Analyzing the Symptoms

A Brief Update

There are no more good days. Occasionally, Nichelle will have a few hours when she is able to be somewhat active, but it appears that even days like our 1/2-day MFA trip are now impossible. The pain is more severe, and Nichelle’s general debilitation is both more severe and the episodes last longer. Walking any real distance is nearly impossible, although she did complete a less-than-30-minute trip to Wal*Mart last week, this is exceptional. There are unexplained symptoms, like the tiny purpura spreading through her skin, as well as inexplicably normal test results, such as for free T4 (one of the thyroid hormones) and cortisol.

It’s very frustrating. Our most dedicated doctor admits that this is outside his specialty (neurology), and other doctors seem unwilling to exert the effort to find the cause of these problems. If we were to diagnose based merely upon symptoms, my conclusion would be hypothyroidism on top of fibromyalgia. However, the hormone tests run so far for hypothyroidism have been negative. (But hormone problems are often difficult to diagnose, and may defy test-based diagnosis for years.)

Symptoms such as she is now suffering go back all the way to 1992, although they have been increasing in severity enough to be very troublesome for about the last 7 years, the last two years have been much worse. More detail and history are available by clicking on the fibromyalgia category for our BLOG.

Nichelle has copies now of most of her medical records. We are leaving no stone unturned. The common theme expressed by doctors is, “I dunno.”

On the bright side, the illness did make shopping for Nichelle’s birthday presents easy: DVDs from Amazon.

By the way, if you haven’t read this post about Nichelle, you should!

Symptom Frequency Possible Diagnoses
Severe edema (fluid shift) with weight fluctuations of 5 lbs. in the course of a day. The swelling varies in intensity, especially around the face, but is always bad. Continuing. Cushing’s Syndrome, Hypothyroidism.
Significant weight gain (over 65 pounds) in the past year, despite healthy diet and a significant daily exercise regimen (until last fall, when exercising became impossible). Constant. Weight tends to suddenly shoot up every few weeks. Cushing’s Syndrome, Hypothyroidism, medication interactions (from the tricyclics used to prevent migraines and sleep problems).
Burning sensations, primarily in the hips and back. Many hours each day. Fibromyalgia, hypocalcemia, secondary hyperparathyroidism.
Pain. Moderate to severe pain nearly always. Episodes of severe, stabbing pain on a daily basis. More than one episode per month of pain as severe or more severe than unmedicated childbirth. Daily. Fibromyalgia, migraines, hypocalcemia, myofascial pain syndrome.
Difficulty walking or standing. Constant. Currently able to maintain only a decreasingly short amount of activity at a time. Unknown.
Rapid deterioration of “normal” health over the space of 1/2-hour (normal as defined by the current baseline: still not very good, but able to function with only minor or moderate difficulty). Daily, when basal health is temporarily good enough to demonstrate a decline. Hypothyroidism, fibromyalgia.
Extreme discomfort in having anything touching the skin on her arms. (Skin sensitivity.). Weekly. Unknown.
Pins-and-needles sensations all over, especially the head. Daily. Fibromyalgia, secondary hyperparathyroidism.
Periodic cognitive difficulties. (This is the only symptom that has been less severe than a year ago, we believe because of partly successful treatment of sleep-disturbing migraines.). Several times a week. Hypothyroidism, fibromyalgia, hypocalcemia.
Sudden or prolonged exhaustion. Nearly daily. Hypothyroidism, fibromyalgia.
Painful, unusually strong sensitivity to having anything cold come in contact with skin. Constant. Fibromyalgia.
Feeling very hot or very cold not in conjunction with actual temperature. (Feeling extremely cold often immediately precedes episodes of severe pain.) Night sweats. Daily. Hypothyroidism.
Occasional inability to grip small items, such as table utensils. A few times per month. Unknown.
Inability to raise arms or hold an item such as a cell phone against her ear or face. Constant. Cushing’s syndrome.
Difficulty putting weight on wrists to support. Constant. Possible bone problems, hypocalcemia, secondary hyperparathyroidism.
Hair breakage/brittle hair. Hair loss on arms, legs, and hands. Continuing. Hypothyroidism.
Small spots that look like dark freckles that are appearing all over the skin and slowly multiplying. The ones that are a couple of weeks old are now increasing in size. (I had previously labeled these as purpura, but Dr. Hall told us that purpura describes such spots only when they are caused by platelet problems.) Continuing to increase in number. Unknown.
Severe pain in the bones of her wrists, feet, collarbone, and ribs. Constant. Secondary hyperparathyroidism, possible bone problems, hypocalcemia.
Stretch marks and skin discoloration over an ever-increasing number of areas. Continuing to worsen. Cushing’s Syndrome, may be secondary to the significant edema and weight gain.
Dizziness. Several times a day. Fibromyalgia.
Nausea. Several hours each day. Hypothyroidism, fibromyalgia.
Low body temperature (1 degree or more below normal) most of the time. Constant. One or twice a week temperature approaches (but does not reach) normal. Hypothyroidism.
Low calcium level (hypocalcemia). Current. Vitamin D deficiency, parathyroid problems.
High PTH (Human parathyroid hormone) level. Current. Parathyroid problems, could be secondary to vitamin D deficiency.

The official diagnoses, which have not helped with a treatment or identified the causes (most are merely descriptions of symptoms), for the most part, the following:

  • Fibromyalgia
  • Myofascial pain syndrome
  • Secondary hyperparathyroidism
  • Vitamin D deficiency
  • Hypocalcemia (probably caused by vitamin D deficiency or parathyroid problems)
  • Neurosomatic syndrome
  • Periodic limb movement disorder (believed being successfully prevented with medication)

What We’ve [Mostly] Ruled Out:

Fibromyalgia is, itself, generally diagnosed by ruling out everything for which a definitive clinical test exists. Here are the few other things that have been ruled out:

  • Lupus (this has been repeatedly tested for about the past 10 years; it has always been negative)
  • Heart problems/heart disease
  • Diabetes
  • Sickle cell anemia
  • West Nile virus
  • Lyme disease

In addition, Cushing’s Syndrome seems less likely than hypothyroidism, due to the fact that some classic symptoms of Cushing’s are absent.

This analysis is hardly complete; there are certainly other possible explanations of these symptoms. If you have other suggestions, please let us know. Personally, I think it’s just Munchausen Syndrome. (Or maybe it’s Munchausen Syndrome by Proxy, just like in The Sixth Sense.)

At any rate, keep praying.

Remote Debugging Attachment to a WebLogic Server

Don’t believe everything you’ll find online. If you work in a moderately complex environment (meaning, you’re running a managed server instance via an admin server instance on WebLogic), you’re sure to be led astray by the dozens of articles offering guidance into this elusive technique. You don’t have to emulate Ray Milland, if you follow this advice:

If you Google “Remote debugging WebLogic” you’ll find a host of discussions about modifying the startWebLogic.cmd or startWLS.cmd files. Ignore them all (assuming you’re using WebLogic 8.1 or later)! (Also remember, never verb a noun.)

Let me review the scenario that I am actually addressing here:

  • You will be remote-attaching to a running WebLogic instance, rather than launching the instance from within your IDE. (I use Eclipse, because I’m cheap—and because version 3.1.1 really works great, unlike its predecessors—but these instructions apply to just about anything.)
  • You run your WebLogic application as an instance under a WebLogic managed server, and start/stop it using the Remote Start options in the WebLogic console.
  • You’ve tried desperately to get your debugger to attach, or your breakpoints to be hit, to no avail.
  • You have deadlines looming, and if you don’t get this one problem solved, you can never see your family again.

Okay, perhaps I went a bit overboard on the scenario, but if you’re reading this, I expect, like me, BEA’s WebLogic isn’t a platform you use every day, but one that you need to work on occasionally.

The key is that most of the documentation presumes you won’t be running your application from the WebLogic Server Console, and gives no indication that the JVM arguments, in such a case, go in a completely different place. Here’s how to prove to the world that you weren’t going insane:

  1. Log on to the WebLogic console, via http://{servername}:9999/console. YMMV as far as the port number (after {servername}) is concerned.
  2. Using the navigation tree, click on the domain on which your application resides, open the Servers branch beneath it, and click on your application’s name.
  3. With the Configuration tab in the top row selected, click on the Remote Start tab in the second row. (Be sure you don’t have Control selected in the top row, otherwise you’ll think I am just as batty as the authors of the previous 743 help documents you’ve read.)
  4. Scroll down to the Arguments: field, and add your debug settings to the JVM arguments in that field. In my case, I added -Xdebug -Xrunjdwp:transport=dt_socket,address=8787,server=y,suspend=n, which (among other things that are too cool for me to share) allows the debugger to attach to port 8787 (address=8787), and the server to start without waiting for a debugger to attach (suspend=n).
  5. Click on Apply.
  6. Then click on Control in the first row of tabs, and be sure Start/Stop is selected in the second row of tabs.
  7. Finally, you’ll need to either gracefully or forcefully shut down the server by using the links provided, and then restart the server. (You’re actually only restarting your application; the ambiguous language surrounding server is another problem.)
  8. Attach Eclipse to the server by Configuring a new Remote Java Application under Debug … Feed it parameters of the server name and 8787 (or whatever port you provided in the JVM arguments).
  9. Debug your problem.
  10. For goodness’ sake, go home and see your family!

Drop me an e-mail using the link in the sidebar, or leave a comment, if I’ve goofed anywhere. I never claimed to be perfect. Sheesh.

Mostly Mummies: Our MFA Trip

Never visit the Museum of Fine Arts in Boston without being accompanied by Debi Costine. Back on February 27, we got to do just that.

Nichelle spent the three days before the trip in “intense rest,” hoping to be well enough to go with us. (I hadn’t seen her so determined to do anything major since singing in the Christmas program in mid-December.) Thankfully, she was able to go, although by the end I wished I insisted she use a wheelchair for at least part of it. (In the weeks since, her condition has gotten worse, and I don’t think we’d even try such a trip now.)

We also weren’t sure we could convince David to come. He seemed fascinated, several years earlier, by the mummy at the Museum of Science in Boston, but in the interim years, that fascinating had turned to fear. I spent three weeks trying to psych him up, but it was Debi who spoke to David the night before and convinced him that he would be fine. By the end of her call he was eagerly anticipating the trip.

Above: Debi Costine provides an introduction to ancient Egypt.

What a wonderful trip! The kids loved it, John especially favored this museum over the science-centered ones that I typically drag him to.

Outside the Egyptian wing, Debi sat us down, gave us handouts, and introduced us to things to look for in the Egyptian artifacts. Among them was a cartouche—generally an ellipse with a line on one side, that would be marked with one or two sets of hieroglyphs. This would indicate the name of a god or a king. We also learned about the burial and afterlife beliefs of the ancient Egyptians, including the false door that the spirits would use to retrieve food offered to them.

One of the things Debi stressed was the grain of truth that many cultures preserved after the Flood in their understanding of spiritual things. It was very interesting to see how a proper understanding of death and eternity became corrupted over the years.

Above: Pointing out the hieroglyphs adjacent to a cartouche, indicating the name of a god. (Note Debi’s red hair.)

One of the ideas I found fascinating was that the existence of one’s name carved in stone allowed the existence in the afterlife to be perpetuated. In some cases, pharaohs or other leaders who fell out of favor were “eliminated” after death by having the names chiseled out of their places, as well as statues destroyed. One pharaoh ordered his name hieroglyphs to be carved especially deep. I wonder if it occurred to them to carve it someplace and then hide it.

Above: Barley (along with a crude mortar and pestal) dating from up to 6,000 years ago.

When Nichelle and I attended the MFA last year, we were awestruck by the Egyptian artifacts. They project such a feeling of age. It is truly amazing to walk among them. The barley shown above is a small thing, but it’s astounding to find it preserved for five or six millenia.

Above: King Menkaure (Mycerinus) and queen (possibly Khamerernebty II).

I absolutely love this statue of King Menkaure and his queen. This couple is elegantly and lovingly rendered, and it impresses me that the artists were able to perfectly recreate the effects of sheer cloth in a stone statue. Note that they are actually clothed, at least in the custom of the time. The statue is unfinished. (There is no name on it; the king’s kilt pleats are not carved, and the base is unfinished.) There are more photos, a write-up, and an audio piece here at the MFA site. Note the folded napkins in Menkaure’s hands. These were authority symbols. Some later statues had rectangular napkins that look more like blocks of wood.

Above: The Egyptian kings would place these stories about their conquests on the borders of their lands. Debi was able to explain the story carved here in much more detail than the museum plaque next to it.

Above: Check out the cartouches on the base of this statue. These have the hieroglyph pairs we were hunting: a sun with a bird, and a bee with a sedge plant. David just told me, “I was the first one who found that one!”

Above: All the geeks in ancient Egypt used these these snazzy pocket protectors. Seriously, it’s a scribal palette, belonging to “The royal draftsmen of the Lord of the Two Lands, Amenemwia.”

Above: The center of the Egyptian funerary room. That’s a bolt of linen in the left foreground that is over 4,000 years old. Amazing!

The funerary room was astounding. It offered much more than the few things we think of as stereotypical Egyptian art surrounding the funeral rituals. Interestingly, the Egyptians were quite reluctant to change the formulae of their rituals, even over the centurals. So, even when the custom of removing the organs and storing them in jars had changed, faux jars were still placed in the burial chamber.

Above: These ceremonial eyes were painted on the sides of coffins to allow the body entombed within to see out.

Above: Debi noticed something about this mummy mask that she had never seen before: It has a beard. This mask (dating from the time around Joseph’s life) may show the result of a Hebrew influence, as the Egyptians didn’t wear real beards, perhaps as a result of Joseph’s revelation of his origin and rise to power.

Above: You’ve read the Old Testament many times, but always wondered what Baal looked like. Now you know! (This one is missing his weapon or thunderbolt. Maybe it was a child’s action figure. It’s about the same size. “Hey, kids! Collect all the Canaanite deities!”)

Above: This Hittite stamp-cylinder seal was impressive, as were the other seals and commercial artifacts, including a set of balance weights and numerous cuneform tablets.

Outside of the Egyptian area, was one of the things we were all really looking forward to seeing: A fragment of a plate (probably smashed by the forces of Alexander the Great) from one of Xerxes four palaces. Debi likes to encourage her students to imagine that Queen Esther herself may have touched it.

Above: Fragment of a Royal Plate
Southwest Iran (probably from Perseopolis, Palace of Xerxes), 485–464 B.C. Diorite. Queen Esther just might have used it. (My photo is blurry, so I’ve linked the image to a better one at the MFA.)

By the time we got to the few more modern things we looked at (much of the 1st century A.D. art, especially from Corinth, is, shall we say, inappropriate for children), they just couldn’t compare to the marvel of the ancient Eyptyian work. They all seemed so … recent.

Above: This painting contains owls hidden within it. I was terrible at finding them, but the kids did well, and really enjoyed the task. This photo isn’t perfect, but I couldn’t find the painting this evening when I searched the online MFA database—even though I found it a few weeks ago.

I’ll also include what is one of my absolute favorite paintings in the MFA. When I first saw it, during my company’s “Winter Thaw” event, I was struck by how beautiful it was. The color is amazing, and it seems photographic in its realism. It really stands out.

Above: Portrait of a Young Woman, possibly Countess Worontzoff, by Marie Louise Elisabeth Vigée-Le Brun, French, 1755–-1842.

And David, the little weasel, announced that his favorite part had been the mummies.

Another Dead End: Endocrinologist II

Nichelle heard back from the most recent endocrinologist’s office. Here are his notes:

  • No further assessment
  • Fasting plasma glucose at some point in the future, not running any more tests.
  • Maybe another fasting glucose—talk to the PCP about that
  • Can find nothing from an endocrine standpoint

However, the office is checking on a referral to an endocrinologist in Boston.

This is really, really frustrating. Hypothyroidism on top of fibromyalgia explains nearly all of Nichelle’s symptoms. Every doctor except the endocrinologists Nichelle has seen seems to think this exhibits as a clearly endocrinological problem.

I’m going for a walk.

Later news:

Nichelle has been referred to a specialist in Boston. The endocrinologist did agree to the referral, and will be following up on the results. This is some progress.

Another Appointment … Rheumatologist II

Today I had my appointment with the new rheumatologist. He’s requesting all records from three different doctors. I was given a new pain med and taken off one that I was recently given by the ER doctor (although I’ve only taken it once). I will have a follow-up appointment in four weeks.

He has no explanation for several of my symptoms, but states the other problems that I’m having is fibromyalgia. Here’s a great site to find out more about fibromyalgia:

The doctor today, too, agrees that the other problems that I’m having are endocrine. I am also waiting to hear back from the new endocrinologist. He wanted to go over my tests results from the first endocrinologist, who claimed that I didn’t have an endocrine problem!

I have been checking my temperature for several days now and the highest it’s been is 98.0 and the lowest was 96.3. The typical range in 97.2 to 97.7.

Next week I have an appointment at the pain management clinic.

Waiting, praying, hurting, and crying, but through it all we know God is ultimately in control and already knows the outcome. Thank you for your continued encouragement and prayers.

Endocrinologist II: Not Much to Tell (Yet)

Nichelle was very impressed with the endocrinologist she visited today. She described him “as thorough as Dr. Rescigno,” which is a huge compliment.

Dr. Bhaghayath took an interest in everything Nichelle brought in (unlike the last two doctors she has seen), including things that seemed “off-topic,” such as the bone scan results. He was amazed by the photos showing the water retention. He reviewed our symptom list, and commented that Nichelle had “a lot of things going on.” He wanted to know if Nichelle had a family history of thyroid problems. (Getting a family medical history for either one of us is a rather amusing undertaking.)

Nichelle did ask him to confirm any connection between the vitamin D deficiency and the serious symptoms she is now experiencing. As we expected, he said they were “totally separate,” but Nichelle wanted a second opinion.

Unfortunately, some critical records were not sent over, despite the fact that Nichelle checked on them this morning. His concern is that (just as Beth has suggested), critical endocrinology tests were missed, and only the cursory levels were measured, especially for thyroid function.

He’s going to examine the records, after Nichelle kicks some butt to get them sent over, and call Nichelle back. (This appears to be a failure in the medical records department, rather than the doctor’s office, for a change.)

Millions and Millions? (Answers in Genesis – MVBC Conference)

Yesterday evening the boys and I attended the Answers in Genesis conference hosted by Merrimack Valley Baptist Church, featuring Dr. Ken Ham. (See event details, including driving directions here.)

There are two more sessions this evening. I highly recommend attending. Dr. Ham is an excellent presenter, and teaches in ways that are both fascinating and amusing.

I’ve now attended three different Creation Science conferences: Dr. Ham’s presentations are on par with the excellent work of the Institue for Creation Research. (There is a third, very well-known Creation Science presenter I’ve seen whose seemed to go off-topic at times, and who left me feeling he was a bit loopy when he did so.)

There were a few things which were of particular interest to me, although everything was interesting:

  • Not a single point mutation ever studied has resulted in an increase of genetic information: They have all (all that we have studied so far, at least) removed information. It turns out that the things we dread, like bacterial resistance to antibiotics, are due to genetic information being lost from the strains. (In one specific example, mutation removed the ability to produce an enzyme that converted the antibiotic to poison within the bacterium, making a particular antibiotic ineffective.)
  • The explanations of how specific breeds of dogs show subsamples of a more genetically diverse gene pool were excellent. He referred to his wife’s expensive-to-care-for hypoallergenic poodle-type dog as, “my wife’s degenerate, mutant dog.” I have always been fascinated by genetics, and enjoyed this part of the presentations immensely.
  • During an explanation of 14C (Carbon 14) dating versus K-AR (Potassium-Argon) dating, Dr. Ham presented a find from a mine in Australia, where samples of fossil trees (not petrified) were found embedded in the bottom of a basalt layer. The layer was K-AR dated at 36 to 45 million years old, while the wood was radiocarbon dated to about 45,000 years old. They can’t both be correct, especially as 14C isn’t supposed to persist in measurable quantities for more then 100,000 years.

Dr. Ham has blogged about this conference himself here.