Suicide and Physicians

This week, it was announced that my colleague and pulmonologist was found to have committed suicide. He disappeared about two months ago and his body was found about a month ago. The medical community in the Fox Valley and Waupaca has lost a wonderful and compassionate physician.

I first knew Jeff as a colleague when I was working as a Family Doctor in Waupaca. I referred complicated pulmonary cases to him as well as getting ICU consults. He was always incredibly professional, but also just a nice guy. After I quit practicing, I went to see him for a sleep study and I was diagnosed with obstructive sleep apnea. I saw Jeff as a pulmonary patient once a year. Again, he was professional and a nice guy. And he always asked about my migraines and about whether or not I was close to being able to come back to practicing medicine.

He hid his depression well, as those of us with depression tend to do. But, 400 physicians every year commit suicide. 400. That's a lot. Too many. According to what I've read, the primary underlying cause is depression or bipolar with substance abuse coming next.

Why so much suicide? I've done a little research and what I've read confirms what I experienced. Even in physician groups that try to do a good job of finding depression in patients, physicians are terrible at taking care of ourselves. Many physicians don't have a primary care physician themselves. Many don't recognize the symptoms of depression to see a physician.

And then, there is the stigma of depression or, even worse, substance abuse. Admitting to substance abuse can affect licensure and future practice. This is devastating to a physician.

There are remarkably few support structures for physicians who are depressed. Apparently, Jeff was known to have a history of depression, so he, at least, was in the mental health system. But, he was in a minority. Most physicians with depression or otherwise at risk for suicide don't seek help and don't have much help available.

Working in medicine can be stressful and overwhelming. I worked in a large medical group that did make some attempts to provide some mental health resources in times of stress. After a case where we lost a baby, both the clinic and the hospital did debriefing sessions to help us process our feelings. At the hospital debriefing, the (humanist) chaplain said, "Well, we know that life has no purpose, but we can still find meaning in it." I left soon after. I was reading the book of Lamentations at home and trying to find meaning through God. I didn't find the chaplain helpful at all. At the clinic debriefing, we were led by an EMT and didn't try to find any religious meaning, but talked through our actions on the day in question. It was much more helpful. So, the current structures to help are iffy, at best.

But, it's not just the bad days that are the problem. Medicine is inherently overwhelming. Physicians are expected to not make mistakes day after day after day. Working in an ICU has the immediate life and death decisions, but even the day to day work of a family physicians has the overhanging dread of making a big mistake. And this is just wearing.

I'm going to miss seeing Jeff once a year for my pulmonary visit. I'm sure his friends, family, and colleagues are devastated by their loss. And what is so sad is that Jeff had an illness that probably could have been treated.

I've written before about depression. Untreated depression leads to suicide. And it leads to suicide more often for physicians than for other people. 

Please, whoever you are, if you are depressed, contemplating suicide, or even just thinking that the world would be better without you, talk to someone. If there's no one around to talk to, call 911. They know who to contact to get you help. 

Depression is a fatal illness. And it hurts more than just the person who has it.

Depression, Medications, and Me

A number of years ago, I read a letter to the editor of the journal of the Christian Medical and Dental Association that questioned the use of anti-depressants. The author suggested that if some of the authors of the Bible like David and Jeremiah had lived in modern days they would have never written their portions of the Bible because they would have been medicated. At the time, I disagreed with the assertion, but I didn't have the confidence or experience to write back. Now, fifteen years later, I'm going to respond to that unknown physician.

Anti-depressants are used to treat depression, not sadness or guilt. Depression is not ordinary sadness. Yes, the primary symptom is sadness, but it also includes lack of motivation, inability to feel happiness, and physical symptoms such as sleep disorders and appetite changes. 

We know that anti-depressants work when someone starts to feel normal emotions, not just happiness. In fact, someone on anti-depressants will feel sad at appropriate times, but will be able to feel happy at reasonable times, as well. A depressed person can't feel normal emotions. I can speak to this because of my experience as a physician who has prescribed anti-depressants to patients, but also because of my own depression.

There's no evidence that David was depressed. He was still able to write much of the book of Psalms. A depressed person has difficulty doing things because of a lack of motivation. According to Psalm 51, David did feel appropriate regret and remorse from his "affair" with Bathsheba and his subsequent murder of her husband.

Jeremiah was very sad about the state of Judah and the prophecies that God had given him, but he was also able to continue to prophecy. Again, there was no evidence that he was depressed.

So, the whole issue comes down to whether or not anti-depressants make us "not ourselves" and whether or not God wants us to use them. After all, if they would change us so much that God wouldn't be able to use us to do something like inspire the writing of the Bible, then they must be pretty bad.

Hogwash! Depression is an illness of the brain. It makes it's victims feel sad and melancholy and unable to feel happiness. Anti-depressants don't make a person feel happy; they make a person able to feel normal emotions, both happy and sad.

I've felt the stigma of depression, but I'm glad I've been willing to accept treatment. My risk for depression was really high based on my family tree. There is depression and addiction scattered throughout my family tree on both sides. I was fortunate that my first bout didn't happen until I was in my 30s. Now that I've got chronic migraine, depression is an unwelcome companion.

Without treatment, I wouldn't just be sad, I'd be sitting on the sofa and doing nothing. My doctor and I are titrating up my dose of amitriptyline, which is the second anti-depressant I'm on (I'm also on citalopram). I don't really like the side effects of the amitriptyline (dry mouth, hunger, fatigue) but I've spent this summer being sad and headache-y from trying to go without my medication. 

My depression meds aren't my entire treatment. They help adjust my brain chemicals, but they are helped significantly by counseling, exercise (when my head doesn't hurt too much), and a (somewhat) healthy diet. 

Depression is real. It's treatable with non-medical treatment and with medications. It seems to me that if God is OK with antibiotics for strep throat, then he's OK with anti-depressants for the biological illness of depression.

And the meds work. I'm still having headaches, but my mood is finally better. I'm tolerating the headaches better. I'm not happy about the headaches, but i can feel a range of emotions again. And it feels so good.

Just stuff . . .

• Chronic migraines suck. Really. I'm on Day 4 of this one and going crazy.
• The increased dose of amitriptyline is decreasing the intensity of the headaches so I tolerate life a lot better. I'm increasing up to 100mg (with my doctor's permission) tonight to see if we can stabilize things even more.
• The liquidators came this week and bought the last of our yarn, notions, and fixtures. They didn't pay near what they're worth, but we knew that. The fact is, they paid something and they took the stuff away.
• Wild Man has the music room in the shop looking good. And we still have a good incentive to replace the old windows and update the heating and cooling system since he's keeping musical instruments in there.
• When my head calms down, PWM and I are going to spend a night at a hotel with Sleep Number beds because we think that we want to purchase one. There's a hotel in the Valley that has those beds, though, and we'd like a full night's sleep to see if they're as good as advertised. Then, Rosie Girl can have our queen sized bed in her apartment and the double bed will go in the guest room out in the shop.
• Poor Wild Man has a cold and went to see the NP today for the cough. He doesn't need antibiotics, but he got steroids, and inhaler and cough suppressant. The combination of steroids and inhaler makes him quite jittery and he's not happy about it! But, he's not coughing as much and will probably be able to sleep tonight
• Rosie Girl has a real, live boyfriend. They don't get to see much of each other because of work schedules in the summer, but they'll get more face time when school starts!
• I've been pondering 1 Corinthians 11. It's the chapter about head coverings in worship and it's quite confusing. The interpretation that makes the most sense to me is that Paul was having a mock conversation with the Corinthians. Here's a link to a good post.
• I've been distressed this week at how little I've been able to do. I cooked dinner on Monday and Tuesday nights. Other than that, we've had food from The HItching Post, leftovers, and PWM grilled. So, we're not starving. I just feel bad when I'm sitting and reading a book when others are working.
• We got a new deck. The contractor was just going to replace the sections that had been made with untreated lumber and leave the good stuff. It turned out that there was untreated lumber even all the way up to the house, so we had them just start over. Now, we have a brand new deck with all the railings up to code and the stairs with proper width, etc. I keep forgetting to take pictures. And, we have to stain it in about a month after the lumber all dried
• Our tags for our items for the fair came in. We're still a bit confused about when to take our stuff and where, but we know who to ask now. The tickes had misspellings that had to be remedied and I didn't now that I could only submit one item per category so they just put my second item under PWMs name. I think we understand the basics now.
• Well, it's probably time to try to sleep. I had a three hour nap today, so I'm not super tired, but I could probably sleep if I had a chance. We'll see.

Sin Management or Grace

First, you need to go read this post by Chaplain Mike at Internet Monk. Done? Good.

I don't want to talk about depression today, although I could and probably will spend lots of time talking about it later, especially now that I feel better. Instead, I want to talk about "sin management".

I grew up Evangelical and Modern and Productive and I'm very good at sin management. This is what Dallas Willard calls our tendency to find a sin in our lives and then make a project of getting rid of it. Our Christian bookstores are full of books to help us deal with our various sin issues. We find the problem, get to the root of it, deal with it, and we're done. I like that approach. We do that in medicine. Have an ear ache? I'll figure out what's causing it, give you treatment, and hopefully you are cured.

But, is sin management really how God works. Some people would say no. In fact, a majority of people, if pressed, might agree that sin management is hit and miss at best. And it's not really scriptural. Have you noticed how the self-help (sin management) books have to do a lot of proof-texting of bible verses to make their plain work? Have you noticed that Paul doesn't write letters saying, "Hey, here's a four step plan to quit drinking, a three step plan to quit lusting, and a six step plan for success in your business." Yeah. The greatest preacher in history didn't write much in the way of how-to.

So, what does Got want us to do? I mean, I grew up in a world of solving problems. That's what I do. When I was working in medicine, my job was to try to understand a person and their illness (not just the illness), figure out the problem, and come up with a rational treatment plan. And that's how I lived the Christian life for a long time, too

When I read the Bible, though, I find something different. In the Old Testament, God has given us the story of Israel. I think God wants us to get to know him through these stories. And I think he wants the same thing when we read the New Testament. We meet Jesus in the Gospels. Then we walk with Jesus through the Epistles and learn through the letters to the churches how we can use that wisdom in our lives today.

The sin management thing hasn't worked for me. And, nowadays, my biggest problem is pain. I don't need God giving me assignments. I'm just too tired. I need grace. I need to walk with Jesus. And when I slip and fall, he's still there when I come back. He hasn't chosen to heal my pain. Yet. 

And then, as Chaplain MIke reminds us, joy can break in. Because God is doing everything, not me. I just walk along with Jesus and do as I'm told. Because grace.

The end of The Knitting Nest

Tomorrow is the last day of The Knitting Nest. I have seriously mixed feelings about this. I really liked being a small business owner. But, I was never really the owner. PWM did all the paperwork; I never got around to learning QuickBooks. I liked the customer interactions except when I didn't. On the days when my head hurt - which was a lot - it was hard to deal with customers. And on really bad days - which are unpredictable - I couldn't get out of bed. So, yeah, I'm going to miss being with customers and talking about yarn and patterns. But, I won't miss trying not to be sick when I really am sick.

Something else that's hard for me, though, is that I have a sense of failure. I feel like I should be able to keep the shop open. My conscious self understands that this is crazy talk. I have chronic migraine which is a chronic illness. I can't predict which days I'm going to feel well. Trying to run a small business even a few days a week is an exercise in futility. Instead of doing something that's just going to lead to closing the shop in a few months, we're doing the responsible thing and closing now, in the summer, while PWM can do a lot of the work (especially since I've had terrible migraine and depression for the last month). And I'm going to keep telling myself that this is a good thing and we didn't fail.

And, it's going well. We've sold probably 75% of our stock already and are hoping that tomorrow is busy as well. What's left tomorrow will be given to some carefully selected charities and the rest will be liquidated. We have plans for the building, including a guest bedroom, woodworking space for PWM, and a music room for the kids. I'm excited because we're bringing my grandfather's armoire into the living room for my yarn storage! (Yay! Redecoration!)

So, this is a bittersweet time. We are glad for the four years that we had The Knitting Nest and for all the friends that we've made. (I've had two people give me their phone numbers and ask me to call them for them to come knit with me on days when I feel OK. Isn't that sweet?) We'll miss the shop. But, we're excited for what comes next. PWM loves teaching and is glad to be able to spend all his time focused on his students. I'm going to start off by spending some time resting and then working on some projects at home. After that, we'll see . . . .

Abortion July 31

Abortion and Planned Parenthood are in the news again. Honestly, abortion should be a headline every day. The killing of precious little lives, even if they are in the womb, is unconscionable.

But, what is also unconscionable is what brings women to abortion clinics in the first place: an unplanned pregnancy and a feeling of being trapped. This is where we need to spend some time and money if we are going to lower the abortion rate. Young men and women need to learn about sex and contraception and have access to affordable contraception. For a long time, I was an advocate of abstinence-only sex education, but studies have shown that kids in those programs were getting pregnant at a higher rate than their peers; it wasn't working. Kids in comprehensive sex education programs are the ones getting pregnant later. And, nowadays, kids are becoming sexually active later no matter which program is being used.

Women need access to contraception. Whether or not it is fair, women control the contraception decisions in couples. And women are sexually active these days whether they are married or not. Affordable contraception is important. For working women, contraception is part of normal healthcare insurance. For women who don't work full-time, Planned Parenthood and other community resources are necessary. In any case, without contraception, abortion becomes the back-up plan. And it's a bad one.

Women also feel trapped in their pregnancies because of what happens after they give birth. Women already in poverty know that having a baby almost eliminates their chances of higher education. Trying to work, find childcare, and a reasonable living situation are difficult enough when you already live well below the poverty line. And more babies equals more pressure.

What can we, as Christians, do to help stop abortion? There are lots of things. There is the political route of voting for candidates who will not support abortion. But this post is focused on social issues. First of all, make sure your own children get a full understanding of sexuality and contraception. If you have the chance to help at a school, then do so. If you are a medical professional who can work at a free clinic that provides women's health-care, then do it. Not only can you help provide contraception, but you can counsel women about minimizing their number of sexual partners, preventing sexually transmitted infections, and choosing life. And we can all participate in anti-poverty programs. Giving food to the food bank, giving to Goodwill or other thrift stores, helping with childcare organizations. Anytime we help with poverty, we are giving women a chance to lift themselves a little higher.

These aren't my only thoughts on abortion, just the ones provoked by a Facebook post by Rachel Held Evans. When my head doesn't hurt so much, I'll write more.  What are your thoughts??

Fort Wilderness 2015

We're home from Family Camp! And, as usual, we had a great time. Here are some of the highlights.

• There was a new music who was great. And, Wild Man got to play bass guitar during morning worship on Thursday!
• On the morning we left for camp, I woke up at 4am with a migraine. Fun! The migraine stuck around for the first 2 days of camp, so I did a lot of sleeping.
• On the last full day of camp, I twisted my ankle while walking to the lake for the Loon Float. We ended up not seeing the loons (the first time in about 10 years that Michael hasn't seen the loons!). On the way back to the cabin, I twisted my ankle again, this time pretty badly. PWM and I went to Marshfield Clinic in Minocqua where I got an air cast and some pain meds (I can't take ibuprofen). I have a badly sprained ankle or possible fibular fracture, but they're treated the same way, so I didn't get an XRay done. So, I'm hobbling around.
• Wild Man won the archery tournament for his age group!
• Rosie Girl and her friend, Maggie, went on several horse rides.
• Wild Man and his girlfriend went on the tube float (floating down the Wisconsin River in inner tubes) and were part of a seaweed fight.
• During the tube float, Rosie Girl babysat a couple of kids for a family who didn't all want to go on the tube float. Apparently, running around after 6 and 4 year old boys for three hours is pretty tiring!
• Rosie Girl, Wild Man, PWM, and Jenna (Wild Man's girlfriend) were all in the carpetball tournament this year. Jenna did better than anyone else - and it was her first year!
• The food was beyond delicious!
• Rosie Girl made a pair of moccasins at the craft shop.
• It rained all day one day, so we played games and read aloud a lot in the cabin that day.
• Maggie is the undisputed winner at Sequence.

That was our week at Fort Wilderness. We can't wait to go back next year. And, we're already unpacked with everything put away except for laundry!!

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. 

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.

Negative

• 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.

Positives

• 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!!

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!

Migraine Update - Migraine and 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.

Sex Abuse and the Church

So, by now we've all heard the horrific news that Josh Duggar sexually abused several young girls, including some of his sisters. Why is this news? This happens all over the place in all kinds of families. This is news because the Duggar family presents themselves on a reality show as model of how living in a large, close, purity-culture family can result in children who grow up without the problems of the culture at large. Information of sexual abuse within the family negates this kind of assertion. It's also news in our culture because we are watching how poorly local churches and the Church writ large handle sexual abuse among our brothers and sisters.

Thank God, I've never been sexually abused, assaulted, or traumatized. Unfortunately, I've been affected by it in churches with which I've been associated throughout my life - and it hasn't been pretty. Churches are screwed up when it comes to sin - likely more so than the rest of the culture.

Churches don't want to admit any kind of sexual abuse has happened among our own because we don't want to admit to sin. We use phrases like "protecting the name of Christ". Honestly, do we want to be associated with a God who can't protect his own name? We are afraid to admit that something sinful might have happened among our sinful members!!

But, yet, the church is the one place where we say we can handle sin! We know Jesus who offers grace! I'm not suggesting that we offer "cheap grace" and that as soon as a sex offender says "I'm sorry" that we let the person back in church leadership, but I am saying that the church needs to get over "making Jesus look bad" by trying to keep our sin secret.

Many churches have also decided that they can handle everything within their own walls and don't need help from outside sources. Ummmmm, this is actually illegal when we're talking about sexual assault and minors being sexually abused. Clergy are mandatory reporters and are required to report illegal acts to law enforcement. It is also important for victims to get appropriate counseling, from someone with adequate training. Most churches don't have these resources in-house.

I've seen at least one church almost fall apart over a sexual victimization case. It didn't have to be that way. In another case, the church leadership listened to the victim and took the person seriously. 

But you know what? It's not like one case ended happily and the other didn't. One ended a little better, but sexual abuse and assault are never pretty. They are sin. One person is using their sexual power over another person. How awful!! The perpetrator requires much work in their life to deal with the sin. The victim, even with adequate counseling, is going to be affected for the rest of their life.

What can I do about this? What can you do about this? It depends on who you are. I'm a mom of two young adults. I've tried to raise them in a loving, open, non-legalistic environment to be compassionate adults. I pray for them daily. Otherwise, I can pray for the church (local and global) and our response to sexual abuse. And, when I find out about abuse, I can stand up about it and not let it lie. Victims deserve to be heard. They must be loved and cared for. Perpetrators must be exposed and not allowed to hurt anyone else. They require care of a very different kind.

What you can do depends on where you are in life and what you do. If you work with kids, keep your eyes and ears open! And believe the children! If you work in a church environment, stay sane and remember that hiding sin is never the answer! And, pray. Always, pray!!





P.S. Here are a couple of the best articles I've seen on the topic so far:
http://zackhunt.net/2015/05/22/wheres-pile-stones/
http://www.washingtonpost.com/news/acts-of-faith/wp/2015/05/22/why-we-cant-expect-sex-abuse-victims-to-generate-instant-forgiveness/?postshare=8791432302693972

I Miss Homeschooling - Kind of

Rosie Girl and Wild Man have both been primarily homeschooled. Rosie Girl was in 3 year old preschool and then took some middle school and high school classes at the public school. Wild Man did 3 year old and 4 year old preschool as well as taking middle school and high school classes.

Rosie Girl completed high school through twelfth grade by homeschooling and is finishing her second year at UW Stevens Point studying music. She's making all As&Bs (while being convinced that she's failing).  She wants to compose and is making her first forays into composition this semester. She's also going to be taking some jazz piano lessons. And she teaches tap dance at a local dance studio. And she's now on the market for a more steady job to add to the teaching. Ah, the life of an adult.

 Are there things I would do differently? Absolutely! Would I send her to full-time public school? Not unless she really wanted to go. I think homeschooling was a great choice for her. Rosie Girl is, by nature, introverted and creative. Home education gave her a great chance to pursue lots of her creative venues, including writing, poetry, drawing, and music. She played piano, ocarina, and guitar. She took and taught dance class and took piano lessons. She also took art class at the high school and was part of the poetry club. Being introverted certainly didn't mean she was bored! But, it appears that home education has pretty well prepared her for college and work.

This year, we sent Wild Man to Wega-Fremont High School for 11th grade. Can I be honest for a minute and tell you how worried I was? I wasn't worried about the social side of things? In fact, I wasn't sure he could be quiet enough to get through a class!! And, I was more than a bit stressed about the whole dyslexia thing - he reads and writes well, but not quickly.

So, he started in a pretty routine set of classes. But, for math, he was in Geometry instead of Algebra 2 because he got behind in math because we were working so hard on reading in late elementary and middle school. And, he isn't in American History since he's already had that class in homeschooling. However, he's in the National Honor Society!! He must be doing OK on the academics and social stuff and volunteer work at school! He also got the Musicianship Award for 11th Grade for Band this year! And was the lead in the school play - Pippin!! And got an Exemplary at State Solo and Ensemble for his Musical Theater Solo and a First for his Classical Solo and a Second for his Snare Solo and a Second for the Percussion Ensemble.

It's been a good year! He's thriving. And planning to study Algebra 2 over the summer so he can take Pre-Calculus next year along with Physics and AP English 12. And he has a couple of jobs. I think he'll be ready for college next year, too. And ready for the world after college, too.

But, I kind of miss homeschooling. I don't miss having to set up notebooks and make sure that the kids were actually doing the reading or watching the DVDs or lectures or whatever. I liked that they were home for more of the day with me. During practice for the play, Wild Man would get home at 8:30 or 9pm. I go to bed around ten, so we didn't get much time to just hang out. At least during the summer, even if he's working, he's at home for part of the day. We can just be with each other. And Rosie Girl will be with us again this summer. 

They're getting so old and are going to start having apartments where they live all the time. And I don't even want to think about the fact that they might need to move away from here to chase their dreams. But, PWM and I have loved our children and talked to them and prayed about our choices and prayed with our children as we launch them on the world.

I think so far, the choices have worked out well. The first two years of Rosie Girl at UWSP have been quite successful. The first year of Wild Man at Wega-Fremont has been also successful. And, I should add, that PWMs year at Wega-Fremont as a math teacher has also been successful. And we look forward to a happy and productive summer!!

Nepal, Doubt, Aquinas, Lament

There are days when I get overwhelmed by doubt about the whole God thing. I'm sure it happens to some of you. Of not. Maybe I have a weak faith.

Technically, I don't wrestle with the existence of God. I would never become a true atheist. I find Aquinas' "first cause" argument and teleological arguments very convincing. I don't think I could ever look at the world and think that it just came into existence without some supernatural help.

But, natural disasters like the earthquake in Nepal are my theological downfall. They make me want to be a deist. On my Facebook feed was posted a picture of a baby rescued over a day after the earthquake, which really is amazing. People were sharing the picture and commenting how God was really looking out for this little one. I just wanted to cry out, "But what about the thousand other little ones?! Was God taking a break then?"

I know that there's some mature, Christian answer to this about it all being God's plan, etc., etc., but I'm not a Calvinist for a reason. It makes God a monster. And the God described in the Bible, particularly the New Testament, is a loving and merciful God, not a monster.

So, what is a reasonable response to this without going flat out agnostic or deist? I think it starts with lament. There are several places in the Bible that we see lament: Job, Psalms, and Lamentations (along with a few other places in the major and minor prophets). These are scriptures where humans are crying out to God for justice and mercy. This is a legitimate request. When are you going to restore Jerusalem? Yes, we broke the covenant, but have we paid enough yet? OUr enemies are crushing us, Lord; when will you save us?

I prefer the book of Lamentations. A bit more than halfway through, Jeremiah (the author) suddenly says this:
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.”

I'm not quite sure HOW he is able to say this, but he does. In the book of Job, Job is talking to his friends about how God has deserted him, but then he says this:25 
I know that my redeemer[c] lives,
    and that in the end he will stand on the earth.[d]
26 And after my skin has been destroyed,
    yet[e] in[f] my flesh I will see God;
27 I myself will see him
    with my own eyes—I, and not another.
    How my heart yearns within me!

Again, Job is hanging on to his faith in the midst of his crisis. But, he is doing so honestly, through his lament.

He is not presenting a triumphalism that isn't real. He isn't trying to say that life is great when it's not. This isn't the Evangelical "happy clappy" "let's show  the world how great life is because we're Christians" kind of airbrushing. He and Jeremiah and the writer of the Psalms are honest and open about how rotten life is. Yet, they cling to what they know.

And I will do the same thing. I am following Jesus. Even when the world around me is crumbling. Even when earthquakes kill thousands of people for reasons I will never fathom. Even when there are riots that I don't understand. Even when I have chronic illness and am stuck not doing what I thought was my calling in life. Because I know that my redeemer lives. And because of the Lord's great love, I am not consumed, his compassions are new every morning.

Join me in lament and prayer for all the horrible things that are going wrong in the world. And let's hang on to the truth of Jesus and not give up.