Well well well...
Winter happened! A week and a half before vernal equinox! (Also, yes, Betty and Fred have new hats... turns out lots of people like to put hats on their itty-bitty pets and if rats and mice, then why not plastic crows? I think they look smashing)
January was like March, so I guess it's only fitting for a little January in March. March snow when we haven't had snow earlier is not an uncommon pattern here, but it was still surprising how persistently the snow fell on Friday the 13th of March! The weather reports kept promising it would become or already was rain, but we live at the highest point in West Seattle and I guess Friday was High Point's day to shine.
The squirrels adapted pretty well overall. They're sneaky little buggers but let nobody say they aren't plucky (or cute as buttons).
Seems they haven't gone too soft here in the temperate Pacific Northwest. At least the little buddy who showed up at our house looking for handouts, seemed pretty determined to run around like normal and dig at seeming random to look for noms.
The birds came in decent droves as well after a slight sleep in. I think they looked at the ground and decided it was not a day to forage. The bird feeder was quite popular
On the downside, the snow might or might not have had to do with the travel interruptions of our would-be guest. Andrew's brother Zach was supposed to arrive mid-morning. Then his flight was delayed. Then by about noon, it had been cancelled and it took a while for the rebooking process to proceed. It was a weird hovering type feeling that lasted pretty much the entire day. We'll see if his flight today works out any better. C'mon, Seatac... it wasn't that snowy!
At any rate. Most of March has been more Mud-Monthy in general. The birds come out regardless.
Flutter flutter. Female finch is ready for a beautiful red male to press his beak up to hers all sexy like and then regurgitate some delicious bugs into her beak. Romance!
And the droves of crows seem more playful and more prone to grouping up than usual.
I can't wait to see the new crow pairings and maybe some crow babies later on. Mostly there are clear mates and what I'm assuming are helpers, but there may be a few new couples in no time as wandering females come to call.
Bushtits and yellow rumped warbler are definitely back in the house!
Itty bitty borbies!
Just for variety, a young double crested cormorant discovered our pond last week.
I thought they were more oceanically inclined, but it's not like they breathe the water, so I guess they can probably switch up between fresh and salt water with no particular hesitation. From what I read, double crested cormorants are the most likely to be found in fresh water. So there we are.
In wonk-body news, I've taken the rather large plunge of finally ending the relationship with my longest held medical professional. It's kind of a sad process, as going to them six years ago felt like a step towards solving my medical mysteries.
Dr. Jain is the expert on MCAS in Washington and has helped people with wildly more complex cases than mine. That first year I had a lot of hope. While I didn't see Dr. Jain primarily, the first doctor I worked with was very reassuring and did all the appropriate testing. I had hopes for xolair and anything else they might suggest.
The doc I had been seeing there left in less than a year. I was given to a few other professionals under Dr. Jain's oversight. Maybe. After hearing mention of it in an online group, it seems he's been disciplined for having medical students treating patients while he is not present and then billing under his name, so who knows how much supervision he ever gave.
I did get onto Xolair, but it seemed like I slipped to a maintenance client at that point, despite not really being "healed".
And after a year or so, the reports of how intensively flaky and non-responsive the office itself revealed their accuracy. Multiple balls dropped over the years and an icy feeling of panic every year when the prior-auth was due. Every little thing required some level of nagging and checking in and a handful of missed doses.
This year I spent at least half the year unable to get into contact with them in any way shape or form (which was a common issue according to several local MCAS groups). They had dropped Klara without telling anyone, never answer their phones. Oh they even moved without notifying anyone, although that at least was on their website.
After some months, I was able to set up a patient account on the new portal by texting a variety of technical numbers and several days of phone calls and even managed to have my six month follow up (required for my xolair Rx and that at least has usually been reliable).
Then a few months after, that portal account suddenly went "inactive" and I had to go through the whole thing again. Finally, I got that back, but nobody would respond to my messages on the portal, so it became kind of a useless token. After my (equally flaky) pharmacy told me they hadn't heard from my doctor and I went through a month of writing, calling and messaging several times a week with no response, I gave up.
There are a couple of other MCAS experienced doctor; they are largely overbooked. Most less specialized allergists are also booked out for months. This general dearth of alternatives is one of the reasons I had just sucked it up with CAA. But after some stressful weeks, I found a doctor in Burien who seems to have just set up shop, and who... lo and behold... set up a consult with me in less than a week of my inquiry.
That alone seems like a good enough reason to move on.
I used to feel self-conscious that often my major criteria for finding a new service provider was "who makes it easy to make an appointment (typically demonstrated by having a way to do so from the webpage or via email and responding quickly)?"
Over time, though, I've come to feel that this is one of the most important parts of a doctor-client partnership. If I can't get a treatment because the office doesn't fill out the paperwork or deal with insurance effectively, it's irrelevant how brilliant the care would theoretically have been. If I can't have guidance in a mast cell flare up because the office doesn't get messages, who cares.
Ease of initial appointment turns out to be a decent proxy for how much the office itself has its shit together, how balanced the doctor's load is, and how well the patient portal generally works. All of which leads to "more likely to actually be helpful if something big or important comes up"
I'm sure there are awful doctors who are responsive, or offices that can set up meetings out the ass, but fail to follow through on medical orders, but... responsiveness is at least a start. And I know that this means letting go of finding The Cure For Everything. Most allergists don't really know much about MCAS or simply reject it as a diagnosis period. Such is life.
Would I like a Dr. House hellbent on figuring out what's wrong with me through thick and thin? Well, sometimes he killed his patients, but otherwise yeah. Do I think I really need a doctor whose main talent is getting things through insurance? Ultimately, yeah.
We didn't talk about MCAS specifically in my consult. In my case the treatment for "chronic spontaneous urticaria, chronic induced urticaria, allergic contact dermatitis, atopic dermatitis, allergic and non-allergic rhinitis, IBS, GERD, small fiber neuropathy, arrhythmia, Hashimoto's and hypothyroid, sicca, conjunctivitis, blepharitis and whatever else..." is no different than "MCAS treatment." Mostly MCAS does just involve hitting the individual manifestations like that. Most things that treat an allergic condition help MCAS because mast cells are the fundamental movers of allergies.
And his questions were tailored to what he could or could not propose to insurance to pay. That's the system we live in.
The treatments we discussed included the one biologic I am taking, the one I've considered taking and the newly approved pill I'm curious about. Xolair treats asthma and urticaria, but also EOE and food allergies. It binds IgE. It's a known mast cell stabilizer. Dupixent treats asthma and atopic dermatitis, but has also been approved for urticaria. It blocks IL-4 and IL-13 signaling, which reduces mast cell activation. Rhapsido is for urticaria specifically, but the mechanism of action is to block mast cells from releasing inflammatory mediators. There are only so many treatment options.
To some extent CIU/CSU is a decent proxy for MCAS as a whole, because it's well recognized mast cell activity that doesn't seem to have a clear and predictable trigger. It's not like an IgE mediated allergy in that way. So, the focus is less on getting used to or avoiding a known trigger, but in stopping the inflammatory cascade.
Not everyone with MCAS has cutaneous manifestations, but since that's pointedly present in my case, I would rather have a doctor treating my CIU (which incidentally helps my other symptoms) than one not-really-treating my MCAS specifically.
At any rate... I'm 99% certain that now that I've contacted somebody else, Columbia Asthma and Allergy will get off their asses and contact my completely incompetent pharmacy and together they will file a Prior-Auth that will clash with the prior auth that my new doctor is planning to file and this will trigger all manner of Insurance related Armageddon. And I have some panic that this new doctor is also just doing nothing and I'll discover this in several weeks. I feel like I have a little baggage-of-anxious from my treatment this far!
But, I'm still more confident that the new doc will in fact go ahead and put in a prior auth and if that takes too long and I start to go without my Xolair, he'll give me a sample at his office like he offered.
Of course, we'll see. It's early yet.
Gulp. Why is this such a damned pain?
On we move!
At any rate, we've had our winter now, so I guess next week can indeed become spring. Preferably a very rainy, low pollen spring, but well...who knows?
Just glad for the belated winter wonderland!
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