The Jabbanese Empire: Cancer Cat, Chemotherapy Cat, Happy Cat

At the time of Jabba’s diagnosis, there were several Facebook updates, and nothing on the blog. I’m in a position now to continue the tale of “The Rise and Fall of the Jabbanese Empire.” It has been an emotional rollercoaster for a pet-lover like myself, but it has taken us to a surprisingly mellow place.

When we last left our fluffy little grey hero, he was covered in snot and blood on a daily basis, losing weight, and snorting constantly. Cleaning his face, nose and fur were daily tasks, and he smelled like death. We had tested for everything the vet specialist could think of that didn’t involve a general anaesthetic, but we’d come to that pass: it was time for an MRI (and a possible rhinoscopy).

So I dropped off my cat, gave him a cuddle, and went and sat around in Burwood, twitching and upset. Eventually a friend asked if I wanted to come and keep her company while she walked her puppy at the dog park and, since it was less than fifteen minutes away, and I wasn’t getting anything done in Burwood, I said yes, sure, brilliant. Also – puppy!

Eventually – after hours that felt like an eternity – my phone rang.

Jabba had woken up from his general anaesthetic, bright eyed and bushy-tailed (snotty tailed?), even perkier than most younger cats that don’t have a heart murmur, so the vets were pleased. And surprised. We can confidently say that he doesn’t have a problem with generals.

He needed a couple of hours to recover, so I sat and visited with my friend and her puppy before heading back to collect my fluff elemental.

It wasn’t good news.

They didn’t even get to the rhinoscopy, because as soon as they looked at the MRI, they saw the giant tumour behind his nose. This meant he didn’t spend too much time under, and the bill was a few hundred dollars less, but really, that was the only positive.

Husband and I were pretty devastated, and we still had a few days to wait for the biopsy results which would tell us what treatment options – if any – were appropriate. We cuddled our snotty, stinky cat, and eyeballed our bank account wondering what was going to happen.

The biopsy results came back: feline nasal lymphoma.

Okay, the first two descriptors were pretty obvious, but lymphoma – as aggressive cancers go in cats – was good news. It’s one of the easiest cancers to treat in cats (especially nasal lymphoma). It’s by far the most common cancer; and it doesn’t tend to spread, meaning that Jabba wasn’t likely in pain from it.

The enormous relief I felt upon hearing that last item is indescribable. I felt dizzy with it. I didn’t even know how much it had been weighing on me, thinking that my cat was suffering from his cancer and I didn’t know how much and whether or not it was time for euthanasia and how would we tell anyway since cats are so stoic, and I didn’t want to let him go and I didn’t want to let him suffer either but… not in pain. In fact, probably just cranky about the snot and discomfort and difficulty breathing.

It also turns out that being on steroids helps with lymphoma, and it just so happened that Jabba was already on prednisone. This was to treat his allergy to the felimazole, which was to treat his hyperthyroidism (“There was an old lady who swallowed a fly…”). He was also on Norvasc, to treat his blood pressure. Three pills, daily. We were working out a system.

Our lovely specialist vet (who I refer to as Super Vet) gave us our first estimate for chemotherapy – the most intensive and well-studied protocol.

For anyone else doing research, I will share the number, which normally I wouldn’t do, but I was trying to find information on this and I couldn’t.

$7000.

That’s for a really intense protocol, with a cannula and transfusions and sedation and blood work. It has an average two year survival period for feline lymphoma.

That… was not in the realms of possibility for us (not at this time). It also sounded incredibly stressful for Jabba, with constant sedations to allow long-term infusion of chemotherapy drugs. I asked if there were any other options, and there were, but they needed to be costed out.

Super-vet went away, and came back three days later with two more protocols. The major drawback to the two of them is that they were less aggressive, and so presumed to be less effective, but more importantly, there weren’t major studies with good sample sizes to tell us how effective they could be. One protocol – the pills, which we have ended up adopting – had been shown to be effective with intestinal lymphoma, but obviously that behaves differently from nasal lymphoma.

A word, here, on chemotherapy for pets. You can find this information by Googling widely, but the take-home point is this: chemotherapy for pets is not like chemotherapy in humans. Chemotherapy for humans is incredibly intense. We essentially torture humans in the hope of a cure, and we sign up for this, knowing that the potential benefits will hopefully outweigh the costs. We understand that we are suffering in the hopes of survival, or at least an extended lifespan.

You could never explain that to a pet. They would never understand. Their suffering would be horrible and to them would seem endless. It’s an ethical disaster.

Chemotherapy for pets is a vastly reduced regime relative to what humans go through. The dose (relative to size and metabolism) is titchy. The goal is to get them remission, and a couple more years of good quality life with their humans. Because of this reduced goal, a lot of pets are much happier and healthier on chemo than off chemo, because the cancer effects are reduced. You can’t really say that about humans on chemo.

I mention this because when you tell people you’ve got a pet on chemotherapy, they look at you like you’re a little bit mad – essentially, why are you torturing your already suffering animal? And that’s a fair response, and speaks well to their humanity and compassion. It’s just inaccurate in this case.

So we went with the pills, which works out to something much more affordable for us, and much less stressful to administer. They have to be kept in the fridge, and as they are cytotoxic, handled with gloves, but Jabba is used to being given pills so adding one more every two days (every three now, anyway) is not the end of the world. In fact, as he is slowly learning that after I give him his evening medications, he gets a giant pile of cat treats, he is getting increasingly mellow about the process.

I cannot convince him to just eat the pills. I have to shove them down his throat. He tolerates this better than he once did.

So, how has this worked out for wee Jabba?

I was actually away in Perth for work when the pills came in, so Husband began the process of administering the cytotoxic medication. Apparently, for the first few days Jabba threw up a few times and didn’t eat much, which was expected, and that settled.

After about a week and a half, Husband reported no change, and sounded worried.

Getting closer to two weeks – not far from when I was due to go home – he said “He… definitely seemed less snotty today. But I might be imagining it.”

Two days later:

“He is definitely looking better.”

Then I got home, and saw the improvement with my own eyes. I’d left for Perth with a mucous-faced, snotty, stinky, bony, lethargic cat, and come home to a clean, fluffy, talkative, but still bony, cat. Apparently while I was away, he’d been eating less. He had even been refusing his beloved treats. Husband had asked Super-vet about this, and she suggested it was separation anxiety.

This is not surprising. Jabba is an extremely needy cat, and he’s always been very much my cat. I’m the one who spent some time wooing him, luring him, petting him, and earning his affections at my mother-in-law’s house, and he pretty much latched onto me like a limpet.

I got home and he started scarfing food and treats like food was about to be banned.

The improvement continues. His fur is growing back. He’s putting on weight. We’ve taken to feeding him full fat Greek yoghurt from our breakfast stash in an effort to fatten him up, which means we’ve created a monster that constantly demands to partake of my breakfast. He sits at my study door and sings the song of his people until I let him in to lick the bowl clean. The vet nurse fully endorsed the yoghurt, adding that the cultures would probably do him some good while he was on chemo as well.

I am so, so, so glad we did this. I’m so glad we didn’t decide that chemotherapy was a bad idea, and that we didn’t listen to people who were saying “but he’s thirteen! Why put him through that?” as it turns out we really haven’t put him through that much and he is so much happier now. To anyone who is not sure about chemotherapy for their cat, well, it will depend on what type of cancer and what your vet recommends, but – if you can afford it (and vet care is really expensive, there is no judgement for not being able to afford it) – I highly recommend it.

I don’t know how long this will last. I don’t know what remission will look like, or when we will finally have to say goodbye to my little grey cat and let him return to the Elemental Plane of Fluff, but in the meantime, he is back to his old snuggly, purry, fluffy self.

He is so much happier on his poison pills.

 

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O Bendy Gymster: That Kid

Remember P.E. in high school? Or primary school?

Remember how there was always one kid who struggled? That kid who got picked last when there were teams, that kid who couldn’t field a goal if their life depended on it and honestly wasn’t sure what “field a goal” even meant, that kid who always tried to get out of it by “being the scorer”? Maybe one day you were having trouble with the drills or the exercises, and you looked down the row and thought, “Well, hey, at least I’m not as bad at it as [That Kid].”

Or maybe you were That Kid. Hi! I’m That Kid too!

I was chubby, which makes running around uncomfortable sometimes – sometimes that’s just psychological, because kids can be gold plated arseholes. I was also hypermobile, although I didn’t know it, and looking back I now know that’s why it hurt so much just to move sometimes, and why I couldn’t move fast enough or well enough to do the things other kids took for granted.

Maybe you weren’t chubby, or bendy. Maybe you had some other issue you didn’t know about. Maybe you didn’t have any physical issues but you just didn’t like doing this stuff in front of other people, or maybe you were just a bit of a late bloomer with physical coordination, or maybe – just maybe – as it is in so many cases – it was a total self-fulfilling prophecy, with other kids giving you shit to the point that you couldn’t even remotely believe in yourself. Or maybe you had the kind of physical issue that makes the whole thing doomed from the very beginning.

There’s a whole club of us sedentary kids. Hating P.E. is not uncommon. I get frustrated when I see a lot of ranting about childhood obesity (oh for so many reasons, but I will only touch on one aspect of this today – trust me, there’s so much else to get angry about) and how kids “don’t want to move and they only want to play with their iPads or Playstations” or some other kind of generational judgemental wankery.

Have they considered that there is a reason kids don’t want to move that has nothing to do with laziness?

Have they considered that “going outside to get fresh air” might actually involve getting picked on by other kids?

Or feeling really stupid and sore when they trip over or bump into things?

Maybe the reason they like playing games, or reading, or whatever indoor sedentary thing they are doing, is that they are good at that thing and it is fun, and being good at things is fun, and doing something you are not good at that is physically painful is really not fun.

I just get a bit tired of this judgement.

I wasn’t completely inactive as a kid. I did like riding my little white BMX with purple tire rims. I came off it many times, but the whoosh of riding down the hill or the driveway was unbeatable to me, so I actually kept it up in spite of the pain. It was an activity that didn’t pummel my joints (not that I knew that was the problem back then). It was amazing. It was the only exercise I did for many, many years, and even then I walked my bike uphill (because riding bikes uphill messes with my hips).

The problem can also be with the system. The P.E. teachers that I had in primary school and (with one exception, which I will talk about in a moment) in high school didn’t seem to know how to deal with kids who didn’t want to participate. They didn’t seem interested in finding out why kids didn’t want to participate. I did have one teacher in primary school who let me score more often than he probably should have, and I suspect it’s because he noticed how much shit I got when I actually participated in the games, and took pity on me. It probably wasn’t an ideal solution, but he noticed, and that was something. I don’t even know if I could have articulated why I hated moving so much – I honestly thought I was a freak for feeling sore and uncomfortable, and that it was my fault for being lazy or fat, so I didn’t really engage with that feeling much – but not once did a sports or physical education teacher ask why I didn’t want to do it.

Remember this was mostly over twenty years ago, and maybe things have gotten better. Maybe P.E. teachers today are more in touch with the problem. And I’m not a teacher. I’m guessing this stuff is pretty challenging! All the same, I’ve seen maths teachers get really passionate about trying to get kids to engage, about finding out where the problems are coming from, about acknowledging when it is a confidence issue and trying to deal with that – as difficult as it is, and as impossible as it might be for one teacher to resolve such a huge issue – and I wonder: I had one P.E. teacher like that.

I had one P.E. teacher who, when she noticed how low my fitness test score was, took me aside and asked what physical activity things I liked doing, and could I make time to do more of those things? Were there places near where I lived where I could do that? She did not pressure me, or hassle me, or pick on me in front of the class. She waited until the end of the class and took me aside for a moment just as the bell rang. She did not make me feel like a failure, or harp on about my size, or emphasise what a terrible score I had gotten. She didn’t have to. She knew I was aware of these things and there was no point making a fuss. What we wanted was a way to make things better.

I rode my bike nearly every day after school for half an hour, and I got my score up by 45%. I still couldn’t run to save myself, but in every other area I experienced massive improvement.

Sadly, that’s not a “local girl makes good” story. In spite of my good intentions, the minute I wasn’t doing P.E. anymore, I was doing VCE (that was year 11 and 12 hell in my state at that time), and time or inclination for exercise – which was, on the whole, still uncomfortable and embarrassing – fell completely by the wayside.

The good intentions stuck around. In early uni, when I still lived at home, I’d go for occasional Very Long Walks (living in the hills has some bonuses), although that was less about exercise and more about ESCAAAAPE, FREEEDOM, AAAAIR, and getting out of a household that was genuinely frightening a lot of the time. When I moved out I’d go for occasional bike rides, and getting around just involved a fair chunk of walking. It never really moved beyond that, though.

What I really wanted to do was scuba dive. It’s funny, looking back on it now (I actually get paid to dive), that I felt like the major hurdle wasn’t money (I was living off student assistance and data entry work, so it was a major hurdle, and it would be some years before I did manage to get my Open Water certification). I felt like my major hurdle was fitness.

I’ve written before about being “diving fit”; the only actual requirement in terms of certification is being able to swim 200m, any stroke, without stopping to gasp for breath. While I can do this now without a problem, at the time the prospect was terrifying. It wasn’t just the idea of flailing about in the water trying to get my body to cooperate with me- it was the idea of people watching me and judging me on my ability to get my body to cooperate with me. I remembered how it felt to have my body watched and judged on its movement from primary school and high school. I remembered that my body pretty much always failed, and I remembered how horrible it felt.

I now know that I have a bit of an advantage on this front, having grown up in Australia. In Australia, we take for granted that kids will learn to swim. They might not swim well, they might not be strong swimmers, or fast, but they’ll stay afloat and be safe in the water. The vast majority of our population lives close to the coastline, and we like to go to the beach when we can (even in Melbourne). We prefer not to drown, so we teach our kids to swim. It’s a part of the school curriculum. Looking back, I also know that swimming was a great place for a hypermobile person to start.

But at the time, I didn’t think of things in that light. I knew I could stay afloat and get from A to B, presuming that A and B weren’t too far apart and there wasn’t much of a current. That was all.

So there I was, early twenties, and terrified of the limitations of my body in light of what I felt were its past (and apparently inexplicable) failures. And yet I was determined to do this thing. I just needed a push to get started.

I’ll be honest. If it hadn’t been for my one supportive P.E. teacher in high school, I wouldn’t have had even the shaky faith I did. She had supported me, and gently nudged me, and taught me that if I did push my body a little bit, it would get better at doing physical things. It could learn; it could get fitter and stronger. Before that, I honestly believed I was stuck. That it could never get better.

Enter my friend-who-would-probably-prefer-not-to-be-named. She was a serious gym junkie. So many classes, so little time! I told her I wanted to swim, and I wanted to get fitter, but I was really nervous and anxious.

She gave me a big spiel about how fun gym was, and how I should totally do Body Pump (which I eventually did) and Body Combat (which I also did, although in the first class I actually did have to sit down because I thought I was going to throw up about halfway through), but when I said I was too scared to do those things, she just said that was fine, she was happy to drive me to the pool anyway, because that was where her classes were.

It turned out all I needed was company, and a lift. I swam while she did her classes, and she drove me home, and we chatted.

That was all that happened for a while. Then I thought, “Well… I did do a little kung fu when I was fourteen…” and did Body Combat. When no-one made fun of me for having to sit down halfway through the class, and the instructor just accepted my “I’ll be fine in a minute” with a shrug and a wave, I thought, “Oh. It’s true. No one actually cares that I suck!”

And I kept going.

And then I did Body Pump, which I widely consider to be a gateway drug to free weights training.

And it went from there.

This was how I learned that my body could get better at moving. This was how I learned I could get fitter, and stronger. I needed the support; I needed the encouragement, the nudge, the lift to the gym and the company; and I needed enough of those things to offset the toxic experiences I had in my earlier years, living in an uncooperative body in a highly competitive sporting culture.

So, maybe next time you’re tempted to say something about how “kids these days” don’t move enough, or go outside, or whatever the relevant complaint is – maybe consider asking why exercise and the outdoors aren’t fun for them. Maybe consider that there’s a reason they’re making these particular choices rather than just assuming they’re lazy. We need to make movement and the outdoors fun for everyone, not just the kids who were going to do it anyway. We need to make it fun for the heavy kids, the uncoordinated kids, the short-sighted kids, the dorky kids, the disabled kids (for whom relevant or useful exercise is already a minefield). We need to learn not to turn a blind eye to the problems. We need to acknowledge them and solve them.

We don’t want people to have to wait until they’re 23 years old to cultivate a half-decent relationship with their body in motion.

Were you That Kid? Did you know That Kid? I’d love to hear stories and opinions in the comments.

Whimsical Banality: How I Find Coffee

I’ve just returned from spending two weeks in Perth, followed by a weekend in Sydney. During that time, I drank a fair amount of coffee, and I did not have a single coffee that was even average, let alone bad. They were all excellent. I manage this by a combination of Zomato and shameless profiling (my “get coffee from the first Middle Eastern place you see” strategy has yet to let me down).

I used to drink cappucinos with three sugars, many years ago. I now drink short macchiatos – or long blacks – or espresso shots – with no sugar whatsoever. This is what happens when you discover that, not only are you mildly lactose intolerant, but you hate the taste of soy milk, and sugar is actually making you feel sick in the long run. To be fair, I don’t mind soy milk in chai, but these days even chai lattes are too high in carbs and sugars for me to safely consume.

The problem with the “macchiato or black” coffee preference is that, for reasons I don’t quite understand (not being a barista), most average to half-decent cafes mess them up horribly. Burnt milk. Bitter beans. It’s the kind of experience that makes my tongue want to curl up and die in my mouth.

In fact, since I moved to the hills, this experience has become so common to me that I’ve started wondering whether I actually like coffee. Maybe I don’t. Maybe I’ve been fooling myself this whole time. Maybe I just thought I liked coffee, but was addicted to the caffeine hit, and perpetuating a cycle of sensory punishment: imminent tongue death.

Then, of course, I went to Perth, and stayed above a hipster “Breakfast Bar.” Not only did they do marvellous spanish baked eggs, but their coffee was exceptional. Every day. Every single day I got a “traditional long mac” (Perth has this weird “topped up” macchiato where they basically fill it with milk, which makes me wonder why you wouldn’t just order a freaking latte, but they can have whatever weird coffee practice they like when they give me such excellent coffees). Or maybe two. And they were unerringly awesome.

When I stopped off in Sydney “on the way home” (it wasn’t really on the way, but hey) to visit a friend I sorely miss, I consulted Zomato, which reliably steered me to the Harika café in Ashfield, which not only had marvellous coffee, but really good baclava (yes, I broke keto that weekend. Long story).

Once again, I had amazing coffees. I had two, because they were so good I needed a second one.

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So, I thought, I’ve confirmed that I do actually like coffee. And I really do like macchiatos. What’s going on back in Melbourne?

Melbourne has an understandably bloated reputation as the coffee capital of Australia. We are – justifiably – proud of our hipster cafes and the glorious influence of wave after wave of European immigrants who brought with them various styles of tasty bitter black brew.

So why can I find good coffee when I travel – nearly anywhere in the world (with the exception of most of S.E. Asia, where instead I mostly drink amazing tea, because why miss that opportunity?) – but at home, I end up stuck with coffee that kills the inside of my mouth?

I’ve found good coffee in Amsterdam, in Scotland (admittedly that wasn’t easy), in Norway (to be fair, I had a friend guide me), in America (Boston and Portland also kind of make it easy), in Indonesia. I’ve had quite passable coffee in Thailand and Malaysia (although, as stated above, I am inclined to take the opportunity to drink tea).

I should be able to find good coffee in the suburbs of freaking Melbourne, but off the top of my head, I can think of one café which usually gives me a good long mac (but about a third of the time will burn the crap out of it. Their food is excellent and the staff are amazing but hell, guys), and one which so far has always given me a good long mac (but it’s a fifteen minute drive away from my house and the food is quite expensive. It’s an indulgent trip, that one).

Don’t get me wrong. In the inner city, I have very little trouble.

But honestly, the suburbs need to lift their game.

Diagnosis Roulette: Coming to Grips with Fatigue

Since our last exciting episode of Diagnosis Roulette, our hero has undergone some more tests (some quite awkward, I must say) and we are still waiting on results.

In the meantime, let’s talk fatigue.

I actually don’t know a lot about fatigue. I have a couple of friends with chronic fatigue, and more for whom fatigue is a symptom of another condition, or a side effect from medications, or (in at least a few cases) a symptom of having very small children who don’t yet believe that sleeping through the night is a good idea.

These people have always had my sympathies, and I’m always angry on their behalf that there don’t seem to be any answers. I was horrified at the idea that one’s goals could be limited simply because someone was tired all the time. It wasn’t the fact that being tired would be a limitation – that made perfect sense to me; it was the simple fact that there didn’t appear to be a solution to this problem. Problems without solutions? Anathema!

And I’m slowly being forced to confront the truth, that now I get to be angry on my own behalf.

It’s been getting worse over the last year or so; really, since the end of my PhD. I put it down to seasonal affective disorder (which I do have, but which feels very different); I put it down to depression (same); I put it down to an infection, or some other issue. Sometimes I simply castigated myself as lazy, believing that I couldn’t really be that tired, because I shouldn’t be that tired, and I should just try harder to be awake.

But it’s like refusing to believe you’re in a fistfight until you get punched in the face.

I’ve also been in denial about the fact that I’m in pain all the time. Don’t get me wrong – it’s not dreadful pain (or at least I don’t think it is; my pain processing is a bit muddled, so it’s hard to tell), but it’s constant. Constant burning cramping abdominal pain. I’d describe it as a low-grade distraction, most of the time, which flares and increases in severity occasionally.

And now, as with the fatigue, I’m getting punched in the face. These things are correlated as well.

It’s funny. I can still do demanding shore dives. I can still run reasonable distances (I haven’t cracked 10 km yet, but give me a few weeks of training). I can still lift weights. I can hike 20+kms over mountains.

It’s just that now those things have more of a cost.

I’m still building muscle. My resting heart rate is still dropping as my fitness increases. According to some metrics (including a rather nice lipid panel), my health is on the upswing.

And yet according to other metrics, it’s in the proverbial crapper (yes, I may have Crohn’s, and yes, that was a deliberate pun. Not a good one, but forgive me, I’m a bit distracted…).

In a way, it’s not as much of a shock as it would have been a year ago. I’ve been slowly suspecting that the combined effect of endometriosis, hypermobility and maybe-it’s-Crohn’s-but-maybe-not has been building up. For a while, I thought keto was a magic bullet (for me). It gave me more energy, more clear-headedness, more get-up-and-go – once I adapted – and honestly, I think it’s the reason I’m not worse (this is confirmed when I go off keto for any period of time – at which point my resting heart rate skyrockets, my nausea gets significantly worse, my joints get inflamed and I fall asleep after eating a meal. I can tolerate it for about a week or so, and then it gets to a point of discomfort that forces me back onto the fat-heavy, carb-light approach).

Sadly, it’s not a magic bullet. It helps.

But it helps in the way that getting enough sleep and proper exercise help. They help, sure.

It’s just that it’s possible to do all those things – to have a good macro- and micronutrient profile, sleep eight hours a night, exercise for a minimum of half an hour every day, take two “rest days” a week (mostly walking and stretching for exercise) – and still be completely fucked (and not in the fun way).

As is my wont, when there is no medical advice in easy reaching distance, I turn to Doctor Google for information. Sometimes that information is in forums for endometriosis and Crohn’s sufferers; sometimes it’s in the primary literature (I generally restrict myself to the abstracts – I don’t have the expertise to critique the methods for these kinds of studies); sometimes it’s the sort of “Did you know…?” stories that wind up in science news. A lot of the time it’s on health and fitness websites (danger, Will Robinson!).

So far, I have found such earth-shattering advice for sufferers of fatigue relating to Crohn’s and endometriosis as follows:

“Make sure you get plenty of sleep.”

Cards on the table. I usually get between seven and eight hours sleep a night. Sometimes less if insomnia is kicking at me, sometimes more if I get to sleep in for whatever reason (I don’t actually sleep in. My body clock is too intense, which is probably why I’m so susceptible to Seasonal Affective Disorder. I have to get up and have breakfast and feed the cats and check my email and even exercise; but then I might go back to bed. I count that as “sleeping in”).

In addition, I’ve recently learned that chronic pain sufferers often don’t achieve deep sleep because the brain is managing pain. I’m not sure if this applies to me, since my constant pain is so mild (my acute pain is very nasty, but the chronic stuff is, as I said, manageable), but it’s a thought.

So, okay, as advice goes… that one sucks.

“Make sure you eat properly.”

Yeah, I track everything I eat, weigh food to make sure I’m getting enough or not too much of the various macronutrients, keep track of micronutrients and vitamins, and supplement things I don’t think I’m getting enough of (yes, scientifically backed supplements. Shush). I think I’ve got this covered. I was briefly concerned I might not be eating enough – I’m at a mild deficit at the moment – but a little research and a little math shows that I would have to cut back a lot more for this to be affecting my energy levels. It’s easy to under-eat on keto, because fats are so filling. When you’re used to carbs, which don’t necessarily hit satiety cues properly, it’s a different game. Mind you, it’s also easy to over eat on keto, because food is so calorically dense relatively to how much of it there appears to be. Depends on how you roll.

So, I’m okay there.

“Get plenty of exercise. Try to get at least half an hour a day a few times a week.”

Ahahahahaha.

Yeah, I’m covered. I’ve been doing Active April; our state government initiative to try and motivate people to get exercise for 30 minutes a day. At this point I average 80-90 minutes a day (that’s including my physio work, stretches and foam rolling, but also running, weights, diving, bushwalking, and walking dogs).

Right! Any more advice, if that’s not working?

“…you might be low on B12.” (Crohn’s)

This is good advice. It’s due to an absorption issue in the small bowel.

As it happens, my B12 is ridiculously high. It’s outside normal testing parameters. I was briefly concerned this meant my liver was not processing it properly, but my GP assuaged my fears. My B12 is good. It is better than good. It is great.

Anything else?

*crickets*

Seriously. I am so tired I can’t move. I’ve had a short black espresso and two bottles – bottles – of sugarfree V. There isn’t anything else I can do…?

*crickets*

If I were certain that my issues were being caused by endometriosis only, I’d be taking naproxen, or possibly ibuprofen, to deal with the symptoms. NSAIDs (non-steroidal anti-inflammatories) are great for period pain, and since my endo pain is not usually crippling or overwhelming (mostly), it really takes the edge off. I’m guessing also that the reduction in inflammation might restore my energy levels.

Unfortunately, I might have Crohn’s. If I have Crohn’s, NSAIDs are off the table. This seems counter-intuitive, since it’s an inflammatory condition, and anti-inflammatories seem like a dead obvious solution. Unfortunately, they can do nasty things to a delicate gut over time, and trigger progression of the disease (apparently), so nope. No naproxen. No ibuprofen. No freaking Voltaren (diclofenac).

This leaves me with paracetamol and codeine. As far as I’m aware – and I could be wrong, my understanding in this area is not detailed – these will help with pain (codeine is specifically good for gut pain, since it slows peristalsis. There’s a rather obvious side effect there, but I prefer it to pain), but do sweet fuck-all to help with inflammation.

Which is probably what is causing the fatigue.

Addendum: I wrote this a bit over a week ago. Since then, I’ve been in Perth for work, where the pressures on my time and mental energy are greatly reduced. Literally all I am required to do is my job (soothing taxonomic work that I love) and working out. While I miss Husband, dogs, cats, friends and my house, I don’t have to do any house work, yard work, pet care, emotional management or social scheduling; while I could do academic work, it’s perfectly okay that I don’t have the energy or presence of mind to do so (I don’t. I finish work, go to gym, watch Supergirl, and go to bed). Most importantly, I’m not worrying about money, or all the things I should be doing that I’m not.

I am still having fatigue. I still have pain and inflammation in the gut region. I still have no brain left at the end of the day. Other academics say that they tend to do a lot of work in the evenings when they travel; that’s not something I can do.

It is, nevertheless, vastly improved. And it turns out I respond well to ten or eleven hours of sleep a night.

When I have limited resources, it’s nice to have a period of time where’s there’s less I have to spend them on. I’ll go back to my normal life soon, and I’ll quickly be back in energy debt, which will suck, but I’ll have the compensations of my loved ones (some of whom are quite fluffy) and my space to help out. So it’s not all bad.

But I think it’ll be a long time before I can make peace with the limitations of it.