Friday, June 26, 2015

Great Is Thy Faithfulness

Great is thy faithfulness, O God, my Father.
There is no shadow of turning with thee. 
Thou changest not, thy compassions, they fail not.
As thou has been, thou forever wilt be.

Summer and winter and springtime and harvest.
Sun, moon, and, stars in their courses above,
Join with all nature in manifold witness
To thy great faithfulness, mercy, and love.

Pardon for sin and a peace that endureth.
Thine own dear presence to cheer and to guide.
Strength for today and bright hope for tomorrow.
Blessings all mine, and ten thousand beside!

Great is thy faithfulness; Great is thy faithfulness;
Morning by morning, new mercies I see. 
All I have needed, thy hand hath provided;
Great is thy faithfulness, Lord, unto me.

This is my favorite hymn of all time. And, now, at age 47 (OK, almost 48), I can still sing it with as much feeling as I even could. God is faithful. He knows how rotten chronic migraine is. He knows how miserable it is to be closing up The Knitting Nest. Yet, He's here and giving us little blessings through the whole thing. And reminding us of the bigger picture - my improved health by not trying to run a business that I can't and Patrick working in the school, which is clearly where God wants him!

What I didn't learn until early adulthood and what wasn't significant to me until a few years ago is that this hymn that celebrates God and his faithfulness is actually part of Jeremiah's lament in the book of Lamentations. Here's the quote:
Lamentations 3:19-33
I remember my affliction and my wandering,
    the bitterness and the gall.
20 I well remember them,
    and my soul is downcast within me.
21 Yet this I call to mind
    and therefore I have hope:
22 Because of the Lord’s great love we are not consumed,
    for his compassions never fail.
23 They are new every morning;
    great is your faithfulness.
24 I say to myself, “The Lord is my portion;
    therefore I will wait for him.”
25 The Lord is good to those whose hope is in him,
    to the one who seeks him;
26 it is good to wait quietly
    for the salvation of the Lord.
27 It is good for a man to bear the yoke
    while he is young.
28 Let him sit alone in silence,
    for the Lord has laid it on him.
29 Let him bury his face in the dust
    there may yet be hope.
30 Let him offer his cheek to one who would strike him,
    and let him be filled with disgrace.
31 For no one is cast off
    by the Lord forever.
32 Though he brings grief, he will show compassion,
    so great is his unfailing love.
33 For he does not willingly bring affliction
    or grief to anyone.

This hymn that celebrates God's faithfulness was born out of a lament. The people of Israel were suffering in an awful way and this was their crying out God for relief. Yet, in the middle of their distress, they remembered God's faithfulness in the past.

This is what I want to do when I sing this song. To remember God's faithfulness and love and mercy despite whatever is happening now. Despite the headaches. Despite the life changes. God is faithful. 

Wednesday, June 24, 2015

My life with Chronic Migraine

Chronic illness has made huge changes to my life. I don't want to write like I'm a victim. I may not be in control of all of my life, but I know that God is. And that's a huge comfort. But, my attitude and my faith are tools that God can use to help me to deal with my chronic illness. But, here are some negative and positive changes that have happened in my life since I was diagnosed with chronic migraine.


  • I had to quit working. I loved working. I was a family doctor who did everything from delivering babies to nursing home rounds. Life was never boring and quitting was the furthest thing from my mind. Until the pain. Suddenly, I couldn't stay up all night without a migraine the next day. Then, the migraines started sprouting up without warning. Soon, I had pain just about every day. Then, it was time to say good-bye to medicine. Temporarily, I hoped. That was eight years ago.
  • Pain. Chronic migraine sounds like a really long migraine. Technically, the definition is 15 migraine days out of a month. That's a lot of migraines. But, in the process of becoming chronic, a person with chronic migraines also develops chronic fatigue, chronic muscle pain (much like fibromyalgia, if not actual fibromyalgia), sleep disturbance, and mood disorders. By the time I got to chronic migraine, I didn't feel like myself anymore.
  • Meds. I'm down to just seven daily medications without prn (as needed) medications, although my chart lists a whole bunch of supplements as well. Mostly, I'm treated for migraine, depression, hypothyroidism, sleep difficulties, muscle pain, and allergies. It could be a lot worse. 
  • Medication reactions. One of my medications, a NSAID, gave me mild chronic renal failure because I took it for so long. When I quit taking it, I had a terrible rebound headache that only calmed down when I started taking Botox.
  • Botox. This gets a special mention because of my love/hate relationship with it. (The same could be said for Prednisone!) I love that it works. I hate that it involves 30+ little injections across my forehead and scalp. My doctor works quickly, though, so it's over with in a jiffy. But, it's not a positive.
  • Isolation. I don't go very many places. My friends generally come here because I don't often feel well.
  • Cognitive dysfunction. I like to think and read. I get frustrated when things slow down and I can't remember events or I can't connect things. Just today, PWM had to finish doing the deposit for the shop because I messed up some addition (with a calculator!). This is beyond frustrating for someone with a couple of bachelor's degrees and a professional degree. 
  • Exercise intolerance. I manage some exercise every day, but not a huge amount. An hour of yoga is max for me. The last two times that I've walked two miles, it triggered a migraine, although I can do at least 1.3 miles and feel really well. I assume I'll be able to slowly increase this, but it's been slow at best. I've been working at it for several years.
  • The Knitting Nest. This was a positive, as you'll see. But, it has become a negative.  In fact, it has become obvious in the last few weeks that I can't run a yarn shop, even part-part-time, with my chronic migraine illness. And it's adding more stress, which increases the risk of migraine, the longer I try to do so. As of the end of the summer, The Knitting Nest will be closing it's doors. Deep Sigh.
  • Knitting. Only the worst headaches and nausea can keep me from knitting. I love yarn and fiber and knitting. I do sometimes set them aside for a week or two when i get into a good book, but then pick them back up with a vengeance!
  • Reading. I love to read both fiction and non-fiction. When I was working, I mostly read medical journals, as you can imagine. I missed all the novels of my high school and college years, so I have been reveling in read books and listening to audiobooks while I knit.
  • My kids. When I quit working, PWM started working in a machine shop and then when back to school to get his math teaching license so I became the stay-at-home homeschooling parent. It was a joy to get to know my kids so well during those years. Rosie Girl graduated from homeschooling while Wild Man started his Junior Year in public school this year (when PWM started at the public school after the school board asked him if he would come teach middle and high school math). So, now I don't have kids around all day anymore, but I cherish those days when I had preteens and teens. And, when they are home, they quite often bring their friends, both college student Rosie Girl and high schooler Wild Man!
  • My faith. People used to ask about my faith story and I said there wasn't much to it. I grew up middle class in the church and I believe what I believe. Nothing bad had ever really happened to challenge my faith. Until migraines. Constant pain of some kind with fatigue and nausea will certainly make a person question God - or at least God's goodness. I spent some time reading Job and Lamentations and Psalms trying to understand the concept of lament and sadness and how God works in that. I still don't understand, but I can rest in it and believe, which is OK.
  • The Knitting Nest. We started our yarn shop to help give me something to do on my good days. I've loved having it and was looking forward to more responsibility this summer and fall. I like teaching knitting and helping people with knitting problems.
  • The internet. It reduces the loneliness by connecting me with others with chronic illness, my friends that I don't see often because I don't get out enough, and helps me make new friends on sites that interest me!
I'll try to come up with something a little happier next time around . . . .

And Yet More Migraine . . . .

My chronic migraine disease has been beyond crazy this month! On my last post about migraine, I wrote how I got injections from my family doctor. That happens, oh, about once a year or so. And, that should have been it. Unfortunately, about a million triggers hit at once, and I got a week long migraine last week!

The prodrome started on Monday with extreme fatigue. I thought it was just because PWM and I had walked a couple of miles the day before. Alas, no. Well, the walking so far might have been one of the triggers. The migraine was in full force by Tuesday, and I was up Tuesday night vomiting. I thought I was over the worst and life would get better. NO. Wednesday night, I didn't vomit, thanks to the early use of nausea meds, but the pain got up to a 9. I don't get pain that high. At least very, very, very rarely. So, at 3am, we trudged off to the Emergency Department (for the first time in three years - that's something, right?).

After Benadryl, Morphine, and Compazine, my pain was approaching a 4, so we finally went home for me to go to bed. I was ready for everything to be done. But, it wasn't I spent the next several days with pain levels from 4 to 7, malaise and anxiety (who knew they came together) and general body pain. It was completely miserable. I couldn't sit to read or knit. I could only sleep for a couple of hours at a time. We tried going out of the house a few times - to get my computer fixed on Friday night and to a movie on Sunday night.

I thought things might be getting better until I woke up Tuesday morning back at a 7. So, I called Neuro and they called in a prescription for a Prednisone taper. I have a love/hate relationship with Prednisone. For one thing, it gives me insomnia, hence my writing at 3:15am. But, it makes the pain - head and otherwise - better. I can sit and read and write and knit - not all at the same time!!

So, with Prednisone for a week or so, I'll be hungry, jittery, productive, and I might gain a few pounds. But, my migraine will go away and I might feel otherwise "normal". I can deal with that.

I'm used to the day to day dealing with migraine symptoms, but this was a whopper. It completely knocked me out from any kind of useful activity for a week. And it has made me remember that chronic migraine is different from episodic migraine. Not only do the migraines tend to be longer and stronger with chronic migraine, but there are more symptoms and it's a constant illness. I was just recovering from one migraine when this one hit. Now I've got about a week to look forward to recovering from this attack. 

This is an exacerbation of daily life, but it's still daily life. Always having symptoms. Always figuring out what is the best thing to conserve energy for the next activity, to prevent or reduce the next migraine.

But, the Prednisone gives me hope that I'll come out of this attack. And let's pray it's another three years before I see the inside of the Emergency Department!!

Monday, June 15, 2015

Bring Them To The Feet Of Jesus

19 years ago, I was a resident in Family Medicine in Western Kentucky just finishing my second year of residency. It was a Friday afternoon and I had had an emotionally and spiritually exhausting week. I was ready for my weekend when I was finally NOT on call and did NOT have any babies due. But, a patient and friend called that afternoon and asked my husband if we would like to go to a revival service at a church in a nearby small town since she knew we "were into that church stuff". Patrick waited to call me before declining the offer. But, what could I say? Here was someone I had been praying for! So, we got a sitter and went to a country church revival service.

You should know what exhaustion looks like for a medical resident. I had been up all night Thursday night delivering a baby. I was looking forward to a free weekend, but that still meant going in to the hospital for rounds. I was on an OB/GYN rotation so I had been doing clinic for 8 hours a day plus hospital rounds before and after clinic every day. I was emotionally and spiritually exhausted from the problems that I saw every day in the clinic. I hadn't had time to get used to the parade of domestic violence, STDs, and promiscuity that came through the clinic daily. And then there were the unplanned pregnancy conversations. Just that Thursday, I confirmed pregnancy for a young woman and she walked out planning to get an abortion with no room for discussion of other options. Add to that the happy stress of delivering a baby earlier in the week to a mom who had planned to abort the pregnancy early on, and I was strung out emotionally!! By Friday afternoon, I didn't know which way was up, but I let Patrick drive and went along with the plan.

The revival service was at Charleston Baptist Church, which I will never forget because the town of Charleston was a church, a school, and a bar. Not even a post office, unless it was in the bar. But, people must have come from several towns over - hey, we came from Madisonville! I had no idea what to expect. This place was as country as I'd ever seen - and my family hails from the sticks of Mississippi!!

Well, they brought in their revival team from Bowling Green, so we got praise choruses as well as hymns! That was fun. And the music really helped to break down a lot of my emotional barriers. And the preacher was good. He spoke on the parable of the paralytic whose friends brought him to Jesus. His tagline was "Just bring them to the feet of Jesus". Dear God, that is what I needed to hear that night.

I had driven home crying that afternoon after the woman left the office after refusing to consider any alternative but abortion. I felt so helpless. I couldn't do anything. All of the sudden, that night, I felt like God was saying, "Just bring her to the feet of Jesus." Everything that had happened that week, and all the way up through residency, that made me feel so inadequate (yeah, so breathing!), all I had to do was "Bring it to the feet of Jesus." 

It was so freeing to realize that my responsibility ends when I bring the person to Jesus. I can't fix their problems. I can't fix anything. Only Jesus can. This is a freeing understanding to a perfectionist like me. Yes, I have to come back to it over and over and over. But, this was a true "God Moment" in my life.

When they gave the invitation, I just got on my knees and sobbed. I saw the faces of all kinds of women I had been praying for and I almost felt God whispering, "It's OK. You laid them at the feet of Jesus." What amazing peace I felt. This kind of thing has rarely happened to me. And I don't expect it. But, it was truly blessed.

And, then, Patrick touched me on the shoulder, to show me that my friend had gone up to rededicate her life to Christ. It was an excellent night!

Monday, June 08, 2015

Migraine Update - Migraine and Headache Awareness Month

National Migraine & Headache Awareness Month

June is Migraine and Headache Awareness Month, so I thought it would be a good time to post about the current status of my chronic migraine illness. When I planned to do this a few days ago, I was all optimistic about how well things were going. Then today happened. 

First of all, today. Actually, to get to today, I have to explain the last week or so. I had a three-day migraine last week that was triggered by storms, but made worse by the fact that I was in need of my Botox. The migraine was not only longer than usual, but was more intense than my migraines have been lately. In any case, I survived with my Imitrex, Cefaly, and a couple of doses of tizanidine (a muscle relaxer). I got my Botox treatment on Thursday, which wasn't fun, but was much-needed.

Unfortunately, Botox doesn't kick in immediately. I started having prodrome symptoms on Saturday night and woke up at 2am yesterday morning with a pretty high-level migraine (7/10). This migraine was triggered by weather and hormones. I didn't sleep much at all last night, so I was back up to an 8/10 this morning. I was supposed to have my annual physical today, but went in for an acute migraine visit instead. Normally, I would just tolerate this  kind of headache on my own, but I already had the visit scheduled and needed to keep the appointment because I needed to get medication refills. So, I got my meds refilled and ended up getting Toradol, Phenergan, and morphine. The migraine isn't completely gone, but I'm feeling a lot better!!

Overall, though, my chronic migraine disease has been stable, if not a bit improved since the first of the year. I have one to three migraines per week. The migraines generally last less than twenty-four hours, which is probably the one improvement in the last couple of years. I haven't been to the Emergency Department for acute migraine in over a year and to the clinic for acute migraine for probably about a year.

I recently stopped taking amitriptyline since my mood and headaches have been pretty good. I figured that summertime is a good time to try to stop it. My main reason to try to stop is because of side effects, and, in fact, I have lost about 15 pounds and am not eating nearly as much. Of course, part of the weight loss is because I'm obsessing on exercising because I want to keep my mood under control. Overall, though, stopping the medication has been successful.

What is working for chronic migraine and my other diagnoses these days?

  • Topamax - This is the base of my treatment. It's an anti-seizure medication that I take twice a day. The cognitive side effects are still problematic, but I'm not interested in trying to change it.
  • Citalopram - I'm using this for depression and it's working well. I have very few side effects, so I'm happy.
  • Botox - Thankfully, the treatments are only every three months. I'm needle-phobic, so 31 injections into my scalp is not my idea of a fun time!! It seems to be helping, though. I can tell when I'm ready for another round of injections every three months. My neurologist came up with another fun thing this time - an injection just underneath each eyebrow! I love it - NOT! We'll see if it helps. In any case, we're definitely continuing Botox.
  • Exercise - This is mostly for mood and general good health. My main exercise is walking, but I've developed metatarsalgia of my right foot (the ball of my foot hurts). I'm seeing the podiatrist tomorrow - Yay! I'm also doing yoga, which seems to be helping my flexibility and overall fitness. Also, Yay!
  • Tizanidine - I've been using this muscle relaxant at night for sleep, but I've also found that it works well for acute migraine. Granted, it makes me dizzy as all get out, especially since I use 4mg for acute migraine. But, it works.
  • Cefaly - This device makes me look like Wonder Woman or Arwen or some alien. It works by pulsing electric current across my scalp. I use it once a day and then if needed for acute migraine. I'm finding it pretty helpful.
  • Triptans - These medications are still the basis for acute migraine treatment. I was using Imitrex because it is the cheapest, but the side effects are pretty unpleasant. My neurologist has decided to try me on Relpax which didn't give me too many side effects on this last migraine, but it also didn't help much. Of course, nothing till the Toradol and morphine helped. In any case, if insurance covers the Relpax, I'm going to try that.
I still have a fair number of fibromyalgia symptoms to deal with. The standard line is that treatment is exercise. I'm exercising every day that my head will let me, but the FM symptoms don't really budge much. They aren't debilitating, so I just keep pressing on.

My depression is pretty well controlled. Citalopram is my primary medication, but I'm also using exercise and counseling as part of my management regimen. Now that I'm not on the amitriptyline, I have to pay attention to my sleep. I am not sleeping as late as I used to, but I have more energy, both of which I attribute to the medication change. I also do mindfulness meditation along with my daily prayer which is no small contribution to my depression treatment.

That's where I am with my chronic migraine and other chronic illness symptoms. There isn't a cure for chronic migraine which is why Migraine and Headache Awareness Month is so important. Research for effective treatment and an eventual cure is desperately needed. The disability from migraine is huge! And that's just MY disability - LOL! Seriously, the amount of time from work lost due to migraine is significant. We need to treat migraine like the serious disease it is.