My Brain’s Falling Out and My Head’s Falling Off: Chiari, Instability and a Whole Host Of Swearwords.

My Brain’s Falling Out and My Head’s Falling Off: Chiari, Instability and a Whole Host Of Swearwords.

This particular post is one that I had hoped I would never need to write. EDS up till now has been frustrating, painful, intrusive and unpredictable, but now it is darn right scary.

As EDS leads us to produce faulty collagen, its effects can become apparent anywhere that collagen is involved. Joints, skin and organs are all affected, with further effects often reaching to hormonal systems, the autonomic nervous system and pretty much anywhere else you can think of. For many people with EDS these effects will be difficult to live with, tho it tends to be something you can adapt around – usually it is life altering, but not life threatening.

However for a relatively small percentage of us things can get a little more precarious when the brain, neck and/or spine decide to join in the party.

This particular tale for me started in mid January (barely 3 weeks after my thyroid operation). I have been experiencing headaches pretty much since I can remember. I grew up with daily tension headaches (not helped by a jaw that loves to snap, crackle and pop), and from the age of 12 I have experienced ongoing neck and back pain. Having been brought up to resemble a musical robot, I had always attributed this issues to spending hours a day in front of a music stand rather then anything linked to EDS.

Over the years my headaches have changed. I developed migraines, headaches when I cough, laugh or strain, and usually feel like my head feels too heavy for me to hold up by the time Ive been up for more then half an hour or so. My neck over recent years has also started to feel noticeably more unstable – along with the usual subluxes I am accustomed too, I do get the occasional clunk that leads to extreme burning pain radiating  up and down my head and back which lasts for days at a time. In general the change has been so gradual that I rarely stop to think about it. I am used to the headaches not going away and the need to rest my head. I’m used to fending off migraines on a weekly basis, and the pulsating pain felt when I cough, bend over or laugh. All in all, I have always just assumed its nothing more then an annoying symptom of EDS rather then anything to be hugely concerned about.

Having mentioned these issues in passing (largely focused on the migraines which are extremely disruptive), my GP decided to refer me to a Neurologist for a formal diagnosis. This finally came through for January, and as I wasn’t feeling particularly worried about anything, I attended the appointment alone. As expected, he diagnosed me with migraines (no surprises there, tho its taken years for any GP to acknowledge them), and when talking about the headaches relating to straining he very cheerfully dropped into the conversation “Oh, and you probably have Chiari Malformation which is where your brain is herniating into your spinal column – its really common in EDS, but just forget you have have it!”

Now Im pretty sure you have all heard the example ‘Don’t think of the pink elephant’. If you don’t want me to be thinking of the pink elephant, then maybe don’t tell me not to be thinking about the elephant – or better still maybe suspect that the words brain, herniating and spinal column may come across as just a little bit terrifying.

This is not the first time I have heard of Chiari Malformation in EDS. A couple of years back, a very dear friend of mine ended up extremely unwell with Chiari and Cranial Cervical Instability that led her to need to fundraise an insane amount of money to cover the costs of the surgery that saved her life (no surgeons in the UK will treat these issues in EDS patients). Granted, she was on the extreme end of the scale – but she had also been told my both neurosurgeons and neurologists here in the UK to “just ignore it” and forget about it – so this line of thinking did not sit overly well with me.

In reality (although the NHS will argue there is no difference) many cases of Chiari Malformation and instability are missed when taken in a recumbent MRI. It seems logical to me that gravity plays a part – especially when you take super stretchy collagen into account. Many EDS patients have been fobbed off with a normal looking MRI only to finally get an upright MRI which suddenly shows up a whole host of fairly serious issues. As the neurologist wouldn’t even refer me for an MRI of my spine (brain and spine MRI requested by a consultant at the RNOH) I am pretty sure an upright scan would not have been on the table without an extremely long battle. So I walked away from the appointment knowing full well that the MRI I was being given was close to useless, and feeling utterly lost.

I feel so very lucky that I had my friend to call that day as I genuinely don’t know how I would have coped with that news with nobody else to ask. She allowed me to have a freak out, and then helped me get together a plan that seems much more proactive then just pretending its not there. On her advice, I booked in privately to Medserena in London for an incredibly thorough upright MRI. I was hoping that the MRI would prove that I didn’t have any problems – tho on some level I knew that this was unlikely.

The scan itself was tolerable – especially as the private sector seems to arrange for pots of tea and snacks to be brought to you before and after your scan! They were great at explaining exactly what each part of the scan was for, and they did their best to put me at ease and keep me comfortable. The scan lasted for almost 2 hours, and within this time we took scans with my head in a neutral position, in flexion, extension and turning left and right. As its extremely challenging staying still (even tho each part is broken up into 2-6 minute sections) they use props and clamps to try to keep you as still as possible. It wasn’t a comfortable experience, but it could have been a lot worse. I returned home that evening with a pretty horrific migraine, and unfortunately the scan does seem to have given me a flare up in migraines and headaches. I don’t work well with my head being manipulated, nor with staying at the extreme ends of motion for any length of time. So far Im on migraine 3 in 5 days, but I trust it will settle again soon.

The report came through the day after my scan, which is just as well as I was climbing the walls with nerves. On the one hand, a diagnosis like this is terrifying, yet on the other it would give an explanation (and the potential for treatment) for so many symptoms that I experience. Just like so many parts of EDS, each new diagnosis is a double sided coin.

Reading through the report I felt like my world was falling apart. It shows not just a 10mm chiari malformation (herniation of the cerebella tonsils), but Atlanto Axial Instability and C3-4 pushing out of place and into my spinal column every time I bend my head forward. AAI is instability in your top 2 vertebrae, and mine showed that both facets sublux when I turn my head in one direction, and one side fully dislocates when I turn my head in the other. To top it all of my degree of hyper mobility in my cervical spine is also pretty darn impressive, but this in combination with the above leads to ‘significant instability’ – words that you don’t really want written about one of your most important supporting structures in your body!

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My Chiari Malformation
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Scans showing my neck in neutral, flexion and extension
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Misbehaving C3-4

It is hard to wrap my head around the information I have been given (pun intended), but more so because there are no specialists in the UK that I can go to for advice. Although both chiari and AAI are regularly treated in those without EDS (with the acknowledgement that these conditions cause symptoms for the groups that are being treated), there is a distinct lack of understanding, acknowledgement and knowledge when it comes to treating (or even consulting with) EDS patients. Just like the advice I was given, most people are told to forget about it, that it wouldn’t possibly cause any of their symptoms and that there is no evidence that treatment would be beneficial – ignoring the research carried out by world experts, and contradicting their reasoning for operating on non EDS patients. In reality, it is likely a lack of funding. The surgical technics required for treating EDS patients with these conditions differ from the norm, and so the NHS would need to plough a fair amount of money into new training. For such a small proportion of patients, there is little incentive to back the idea, and so it is far easier to claim ignorance then acknowledge  a lack of funding and knowledge.

Unfortunately this leaves me with few options for advice or treatment. Those that deal with EDS patients are based in either Barcelona or the US, and although I could fight to see different people in the NHS, the results would almost certainly be the same. I want advice on how to manage these conditions – advice on activities that should be avoided, or ways to help myself. I also want to know exactly how serious my scan results are, and whether surgery will be needed in the future in order to maintain some quality of life. The last thing I want to do is ignore its presence, and risk deteriorating to the point of paralysis or even death. Not every patient will deteriorate to such extremes, but its a possibility, and its a possibility that I would rather try to avoid. With all of this in mind, and through an amazing bunch of fellow sufferers, I have begun to make contact with some surgeons abroad. I am beginning the process of sending in my scan pictures for them to look out, and will hopefully be able to get some views from people who know what they’re looking at. If they say that surgery won’t be necessary, then I’ll be jumping from the roof tops, but if it is necessary, then I need to know sooner rather then later as I would need to find a way to self fund. At the very least, it will give me a chance to ask questions about how I can best look after myself from here on in, and what I need to keep an eye on symptom wise.

All in all things are looking pretty scary at the moment, and normal life seems to be slipping further and further away. I really did think that once I had attended the rehab course at Stanmore I’d be able to get well enough to study through hard work and determination, but now I’m not so sure. No matter how much physio and pacing I put in, I won’t be able to fix my brain or my neck. There will be no guarantee that things will stay as they are, and so how can I be sure that I would get through the year without things going disastrously wrong? Thats without taking into account the fact that I have far to many symptoms at my current level to even consider it as it is.

Each time I convince myself that theres a way to sort things out, the unpredictable and frankly horrific nature of EDS rears its ugly head to set me strait again.

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Part Two of ‘The Not So Sexy Side’…

Part Two of ‘The Not So Sexy Side’…

As you may remember from one of my older posts, EDS causes problems only a woman can get. Pelvic organ prolapse is usually something only reserved for those lucky women who are older and/or have had kids, yet with EDS we often get this thrown into our 20’s free of charge!
Pelvic organ prolapse referes to a prolapse within the pelvic region. A prolapse means that the muscles and ligaments (in this case within the pelvis) have stopped being able to support the organs sufficiently, and this leads to hernias. In pelvic organ prolapse this can be concerning the bladder (a cystocele), the rectum (the rectocele), the small bowl (an entrocele), the uterus (utrine prolapse) and a vaginal vault prolapse (a prolapse following a hysterectomy). With pelvic organ prolapse these organs bulge into the vagina causing an array of fairly uncomfortable symptoms.

 

Having finally been diagnosed with a prolapse after a 2 year fight with medical professionals, I was eventually referred to a local gynaecologist to get things sorted. Being of typically English sensibilities, it was not exactly the least embarrassing appointment I’ve ever attended!

I spent the few days before my appointment in obligatory panic mode. What if I was brushed off again? What if it wasn’t a real illness and I had made everything up? What if I would be laughed out of the clinic in shame?! I am aware non of this was a logical thought process seeing as a professional had already diagnosed me, but with EDS a diagnoses is often brushed aside when it seems inconvenient for the next professional to take into account. I am so used to having to fight my corner that I get huge anxiety before each and every appointment. With this appointment, I thankfully needn’t have worried.

 

As soon as I stepped into the room, the doctor was friendly. The more nervous I am, the more I spout random nonsense, and what with this particular appointment concerning my lady bits, there was a lot of nonsense being spoken. Thankfully, she was more then happy to join in with my nervous chatter.

She started off with some questions concerning my symptoms. We spoke about pain and a downward heaviness down below, issues with incontinence, issues with intercourse etc. She kept the questions going, so there were no awkward silences in which I could get painfully embarrassed.

 

Next came an internal exam – I was expecting the cystocele, but it did come as a bit of a shock when she also diagnosed a utrine prolapse and rectocele. It seems the party for one just turned into a party for three down there.

My options for treatment at this stage are limited. I will eventually require surgery as these issues don’t fix themselves, but as I am still to have children, and own particularly crappy collagen, they would rather try ‘conservative measures’ first. These consist of specialist physio therapy focusing on training up my rather lax pelvic floor, and the use of a pessary – a silicone device inserted into the vagina that helps to hold everything back in place.

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A selection of different pessaries

 

The physio doesn’t sound like a whole lot of fun – obviously to retrain your pelvic floor, it requires feedback, and from what I can gather this will be via another person and via specialist equipment. I am not by nature prone to flashing my bits to random strangers in hospital settings, and this will be no less embarrassing then turning up to my own wedding naked. I know that. The physio will largely be aimed at trying to halt the progression rather then curing it, and that is a thought thats hard to swallow.

The pessary is probably the thing that I am struggling most with. There are many different options from your doctor to choose from, each supporting different areas and providing different levels of support. Some will support just the uterus, the bladder, the rectum – some will support more then 1 area. There are things like a ring pessary for those that don’t require as much support, and then there are ‘space filling’ pessaries for those that require a little more help. I am unfortunate enough to end up with the latter. I have been given a cube pessary. This is basically a silicone cube which has indents in that form suction to support the walls of your vagina, complete with a rather undignified silicone cord – just incase you manage to loose where it is up there! For the cube pessary (all pessaries require different care), it needs to be removed every night, washed, and left out until the morning, when you have the really fun job of trying to stuff it back up there whilst trying not to swear – really not an easy task, especially when you fling it half way across the room and have to race your way there before the dog thinks he has a new chew toy (yes, that really happened)!

It is not so much the rigmarole of using the pessary that is the problem – its knowing that I need to use it. I somehow feel less attractive. As it can’t be left in during intercourse, I am dreading the day I will need to push a hand away and shimmy off to the bathroom to get the thing out before things can get started – spontaneity in the bedroom is truly a thing of the past. I feel embarrassed knowing that its now a part of my personal life, and worried about how people will react. As a young woman of 29, it feels unfair that my body has given out now – it is rare for women that haven’t had kids and especially rare for  young woman to suffer with pelvic organ prolapse, but thanks to EDS it here, and its here to stay.  I can cope with so many of the joys that EDS brings to the table – the pain, the subluxes and dislocations, the difficulty swallowing and digesting food, the fatigue – but for it to affect my lady bits just seems like a massive step too far.

As if I wasn’t a crap enough catch before, yet more super attractive health issues are handed to me on a plater!

Tomorrow morning I have a super early appointment to go back to the gynaecologist. Pessary fitting is a bit hit and miss – its basically trial and error to find a shape and size that works for you. Unfortunately mine is shifting down throughout the day and pressing into bits that really don’t want to be pressed. With the right size and shape, in theory it shouldn’t move about, expel from the body or even be noticeable to the wearer – lets hope I find the right one soon! The doctor very kindly offered to see me after being on a night shift to try another size or shape, so I somehow need to make sure that I am up bright and early to duck in for a repeat embarrassing experience.

EDS is one pretty tricky bedfellow to manage these days.

Learning to Live Again

 

Since my fling with optic neuritis, a lot in my life has changed. I’ve lost a lot, and its been pretty tough trying to accept the things that I can no longer do. With this loss comes depression, and between this and my physical decline it becomes near on impossible to find the joy in life.

Once you have time to adjust to the life you now have, it is surprising what sort of things come into your life to take the place of your previous interests. These are by no means a replacement for your old passions, but they are seedlings that just may grow into the next thing that keeps you going in your darkest hour.

When I lost the ability to dance, I was devastated. My whole life centred around setting myself free in that studio. Every good day, every bad. No matter the weather I was there, ready to put my all into every step. It was the only physical activity I enjoyed, and a never thought I would find a replacement. However, after a rough couple of years, something that feels absolutely amazing has crossed my path again – and that something is horse riding. Yes – horse riding!

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Claymore

 

I would never have thought about this sort of activity if it wasn’t for a neighbour of mine. She has hyper-mobility, and maintains its the thing that keeps her well. So, after months of her casually mentioning it (and me brushing it off), she finally dragged me along a month ago and persuaded me to book a lesson. I had my reservations, and was worried I wouldn’t even manage to get on the horse, let alone be up to riding it. I wasn’t sure what my POTS would be like, and getting dizzy or faint when on something so high up was a scary idea – but thankfully this hasn’t been an issue. I started off with the idea of just having one lesson, but now it seems that I can’t wait for the next week to swing by so that I can have an hour of freedom where my disability doesn’t get in the way of my enjoyment.

I never thought I would find another physical activity that felt as good as dancing.

As far as the effects of my illnesses on top of a horse, there are a few things that I notice. As far as POTS goes, its actually a pretty good type of exercise if you are ok sitting. Its basically a sitting down type of exercise, and as such, I don’t find myself getting faint, dizzy or spaced out like I do when I’m on my feet. It also gets you really working your leg muscles, and I think this also helps with getting your body circulating your blood back up to your heart much more then other types of exercise seem to.

With Ehlers Danlos Syndrome its a mixed bag. In the long run, the muscles that you work will strengthen hugely, and it really works the insides of your legs, which for me are muscles that really don’t tend to work properly when I walk. In effect, it can eventually balance out and strengthen your leg muscles, which should hopefully stop things subluxing and dislocating as much. It also really strengthens your core – I don’t think I’ve needed my core anywhere near as much as I do to balance on a horse, and in the long run, I think this will be a big positive. This type of exercise constantly moves. Although I work hard, my muscles don’t tend to get as tired as I would expect, and I think this is because I am not needing to hold a fixed position when I’m working. Weights at the gym have never suited me as my muscles fatigue quickly, but because I am constantly engaging different muscles, it seems that no one muscle set gets overworked which is a big plus!

On the other hand, it does have its downsides. For me, the biggest of which is that my hips tend to pop out of place within the first 5 minutes of getting onto a horse, and this is pretty painful! I tend to just keep riding as I know that even if I got off and popped them back into place, the same thing would happen as soon as I got back on. My knees and ankles are also vulnerable to subluxing when riding, and again this does hurt. I am just banking on the idea that it will strengthen them in the long run and so will be worth the initial pain. It is also hard work – I am using muscles that I never knew I had, and engaging my core when I have been largely inactive for the last 2-3 years is no mean feat.

Its not easy to get myself there on a bad pain day, but it never ceases to make me feel better by the end of the lesson! The sense of achievement I get from a good lesson means the world to me, and spending time around such intuitive animals is extremely therapeutic. No matter whats gone on in the week, it all gets left at the door, and 100% of my focus goes into that lesson, and that horse. After all, the minute you get distracted that horse will pick up on it and will stop doing the things you need it to do.

At the end of the lesson, I do end up wobbling about looking a little on the drunk side until my joints pop back in and my muscles acclimatise, but its totally worth it, and no matter how much pain I’m in, I have the biggest grin on my face for hours afterward.

For me, this is something that works. Remember that I’m no doctor, and that it may not be suitable for you – we are all different. However, never rule things out. We can do so much more then we think we can – sticks, wheels or pain, it doesn’t have to stop us finding things we love to do. Never stop searching for the things in life that make you happy. We deserve it as much as anyone else, and EDS/POTS doesn’t mean we can’t find the joy in life.

Be brave, and find that ‘thing’ that makes you forget your ill.

Living Alone with Chronic Illness

Living with a chronic illness is hard.
It effects every aspect of your life – from eating and sleeping to getting out and socialising. Every day presents new issues and a continuation of the same old struggles that intrude on every minute that passes.
I am tired of being tired. I’m tired of being in pain, and tired of feeling like every single job to do is a mountain that is hard to climb.
Every task is broken into parts – parts that I never even knew existed before my condition deteriorated. Having a bath isn’t just having a bath; It consists of running it, finding a towel, turning it off, undressing, getting into the bath, washing my body, finding the energy to get out of the bath, drying myself, taking the plug out and dressing. This one small task that usually takes minutes for most has to be split into 10 different parts and usually takes me the best part of 2 hours. Whats is more is the exhaustion that follows this can knock me out for half a day or so.

Its hard to explain why you can’t manage to cook or do the washing up, but if every task has to be split into bight size chunks, the energy and time needed for this far exceeds any that I have in a day.

For this reason, living alone has its perks.
I don’t need to feel guilty that theres washing up on the side, or that some days I don’t have the energy to pick up the dog toys on the floor. I don’t need to explain why I can’t join in with the communal cleaning day, or that I would rather paying a cleaner thus looking lazy. I don’t need to worry that my washing stays in the machine a few extra hours before I manage to put it out to dry, or feel bad that I am not up for work like every normal person is.
In a lot of ways its done me good – but there are also some downsides.

Sometimes I am desperate for someone to chat to in the evenings, and someone to share the cooking with.
Eating is a challenge when its hard to cook, and the energy needed for the washing up doesn’t seem worth the effort. Sharing a meal gives food a purpose, and I am much more likely to cook if someone else is about.
The extra challenge is managing food when every time you eat you feel ill anyhow. I struggle to swallow properly, and often end up feeling horrifically full after just a few bights of food. Each day is different, and feels somewhat unpredictable. Some days I manage just fine, but other days even water comes back up, and often makes me choke.
For someone who used to be anorexic its a very hard thing to balance.

Seeing people day to day is also a big challenge. I go days without seeing anyone when I’ve crashed after doing too much, and this can really effect my mood. Loneliness is a common feature in many of us with chronic health conditions, and I have yet to find the answer to this. I have lost contact with many of my friends, and there are few that understand that most of the time people coming to mine is the only surefire way of seeing me.
I find it hard to meet new people. In a body that doesn’t look nor feel like mine, I am embarrassed to introduce myself. Walking around with a walking aid has dramatically shifted the way strangers react to me. No longer am I a ‘normal’ pedestrian – instead people stare and give me looks of sympathy. Those that have the guts to talk to me treat me like some poor young person who has had bad luck to deal with, but this interaction is rare.
I hate this part the most. I want to look and feel normal. I want to be back to the person I was before things went down hill – but I know that this is no longer possible.

Living alone is great most of the time, apart from when it isn’t.
I am lonely, the house is a mess, and most of the time my head is too foggy to function. Some days it doesn’t feel as great as it should.

Another Day, Another Diagnosis

Yesterday I took yet another long journey down to London for another hospital test. This time around, I had the joys of a gastroscopy, which too be honest is not the nicest thing I have ever experienced – 6 hours nil by mouth may be tolerable if you live right by the hospital, but doing this along side a 2.5 hour journey was particularly unpleasant – I never realised how much I love drinking water!

I elected to have sedation as I am not a fan of feeling like I can’t swallow or breath, and judging by the bits I remember (namely choking), I’m pleased I did! They also took a couple of biopsies whilst down there, and again, the idea of knowing someone is taking a small chunk of my digestive tract isn’t something I want to be aware of while I’m unable to run away.

Sitting on the ward with a cannula in my arm felt odd. I don’t often consider myself to be ‘sick’, but each time I’m faced with a hospital test, it suddenly becomes real. I become painfully aware that these tests aren’t given to healthy people, and the number of tests I am in the process of having are certainly above the average for a healthy person of my age. This last year I have had far to many tests. Scans, an MRI, an echo, cardiac stress test, lung function test, 7 day halter monitor, numerous ECGs, tilt table test, a sleep study, 2 weeks wearing an actigraphy monitor, many hospital appointments, too many blood tests to count, and now comes the barrage of tests for my digestive tract and bladder. EDS really doesn’t let up. The worst thing is that I am fully aware that these are by no means the only tests that will come up in the near future as there are still other referrals to be sorted.

With every test comes the chance of yet another diagnosis, and this gastroscopy was not to disappoint. I have had digestive issues for so long that I forget it isn’t normal – recurrent issues with acid reflux, dysphagia, bringing up food (either undigested or partially digested), feeling sick every time I eat, bloating, pain, food intolerances, IBS type symptoms and only managing small amounts of food in one go before feeling like I’m going to throw up. I spent years trying to get help for it, but have repeatedly been told that its ‘probably just IBS’, or other equally unhelpful comments.

It wasn’t until I paid for that private appointment with a POTS specialist that these issues were taken seriously, and I after a long fight with my GP, I finally got a referral to a gastrologist.

With Ehlers Danlos Syndrome and POTS, gastric issues are common. A body thats too stretchy often leads to complications, and POTS is no better. Common issues include dysmotility such as gastroparesis, GORD, hernias and dysphagia, alongside issues with constipation, diarrhea, pain and cramps. To put it bluntly, its a whole bundle of fun.

I hadn’t really put much thought into weather they would find anything wrong during the gastroscopy – I think things have been belittled so often when I have gone for help that I had thought that there was nothing really wrong. If you spend enough time telling a patient that it must just be because they are tired/stressed/nervous then they start to believe it. I genuinely thought that perhaps everything was in my head rather then a real problem, and that these tests would only highlight this.

So after I came too, I headed into the nurses office who went through the exam. To my surprise I have a fair sized sliding hiatus hernia (and some damage done by acid reflux) to add to the list of weird and wonderful conditions caused by my faulty collagen!

The thing that has thrown me off most about this is that according to the nurse, this doesn’t explain a lot of the issues I have with my stomach, and so chances are there will be another unexciting diagnosis right around the corner. I have a couple more tests for these on the horizon, and it is safe to say I am looking forwards to these like a hole in the head.

Sometimes I think that I don’t really want to know what is going wrong anymore. I have a list of diagnosis fit for any 90 year old, and its scary to think just how many more may be added to the list. Ignorance is bliss as they say.

To add another spanner into the works, my blood test results for my thyroid levels have come back wrong for the second time – so no doubt that will be the next thing on the list to figure out.

For someone that looks so well, I certainly have a talent for being broken!

The Reason I Speak Out

Recently I have had a few people telling me that I am ‘strong’ for talking openly about this. ‘Brave’ to publicise my illness, and that this sort of thing takes guts.

In all honesty, I do not feel any of these. Strength, bravery and guts come from being left with no other option. If I do not talk about my invisible illnesses, how on earth can I expect those around me to understand that I am ill? I have spent years getting angry, upset and frustrated with being continually labeled as lazy, but in reality what is there to go on?

I am young, I look fit, and I look healthy. I make the effort to go out, and on the days that I know I can’t bear the pain or exhaustion I hide away so that nobody has to deal with it. To the outside world I am not obviously disabled – I am normal.

The fall out from this continual cycle of putting on a mask for the world is that you begin to feel low. I have struggled with depression for over 11 years, medication has been a life saver, but it can’t do it all. In reality as much as I do need that medication, I also have to change to survive.

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Recently my mood dipped again – its a deep dark world inside the head of a person with chronic pain and chronic health conditions. Who wouldn’t get depressed if life day in and day out was painful, unpredictable and lonely? Who wouldn’t get depressed when being forced onto a different path from the one you have worked so hard to be on? Depression is a very reasonable response to chronic health conditions, both physical and mental illnesses.

Although I am low, I have also been in this cycle enough to know that I will bob up again, even when it doesn’t feel like it. I put things in place to keep me safe, and I force myself to engage in the outside world. Sure, staying in bed in a numb state or crying for hours on end are the things that I want to do, but I also know it does nothing to help me climb back into the light. This particular time I have gone so far to remove any spare medication from the house. That was a massive decision to make, but I know it was the right one. I felt extremely anxious without them (oddly they are like a safety blanket to me – both for pain and depression), but with the temptation out of the way it has given me some breathing space from the darker thoughts that I was having.

I also had to find something to motivate myself. It used to be dance that I ran too when I was depressed. It was the most amazingly wonderful hobby in terms of my mental health. Any anger or sadness got ploughed strait into a class, and as my whole attention was focused on how to get better, it gave me some wonderful time out, no matter how rough things were. Unfortunately I am far from able to balance on one leg, let alone be jumping around a dance floor now, and when I started getting low, I was also hit with just how much I have lost.

I knew I had to find yet another coping mechanism, and thankfully I have found and joined up to what is effectively a community pottery studio. I have a code for the door, and can go any time. The place is filled with absolutely lovely people, and everybody has welcomed me. The clay work is therapeutic, but what is most amazing is the sense of belonging that I never usually have. They take me as I am, and I don’t hide myself away – I can spend my time chatting and creating and bonding to people – this is the gem that will pull me out of myself and back into the real world once more.

Depression for me is always followed by change because I literally couldn’t stay alive if I carried on as I was. It is not something that I will be ashamed of, and it is not something that I hide – it forces me to keep pushing myself upward when everything else is pulling me down.

This is not a choice though. Talking about this is no longer just an option. If I want to beat this depression, to cope with the pain and build a life with my illness then I absolutely have to explain the invisible to those around me.
It isn’t strength – it’s necessity.

Pain & Fatigue

I have often wondered quite where the pain/fatigue cycle started for me. It seems to be a little like the chicken and egg scenario. My high pain days seem to coincide with the days I am most exhausted, but weather thats because the pain tires me out, or the lowered energy levels give me less tolerance to my pain I will never know.

This particular cycle is tricky – particularly with EDS and POTS. In theory the more you can strengthen your body through appropriate exercise the better you’re body is able to keep its joints in place, and regulate your heart rate and blood pressure in an upright position. In effect this would mean a decrease in both pain and fatigue.

In the case of POTS this is largely things you can do lying down (no, not the one your thinking of), and in EDS it is exercise that will gently build up strength without putting undue stress on your joints.

In practical terms however, this only seems to work so far. Sure I am aware of these factors, but on days where it takes all of my strength to head downstairs (on my bum) to have a change in scenery, and struggle to work through the fogginess or push through the pain enough to get dressed, it feels absolutely impossible to get myself down to a swimming pool or off to a pilates class. On the days that I do push myself to do things (such as appointments or family gatherings) I am able to put on a good enough show, but the following few days are a living nightmare.

Having had a busy weekend, and 2 hospital appointments in London in the space of a week, I feel like a zombie. I may not look like I have an axe sticking out of my head, but I sure as hell feel like its there. My whole body aches, far too many joints have subluxed, and I appear to have a forcefield surrounding me ‘protecting me’ from any outside information getting near to my brain. It is on days like today that I begin to wonder just how on earth I can manage another 50 years of this.

Insomnia is another part of this cycle for me and many others. Again, it is hard to know where it got added into the mix, or if this was an initial member of the party, but it doesn’t half play a large role in keeping the cycle running. I struggle to sleep at the best of times, particularly if my pain levels are high or I’m too tired (oxymoron I know). I will toss and turn trying to find a semi comfortable position till about 4am, and often wake up to 4 times a night in a huge amount of pain. I attempt the usual sleep hygiene advice, and practice mindfulness with mixed results, but this never solves the problem.

I remember a doctors trip just over a year ago. I felt like I was loosing the plot. I was going through a particularly bad patch with both pain and insomnia whilst writing my thesis, and plonked myself down begging for help. I had been countless times before pleading for a referral with a pain specialist to no avail, and I had no idea how to manage things. I was barley sleeping at all (we are talking months of waking up countless times in pain averaging 0-2 hours sleep a night) and tried to explain to her the problem. Her answer was ‘well I don’t want to prescribe you anything for your sleep because your waking up in pain’. Fair enough – to which I replied ‘Can we do something about my pain then?!’. Her reply was ‘No, theres nothing we can do’.

I came out of that appointment and cried. To have insomnia on top of pain is extremely tough. Not just because your exhausted, but also due to the fact that you get absolutely no break from it. Sleep (when I do get it) has often been the one and only time in the day/week/month where I have managed to have some time out, and doctors often forget that this is extremely important if you suffer with pain on a daily basis.

Having deteriorated hugely at the points in my life that I was exercising most, and having gotten to a point where just cooking a basic meal can be the sum total of my energy or pain tolerance for the day I am at a loss of how to help myself. I can not push my body much more then I already do, and each day seems to bring a worsening in pain and fatigue. I couldn’t tell you the last day I had no pain, or even the last day that the pain was able to merge into the background. I can’t remember the last time I felt like I had energy to spare, or a night that I was able to wake up feeling truly rested. It is exhausting in and of itself, and extremely isolating.

Those around me recently have tried to be positive. ‘You will get better soon’ or ‘They’ll find a way to fix it’. ‘It can’t be that bad’ or ‘If you just do X then you’ll feel better’, but the reality is very different. EDS is a genetic condition. My genes can not possibly be fixed. Chronic pain is notoriously difficult to deal with – as you experience pain, your brain builds pathways. The more pathways that are built, the more you feel pain. I have been in pain for as long as I can remember – this isn’t going to be a quick fix, likelihood is that this isn’t going to be fixed at all. I pushed and pushed myself until I became too unwell to do so – there is no more energy left to ‘just do’ anything.
I don’t feel positive, and am struggling not to allow my angry side to run free with the next positive comment thrust in my direction.

Accepting that I am ill is much like grieving for any other loss. I am hurling between all 7 stages at a rather alarming rate – the rational side of my brain that may be able to tolerate the views of those that don’t have experiences in chronic pain/fatigue or other illnesses appears to have left the building.