A Quick Word about Duloxetine.

I have been taking Duloxetine for more than 3 years. I ran out once and had to wait a week for a prescription refill. During that week I had the usual withdrawal symptoms such as "brain zaps" or lack of concentration, but overall I felt awful. I think a great deal of my depression is related to pain. Before taking Duloxetine, I started taking 2 vicodin every morning and after doing so, I felt like showering and getting dressed was somehow easier. I was more productive on days I took vicodin in the morning. I noticed an even bigger improvement when I started taking the Duloxetine. Now I use Vicodin more of an as needed basis, which is better for my liver.

When I read the PubMed posted on Twitter by @fibroaction, I was happy to read “In addition, the efficacy of Duloxetine was found to be due to direct effects on pain symptoms rather than secondary to improvements in depression or anxiety." It's tough to just "walk off" chronic pain at such high levels.

It's good to see other patients will benefit from this pain relieving benefit and I am not imagining things. Sometimes pain is so frequent and intense, it really feels like I'm crazy. I may be a mental patient with depression, but I fell less like a nut today.

"So Now Sweet Sixteen's Turned Thirty One"~Bob Segar

Change that 31 to 40 and that’s me. In 1994 I was 23, recently honorably discharged from the Navy. I was full of ambition training for softball, found work waiting tables, Mobile Disc Jockey (picture) and a beer cart girl with an ass so perfect you could bounce a quarter off of it. I had just moved to Wisconsin and I was waiting for my freshman year of college to start. No signs of my upcoming battle with Scleroderma and Sarcoidosis except for that tingling in my fingers, which was only a nuisance back then.

Fast forward to 2010, I’m walking on a treadmill because it hurts to run. I’m not fat, but my ass is no longer in its prime (and that’s being VERY kind). I start daydreaming about what had happened to that hot chick I used to be. My hands once beautiful and played Stairway to Heaven on my guitar, were now fist like because of their contracted tendons. I became sad about loosing that, but I think as we grow older, all of us long for the beauty of our youth.

As I grieved for the hot chick, I started thinking about how as hot as I was- how underdeveloped my brain was as age 23. My walk on stubled on one of those “If had I knon then what I know now” moments. I kept plugging away at the treadmill and then I had an idea. What if the hot chick wasn’t gone? Maybe I had just become so terrified by what had happened to my young body I just shriveled up inside in a futile escape attempt from the shell that was once my strong body. I suddenly realized I have been going about this all wrong. I had been working so hard on the outside; I forgot to take care of what was inside. I’m not saying I should just take a meditative pose and stay there. I’ve just decided to start working from the inside out, rather than the outside in. I have to accept myself as a work in progress, not incapable. I have obstacles, but I have to forgive myself when they cannot be overcome. I need to start hiking in the foothills rather than trying to conquer Mount Everest.

So maybe you can't bounce a quarter off my ass, but I'm still the hot chick from the inside out. We all have an inner hot chick (or dude), you just have to remember to look.

Giggity, Giggity, Giggity, Let's Have an Endoscopy!

I had the pleasure of upper endoscopy December 6th at the VA hospital. It was performed without a hitch because I had a great team. During an Endoscopy, the patient is sedated, but awake and instructed to swallow a tube with a camera on the end. The gastroenterologist performing the procedure examines the tissue of the esophagus, stomach, upper intestine, and takes biopsies for further diagnoses. It’s one of my annual routine tests to monitor the progression of Scleroderma, Sarcoidosis and its complications. I don’t mind endoscopies because I never remember a thing and I wake up feeling very relaxed, but there was one time that was not the case. In 2002, because of a lousy IV placement and an overscheduled doctor at Hemet Hospital more concerned about his quota, I was conscious during my endoscopy procedure. (I had an HMO. This has NEVER happened at the VA.) If you are ever asked to do one of those awake because your doctor is a douche bag, just say no, but I digress.

Diagnostic procedures have become as routine as annual dentist visits and flu shots. My GI tract doesn’t get any special treatment. I have routine tests every year for my heart and lungs. My liver, blood platelets, white cell count and kidneys are monitored by frequent blood work, but tests for my GI tract are the most invasive. I don’t remember much about my first GI test in 1996, but it did involve a dark room and two radiologists (Giggity). While lying face down on an x-ray table, one radiologist fed me a drink, while the other operated a camera and kept telling me to hold still and swallow. The camera was an x-ray machine, the cocktail was a chalky barium drink that felt like Pop-Rocks going down my throat and the procedure was called a barium esophagram. Luckily, I only needed to take the test once. The radiologists worked hard to provoke reflux symptoms and unfortunately, they were very successful. The good news; no more chalky Pop-Rock cocktails, the bad news; it only took one of these tests to determine Scleroderma was targeting my upper digestive tract and my doctors needed more information. I had been promoted to upper endoscopy.

I don’t remember my first endoscopy. Probably because of the great drugs they gave me to forget about it. (Roofies?) Eventually, a world of ways to view my digestive tract was opened and an endoscopy was just the beginning.

In 2005, I was given a test to determine my ability to swallow called a barium swallow study. A swallow study is performed by a speech pathologist and a radiologist. I was given barium-laced banana, chocolate pudding and juice while filming the food traveling down my throat made possible by x-ray. The radiologist doing the study was surprised it took four seconds for food to travel down my esophagus. That doesn’t sound like a long time, but next time you’re eating, take a bite and swallow, then count one one-thousand, two one-thousand, etc… It’s longer than you think. Later, an endoscopy confirmed what the radiologist and speech pathologist hypothesized: My esophagus had slow motility due to scar tissue caused by reflux. In addition, I had a hiatal hernia which prevented my stomach from closing and causing stomach acid to flow into my esophagus while sleeping. I also received the diagnosis of Barrett’s Esophagus, a pre-cancerous condition where the white lining of the esophagus is replaced by red tissue. It is caused by long term repeated damage from chronic acid reflux. The pre-cancerous part of it sounds ominous, but the percentage of Barrett’s becoming cancerous is low and treatable if diagnosed the early stages.

Barrett’s Esophagus must be watched by my doctors, but maintaining my esophagus is a full time job. After the swallow study, I was given a series of exercises I practice every day in the shower and techniques to protect my airway when swallowing. I have to sleep in an elevated position. The current medication prescribed for treatment of my symptoms is Nexium- 40 mg twice a day and Ranitidine (Zantac) 300 mg twice a day. The Ranitidine was prescribed by my physician as an as-needed med. My diet (mostly) consists of foods that will not cause reflux. I start out my day with a protein shake to assist with swallowing of my meds and allow an easily digestible form of protein to jump start my day. I keep my meals small. Size really does matter and too large a meal can cause reflux. I love Mexican food and have switched my salsa from a chilie-base to a mango or fruit salsa. Ranitidine is great before meals with ingredients that can cause reflux. It’s different for everyone but for me it’s anything with garlic. For my own sanity, I have to have some of the foods I love but shouldn’t eat once in a while. Things with onions in them etc… Nothing too crazy, but when I do, I plan the meal in the middle of the day or stay up very late, take my Zantac and drink lots of water the rest of the day. Regular exercise is also helpful, but movement is always a good idea- as long as it’s not upside down on a full stomach. Stress management has helped me manage my symptoms with a great deal of success. Divorce almost cured my reflux, but because I have to share custody of my son, the Ranitidine really comes in handy along with a good sedative- but that’s a whole other entry.

Esophagus Pictures

Quagmire's Horniest Video Clips
Check these out:
Bounce to a Cure
Ironman for Scleroderma

It's A Trap!

And Now, a Tease...

Excuse my grammar, but I want to get this out there. I will have a more detailed blog in a day or so, but is you have any circualtory problems, look into this finding. I'm on my way out the door for the VA, but I just wanted to say something about the recent findings having an immediate effect on blood vessels. This is an step toward better education about the toxins around us and how it effects the smallest parts of us we take for granted. The first thing I was told back in 1992 when my fingers turned blue and tingled for what appeared to be no reason is, "Stop smoking".

18 years ago doctors knew nicotine was a vasoconstrictor. If you get a chance, do some more research about it. I will be posting a full entry about it in a day or two if you don't get to it.

Have a great Thurs. everyone!

More to read: Livestrong

Me, Myself and Viagra

Back in 1996, the results of an arteriogram had shown that the arteries of my thumb were completely closed. The only nutrition the tip of my thumb received was from retrograde blood flow from one vein. What started as a small sore on the tip of my thumb had became huge, gangrenous and black, which is how I got to have an arteriogram at age 25. At the time, there were two treatment options: digital sympathectomy or a sympathetic block. I opted for the digital sympathectomy. By the time I got to the VA Hospital four hours away, I was already in a percocet, and then morphine induced haze. The most invasive and drastic intervention appeared to be the most logical. I will never know if I made the right choice. I know it won't happen, but I still cling to some fantasy that one day I will wake up and the tip of my thumb will be back and I will have forgotten it was gone.

The biggest influence to have the procedure was a dangerous idea I would have normal hands back. It was the wish of 25 year old young woman in denial of what was really happening to her. A digital sympathectomy is a microscopic surgical procedure that removes sympathetic muscle tissue, the involuntary muscle tissue of “fight or flight” surrounding arterial walls of the hands. When the body gets cold, blood vessels and capillaries constrict to preserve the vital organs, such as the heart, lungs and digestive system. For a person without Raynaud’s, this is a gentle constriction, allowing some blood to flow. In extreme conditions without taking precautionary measure, the blood flow would eventually stop to the distal places such as fingers and toes causing frostbite and eventual tissue death. With Raynaud’s, sometimes just a slight drop in temperature can trigger this reaction to the cold as if the muscle tissue is on crack resulting in an ischemic or Raynaud’s attack. A Raynaud’s attack is the sympathetic nerves signaling muscle tissue surrounding blood vessels to over constrict where the Raynaud’s is more prevalent. It can be as obvious as fingers and toes or as stealth as the blood supply to part of the digestive tract. Fun right?

Back in 1996, Viagra was still in the very early stages of development. Fast forward to 2010, I take Viagra three times a day, plus Niphedepine once a day so I can keep blood flowing to my fingers and toes. But despite all the medication I have on board, my best defense is exercise. I still need the medication to maintain because my Raynaud’s is so bad. So why blog about it?

I feel very self-centered writing about my experiences. I want to share them and maybe they could be more interesting if I added some fiction and write in third person instead of first, but I don’t have time for all that. I want to get this information out so maybe someone who is having these symptoms can take the steps I didn’t. There are times I became so depressed and let denial rule my life and my weight dropped to 96lbs. I didn’t realize it, but I had stopped eating. I would have meals but I would only take a few bites. So, there it is. I’m self centered; I want people to learn from my mistakes. Mistakes that aren’t all mine. Mistakes my body continues to make at a cellular level that I have no control over. Blaming myself makes me feel like I have control, because once I relinquish the reigns, my ride is over. So I continue to convince myself my mistakes are not made in vain and I really do this to help others. But really, I want a cure, treatment or reversal of what is happening to me. Yes, all about me.

My Yoga Has Been Secretly Replaced With Angry Running.

Day 11 of my 120 days of yoga.


I did well the first three days. The fourth day, something happened. I was very distracted and I quit yoga in the middle of it and went to the gym. I started on the eliptical machine, but became starngely drawn to the treadmill in row in front of me. I can’t run well. My feet have contractures and the repetitive pounding can be very painful, but not that day. Maybe it was the music, but I think it’s less Rage Against The Machine on my Ipod and more rage I have cultivated inside of me thanks to my immune system acting like a meth-head on a crime spree.


I not sure what I’m angry about. My condition is stabilized, but every now and then I have transient thoughts of opportunities missed in my 30’s- but that could be more of a turning 40 thing. It could be related to my ongoing life with Scleroderma and Sarcoidosis, but that feels very ego-centric to me. Everyone has ups and downs throughout their life. Why would mine be any more difficult? Maybe it’s the silence of having a stable condition. No ER visits and fewer flare-ups have given me time to slow down, smell the flowers and notice a few of them stink.


Since that fourth day, I start with a warm up on the floor with some yoga for about 20 minutes, then on to the treadmill. I start slow, take big strides that feel like lunges to me, and then back to a comfortable pace while intermittently raising my treadmill speed two beeps at a time. After 10 minutes, something very strange happens. I get this burst. It’s not happy or sad, it just is. Like someone's targeting me with a rocket launcher from the eliptical machine behind me and suddenly fires. I explode and run like I stole something for a few minutes, then I drop my speed to fast walking and continue this walk/burst thing until my 60 minutes on the treadmill is up. When I’m finished I feel emotionally lighter. It works better than any sedatives I’ve ever taken. Somehow, this running is helping me rid myself of stinky flowers. Maybe that means someday when I stop to smell the flowers, they will make me happy instead of reminding me of what might have been.

This Time, It's Personal. I Had to Say Something.

Not Slums, Jobs. Are Yoi Listening Murrieta?

I had to say something. Some of us with ongoing chronic conditions live on fixed incomes and need Section 8 housing and also appreciate affordable housing.

When I came to Murrieta, the population was a booming 29,000. At the table next to me was a group of teenagers. They were concerned their peers were being led astray of their Christian Faith because of Harry Potter’s glamorizing of witchcraft. The group appeared to conclude Harry Potter was not good for Christianity. The one fragmented statement I remember verbatim is, “…if you are not a Christian, get out of here.”

Being new to the community, I just blew it off as a group of teenagers in a phase. My first Halloween was an eye opener. It’s a holiday to me. Not because I worship Satan, because I do not. It is the day of the dead. I know two things, we all die and certainty is a reason to celebrate. We had very few trick or treaters that night. The next day, a small group of my neighbors paid a visit to express their concern regarding my relationship with their Lord, Jesus Christ. I thought it was nice my neighbors were thoughtful enough to want to include me in their after life, seriously. More than two weeks is long time to spend with anyone, let alone eternity. I have met some very thoughtful and giving people in Murrieta of all faiths. I bring up Christianity because it appears to be the most popular and Jesus was a huge fan of the poor- at least that's what he appeared to be with all that caring for them and all.

I grew up in Orange County, before it was ever called “The O.C.” We pledged allegiance to the flag, we said “Under God” and never really thought about it, we understood the separation of church and state. There was choir in public school where we sang about P.T. Barnum and CCD on Saturday where we sang about Jesus and talked about about eating him. I don’t remember people advertising what faith they practiced. Here in Murrieta, you can’t swing a dead cat without hitting an SUV with a "Not of This World" bumper sticker. The question, “Where’s the part about a Christian country in the constitution?” has become a rhetorical one because I have yet to receive an answer. But my shock about the community I have grown to love and call my home did not come from the photographs, it came from an email.


At first, I thought it was spam. Then I realize the person who sent it was a business associate. Here is the text. I did a straight copy and paste of the email because I want you to see what I read.
“Hello

I am writing this e-mail to raise awareness about the 80-acre slum housing project to be built across the street from Antelope Hills Elementary School, in Murrieta. This project will contain somewhere between 1,400 and 2,400 low income units, including a large area of Section 8 housing. The Slum Projects will span from Antellope Hills to the Orchard Tree Shopping Center, and from Clinton-Keith Road to north of the Target Store.
Obviously, this project will affect us all personally. Antellope Hills, Shivela, Vista Murrieta and Murrieta Mesa schools will never be the same, either.

The project is scheduled for final vote on:
Wednesday, December 8, 2010, at 6 p.m. at the Murrieta City Hall.
Please plan on being there to protest the project.

Please send this e-mail to anyone you know who may be interested. Protest events are being organized before the vote. If you know someone who would like to help, please have them call…”

I decline to name the author of this email because he/she can do their own advertising. Reading this from someone I respected, shocked me into doing research. Today, the pictures shocked me into writing about it.


There are so many residents of the Inland Valley who are unemployed, on the brink of or in foreclosure while some are clearly confused about the definition of the word “slum”. The lot in the picture is Antelope Hills, north of the new Super Target shopping center on Clinton Keith near the 215. Lots of tape was used to secure these handmade signs. They were around and directly on the private property. As you can see a sign was taped over the sign explaining the usage of the property. The group against this project clearly does not wish to hide their obvious disdain for those who do not share their income bracket. They can’t even come up with something clever about the increasing number of empty homes due to foreclosure. Their strong suit appears to be four letter words like “Slum”.

Let’s clear something up right now. A slum is not built. A slum is a product of dilapidated real estate and slum lords, usually occupied by those with low incomes because that’s what they can afford. I find this display disgusting and I hope it is coming from a misguided minority of this community. Everyone has a right to their opinion, but this appears to be destructive.
Here’s what those “slums” will bring to this community- jobs. Construction jobs, remember those? You need someone to build the foundation, framers, dry wallers, electricians and plumbers. Not to mention the businesses who support those construction jobs like Dixiline, Lowe’s and Home Depot. Those workers have to eat too, right? They will need things like gas and office supplies. The finished homes will need maintenance, furniture, the occupants will need things like groceries and TV’s. Not to mention there’s a giant medical center they are building up the street and it will bring medical and support personnel who need places to live. Some will just be starting out. Some more established members of that community will help us with our empty high end real estate problem. Not to mention newly discharged Veterans, starting out after serving their country. Some will be loking for an affordable place to call home. Some will be disabled and will need to retrain for employment or recover from serious injury. That's not an easy road. I have experienced it first hand and you really need the breaks where you can get them during that transition. Are those signs in the picture what we want to welcome new members of our community who might prefer to live nearby rather than commute? If so, Murrieta may be missing a great opportunity. Stay tuned.