Throwing darts and hoping for a hit

Much to my surprise, I got a call Thursday morning saying that they DID have a room for me and could do a direct admission! Even the nurse was shocked, as it has been almost impossible for them to direct admit anyone recently. I was SO relieved not to have to spend hours waiting in the ER, and I fully attribute this blatant miracle to the power of Purim! Even better, they didn’t call me to come in until about 4pm, so I got to enjoy a full Purim seuda without interruption. Celebrating Purim before going inpatient definitely helped put me in a better frame of mind. I also realized that getting mishloach manot immediately before being hospitalized was absolutely perfect. Instead of going shopping for hospital snacks, I just waited at home and the snacks came to me! Winning!

We did a CT scan, and fortunately I DON’T have a pulmonary embolism. Unfortunately, I once again managed to develop pneumonia while on IV antibiotics, because I am super talented. This time I decided to take it to the next level and get pneumonia in BOTH lungs, because I’m an overachiever. If you’re gonna do something, may as well do it right!

There’s no way to tell whether the pneumonia is due to infection or due to aspirating reflux in my sleep, so we’re tackling both at the same time. On Monday I’m hopefully having my G-tube changed to a G/J-tube, which is less likely to cause reflux overnight. In terms of infection, the original plan was to continue IV antibiotics, as well as a whole lot of nebulizers and chest PT, and see if I had any improvement by Monday. If I didn’t improve, the plan was to start treatment for the NTM (non-tuberculosis mycobacterium) that’s been showing up in my sputum in recent months. The problem is that requires 3-6 months on multiple antibiotics, one of which is IV Tobramycin, the antibiotic that gave me tinnitus and can cause hearing loss. I REALLY wasn’t thrilled about having to choose whether I wanted to breathe or whether I wanted to hear. HOWEVER, on Sunday they got some new test results back, and discovered that my pseudomonas infection is now resistant to 2 of the 3 antibiotics I’ve been taking. Surprise! They also found one more antibiotic that it should be susceptible to, so the new plan is to try that for a week and see if I feel any better. I’m all for anything that pushes off going back on Tobramycin!

It was a pretty rough weekend. Between coughing, fevers, being poked and prodded at all hours, and just generally feeling gross and uncomfortable, sleep hasn’t been happening on any sort of regular basis. Additionally, I have been coughing up A LOT of mucus. Getting it out is definitely a good thing, but it isn’t coming out easily, and the whole process has been exhausting. My throat is ragged from all the coughing, and I’m having trouble sleeping because I keep waking up choking on mucus. I’m not exactly living my best life right now, but hopefully the new antibiotic will help and things will pick up soon.

I’ve also been doing vlogs of my hospital adventures if anyone is interested in a slightly different version of these health updates. If you subscribe to my YouTube channel and click the notification bell, you’ll get alerts when a new post goes up. Let me know what you think!

https://www.youtube.com/channel/UC0yVedzFwXoGoqVI_Sp9NhA

Back to the hospital

I’m convinced my lungs looked at a calendar and are trying to make sure they hit every Jewish holiday.

Last week I did feel the tiniest bit better, even though it wasn’t anything to write home about. Sunday, however, I inexplicably started feeling worse. I hoped it was just a weird random bad day, but since then my oxygen has been dropping, I’ve been incredibly short of breath, and I’ve gotten significantly more congested. I was supposed to have a follow up appointment next week, but I emailed my doctor and they told me to come in today instead. They also mentioned that I might need to be hospitalized.

I felt pretty defeated yesterday. Hospital was NOT the word I wanted to hear, particularly since my last hospitalization was so long and brought so little improvement. It’s extremely frustrating to once again end up feeling WORSE while on IV antibiotics instead of getting better. It’s also scary, because we keep trying different treatments, and keep not seeing any significant improvement. It’s really hard to keep fighting when you never seem to get a win.

My lung function numbers ended up being even worse than I expected. Somehow over the course of a week, while on IV antibiotics, I managed to drop from 48% to 42%. At that point I knew there was no way out of being hospitalized, but I did ask my doctor what they can accomplish in the hospital that we haven’t already tried at home. She pointed out that in the hospital they have full access to all kinds of testing and other diagnostic procedures to help figure out what’s going on, and that it’s much easier for them to make quick medication adjustments and try different treatments. They tried to admit me directly from clinic, but there were no beds available. The only other way to get admitted was through the ER, but thankfully they had mercy on me and told me to go home and enjoy Purim instead. They’ll try to direct admit me again tomorrow, and if they’re still unsuccessful I’ll start yet another ER adventure after I finish my Purim seuda.

They really don’t know why my health has been so poor and why I’ve been so unresponsive to treatment. It feels like we keep throwing darts hoping to hit a target, except I think we might also be throwing the darts while blindfolded. We tried an antifungal and got rid of the fungal infections, we tried an antibiotic and got rid of the MRSA, we tried IV antibiotics to treat the pseudomonas… and yet, I’m still getting worse. So now we’re trying to figure out what is it that we’re NOT treating that could be causing these problems. There are currently 2 top contenders. One possibility is a pulmonary embolism, a blood clot in the lungs. We actually tried to schedule a CT scan today to rule that out, but my lovely insurance is dragging their heels in approving it, so I guess they’ll just have to pay for it in the hospital instead. The other possibility is aspiration pneumonia. Even with medication I have terrible reflux, and they’re concerned that I might be inhaling reflux in my sleep since I use a feeding tube overnight for extra nutrition and hydration. We’ve explored surgery to combat the reflux, but my health hasn’t been stable enough to move forward with it. However, one thing we can do is change my G-tube to a G/J-tube. A G-tube pumps the supplement directly into my stomach, whereas a J-tube would bypass the stomach and pump it into my intestines. This could reduce overnight reflux issues, and apparently is a very easy change to make. So that will probably happen while I’m inpatient.

I didn’t have the energy or brain power to pull together a Purim costume, but fortunately I did have an unused super fun hat stashed away in my closet. And when I pulled it out I discovered that it also came with a tail, so that was an exciting bonus! I made it to shul for megillah reading tonight, and tomorrow I plan to go to shul again before joining Martelle and her family for an early seuda. At least I have the chance to get my Purim on before embarking on the next round of medical drama!

After megillah reading, Sarah Bienenfeld reminded me that Purim is the time of v’nahafoch hu, of things turning around, and of sudden unexpected salvation. Hopefully this hospitalization will be fueled by the power of Purim and I’ll see my own v’nahafoch hu soon!

Not again...

I guess I should’ve gotten an update out yesterday before anything had a chance to go wrong…

I felt noticeably better over the course of the weekend. My heart rate didn’t shoot as high with mild exertion, I was able to maintain oxygen without using the concentrator, and I had a little more energy. At my appointment on Wednesday my pulmonary function was up to 52%, which made me very happy. Overall we were pleased with how things were going and I seemed to finally be on a stable, upwards trend.

But apparently this rollercoaster isn’t over QUITE yet. This morning, after 2 full weeks with not the slightest hint of blood in my mucus, I suddenly coughed up 15 mL of pure blood out of nowhere. I literally yelled “NO!!!” as soon as it happened, because I was so frustrated to once again take a step backwards right when things were looking up. Fortunately it was less than the bleed from 2 weeks ago and wasn’t close to ER level, but I still can’t help feeling that my lungs are like dilapidated, rusty pipes right now, just springing leaks all over the place without warning. So once again I’m holding various treatments until I’m completely blood free for 48 hours. Unfortunately this time I’m not on any home infusion, so I don’t have that extra support to help make up for the missing treatments. Hopefully the bleeding will stop soon and I won’t lose too much ground.

I also got to do a super fun barium swallow yesterday to see whether I’m aspirating things into my lungs when swallowing. Fortunately it turns out that I’m swallowing fine, but I’m definitely having significant reflux (which we already knew), and there’s concern that I may be messing up my lungs by aspirating that. I’m already on a bunch of reflux meds, which control the acid level but can’t stop the reflux from coming up. We started exploring surgical options a few months ago, but put that on the backburner while dealing with respiratory issues. Once we get things stabilized the plan is to continue testing and consultations to move towards surgery and see if that helps with some of the respiratory issues.

On the plus side, before things went south, Katherine and I took advantage of the good weather and my relatively decent health to go to the Mummers Parade! I’ve been watching this Philadelphia New Year’s Day tradition on TV since I was a kid, but never actually made it there in person. We shlepped the wheelchair on the train and joined the crowds at Broad Street and Sansom to watch the string bands perform, and had a great time! And one of the mummers even gave me his parasol, which was super cool!! Apparently looking pathetic in a wheelchair has its advantages!

I’m definitely frustrated about backsliding once again, but I’m glad it at least waited until after I squeezed in a great experience! Hopefully that was the last hurrah for this CF exacerbation, and I’ll get back on a steady upwards trend soon!

In it for the long haul

Well, that didn’t exactly go as I had hoped.

At the end of October my lung function was at 57%. Just 2 weeks later, despite IV antibiotics, it had unexpectedly plummeted to 45%. After three weeks in the hospital and an additional week of home IV antibiotics, my lung function now is up to… 48%.

I knew I was nowhere near my baseline of 60%, but I thought I had at least made it back into the 50s. It was definitely disappointing to see so little progress after so much treatment. I’m certainly doing much better now than I was 6 weeks ago, but no matter what we try I just can’t seem to get very far. My lack of progress doesn’t make sense, because various tests have shown that my infections SHOULD be susceptible to the 4 IV antibiotics we’ve tried so far. But for some reason, during each of the last 2 rounds I only made a little progress before stalling. We’re going to try 1 more IV antibiotic and see if that finally makes a difference. Unfortunately, that antibiotic is Tobramycin, which caused tinnitus (ringing in the ears) back in January that never fully faded. Hopefully a brief course won’t have auditory side effects, but I will be monitoring things carefully, and we will stop at the first sign of any problems.

If I still don’t have any progress after a week of Tobra, we’re going to take a break from IV antibiotics and give my body some time to heal on its own. We’re also going to do some testing to see if it’s possible that my terrible reflux is contributing to the problem, and if maybe some of this is being caused by aspirating things into my lungs. Unfortunately, the steroid which is helping control the inflammation can also exacerbate reflux, so it might actually be making things worse. I’m in the process of starting a monthly injection used for severe asthma in the hopes that it will enable me to get off of or at least lower the steroid.

On a positive note, I do have a terrific hashgacha pratis (divine providence) story! While hospitalized I met one of my neighbors as we both walked up and down the halls getting our exercise. He doesn’t have CF, but he did have a lung transplant back in March. It turns out that he had multiple oxygen concentrators that he no longer needed, and he and his wife had been looking for a person or agency to donate them to in order to pay it forward. This week they dropped one off at the outpatient clinic, and I am now the proud owner of my very own portable oxygen concentrator! This is GREAT, as my oxygen continues to drop with exertion, but not low enough to qualify for supplemental oxygen to be covered by insurance. These machines cost thousands of dollars and I never would have gotten one on my own. Having supplemental oxygen available will make it easier for me to be active and get back on track with exercise so I can build my strength back up. So, I HAPPENED to be next door to this gentleman, who HAPPENED to have a spare oxygen concentrator, EXACTLY when I could benefit from in-home supplemental oxygen for the first time in my life but had no way to get it. Thank you Hashem!!

This has definitely been a long haul. It’s still unclear how much longer of a haul I can expect, or what the eventual outcome will be. Which is, honestly, frightening, frustrating, and discouraging. But I am still hopeful that things can get better than they are now, whether through treatment or simply with time. And even if they don’t, I am also confident that I will learn to adjust to my new normal and figure out how to live life within it, just like I have in the past. One way or another, I will roll with the punches and come out on top, just like I always do.