Road to Diagnosis – Part 4

Turning 21, getting a good job at the microchip factory, and finally having my own place seemed to solve so much.  Having some illusion of control over my life helped my mental state immensely.  The shifts at the factory were long, and they caused a great deal of pain, but I was self-medicating on my time off and my situation really wasn’t THAT bad yet.  Or at least I convinced myself of that.

Not that bad still included some injuries to my hands and some back issues that kept me off work for over three months.  Another diagnosis of degenerative disc disease, and now also bone spurs on a couple of my thoracic vertabrae.  When I returned to work from my ‘back vacation’ I could tell that my co-workers thought I was faking it.  This only made me work harder.  In retrospect I realize that I was doing a lot of damage to myself during this time, pushing myself and trying to prove something, but I was medicated and most of the pain hadn’t set in yet.  My factory job got harder and harder for me to do, but being a union thing, I wasn’t going to be fired for medical issues when things did fall apart.

I knew I couldn’t keep doing that job forever, so I started to look for other openings within the company.  I thought I found my salvation when I landed a job on the ‘management’ side as a Document Controller.  This meant a cushy office chair and no more walking around on steel floors and taking that pesky suit on and off 10 times a day.  I had the computer skills needed from my time at community college and the position was mine!

The triumph was short lived though, I guess the boss just didn’t like me.  Maybe it was adrenaline rushes on my part too, but I spent most of the next six months anxious I’d be fired and battling ‘tension headaches’ on a daily basis.  My menstrual cycles were still horribly painful, so between the headaches and the monthly – I became ‘that sick girl’ at work yet again.  I kept seeing my doctor about the anxiety and headaches and he kept prescribing medication that masked the symptoms so I could function.

It was a Friday morning, the one before Labor Day weekend in 1999.  I woke up feeling nauseated, with a headache worse than normal.  I wanted nothing more than to call in, but I was afraid to.  My boss scrutinized Monday and Friday absences worse than the rest, much less on a holiday weekend.  I drug myself into the shower and leaned against the cold tiles and tried to summon the courage to get myself to work.  In the shower I just felt dizzy and more ill, and I knew this was going to be another call in.  I bit the bullet, called my boss and slid back between my covers and slept most of the day.

The next morning, I woke up even worse.  When I opened my eyes, everything was blurry.  My head was pounding, and the shafts of light coming through my bedroom windows felt like icepicks in my head.  The good news was, at least it was Saturday on a holiday weekend.  I had three days to get myself back right for work on Monday.  I laid in bed a while longer, discussing the symptoms with my then live-in boyfriend and assessing what I needed to do.  We mutually agreed that the eye symptoms were too weird to ignore, so I called the nurse hotline I had available through my insurance.

The nurse of course insisted the emergency room, yet I still argued with myself that it might not be necessary.  I waited and took another shower leaned against those cold shower tiles.  Not feeling any better after the shower, I allowed him to drive me to the ER in Orlando.  The next few days are a bit of a blur, but I’ll do my best to recall the highlights in part 5 of my epic saga.

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Reverse Namaskar

EDS Patient’s Bill of Rights

Reverse Namaskar

Reverse Namaskar

The purpose of this Bill of Rights is not to be combative or argumentative. I have experienced all of these things during the time that my EDS was undiagnosed. My experiences don’t seem to be unique. Many members of the support groups I participate in have had talked about similar experiences with new doctors. Because of these issues, I have a very hard time trusting doctors. This is common in patients with Ehlers Danlos Syndrome. The sole purpose of this Bill of Rights is to ensure that my needs are communicated up front, and to discuss them with you so that we can build a great doctor-patient relationship.

1. I have a right to be treated by medical professionals that believe that Ehlers Danlos Syndrome exists. It is hard to believe that there are still people in the medical community that don’t even think hypermobility causes problems and chronic pain. My hypermobility is not benign, and my symptoms are NOT limited to my joints – because collagen is not limited to my joints either.

2. I have a right to be treated by medical professionals that believe that I have Ehlers Danlos Syndrome. This is a rare condition, but invalidating my diagnosis on the first visit means that we can never have a good relationship. I’ve struggled fifteen years to find an accurate diagnosis, and I won’t be treated by someone who thinks my diagnosis is wrong on the first visit.

3. I have a right to be treated by medical professionals who are willing to continue their education to provide support and treatment that is appropriate for my specific condition. EDS is such an unusual set of disorders, the cookie cutter approach to treatment will not work for me. I have tried so many treatments before arriving here that it’s very unlikely that any solution for me will be simple, and as a doctor you must be willing to think outside the box.

4. I have a right to be treated by medical professionals who believe in my complaints. As a patient with undiagnosed EDS, I was often questioned extensively about my symptoms and then accused of being a hypochondriac or malingerer. You must believe that I don’t want to be sick either, and that my symptoms are real. I need to trust you, and a huge part of that is knowing that the trust is mutual and that you believe in my will to improve.

5. I have a right to be treated by medical professionals that do not solely focus on my psychiatric issues as being the source of my problems. EDS causes anxiety and depression, chronic pain causes anxiety and depression, POTS causes adrenaline rushes and tachycardia. It’s all very complicated, and there are psychiatric issues, but they are more symptoms of a bigger problem and should be treated as such. Don’t dismiss me as anxious or depressed without treating my other problems too.

6. I have a right to be treated by medical professionals who are able to admit they don’t have the answer to everything. In order to find new treatments and make progress, it is imperative that my medical team never gives up on searching for answers. Many EDS patients miss being diagnosed because their medical team labels the issue as fibromyalgia or chronic fatigue and then stops looking for new answers. Diagnosing EDS is likely just one piece of my medical puzzle, so it is important that the search for treatments and answers doesn’t end there.

7. I have a right to be treated by medical professionals who take my pain seriously and work to bring it under control. The link between unbroken pain cycles and psychiatric issues in the chronic pain patient isn’t debatable. I realize you are bound by laws and your oath, but EDS is very painful and often requires use of strong medication and other pallative interventions. If you don’t believe in the severity of my pain, if you don’t have the resources to treat my pain, if you think I am drug seeking, tell me so that I can find a doctor who is able to help me.

8.  I have a right to be treated by medical professionals who respect my intellect and knowledge about my disease.  Because EDS is a rare condition, we are much more informed about our medical issues than your average patient.  We live EDS every day, some of us research our conditions every day.  Unless you are putting in the same number of hours researching my issues, please don’t dismiss me when I come to you with a specific concern.  I am open to being wrong (and if it’s a bad thing I *want* to be wrong).  Please explain to me why I am wrong though, so that I don’t need to worry.  My disease has made me capable of understanding things that your other patients might not understand.

I know that YOU were not one of the doctors who let me down. I’m not blaming you! My case is complicated, and I definitely don’t expect you to have all the answers. I realize that I am the sort of patient that can scare a doctor because you can never make me well again. But, if you are willing, I will do my very best to start our relationship with a clean slate, even though I’m scared. If you give me a chance, I promise I will give you one too. You might not be able to cure me, but together we can make me better than I am today – and I really need your help!

The Harm of Inaction

You don't LOOK sick!

You don’t LOOK sick!

Living with chronic pain is hard enough when people believe you.

When it comes to Ehlers Danlos Syndrome, the condition being mostly invisible, I’ve experienced much more skepticism than belief in dealing with the medical community. It seems like very few doctors are ever willing to admit that it’s possible that they don’t know the right answer, or that someone so young could be in that much pain so frequently. When my intracranial pressure was high, and measured at three times normal, I got more pain medicine than you can shake a stick at. It flowed like water from the pens of the doctors – all because the problem could be observed and measured by shoving a needle in my spine.

The issue is further compounded because my mother died of a drug overdose. I want to be honest about this with all of my doctors, but its already such a struggle to get any pain management that I often won’t tell them because I’m afraid of the knee jerk reaction that always follows. In the state of Kentucky, the reaction is even worse. The good ole’ Bluegrass State has one of the most horrible pieces of legislature in place that I’ve ever encountered as a patient. It’s called the Pill Mill Bill, and I really think that it’s going to kill some people. The victims will be people who just can’t manage to obtain pain medicine, but also can’t manage to live with the pain either.

I read a story today about a male model named Dorian who had complications after a routine oral procedure. He wanted to fix some slight imperfection, a bad tooth or something. He got more than he bargained for when the procedure caused a dislocation of his jaw. Dorian didn’t know he had EDS when he signed up for surgery and had been mostly asymptomatic prior to having dental work. What followed for him was a quick spiral into the land of EDS pain as his body started falling apart. He managed to get a diagnosis of EDS, which is more than a lot of people ever get, but it wasn’t enough. He hung himself out of desperation to escape a pain that was inescapable.

I know that doctors are sworn to do no harm, and I believe that most of them are actually trying to do no harm when they tell you that you couldn’t possibly be in enough pain to warrant a long acting pain medication. Morphine at 40, surely you’re joking?  There is a lot of harm being done by not prescribing, doctors giving in to fear that you’ll be addicted or that they’ll lose their license. Where is the fear for people who can no longer stand the pain and will want to give up and die? Dying is dead no matter how you get there, and even in addiction there is still hope for life.

Addiction and dependency are not the same thing.  The American Society of Addiction Medicine defines addiction as “Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”  Many drugs cause side effects, such as somnolence, confusion and problems with coordination.  These are not behaviors, they are side effects.

There have been points in my life prior to this diagnosis when I didn’t know if I could go on living with the pain. I doubted my own mind, my own experience of the pain and sometimes even managed to convince myself that it wasn’t that bad. It was that bad, it has been THAT bad since I was only 13 and it’s getting worse every day. I may be at a crossroads where I have to choose dependency on medication or dependency on pain. It seems like an impossible choice to make.