Wednesday, August 31, 2011

NCIS and the ADA, plus another doctor visit

With a few days of trying to get a system going. Ten days of a stable routine is what Linda and I have worked toward for over a week. We’ve gotten as high as three days. I might have eaten five meals in the last three days. I’m just not awake enough, and when I am, most of time…I am distressed.

I see the doctor tomorrow/today about my stay at the palliative respite. My bloodwork came back and beyond the anemia one test stood out, going three times the maximum. That result is an indication of A.A.N. thanks to a medical article found by Cheryl. So perhaps at last my GP will have the name and results he needs and give the nod for what he sent in a request for in the first place: a place where I can get counseling and a week’s respite with workers who are used to complex end life complications. Will wait and see. (hate that).

I’ve been watching some DVD sets, which helped with the physical pain. Overall, in watching, I am saddened to watch diversity and disability wiped out of the media. In season three Sheldon moves away from ausberger’s and toward the ‘geek’ factor, both in his back story and his weekly displays of passion. Even his love of his ‘seat’ is shown and explained as a form of greed: believing he deserves the best as he is superior to others. It was too bad as the show is now ‘Friends’ where no one seems to work and all must return to status quo. That’s not neurological diversity, that just a writer’s pool.

Of course that didn’t stop Linda from laughing hysterically behind her hands when I had to pause the show to explain the discrepancies, and the ‘dumbing down’ of the math/science to the point that it become inaccurate. It appears that she is fine to continue life without precision.

NCIS, while Abby is fun (there is an Abby T-shirt at Hot Topic) has a pretty horrific reputation for diversity. Gibbs walking up and shooting a trans person (in the middle of the forehead) for being trans at the ending of on episode gives you an idea of how the LGBT fare. There are gay military personnel driven out of the service or shown to be a shame. But suddenly, after eight years of this, Gibbs seems to care (I guess all that woodwork in his basement gave him some tolerance) and after pressure from above continues to label one case death by gay-beating.

Service personnel and others with physical and mental disabilities fare badly in the show. This surprised me because in Iraq and the other US conflicts in the REAL world, the increase of armor has the official counts of 20 people wounded to 1 killed. That is tens of thousands of disabled service personnel not including those with PTSD or other mental disabilities (though a fairly famous study showed up to 50% of those who were serving after a year had serious mental issues that needed addressing, like psychotic breaks). Back in 2011 NCIS, In episode three, a bomb expert Dempsey goes after a gang banger who had been arrested, served and made a deal, finally released to a farm. This person was the one who hit her brother (who is so much the ultimate victim/saint that they don’t list his job but that he ‘worked in a soup kitchen’ for the poor).

When they find Demsey, she has had the guy with a mercury switch bomb on his lap (if the mercury hits the end, it goes boom) and tied arms.
Dempsey (smiles) : Yeah, I wanted him to suffer. To feel a little bit of what my brother feels every day. Stuck in a chair. Constant Pain. Unable to do the simplest things without help. At the mercy of others.

She doesn’t get charged, as Gibbs puts it, “She’s a hero as far as I’m concerned.”
This, they think, is being ‘nice’ to us. Hey, they actually made others suffer so people can understand how we aren't full human being. Gee, thanks, except we meet the guy in rehab, and he has full arm use, hand use and, indeed, can cross his arms and gesture: if he was portrayed more realistically, would be in a manual but they put him in an electric to increase the ‘helpless’ image (a post soonab out why the wheelchair shown in media matters…as much as showing the persons’ face). If he wanted to go work a soup kitchen, they would welcome him.

So the NCIS interpretation of the American Disabilities Act is that we are ‘Stuck in a chair’ and ‘at the mercy of others’, an 'other' needing to be rescued, but not interacted with – not exactly the equality of individuals. Indeed in a later episode Abby is threatened with mental disability or ‘madness!’ (as in, “That way madness lies!”). A poisoned brilliant young chemist is denigrated for having Bipolar early onset, her OCD routine and anxiety makes the team worried when Abby identifies with her. Because you don’t want to identify with madness, and is given several ‘interventions’ to stop her until Gibbs steps in to tell her to ignore the person, work the evidence.

We see both acceptance and a parallel when Abby finds K., which is a professor who she confided in and who saw her as a person, and would read Leaves of Grass with her, accepting her as she was, but also exploring how she was changing and growing. Everyone else is threatened into avoid the danger of looking too close to her as a person, for there does madness lie.

So could NCIS change for those who need accommodation for disabilities? No, they tend to go by the ‘one odd ball’ rule which both TV and corporations go by. Gibbs so far as to tell Abby she is the ‘mascot’ in the same way a dog is a mascot for Coast Guard ships. The next episode Agent Gibbs gives Abby a massage for several minutes on her leg and thigh for a muscle spasm. But in the same way he wouldn’t hire someone with MS. The biologist who died earlier was called ‘crazy’ by all members many times. But then, Abi has been the double standard for sexist behavior since the start of the show. While it was nice to see some of my clothes (she has the blue top with wings too) as much as I love her taste, the Giibbs/Abi relationship is way too hands on. Abi is always the victim/vulnerable yet brilliant cliché, which doesn’t stop me from finding her the best part of the show. But NCIS gets a FAILURE as being ADA compliant, as do the writers. Eight years to accept one dead gay guy? So, what, if we get to series 15 there might be someone with a disability?

I ended up re-watching Law and Order Criminal Mind season two so I could see Goren, whose OCD, and mother with known mental illness, who himself struggles to keep within the limits of what can be understood by others. Luckily he has a partner to help him express his mental diversity and help him stop also.

I’m off to sleep for the doctors. If you know a good series that accepts disabilities, let me know. Also one a little more….well in NCIS everyone up to the director and CIA director threatens people, while the one character who simply shoots people (Mike) is retired. I think of Life, written by one person who had not only mental diversity but a cop who simply did. He didn’t say with his breast all puffed out, “If HE doesn’t get you then I will!” He just survived, and broke a trachea without warning. Perhaps that is why it got cancelled.

Friday, August 26, 2011

My dementia (snapshot)

I don’t talk about the dementia and I don’t write about it. That’s my cowardice.

My diaphragm is failing, which means my lungs are failing. My heart is failing too. So I point people to the physical, except that this is physical too. One of the common side effects of vascular dementia and Lewys Body is being awake at night, the day and night reverse and this is just what is.

I ran away, except I didn’t run, I wheeled away, naked with a blanket to cover me. I don’t know how long I was gone, a couple hours I think, I am not sure, but Linda and the Police found me at the same time. Then the Ambulance because my feet were purple to black exposed on a cold night, an early summer night. So now the Police know that calls from this address are usually caregiving calls.

Those aren't the picture we show, me with a lost look on my face, surrounded by medics working on my feet and four police officers.
Workers, medical staff, they all stay the same thing, “I wish I knew you when…”
There is no other when, just now. I am not a good teacher, I am great one. But I won’t have years of students to say that. Just all that knowledge up in the head and me sitting holding my head trying to remember the word, the phrase, the idea I was just talking about.

Today someone told me that they were glad to know me now, to know the me that is here, whatever condition. I smiled because I hadn’t heard that before.

People don’t want to know the you of now, but mourn in front of you the loss of the you that they remember and you don’t.
I don’t know what year it is, and often I don’t know where I am, or when I am. I don’t recognize anyone. I looked around recently and couldn’t understand why the hospital room was so cluttered, and what happened to the heart and oxygen monitors.

At first it is pretty easy to build up the devices that allowed me to appear to know and remember things. But then it gets to the point where the notes make no sense and I ask myself ‘What would Elizabeth Do?’ to try and figure out the day before, and I don’t know. I don’t know.

But I have ‘now’ and while often while watching with Linda I don’t have the slightest idea who the characters are, or what the background story is, I can pick up enough to figure it out. And Amazon tells me what I have ordered before, so I avoid buying the same thing over and over only because I am too weak to leave the apartment and Amazon gives me a warning.

In some ways it is easier because I am young and a quirky female so people expect me to say odd things. And if I don’t recognize people or places then I just make observations and they think I am being witty and sardonic, pretending to look at the apartment/street/city/woods anew.
Why do I run? Found fallen in side streets, and shivering on pavement? Why do I wheel off? Because my emotions build up, faster than I can ever express, even if I had the words, only I no longer do. I need to be someplace where everything was okay. So I wheeled to the time of happiness, when Linda, Cheryl and Maggie dressed up in goth and corset and we all went to the cemetery. Here, even in the darkness of the cemetery I know about love and peace, not the terror of finances, and other complications. Here, in that feeling, the medical appointments, the lack of medications, the late rent checks are far away and the bright day with us playing in the sun is what I know. Because back in that apartment, I can see a Linda who is preparing to continue on without me.

I want to plead for her not to leave me, but I am the one who is leaving, decades early. In many ways, I have already left, as Linda sometimes is an Aunt, a friend, but always someone trusted who helps me find my way out of the confusion. She leads me to bed, and tucks me in and promises that she will always be there.

Vulnerability: that is what dementia is about. We are vulnerable, and naïve, and we don’t even know it.
Often I don’t understand the difference between the TV shows and the world. So for a show to end, to not have more, it is hard to understand, and upsetting, because it is like saying everyone is gone, everyone has died. But then, a while later, I watch it again, and remember nothing at all of the last time.

I don’t recognize the people who come, nor do I know how long they have been here. Linda said today that one worker has been here for more than two years. But I don’t know that. I don’t know her. When a worker comes who reminds me of something I think I might remember, I call her that. Sometimes it is named after a pre-Victorian poem, sometimes after a body type, but this is the only name I will know, perhaps, the next week. And the workers that matter play along because they know that I am not insulting them but trying as hard as I can, still not knowing what day it is, or why they are there, to remember them.

Perhaps you will, like the question in Equus, never know the emotions I experience, and how vivid they are. But you will know your ATM number and computer passwords, also what month it is and remember last year instead of when you were 9. And that will probably make you feel you are on the better half of the equation, because you can handle change.

Today the police were here. Fran and the owner Peter Kerr won’t allow a locked box so workers can have a key to enter the front door. They say it is for ‘security’. Because of the letter from Linda asking, after three years of trying to get care, for them to do what is right, I got no care this week, as no workers were buzzed in.

The Police were here to tell Linda that as I palliative in a critical stage, that they will come and simply break down the front door (though they could get through it ‘in four seconds’ – so ‘security’ isn’t being maintained by our building’s front door) to give the worker access. And the next day, they will come and break down the front door again. And again. And again.

Because I sit up in the room waiting for the worker to come and tell me what meal I am eating, or when and what day it is. And recently I haven’t been eating for over 24 hour for many days. They help me dress, they help me feel safe. And talking about options, the idea of a ‘care home’ came up but Linda asked if the officer would like to be in a care home and he said no. She said that I am someplace I know, and I am someplace where I feel safe and why should she move because the manager and owner are being bullies after taking our rent month after month, year after year?

Change is more than worry, more than terror, it is ripping away parts of my mind and my knowing. Where I have been, in some part, who I have been. I have now this room, and that is what I know: I have this manga, and that book because I can see them from this desk. I know where the lights are, I know where the treats are, I know that here, only HERE am I safe and loved. Here is where I see the things that we have shared together over the 18 years together.

No, that isn’t going to stop me from getting worried and crawling under the hospital bed. And it isn’t going to stop the frustration at trying to find a word, a phrase, any way at all to communicate when I am tired, and everything seems to go away until the dreams and the memories mix together. It is the ultimate loss of control and nothing can stop it, or slow it. It is a falling feeling that never ends.

I don’t have very long. I know that, and my doctors do as well. But however long that is, it would be nice to be around people I know, or if I don’t that day, people I feel comfortable with, or who, when I am scared of them, will understand. Because having a life stripped away, leaving you naked, not at school in a dream, but in front of the whole world, it is scary. And so I might need plushies, for when I am not too sure who Linda is, nor do I recognize the plushie, but it is something to hold onto in a world of sharp angles and confusion.

Serenade is arranged by a singer and composer, who also plays all the instruments and posts the songs on youtube. It captures one aspect of dementia and the feelings of confusion.

My fragile heart beats at times secure and times alone
My first treasure took me years to find
It's what I cling to when confusion clouds my mind

Dedicated to Linda who deflected my fear today, that I would have to go away, to someplace which isn’t here, someplace strange. And for that smile, when I was on the floor, and the worker had put a pillow under my head and you told me it would all be okay.

When you come to me and you smile
Suddenly I feel as if everything's okay
Lost in your smile all at once I'm swept away.
When trouble falls upon me like rain
When the world becomes what they call a lonely place
You carry me through
From dreary skies the sun breaks through

When you're feeling lost and don't know what to do
Just look and see me calling out to you
When listening/watching, please hang in until the first minute, and I promise that this will be a song that matters to you, particularly for those of a variety of illness’ and disabilities, or just the lonely.

Wednesday, August 24, 2011

Needlepoint, Cats, Wake Island and all that

An apology for my lack of blog posts as I did not post every other day due to appointments and ill health. The County Fair was what is expected, and like many country fairs. It was not the State Fair but there were the various organizations of the county at booths. We left the annual Demo Derby Sunday Nite, and talking to the organizers, the money taken for attending is what is used for prizes in the various categories. There was animal, art, photography and craft. Cheryl has participated in the past and if possible I will enter some thing next year.

As we spent most of Saturday eve there, I will tell later of winning a prize, and the duel, but leave you with this Needlepoint, which was at least 4 feet by 3 feet. It simply was so far ahead of the other works in difficulty and complexity that I was amazed. Plus: Cats!
Here is an odd fact I learned from the Corrections Booth, which had an officer (in full body armor including bulletproof) there advertising the work done by the prisoners in the chain gang. Yes, Port Angeles has a Chain Gang and they are proud of it. Also the strange and threatening signs on the road: “Litter and it will HURT” (which implies gangs of deputies giving you some beat down) was a bag, and Linda happily got one. The Corrections Officer said that it was an ‘old campaign’. I guess it was the ‘tough face’ while the NEW road signs say: “Please do not do drugs and drive”

PLEASE? I think they might have erred into overly polite when you are asking people to not take mind altering drugs and then operate heavy machinery by saying: “Please?” Since I know one transit driver and one ex transit driver who daily take and drive on heroin, I don’t think that campaign works. (me shaking my head muttering ‘please? Really?’)

The one thing I learned is that conjugal visits are not part of county detention but are part of State corrections detentions, that is for y’all who want a pen pal with benefits. Tip: Try not to think what has been done on that bed or in the sheet when using the decorated trailer.

More interesting: Washington State does not allow conjugal visits either in State or Country. Yes, we are mean. See, the things you learn when you talk to the chain gang.

There were many restored and original auto’s and steam machines on display but this one caught my eye. The 1941 Ford Fergunson 9-N airplane tug. This is the re-conversion that Ford made to the tractor, and were used in the pacific extensively, both on airfields and on the aircraft carriers (you see these in the background of most US war films, though the amount of Ford 9N, or Ford 9-N are few in number today). To give you an idea, these would have been the type on Wake Island (attacked at the same time as Pearl Harbor where 1,200+ civilian contractors were building a defense system. There were also 550 marines and a few wildcats). If this is a 1941, it was pre-attack, and not part of the mass production of these for the war effort from 1942-45.

A recent book on Wake Island is in my mind as there are several interviews with those who survived the camps as the Japanese took the Civilians and Marines as prisoners together. The interviews from the contractors, who were there to make fast money (you get a couple thousand after six months, but if you quit early, you had to pay your way back). One of the big frustrations was that the commander, even after the air attacks and the start of the landings refused to integrate the 1,200+ contractors as THEY were not MARINES and thus not ‘really useful for defence’. Wake fell in record time, to a landing force smaller than those opposing them on the island. So, maybe not the best idea. Except they continued it into concentration camps, the Marines looking out for marines and the civilians left to fend for themselves. The author notes of ALL the nationalities and military: Dutch, New Zealand, Australian, British (from Singapore), Canadian (those two battalions landing in Singapore too late), Philippine military and others plus the Americans – ONLY the Americans, of all those Nationalities who tended to keep to themselves, killed each other, often by spliting into smaller groups (civilian labor v. Marines v. Navy v. Army v. Officers.

I found that fact and it made me sad.

But still interesting to see this bit of aviation and war history at a county fair.

In case you are worried I only talk to chain gangs and morbidly obsess on concentration camps there were kittens and EMT’s and other booths I talk to as well.

Till morrow!

Friday, August 19, 2011

Sleeping, UK TV, Whales and me body slamming you at 25 mph!

As the pain patches kicked in, so my sleeping kicked up (like 18 hour a day for a couple days). For the last day or two, my exhausted system struggled with being able to keep up with using my diaphragm to breathe.

So that is: Two days found collapsed on bathroom floor, passed out. Two days using ambi-bag for more than 20 minutes to give my diaphragm a rest and ensure I am able to breathe. And two days I have lost eyesight from exhaustion.

Due to the long delay of DVD releases here in North America, I had pre-ordered and have been watching some UK DVD series releases. I kick myself for missing the week that ‘The Killing’ was ‘only’ 30 pounds ($48) as it sells for $95+ here in North America, and the BBC has not lowered the price since.

However, The Shadow Line, a seven part thriller, brilliant in building and execution has a police officer with a bullet in his head. He has to stuggle as he has forgotten HOW it got there, his life left with being told the case is closed, not knowing how it is tied to the execution of a drug lord or even if he was shot being a dirty cop or a good cop? Did he ‘Walk the Line’, or did he walk ‘the Shadow Line?’Plus it has one of the creepiest, genuis, lethal villians of all time: Gatehouse. Personally, I cried seeing in full brutal BBC writing the display of rapid onset dementia, as shown in the wife of a side character. It is the best acting of dementia I have seen and both Linda and myself recognized all of the looks, the actions, the talks, the good times and the despair.

Right now I am starting Silent Treatment, a forensic show, but selling off the other DVD’s on ebay including Shadow Line (which went out of print right away, listing as available in three months), with free US shipping, all are Region 2 and 4. Also includes The Sins with Pete Postlewaite playing a wheel man out of prison trying to go straight, and how his wife, children, partners and friends all want him not to, and all have secrets which he has to learn, incorporate into the relationship and grow from. An amazing series, just released. That and five other series from BBC, and other TV series as released are HERE .All are top series, and sometimes my brain can handle a show with a laugh track or odd incongruincies and other times I need the best actors and brilliant writing like in Luther Series 2 or Judge John Deed.

I am going to try and go to the county fair. Last trip on the Coho, Cheryl saw TWO GREY WHALES, and I have been living in envy ever since. So I will try to go on the Coho (and see many more whales!) and see the State fair in Port Angeles. I think that it would be fun to go on the swings (you know that ride with lots of swings rotating out as it spins you around at 25+ mph). Linda thinks since I pass out so much it is a bad idea. I think that my slumped body ping ponging around the ride, a potential body slam danger is just the kind of kooky excitement that ride could use (will she hit me? Ride and find out!). Plus they have a petting area for animals.

Wednesday, August 17, 2011

Pain (Wit and I)

Due to an incident with Fran, lack of sleep, a care plan in flux (i.e. lots of holes to fall through), my pain medication, nerve medication all left the body. By the time I woke, from the last sleep I was to get in almost two days, the Fentanyl was already gone (I have the same dosage as end stage bone cancer patients). Once the appointment Linda picked me up for was over, we could apply, though by this time, I was curled up on the floor, my breathing stopping..then starting. I wanted to pass out but the pain kept pulling me back.

I haven’t ever experienced anything like that, which became like a fever of pain, and dragging myself from the hall to the bedside I can’t remember but I remember getting my torso on the bed and too weak to get my legs up. I felt like I imagined it would be like if I was on fire, and crawling, dragging yourself slowly, while burning bright flames towards a chance of lessening. I fell down on the floor, but the worker wouldn’t let me stay, and I was told to ‘try again’ and ‘Beth, Beth, Beth, you have to get in the bed.” Over and over, I heard.

The effort it took to get there and the implication that I wasn’t “trying”, and had to do MORE, it overwhelmed me along with the pain. Moaning sobs erupted from me as I clawed at the bed, trying to find a handhold. Preserving my mind and heart, the blood had been withdran from my eyes; I was blind, my hand clawing out and pulling back, as I could not feel what my hand was hitting, I only needed to know if it would hold me, or help me get those last two feet, dragging my legs up behind me. heard myself making the sound I had heard in Wit, the DVD watched only a short time before. "This is that state," I thought.

Only for me, no help came. There was no one to reassure me, or intervention. In Wit, the doctor is covering up his mistakes and instead of a Life of Quality, she is to be kept under, no control, conscious only when the pain breaks through (a morphine flow to put a person in a coma until they starve or die in other ways).

For me, the little minutes, literally 10 or 15 minutes of sleep I got before my diaphram failed and I was woken in choking: that allowed me the strength to turn my torso, and roll my head. It would be another 12 hours until the pain medication kicked in. But now I could at least rest, in between the fever hallucinations.

So, since the last post, I’ve been out of it, and now, though the pain of smashing my thumb with a hammer is flooding into my senses from most of my body, it is a relief to be down at levels enough to see out of one eye. And put words down. I have control of my brain once more.

Soon I will watch TV or something, until then I have to watch out as it has weakened me to the point I have to wake every few hours to rid myself of the air breathed into my stomach and intestines: through vomiting, or manipulation for oral or anal release of the air.

I’ll get better. I just wanted to spend the time to say I still go on, and thanks for being there. Oh, my right eye is losing focus (I am too weak for my autonomic system to focus my eye, so it is effectively blind. I type this with both eyes giving only darkness - thank goodness for all that touch typing over the years). I have passed out twice in the last couple minutes so I leave you for now.

A two minute AMV: Some views from Pain-world, accompanied by Sarah McLachlan

Monday, August 15, 2011

The 1, 2, 3 to getting blood work done with Needle Phobia, Trypanophobia or Aichmophobia

Here I am a few seconds after 9-10 vials of blood, which included six of the large ones were taken from my arm. As you can see, the room is starting to overheat me, along with the screaming I was doing.

Needle Phobia, Trypanophobia or Aicmorphobia is real and affects up to 10% of the population, read about the 4 different types and how it can affect you HERE. People die every year, from women trying to run if a C-section is mentioned, to people simply dying from syncope - the heart dropping so low it just stops. Hospitals, medics and clinics are finally getting aware that just because THEY work with needles all the time doesn't mean you are fine with a needle to test if you have diabetes. For more information on Trypanophobia and Needle Phobia, read about the start of the disease I have, about 180 vials of blood, 3 injections of radioactive materials, 5 hospital visits, 1 main line, several hand lines, and countless blood tests. A friend with needle phobia got cancer, had it treated, and recovered, all while an advocate made it clear that she have control of all the tests and needles. Without it, she definately would have avoided tests and perhaps some treatments, as who knows how many do.

As part of the protocol, I overwhelm my ears with sound, as studies with MRI’s of brains show that there is a limit of stimulus that can be accepted. This is why I have some club trance music with a strong beat going, loud enough to cut off all noise. So even if there is pain, and movement on my arm, it has to fight with the other info flooding in to register.

I tell them “Yes”, and Barbara (pseudonym) who is an expert on taking blood without problems (11 years experience) cleans my arm of EMLA, a topical anesthetic (meaning you rub it on the skin, cover it with plastic and after 40 minutes that area is numb and won’t feel pain).

For me, the rubber they tie on the arm is a trigger of panic, as it means to me: Here they come! So when I say “Yes!” the second time, Linda holds my arm, enlarging the vein.

Barbara will be using a micro butterfly (as for the butterfly), which is what they use on babies and children who have small veins. This means the needle is small and thus can hardly be felt, in fact it isn’t a ‘needle’ at all but a pointed piece of Teflon in most cases. The ‘Butterfly’ has a two inch tube attachment. This is important as in changing vials, she does it away from the arm and so I don’t have to feel the ‘needle’ twist inside of me every time she changes a vial. This way she places it in, then changes the vial while leaving the arm alone and me, on 15 milligrams of valium, screaming away.

I listen to the trance music and wait for my heart and breathing to relax. There is a handhold which I grip and then say the third “Yes!” I usually yell, ‘Yes, Yes, Yes!’ or ‘Go! Go! Go!’ and then scream or cry or whatever. Due to the phobia, the body is in a flight or fight situation. As long as I keep my arm still and have CONTROL (I tell them when to clean, I tell them when to hold the arm to enlarge the vein and I tell them when to start), I let the rest of the body do what it wants.

I am full of adrenaline, but I am lying down. I shout, I cry. When I had muscles and nerves in my hips I might have kicked my legs, but the arm stays still and all that “Flight or Fight” energy is released. Embarrassing maybe, but not for me anymore. I don’t laugh when someone is scared of spiders and leaps away, so why should they laugh at me screaming but getting the JOB of giving blood for about 40 straight seconds, done without incident.

Afterwards, Linda has brought our own bandages (Yes, I choose my own rewards and try to make everything negative into a positive in this experience) and I get Kutachan, a San-X kitty who is playing with a sock, and sparkles in the sun. You can see in the picture up top that the blood has drained away except for my head and neck and my arm. I am a little light headed but from helping me onto the bed to finishing labeling all the vials of blood is five minutes. A new record. The first time was 44 minutes, and my previous best time is 7.5 minutes.

For staff, find someone sympathetic, and ask when it is least busy. Often it is just after they open (if they open at 7:30, by 8:30 the people who have been waiting outside for them to open at 7:30 have been processed). Go when it is least busy and you can build a relationship with the person taking blood. This will help you the next time you need a blood test as well.

Job done, now I just have the second set tomorrow. Ug.

Trypanophobia, the blood test and failure of doctors & medical staff in a service industry

Today I go to get a needle for a lot of blood work. I will sleep 4 hours, get the needle which must be done by 8:00 (the clinic opens at 7:30) and then go back to sleep. My disease, like many, changes the clock in the body so I do better in late day and evening/night, instead of during the day. For example vascular degeneration and Lewys-Body both have this as a common body change.

I was able to stamp, decorate and write over 30 postcards, maybe over 40, that I had matched both several weeks ago and this week. I don’t think I will ever be able to be strong enough to do postcards like I did them before: every week and in numbers from 30 to 90. However, to need assistance and have a severe disability does not make me less of a person, or less than what I was, it only makes the ‘now’ different.

But then everyone who sees me and has seen these last months thinks that there is no way I will live until Xmas much less next spring or summer. But after thinking about it, most decide that they just don't know, and maybe I can, since they have seen me when they were sure I would not last the week, or the month, and yet I survive, somehow. I want to see the next season of White Collar, and have no TV, so I need to wait for the DVD release. I look for a future where I have goals beyond this day, this week.

The actions I take now are deliberate and carved out of small pieces of time and energy that I can spare from the challenge of the work of living, and by that I mean running a Central Autonomic System. That it might take days or weeks of planning, and energy that takes 48 hours to recover only indicate the level of seriousness or care I put into what I do, NOT that I am 'lesser' in some way. I am busy trying to keep a failing heart beating, lungs with a failing diaphragm breathing, having a resting heart rate of 70-120 bpm (about what most people have when jogging), yet unable to cool my body and a body temperature of 68 degrees. You don't have to do this, so your life is considered 'normal' and mine, not. Beyond the heard and lungs, while for others 75-80 degrees is ‘room temperature’ and comfortable, for me, it is deadly as it overheats my body, slowly draining the energy and turning my heart to faster and faster beats until two to four hours later, after blood vessels have burst from the pressure of my body trying to sweat, attempting without hope to cool itself, I enter heat stroke. So people around me wear sweaters and talk about how cold it is. I meanwhile, get overheated in the ER or doctor’s offices, so that by the time I am called, my speech is slurred and I am in poor shape, my face red and swollen, my edema swelling my body.

Since I have Typanophobia, otherwise known as needle phobia, the knowledge that I need blood work, and must have it done today is all I think about, and the only way I can cope with it is by assuring myself that my protocol has worked and that soon it will be over. However, since the doctor list is long, it will be about 11-15 vials of blood which will mean there will be a needle in me for a full minute. After about 10 seconds or so, the control I have over myself gives out, and even with sound diversion, Linda holding me, visual diversion and the rest, I will scream, without stop for the remaining 50 seconds. Is it the knowledge that there is a piece of metal inside of me, piercing me like someone who is impaled on a knife in a fight? Or is it the actual pain of the needle as each vial makes it twist inside my vein.

The specialist had said that what ‘normal’ people cannot feel, I and one other person he has met in his decades of practice CAN feel. I am getting extremely tired of the word ‘Normal’ and second, I think this is probably the worst super power ever – a super extreme sensitivity which makes me feel pain and awareness for things most people cannot feel at all.

Either way, today is about survival, and once it is over, I will be relieved a bit……as I have a second needle procedure tomorrow. Only after that can my life start up, like a merry go round which is dark, and the lights go one, the music starts to play and it lumbers to life. Now, we are shrouded in the darkness of the unknown.

I woke today realizing that in the four years I have had this disability/disease, I have not met one medical professional, tech, receptionist, or fellow patient who had expressed anything other than distaste or disbelief that Linda and I are not only together but legally married. The second line of my care plan at Beacon says, “Linda is her married spouse”. And I wonder how many workers have refused, as they are allowed, to come and care for me simply because of who I love. When things go wrong they get: “That woman who came with her.”, “Her roommate.”, “Her Neighbor.”, “That friend”, “The…you know…HER.” Or they simply let things go and tell Linda that ‘Only family is allowed’, ‘There is no room in an Ambulance’, ‘Are you her care worker, can you come in? Oh you are her what? No, I am afraid that you can’t come in here.” And the dozens of variants.

Also, if you happen to work in health care, after several hundred visits to medical facilities, I want to let you know that if you are so unhappy in your work, please quit. I am there because I am having a bad day in what I thought was to be a long life, but now I find is a short and very painful one. Why I need to be grouched at, ignored, yelled at, lectured (because I am in a wheelchair and you don’t have space), or the dozen of other negative experiences you provide, is something I don’t understand. Perhaps it is the lack of snow, the sunshine, or just this province or city. I am fatigued from it.

The medical profession is a ‘service industry’ in which one is emotionally, verbally and sometimes physically abused, judged, assumptions made, full of strangely uptight and angry doctors, RN’s, administrators and other care workers. I dislike medical visits so much because it is always draining and almost always leaves me crying in the van afterward from the casual cruelty, being called ‘stupid’, ‘idiotic’, ‘time-wasting’ is something I have come to expect for simply asking the question, “Why?”

I am sure you are overworked, as I was when working a 14 hour shift, then a 7 hour break, a 11 hour shift then a 9 hour break and a 14 hour shift to make a full work week in a weekend. Yet, as I worked for a cinema, I was friendly, I was helpful, I listened, I cared, I gave away free popcorn, I saved toys of promos and gave to children and adults to make them feel that this was a special experience. I then worked another full time job and two part time jobs at night.

Sadly, I have yet to meet a doctor who could get hired to do customer relations or even serve popcorn with a smile at a cinema. As for trying and help a mother choose the right type of soft porn at a DVD rental shop for her 23 year old son who sent her in to get some for him, then help a 12 year old who is telling his parents that unless you can see a real dismemberment, the film isn’t worth watching (usually followed by a girl in an entire pink jogging outfit who is getting the latest Barbie film for kids). I say sadly because the closest I have come to kindness was an EMT who smiled when I was on the floor, overheated, having seizures and a police woman and female who assisted me when I was naked, outside and kept asking to be arrested. I had frostbite on my feet, and some other physical injury, but they treated me as a person, instead of an incident to be done with as quickly as possible.

Doctors and medical staff tend to be rigid and create conflict. Just try asking for things to change becuase you have say, a life altering chronic condition which makes doing things at an exact minute impossible and see how 'flexible' and 'understanding' they are. I ask for kindness or understanding, and it is considered conflict. Except for me, conflict was a guy who is trying to climb over the desk at you because he forgot to return two films before his three week vacation and your voice leaving him a daily message of overdue means he owes “WHAT? Not on your F**KING LIFE, GET YOUR C**T HOLE OF a MANAGER HERE.” And you have to say that a) you are the manager on duty and b) You are very sorry that he is unhappy with the service. Or someone who screams at you, or talks about how you are only there to rip off people selling overpriced junk food while they are buying it, and then you thank them. To do that every day and know that you are a person of worth and more than your job, while doing 14 years of studying, to know that having a good film to watch to unwind IS making the world a bit better, and that it is important, is true service.

I have had doctors tell me I won’t be here for more than a few months before telling me they are leaving for a month long cruise. More common in tests is doctors or trained technicians talking over my body about lunch, what they are doing that night, how long they are on shift and how much they dislike patients in general and how wheelchairs are such a bitch to deal with.

Yes, I have a blood and urine test today….

Friday, August 12, 2011

East Sooke Park by Wheelchair

East Sooke Park is the largest of the Capital Region Parks at over 3,500 acres and 31 miles of hiking trails. It rates in the top day hikes in Canada, a full ‘West Coast’ experience only 40 minutes of driving from downtown. The route I take, which is the shortest trail, has Douglas Fir, Western Hemlock and Sitka Spruce (yes, the tree we saw in Yosemite and the California Redwoods). Also common are the red peeling bark of the Arbutus tree, which is found close to salt water ocean, only on the lower island and sunshine coast (accessible by boat: see the 2007 vacation, where I learn about Wheelchair outhouses: see next paragraph). These trees can be found standing atop bluffs with the sheer drops of the west coast.

The trail starts at the old Anderson Farm (from the 50’s, the lines of apple trees are still present, as are the open fields now returned to wild grasses like wild rose and blue-eyed grass). You can see the Arbutus tree at the far end of the field, closest to the ocean. There WERE some blackberries ripe but Cheryl ate them all before I could take the picture (grr!). During late summer, the hike will smell of salmon and blackberries and loam. There are two wheelchair parking spaces and wheelchair outhouses at the end of the parking lot (only in BC do we have more accessible wheelchair outhouses than downtown wheelchair bathrooms).

Since it had been sunny with weather in the 20’s for two week that meant that the trail was likely dry. This is VERY important as it is a hard enough trail without adding the horror of slippery wheels and gloves and having yourself covered in mud. The trail goes through this second growth forest, along the ocean with mini trails down to coves (for able bodied people) where star fish and sea urchin can be seen at low tide. Further along are petroglyphs (at Alldridge Point) which has made this a heritage site since 1927. The trail starts as an old road, much like most of the roads in East Sooke, two tracks with grass in the middle, grown through the gravel laid down decades ago (much like my grandfather’s East Sooke property and all the other driveways passed on the drive down).

The open field soon starts to become enclosed by trees as you can see here, where young robins were practicing flying as we went by. The trail is best for manual chairs because it requires some ‘gutting it out’ where you push over the roots of trees, which cross the four miles of trail frequently (as seen here). But other times it requires plotting how to get around particularly tall roots, or rocks, as I balanced on my Big wheels, raising my casters and footplate up so the obstacles clear underneath. Other times the trail will narrow, here, though obscured by a bush, is a 25 foot drop on my left with my wheel less than five inches away from the drop. With the roots, multileveled trail and the distance, it seemed too hazardous to take Indy. I don’t remember the roots being this bad, and we decided that usage over the last few weeks might have lowered the level of dirt, as no one goes around spreading dirt to bring the level back up (odd that).

If you are quiet and watch, there are birds all around, many pictures I took were too small for use, but a Cormorant burst out of a nest and zipped past me at head height. Frequently the trail breaks so that there are not only views of the ocean but little private coves, with the rugged rocks of granite and trees of Arbutus gripping a few bits of soil. The island is essentially the top of a mountain and so bedrock rises up everywhere.

Half way along the trail is a break to the left which is a good place to stop for lunch. I transferred to a rock ‘bench’ but since this is the tip of bedrock, there isn’t a lot of nice flat rocks and after a while my neuropathy told me as I said to Linda, “I am getting a rock enema” (yes, can’t you wait to take me home to show the parents!). I scooted toward the edge, as seen in the last blog, then finally found a full edge of the 40 foot cliff to hang over. The water, which is blue when deep, turns green and transparent closer in. While the temperature is close to freezing, the west coast is one of the top Scuba sites in the world due to diversity and clarity. While I was drinking my root beer and eating fresh cheese curds (yum), I heard the familiar honk honk and turned to see a flock of Canadian Geese circle for a landing. You can see them in a staggered line by the tree trunk, looking across at where the water and tree line meet (I recommend clicking on the picture to enlarge).
Each time I come, there is more development, but luckily much of the view is still pristine, through several ’14 acre’ or ‘124 acre’ developments are being built or planned. I think like everywhere we protect the land, we think the view will remain, but money and people take a publicly shared view and turn it into private ownership (like lower Pender island which has a Killer Whale pod that stays there all summer, literally 15 feet off-shore, but with no camp ground and rare ferry service, the attitude is less about conservation and more about exclusiveness).

We started in the late afternoon to avoid heat and get good light for pictures. The cool brought out the birds. We didn’t see other wildlife today but there are also cougar occasionally, bear frequently (including a white bear, a genetic albino), deer, hawk migration in Sept-Oct and other wildlife. The private cove which joins the end of the beach trail is particularly good for tide life when at low tide, but is not wheelchair accessible. There is a series of outcroppings, and a mini trail for those who like to climb to the very top. At the join of the trails in a bench, and I could see the snow on the top of Hurricane Ridge in the Olympic National Park, the whole Straits, which seemed private, as in four hours we passed six people, on a Saturday. There are a series of rocks which go down to the waterline, and I scooted down one, to get some pictures of the fading sun, on the rock rises (and Linda came after to get a pic of me).
You can see both of the main rock rises here at the junction in this picture and if you look closely on the left, you see the coast trail which emerges out of the tree cover. The outcropping with the three trees atop is where the coast trail ends and it is just down from there you can see the petroglyphs. There is a six mile trail that I would like to try, but I will need to trail up for that as parts of the trail this far had been literally plotting every 6-10 feet: going off trail to get around one set of roots then powering over the next root with my casters in the air. I was exhausted and the sun was heading down. Linda gave me a hand at times, as we stopped rarely, like this pictures of a bird against the sunset.
The coast road meets up with the gravel road and path which connects directly to the parking lot. The Coast Road continues on for a couple miles but this is as far as I went today. With the cool coming in with blasts you could hear rattling the trees before arriving, ravens were playing in the sky, as shown in the previous blog post. There is a set of tables you can reserve (or use if empty) here at the end of the road, and it is perhaps just under a half mile to the cars from here.

Back to home and exhausted sleep. Thankfully I am not driving, just navigating. You CAN bike this, as I biked further than this and back from downtown, but recommended only for serious cyclists and please get a good map, I recommend Happy Valley Road’ for a good sets up the up and down, twists and turns that make BC roads so fun.

Hope you have a great weekend. I am recovering and doing medical’s like blood draws and other appointments for the next two weeks. But still planning on exercising, and doing wheeling, including the Kidney walk/wheel. It seems I am going to miss the Navy 5K, which occurs just before our 18th anniversary this week.

Tuesday, August 09, 2011

Coming Home, East Sooke and Wit with Emma Thom

The doctors talk to me now like car mechanics do when you haven’t any money. With money it is ‘Oh, the transmission needs work, then in a few months we should…” But knowing that you are without money or options they tell you, “It might last a few months, or it might go a few weeks, no sure way to tell.”

After hearing the metaphor Linda paused then said, “I think you’re right.”
I’ve been struggling for most nights with my diaphragm, with my lungs not working, as the bed is elevated, and elevated again, until I am sleeping sitting up, as I suffocate else. ‘Beth, wake up!’ Linda called, and she helped me roll over to the best access for the good lung. She said that breaths had been softer and further apart until, while asleep, I had lifted myself up to take a breath.

I wonder if I have the time to rest and get strong enough between exercising. I watched Wit with Emma Thompson about, like me, a Doctor of Philosophy who studies 17th century metaphysical poetry. She has stage 4 ovarian cancer and as she says, “There is no stage five.” The writer, Mike Nichols went on to create Friends In Deed, a group for those with life-shortening illness’. They have the Five things to remember, of which I no longer qualify for four of them. They advocate the Life of Quality, which I also do, over the ‘quality of life.'

The film made me laugh till I cried at the parts I was not supposed to laugh at. I guess the idea of intestinal lining irritation as a major side effect isn’t supposed to be funny, but then I have been working on manually breathing: literally using my arms to force the air out of my lungs and pull more in. But then, “Not breathing” or “Heart stopped” isn’t usually told to you as a side effect.

I went to East Sooke on Saturday, and it was hard going. But then, it seem that everything is merely a level of hard going these days, so I might as well go someplace that is cool, beautiful and home. This is where I learned to be a Canadian, in East Sooke, and so this perhaps is ‘my land’.
The song, After the Storm, has a significant following after being heard in cancer clinics, hospital wards, recovery, the palliative playlist. It was in East Sooke that I learned to hear the heartbeat in the land, the ways of moving slowly to walk among the deer, the rabbits, the cougar now and then, and birds, the crows playing in the wind that sweeps the long grass, which ripples like ocean waves.‘Remembered our own land/what we lived for’

Death IS big, and I am small, oh how small. That I’ve learned too. But mostly I learned that kindness, the comforting kindness is something which is the highest gift. So often I have to balance in the narrow margins of my disease that I can’t relax, and only after a long time, after I am well and truly safe. Once my body accepts that it is cared for, in all the aspects of that word, does my body allow me to cry, but only a bit, because it can threaten the air passages.
I laughed and laughed as Emma vomited in Wit, to the cadance of ‘Oh God, oh God, oh, okay, maybe….oh my God’ while rocking back and forth is one I know too well. Sadly, ‘intestinal irritation’ doesn’t tend to make you a poet. I had rejoiced that day as I had finally, after some weeks, not bled anally, just from my nose. Though I woke up with my eye full blown of blood, the red out-colouring the white, with complete red saturation after a quick pull down under the eye check.

How much do I fight because I am afraid of what happens next? I’m not sure, though as the film Wit shows, pain reduces us all to the point where all we desire is comfort. My pain too comves in waves, great giant wave surfing ones, where the slightest sound is physically painful. And my back, now full of chemical burns from the patches changed every other day, seems a preferred pain. Better than a bad pain, which is what I fear, those times when the patches or the nerve pills are forgotten and I am going to have to survive six or 12 hours with only break through meds and two of the three main pain agents.

“How is it at 200 mg?” The doctor wanted to know.

“Oh, a lot better, I think, I still have the pain but I only use three of the breakthrough pills a day.”

Linda interrupts, “Don’t forget before the nap, and overnight.”

“Oh, right, then only five or six break through.”

The doctor’s face is a study in micro expressions, “So how many was it last week?”

“Uh, 15 a day, no wait, what is three pills every four hours?”

Linda interrupts, “More like three or three and a half hours.”

The cost of all those tree roots and going on the back wheels of the manual wheelchair plus the up and downs was four hours struggling to sleep and breath, and failing. A living hell, where a single breath measured time like hours, in and out of consciousness until enough minutes of sleep were ticked by to start, as I lay gasping. That was part of the cost too. But it is a lovely place isn’t it. More pictures tomorrow/later. I just wanted you to know that I am, and I sent out a couple postcards, which is my defiance against the universe, though Linda and Cheryl did most of the work.

Weekends are odd times, now that I am able to go out after a couple years, seeing people who thought I died last year. It makes the conversation rather stilted. They can’t say, ‘Looking good.’ So I say, “Like tile rot, you can’t get rid of me that easy.” Then I laugh until the shocked look fades and they laugh with me.

Friday, August 05, 2011

How to have the best months of your life

I started this week with vertigo so bad I couldn’t get out of bed. It was an infection of a part of the ear which is inaccessible and was told it is “medically one of the most debilitating”. Since I wasn’t sure, between the pain and my world being literally on ‘tumble dry’ that I would make it for very long (since the nausea is pretty intense), as I had been eating only about 5-7 meals a week for the last few weeks. The current manager Fran, telling the Assistant Manager NOT to let care workers in isn't helping this (currently I am the ONLY 1 out of 6,000 clients whose building owner/manager will not allow a lock box for the workers to get a key, but won't let them in either).

Back to medical week! You would think a specialist appointment where he tells me that ‘others (xxxxx) died a couple years ago with this disease’ would depress me. Except it is about the level of exercise and the level of autonomic failure, particularly of my diaphragm and heart. The muscle failure, and function failure of my diaphragm is causing breathing problems and loss of oxygen. After taking a long history, labeled ‘difficult and complicated’ (the disease, not I), we talked about the amount of exercise I do, why I do it, and the results it brings (sweating, reduction of edema, pushing blood and oxygen to the extremities and into the capillaries). He stated that ‘others would have died a couple years ago’, that is, without the proactive targeted exercise I do.

The hour at the specialist started with him telling me I couldn’t have this disease as women’s in their 20’s don’t have this complicated a disease. It was the only time being told ‘Your disease isn’t possible’ got a smile, as I explained that I was actually not in my 20’s anymore.

No specialist had ever talked about who died and why, and who lived and why, before. Is there going to be a miracle cure? No. After a specialist and regular medical appointment this week I may have Kidney problems, and am having catheter specialist coming to the home on Monday (oh, that is going to be fun, right!!). And if the specialist is right he wants to take a Biopsy of my Kidney….while I’m awake. That isn’t going to happen, but I still have a stack of vials of blood he wants. And the Diaphragm problems means lung weakness and breathing with the top of my lungs. This is ‘bad’. Plus, in just over five months I am now stabilized at just under 50% of the maximum of Fentynal, and I take them every 48 hours instead of every 72. I still hurt in joints, muscles, nerves but can function, think and sometimes speak (I wasn’t doing so good yesterday after a quadruple intensive exercise session at the Y: only those who work with me several days a week could understand anything I said at all).

The Specialist identified I was taking my syn-thyroid at the wrong time and that it is likely too low. This means I can have less fatigue. And he was the first specialist to acknowledge that something I do because it seems to work (intensive boxing and exercise to make myself sweat) is keeping me alive longer.

Of course, after being told that I am alive because I exercise, I went the next day and exercised like crazy. This it turns out caused massive heart erratic and diaphragm/lung failure which worsened every three hours until I was significantly elevated just to breathe: imagine is as keeping your head above water – if the bed is lowered, even in sleep, I drown. The bright side was waking up to a face that was Edema free(notice the original artists' sketch of me as Oracle from Comic-Con at top left behind me).

In order to lower the edema, I have to retone the muscles, cells and walls which have been stretched. That is a lot of exercise over a long period of time. But the specialist explained that some of what I do, while painful and hard, isn’t actually suicidal and stupid.

Specialist: “If you aren’t dizzy then it doesn’t matter.” (regarding increased heart rate on being vertical)
Me: “Except that I have a heart rate of 176 to brush my teeth, I’ve checked.”
Specialist: “If you aren’t dizzy, then it doesn’t matter.”
Me: “Even over my maximum heart rate? That’s when I tend to pass out.”
Specialist: “Yes, loss of functional oxygen in blood to the brain. But until then, it isn’t dangerous.”

He also explained that what seemed like seizures after I pass out was in fact a combination of lack of oxygen, heat, high heart rate and high blood pressure causing a reaction which looked like a seizure but wasn’t (errr...I hope Linda remembers this). Which means that I can continue working past those incidents.

I am still limited by being MORTAL and though I exercised for an hour at close to my maximum heart rate or higher Wednesday night, I won’t be able to walk, hike, run or the like since just holding on to my walker and using the quad muscles I have still, due to the extremely high heart rate from being upright, is like sprinting up stadium stairs while carrying 100lbs. You might be able to do it for a while, or even get used to doing it for a couple minutes, but that’s all. And you are going to be REALLY tired and sore afterward, no matter how hard a person trains.

So at the beginning of the week, I was looking at how I don’t have that long before I die. While now I am looking at lung, heart, kidney, (perhaps liver) and other problems, but I have the chance to PLAN and try to live longer. Having that makes a big difference. Even knowing that I will run out of pain meds in the future means I need to fight for the highest quality of life now. I know my quality of life is low now and will be as low or lower again BUT I can fight to get it as high as possible and live longer hopefully. I just have to continue to do what is hard and painful and difficult.

Just having the chance to FIGHT for a better life is the gift I have been granted. Let's see what kind of journey I can make of it. It IS going to be an adventure. First, having a little less vertigo and more rest probably would help.

I hope you have a good weekend. I am planning to get out of here for the first time in a long time and go see if the blackberries are ripe. I want to see the world. Thank you again for your comments, letters, postcards of support. I am going to make these next months the best months of my life, if I can. Because I know how easily they can simply go away. Having a diseases like this makes a mockery out of anything ‘expected’ – I do when the disease allows it, and I am working so it will allow me out a lot more (I have most of a pizza gift certificate left for example!).

To try and distract from the pain, I have been watching The Good Wife, on DVD (Season 1 cheap from the UK!). It is produced by Ridley and Tony Scott of Gladiator, Black Hawk Down, American Gangster fame. Together with Michelle and Robert King (writers of all 46 episodes) it has gotten the Golden Globe, six more awards and 39 more nominations. I avoided it because I thought, ‘Oh great, another ‘loyal’ wife as sleezy husband claims he is changed after sex scandal’ But that is covered and done with in 10 minutes. Then it is about a top lawyer who stopped after only a few years practice, now a junior lawyer at a firm, fighting it out (two hires for six months, only one is kept) to keep her job and prove herself more than just a ‘face’ off the tabloids.

While she dresses like Jackie O. is making a fashion line, she’s learned how to not back down, how to let silence do the talking for her and to know when to push her advantage. Each episode is her participation in another case, sometimes as first chair on a small case, sometimes just as a lowly researcher, as she gets dumped the pro bono work, then pulled off for ‘all hands on deck’ disaster regarding a big client.

It has gotten me through one day and a night of extreme pain, which is a high recommendation.