You Don't Say

As some of you may know, I recently started at a new job.  Yes, that's right, I've moved out of the world of the frazzled auditor and into that of the in-house accountant.  My new coworkers are very nice, and I get to be part of some process analysis and revisions which are very exciting to my inner dweeb.  But the best aspect so far?  I leave every day before 5:30!!!  That's right, I'm bragging:)  (Ok yes there will be critical times when I have to stay 'late' but that's part of the biz, and late here will mean 6-7ish.  Holy mackerel.)

I've come into the team as a Senior Accountant, commensurate with my experience and the need to complete my CPA (yeah...that didn't die).  The same day I started, another new hire from a different Big 4 firm came in as an Accounting Manager (he had been a manager at his former firm).  I think we need a nickname for him...hm...let's call him New Dude, Too (NDT for short).  NDT and I have found that it was beneficial to start together because we can relate to each other's backgrounds and help each other transition to our new worlds.  None of our direct peers and few of our extended coworkers come from a similar background, making our connection that much more valuable.

There are aspects of the transition to a new role that I anticipated, such as learning to express myself in ways my new team understands and establishing my reputation anew.  Naturally, there are also things I couldn't prepare myself for, like the different approach a small company has to onboarding and training.  Figuring out how to more autonomously structure my days based on the combination of ongoing tasks and special projects on my plate is a surprising though welcome learning curve.  I realize these types of challenges are familiar to most people, but this is my first job change as an "experienced" hire so I find myself marveling at the experience itself!

NDT and I find ourselves on the same page about most things so far.  We like the same people, we note the same peculiarities with others, and ask ourselves the same questions as we learn how the company functions.  Since we are at different levels, we have been asked to take on different tasks, but we've leveraged that too. He's been working on projects related to mapping accounts which he explains to me, and I've been learning the nitty gritty things like how to work parts of the accounting system which I show to him.

I'm aware that as we're each establishing our images with the rest of the company, we are also developing our understandings of each other.  Maybe I'm not supposed to say this, but men at the Big 4 just tend to be more traditionally polite; some might say chivalrous.  They offer to carry things, volunteer for errands, and there are some you will never see walk through a door before a woman.  My observation is a combination of my personal experiences as well as discussions I've had with countless coworkers of both genders.  Perhaps it stems from the emphasis these companies place on classic manners such as which silverware to use for which course and email etiquette   As a pair of X chromosomes, I have to say that this is pretty nice.  It simply makes someone feel good to have someone else take a little extra effort to make their day a bit easier.  And as a clutz with occasional physical challenges, this kind of treatment can really come in handy.  However it's always been my opinion that men don't necessarily OWE this to women, and certainly that women can and SHOULD return the favors from time to time.  I'm just as capable of holding the door for a man or taking a package from an overloaded coworker.  Sometimes it just seems right to take care of my own task or get something for myself, even if it's just for the sake of taking turns.

I suppose this is why NDT made an interesting observation the other day.  It was a particularly nice, warm day and our company has a few tables outside for employees to use as well as a small walking track, and NDT and I like to use our newfound energy and time to make use of these amenities.  On this particular day, we had grabbed our lunches and headed out to one of the tables.  On the way, I offered to hold a door and press the elevator button, but NDT wouldn't let me.  During the ride downstairs he observed "you're a very ... [pause] independent [pause] person.  Like the other day when you wouldn't let me get the chair".

Me?  Independent?  Perhaps to the point of stubbornness?  Tosh.
...Well.  I don't know I'd use the word 'independent'.  Maybe 'empowered' or 'capable'.
...Ok, independent.  But that's a good thing!
...Ok yeah I see your point.

Fr. Anthony Messah describes what's it like to be an "independent-aholic" with this graphic, here.

So I tend to be a bit strong-willed, empowered, enabled, self-propelled...so what?

We could go with an old-fashioned childhood experience psychology here if we wanted.  I have strong, distinct memories from elementary school of teachers asking for a boy in the class to carry a heavy box.  The funny thing was, I was larger and actually stronger than most boys in my class at that age.  I was simply more capable of carrying the box than they were, but the teacher only asked for boys.  I usually challenged the teacher (yes, at the tender age of, oh, 6 or 7 until 11); some would acquiesce and ask for any student capable of carrying the box, but others would still insist to my face that they wanted a boy to do it because it was really heavy or a girl might get hurt.  It wasn't until well into my 20's that my strength began to fade.  I may have always been a clutz and accident prone, but I was also particularly strong in my younger life.  And those memories stayed with me.

But we could also acknowledge the effect of a chronic diagnosis on my will.  My strength as a child was sometimes dismissed, but on top of that it was threatened by chronic diagnoses as a teenager.  It's well established (in my mind) that this was the point when I developed the mindset that I don't know how long I can do any given thing, so I'm going to do anything I can as soon as I can, because I don't know how long that opportunity will last.  Maybe this same mindset led to this "independence".

Or you could ask my parents, who would say I was born that way.  There's a legendary story in my family about the L&D nurse who observed during my first bath that I had a "worried, worried look" and my innate perspective for simultaneously respecting and questioning authority.  I never took any explanation at face value, though I wouldn't exactly violate it until I was sure it was flawed.  It is said I was born middle-aged, with an independent questioning mind and a will that considered other people but didn't automatically agree with them.

And so between a natural inclination, a childhood perception, and an adolescent encounter, I stand before you today, "independent".  This is one of the first traits a new coworker noticed and went so far as to comment on to me directly.  Well, you don't say ;)

Enervated

I learned a new word this morning: Enervated.

Image found on a very cool Visual Dictionary site from Manhattan Prep GRE Blog.  I relate to this hippo.

I was a voracious reader as a kid.  Remember those summer book lists they put out for each grade level, and you were supposed to pick one or two books - depending on your level and just how far the school board had that stick up their collective butt that year - which you would read over the summer and report on at the beginning of the next year?  And inevitably, it would be two days before Labor Day and your mother would be hanging over you threatening not to let you enjoy those last few days of freedom if you didn't read that book already even though you both knew she was bluffing because unlike the school board your mother's butt was stick-free?  I loved those lists.  There were summers where I read the obligatory books from my list, but they had posted the lists publically so I went through the ones for other grades which were always 10 times cooler than my list and read a bunch of those.  One year, I think I knocked out the entire list for two grades.  And yes, I did other things, but no, I wasn't much of an outdoor person and I think in retrospect we can be glad I didn't spend more time in the sun at that age!

Anyway, as a result of reading so much I've always had a pretty respectable vocabulary.  Of all the "nerd" things I did, I never really minded being mocked for using "SAT words" because I liked being able to say precisely what I meant.  But when you're a smarterish kid and go to a smarterish kid college (Villanova) and work with smarterish people in a professional setting, it takes more than compulsory school reading lists to maintain this reputation.  It also doesn't really help that my best friend from school is an English major and my best friend now is a Journalism major with an unimaginable flair for all things peculiar and unusual.  And I'd NEVER want to let you, my dear readers, get bored with my basic and unenlightened language when I write!  I still love to read, but don't have the time to take down the volume of literature I did in the good ol' days, so now when I need a word to make my point or to do so in an engaging way, I leverage the wonder of the internet and hit Thesaurus.com!

So how did we end up with "enervated" today?  Well, all week the husband and I have been trying to take down some household projects which involved a significant amount of time running errands and traipsing through stores to find just the right thing at just the right price as well as drilling, assembling, moving, and arranging several rooms worth of goodies.  I've hung curtains in two rooms and a ladder on the side of the garage, made a truly manic pass or two around the yard with an imposing set of hedging shears, and assembled furniture.  In the process, I learned a few things:

• Sauder brand furniture is gorgeous and of a delightful quality, but heavy (each of our two dressers weighs as much as I do or more) and when they say "assembly required", they ain't kidding!  
• Left in the wrong hands (mine), even a moderate pair of shears can be leveraged to take down several bushes not to mention weeds, overgrown flower beds, and some God-awful plant by the AC compressor.  Also, with shears in hand I feel like a lady Paul Bunyan, felling microforests of weeds with one pass of my blades...but I digress before this gets creepier.
• My favorite weather is that which keeps me in a very mild sweat, and this makes me feel invigorated and up to taking on physical challenges, but also obviously makes it crucial to hydrate myself carefully.  Because of my combination of Sjogren's Syndrome and Dysautonomia, managing hydration levels involves a balance of taking in the right quality and quantity of liquids as well as the right volume of salt at the right times (I use a high sodium diet to avoid Beta-blockers).

And so, after yesterday (the apex of my physical activity for the week as performed on the hottest day) and without having consumed a drop of alcohol, I awoke this morning feeling remarkably hungover.  It took me a few minutes to piece together that it was really straight dehydration.  Guess I didn't quite hit the magic combination and timing of fluids and + salt yesterday after all.  I also went to bed last night with significant arm and shoulder pain from overuse, so at least it wasn't a surprise when that was my worst symptom again today.  

I wanted to come on here, share with you this tale of exertion and dehydration, and describe how my arms feel...but I needed just the right word to describe it:)  Unable to come up with this adjective myself, Thesaurus.com provided this gem:

Enervated: adjective; without vigor, force, or strength; languid.  

Example of use- "He had come in dehydrated, with sunken eyes, too enervated to even cry." 

(How ironic!)

Child, after my own heart, cited as Funny-potato.com but sourced from this vocab study guide.

I think that says it all.  Most of my body, and particularly my arms, are enervated.  I'd love to soak in a tub but it needs to be cleaned first and I don't have the strength to do it right now.  On top of it, my mother-in-law may come by to help teach me to garden (perhaps with a little less destructive yet cathartic abandon) and my Journalist friend offered to hop over and go on a trail walk with me.  I know that when my body feels like this I should really give it a FULL day truly recuperating, but I can feel my energized spirit fighting my enervated body on this one!  Perhaps I can try to limit myself of bouts of activity interspersed with couch-floppage?  I'm sure my friend will be just as happy to veg with me, the puppy, and a glass of iced green+white tea with mint, right?  Cause that sounds mighty good to me...

All-too-realistic comic strip by Chris Spain, found on his blog from 8/20/2012.

Solar Flares and Sjogren's

In a recent post of mine, I told you I was participating in our good buddy Julia's competition to design an image that symbolized Sjogren's Syndrome (or my experience with it).  Since Julia has now posted her finalists, I can reveal my full contribution (and I use the term loosely) to her effort.

As a visual thinker, I hoped the inspiration for this piece would come to me easily, but alas it wasn't that easy.  The only symptom that every Sjoggie I know has in common in fatigue, and nearly all experience brain fog, but I have no idea how to visualize these experiences.  I'm also not aware of any test, treatment, or device/tool that would resonate with all Sjoggies.  So instead, I thought about what having Sjogren's means to me.  To me, knowing I have Sjogren's frequently calls to mind the biggest, baddest trigger I have - the sun.  Sun exposure is what kicked my disease into an active state when I started high school, and even mild exposure or God forbid, a burn, can send me into a flare now.  The extreme, months-long flares I had in high school were much worse and it took a long time to learn how to manage my sun exposure more effectively.

That's when it struck me - the sun...causing flares...a solar flare!  That's a sufficiently sardonic and yet punny symbol if ever there was one.  It symbolizes both a burst of energy which people would usually consider a positive thing but which for a Sjoggie can precede a disease flare, and a destructive and essentially unpredictable force outside of our control.

Dear Lord, it looks worse every time I see it - I swear, it's less embarrassing in person.  Ok not by much, but still!
(PS- I gave Julia permission to use the image as she sees fit but since it was contributed for her use, I ask that you not use it but rather link to her or my site...you know, if you want to share an entertaining example pathetic adult artistry in crayon.)

Unfortunately, I must have been out sick the day they taught reasonable artistic skills in school (hey, I was out a lot, it's possible).  It is PURELY out of my sense of obligation as a health activist to you and my fellow sickies that I forced myself to create my embarrassing image and submit it to Julia.  Naturally, in True Julia Form, she couldn't let my humiliation go quietly into her files - no, she included it in her post today about the entries for her contest, Creative Challenge Finalists Revealed.

Fortunately, though, her post also contains submissions from truly gifted and exceedingly clever individuals.  I am quite content to leave this type of imagery in their far more capable hands.  Head on over and check out their handiwork - it's really quite touching!  I think you'll like it....

New Therapy Checklist - 10 Answers You Need

On any given day, we patients progress through a common linear set of events, such as the following:

• We go to the doctor with a problem - a new symptom, increased frequency or severity of an existing symptom, or even to manage an asymptomatic issue of which we were already aware.
• Especially in the case of a chronic illness, we celebrate a possible treatment which may alleviate this problem.
• Eager to improve our lives, we start down the treatment path prescribed (be it pharmaceutical, physical, or another type of therapy)...and quickly encounter a side effect.  Or perhaps we don't seem to experience relief, or maybe we do but this relief is incomplete or short-lived.

We're now faced with questions: Do I stop my treatment?  Is this normal and safe?  Is it normal but not safe?  Are there things I can do to make it more tolerable?  Does this mean it isn't working for me?

We have these questions because we didn't know what we were getting into.  Either we misunderstood what our doctors told us, or perhaps they never even told us many of these details to begin with.  The doctor's role isn't restricted to managing our illnesses, it also includes managing our expectations, and that clearly doesn't always happen.

Today while covering day one of the Patient Summit USA conference as part of the WEGO Health Press Corp, I listened to several presenters discuss critical aspects of the patient-provider relationship that impact how likely patients are to adhere to a course of treatment (especially medications).  In fact, "adherence" was the buzzword of the event.  From these conversations and drawing on my own observations as well feedback I've received from other patients, I was able to identify several key questions I believe a patient should ask about any treatment prescribed for them.  As was pointed out to me by Dr. Steven Feldman who gave the opening speech this morning (yes, a DOCTOR said this, not a patient advocate), the fault doesn't lie solely with the patient - the provider has an obligation to communicate with the patient and to do so effectively.  After all, if you say something but no one hears it, did you say anything at all?

So, in light of this argument that doctors should take a more proactive role in getting information out to patients even if they don't ask, I believe that, as always, it is ultimately on us to ensure we get the level of care we require.  This care and information need to be at a level we can understand if they are to be used to their utmost whether we get that by reading information sheets or asked questions of the provider during the visit.  And therefore I present to you not 10 Questions to Ask, but 10 Answers to Have about any course of treatment before leaving the office.

I feel like purchasing this post, found here, for a few physicians - and patients - that I know!

1. What diagnosis does this treat?
2. What symptom(s) does this treat?
3. How does it work - what is the mechanism or process (i.e., stopping this from happening, increasing that, and so on)?
4. How much improvement can I expect (full relief, partial recovery, etc.)?
5. How long does it take to begin seeing a change in my symptom or condition?
6. How long before the full extent of relieve I can expect should be realized?
7. What are normal side effects which don't indicate a safety risk, and how can I cope with them?
8. What are abnormal or particularly worrisome side effects which signal I should stop the treatment?
9. Are there any other risks I need to consider, such as long term effects or interactions with other medications or supplements?
10. Why do you think this is the best treatment for me at this time? OR I have some concerns I'd like to discuss first.  (Depending on how you feel about the treatment.)

I can't stress enough the importance that you don't just ask these questions, but that you really get answers.  Answers which MAKE SENSE TO YOU, at least to a reasonable extent.  YOU have to follow this course of treatment; YOU have to make decisions while on the treatment about hurdles that may arise; YOU have to live in the body that was affected by these decisions.  Here's an example of what I would consider reasonable answers for taking Plaquenil, a common maintenance drug prescribed for Sjogren's and related conditions.

1. Plaquenil is being prescribed to treat Sjogren's Syndrome.
2. This medication should help minimize overall inflammation and general disease activity such as brain fog and fatigue.
3. Plaquenil helps reduce these symptoms by suppressing the autoimmune system so it won't attack healthy tissue as much.
4. This course of treatment is meant to reduce existing symptoms that are due to highly active inflammation processes in the body as well as slow the progression of the disease going forward.  While possible, it is not likely that the patient will have complete relief from these symptoms.  The patient should expect to notice an overall more comfortable level of functioning with less fatigue and brain fog and fewer and/or less severe flares.
5. Patients usually begin to notice improved symptoms in 3-4 months though not complete relief.
6. It may take as long as 9 months to realize the full extent of the improvement so we usually ask patients to stay on the treatment at least this length of time if possible.
7. Some patients have mild nausea when taking the pills, so patients may want to take them with a glass of milk.  Also, it is not uncommon to have unusual dreams while taking this medication but this side effect is not harmful to the patient.
8. Patients may experience more concerning side effects.  If a patient become physically ill for 3 or more days after beginning the treatment, discontinue use and contact the prescribing physician.  If the patient has symptoms of a severe allergic reaction such as swelling of the throat, discontinue use and seek emergency medical assistance.
9. Two primary long-term risks are associated with Plaquenil.  In some cases, patients taking this medication for a long time develop retinal toxicity which affects vision - therefore, we will have to get certain eye exams every 6 or 12 months to detect any build up before it affects your vision and can be reversed.  The other effect can be liver damage, so we will run common blood tests before every appointment to monitor for signs that it might be affecting your liver function.  We don't see these very often and both are reversible when caught early so we will stay on top of these tests.
10. I believe this is a good treatment for you because you do not have many risk factors, the treatment has a strong history of success in long term disease management, is inexpensive under your insurance, and simple for you to use.  Other treatment options have lower success rates and more side effects, so I'd like to see if this works before trying those.

These really are basic pieces of information every patient should have about their own care.  We are not employees to be directed, we are customers hiring a doctor to provide a service - care and guidance.  Never lose sight of your own right - and obligation - to make the final decisions about your own health!