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Uncharted Waters

I’ve reached a new physical low and I don’t have any idea of the best direction to go from here. When it comes to my health, I don’t do well emotionally without a plan of action. I can only rest easy when I have prepared for all eventualities to the best of my ability, whether it is going for a drive in the car or thinking about major surgery. As an example, I made a will when I was 37 and, in 2011, I asked my boyfriend of 13 years to marry me so he could legally speak for me if I couldn’t speak for myself. That’s a romantic proposal.

But I’m currently blinded by pain, fear and exhaustion from constant interrupted sleep. I’ve been working so hard this past year to get the appropriate testing of my GI tract, do the hail mary treatments and line up willing surgeons for the operation that is undoubtedly needed, but… a decade into this shite, I am finally at that stage where doctors look at my records and show me the door.

One doctor said right off the bat: “Do you know what scares surgeons the most? EDS [Ehlers-Danlos Syndrome]. Do you know what scares us the second most? MCAS [Mast Cell Activation Syndrome].” She sent me on my way, unwilling to even discuss what was happening anatomically.

I had another surgeon walk into the exam room and, without any greeting whatsoever and without even looking at me, she said, “Well, you certainly are obsessed with your bowels, aren’t you?” Immediately after that, she asked for the name of my therapist. There was more and worse derogatory interactions with her, but I’d like to not get riled up tonight. My great therapist said, “You encountered one of life’s assholes, this one just happened to be a doctor.”

I’ve decided any surgeon who is a) compassionate and b) willing to help people with connective tissue disorders and idiopathic anaphylactic reactions is a bloody hero. I had no idea I would become a medical pariah. 

There was a time when I was trying to fix my immune deficiency, my hypotension, my hypothyroidism, my chronic migraines, flu-like symptoms, reactivity etc… It’s all still there and I’d give anything to “just” be dealing with those. I’d have some semblance of life; I’d not be in crisis every day. Sick, yes, but not crisis. I was once chronically, predictably, stably ill and it feels a bit perverse to long for that life again.

Five years ago, I started to have intermittent pelvic floor spasms. Some were very obviously bowel spasms and some were the muscles/ligaments of the entire pelvic floor. The latter were more severe and often triggered a vasovagal collapse where my blood pressure and heart rate would plummet and my husband would call the paramedics. I stopped a lot of things to try to control these. I stopped having periods, I stopped taking stimulant laxatives, I stopped holding my pee, I stopped eating “FODMAP” foods that can generate gas, I stopped having sex.

A year ago, the spasms started to escalate. I had one single episode in January, 2022 and, this week, I have had at least one a day, six days in a row. They are SEVERE. I never use that word lightly. They are agony and I never know how long they will last and whether they will trigger a cascade into hemodynamic instability or loss of consciousness. 

screenshot of my calendar this week

The spasms usually start in the mornings when I stand up (or sometimes just sit up in bed) and my intestines drop towards the ground, along with my bladder and uterus (which have also fallen from their normal positions). The weight and pressure this causes on my pelvic floor kicks off a spasm and it is greatly exacerbated by stool or gas in my colon, so eating anything has become scary. Terrifying, actually. Even drinking causes problems — I recently realised that my electrolyte water (TriOral rehydration solution), which I’ve been drinking day and night for two years, was causing a lot of gas production.

Gas causes more issues than anything because it gets trapped in the folds and herniations and the pressure increases to unbearable levels. The pain is blinding. And by “gas,” I really mean air because there is absolutely no smell at all. It is as if someone inserted a hose into my transverse colon and pumped it up. I’ve been eating a very limited diet for years – there really is nothing more I can cut out to try to manage gas production. It’s there even if I fast and it’s made worse by the medications I have to take for constipation like Miralax, Linzess and magnesium oxide. It’s there because I probably have SIBO, too (small intestinal bacterial overgrowth — I’ve treated it many times, but I’m not sure if it’s worked).

My small bowel is “lying on the bottom of your pelvic floor, like a hose curled in the bottom of a bucket,” one surgeon told me. “Nothing is connected to the sacrum anymore — you have complete internal rectal prolapse with intussusception of the rectosigmoid.” He drew a picture of this “intussusception” – the intestine looks like a sleeve telescoping into itself when you pull your arm out. 

My umbrella diagnosis is visceroptosis – abdominal organs falling and prolapsing out of their normal positions – but there are different names depending on which organ has the issue. The ones I have are:

Enterocele: where the small intestine falls between the vaginal wall and rectum (which should be fused, but, in my case, are separated).

Sigmoidocele: essentially the same as an enterocele, only the sigmoid colon has dropped.

Rectocele: the rectum herniates forward and into the vaginal wall.

Cystocele: bladder falls. 

Uterine prolapse: uterus falls.

Perineal descent: perineum bulges downward. 

Intussusception: telescoping intestine. 

The two most profound issues I have on the MRIs are the enterocele and rectocele, above. So, as you can imagine, with both of those bagged-out intestines holding onto poop and gas, prolapsed into the same low-down space, as well as my uterus and bladder sagging, it is an unbelievable amount of pressure on my pelvic floor. The only thing that has helped marginally is lying on an adjustable bed with my head as low as possible and my legs elevated, which allows gravity to shift my intestines back towards my chest. I do this over and over throughout the day to reverse the downward pull – after standing in the kitchen, after sitting at the table or on the toilet. But it doesn’t last long and just moves the pressure under my diaphragm.

Recently, though, things have escalated. Cramps wake me up all night long and, during the day, I can hardly be upright without my pelvic floor going into a spasm. I quickly get on the floor, put cushions under my bum and moan, pant, cry, try to focus all of my attention on relaxing those muscles and easing the weight on the ligaments, while begging the universe to make it stop and vowing to never let anything pass my lips again. I’m hungry all the time.

I can’t keep doing this every day. I don’t want surgery, but I can’t avoid it. I don’t want mesh implanted in my abdomen (my immunologist says absolutely no mesh in someone with a mast cell disease), but I’m told the only other option is a colostomy bag. I’m told whatever I do will probably fail (even the bag) because I will still have slow-transit constipation and shitty connective tissue. I’m told that the spasms might not stop. That thought is very overwhelming. The spasms are more life-altering that anything else. What would the future look like trying to avoid them? Pooping into a bag, but nil by mouth? IV hydration and parenteral nutrition? I need doctors to think outside the box about how to stop the symptom escalation. Botox? Prolotherapy? Nerve stimulators? Nerve blocks? Am I going to have to live mostly on my back to stop my organs from falling?

There are Facebook support groups for everything you can think of, but not for visceroptosis caused by EDS. I’ve met two people in a similar boat. (One of them shared photos of herself in the morning and at night showing how her displaced intestines caused her abdomen to balloon out over the course of the day. I did the same thing yesterday and it is striking, but, although I share everything about myself here, I’m not sure I want to post photos of myself in my knickers. Sorry to disappoint.)

There are no doctors who really understand this particular problem and there is an incredible paucity of studies. A prolapse specialist said to me: “I wouldn’t refer you to any of the colorectal surgeons I know. They really only do routine tumor excisions or coloectomies for things like bowel cancer.”

Oh. I see. What an education I’m getting! Silly me thought that any colorectal surgeon could fix this. My problems are “higher up,” not a “simple” rectocele repair. My issues are from connective tissue laxity, not from pregnancy trauma. Not only do most colorectal surgeons not have the expertise and experience, most wouldn’t take me on, anyway, because they and their hospitals like success – they don’t want to take chances on patients with high rates of complications and surgical failures. These are uncharted waters.

My only plan of action right now is:

  • continue doing everything I can to get calories in and out.
  • keep trying and retrying bowel medications.
  • continue pelvic floor physical therapy (which feels useless – breathing exercises, bowel massages, visualisation).
  • get a “small bowel follow through” study (which is proving to be complicated – shocker! – because they don’t usually do upright x-rays and they don’t have any barium drinks that look okay for me to ingest).
  • get a mesenteric CT angiogram (which I’ve been putting off for a few years because I had a small reaction to the IV contrast last time and I’m nervous it’ll be a bigger reaction this time).
  • talk to my surgeon about a stoma (for a colostomy bag) since he won’t entertain the notion of a repair surgery without mesh.
  • trial a fentanyl patch in-office with my immunologist and then other medications to develop a post-op painkiller plan (how on earth do I get the nerve to do this??).
  • do I continue looking for other surgeons who have experience with these more complicated, “higher up” repairs and who won’t use mesh?? It’s exhausting and I really don’t think that doctor exists.

But none of that feels possible when I’m so depleted. My husband had a total knee replacement surgery a few weeks ago and the extra walking, driving and chores I was doing made it very evident that my tethered spinal cord is a major player, even though I don’t want to face it. When I’m pushed outside of my energy envelope and normal step count, I have great difficulty walking. I’m hoping now that he has turned a corner with his recovery, I’ll be able to gain some ground and see a clearer path forward.

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Bowel Answers Finally

I finally had most of the colon testing done that I needed and I think I will put off or ignore the other proposed GI tests because I have one big anatomical* problem that is at the root of all of my bowel troubles and it needs surgical intervention.

*My surgeon always says ‘anatomic,’ but the internet tells me there’s no difference between anatomical and anatomic, so I’m sticking with the former (unless I need to write about ‘an anatomic bomb’ because that just sounds cooler). 

This week, I had four back-to-back appointments at the hospital and – for anyone in my area – every aspect of this visit to Virginia Mason was so much better than the last decade of overall experiences at Swedish or the University of Washington. Everything was streamlined and on time (even when I was late to my first appointment–total calm kindness greeted me); every clinic was in the same building; everyone I asked to wear an N95 did so with no issues; nobody read my lengthy records and insinuated anything negative or dismissed me for being too complicated or too young; everyone knew what Ehlers-Danlos was and they weren’t scared of it; and, most importantly, everyone was kind and didn’t rush me and answered all my questions. 

I had a barium fluoroscopic defecography, an anorectal manometry and internal exams plus consults with both the colorectal and urogynaecological surgeons, separately. 

The results from these appointments, along with the info gathered from my own daily hellish routine and other testing from this past year (colonoscopy, MRI defecography, abdominal CT, two mesenteric vascular duplex ultrasounds (one with breathing protocols), Genova Diagnostics stool test, urodynamic (bladder) testing, pessary trial, splinting trial, pelvic floor physical therapy, exams by a prolapse specialist and another colorectal surgeon, diet changes) have finally given us a very good idea of what is happening. And–shocker!–fiber, papaya and probiotics aren’t the answers to my problems. Neither are Miralax, Linzess, Motegrity and all the other medications that have been thrown at me (although, I’ll have to continue to use them for life). 

In the interest of transparency, education and destigmatization, I’d like to tell you exactly what I go through every day in order to defecate, but I’m going to save that for another time (you’re welcome). Instead, I’m going to tell you exactly what is happening to me anatomically because everyone has an asshole, so this shouldn’t be taboo.

My big, bad problem is an enterocele. An enterocele is a prolapse or hernia of the small intestine. The back of the vaginal wall and the front of the rectal wall should be fused, but mine have separated and my intestines–probably the small bowel, but it’s not quite clear which part–have dropped into that space, obstructing defecation. I also have a severe rectocele and less important sigmoidocele, cystocele and uterine prolapse. Everything is collapsing and falling. I also have intussusception of the rectum, which means it is telescoping into itself when I bear down. If you google this, it says it is very rare and life-threatening, but mine is happening every day, whenever I have a bowel movement and, so far, hasn’t caused a complete blockage and hasn’t telescoped itself outside my body. However, that is the normal course of things – it is probable that one day my small bowel will fall out of my anus and that will be a surgical emergency. Or my uterus or bladder might fall out of my vagina. These things have been happening to women forever and no one talks about it. Thank dog for online support groups – I can’t hate facebook when it has connected me to others going through this craziness.

Prolapses, both internal and external, are almost always caused by childbirth – usually in women who have had multiple pregnancies. Mine is caused by the poop babies I’ve carried around my whole life (chronic constipation) coupled with Ehlers-Danlos Syndrome (EDS), a disorder which affects the integrity and strength of the connective tissue throughout the body. In other words, the walls of my intestines aren’t strong, so they herniated under the pressure of poop. My pelvic muscles are affected, too, and have become lax and atrophied, so they’re not holding anything up and in place. 

I have found all of my testing incredibly fascinating (although, brutal because of the way my body pays me back for any intervention). The other day, I got to watch the barium defecography on the screen–I got to see how my anatomy moved as I pooped and ask the radiologist questions in real time. There was a huge pouch of barium mash (they literally squirt instant mashed potatoes up your bum) that descended anteriorly across the base of my pelvic floor when I bore down. I asked if it was my rectum and the doctor said no, it wasn’t meant to be there at all – that was the rectocele (or maybe enterocele–I need to get the imaging disc and look more closely). I couldn’t believe it – I wish I’d had the foresight to take a photo. It was upright and vertical and, when I pushed, it just splooged forward into a horizontal cavity that shouldn’t be there. By “it” I mean my intestine, which was outlined by the barium.

I told the tech that if she ever had another nervous patient (I had never had barium before and didn’t know if my body would react to it), tell them they get to watch the x-rays and talk to the radiologist as the test is performed. I would have been sprinting into the exam room, if I had known that!

The surgeon said this is not a functional problem with digestion and motility and there was no point in doing a Sitz Marker Study (or Smart Pill) because it would give false information. It measures how long it takes for markers to move through your GI tract, but they wouldn’t move due to the enterocele and rectocele clogging up the pass, rather than a problem with the migrating motor complex.

He said an upper barium study and/or endoscopy (my GI doctor wanted both) might be warranted if I had reflux or problems with swallowing, but I don’t. I was diagnosed with “gastroparesis” (food won’t leave my stomach), but it’s only a problem when my bowels are backed up. He thought I might have a hiatal hernia because they often go along with pelvic prolapses, but since the symptoms aren’t bad, he’s not concerned.

The other tests that I found fascinating and informative were:

  • The anorectal manometry was mostly normal: No evidence of nerve damage or Hirschsprung’s disease. No dyssynergia, meaning the muscles work as they should and in the correct order (rectum contracts first and then the anus relaxes). No pain, pressures were normal and sensations were okay-ish. The two abnormal findings were my anal sphincter is tight (cue the tightass jokes) and it took quite a high volume (a balloon being inflated inside my rectum) for me to have the urge to defecate. This could be because I’ve become desensitized from daily large-volume enemas for so many years or it could be because the rectocele creates more space in that area for the balloon to expand into. 
  • The abdominal CT, which showed an “enormous bladder,” four times the size it should be, and a distended sigmoid colon that was “pushed up the wazoo” (quotes by my neurosurgeon, Bolo, which his other patients will appreciate). 
  • The stool test, which I assumed would show dysbiosis, infections and metabolic imbalances, but it didn’t. It was pretty okay. 
  • The Duplex ultrasound that showed my duodenum was being compressed, which could explain the pain in a certain high-up place after I eat.
  • The colonoscopy, which showed the inside of my large bowel is lovely, with no issues. I’ve had constipation my whole life, my mother and aunt have diverticulosis and my grandmother had bowel cancer, so I assumed I’d have something wrong, but she didn’t even find a polyp. Even more interesting to me was that my cleanout in preparation for the colonoscopy was easy. I didn’t even need the second prep. I assumed I had loads of backed up stool. I thought I’d be one of those horror stories: It was found during the autopsy that she had 10 pounds of fermenting meat in her gut!

The main issue found during the colonoscopy was that it was difficult to get the scope around the bends in my colon, even using a pediatric scope, which means it is difficult for poop to get around the bends, too. My GI doctor said things were tweaked and compressed within my abdominal cavity because I am such a small person and it’s further complicated by not having a lot of fat around my organs – my colon bends at acute angles rather than soft curves because there isn’t enough fat to act as a buffer to smooth out the turns.

This is exactly how it feels, subjectively, when I’m sitting on the loo. I know I said I’d spare you this part, but one of the things I have to do is squeeze my intestines with my hands like a toothpaste tube. I have to physically push stool around those sharp angles with my fingers. 

The lack of organ fat contributes to the issue they saw on the ultrasound, too. My duodenum is compressed in between vasculature (the aorta and the superior mesenteric artery*) and the first-line treatment is to gain weight to try to bulk up the mesenteric fat pad, which will help separate the arteries enough that food can pass freely through the duodenum. 

*This is called Superior Mesenteric Artery Syndrome (SMAS), which can be very serious and life-threatening when it lets nothing pass (mine isn’t, thankfully, and we’re not even sure if the measurement was accurate, so this may not be my diagnosis). It can occur with other abdominal compression conditions, such as Median Arcuate Ligament Syndrome, Nutcracker Syndrome or May Thurner Syndrome, and seems to be more prevalent in people with EDS, mast cell disease and dysautonomia.

I didn’t believe my EDS diagnosis for years. I’m not the typical bendy person who did body-contortion party tricks as a kid and suffered subluxations my whole life. After being schooled by numerous doctors, I now believe this might be the root of all of my issues. My rheumatologist showed me what my joints aren’t meant to do, my physical therapist told me I had the most hypermobile neck she’d ever worked on, my neurosurgeon explained how a tethered spinal cord, which happens more often with connective tissue disorders, is damaging nerves and pulling my brainstem down, blocking the normal flow of cerebral spinal fluid. And, the other day in the hospital, every doctor I spoke with said, yes, the reason for all of my poop woes (and digestive, bladder and uterine woes) is shitty connective tissue that has weakened the walls of everything: fascia, vasculature, intestines. 

The bad news is these conditions will only get worse and the only thing that will help is major surgery. The colorectal and urogynecological surgeons perform the operation together to fix the prolapses, lift everything back where it should be, suture organs to the tailbone and add mesh, so your body creates scar tissue to strengthen the vaginal and rectal walls.

The really bad news is that I can’t risk mesh. Not just because of the scary outcomes you hear about in “normal” people (those mesh class action lawsuits advertised on TV), but because my immunologist warned unequivocally that with mast cell activation, my body would react to and reject the mesh, causing complications. Not to mention the much higher probability of surgical failure because of EDS – my tissues would probably just sag and drop again, sutures would fall out. I’d have to be careful with coughing, sneezing, bearing down, lifting even a light amount of weight for evermore and there would be repeated repair surgeries. I can’t imagine a life where I don’t bear down. I even have to push to pee lots of the time.

And it’s not like I would miraculously be able to have normal, formed stools and easy bowel movements. I will still be taking daily medications, I will still have the acute intestinal angles and will I be able to toothpaste tube-squeeze my guts after surgery or will that be too risky? It’s a scary proposition.

The colorectal surgeon said, without mesh, it would be a “placebo surgery.” He said there was absolutely no point. I asked about the ACE surgery that allows you to flush water from a stoma created by your appendix – kind of like an enema from above – and he said it wouldn’t help because the enterocele would still be there.

I asked about a sacral nerve stimulator and he said they are usually used for nerve damage that causes incontinence issues, which I don’t have. He said the only real alternative to a mesh repair is a colectomy (with a colostomy bag). He said he wouldn’t do an ileostomy, but I can’t remember why. My immunologist suggested the same thing – go straight for the ostomy.

Mind you, removing my colon and getting a bag — even if I had a perfect surgical experience and recovery — won’t make all of my problems go away. There might still be complications with the mesh they put around the stoma to try to reduce the likelihood of a parastomal hernia (which is quite common). And I would probably have issues with scar tissue and reactions to the adhesive coverings and deodorant smells and bag emptying (which involves body positions that my spine doesn’t like to do), and your rectum still generates mucus after you get a stoma and there is leakage, both rectal and around the bag etc etc… It can still involve hours in the loo and pain and regular medical interventions. It is definitely not a cure-all or an easy road. You can’t believe the difficulties until you read patient stories. Some people’s quality of life is drastically improved – they can travel and exercise again, for example – but, of course, this wouldn’t be my case because ME/cfs is still very much the specter that keeps me mostly housebound. 

So, how long can I limp along like this and when will I have to get surgery? My doctor said, one day my small intestine will probably prolapse out of my body and I will have no choice. It could be in 7 days or 7 years, he couldn’t predict. And my daily interventions will eventually not work – more medications, more enemas with larger volumes of water, more pain, more dietary restrictions.

My quality of life from this one issue is very compromised, though my fear of surgery overrides this. I think I could probably manage to continue with my current routine for years if it weren’t for one thing: The vasovagal collapses. 

Those who know me know that these have been happening for 20 years. They started with dysmenorrhea (period pain would trigger prolonged blood pressure drops and my body would go into a sort of shock), then they started happening with bowel pain. I controlled these (or tried to) by taking nightly progesterone, so I never menstruate, and not taking any laxatives that cause cramping, like Senna or Dulcolax.

Then they started happening with pelvic floor spasms – once while using a vibrating device on my lower abdomen to try to stimulate stool/gas movement and twice from orgasms. I can stop doing those things, too (not happily), but, recently, my pelvic muscles go into spasm for no reason other than gravity dragging them down or pressure building up in my colon.

It’s not the spasms that are the problem – I can handle quite a bit of pain – it’s the subsequent collapses. They aren’t “faints” – I don’t recover by lying down and getting oxygen to my brain. In fact, they often start in the morning, after I’ve been lying down all night. My husband describes them as “catastrophic system failures.” Pale pallor, cold sweat, breathing difficulty, tunneled vision, unable to speak, bradycardia, prolonged hypotension, sometimes loss of consciousness, and often a call to 911. When an abdominal spasm occurs, if it goes on long enough and is painful enough, I will feel my body start to shake and then all the other symptoms encroach. I usually call my husband and have him on the phone until we know whether it will stop or if I will fall off the edge and need medical intervention (paramedics can’t do much besides make sure I recover, check my heart, give me IV fluids). 

I’m trying to describe this clearly, without hyperbole, but these episodes are terrifying. They are unpredictable and it feels like I’m going to die because I’m so weak and my blood pressure is so low and I can’t get a breath and everything is fading out… My specialist says it feels that way because, physiologically, it is the closest I come to death. Yikes.

Point being, if I thought these collapses could be curtailed by excising my colon, then I would be much more eager for the surgery. But nobody has ever heard of this issue. Is it vagus nerve damage? Part of dysautonomia? To do with spinal cord and brain stem? These episodes are still more frequent with hormonal fluctuations, so I’m praying that after menopause they will get better.

Maybe that’s my decision. Maybe I can hold out until after menopause – hope my organs stay inside my body and don’t rupture, hope I can keep getting food in and out with all of my exhausting interventions – and see what gets better and what gets worse after menstruation isn’t playing a part. Maybe then I’ll be able to stop taking progesterone, which might help the overall picture because it can cause constipation (in some people I’ve talked to, it paralyses the gut or stops motility entirely). I’m currently not willing to come off it and risk the angry mast cells that come with periods.

I held out a smidgen of hope that having my tethered spinal cord fixed would also solve my bowel problems and everything would get better, but it looks like there’s no getting out of this one and I have to face multiple future surgeries. Time to find some safe painkillers that don’t cause reactions! 

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Damn Your Eyes

A note about my eye exam today:

I need to update my blog more often — for myself, more than anyone else. This morning, I had my first eye exam in 7 years and I looked back here to see if I’d said anything about the last time and saw I’d had a reaction to the yellow eye drops. I had no memory of this and it saved me from possibly having another reaction today for a not-really-needed test. So, I’m going to make a note about today’s experience to remind myself in the future not to bother going to an ophthalmologist again!

My vision was 20/15 the last time I had my eyes checked. I never needed glasses at all until July of 2020, when I realised I couldn’t see my vein very well when putting in a peripheral IV catheter to do IVIG. Since then–not even 2 years–I’ve gone up 3 magnification strengths and my right eye has significantly worse vision than the left. My distance vision is a little worse, too, which I realised when my husband (who is 12 years older than I am) could make out signs on the highway that I couldn’t.

July, 2020: The first day of the rest of my farsighted life: I had to borrow my husband’s glasses to put in my IV.

Of course, this is totally normal for people my age, but my brother started to need glasses after spending time on a submarine and had a theory that it was because he didn’t focus on anything more than about 8 feet away for so many months. I think this might hold some truth for those of us who spend so little time outside, looking at horizons and focusing on long distances.

I have a ton of eye symptoms, which bother me much more than the need for readers, but I’ve been told there is no remedy for any of it (except dry eyes). I was told in the past: “When your overall health is poor, your eye health is poor, too.” The ophthalmologist today actually said that my eye health was good, but my symptoms are probably neurological (migraines, dysautonomia etc).

Some of my eye symptoms are: floaters; blurriness; pain in orbital muscles when moving my eyes; itchy eyelashes; dry eye to the point that when I blink in the mornings, my tears feel like acid hitting my eyeballs; right eyelid spasms; light sensitivity; trouble tracking when scrolling on my phone or reading blocks of text; migraines that feel like my right eye is going to explode out of its socket (it’s silly, but I often push my eye back in with the palm of my hand because it really feels like it might pop out). I used to say that my eyes felt like I’d put grit into Vaseline and then smeared it over my eyes.

I have had radioiodine ablation on my thyroid for Graves disease (or some sort of autoimmune presentation of hyperthyroidism–endocrinologists have disagreed on whether it’s actually Graves) and was told to pay attention to eye symptoms, but the doctor today didn’t see any evidence of that being a problem. I am also positive for one of the Sjogren’s markers (carbonic anhydrase VI IgG antibodies), which ophthalmologists treat no differently than dry eye. He rattled off a bunch of things that I’ve tried in the past that have done nothing (eye drops, eye scrubs) and some I haven’t (take omega 3s, humidifier in bedroom).

He said my optic nerves, blood vessels, maculae etc were all normal. During the visual acuity test, none of the letters were sharp, but I could guess most, even though they were blurry. The doctor said my vision was considered 20/20 because I could guess 3 out of 5 of the bottom line, adding he wouldn’t be able to see any of them at all. This is the thing when you’ve had great vision your whole life–you don’t really know what is “normal” or acceptable.” I hate not being able to see the letters clearly, but being able to guess them at all, even though I was straining and it was very blurry, is still considered 20/20.

They said I am doing no damage to my eyes using the cheapo 3-pack of Costco reading glasses. It doesn’t matter what strength I use or whether I use different magnifications (I have various glasses scattered in different rooms) or whether I’m using the lenses that work for one eye, but not the other. Essentially, if you can move the phone/book closer or further away and make it work, then everything’s fine. They said I could get prescription glasses, but, if I’m getting by, there is no need. I don’t want any more energy expenditure on anything, so I’m sticking with what I’m doing. My husband was mildly alarmed by this: But if you can get prescription glasses that correct for the differences in your eyes and it makes your life better, why not? Energy is why not. It all comes down to having nothing extra to give.

For anyone with MCAS, I have had the yellow eye drops 3 times and, the last time, I had a reaction. A friend told me I could ask for a retinal scan in lieu of dilation, which I did and it was easy and only took a few minutes. Once in the past, I was told that one of my eyes had high pressure (intraocular fluid pressure) and this can be a warning for glaucoma and I should keep an eye on it (I just caught that totally unintended pun when I did a reread 🙂 ). The gold standard for checking eye pressure is the use of yellow numbing eye drops, which are used with a slit lamp and blue light. A step down from that is a handheld tonometer, which still needs numbing drops, but they don’t have the yellow dye. Lastly, there is a device called an Icare, which doesn’t need drops at all. The latter would have been my preference since I don’t know what caused the previous reaction (the dye, the numbing medication or the preservatives), but they didn’t have one at the location where I had my appointment today, so I decided to skip the pressure check, thinking/hoping I probably don’t have a problem.

Lastly, I want to note that this was BY FAR the most risky covid exposure I’ve had (or, really, just human germ exposure, in general). The rooms are tiny with no windows or ventilation and the doctor and his assistant both had to get very close to my face. Also, they cancelled my appointment last week because the ophthalmologist was out sick and I wonder — out sick with what? Even a head cold would be a deal-breaker for me. All in all, I regret the appointment because the risk of contracting a virus was very much outweighed by the chances that I have eye problems that can be remedied (I now know). But I didn’t know what was normal or should be treated and I certainly would want to know if intracranial hyper/hypotension was causing any eye damage (as seen on a CINE MRI, I have blocked cerebral spinal fluid flow in my brain because of low-lying cerebellar tonsils, which can cause intracranial pressure issues). I didn’t know if wearing shitty readers could damage my eyesight further (they can’t) and I didn’t know if having worse vision in one eye was a concern (it’s not) and I didn’t know if I could brush off all of my eye symptoms as neurological (I can). Now I know and you do, too. 🙂 Title Credit

by

Many symptoms. Many tests.

I’m going to start with the last things first:

In the next month, I am having a colonoscopy under anesthesia, a fluoroscopic barium defecography, an anorectal manometry, an ACTH (Cortrosyn) stimulation test, a transvaginal ultrasound, a thoracic MRI, skin prick allergy testing, a teeth cleaning and exam, an eye exam, and two blood draws. As well as trying to do IVIG every week and regular online doctors’ appointments.

What I really want to do is cancel everything, drive to the desert and live in peace.

The one thing I know for sure is that the more I rock this body’s boat, the worse things get, so I usually freeze and do nothing. But, lately, there seems to be a new mini-crisis most days, even though I took a long break from everything during the Omicron spike. It was lovely and peaceful for a while, but my body has been scaring me this month.

One day last week, my legs started to shake and then just buckled with no warning and I couldn’t walk. I had been moving a side table, so I guess I injured something, but I didn’t feel an injury, I just suddenly couldn’t walk and it is always in the back of my mind that I have a tethered spinal cord and leg/gait issues may get worse (many symptoms — like nerve pain — that could be attributed to tethered cord have gotten better, so I’m not convinced that “detethering” surgery is the answer for me).

Over the following days, unusual deep pain traveled from my buttocks to the back of my thighs to my left calf and then disappeared. During that time, I became desperate for a house with no stairs. I bought a bedside commode. I gave up a foster dog with whom I’d already fallen in love. Losing the limited mobility I have is terrifying. My husband would have to manage so much more and my quality of life would quickly plummet considering the energy it takes to keep my intestines working and food moving through. Not to mention losing dog joy, which is almost all joy in my world.

This week has been awful whack-a-crisis every day. Over the weekend, I was hit with terrible vertigo. This is one of the most sickening feelings — like your eyes are tumbling around in their orbits and you have to keep very, very still to stop from groaning outloud. It got mostly better the next day, but I still feel like I’m walking on a ship.

Monday, I had a pelvic spasm or bowel cramp so painful, I thought it was going to trigger a vasovagal collapse because I started to tremble and got weak and breathless.

Tuesday, I spent the day on the dog bed in front of the fireplace in a 76 degree room, shaking, chilled to the bone, with blood pressure all over the place, trying not to black out. I thought I’d left these episodes behind.

Yesterday, I developed an extremely bad right-sided migraine, which woke me out of sleep, panting from the pain and dreaming of IV narcotics — which I’m allergic to, but the pain was bad enough that I thought it wouldn’t matter if I stopped breathing, I’d let them inject anything to take the pain away.

So — it’s like that. In 14 days, I’ve gone on 3 scooter walks with Penny and I’m going out of my mind, desperate to get my slow, predictable days back.

In the midst of all this, I tried to continue weekly IVIG, which is undoubtedly the cause of some of this. I don’t know why it has turned on me and I don’t have words to describe the despair if I lose the one treatment that has helped me so profoundly.

I also saw another pelvic floor surgeon who was so rough while fitting me with a pessary, that I cried out involuntarily in her office. Her exam wasn’t even that bad in the grand scheme of things, but I was mute on the drive home, feeling traumatized by the brusque anal/vaginal invasiveness of it all. I only managed to keep that torture device inside me for 3 days because it made urinating very difficult. $100 down the drain and the only reason I was able to remove it was because I joined a FB pessary support group to get tips. Thank dog for other patients!

My biggest fear at the moment is the looming colonoscopy. I’ve been rescheduling it for 7 years. Before covid, I was cancelling out of fear — feeling the information gleaned from this test was outweighed by the risks. Just in the last 2 years, I’ve cancelled 8 times. They were legitimate reasons — covid spikes and my body being too unstable — but my GI doctor is frustrated and I still don’t feel confident that this is the right decision, even though it’s now 4 days away. My blood pressure is chronically low. I can’t get it to budge above around 85/55 — often lower. I wanted to try Fludrocortisone (a corticosteroid that can boost blood volume by increasing sodium in the body) before doing this procedure, but it takes me an excruciatingly long time to first get the nerve to try new medications, then to find a good day when I feel stable enough and then it takes weeks of eating little slivers to work up to a meaningful dose. It didn’t happen, along with dozens of other meds in my cupboard, waiting to be opened.

I was going to give myself IV fluids at home during the colonoscopy clean-out (I do my own peripheral IVs), but, in the last year, I’ve been having scary episodes and just this week realised they might be from IV saline. My vision starts to darken, like I’m going to black out, I get very cold and shake badly, my blood pressure spikes — this can go on for hours. It’s always the day after IVIG, so I stopped my infusions for 3 months, but then it happened when I did IV fluids without IVIG. I thought it must be the saline coupled with Midodrine, the low blood pressure medication I was on, so I stopped taking Midodrine and for 6 weeks, I was sure that was the answer. Until this week when it happened again.

My blood pressure has been dropping very low during IVIG, so, on top of the liter of IV saline, I’ve been drinking around 3 liters of salt/electrolyte water on infusion days (and eating a ton of salty snacks). It didn’t help boost my BP during the infusion, but I had another one of those episodes the day after. It almost feels like volume overload because my eyes get swollen, my BP spikes and I feel breathless, but my “high” blood pressure is still low by other people’s standards. During this episode the other day it was spiking to 107/74. How do you explain to a doctor that you’re in a “hypertensive” crisis when your BP is still lower than normal?

So, I’m about to start a dehydrating colon cleanout when I’m already weak from chronic hypotension, hemodynamically unstable, battling presyncope, having pelvic floor spasms and bowel pain, prone to hypoglycemia, my heart is tripping all over the place, and my brain feels like it’s going to explode out of my right eye. If I get through the prep without having to call the paramedics, I’m then meant to volunteer to let a stranger inject powerful sedatives and painkillers into my vein and hope that I don’t go into anaphylaxis or have my vitals bottom out. Or catch covid, for that matter, since vaccination is too risky, yet I have a primary immune deficiency, which feels like the worst combination during a pandemic.

Being released from the hospital and coming home almost feels the most reckless because all hell breaks loose in my body AFTER the fact. It’s in the middle of the night or the day after that the adrenaline wears off and the real problems start. I wish they’d admit me afterwards for observation, honestly, but it would be ludicrous to even ask. These are routine procedures that everyone gets done, after all.

But it doesn’t feel worth it. It feels dangerous. Which is part of why I’m writing this, I guess. I got out my advanced directive and durable POA. FFS.

We also found out this week that my healthy rock of a husband has a brain aneurysm and will need surgery. Surprise! That’s a story for a different time. But, really, forget all of my stuff. If anyone out there is going to send good thoughts/juju/prayers this way, please send them directly at my husband’s brain.

by

In Amber

A DECADE

A decade since I felt well.

A decade since my body and health were not on my mind. 

A decade since my last cold, flu or bronchitis.

A decade since my last vaccination.

A decade since I enjoyed Halloween, my favourite holiday.

A decade since I was in a lake or ocean.

A decade since I was on a train.

A decade since I stood up at a concert.

A decade since I didn’t wear a mask on a plane.

A decade since I went to a wedding.

A decade since I went to a barbecue.

A decade since seeing so many friends.

A decade since I married my longtime boyfriend because “I feel like something is going to happen to me and I want you to be able to legally speak for me, if I can’t speak for myself.”

A decade since I was in Ireland, in my childhood home, walking the streets of my heart.

I thought about this anniversary so many times in the past. For a long time, I thought there was no way it would come–I couldn’t possibly stay sick this long. Every other illness had a beginning and an end, so, surely, one day my body would recover and this spectre would leave, it was just taking a little longer than the usual virus.

Once I realised it was lifelong, I thought the 10-year mark would be a momentous and heavy occasion. It turns out, it’s not. 2 years seemed much harder to accept. Back when isolation was still harrowing and loneliness still suffocated. You get used to both. It helps if you can develop a deep disdain for humans, so you can trick yourself into believing you’re not missing out on anything. And the 5-year mark was hard. I’d felt small, but miraculous changes from IVIG and then had an epic autumn backslide that year. The dowsing of that little flame of hope was devastating and it was inconceivable that I would be physically or mentally resilient enough to continue the maybe-I’m-getting-better!-Oh-no-what-fresh-hell-is-this? cycle for years to come.

But, then, suddenly, 10 years have passed. I could almost believe the rest of the world is trapped in amber, frozen in time, awaiting my return. As soon as I kick this thing, I’ll drive back down to the office–each street scene melting and returning into motion as my car passes by–and get back to work. Thanks for waiting, guys.

INFECTIONS

What’s far more unbelievable to me is that I haven’t had a muggle illness in a decade. [Please don’t let this jinx me.] No head cold, no flu, no stomach bug, no chest/ear/sinus/bladder/any-other-part-of-the-body infection. The more time that went by, the more ominous was the thought of contracting an acute virus. For years, I had relentless flu-y symptoms–headaches, sore throats, muscle pain, weakness, chills (and still do, sporadically)–and I have many high out-of-range infection titers*, so the thought of another malady compounding the daily slog was harrowing.

*HHV6 IgG; HSV IgM; EBV IgG; M Pneumoniae IgG; S. Cerevisiae IgG; Varicella IgG and IgM; Coxsackie A7, A9, A16, A24, B1, B2, B5 and B6; Anti Streptolysin O Titer, and Candida IgM and IgA. Yes, really.

Three years into my illness, Dr. Chia told us unequivocally that a run-of-the-mill cold could make me permanently worse, so we have always taken great precautions to avoid exposure, which have only intensified during this pandemic. I honestly wonder if I’ll ever be indoors and maskless with anyone besides my husband again. Even worse, will my husband ever be indoors and maskless with anyone besides me? It’s one thing to choose this life for myself–I’ve made peace with only having remote communication with friends and family; I have a partner and a dog to keep me sane–but my healthy husband’s life has shriveled to keep me safe and the guilt from that is indescribable. I imagine if he weren’t yoked to someone at such risk for serious complications from viruses, he might be out gallivanting and socialising, as well he should be.

VACCINES

One of the first doctors I saw after falling ill said, “You are very sick. We don’t know what’s wrong with you, but you should never get another vaccination as long as you live.” I was confused because, until that moment, I hadn’t linked whatever this sickness was to the flu shot I’d gotten a week before Halloween. I was also confused because, in my healthy ignorance, I thought vaccines only bolstered your immune system. I really didn’t understand, in certain unique circumstances, that they could break it. I used to get every immunization available in an effort to protect myself.

Before I traveled to Central America, I was vaccinated for polio, live typhoid, hepatitis A and B, tetanus, diphtheria and gammastan–all on the same day. In the years after, I got the live varicella vaccine, the 3-shot hepatitis B series, measles, mumps, and rubella and, of course, the flu shot every year, along with a pandemic flu vaccine (H1N1) when they were offered. I didn’t get majorly sick while traveling, I didn’t get chicken pox when I tended to my horrifically poxy husband and I never got the flu despite working very long hours in restaurants, among infectious people (note to the public: restaurant staff work when they’re sick; you have to be on death’s door to ask someone to cover a shift), so I guess the vaccines helped… until they harmed.

COVID

There’s such polarization these days when it comes to covid vaccines. There’s a lot of hatred directed at those who are trying to protect themselves and others by getting vaccinated and wearing masks and there is an equal amount of contempt directed at anti-vaxers. I have yet to see a single news story talk about those of us who want to get vaccinated, but cannot. Or those of us who have to make the agonizing decision to live a life of extreme isolation or risk very serious repercussions from a vaccine–any vaccine. I wish individuals would always take the collective into consideration and try to protect those that are vulnerable, but that’s not human nature, unfortunately. People will refuse vaccinations or not wear masks or not get tested because they don’t want to quarantine. And, all the while, those of us with weakened, damaged or overactive immune systems–be it from chemo or old age or autoimmunity or ME/cfs or steroids or stress or another condition–will have to choose seclusion over risk.

Against one of my doctor’s advice, I will be getting the first covid vaccine next month–but I’m getting a pediatric dose. We will see how I do and then I’ll get a second dose and test antibodies. They will be keeping me for observation in the clinic for an hour because of my history of anaphylaxis, but that’s not what I’m worried about.

I’m worried about being bedbound again. I’m worried about volunteering for an injection that could further damage my autonomic nervous system and intensify dysautonomia and hyperadrenergic symptoms. I’m worried about triggering more vasovagal collapses or making myself more hemodynamically unstable. I’m worried about a cytokine storm and/or a mast cell meltdown that creates a permanent worsening of reactivity when I’m already so limited in medication options and trying so hard to keep on weight. I’m worried about a blood clot causing sudden death because IVIG, oral hormones and inactivity already put me in a high-risk category. I’m worried about losing the limited amount of independence and mobility I have now (but it’s enough for a happy life) and becoming too weak to even wash my hair again. I’m worried about being that burden to my husband again, especially now that it takes so much work to make my GI tract function–it would be a monstrous task for him to take on. Mostly, I’m worried about once again losing the small joys, like taking Penny on our scooter walks, being able to talk on the phone for hours and laughing. I spent years without those gifts and I’m not sure I can claw my way back over another decade. 

It feels good to write out those fears. There are very few people with whom I can have these discussions because not many healthy friends understand the risks involved when dealing with such complex conditions. Everyone in my family has had at least 2 covid vaccinations with no side effects, but, in my support groups, it’s a different story. Even there, though, I am careful–I want everyone to get vaccinated, if they can safely, and I never want to dissuade others by voicing my concerns. And doctors aren’t much help because the vast majority take the practical stance that, statistically, the chances of negative repercussions are low and that the risks outweigh the benefits. That’s absolutely true for the typical bell curve of the typical population. Not true for me.

Let’s just hope it’s all smooth sailing. I’d like the next decade to be different.

Update: My doctor pretty much talked me out of getting the C vaccine. I’m too high-risk for long-term reactions. I’m going to have to get surgery next year, so not being vaccinated in a hospital setting adds another layer of fear, but I won’t be stable enough for surgery if the vaccine caused damage. So I will be remaining in strict isolation and putting my life in other people’s hands.

Title Credit