2023 was a much more stable year for our family. Eric and I settled into being fully self-employed, turning our two side hustles (knitting book publishing and commercial design) into our regular full time work. We enjoyed another summertime trip to Montana, and I hope to someday be able to travel further from home to see family and friends far away. The "kids" (two of three now adults!) are all doing wonderful things out there in the world, if you would like to keep up with some of their adventures, send me a follow request on Instagram @ joanna.loveland as I tend to share more there than on other platforms.

As usual I have a big team of practitioners on my team to see: research physicians, specialists, primary care, acupuncture, massage, and routine things like skin, eyes, along with social workers and too many others to list. One of the highlights of the year for me was being connected to an integrative doctor whose clinical background is in palliative care, and is working with me on something called narrative medicine. This is a branch of medicine developed at Columbia University in 2001 and has been a topic of interest for me for years. "Narrative medicine is an international discipline at the intersection of humanities, the arts, clinical practice, and health care justice with conceptual foundations in narratology, phenomenology, and liberatory social theory... Narrative medicine also engages with writers, artists, scholars, activists, and human services professionals of all kinds to improve health care from the perspectives of patients and providers." It has been a valuable resource for me to have regular meetings with a practitioner who understands the complex systems I have to navigate and what I need to be understood and find a strategy to not get completely lost in the ever changing landscape of my body and the health care system.

The two biggest struggles I have had in 2023 were relevant to mast cell reactions and mobility issues. Thankfully my immunologist at National Jewish Health is very comfortable addressing what she is calling my chronic idiopathic anaphylaxis, which is like living in a minefield. An attack can hit me anytime with less than a five minute warning, and it can be severe. My mobility declined a lot this year due to several things including chilblains, a very painful foot condition that I thought was reserved for characters in a Charles Dickens story. We found a way to manage to get them calmed down, but it is a year later and I still have lingering visible effects from this condition. 

The next paragraph has a content warning, if you are squeamish you may want to skip it. Over the summer I developed a very painful and large thrombosed area of tissue in a very, um, sensitive and important part of the body. Outpatient sent me right to the ER where I had a conscious emergency excision in a small curtained-off triage area. It took months for it to heal. I recommend this experience 0/10 stars.

I had a second visit to the ER in 2023 due to instability with my blood pressure (56/39!?!), triggered by a weekend trip to Salida. The journey through the high altitude is really hard on my body, no matter how diligent I am about my fluid intake and electrolytes, I can't seem to recover from this on my own. The docs did a quick assessment, IV fluids, and monitored until my Orthostatic vitals were good enough for me to go back home. I am really glad I didn't faint and injure myself, but do think my days in the "2 mile high" club days are over. 

My team at National Jewish has been consistently attentive to monitoring my disease processes and offering support. My lungs were relatively stable this year with no dramatic loss of function. My rheumatologist, gastro, and particularly my immunologist have been great. Immunology wants me to trial a compounded medicine called Ketotifen, along with a biologic injection called Xolair, to see if it helps my mast cell attacks be less intense. I started the Ketotifen in December, and started the long process towards trialing Xolair towards the end of the year.

I have continued to enjoy biking on our nature trails on my recumbent tricycle, along with swimming and weight training at the gym. The hardest part of the end of 2023 was addressing my mobility limitations, which I think I will address in a separate journal entry as it is a complex and ongoing concern. 

Your prayers, notes, comments, text messages, and calls are all so very encouraging to me. I appreciate the amazing people God has brought into my life and am especially thankful for Eric, Laurel, Sam, and Grant who bring me so much love, support, and encouragement into my life.