reading facebook.  I sat in the living room for a moment and pictured it as a safe welcoming space, a place where I am safe.  And that worked for a while.  Then I got up to do dishes, to start making food, and the retching started.

Akathisia? I don’t even knowah!

Yesterday, I wrote about having found a term that seemed to describe my experience since increasing my dose of Reglan to 40 mg/day.  The term was “akathisia”.  I was nervous about calling my GI doc and my neurologist.

The GI call.  Went about how I thought it would.  She blew off that this continuing effect could be due to the Reglan.  I suppose that some of this is ignorance due to the fact that the articles about these effects of D2 antagonists (Reglan among them) do not appear in GI-specific journals so much as neuro, psych, and pharmacology publications.  You’d think a really good gastroenterologist would be on top of that, about a drug that has a black box warning and which she prescribes and increases rather often.  But see, there’s the rub.  A REALLY GOOD gastroenterologist, and while this doc I see is listed as a top motility specialist, I have not found her to be a really good doctor.  She worked me up, dx’ed me, but all along the way she kept forgetting what my main complaints were (to the detriment of my care sometimes, e.g. prescribing nortriptyline to “desensitize” my gut for pain and nausea, which sounded like a swell idea for someone with chronic diarrhea, except that I had told her that the chronic diarrhea I’d had for years changed nearly overnight several months prior into chronic constipation.  I didn’t tell her this just once, I mean constipation was a major topic of our discussions and appointments for MONTHS.  And yet she prescribed a constipating med, and was surprised when I ended up impacted and syncopal on my bathroom floor, and eventually in the ER).

She forgets dosages.  She cancels appointments only to reschedule them months later.  She runs so late for her appointments that you can’t plan to do anything else the entire day, and her office will not be up front about it and give you an honest estimate of how late she is.  You call and ask and they always say she’s on time, even when she’s not.  My last appointment with her was her second appointment of the day.  She was over two hours late.  She was not with the first patient for two hours.  She was late getting in.

So the GI call back last night left me in a bad mood.  I woke up feeling despondent, the old Deep Dark Despair, on top of the agitated anxious racing negative thoughts that are happening right now.  Not a good combo.  Took an Ativan.  The DDD is because if this doesn’t go away with SSRIs and Ativan, what then?  Is throwing an SSRI at it even the right thing to do?  And how can I trust my continuing care and management of my sometimes tricky gut to someone who is just so either checked out or in denial?  It leaves me feeling abandoned and scared.

But then a miracle happened. A young man called, (Dr. F) saying he was the covering for my neurologist (Dr. H).  So what’s going on? he asked.  I rambled.  I apologized for rambling.  I explained that I saw Dr. H only recently for autonomic issues secondary to Ehlers Danlos, and one of those issues is slow gastric emptying, and I’m on Reglan for that.  And that in late March my GI doctor increased the Reglan to 10 mg 4x/day (how much were you taking?  10 mg 2x) and that slowly over the months after I started getting these restless, agitated feelings, feeling what I guess was anxiety, but also with some leg restlessness that I thought was just a magnesium deficiency, then about three weeks ago it just sort of blew up and I started having this all the time, intensely.  I started to go on, and he interrupted me.  “Well I can tell you that sounds like something that can happen from Reglan and those medications that affect dopamine, we call it AKATHISIA.” he even spelled it for me.  He went on to say it is primarily considered a movement disorder but that it can come with emotional feelings or restlessness, agitation, anxiety, and depression.  I told him I had stopped the med but it was continuing.  He said “typically, it takes a few weeks to a month to clear up” but that if it continued, I can make an appointment with their clinic.  He then went over my med list, stopping at the Zoloft and said “how long have you been on that?”  Just about a week, I said.  “It can trigger or worsen akathisia, I’d consider stopping it for now, at least until this clears up.”

If I could have reached through the phone and hugged him, I would have.  “Um, I’m happy to try to convey this to my psychiatrist who prescribed that, but I know that sometimes its better if communications like this are directly between providers, is there any way I can put you in touch with him to discuss that?”  He said sure, gave me his email address and said that my psychiatrist can email him to set up a time to talk (no private info over email).

I’m also going to call next week and see if there is a note on the phone call that can be sent to my primary and GI doctors.

And I think I should send this guy flowers or something.

Well that didn’t work out so well

We tried the SSRI.  Zoloft to be precise.  I had been retching when I got upset, or moved sometimes, despite not having much by way of nausea…this was prior to starting the Zoloft.

After starting the Zoloft?  Retching and nausea and vomiting.  After increasing to 25 mg of the zoloft?  Crushing nausea that makes you want to die, vomiting, can’t eat, awful, can’t keep down what you do eat.

So I saw the shrink on day two of that awful 25 mg of Zoloft and he said that we can cut it back to 12.5.  I’m wondering now why not just cut it back entirely.  I was hoping it would help, I’m not sure it will.  And given what I’ve been reading on Reglan and it’s side effects (tardive and otherwise), I’m wondering if the Zoloft might do more harm than good.

Harm:  It’s making me nauseous even at 12.5 mg.

Potential Harm:  In the case studies I read, it is associated with return/increase in some of the neuropsych Reglan effects, specifically an interesting one called “akathisia”.  Never heard of it?  Neither had I.  I think I read it in the list of “movement disorders” that Reglan can cause.  Here’s an article with a set of case reports on akathisia, Akathisia: overlooked at a cost.  In the discussion, you’ll note that both dopaminergic drugs and SSRIs can cause it.  So if this is what’s going on with me (and oh it really does sound like it fits the bill), taking an SSRI to treat it is perhaps not the best idea.

So after researching this akathisia thing, I called my GI doctor and my neurologist.  I’m nervous about both calls.  GI because I just always am, talking to her is a chore.  She’s going to hear about the nausea and suggest putting me back on Reglan, then ask if the psychiatrist said that the reglan can cause this.  She’ll discuss “neuromodulation” again, which means (surprise!) more drugs.  And then finally we’ll discuss a feeding tube.  Here are my answers to these presumed queries:

No, I’m not going back on the Reglan.  I really feel that it played a significant factor in what is going on right now with my neuropsych symptoms, and they are scary and dangerous and completely debilitating.  So no to Reglan.

Yes, he said he’s had patients who have taken it and have not had this but he said Reglan can do this.

I am reluctant right now to add another medication into the mix.  Tell me what this med is meant to do, what the side effects are, is it likely to make anything I currently have worse?  Add something new?

I am eating about 600 calories a day if I am lucky.  Now that I’ve reduced my dose of the Zoloft to 12.5, while I am still very nauseous and it is not helping my appetite, I am not actively throwing up as much…just dry heaving mostly.  But even with this “progress”, I am not getting more than 600 calories due to ridiculously low appetite (which I think is an enduring side effect of the Reglan, it started when I was still on it).  I have lost a lot of weight since this started, I am now down to 120 lbs.  You mentioned a feeding tube last time we talked.  I’d like to set criteria for that.

I’m nervous about talking to the neurologist because I don’t know her that well.  And she seems kind of, glib.  What if she’s like “what the fuck are you asking me for?”  She didn’t prescribe the med.  But I guess the answer is I’m asking her because she’s my neurologist, and because I’d like her opinion on whether this is some effect (tardive or acute) of taking a D2 antagonist for way too fucking long.  She’s not only MY neurologist, but she happens to be a specialist in parkinsons and parkinsonian diseases, as well as run the movement disorders clinic at the particular BATH where she’s on staff.  So I figure if you’re gonna ask a neurologist about neuropsych consequences of a D2 antagonist, why not go to one who kind of specializes in dopamine?  Why not.

But how to say all that.  Erg.

Because it’s like “hi, can you tell me if it’s this drug or if I’m just completely and suddenly insane?  Thanks!”  Doctors must love being in that position.  So I wait here today with some trepidation for my return calls.  The GI doctor MAY call back tonight, she has a piss poor track record.  The neurologist, I don’t know, this is the first time I’ve called with a question.  I was told it would be given to Keith, her nurse.  So we’ll wait and we’ll see and in the meantime we’ll take our Ativan because my god it is the only thing that helps.

Vertigoing

I’m on leave from work right now.  This is for two reasons.  Primarily, last week I started having vertigo.  We’re not talking “a little dizzy” or off kilter, although I have that too.  We’re talking move my head and everything goes violently spinning fast fast fast.  I have a nice collection of bruises after a week of this crap.  That’s because even if I hold really really still, I still have this general “rocking” sensation and it’s making my already rather uncoordinated self into a wrecking ball.  Bathroom mirror?  Check.  Window sill?  Check.  Coffee table?  Check, check, check.  I’ve hit them all this week.

The second reason I am on leave is my experience at work having tried to deal with a new/acute and difficult symptom was the onset of the gastroparesis last year.  Last year, I stayed working through it – through days of nausea and vomitting before I knew what was up and how to modify my diet to at least lessen the symptoms.  I took time off for medical appointments, I had to come in late and leave early a lot, I had quite a few sick days.  I made mistakes, notably on my time card, because I was dragged down horribly by the illness and because there was just so much sick time to keep track of.  And weird sick time.  .3 hours lost here, 1.8 hours lost there.  And I got in a heap of trouble when my boss decided that a doctor’s appointment she had previously approved time off for was a day she needed me in the office.

So this time, I decided to cut myself a little slack, to accept that I am really not well, and to just take time off to see doctors and feel better, or learn to cope with a new reality.  Jeeez I hope this isn’t a new reality.

I have quite objective symptoms here too.  Not just the bruises and the subjective sensation of spinning.  I have some pretty intense nystagmus.  I’m up and typing only by holding very very still and even then, I’m going to start feeling too much motion sickness to stay here looking at the flickering computer screen for much longer.  Nystagmus is an involuntary movement of your eyes, I think it’s compensatory for the sensation of spinning/rotation.  You can’t control it.  It just happens.  And mine looks like I have doll eyes and someone shook me HARD.  From what I can tell, the pattern is peripheral vertigo, which is a good thing in the grand scheme of things.  Peripheral meaning something with my ears rather than something with my brain.  But I do get some vertigo with migraines, so that’s in the running too.  A week long migraine?  I hope not.  Vertigo is hard to nail down and from what I read, tough to treat.  So today I have an appointment with a neurologist at a balance clinic near me.  Please let this not be a waste of time.  And not a new trick.

neuro today, gone tomorrow

I saw the new neurologist yesterday.  I saw him once before, this is someone who was trained in autonomic function and who has opened one of the only autonomic function labs at a hospital in my area.  Yesterday’s appointment was a follow up to talk about blood test results (negative) and where to go from here.  Oh and to let me know that he’s taking a leave for at least a year because his mother is sick.

Crap.

I liked him.

This is the second neurologist I’ve had since moving back to Big Historic City in 2009 who has left his practice.  He’s trying to do it right.  He says that the practice is going to try to find someone with autonomic dysfunction training to replace him and that he’ll be here until the end of April, asked me to check in by phone or email before then.

So what’s new from the appointment?  Other than “Good bye new neurologist?”  My bloodwork was negative for Antiganglionic acetycholine receptor antibodies and antineuronal antibodies.  That’s good, it means it’s unlikely that it’s cancer and less likely that it’s autoimmune autonomic ganglionopathy.  Then what is still on the table, Mr. Patient asked my soon to be former neurologist.  The most likely is the Ehlers-Danlos, other than that, there’s also mitochondrial disease – it’s hard to diagnose and not very treatable.  Well, better the devil I know, so I’m going with Ehlers-Danlos.

One interesting thing that did come of this appointment.  Sleep.  I don’t sleep well anymore, had a sleep study and I saw it as relatively useless since it just said what I knew going into it:  I don’t sleep well. I fall asleep but I wake up a lot, so much that it basically turns my night into a series of small naps rather than good, restful, sleep.  My soon to be former neuro said that he’d been trying to get the results of my sleep study but failing.  “Oh I can get you those” I say.  “They recommended a follow up study with a CPAP because I guess they say I might have upper airway resistance syndrome….whatever, I just wake up every night in the middle of the night drenched in sweat.  I doubt it’s gonna help that.”  Turns out that I am very wrong about this.  I should have realized, I don’t sweat.  Unless I’m passing out.  That should’ve been a clue that the waking up in sweat was something other than being overheated.  My soon to be former neurologist explained (and I won’t do it justice here, so pardon my paraphrasing):  when you have something like sleep apnea or upper airway resistance – they’re really kind of the same thing, just a little difference in the mechanism and severity – it can activate a sympathetic response (hence the sweating).  There’s also evidence that it can contribute to the development of cardiac arrhythmia.  Hands up, who just had two weeks of intense palpitations and a racing heart rate for no good reason?  Oooh, oooh, me!  I did.

Ok, to sum up, what he’s telling me is that the waking up drenched in sweat is probably caused by the airway obstruction rather than in addition to (which is what I thought), and that this potentially has much further reaching consequences than a bad night’s sleep.  I’ve done a bit of reading since the appointment, and it sounds like it’s a sort of “chicken or the egg” thing with regard to autonomic function too.  I.e. bad one makes for bad other, although which one comes first is up for grabs.  But maybe fixing the sleep could help with some of the autonomic function.  Gosh that’d be swell.

Now, I just need to get my ass into the sleep lab in the next week or two and maybe this will all have been worth something.

“you look hypermobile…”

This is what the physiatrist said to me yesterday in her office.  Oh how nice to have someone not question this because I no longer can do all my bendy things without hurting later.  Even the easy guided motions we did during the exam made me hurt about a half hour later.

“People like you, they don’t usually dislocate all the time as much as they sublux.  Subluxing is like a partial dislocation” she told me, moving my arm into a ridiculous position behind my back while checking my range of motion.  “Oh boy, yeah, look at that…you’re really flexible.”

The disappointing thing was that she had been saying PT with weight training and I was like “!”, but that was BEFORE she examined me.  Specifically, it was before she got to my hips and sacrum.  “This is….did you know your left hip is considerably higher than your right?” she asked.  “No, but I’m not surprised to hear it,” I told her.  “When I’m symptomatic, there is a lot of clicking and popping going on back there.”

As we were wrapping up the exam, she said “I don’t think PT would be good right now.  Until that’s fixed, it’ll actually just make things worse.” She has a chiropractor that they use, she said he is really good and doesn’t rack up the extra visits.  Ok, well I’ll give it a shot.  If it’ll have some promise at fixing the shockingly intense and enduring pain I get from things like walking or going over a bump in the car, I’m game.  I can’t imagine that this is a good thing, to have your hip all bent out of place.  Can’t imagine it’s good for your hips, pelvis, back, etc.  You get the picture.  She even drew me a picture, showing me how she thinks my hip is rotated.  Well now.  How come no one mentioned this before?  She also strongly recommended I start taking melatonin and magnesium supplements.  She says they’ll help with the pain sensitivity, but for me, honestly, better sleep would help with a lot of things.  When I don’t get enough sleep, I am spacey, and when I’m spacey, I move badly – then I hurt myself.  I also identified sleep deprivation as a significant migraine trigger for me many years ago, even back before I had them all the damned time.  Magnesium’s supposed to help with migraines too, so we’ll see.

Other doctor stuff this week…

I finally had my appointment with Neuro #3.  It went pretty well.  I’m finally (!) getting that ganglionic acetylcholine receptor antibody test I’ve been asking about for 6 months.  He’s the only person who has said he’d like to rule out what I would like to rule out (autoimmune autonomic ganglinopathy).  It can take months to get back, only two places in the country do it (Mayo is one, I think I knew this from my research, they had a really nice protocol for testing).  We talked about midodrine for the POTS, he thinks it might help my gut if I got my POTS under control.  Hm.  Maybe.  Mr. Patient was there with the magical ID badge too.  Mr. Patient asked “And would you just recommend treatment to her primary care or would you prescribe it yourself?”  Neuro #3 said “Oh no, I’d follow her.  And I’d want to follow you, I wouldn’t just prescribe.”  Good.  Finally a specialist who isn’t like “ok I did my thing now fuck off!”

My cousin, who is not related by blood but should be, had asked me the day I saw Neuro #2 back in September if I could recommend a good primary care because she was done wit hers.  I gave her my doc’s contact info.  Texted with her last night and she says he was great.  She also says he agrees that we must be blood relatives somehow, because not only do we sort of look alike and act alike, but we also have crazily similar medical stuff.  I’m glad that I could connect her to my primary care.  He doesn’t have all the answers but he’s smart and caring and I think he’s exactly who people like us need.  First on the list, he’s sending her to the geneticist I saw in 2012 after serend-hip-itously “subluxing” my hip at a visit with my primary care.

So that was my two days of doctor appointments this week.  Back to the office today, where I am scheduled to meet with HR to discuss the locking of the accessible entrance to my work building.  I’m not sure it’ll make a difference, but I am sure doing nothing will not.  So off I go, to charge another windmill!