token post

The good news is that I am actually typing this myself so there's physical improvement! I switched from Orencia which seems not to work very effectively for me (it seemed to have some benefit but not enough to decrease the "supportive bridge" medicines or to reach the prior level of functioning that had been reached on Humira or Remicade) to Enbrel. Yesterday was the 2nd dose of Enbrel so I don't know about the total amount of effectiveness yet. I have high hopes because it functions like Humira and Remicade both of which worked well for as long as they were effective.

The bad news is I am typing in a modified way because I have 3 stitches in the end of my ring finger. Other bad news is that the power supply on the desktop (faster with better keyboard) died. The new one arrived and the plug for the hard drive was the wrong kind. So no further training or use of DNS for now and limited typing before I have to quit.

And there have been more hospitalizations and serious illness since Christmas than in the last 6 months. So the dissertation is pathetically lagging. It almost seems like a conspiracy to keep me from working on it in any significant way.

Meanwhile, both girls are significantly involved in sports and music so life is incredibily busy. And, the small raise in salary helped me move forward in hiring, rather than merely wishing to hire, domestic goddesses!

What's been going on

To make a long story long, I really need for Dragon naturally speaking to work correctly. So I have to train it. Therefore, you will get posts that are too long and have too much detail with the sole purpose being to help me train DNS.

I sincerely apologize for the drudgery, the whining, and the extraordinary amount of detail that is completely unnecessary. If you are looking for an upside: it does put something to read on my blog.

TMI Chapter 1: education

I passed comprehensive exams!
I was convinced that I would receive conditions (conditions must be completed before beginning anything to do with the dissertation). I received a question that was dramatically different from what I was told to expect. When I finished answering the question asked, I knew that I would have a condition related to that. But I didn't.

There's a five person committee (professors from the department) that prepares the essay questions for each student. Most of the professors will communicate with the student and give some indication of the nature of the questions to be asked, the areas to be covered, or specific items that are “helpful” to know -- which usually means “memorize” this. In many ways, through professors and students, the repeated advice was “know” the theories and their theorists.

It was a huge compliment when, following the oral interview with all five professors, my chair said to me, “of all those sitting for comps this time, it was very clear you had the best grasp of theory." When I met with her a week later she asked, “has it sunk in yet?” I said, I keep wondering if they really meant it. And if maybe I got a “preacher pass.” She said, “let me assure you there is no such thing. You earned it.”

So now I am officially admitted to candidacy, and in dissertation phase. I'm working on clergy and grief. I'm still working on defining the parameters but if you would be willing to be considered for an interview say-so in the comments.

comps outcome

I passed comps! totally and completely!!!

I am officially in dissertation phase

ABD (all but dissertation)

And a doctoral candidate

comprehensive exams begin in 3 weeks

“If you are distressed by anything external,
the pain is not due to the thing itself,
but to your estimate of it;
and this you have the power to revoke at any moment.”
Marcus Aurelius

the application of theory update

Today, I received the first dose of Orencia. Yeah! The insurance approval came through on Wed July 30 late in the afternoon. But the infusion nurse was out of the office on Thursday and Friday, so when I called on Friday to check the status of the request, the "office" nurse thought it was approved but not positive. I found out, for sure, when I got there this morning.

The first three doses are administered at two week intervals. The next doses are August 19 and September 3. Comprehensive exams begin September 9. Today, I was told that Orencia tends to have a slow start -- not exactly what I wanted to hear. How long? It may take 3 months to really tell the difference. The infusion nurse said a lot of her patients have told her they could tell the difference in 6 weeks.

side note: A long time ago, I thought I would be an MD. When I finally relented to the call that was so powerful, I said to God, "Fine. If I can't be an MD then I want to be a PhD." The timing and money fell into place for the PhD all the way up to this point.

So, at this point in the intersection of PhD and arthritis, I am consciously choosing to keep trying to study and adopting the mantra, "The God who brings you to it will bring you through it."

software solutions

In an attempt to reconcile myself with the functionality of my body and my need to produce documents, I have obtained a well known voice recognition software program. This is proof that it really does work pretty well.

On the advice of Disability Services at the University where I am scheduled for comps, I was exploring the software options before the most recent arthritis concern. Just in case. Now, I think that was pretty good advice. The software package came with a wired microphone headset that seems to work well. However, if I upgrade to a Bluetooth headset microphone, I can even wander around while writing.

I guess the next thing to do is to write my sermons with this program. So then I will get used to it before I have to take comps.

The most awkward thing so far is actually speaking my thoughts out loud. I'm so used to typing my thoughts that speaking them is odd.

And then there's the editing, I don't have it completely figured out yet. But a few mouse movements and keyboard strokes go a long way.

when the theory applies

The Theory
Excerpted from Ask the Expert (While this refers to psoriasis and psoriatic arthritis, I have Rheumatoid Arthritis and the facts here are also applicable to me.)

"All 3 anti-TNF medications (etanercept [ Enbrel ], adalimumab [ Humira ], and infliximab [ Remicade ]) have been shown to be amazingly effective and safe in the treatment of psoriasis and psoriatic arthritis. However, a few important anti-tumor necrosis factor (TNF) realities must be appreciated, all gleaned from a worldwide experience with these wonderful new medications over these past 5 years: [huge snip of of points 1 and 2 which also apply but aren't the particular focal point for this post]

All of the anti-TNFs may "run out of gas" to one degree or another after 2-3 years, and some type of medication switch or dose change is needed. "

The Application
Two years ago I maxed out the dosage while losing effectiveness for Humira and switched to Remicade. Now I am 0.5 mg/kg short of maxed out on dosage for Remicade and I am very clear that it is no longer effective. (My methotrexate has increased and I am very clear that it is providing as much relief as it can. But it's kinda like a 4-cylinder car trying to do the work of an 8-cylinder truck.) My next dose is scheduled for the first week of August. Depending on insurance, I may receive a new medication by then (probably Orencia). I am so clear about the lack of effectiveness of the Remicade that I called my RA's office on Friday to make sure the paperwork with the insurance company is being done. I rarely follow up with them because they are so efficient. That phone call really was a reflection of my anxiety.

Let me elaborate. The anxiety is driven, in no small part, by the fact that I am scheduled to sit for comprehensive exams for my PhD in September. A delay in the paper work or approval by insurance means a deteriorating ability to study which is already compromised by "brain fog." "Brain fog" is one of those things that you usually learn about from others taking methotrexate not the doctors, although some of them do tell you. Brain fog tends to occur close to the dosage day and your brain is slower, better with recognition than recall, and sometimes stuff is just gone. As you move away from the dosage day, clarity returns. With the increase of the methotrexate, I've had an increase in side effects that my body had pretty much adapted to on the lower dosage so I've had a return of brain fog that I was kinda used to not having. And, further more, since the Remicade is failing, I am noticing the drop off of the relief provided by the methotrexate toward the end of the week. So when I don't have brain fog, I have pain -- which isn't so conducive to thinking either.

So now, already overwhelmed with the task of organizing and studying for comps, I have added brain fog, pain, and fatigue. So, am asking for you to pray for these things: 1) that the paperwork is completed in a timely manner and the insurance approves the switch for the first week of August; 2) that I can set aside the "overwhelmedness" long enough to get some focus for the organization needed to study; and, 3) that I can actually have productive study time.

And applications for study buddies are open now.

the last class

According to the online grade book for the last class for PhD:
points earned: 1081
percentage: 88.244897959183673469387755102041 %
letter grade posted: A
building relationships with professors (aka being a teacher's pet): priceless

update (otherwise known as procrastinating)

I am almost finished with the paperwork (Is it still called paperwork if it is all electronic? Are they still papers if you never print them?) required for my last doctoral class. I have a system that works well for me most of the time: sit on the end of the couch closest to the lamp, prop feet up on coffee table, use the rest of the couch as a desk, strategically place reference books on the floor, and, turn on tv.

I managed to crank out some serious verbiage today with this system.

But it's quite humid here and The Entertainer is having a smidge trouble breathing so she planted herself on the other end of the couch for a breathing treatment. She then had the audacity to fall asleep! Nevermind that it was already well past her bedtime -- she's on MY DESK SPACE!!!

I'm gonna have to move my system to my bed. Where I may very well fall asleep, instead of cranking out the last bit of required verbiage.

some people

Sat 5/3

On Saturday, instead of attending the last class session for my last doctoral class, I will be officiating the service for a 30 year old who was murdered.

There are way more questions than answers.

His grandmother is one of the very active older members of my church. He was living with her when I first came here almost 3 years ago. So, while I didn't know him well, I did know him and had talked to him casually. I just recently learned that he was divorced and had a 7 yr old son.

Please pray for his family. Pray that the police officers who are working the case get the information they need to bring answers to the family. Pray that in this difficult time there will be much kindness and gentleness.

I, for once, have a crisis for which I have had training and so have been able to be helpful to the family. However, I've never had to officiate a service like this before so I could use some prayers that the sermon is what it needs to be.

And, prayers that I actually get the course work completed on time, might be a good idea, too.

the best laid plans

I am taking the last course of doctoral work right now. I have turned in my application for comprehensive exams for the fall which usually means the 2nd or 3rd week of September.

After turning in the application, I was notified by my adviser that as of August she will no longer be with the university. She is the one who is supposed to gather the questions from the four other professors on my committee and prepare the packets of questions for comps that will total 24 hours of writing time (yes 24). I have taken way more than a majority of classes with her and was planning for her to chair my dissertation committee.

I'm working really hard not to freak. As if comps isn't stressful enough! And because of all that, I'm having a hard time finishing the tasks at hand for this one class -- that are not all that hard. So, please do me a favor, when you read this, if you don't want to comment, but you will pray, put a + in the comments for me.

the ending of the beginning

The first class session of the last course for the Ph. D. meets on Saturday. So, that means the procrastination by blogging will probably increase. I'm taking Advanced Quantitative Research Methods. But really, I'm starting to put some thought toward the dissertation that comes after the comps.

When I started (Fall 2002), I knew exactly what I wanted to do. That has shifted. I'm now considering clergy and grief. I know that is not defined enough yet. However, I'm thinking that there are times when clergy are involved with church members in multiple relationships that cross boundaries, like the church member who is a 3rd grade teacher and has the preacher's kid in class while the preacher is also the room mother (or whatever they are called now) and a leader in PTA with the husband of the teacher who is also a Trustee at church. When that 3rd grade teacher dies from breast cancer, the grief cannot be contained in a neat little professional box. There are times when, for clergy, to adapt someone else's phrase, the professional is personal.

That is the kind of grief and clergy study I'd like to attempt. I have not found it addressed in any professional literature. (If you know of some please let me know!) What do you think? Would you consider participating (this is not a commitment, just a question)? I could use some conversation around this with other clergy. So comments or questions would really be helpful.