Tag Health

Meet the Dogs

Angel Ackerman 4 Comments

Yesterday, I met the dogs.

Today, I woke up from a terrible anxiety dream for the second time this week.

The first anxiety dream had me working in the newsroom again and I was behind on stories because of my other jobs– and I missed a council meeting because of job conflicts. I considered quitting one of the other jobs and remembered the newspaper hadn’t paid me in a long time. (Yeah, about 18 years.)

This morning I woke one minute before my alarm from a dream where I was traveling, and I was attending some sort of Asian-themed conference in France. I suddenly found myself without plans for dinner and thought I would visit a nice restaurant. And at the last minute, I remembered my traveling companion M was in the hotel. I opened my phone to text and invite him and none of the apps would give me his number. I took out my iPad (I last had an iPad when they first came out, it was a first gen) and it wouldn’t work either. And then some guy tried to steal my iPad, realized how ancient it was and gave it back to me.

And then I got up and walked to the hospital for my bloodwork.

This is what happens when you overschedule, have been life events, and stuff happening.

So, I came to the magic table at Panera to write down my thoughts about the dogs.

We left around 11:20. It’s a 90-minute drive to Grantville, where Susquehanna Service Dogs has a beautiful training facility. Our appointment was for 2 p.m. but when traveling long distances for important appointments, I leave wiggle room for traffic, accidents and construction.

On this particular journey, we always stop at a certain Sheetz before Route 81 that we never remember where it is until we almost miss the exit. We stop here because it has a wall of icee and smoothie flavors. On this particular day, this is extra important because Eva has an ear infection. It is the same exit for Eva’s favorite Girl Scout Camp, Wood Haven.

We always think maybe we’ll stop somewhere else or visit something, but there’s not much out there.

But Eva got her icee. I probably should have gotten gas, but that place is always crazy. I still haven’t gotten gas, and that’s on my mind.

We arrived at the facility early. I checked my email and answered some business messages. We got out of the car and went to the building at 1:45 p.m. We went into the classroom at 2:05 p.m.

I met a whole panel of employees. Many of whom I’ve met before, some were new. The head of the agency was there. Everyone had tablets and paperwork. They asked me about my health, my life, and we reviewed all the tasks that I requested.

And then we got to meet some lovely yellow labs.

This process is long, and weirdly precise. They’ve had several weeks of people meeting various dogs. And they take notes on every interaction to try and match the person with the right dog– personality, energy, brains, willingness to do the tasks needed. If I match with one of these dogs, they will tell me I matched in about a month. But I won’t be told which dog. They train the dog for your jobs before they tell you who it is. Because it could happen that a dog couldn’t learn an important task, or that another dog was better for it. Or maybe a dog completely washes out of the program.

There’s a lot of moving parts.

And as someone who’s worked with animals my whole life, volunteered in cat rescue and dealt with/helped rehab difficult cats, and learned about dogs and dog training from my daughter and her business (and I inadvertently trained a chicken alert dog!), I get it. I trust them to know their dogs and to stand behind their work.

I met four dogs. They use the information from those four dogs to weigh options in the future if this doesn’t work out. So even if this doesn’t come to fruition, it helps get me to the best dog possible.

And man– looking at these videos I feel so old and frumpy. I hate watching myself walk, and I had frumpy even more.

I did attend the session with no muscle relaxers in my system after a long car ride. I wanted that dog to interact with me when I was more prone to need help.

Dog 1: Marlin

Three out of the four dogs were large and male and from the fish-themed litter. Marlon was the name of the local police officer who would come break up the fights when my mom and dad would have violent fights.

He was big, but not huge. He did his job well, had his basic obedience down. His only interest was food. He didn’t really want to interact with me socially, he actually back away a few times. But he did what he was asked to do. When we walked together, his heel was a tad drifty.

Dog 2: South

She was the oldest (by two weeks) and the only female and from the Wanderer litter. South is also cardinal direction associated with fire and creativity, but I can’t pick a dog on my witchy ways. At first I thought her name was Sal, then I thought Sol, like Sun. But when they said it again, I realized it was South.

Angel, a trainer, and SSD South

She had a bright pink collar. That’s my business color. And when I touched her– she didn’t feel like a lab. She felt soft. She was like a stuffed animal I wanted to cuddle. She came out and greeted me. And she was excited to meet me and interacted with me more than looking for food. She prances when she walks. She has a really nice gait. When we didn’t tell her to do anything, she sat down and focused on the treat pouch. When we still didn’t ask her to work, she flopped down on the floor and waited.

And she was small. Compared to the boys. I liked that about her. Some of the trainers said some people found it hard to treat the smaller dogs because you had to reach down. And her heel was tight– so much that when my treat pouch shifted she followed it. And because of that I thought I was failing her, when it reality, the treat pouch had moved. And when we were sitting and it came time to treat her, she patiently put her head in my lap instead of getting pushy like the boys.

They asked if I could take a dog home today, fully traied, who it would be. I said South. Eva said South.

Her small size would make my life easier with the strange and crowded types of public access we might encounter. And there’s a good chance this dog will end up on a plane or at the very least a train. But her mellowness when we weren’t working is great for my office days. And I believe the incident with the treat pouch shows she can walk on the right. That’s the main task we need.

Dog 3: Skip

My father’s brother was Skip. So another dog with a name from my past. And another fish. He was massive and a drooling mess. And I was told he was not a candidate, but they were giving him a chance to learn and practice by meeting me. He had me covered with drool. He was the biggest dog. And he had so much energy and pushiness. And he struggled with basic commands.

Dog 4: Pike

Smaller than Skip. Bigger than Marlin. Another fish. High energy. But fairly patient and responsive. If I needed a big dog, he would be my choice.

Am I Alice? The White Rabbit? Or the Mad Hatter? Or the Queen of Hearts?

Angel Ackerman Leave a comment

Who doesn’t love a good mystery?

Anyone who deals with serious medical issues has experienced a sense of Wonderland. Is your regular life Wonderland? Or is the medical system Wonderland? Who is Alice? Who is the White Rabbit leading Alice down the rabbit hole?

We all have a lifetime of experiences. Some good, some bad. Some of us got “good” bodies, some of us have bodies we hate. Some of us have learned to accept our bodies. Some of us work really hard to change our bodies.

Some of us want to understand. Some of us want only to survive.

All of those things are okay.

We all have Alice in Wonderland moments.

It’s been a couple of weeks since my daughter, who has ADHD, floated the idea that she inherited the ADHD from me. It’s been one week, almost to the minute, since I took 10 mg of extended-release Adderall to test her theory, at least to give us data on if the drug brought me up or down. And the answer was down, pointing toward something not neurotypical.

And as you will see later in this entry, one of the stumbling blocks to determining what exactly my brain needs– whether that is treatment for ADHD, anxiety, depression or nothing– is, as my daughter would put it, I mask so hard even I don’t see the problems.

I have always been extremely organized, and I forgot nothing. And yesterday, at my second doctor appointment of the day, the clinician got out the standard short ADHD screening and asked the questions related to inattention. I don’t have a problem there. But I am realizing more and more, I write everything down multiple times. I write in my journal, on my paper calendar, on post-it notes, on my electronic calendar, in this blog. I write down when I take my medicine. My blood pressure.

And this morning– I went to blow my nose. Allergies are hitting in full force and Eva has an ear infection. In the middle of blowing my nose, I put the tissue down so I could take a Zyrtec before I forgot. I do not remember if I took the Zyrtec. I did not log it in my phone. The cap is off my water bottle, but did I take the pill?

Could my “obsessive” habits, like checking my bank balance several times a day, be not a form of soothing my own anxiety but something I do to prevent myself from missing something?

And even right now, as I write this, Eva has interrupted me and the entire train of thought for what I was writing completely disappeared. I had to reread the whole paragraph and reconstruct what I was trying to say. Is that normal? I’m honestly asking. So before I get too much more ahead of myself, let’s talk about yesterday.

Yesterday, I met with my longtime mental health therapist. I wrote a quick entry yesterday about that visit, posted it, somehow managed with a same day appointment with the practice who handles my everyday care, realized that the post was worse than I thought it was, and so I took it down with the intent to do a better job with new information.

And here we are.

Some observations from that appointment with the therapist who started treating me for anxiety more than 15 years ago. (That seems crazy. It can’t be that long. It just can’t.)

  • My individual complexity may prevent a simple diagnosis/solution. My history of childhood trauma and neglect, my family history of addiction, substance abuse and domestic violence. My physical disability (to which he adds “never discussed nor treated). So my brain could be doing anything for any reason. I believe this is why I’ve developed many of the habits I have that are masking how I feel on the inside. Whether we attribute this to ADHD or anxiety, that is part of the mystery.
  • Even looking back, with my history of doing and achieving all the things and doing them pretty well, it would be difficult for a clinician to trace this back to my childhood. Childhood presentation is one of the required elements for an ADHD diagnosis. (But, again, I was dealing with a lot of things, things I didn’t understand… from my body and my environment.)
  • My therapist theorized that if I have ADHD, I may have inherited it from my biological father. And that was a lightbulb moment for me. The first time I met him, I was

(I picked up my phone while typing this. I have no idea why. Got lost scrolling Instagram. Put the phone down. Realized I was in the middle of the sentence. And don’t remember what I was saying. So I distracted myself?)

  • … impressed by the breadth of his creativity and the projects he undertook. But I also remember that he had decided to remodel the bathroom and had never finished the one wall. It was still primarily the framing. Functional. But no real wall on the inside of the room. And when he and my mother split up, he went with his dog and lived in a cave in the woods until it got cold. Then it built a shelter. And when he and his wife split up, he left in his pickup truck, with his dog and a duffel bag and moved to the midwest. Where he got a job at Russell Stover chocolates.
  • My therapist can provide a letter of support to my primary care provider, and he reminded me that it didn’t matter the diagnosis if we could find a treatment that could bring relief. (And my therapist and doctor know each other so that helps.)

Now, I know “euphoria” is one reason people who don’t have ADHD take Adderall. And I’ve taken other types of medication: Lexapro for work stress and then depression (which helped in that “take the edge off” kind of way); beta blockers to control my heart rate (which failed); and Ativan for panic attacks (great, as long as I just wanted to come down and not do anything for the rest of the day). When I took Adderall, it wasn’t euphoria– it was the sensation of being able to let go of the adrenaline, the sense of doom and the constant muscle tension and being able to effectively regulate my emotions because normally my emotions also stress me out because I can’t do anything to work through them. I could on Adderall. If anything, that is what I want. I want that.

I asked my therapist: What would you recommend as my next steps? Since I have not been able to get past the waitlist for a psychiatrist, should I make an appointment with my family doctor?

I went home and called the office.

(Right now I am sitting here, forcing myself to finish this because it’s important. I need to pee. I’m very hungry. It’s 9:22 a.m. and my daughter and I are leaving for Susaquehanna Service Dogs which is sooooo exciting and stressful and… but if I don’t do this now I will not do as good of a job if I do it later and I don’t want to forget a single detail because the details can mean the difference between finding answers and getting the run-around from the medical establishment. This is how my brain works.)

I was offered an appointment with my regular provider October 13 or I could see another doctor in a couple hours. I took the appointment in a couple hours. I knew nothing would get resolved quickly, but wanted to position myself “in the system” to get the process working. That’s the hardest part of the medical system. Positioning yourself to get access to physicians and presenting the case with evidence, not anecdotal experiences.

That was why I started with my therapist. While he’s the most expensive provider on my list of medical professionals, he was the most qualified to give an opinion. Offering his opinion, based on our experience of 15 years, will hopefully show this is a legitimate possibility and not just a drug-seeking behavior. I specifically work with this therapist because he is a Ph.D. psychologist– I wanted someone who could help me grow as a person, not just medicate my brain. I have done a lot of worth in those 15 years, but recent years have shown me how much I fight myself and that I could have a chance at actually slowing down and enjoying more of my life, not just frantically surviving it and celebrating sporadic moments. Because in my brain, nothing is ever safe, or enough, or helps me overcome the doubt and doom.

(Okay, I need to get up and pee now. I’ve had 10 ounces of coffee and like 24 ounces of water… Be right back.)

(Hi, me again, I stopped to look in my protein bar basket. I should eat something. My belly hurts I’m so hungry. I have these blueberry breakfast biscuits that taste nice but don’t have any real protein. I also have a cookie dough protein energy bar from Aldi that is high in protein but full of chemicals, sugar and preservatives… I can’t decide. I have them both on my desk. I really want a piece of toast, but then I need to find and decide on bread, wait for it to toast. I should make an egg sandwich, but that is a whole undertaking of cooking. I guess I’ll open the breakfast biscuits… The taste bad. They usually don’t taste bad. And they smell weird. Are they spoiled. “Best if used by August 2025.” Did I mention I tend not to eat food I like because I might want it more another day? And then I panic that it’s not the best day to eat it? And now I’m sad that I let them spoil. Like really said. But honestly– they were Dollar Tree biscuits. So now I feel bad that I feel bad. I don’t need to beat myself up that much.

Now, do I eat the protein bar? Because I do not want to eat now. I threw out the biscuits. But I put them in my office garbage can. And the dog often gets in that can. Maybe I should empty it. Yes, let me do that quick. BRB. Again.)

So the doctor. She’s a great doctor. I mention that my daughter, and I both use the practice and my daughter does have ADHD. I tell her that I know we won’t have answers today, and I don’t expect that but I would like to start investigating this. She listens attentively and we explore the classic short ADHD. I have the anxiety-laden portion of hyperactivity impulsivity but not much else– and I ask her– I probably do fidget, but I have a spastic muscle disorder that means my legs cannot move. So how do we know? And I have similar I don’t know answers to some of the other questions. The test is inconclusive. She mentions other SSRIs. And that Wellbrutin has shown to improve symptoms of ADHD that coexist with symptoms of depression but it makes anxiety worse. And then she adds, “so that would be a bad idea for you.” And she wonders if I should try other SSRIs.

Her plan becomes three-fold:

  1. Get the letter from my therapist.
  2. Book an appointment with my regular doctor ASAP because he’s a busy guy. (Did not expect that.)
  3. She gave me a referral for a behavioral health case manager. This professional should be reaching out to me to prepare my case for review by a psychiatrist. It sounds like she does the evaluation, makes notes and gives them to the doctor so I can get medication through primary care… or through that psychiatrist. It’s a program designed for people like me who don’t have dangerous behaviors or immediate needs. And reduces the waitlist problem. That people never get off the list.

(I don’t want to write this anymore. I am forcing myself to do it. Just so you know.)

I leave the office. Hear from Eva that she got antibiotics for her ear infection. I email my therapist but then decide a phone call is more expedient and professional, so I call. He leaves me a voicemail a little later that we will get the letter together. And then the funny part– my actual primary care doctor comes to the restaurant, drives up to me in the drive-through, and chuckles when I ask what name to put on his order. He knows nothing of what I have gone through this week, or maybe he does, but I don’t think the other doctor finished her notes yet.

And that’s where all that stands.

Now if you’ll excuse me, it’s cold this morning and I am debating making a can of Spaghetti-O’s for breakfast.

The ADHD rabbit hole

Angel Ackerman Leave a comment

My daughter, now in her senior year at Lafayette College as a psychology major, has been armchair diagnosing our friends and family since her early high school days when she would read the DSM-V for fun. It’s fascinating for me as a parent to hear my child talk academically about topics and use language outside my understanding. And I do enjoy it.

If you know me, or you’ve read this blog for any significant time, you may know that I have struggled with my mental health. I exhibit symptoms of anxiety and depression from time to time, love routine yet challenge rules, obsess over numbers and patterns, overschedule myself and never relax. And the funniest part of that– I have gotten better about these things.

Through casual observations, it seems obvious that ADHD runs in my husband’s family.

But my daughter continued to study people– and me– and one by one she made her diagnoses. “Your dad had a type,” she said to me once. “His wives were all narcissists.” Or she’d suggest a medication to a friend looking for relief. And I have never seen her be wrong.

She has recently declared that her father is “autistic as all shit,” (which my mental health therapist had suggested might be the case more than a decade ago) and that she thought that she “inherited her ADHD” from me.

I protested. “My executive function is fine.”

“Is it, Mom?”

Her words make me recall a conversation I had with a friend of mine before I left for Ireland in the spring. I don’t even remember details of what we said, but it was a business call, and I remember listening to this woman I respect and adore the creative work of, a woman who had ADHD, and thinking “that sounds a lot like me.”

At Eva’s urging, and her constant reminder that traditional medical research applies to 40-year-old white men, I looked at the symptoms. And when I google information, I always evaluate the source. I look for articles from medical centers, government agencies, professional organizations and publications like Psychology Today. (It may reduce everything to layman’s terms but it does have a responsibility to be accurate.)

These are symptoms of hyperactive impulsive ADHD in adult women that spoke to me:

  • racing thoughts
  • subtle fidgeting
  • excessive talking
  • overcommitting
  • burnout
  • rejection sensitivity
  • hiding internal struggles to appear calm and organized
  • burn out
  • signs of anxiety
  • signs of depression

Let those last couple sink in. Women with ADHD are commonly misdiagnosed and treated for anxiety and depression.

I wonder if I would be more restless and move more if I didn’t have spastic cerebral palsy that prevents my legs from doing things. The more I pay attention, the more I see how my daughter’s ADHD habits totally mimic my own. And I never noticed.

And I know people with ADHD often self-medicate with caffeine and sugar. I never experienced a cup of coffee calming my thoughts, but I do know I can drink a lot of caffeine with minimal reaction but I get a sugar high really easily.

I am also prone to hyperfixation. And taking on hobbies with gusto and then suddenly never doing them again. It’s like one of my existing hobbies will suddenly explode and become all I do and then, one day, I never wanted to do it again. When Eva was born, I made something like 18 scrapbooks in her first three years of life. Since she turned 4, I did not have a photograph printed. (I blame the iPhone. Not my brain.)

As a well-behaved patient should, I called my mental health therapist/psychologist to see if we can explore this idea. He will see me Thursday. And it might be wishful thinking, but he sounded like the concept might have triggered a “lightbulb” moment for him– because I know he has grappled to find “what I need.” His formal diagnosis has stated that I exhibit occasional symptons of generalized depression and anxiety.

Any good theory deserves an experiment. So, after a few online surveys, I took a trial dose of Adderall. I was terrified to do so. I have issues with high heart rate. I was fairly confident I would be very uncomfortable.

And then, in a conversation with my daughter about 20-30 minutes in, my brain felt soft. And then about 40 minutes in, my hands started tingling. All my fingertips felt weird.

“Mom?” my daughter said. “Is something happening? How do you feel?”

“My brain feels like goo,” I told her. “And something’s wrong with my hands.”

She took my hands and looked at them. “What’s wrong?”

“They’re tingly.”

“Mom,” she said. “They’re warm. That’s all. You have circulation. Your hands are not cold.”

My hands and feet are never warm. My body temperature is usually around 96 degrees. I had first-wave COVID, and my “fever” was a body temp of 99 degrees. And even on the hottest summer day, my hands are usually chilly when other people touch them.

And in that moment, I knew I had slowed down. It was like someone just took the energy that was “me” and turned down the flame a couple notches. I read my tarot cards; they felt it. I went to the grocery store and casually looked at the options and didn’t run from one aisle to the next. I wrote a Substack newsletter. Because I wanted a record to see if my writing had changed. (You can read that here.)

All the stuff I normally worried about and used all my energy to “do,” it didn’t feel urgent. I laughed easier. Moved slower.

I remember the day my daughter first took her ADHD medication. She was standing at the table in her grandparents’ kitchen, animatedly telling a story. As I listened, I realized that she had stopped vibrating.

I had stopped vibrating.

“It’s like your aura has changed,” my daughter said.

“I’m calm,” I replied.

“I never understood what you meant when you said that I ‘stopped vibrating,'” she said. “I get it now.”

I had stopped vibrating.

The thought that I really could stop vibrating made me want to cry– from relief, because of the new understanding, in fear that I would never feel this way again, hope that I could.

I slept like a baby that night. And the next few days I went back to being me. The me I know. My heart rate and blood pressure hadn’t been impacted.

We opted to do the next trial dose yesterday. I was meeting a good friend and wanted to see if she saw a difference. I was scheduled at the restaurant. I wanted to see how it felt in a different environment.

I took the medicine. Went to Panera for my writing date. I drank herbal tea to be safe. At 9 a.m. I caved. I had 12 ounces of coffee. And then about 6 more. It did not disrupt my zen. I did my writing. I was less talkative.

I came home, did more work on my personal project because I wanted to, and I didn’t fret about all the things I “should” do. I knew I would do the things I should, but I didn’t stress over doing them right now. Then, I watched TV for a while. And I didn’t feel guilty about it. My daughter came home from school and her 3:30 dog walk canceled so we didn’t have to rush out the door. I sat on the couch and chatted. I didn’t try to do more.

Now, the medicine should have worn off by the time I went to work at the restaurant. But I don’t think it did. I sat in the lobby watching everyone. It made me happy to sit and watch them. I thought they were moving slowly. That maybe the restaurant wasn’t the busy place I thought it was. I am often stressed by the fact that the kids I work with don’t think anything is urgent. Maybe they are right. My heart was not racing in anticipation of my shift.

I was not thinking about all the stressful things that could happen.

But as the medicine started to wear off, the restaurant got busier. But even as my heartrate and workload increased, I didn’t feel the “panic” I would normally feel. I didn’t feel the need to analyse and make a plan every two seconds. And then I thought of the perfect way to phrase it– because I got moved to a work center that stresses me out– even though the medicine was wearing off and I could feel the stress in my body, my brain and my behavior were not motivated by a sense of impending doom and disaster. I know that sounds dramatic, but every piece of stress I feel it my body feels like if I don’t keep up with the moment/the environment/the task, I will face a disaster.

Remember the television show LOST? There was a button on the island that someone had to push. I believe it was every twenty minutes. No one knew what the button did, but they all believed that if they didn’t push the button, something terrible would happen.

My brain is pushing that button all the time.

But on the show, I believe something bad did happen when they did not push the button.

And I feel like even when I did not have the full effect of the medication in play, my sense of doom dissipated. And that was amazing.

When I took this medication, I felt like I could relax. I have been wishing for decades that I could find a way to relax. I thought I needed a hobby, not amphetamines.

And today my daughter tells me that cerebral palsy is also lumped into the neurodivergant classification… More to think about.

**I cannot find much information on this, but my anecdotal experience on medication suggests that although it should not, my mobility and spasticity improves when I take Adderall. My experience feels like I no longer hold as much stress and tension in mu muscles. Which is why I wanted the small dose of Valium. Maybe I need the opposite?

Hello, Ferritin, my arch-nemesis

Angel Ackerman Leave a comment

If you don’t already know, I had ridiculous anemia when Eva was in kindergarten, circa 2009. Luckily, we had already trained her to make a pot of coffee.

My stored ferritin was in the low single digits– I want to say if I was lucky it might have been a four. My menstrual cycle had always been heavy and at that particular time period, it had gone positively insane. My primary care provider at the time shrugged it off, which made me cry. And I remember sitting in the car, on my cell phone, crying to my husband, Darrell, who basically reminded me that I don’t usually take shit from anybody and I should direct my infamous temper at said medical provider.

One of the fun symptoms of anemia is that it gets worse in the hot sun. My problems started due to work stress wreaking havoc on my body in the spring. I (luckily) got fired from that job in March and the problem got diagnosed in the early summer. My daughter started afternoon kindergarten in late August. I would walk her the half-mile to school, and somehow walk home, and then back to retrieve her, and home again. But by the end of that last walk, I was so exhausted I would sit on the couch (and sometimes lay on the floor if I couldn’t make it to the couch) and wait for my five-year-old to make me a pot of coffee at 3:30 in the afternoon.

She would bring me the coffee. I would drink enough that I could stand up again and make it to the dining room table. Around 3:45 I would make my way to the dining room table, where she would refill my cup and do her homework until her father arrived hime at 4:40 p.m. On the days he found me sitting at the table drinking coffee, he would make dinner.

When my doctor showed no desire to investigate or improve my condition, I started the search for a new primary care physician (the one I am still with today). I had heard so many good things about this potential new doctor, and they turned to be true, because he had a three month waiting list for new patients. I really thought I would be dead in three months if the intense bleeding and the iron loss continued.

And then brilliance struck– I called my gynecologist. If anyone knew about issues from menstrual bleeding it should be my gynecologist. They heard my story and brought me in to see a nurse practitioner the very next morning.

When they saw the results of my blood test, my medical team asked how I was still walking around. The answer was adrenaline and stress.

The gynecologist’s office gave me a mountain of prescription Vitamin D and iron tablets. I started eating more cream of wheat, drinking nettle tea and getting more Vitamin C.

But my iron has never fully recovered. It’s at the highest it has been in a long time right now–31. Which is technically normal. But evidence shows that a level around 50-75 (and the higher end if you have problems like restless leg) is optimal. I heard that from my primary care physician and from one of my favorite doctors on Instagram (smilesandscrubs, her stored ferritin is 22 right now.)

I get my blood tested– for the third time in six months– next Saturday morning. My doctor wants the full iron workup, my A1C and my cholesterol.

My eating this week has been mediocre. And this weekend it got worse. I was down to 162, then yesterday I was 169, and now today I am a little under 168. Can I clean myself up?

I’ve been taking iron at least every other day, two vitamin D plus calcium tablets every morning, a multi as often as I can, and the occasional zinc.

Symptoms of anemia start a lot more basic than crippling exhaustion, although falling asleep in the middle of the day and not being able to stay awake despite buckets of caffeine does make it rather obvious. Other signs:

  • brain fog
  • mixing up/forgetting words
  • pale/dull skin
  • brittle nails/pale nail beds
  • cold feet and hands
  • racing heartbeat
  • shortness of breath

Do I need to put on clothes today?

Angel Ackerman Leave a comment

Tonight I have a long-for-me shift at the fast food restaurant. 4 p.m. to 10 p.m.

Tomorrow I have a very busy day– gynecologist appointment at 7:30 a.m., helping Nan with her stuff around 9:15 a.m., teaching in the afternoon.

Thursday, we are recording our radio program at WDVR. Then, selling chicken from 4 p.m. to 9 p.m.

So, today I wanted to send out our acceptance letters for the Greater Lehigh Valley Writers Group The Write Stuff conference, March 11-13, 2027 at the Homewood Suites by Hilton in Center Valley, Pa. And I almost sent one so far. It’s ten minutes from noon.

Did I do things? Yes. Were they important? Yes.

Just not what I intended.

One of the items I have needed to do is grab a few groceries. I have been very careful with my diet lately (which has led to a new number today, one I haven’t seen in more than a year if not since the pandemic when I started rapidly gaining weight). And my daughter made me get dressed and go to Aldi.

Why Aldi? I wanted chicken salad and shelled endamame.

They didn’t have chicken salad and only had whole edamame. I didn’t want whole. I also wanted a salad and all their greens and pre-bagged salad mixes looked past their prime. So I came home with baby carrots (which I don’t eat, and I was hoping to make carrot pickles but I didn’t get the vinegar…), plain greek yogurt (because the flavors have too much sugar, but I probably won’t eat the plain), half and half (but I did not get coffee), crab cakes, and cheese. And bologna. Cheap cheap bologna because despite my primarily vegan tendencies I just really needed a bologna and cheese sandwich.

And two boxes of protein bars since I didn’t buy much food.

I did not want to get dressed. Until later.

Yesterday, I had my annual physical with my primary care physician. It was the first appointment of the day, and he spent 45 minutes with me. I had told myself that I did not intend to bring anything up. That I wanted to get in and out, continue my own experiments into diet, exercise and sleep, and ask for follow-up bloodwork.

He went through my late June bloodwork I did for him and the mid-August bloodwork I did for the life insurance company, with me, and requested I do another A1C and some vitamin D and some stored Ferritin… He was surprised to see– that as I told him– my “bad” cholesterol and my weight change very quickly according to what I eat. It’s how I gained almost 15 pounds this winter and lost it since July.

I still think I am among a rare amount of people who really pay attention to their bodies and try to understand and improve. He also asked how long I’ve been off my blood pressure meds– and I said– “about a year,” and then I reminded him that my cardiologist knows, or at least I told her I would probably stop taking them.

“Your blood pressure is great,” he said.

“The pills didn’t help,” I replied. I was prescribed the beta blocker because of my single incidence of afib. I stayed on it because I hoped it would help my anxiety– specifically the way my heart will sometimes race for hours for no reason. But the medicine never stopped that. If anything (and I have yet to prove this, my evidence so far is purely anecdotal, it’s food. I think the right blend of high sodium and refined white carbohydrates makes my heart want to explode.)

And my blood pressure has maintained itself in a healthy zone the entire time I have been unmedicated.

But then my doctor found out, I have been having stress dreams, disrupted sleep routines and general poor sleep since incorporating more “easy food” and less of my “outside aisles of the grocery store” home cooking. And now he’s worried about sleep apnea, my tendency to display symptoms of mild clinical depression, and my inability to relax (or have fun). He offered me a temporary antidepressant, and I declined.

And then today I remembered… I have been on the waitlist for a psychiatrist appointment for almost a year. During my routine physicals last fall I talked with my entire care team (primary care, cardiologist, mental health therapist, and neurologist) about the prospect of trying a low dose of valium as a breakthrough medication.

According to my research, doctors often give valium to children with cerebral palsy to calm spasticity and help them sleep. I asked my team about it. No one has experience with that sort of thing so they referred me to psych. So I reminded my doctor of this is an email. I told him that on bad days I often take 60 mg of baclofen– so could we try a small dose of valium in a small amount of pills to see if I took 2 mg of valium instead of all the baclofen if that would calm my muscles, alleviate my twitching hamstring, settle my heart, reduce my spasticity, and allow me to (1) stretch everything, (2) sleep better and therefore (3) recover better.

Remember– my leg muscles are unable to relax. I can’t even describe what it feels like. Sometimes it feels like my calves are so tight they burn. Sometimes my thighs feel like bricks. So if my doctor thinks I might benefit from a little something… this might be the something.

And on my one tangent for today: I have been binge-watching Nurse Jackie. I never liked Jackie, found her repulsive as a person but the older I get the more I recognize the accuracy of the depiction of people in addiction. And my daughter brought up something vital to consider:

Is Nurse Jackie an unreliable narrator?

My daughter votes yes, because there’s no way that an addict taking as much shit as she does (especially as a nurse) could appear to have her shit together as well as she does.

Interesting thought.

I have reached the midpoint in the series, and I’ve never watched this much before. And she has entered rehab and thrown her husband out of the house. And I’m thinking about it.

Meanwhile, my daughter has been tracing ADHD and autism in her family tree. My daughter– from a young age– has been super keyed in to people’s minds, patterns and habits. And just like she’s freakishly good at seeing every ripple in a dog’s body language, she’s damn accurate with her psychiatric diagnoses. And she’s finishing her bachelor’s in psych at Lafayette, she’s also developed some ideas about medication (so I asked her to do one of her recent psychopharmacology assignments on valium). She’s wondering if I might have ADHD.

My response is typically that it doesn’t matter.

I have a disability. One that stems from lack of oxygen at birth. One known to affect GABA in the body.

I score fairly high on the ACE scale for childhood trauma.

My parents were alcoholics.

Did I inherit generational trauma? Probably. Do I exhibit everything from OCD to depression to anxiety? Yes. Because my brain never learned how to feel safe and/or let its guard down. I never relax. The last time I felt truly relaxed was during some good adult physical activities that I don’t get nearly enough of. And do you know how much I need to trust my partner to let that happen?

My daughter believes something interesting about this whole ADHD hypothesis. She basically said I have not allowed myself to fail enough to recognize the truth it what she’s said. AND that because of that no clinician could ever diagnose me.

Strange food for thought.

Reflections on Health Improvement (and other updates)

Angel Ackerman 1 Comment

Part One: Reflections on Life Insurance

Earlier this month, I received a letter from my life insurance company. When I turned 50, my term life insurance policy could no longer continue at the rates I had paid for 20 years… after all, I am old now and the likelihood of my death exponentially increases.

I thought I had reduced the coverage– after all, the house is almost paid for now and the child is almost out of college so the need to have a healthy policy no longer seemed so important. Now I just want to make sure the child can burn me up and dispose of my ashes. Apparently, I never complete the process and find myself receiving a new letter that my premiums are almost doubling, after they almost tripled last year.

I called the company, spoke with an agent, and reduced my current coverage. But to maintain a long-term policy at stable rates, I needed to prove I was insurable. I scheduled an appointment for two weeks out to have bloodwork, urine and measurements done as part of a physical. For that two weeks, I drank no Diet Coke, ate no added sugar, avoided salt and processed food, ate lots of fruits and vegetables, drank ridiculous amounts of water and took my vitamins.

I lost seven pounds in that two weeks. All while thinking about the fact that life is so much harder when you’re not traditionally healthy. It doesn’t matter if you’re fat or disabled or diabetic. Part of the issue with my life insurance stemmed from the fact that I had an incident of Afib with RVR after a bad fall four years ago. Here’s some of that saga.

I believe, and my cardiologist agrees, that the Afib occurred due to bodily trauma. It was my second hard fall in two weeks that required medical attention and my body had enough. I have not been taking any medication, and my blood pressure has been fine. (And part of me still wonders if food doesn’t play an issue in that.)

But I find myself thinking once again about the gatekeepers who decide what our lives and our bodies are worth, and yes, I’m referring to life insurance and medical insurance companies. It’s exhausting to have to prove to corporations and to doctors what goes on in our bodies.

I finally had a chance to look up the numbers for my test results (and I downloaded the PDF and sent it to my doctor). Most everything looks really good and even the results in the cautionary zone of normal (all the stuff that relates to blood sugar and what not) are still normal. So, we’ll see if the insurance company declares me healthy.

Part Two: Service Dog Update

Yesterday while I was in Maplewood, N.J., with R. Diskin Black, the poet and writer and YA novelist who wrote The Night of Swaying Grass, (an experience I wrote about on my Substack newsletter here and hope to write more here in another entry) I checked my email while we were preparing to leave the diner where we had a classic New Jersey meal: eggs and hashbrowns at two in the afternoon.

I had an email from my service dog program where I have been on the waiting list for a couple years now. This might be the first post I made about filling out the application. 4 years and one month ago. They said then that the process took 4-5 years. This is a post about my early in-person interview. And here’s one from my most recent visit to the training center.

ANYWAY.

The email was from Deb Tack, the executive director at Susquehanna Service Dogs. I open it.

Hi Angel,

I am reaching out today to extend an invitation for a Meet the Dogs session. Please read the following information on how to sign uo and what to expect:

I froze. “Meet the Dogs.” Does that mean what I think it means? My heart skipped a beat.

Now, a few weeks ago, I admitted to Eva that I often felt like I was a failure because I haven’t been able to pay off a $20,000 personal loan I took out when I lost my job at Stitch Fix. It hangs over my head like a car payment without the car. I mentioned that in all this time I haven’t touched any of the money that I have saved to pay for my service dog (some of which came from that $20,000 loan) and that maybe that shows that I should be working harder to pay down my debts, that I do waste too much money, and maybe I should use some of that service dog money to reconfigure some household debts.

“But,” I said, “If I did that, the service dog people would tell me my dog was ready.”

So… Is my dog ready?

I didn’t finish reading the email. I mentioned it to Ray, who in his professional life was a lawyer. I offhandedly mentioned, “Of course, this could happen now. I have my little part-time job in a restaurant so I wouldn’t be able to bring a dog.”

“Why not?” he asked.

“It’s food service. I could bring the dog there to eat, but I can’t bring the dog behind the counter.”

“Isn’t that discrimination?” he replied.

“Put your lawyer brain away!” I told him.

We continued our outing, and checked the oil in my car with a dryer sheet from Food Lion, and read the email in the car, quickly, and forwarded it to Eva without finishing it.

I texted her.

I sent you an email. If you want to call and talk about it, give me ten minutes to find the highway.

Eva, the practical one, replied: I’m leaving for work. We’ll talk when you get home.

When I get home, I don’t have a chance to talk to Eva right away. I book an appointment for September 25, because it’s the only day that Eva and I can both go. It means I have to reschedule my day trip with another author, Geraldine Donaher, but I think she’ll understand. Or so I hope. Then– and only then– do I print and read the letter.

– What is goal of Meet the Dogs? The goal of a Meet the Dogs session is to begin to understand what type of dog you fit best with and what definitive task list our trainers will need to train your dog to perform. We intentionally invite more Partners than there are dogs available to ensure that we are able to make a match. Not every Partner will match during their first session, and some may need to come back for multiple sessions in order to find their match. Overall, our goal is to match you with a dog that you will be able to have a successful bond and work well with for many years to come. 

– What happens during a session? Members of the Partner Services and Training staff will meet with you for your session. First, we will spend time discussing any pertinent updates and then delve into which tasks and cues would be most beneficial, as well as places that a trainer should focus on taking your future dog to train. Then, you will have the opportunity to meet 2 to 5 dogs-in-training, work with each individually for a brief period and provide your feedback. 

– What happens after my session? Following the session, the SSD team will meet to discuss their observations of the interactions with each dog along with the dogs’ responses and strengths.  Approximately six weeks following your Meet the Dogs session, you will receive an email regarding whether you have received a tentative match along with information regarding Team Training. 

– Can I bring someone to the session with me? Absolutely- We highly encourage that a support person/s are present. While they will not interact with the dogs during the session, they will be able to be a second set of eyes, help with building the task list and take pictures and videos should you choose. 

As you can see, there’s a lot of “maybe” in this whole letter– and there’s more when you schedule the appointment. The confirmation reads:

“More potential partners have been invited than there are available dogs to help us ensure we find the right placement for each dog. We know everyone has waited a long time, and those who do not receive a tentative match will experience disappointment.”

No, I won’t be disappointed. I have no doubt the dogs will know. The right dog will find me and any potential disappointment will be flanked by resolution and commitment– that the closer I get to meeting my dog, the more I have to take care of myself, the less excuses I have, so that my service dog and I will have a good life together. When I think back to the animals in my life that meant the most to me, I didn’t pick them. They picked me.

And this dog– this dog is a working dog. This dog has to want to work for me.

Some things are worth the wait.

Some general background

I have applied for a light mobility service dog to improve my gait and help me recover from falls. Statistics show that walking with a dog automatically helps people with an unsteady gait walk better, and my dog will do small tasks of retrieval (fist aid kid, light folding stool), potentially carry items if I need my hands, get my phone if I need help, or pick up items from the floor if I can’t bend. Crazy to think that the steady walk of a dog, and being near it, could decrease my likelihood of falling.

The program with which I am working breeds their own puppies, sends the puppies to families for raising and basic obedience, and only when they are two years old can a dog ethically be cleared for light mobility work. The dog must be cleared by a veterinarian to be healthy enough, big enough and have the bone structure to do such work. If I understand correctly, once the dogs return from their puppy raiser families, they learn certain tasks ALL their dogs learn. Like how to walk with different gear.

And depending on the type of mobility gear– only certain dogs will do that work. A mobility service dog can wear a hard hardness, a soft harness with strap, or just a leash. The bulkier the gear required, the more likely a dog might not want to wear it. In my case, I would be fine with just a leash, though a strap might not be the worst thing.

But there is one potential hang-up for my dog… In my evaluations, if I remember correctly, we determined that while they train the dogs to walk on the left, my dog needs to walk on the right, and the ambassador dog I was working with did not like walking on the wrong side and fought me a little. Apparently, according to Eva, I walk like a drunk with the dog on the left and walk in a straight line with the dog on the right.

Once the dogs are tentatively matched– and the dog could still wash out so even that is not guaranteed– the dog spends time training for the tasks for its handler’s specific needs. Then, a few months later, the dog and its handler spend more than two weeks in an intense in-house training program.

So, it’s an exciting time, and either way, I’ll meet some cool dogs.

Seasonal summary and hoping for new beginnings

Angel Ackerman Leave a comment

My daughter is in the garage doing yoga right now– an old set of yoga DVDs I found on a discount pile somewhere 20 years ago. I used to used those DVDs once or twice a day, each routine a mere 20 minutes, and its impact huge on my body. I should be out there with her right now, but although it is 8:30 in the morning on a Sunday, I am already knee-deep in work. So maybe after my 9 a.m. meeting I will give it a go on my own.

I’ve had some successes in life lately, but health and fitness is not one of them. I’ve been struggling with my mobility since before my trip to Ireland in March. Some of that is due to lack of movement in my routine. Some is due to lack of chiropractic care and not enough stretching. Some is weight.

But now I’m experiencing more and more symptoms of anemia. What started as mistyping words– not misspelling but using completely different words: “basket” coming out of my fingers instead of “basic” and “winter” instead of “window”– has nos (and I just typed “not” instead of “now”) escalated to incidents of brain fog (driving past the bank instead of to the bank) and drinking too many caffeinated beverages without feeling their impact and literally not being able to keep my eyes open at 2 or 3 p.m. despite having healthy sleep hygiene and getting to bed on time. And all of these symptoms get worse with the heat and the sun. Which is also classic anemia.

I scheduled my annual blood work for tomorrow morning at 6:45 a.m. It’s not due until September so the insurance company will probably love that. I also left a message for my chiropractor, Nicole Jensen at Back in Line, because even though it puts a strain on my finances, I need the care.

My right leg is definitely leaning into its femoral anteversion, and the best way I can describe it is like I have a tree trunk instead of a leg that I’m dragging around. And then once it’s a little straighter and not locked into a weird position, any yoga I do will help keep things limber.

I started taking my vitamins last week: vitamin D/calcium with breakfast, iron with lunch, and vitamin C with dinner if I remember).

I’ve also cleaned up my diet and I think I can say that except for breakfast with Laurel at Panera on Tuesday, all food has been prepared at home. I have tried to make sure I get more fresh fruits and vegetables and include a protein with every meal. With this routine, I have lost five pounds this week. And I know that is all the sodium/water weight leaving my system. But if I with another 7 pounds off this summer, I could be at the weight I was last fall when I saw my primary care physician last fall.

Both Eva and I have struggled with motivation to eat so far this spring/summer season… We’ve both been busy, stressed and exhausted. Eva’s taking an online American Sign Language class through Purdue University and her midterm is tomorrow. It’s really cool to watch her learn. And to help her study.

We’ve both taken to finding items that are easier to eat. Often these are easy-to-grab meat products and snacks for her, and meal-prepped items like overnight oats for me. Last night we both needed something for dinner so I made tuna fish sandwiches which also helped us use some of the aging iceberg lettuce in the fridge. I’ve been adding kale to everything I can, especially pasta and eggs. My other coup was a make-your-own quesadilla bar– I had flour tortillas, corn tortillas and refried beans from the dollar store, all items I keep on hand (in addition to beans I cooked from dry and froze, in seven different varieties); we had lettuce, tomato, and onion left over from burger night; and on a whim, I had just purchased sour cream and a huge block of cheddar. We even had fresh limes to give everything a citrus kick.

Speaking of food, I’ve been tracking my food in the Omada app again. I still believe the Omada program is a waste. If you have issues with food and weight and health and don’t have a previous understanding of nutrition I can’t see it helping. It only helps me because it reminds me what I’ve eaten, how I’m trending and gives me some basic nutritional summaries. But the fact that my insurance company gets charged $30/month just because I stepped on a scale is nuts. My coach is really good, but for the most part she can’t tell me anything I don’t already know.

So much of health is making the hard and responsible choices.

And doing what you need to do.

It’s also the only app/system that gets worse over time. Their AI-driven logging system can’t identify basic foods, and when you try to edit the listings with information from the actual label, it just ignores you. Omada does not believe in tracking calories. It encourages instead you make better, educated decisions based on your hunger and how you feel. I understand that calorie-counting can lead to some psychological issues, but in the end, weight loss is math. They do track fiber, added sugar, protein and saturated fat. But not sodium. If you have a chronic weight or heart problem, you need to understand sodium.

And they encourage you to aim for 50% nutritous. I average 50% on any given day. Today I’m at 57% so far, but I’m due for lunch. That may change. Now, if you know me, you know– I try to make my meal choices as close to vegan and minimally processed as possible. I had gestational diabetes when I was pregnant with Eva, and trying to eat 2800 calories in six meals a day with no sugar on a vegetarian diet got me very bored. Thank God I decided to incorporate tuna into my routine. I can still remember some of those routines. My ten-thirty a.m. snack was large curd cottage cheese and usually strawberries or raspberries and my 8 p.m. snack was decaf coffee and unsweetened soy milk. (I had to do something to make the “milk” drinkable.) I still can’t look at a plate of food without seeing its protein and carbohydrate estimates in my head.

screenshot of the Omada app showing the list of protein, fiber, fat and sugar stats

Most people don’t have my experiences. And I know myself. For instance, if I eat a meal out, even if I make the good choices, I will gain 3 pounds the next day.

Most people don’t stay invested in their choices like I do– so if I only eat 50% nutritious, how does a standard American diet rank? I wouldn’t want to know.

So far today, I have had:

  • about 16 ounces iced coffee with a healthy pour of half and half. (That comes in at 50% because the coffee is considered a healthy drink, even if I drink it at every meal. The half and half on the other hand is not nutritious, because of its saturated fat content, but it has calcium, vitamin D and protein and isn’t sweetened or processed like other creamers.)
  • For breakfast, a little more than half an apple with skin on, with cinnamon sugar and mixed nuts. Water, 30 ounces, and one scoop of my Powdervitamin electrolyte powder which has no calories, is the most dense with minerals and salt, and sweetened with stevia. But because of the sugar on my apples and the powder, that again ranks my meal as only 50% nutritious. I could have used a processed caramel fruit dip or an icing and Omada would have ranked my choice as just as it did when I added just a touch of sugar. And the electrolyte powder gets treated like a sugary Gatorade even though I need that supplement to prevent orthostatic hypotension because I don’t eat many sodium-rich foods and I drink so much water. How many other people drink 50+ ounces of fluid before 9 a.m.????

My plan remains simple… More movement, more yoga, eating at home, and not eating due to stress. And in a few months or maybe a year I will write a blog post like this. Again. Which I do so frequently. As I struggle and fail and disappoint myself. But permanent change is a long game and it’s hard when the only person who holds the power and the motivation is yourself.

The Medical Refund I Didn’t Ask For

Angel Ackerman 1 Comment

I keep promising myself that I won’t let this blog anguish and fade into nothing, and then I fail. If you miss me, check out Parisian Phoenix Publishing on the web or social media or sign up for my weekly-ish Substack newsletter. (Which you can do here.)

While I keep intending to do more jovial hometown adventures and life updates about the cats, the bird or the dog, it doesn’t happen. (We have TWO dogs this week as we have a jovial mutt with us as a boarding client. He’s a joy to be around, and he’s such a confident and stereotypical dog compared to our depression-prone backyard-bred pit mix.)

Eva’s dog has received a custom muzzle as a safeguard against her fear-based reactivity. And the difference it makes in our ability to trust her with new dogs and people and her comfort while wearing it is amazing. If you have a dog with issues, a custom muzzle is a game-changer.

But today I want to talk about what happened when I returned from Ireland regarding my emergency room visit two months prior. And I might sound like a conspiracy theorist, but it is what it is.

I have a high-deductible, employer-sponspored health plan through my husband, but as we are separated, I do not ask him to use his HSA. The HSA absorbs a lot of those out-of-pocket expenses. And my husband’s employer gives him money for the HSA as an incentive to take the high-deductible plan.

I have done the math. As a family, we have had the high-deductible PPO plan for 20 years. It sounds scary at first, but the monthly premiums are way cheaper than the other plans and the PPO allows us to see any doctor we want when we want, and when you have chronic issues, that’s important. I briefly had an HMO in the late 1990s when I had never had any health insurance before and no real medical treatment post age five, and my primary care doctor sent me to a podiatrist who specialized in ankles for my gait issues because he was pretty much the only provider in network. He told me there was nothing anyone could do without finding a provider in a major city.

And by the way, he was wrong.

If you don’t know, a high-deductible plan means that the insurance company pays nothing of any of your expenses until the deductible is met. In my case, that’s $3,500. BUT, my out-of-pocket maximum is $5,000 a year.

The ER Bills

As you may recall, (if not here it is: the original post and the ortho follow-up) in early January I had a fall and I debated between going to the ER or the urgent care because of my history with afib after bodily trauma… I was not in afib, but I did break my thumb, which has not fully recovered.

That fall led to about $800 in out-of-pocket orthopedic specialist bills and about $3,000 for the emergency room. Now, I use AblePay which allowed me to schedule payments for these services and gain a cash discount. For the ER bill, I opted to pay more than $2,000 in one lump sum of my American Express because it allowed me the largest discount. I then used the AmEx PlanIt feature to schedule that into monthly payments for a fee instead of accruing interest. In the end, I didn’t save money but it allowed me to space the payments.

But then… randomly, a full month after I paid 100% of the ER bill in a lump sum of on my credit card, my insurance company (Capital Blue Cross) decided to renegotiate the bill– which remember, they did not pay. I did.

I did not know this was happening. I was less than $200 away from my out-of-pocket maximum for the year so I scheduled regular chiropractor appointments and a mental health check-in with my therapist. The chiropractor appointments help me not twist my body into weird contortions that further cause complications from my irregular gait, and since my chiropractor Nicole was originally a physical therapist, she helps me stretch and monitors my gait to make sure my feet “do feet things.”

So, while I have debt from the ER visit, I can now have chiropractor appointments every other week for a small coinsurance amount ($40). And that is a huge help to my mobility.

On a Friday afternoon, I get an email from AblePay and a notification from AmEx that I had a $1700 refund on my recent medical bill. Which sounds great, right?

I logged onto Capital Blue to see what was going on, and indeed they had renegotiated my bill, which rolled back my previously met deductible and out-of-pocket maximum. And I had two chiropractor appointments and two therapist appointments that I was now responsible for. That’s about $700.

And I know what you are thinking, that still leaves me $1,000 ahead. But oh no it does not. Because remember, I had only paid one payment of my planned credit card charge. So the whole refund went to the charge, and I still needed to pay the remaining several hundred.

I negotiated a payment plan with my therapist and canceled all my upcoming chiropractor appointments.

I wish I could tell you that was where the story ends.

Present Day Repercussions

When I was in Ireland, I walked a lot more than usual. A lot more. As it was a relatively last-minute trip, I didn’t have a chance to try and get myself in shape. So I attributed the discomfort to my out-of-shape-ed-ness and called it a day.

But I am experiencing problems again. For the last week, I have been experiencing increased muscle pain in both my legs. My left leg usually does not hurt. My right leg always hurts. Like every day, I experience at least a pain level one but typically two or three. It’s like there is a braid of muscle that splits the back of my thigh muscle and presents with a constant pulsing, ache. But increasingly, my calves are experiencing extreme, painful muscle stiffness, in both legs, and my knees hurt.

My flexibility is better than usual, and I have no problems with my back, but if I touch the floor, it kills me to straighten my legs.

And this morning, after a week or so of this, and several days of feeling like my legs aren’t attached to my body when I walk, I started to cry. I caught myself, but I still started to cry. I took an extra dose of my baclofen– at double strength, and that made the calf pain go away. But I’m struggling to use my legs. And I’m getting damn tired of it.

I have tried to find and label what muscle hurts, but I can’t.

I suspect I need physical therapy. I have tried to take short but regular walks, making sure that I hit at least 5,000 steps daily, but I think it’s too little too late, and my muscles have forgotten how motion works. This winter was hard, long and cold; and with my part-time fast food job laying me off, I don’t stand and walk as much as I have during the last year.

But that leg pain I refer to as a braid? That started shortly after Stitch Fix closed. I think because I went from a job where I stood eight hours a day to a sedentary job. That’s almost three years of the same pain. That has now intensified.

So, why don’t I call the neurologist?

Because she costs $220.

And if she wants tests, I can’t afford those.

And If she agrees that I need physical therapy to stretch out and retrain muscles, that’s thousands of dollars. It sounds ridiculous. That a six-week physical therapy session would rack of thousands of dollars, but when I broke my ankle, which was TEN years ago, that cost me $5,500. That deductible and co-insurance adds up.

This is when I miss my Medicaid.

Becuase I work hard, everyday, and I just can’t afford the treatment and maintenance that would improve my quality of life.

And it sucks.

To make a choice everyday to deny yourself care you need.

Because of money.

And I believe– and maybe I’m wrong– that Capital One renegotiated my ER bill because I hit that out-of-pocket maximum and they didn’t want to pay my upcoming bills.

Our health care system, specifically for-profit, employer-sponsored health insurance, sucks.

It’s broken.

Broken Thumb

Angel Ackerman 3 Comments

In 2023, I had two falls close together (two bouts tumbling down the stairs in two weeks) and in general, I tend to fall more in winter (and not even outoor falls due to weather and ice). These two factors and my hospitalization with AFib after my falls in 2023 led me to go to the emergency room yesterday because of my fall at lunch time on Wednesday.

(For more info on my hospitalization in 2023, click here.)

I just wanted to make sure that this fall didn’t lead to a sequence of falls.

In similar cautiousness, today I visited my old ortho practice from when I broke my ankle in 2016. That’s the infamous “I broke my ankle and went to the Chinese buffet before heading to urgent care for an x-ray” incident. Read more about that here.

I felt silly, because my injury is pretty minor compared to other orthopedic cases. The ER told me that if it didn’t feel better in two weeks to follow up with ortho.

But I know from past breaks that the first two weeks is when the healing really solidifies and if it heals wrong, I would have more problems. And I wanted better direction on how to splint it, a better splint, and confirmation it was broken.

It is. In two places in the knuckle.

This is my right hand. At this point only one finger of my right hand has not been screwed up in some capacity.

And the doctor seemed to agree with my fastidiousness. He gave me a better splint and some first aid tape and told me to come back in four weeks for a follow up and new x-rays. His assistant gave me some Coban tape and some buddy strips for the splint.

I have a high-deductible insurance plan and I do not have an HSA, so I know I will pay more than I want to for this, but it’s my dominant hand and I need it to work.

Playing my favorite game: ER or urgent care?

Angel Ackerman 2 Comments

Yesterday, in a strange turn of events, I had a fall. More of a trip.

But let’s back up. Remember that tire incident from my last post? The day after that post (which was not the same day as the incident) I came down with an ailment that still has me congested and softly coughing.

I have to wonder if I had COVID.

It’s only been the last few days that I’ve felt myself. And that might contribute to the perfect storm that put me in this position.

I forgot to take my baclofen yesterday and all I had before I went to pick up Nan for our errands was coffee and a couple Munchkins. (With Eva on vacation, those of us left behind had to take the dog to the Dunkin Drive Thru window.) I even forgot to take my blood pressure.

When I got home, it was probably 11:40. I had coffee from Panera and groceries in the car, as well as some plastic bins from the dollar store to organize the deep freezer.

I brought the coffee in first and got the dog out of the crate. The backyard had a lot of dog poo, and I wasn’t sure she peed.

So I put on her collar and her prong, leashed her up and checked for dogs and people. We went across the yard.., and the mailman popped off a porch four houses down.

I had not put on my hands-free, waist, back-up leash. So I dropped to my knees to better control the dog lunging at the mail carrier. I got her settled (the dog, not the mail lady) and put her back in the house.

I went to the store to get the items from the dollar store. The mail lady approached me to give me the mail. I accepted it, placing it in the large-ish plastic basin containing all the items from the dollar store.

I turned, got my foot caught on the dog’s outdoor place stay, and fell. I fell with a bit of a twist, landing both on my stuff and on my right thumb.

Assymmetry percentage

I landed on the sidewalk and along the steps.

I smashed the basin. It never even made it into the house.

The fall probably happened around 12:20. My watch didn’t register it as a hard fall, probably because the basin broke my fall and prevented more serious injury.

The thumb hurt but it moved well, so I took my Baclofen, had some lunch and sat down for a while. My phone suggested my gait had been awful that day.

Thumb directly after accident

At 5 p.m., I did a shift as the front counter bagger at Chick-Fil-A. 4 hours.

Had dinner. Came home. Went to bed.

Woke suddenly in the middle of the night. My thumb hurt and it was bending less than it was earlier. I went back to sleep, planning to go to urgent care in the morning. The recycling truck came around at a bit after 4 a.m., woke me, and I couldn’t get back to sleep. I decided that even though I got less than five hours sleep I would just get up.

When I looked at my phone, I noticed a series of notifications. Apparently, my heart rate had been high while I was sleeping. Since I had that afib incident after my falls in 2023, I did an ecg on my phone. It was fine.

I headed for the bathroom. And as soon as I opened my bedroom door, I had to fight not to urinate on myself. With no warning. As I got closer to the bathroom, it was harder not to lose control– and in the end I didn’t really make it.

Thumb in the ER

Now my thumb would not bend at all.

I began to wonder: Do I have too many complexities for Urgent Care? With my disability and my heart history…

At 5:30 a.m., I decided to bite the bullet and walk to the ER.

A ten-lead echocardiogram was normal. Thumb shows a possible chip fracture.

I came home and called my neurologist, who is also a physiatrist, leaving a message in case she wanted to see me since I had a weird combination of symptoms. The person who assisted me asked me all sorts of questions.

While on hold with their office, I looked up the number for the Institute for Hand and Upper Extremity Rehabilitaton. I have worked with their therapists for two of my previous finger injuries on my right hand. They are now closed.

The person on the line with me from the neurologist’s office suggested I call the orthopedic specialist, especially since it’s the same doctor whom I consulted with when I broke my ankle ten years ago. The ER advised I call them if it got worse or did not improve.

But I would like to confirm whether or not it is broken and get a better treatment plan than this huge, cheap splint the ER gave me.

The person on the phone at the ortho’s office assured me that it was smart to be seen, right away, versus waiting for time to pass. She even had a cancellation for tomorrow morning.

So I guess we’ll have more updates tomorrow.