Welcome to My World, In Which I Compare MS and Social Distancing

When social distancing first kicked in I was on a call with my usually globetrottting but newly homebound colleagues who were bemoaning the fact that they were sitting all day. A particularly sensitive one of these lovely humans wrote soon after to check in, worried about how those comments might land on someone that has no choice but to sit most of the day. I gave it some thought and realized that, while I did briefly want to sing “Cry Me a River,” I was primarily interested in the fact that the whole world was getting a taste of what it’s like to have MS.

You cancel plans you were looking forward to because you can’t leave the house.

Sure, there aren’t government decrees insisting that people with MS stay indoors, but, believe me, my body is harsher than any mayor. I don’t leave the house because I can’t. Literally. Due to fatigue. Due to my legs being little bitches. Due to it being 80+ degrees. Due to depression. You get the picture.

You spend hours wondering is this cough due to COVID . . . or is it just a cough?

MS symptoms are a Pupu Plattter of weirdness. Spasticity, gait issues, bladder/bowel problems, and sexual dysfunction are all clearly MS-related for me. Fatigue? MS likely plays a big role but so does not exercising enough and eating poorly. And my short term memory issues that scare the hell out of me? That could be MS or just the fact that I don’t focus well or pay enough attention.

You don’t know how long this will last.

MS, like a diamond, is forever, but its individual symptoms’ lengths vary. I had double vision ten years ago that seriously affected my day-to-day to life and had to stumble through without an end–or two–in sight. It was mercifully finite. Lower back tension and pain that settled in two and a half years ago have been my constant companions ever since. Now that I’ve reached the progressive stage of illness, I have to make peace with the fact that things aren’t going to improve much. Good news: you don’t have this problem.

You feel isolated from friends and family.

I am #blessed that this is not an issue for me. All of my friends and family have been crazy supportive since my first pre-diagnosis tingle. If MS Twitter* is to be believed, this is not the norm.

a glass of bourbon
a tasty coping mechanism

You find new ways of doing things.

You’re moving your weekly coffee date online, adding ad hoc teacher duties to your routine, and cutting yourself and your family some slack. I’m sitting down (or, UGH, asking for help) to cook dinner, working Pilates into my schedule, and cutting myself some slack. Your new ways of doing things are constantly evolving as your circumstances change and you figure out what works. Mine, too.

 

You are on a roller coaster of emotions.

Some days what works is lying on the floor crying, And that’s okay, so long as you get up eventually. Some days you are a goddamned rock star with one hand ready to unmute yourself for a meaningful contribution to a Zoom meeting while the other is cutting Shrinky Dinks.** Some days are hopeful. Some days are not. But you (and I) press on because there is far more good in the world than shit, even in these particularly shitty times.

 

*A thing! Really
**I saw this happen last week.

It’s OK That My New Year’s Blog Is Posted in February: In Which I List Other Things I Learned in 2019

Being both a nostalgia whore and a planner, I adore the change from one year to the next. New Year’s Eve as an event ceased to be fun when close friends moved too far away for quietly drunken nights in together. Now I immerse myself in reflection instead. I scroll through photos on my phone. I sort through the basket filled with cards received and Playbills from shows seen. And I think about what I’ve done and what I hope to do.

a pile of cards and Playbills
A basket of memories, 2018-2019.

In my reflection, I realized I have learned some things that might be useful to folks with chronic illness–and even a few tips for you healthy people.

1. Go easy on yourself.

You may have noticed that I don’t blog regularly (hi, Patrick!). I started this post New Year’s Eve and have thought “Damn it, Rebecca! Just finish it already!” repeatedly over the month. When I can fit in only one Pilates session a week, I think “Damn it, Rebecca! Even for someone with MS, you’re a lazy blob of humanity!” Too tired to finish dinner prep? “Damn it, Rebecca! If you’d planned better, you could have done this without help!” There are kernels of truth in each of these statements of self-abuse, but focusing on them neither helps me exercise nor gets dinner on the table. So I’m leaving self-damning behind and doing my best to accept my limitations without discouraging notes from my internal peanut gallery.

2. Don’t apologize.

Okay, I don’t mean NEVER apologize. I didn’t become a jerk in 2019. Apologies have their place, but that place does not need to be a permanent residency on my lips. If I move awkwardly through a crowded room, I smile and say “excuse me.” If I step on someone’s foot in the process, I apologize. I would never expect someone else with a disability to say “Sorry!” to me, so why on earth should I expect it of myself?

3. Ask for what you need.

I’ve spent a lot of time grumbling about being placed in the back of planes in spite of having declared a disability and requested assistance getting from gate to gate. Should that trigger a “hey, give this lady an aisle seat near the front of the aircraft” notification in the system? Yes! But we aren’t there yet. Airlines have numbers you can call to ensure your needs are met. You may have to call regular customer service first to get that number. Once you have it, save it in your phone and use it.

On a more quotidian note, I exhibit fierce independence usually seen only in toddlers determined to pour orange juice from big jugs into their tiny cups. I want to do everything MYSELF, even at the risk of my safety. After one too many burned hands and sloshed waters, I have humbled myself to bravely ask strangers (without apology!) to carry things to my table for me at restaurants. And they’re happy to do it.

4. Find and embrace things that make life easier.

Perhaps the biggest revelation of 2019 was my discovery of True & Co. bras, many of which have no clasps! Plus, they’re pretty, flattering (no uniboob, a usual risk with this style), and comfortable–even for those suffering from the dreaded MS Hug. Being able to put on a bra on my own is the smallest of victories, but eliminating little frustrations gives me a greater chance of making it through the day happy.

5. Make peace with your body.

Years ago my massage therapist Laura suggested I ask my legs what they need. Although I have yet to get a clear answer from any of my body parts, I have changed the way I talk to them. (Sensing a pattern? A+!) Uncooperative legs used to get an audible “Fuck you legs! Pull it together!” Now it’s much more of a calm “You’ve got this. You are strong, and you can do it if you go slowly.” I often feel ridiculous hearing myself utter this sort of positive self-talk, but I’ve realized that taking an adversarial relationship to my body–and, for that matter, my disease–does not help. I’m not sure that kindness makes me stronger. It does make me feel slightly less shitty, though, and we could all use more of that.

 

New Doctor. Who dis?: In Which Cautious Optimism Does Not Pay Off

My beloved neurologist recently moved to Florida. How did I love him? I shall count the ways. I loved his quietly avuncular nature. I loved that appointments with him lasted a full hour, leaving plenty of room for “oh yes! I’ve been meaning to ask . . . ” queries that never made it to the list I always brought with me. I loved his one-two punch of experience and openness to new treatments. I loved that he took an interest in my life beyond my disease and gave me small glimpses into his. I especially loved that he sent me to the wonderful Dr. B, who calms my head tremors with Botox. And, most importantly, I loved that changed my DMT (disease-modifying therapy) to something that has prevented new brain lesions for six years.

Each time I have changed neurologists the results have been good. The kind and quiet Dr. W passed me on to Dr. C, whose fondness for Shakespeare gave us an entryway to rapport, making it easier to discuss excretory mishaps and other concerns. I left him for the recently departed (from DC) Dr. M in the name of getting more specialized care. His warmth and good humor were welcome bonuses.

So when Dr. M announced he was leaving, I was crestfallen but cautiously optimistic. Perhaps a new neurologist would bring new ideas. Unconventional approaches. Maybe even a prescription for the massages I invest thousands of dollars in each year. This could be great!

I went into my first appointment with Dr. A like I do most nervousness-inspiring situations, with a big smile and a tendency to talk even more than usual. I wanted her to like me, to see I’m not the average patient. I am good natured and funny! I know WebMD isn’t a real doctor! I understand science! (Sort of. My AP Bio exam score 25 years ago may have given me overblown confidence in this realm,)

I was greeted by the blankest face I’ve ever seen. Not a great start, but I could deal with this. I modulated my manic tendencies, directing my good cheer at the three med students to my left who seemed to need it. In our half hour together, the only flicker of emotion that crossed Dr. A’s face was repeated eye rolls when the students’ responses to her questions disappointed her. Corrections were delivered in a condescending tone. My heart broke for them . . . and for me.

We spoke about the need for an MRI and bloodwork. About how decreasing the frequency of my infusions is wise since the complications (which include DEATH, by the way) grow more likely the longer I’m on the drug.

“Should I maybe try another drug now? I hadn’t realized my risk went up with time.”
“It’s an option.”
Silence.

Ooooookay. Now to my list of questions

With a grin to the medical students, “Sorry, you get more than you bargain for with me in the office!” Back to the doctor,
“I’m finding orgasms especially elusive these days.”
“Yeah, unfortunately there’s no female Viagra yet.”
“And if there were insurance wouldn’t cover it! Or let you get some internet doctor to prescribe it!” I laughed.
Silence.
“Talk to  your urologist.”

“I’ve noticed that my voice is froggier than it has been.”
Silence.
“It’s hard to describe . . . it isn’t as strong as it was . . . it’s sort of creaky?”
“Do you mean how it’s kind of sing-song?”
“Well, no. But now I’m self-conscious about how I’m talking.”
Silence.
“That’s not MS.”

I felt embarrassed, dismissed, and foolish. I barely got through the rest of my list.

an obvious graph
Lifted from thisisindexed.com, which is great fun!

 

The physical exam was performed by the med students, deemed worthy of Dr. A’s eyerolls yet entrusted to try their skills on me all by themselves with her interrupting only occasionally to say things like “What do you notice about her gait? What causes that?” They did a fine job, but I couldn’t help but wonder if their assessments would accurately represent my progress. Maybe these benchmarks don’t matter, especially when one is as far along as I am? I was too discouraged to put up a fight.

In typical form, I kept my shit together long enough to exit only to fall apart in my Lyft home. How could I go back to someone that belittles med students in front of patients? And, worse, who addresses my concerns without compassion? I understand that you may not be an orgasm whisperer and that my vocal issues might not be caused by MS, but I definitely need a flicker of a smile when you tell me these things. My inner voice sing-songed my distress, dismay, and despair all the way home.

It’s now a month later, and I have an exit plan. With the best neurology department in the US just an hour away, it seems foolish not to give it a try. Plus, I had the good fortune to meet a charming doctor who works there at an event I attended recently. Here’s hoping we’re as compatible in the office as we were over dinner.

 

 

On Sparkling: In Which I Examine Why I Don’t Write

Sadly, my “dolls” have the opposite effect.

My friend Patrick can be relied upon for unexpected and amusing non sequiturs delivered via text. So I was intrigued when he appeared on my phone last week saying, “I’ve given this a lot of thought.” I watched the three dots expectantly, wondering what delight awaited me.

“You suck at regular blogging.”

Hm. That was unexpected but hardly amusing, especially because it’s painfully true. Regular blogging falls somewhere between carrying a full cup of liquid without spilling it and doing jumping jacks on the list of things I suck at. Four blog ideas have rattled around my head for months, and I haven’t managed to put finger to keyboard since January. What the hell is going on?

On the surface, there’s plenty. I continue to work part time. My leadership coaching program also continues, now with the bonus of three pro bono clients. I have scattered doctors’ appointments plus regular wellness ones (chiropractor, massage, etc.). It isn’t the most demanding schedule, but adding anything to the mix is hard when showering requires a 15 minute recovery period before I can make it out of the bedroom. If I work all afternoon, lifting my arms to the keyboard after hours is an exhausting proposition. On the rare occasions I have remaining energy, I tell myself should devote it to exercise (something I also suck at doing regularly of late).

Here’s the thing: I could schedule my day better. I could write in the morning, as I’m doing right now. I could make it a daily habit. I genuinely like (and hate*) writing this confessional-informational blog. So what gives? Why can’t I get my shit together to do it?

Luckily, there’s a tool for that! Immunity to Change (ITC) posits that “failure to meet our goals may be the result of an emotional immune system that helps protect us from the fallout that can come from change–namely disappointment and shame.”** Last spring I had the good fortune to participate in an ITC workshop delivered by two of my brilliant colleagues. What was my improvement goal?

This is an Immunity Map worksheet. You can get a blank one online.


I AM COMMITTED TO MAKING TIME TO WRITE ON A REGULAR BASIS.


It’s been a year, and I have yet to reach my goal. Still, the insight I got from this exercise has stuck with me. The basic idea of the chart is that column one is what I want. Column two is what I’m doing (or not doing) that prevents me from achieving my goal. Column three begins to unpack the why of it all, listing good reasons why I’m behaving the way I am. And column four both blows things to their extremes and reveals some underlying and (in my case, at least) previously unexamined truth.


I assume that now that my body is failing me, all I have to offer are my smarts and wit — and if I don’t sparkle in all things I do, people will stop putting up with my limitations – and if people stop putting up with my limitations, my friends (and spouse) will leave me – and if they disappear, I will have to move back in with my parents.***

My friends, in rational moments, I don’t think you will abandon me just because my body is in decline. That said, I must acknowledge that I worry constantly about being a burden. It’s no fun watching my 80-year-old mother, who has her own mobility issues, roll my suitcase into the airport and hoist it onto the scale. Or making half a dinner only to get out of the kitchen because I literally can’t stand the heat. Some nights after going to bed I ask Neal to fetch three separate things on three separate trips because I can’t do it myself (nor can I gather my thoughts enough to make a single request). If you socialize with me, I will sparkle with all my might to make up for the fact that I’m likely to need you to go for a napkin run or walk me to the bathroom or, heaven forbid (but it’s happened), cut my damn food for me.

It may seem silly that this same impulse arises with blogging since I can’t very well ask anything of you except your attention, but I’ll be damned if I’m going to serve up mediocre slices of my beautiful, mostly intact mind for your consumption! You deserve better, especially since I am burdening you with my trials and tribulations. (See column four’s “being whine-y = being a less good friend.”) As I’m trying to wrap this up, I’m worried that this hasn’t been funny enough and that I don’t know how to stick the landing. Perhaps I will let it go this time.

Pat, I’ll try to be easier on myself to ensure you have something to read on your commute. Thanks for inspiring me to write again.


*I don’t trust people who write who don’t have a healthy dose of hate with their love of the craft.
**
I pulled this quote from a Harvard Extension School article, which I highly recommend but is unlinkable. Google it! There’s also a whole book about the subject. And this terrific video.
***Mom and Dad, I love you dearly. I just don’t want to live with you. I hope you understand.

The Urethra Monologues, Part Three: In Which I Look Forward to Twenty Shots to the Bladder

For those of you tuning in late, here are parts one and two.

During my first two years self-catherizing, my urologist tweaked my medications multiple times to further reduce the frequency of my urination–and to eliminate my nocturia, which is a fancy way of saying “the need to get up in the middle of the night to pee.” Vesicare was rejected because it made me so thirsty I drank enough to offset any positive effects it might have. Oxybutynin was replaced with a higher dosage of Doxazosin, which was eventually revealed to be the cause of my leakiness. So long, Doxazosin! Then Myrbetriq came along and put the rest to shame. Effective with no side effects (for me, at least), it was a godsend. A very expensive godsend ($60/month copay if memory serves) but a godsend nonetheless.

Still, I almost never peed the mere six times a day that self-catherization initially promised. It was time to try something new. In the summer of 2015, my neurologist suggested a urogynocologist with a compulsive nervous laugh and a penchant for quizzing me on Shakespeare while examining my ladyparts. What she lacked in bedside manner, she made up for in action: it was time for Botox at last! 

My first appointment was delayed due to insurance issues and then a UTI (something that’s no longer an issue since my doctors now prescribe a week of antibiotics prior to the procedure), but on January 19, 2016 I happily wrote the following to my family:


After months of anticipation I received my first dose of bladder Botox today. As I (over)shared on Facebook, my nurse’s running narration of the prep included her referring to my urethrea, which did not make me feel I was in the best hands. Still, she did her work well enough (filling me with numbing liquid and gel) that the needles didn’t hurt much going in, even in the inexperienced hands of a urogyno fellow. I continue to find the office lacking in efficiency and am tiring of having to discuss Shakespeare with my legs akimbo. If this works, though, it will all be worth it.



It was totally worth it! With Botox working with MS to almost entirely immobilize my bladder muscles, I reached the magical six pees a day goal and even slept through the night. The effects usually last nine to twelve months. I initially received Botox again in early 2017 and then was scheduled for a second treatment the following September when I ran into prior authorization issues. Not familiar with prior authorization? It’s a fun thing insurance companies do where they receive a prescription from your doctor and then say, “Are you sure? Please fill out additional paperwork to prove it.” Because I also receive Botox injections in my neck, it takes some administrative finesse to juggle my authorizations since (also fun) you cannot have two prior authorizations for the same medication simultaneously. It took 40+ calls to my doctors, the pharmacy, and the drug company to straighten everything out. After a lot of stress and even more tears, I finally got my Botox in February of this year.


Comfortably Numb

I also got a new urologist, one who laughs at appropriate times and has a helpful, responsive staff. She administered my latest set of Botox injections this week. Curious about the procedure itself? Lucky for you I took notes.

  • First I stripped from the waist down (in prior visits, a hospital gown was involved) and lay on a table with my knees up (no stirrups, which felt more dignified than previous procedures).
  • The nurse swabbed my urethra with iodine and then used a large, needleless syringe to inject my bladder with lidocaine jelly. 
  • A catheter was then inserted to transfer lidocaine liquid into the bladder.
  • Lidocaine is a numbing agent, by the way, and it takes a while to do its stuff. To ensure it covered all of my bladder walls, I lay on my back for ten minutes and on each side for five. (This was much better than being told to “move your hips around,” which is what the urethrea nurse suggested.)
  • I received another swabbing and then another squirt of lidocaine jelly for good measure.
  • A new catheter was used to empty my bladder into a big cylinder,
  • Then it was time for the main event. An itty bitty lighted scope was inserted through my urethra, et voila! The inside of my bladder appeared on a screen to my left. Next thing I knew, I saw the needle within the scope puncturing my bladder walls, leaving behind a bright red trail of blood each time it exited. The sensation is tough to describe . . . it’s a sort of pressure followed by a light sting. After a few minutes of discomfort, the twenty injections were done. I was given an antibiotic and sent on my merry way.
Now I await the results, which take a week to ten days to kick in. I look forward to sleeping through the night again, as well as no longer being the weak link on car trips. Sometimes it takes some discomfort (and tenacity) to improve your quality of life.

Stumbling Towards Ecstasy: In Which I Say Orgasm A Lot

I learned about sex under the geodesic monkey bars at A. Brian Merry Elementary School in the first grade. My friend Brandy* stood amid a rapt group of girls, telling us what she’s read in a book she found in her parents’ bedroom. I was shocked. Surely no one would ever do that. Surely my parents would never do that. Ew ew ew.

I got over it relatively quickly. In middle school an article in Glamour led me to my first, accidental orgasm, and, once I got over the initial shock (because, really, who is prepared for that first one?), I was a fan. No need to go into details here–I sorted out what worked for me and happily took things from there.

As I got older, articles about women that were unable to achieve orgasm would cross my path occasionally and I’d wonder who these poor people were, thinking fondly of my bedtime triple from the previous night. Even the fumblings of inexperienced boys could usually get me where I wanted to be. In college I joked that if you looked at me funny I would come. It was that easy and remained so for a long, long time.

I used to have what she’s having.

Several  years into my MS diagnosis, something changed. Orgasms were elusive and could be coaxed out of me only with toy-based assistance. That was a bummer, but, hey, you do what you gotta do, right? I’d read enough women’s magazines to know that vibrator-dependence was normal for lots of women. I’d just be one of those women now. Sigh.

My sex life was humming (get it?) along just fine until one day the unthinkable happened: I peed. Mid-orgasm. I PEED. I was embarrassed, but maybe this was a one-time thing? Nope. It happened again. And again. I asked my urologist if anything could be done, and he shrugged, saying “Try not to eat asparagus before sex?” So I bought a protective cover for our mattress and worked towel placement to the foreplay. I tried to be grateful to still be amongst the orgasm-havers, but this undesired new kink shook me. As I inched closer to climax, my brain would beg my bladder to get ahold of itself to no avail. The afterglow is less glowy when experienced from a puddle.

As mentioned in previous blogs, my bladder has long been problematic, and the switch to self-catheterization was traumatic but helpful. It had an unexpected upside: those little tubes allowed me to fully empty my bladder whenever I wanted, so, not only could I sit through an entire movie, I also had fewer mid-orgasm surprises. Hurrah!

Then I had fewer orgasms. Way fewer. My brain and body would be in the zone. So close . . . so very, very close . . . and then . . . then . . . nothing. Again, I must acknowledge that lots of women have difficulty achieving orgasms or don’t have them at all, but I WAS NOT LOTS OF WOMEN. Now sex could end in tears, and not the oh-my-god-that-was-amazing kind of tears. These were fuck-you-body-how-many-more-things-can-you-take-from-me tears. I mentioned my troubles to a new, less humorous urologist who swiped a cotton swab along my lady-bits and said, “Your clitoral reflexes** are fine. You probably need a stronger vibrator. Get a Lelo.”

So I got a Lelo, which helped some. Sometimes sex still ends in tears of frustration. Sometimes it ends in a tiny little orgasm after lots of build up. Sometimes, rarely, I surprise myself, climaxing with the speed and intensity of a pre-MS me. And sometimes I just have sex for the sake of having sex, orgasms be damned. That mindset has been tough to embrace, but it’s gone a long way to improving my happiness in the bedroom.

I realize you, gentle reader, may not have MS, but should you face any sexual frustrations like mine, here are a few tips:

  • Get yourself an understanding partner. I’ve tried to keep Neal out of this post as much as possible, but it must be acknowledged that he has weathered my evolving sexual self brilliantly. I’m very grateful.
  • Communicate frankly with that partner.  
  • Figure out what works for you. Read some erotica (and if you find any good stuff, send it my way). Splurge on a fancy toy. Hell, try something kinky. Life is a banquet and most poor suckers are starving to death.*** 
  • Try to get out of your head. Nothing makes you less likely to have an orgasm than thinking “I hope I have an orgasm!” on a loop. 
  • Remember: orgasm-free sex is still sex, and sex is awesome.  

*Fun fact: Earlier that year I told my parents I’d made a new friend whose name I couldn’t remember but I knew it was a type of alcohol. Brandy was that friend.
**Clitoral Reflexes would be a great girl punk band.
***This is, of course, from Auntie Mame and is good advice in and out of the bedroom.

Ch-ch-ch-changes: In Which I Stubbornly Resist Things That Make My Life Better

The trend began with tears at the good CVS on Capitol Hill. The one with aisles so wide that two people can pass each other without having to turn sideways. The one with a nice selection of greeting cards. The one with a rack of canes near the pharmacy.

It was spring 2010. Birds were chirping, and I was raising money for the MS Walk, which I jokingly referred to as the MS Stumble. I walked reasonably well back then, but my stamina was fading. Neal pulled a cane off the rack and wisely/annoyingly pointed out that now might be a good time to give it a try. I didn’t quite point out that he could go to hell, but I did resist, first angrily and then dissolving into a puddle of tears and acquiescence. He paid $25, and I was the defeated owner of a drug store cane, which made its debut at the Walk and became increasingly present and useful over the years.

The next battle was shower grab bars. “They’ll reduce the value of our home!”

A shower bench. “It’s so ugly! Where will we store it?!”

Mobility scooter. “I’ll look old! Besides, where will we store it?!”

And now we’ve come to the biggest change of all: moving from our lovely, old, completely inaccessible house to a beautiful, though less charming, condo. Friends, my brain knows that this change will make my life better, but my heart and tear ducts beg to differ each time I look out at the screened-in porch I have just a few weeks left to enjoy and the fireplace whose final fire I didn’t properly appreciate, not knowing it would be the last. I’m giving up a proper dining room, a jacuzzi tub (which, admittedly, I’ve needed help extracting myself from multiple times), exposed brick, THREE fireplaces . . . and the worst non-spiral staircase imaginable for someone with balance and fatigue issues. 

The staircase loss is an enormous gain, as is the fact that our new bedroom not only lacks a step but also has an en suite bathroom. My day-to-day life is about to get so much better, but still I’m weepy and not just in a sentimental I’ve-spent-six-years-making-this-my-home sort of way. These tears, like those that came before, are about personal loss. Needing to move to a condo is my 41-year-old version of being put into a home. It’s the most tangible (and expensive!) sign yet that my body, my life is different than it was a few years ago. It is–really, I am–weaker. And that sucks. I try to frame it as empowerment rather than loss. (Thank heavens for Neal, who is much better at this than I.) These first few weeks sting, though.

When I watch tv now and see a character walking unassisted, I sometimes think “Oh no! She’s left her cane at home!” That’s how normal previously weird and painful changes can become. I have faith that once I’m ensconced in my gorgeous new kitchen, I will feel sorry for those suckers whose homes have more than one story. It will take some time, though . . . and perhaps some assistance from my new wine fridge.

Aforementioned gorgeous new kitchen. Wine fridge not pictured.

What’s a Nice Girl Like You Doing on a Scooter Like This: In Which We Examine Life with MS for the Vain

Back in middle school, my BFF Sarah and I would spend Friday nights on her four-poster bed, a fan pointed directly at us so we could snuggle under all of the covers no matter the time of year, talking into the wee-est of hours. Our favorite game was “What would you do?” and it went pretty much as you’d guess – one would ask the other the question, invariably about a boy’s action. The game almost always began with “What would you do if [insert boy-of-the-week’s name here] put his hand on your leg and told you you needed to shave?” This led to a flurry of giggles and protestation from the person being questioned because neither of us would ever be caught with less than silky smooth legs when boy-adjacent.

Oh, how times have changed.

I wince every time I catch a glimpse of the pelt on my legs presently. It’s only a couple of weeks’ growth; I am a quarter Italian, so genetics are against me in the battle against body hair. Until the past year I usually could muster up the energy to shave a couple of times a week, if not every other day. Now just standing under warm water long enough to shower thoroughly can leave me with barely enough energy to dress myself after. Wielding a sharp tool partway through the process is ill-advised.

Facial hair used to be managed with the excellent bliss Poetic Waxing kit (a joke I literally just got), but, when waxing sessions ended with my sink covered in green goo but my lady mustache intact, I switched to wax strips. Even that grew too difficult, so I’m now stuck with depilatories, the stink of which send me back to middle school faster than wondering what I’d do if Benji Barton put his hand on my hairy leg. Still, that cream gets the job done, and I am grateful . . .  until I spot a rogue hair requiring plucking.

Intention tremors are the enemy of good grooming, and nothing underlines that like trying to pluck a single hair. NIH says intention tremor “is produced with purposeful movement toward a target, such as lifting a finger to touch the nose. Typically the tremor will become worse as an individual gets closer to their target.” So when I aim a pair of tweezers at a single hair in my eyebrow (yeah, that’s the ticket, my eyebrow), I activate a hand tremor that makes it damned hard to get purchase on that hair no matter how coarse and dark it may be. Add my head tremor to the mix, and it’s amazing that I haven’t poked an eye out.

(Speaking of eyes, my interest in real eye make up–not just a swipe of mascara–sadly coincided almost exactly with my tremors’ onset.)

It would be disingenuous to bemoan MS’s effect on my hair (that which grows out of my skull, that is), as even in my liveliest, steadiest-handed days, I’ve never had much skill in the styling realm. Wash and wear has always been my way, barring a brief and failed flirtation with late 80s peacock bangs. That said, often I can manage merely a half-assed blow dry once shower fatigue has set in.

So what’s a vain girl trapped in an uncooperative body to do? Here are a few things that work for me.

1. Enlist an ally. I found Andre long before MS reared its ugly head. He’s the only person I’ve allowed to touch my brows for over a decade. Without him, my entire forehead would be one big eyebrow. He also is in charge of special occasion make up, because, lord knows, the chance of my expertly creating a smoky eye once is less likely only than my doing it twice in a single sitting.

2. Throw money at the problem. I lasered the hair off my underarms a decade ago. It didn’t go away completely, but I can now go a full month without shaving them before entering dirty hippie territory. Do your research to find a reputable place and keep your eyes peeled for Groupons.

3. Sit yo’ ass down. If you’re going to be vain, you might as well get yourself a vanity! You can buy a proper one or DIY. Mine consists of a smallish table with a desk lamp and mirror atop it plus all of my make up and jewelry. Sitting to primp is less fatiguing than standing. Yay! Plus, bracing my elbow on a table steadies it a bit, making it less likely that I stab myself with a mascara wand.

I imagine a different (and perhaps better) woman would say “Screw it!” and embrace her hairy, unadorned body with acceptance and love. Instead of leaning that way, I’ve gotten vainer. I accept the fact that I will fall in public and that people will think, “Oh, that poor lady! What’s wrong with her?” I just hope the word “pretty” will cross their minds, too.

“Who was that dazzling woman on the mobility scooter?”

The Urethra Monologues, Part Two: In Which I Am Thrust Into the World of Self-Catheterization

Six months after braving Urodynamics, I was still on Doxazosin and pursuing a new approach: physical therapy. I first met with a wonderful woman outside of DC whose office was welcoming and yoga studio-like. I desperately wanted her to take care of me but knew that a 90 minute commute each way via Metro (ah, the good old days when I still traveled independently!) was too much. She referred me to a rehab practice in DC where I worked with a woman who definitely knew her stuff but was significantly less nurturing. Under her tutelage I did Kegel after Kegel to strengthen my pelvic floor. I was sent home with a rented device to put inside me while I did my exercises. It was a hard and unpleasant couple of months, but I did come out of if with better bladder control. For a while.


I continued to see the wonderful Dr. Phillips and returned for my second urodynamics study (some girls have all the luck!) the summer of 2012, two years after my first one. There were some unexpected updates. This time I was treated to a rectal probe (yay!) as well as a real-time x-ray type scan that allowed me to watch my bladder filling up like a balloon, which was a bizarre experience. Even before the test, the nurse scanning my void diary (which included 15+ bathroom trips/day) mentioned intermittent self-catheterization as a possible solution, and, by the time all was said and done, everyone agreed that we should give it a try. Um, right now? Ack.

I cried a little and then pulled myself together and gave it a go with the amazing nurse Hazel talking me through. It was neither easy nor comfortable, but it also wasn’t as hard or painful as I’d feared. And, as horrible as self-catheterization seemed, Hazel unintentionally provided me with some good perspective while giving me instructions. “You’d be amazed how many women look at me blankly when I say ‘Put your fingers around your clitoris.'” I might have to pee through a straw but at least I know where my clit is!

That first week was awful. In addition to having to lug my new catheter samples (including some alarmingly long ones) and lubricant, I carried what is commonly referred to as a “hat” — a plastic container that sat on the toilet seat so I could measure my output and report back to Hazel, who would then help me figure out how many catheters to order. Some days I managed to catheterize maybe twice after rendering my ladybits sore from inept poking around. It is a cruel coincidence that folks with MS who have to self-catheterize also likely have hand tremors and/or poor manual dexterity. Even now I sometimes struggle, but I did eventually get the hang of it. Dr. Phillips told me the goal was to be able to sit through a whole movie, and within a month I could do just that. 

Look I made a hat!
So, since 2012, I have peed unassisted only rarely, usually in what my father charmingly refers to as “floating molar” situations, where even my uncooperative bladder cannot help but behave properly. Self-catheterization has become as normal to me as toothbrushing. I cheerfully discuss my catheter needs and preferences with the staff at 180 Medical. (If, heaven forbid, you or someone you love ever has catheter needs, I cannot recommend them highly enough.) I have bought myself a series of stylish bags in which to hold my stash. I have been grateful not to be a slave to my bladder. Still, when I hear someone forcefully peeing in a stall next to me, I get a little wistful, knowing that will never be me again. Next time you have a really good pee, enjoy it for me.

P.S. Medical lubricant seems to come in two sizes — ketchup packet and large toothpaste tube. Once when I was out to dinner with my friend Donna, while getting up to go to the bathroom, a toothpaste-sized tube clearly marked LUBRICANT leapt from my purse, falling at the feet of our waiter. Donna made a noble effort to kick it out of the way, but it was too late. Lord knows what that waiter thought I was doing with that lube, but he didn’t make eye contact with me for the rest of the night.

The Urethra Monologues, Part I: In Which We Embark on the Long Road to Botox

A few months after diagnosis (way back in 2004), it dawned on me that my frequent urination might be related to my MS. My neurologist put me on a few medications over the years in an attempt to calm this symptom None worked great and some came with annoying side effects like dry mouth, which caused me to drink more, which led to more urination, which defeated the purpose.

In 2009, I asked for a referral to a urologist and met with the cheerful Dr. Shin, a young-ish dude with a fauxhawk (hey, it was 2004) and an easy manner — upon learning we lived in the same neighborhood, he said, “Is it okay if I say hi when I see you? That freaks some patients out, talking to their urologist in public.” I assured him it was fine so long as we weren’t discussing my urinary habits. I believe Dr. Shin was more accustomed to dealing with men and their man problems, so at my next appointment I saw Dr. Phillips, a kind and good humored guy who knew a thing or two about neurological issues. I liked him immediately in spite of what he had in store for me.

And what was that, pray tell? Urodynamics. Sounds a little like a facet of Scientology, no? Of course, Scientology is full of shit, whereas urodynamics concerns itself with pee. Here’s how it goes:

Part one:  I emptied my bladder in a fairly traditional manner (just with the added clean-catch bells and whistles) and then having an ultrasound to see just how empty it was.  I passed this test just fine.

You can be the President. I’d rather be the Pope.

  

Part two: I stripped from the waist down and then sat on a strange throne sort of chair with a round section cut out of the front of the seat. A catheter was then inserted into my urethra, which was pretty damned uncomfortable going in and coming out, but wasn’t bad once in.  Three sensors were stuck on as well – one per cheek and one on my left thigh.  These measured nerve function.  I coughed a couple of times for the warm up, and then I had the bizarre experience of having my bladder filled from the bottom up with saline from an IV bag. I notified Dr. Phillips at various intervals of fullness sensation, later learning that my impulses were pretty normal there, barring my feeling full up a little earlier than most. I was then left alone to expel what had been put in, an awkward experience to say the least what with the sensors and tubes and the fact that I was sitting on a chair, hovering over a funnel and beaker. “Don’t worry if you miss,” said Dr. Phillips. I laughed, secure in my aim. Ha. I missed and missed good, peeing all over the pads they’d left on the floor. When he and the nurse returned, Dr. Phillips said, “You missed!  Honestly, men are so much easier.  We just point and shoot.” I was disconnected. The indignity was over.
At the end of it all I learned that my bladder function was all pretty normal except that my full stream (measured when I was peeing on the floor, I think) was about 40% of what a normal person’s should be.  This was due to detrusor sphincter dyssynergia, which means my bladder is saying, “Come on, guys! Everybody out!” but my sphincter muscles can’t hear them. This explained the hesitancy issues experienced. We started treatment with Doxazosin, which is usually given to men with prostate problems (leading me to believe my dad was right all along – I did, in fact, pee like an old man).  I also stayed on Oxybutynin, which I’d be taking for a while, so we were only adding one variable at a time.

Thus began my attempts to wrangle an uncooperative bladder.