Osteoporosis

I have trust issues. And amazingly, they don’t stem from one too many “trust falls” gone wrong from my younger years (though maybe that contributed). My trust issues center around bigger things: trusting my body, trusting my doctors, and trusting… life. I was diagnosed with atypical cystic fibrosis (CF) one month and eight days before I turned 20. I had been complaining to doctors for as long as I can remember about having trouble breathing, being tired all the time, getting sick if I ate “normal” kid food, and of course, my bi-monthly “asthma attacks” that left me unable to talk, breathe, or swallow for up to a week. “It’s asthma,” my pediatrician would say. “She’ll grow out of it.” When my chronic digestive symptoms worsened around age 13, I was told to drink prune juice. When that didn’t work, it was medication. Nothing worked. My diet became more and more restricted to the five things I knew wouldn’t make me sick: lettuce, cucumbers, frozen strawberries, bananas, and protein powder. I got sicker and sicker, and it was clear that I wasn’t healthy. I started figure skating when I was 8 years old and quickly knew I had found my heart’s passion. I fell in love with it and trained to the best of my body’s ability — withholding from my coaches the pain it caused. I felt like figure skating seemed to wear me out and be a lot harder for me than for my training partners. Skating isn’t a sport that welcomes showing “weakness,” and since I was being told by all of my doctors I was “fine,” why would I say anything? After graduating high school, I moved and started training at an Olympic training center with renowned coaches from all over the world. I was living my dream—but trying to ignore the so-obvious fact that my body was breaking down. Just from my appearance, it was hard for anyone to ignore it — including my coaches. After only five months of professional training, I had a serious fall that took me off the ice and also led to my getting diagnosed with osteoporosis at only 18 years of age. I was terrified and heartbroken — being told I needed to stop skating because it was too risky for my bones was hard. I was no longer able to train or skate at all, so I moved home feeling utterly defeated. I knew something wasn’t right — everyone did — but I didn’t have any faith that doctors would finally be able to tell me what was wrong instead of just dismissing me as usual. Ironically, my saving grace came in the form of a lung infection — pseudomonas aeruginosa, to be exact. I woke up unable to speak or swallow, thinking my training-too-hard days were finally catching up with me — only to find out that my lungs were swimming with super-rare, hard-to-harbor bacteria. The urgent care doctor casually dealt me some medication and assured me I would be better in 10 days. Being the investigator — and skeptic — I am, I wasn’t convinced (or reassured), so I consulted “Dr. Google” to find out how in the world I came down with this rare infection. I learned that there are basically three conditions that can make you contract this bacteria — acquired immunodeficiency syndrome (AIDS), cancer or cancer treatment, or cystic fibrosis. I knew I didn’t have AIDS and I had not had chemotherapy or radiation, so all that remained was cystic fibrosis. “There’s no way I have that,” I said to my mom. “That’s that ‘baby disease!’ They would’ve caught that.” I pulled up an article about CF, reading through the symptoms just in case. As I did, my heart sank and tears flooded my face as I realized that everything made sense. All the puzzle pieces fit together. How in the world had the doctors missed this? I returned to my pediatrician — now no longer content to accept her prune juice and prescriptions. “I want you to test me for cystic fibrosis. I think I have it,” I insisted. She ceased her note-taking and looked up at me blankly. “I think you might be right,” she replied. I was referred to my nearest cystic fibrosis center for evaluation and testing. By the time of my appointment, I had struggled to eat and was so weak I could hardly walk. When the doctor at the cystic fibrosis clinic walked into my room, she took one look at me and immediately sent me down to the emergency room to be admitted. I had a complete abdominal obstruction, pancreatitis, four different lung infections, liver disease, and kidney disease. A few days later, I was also diagnosed with cystic fibrosis. A little less than a year after that, I got my genetic test results and was told it’s not “typical” CF, but a rare variant of it instead — one that doctors and researchers know absolutely nothing about. All they knew from clinical observations is that those of us with this form of CF fare no better than others with CF… and sometimes we’re even more affected. My initial shock-turned-sort-of-relief after actually having a diagnosis was smashed once I was told, “We don’t know how to help you.” The fact that my condition was getting more severe every month didn’t help. I started having one obstruction every week. I upgraded to GoLytely as my drink of choice — until even that stopped working. I did everything I knew to do, and my efforts did help — but only to keep things at bay. Eventually, the things I tried weren’t even readily doing that. In 2019, I had surgery for an ileostomy, which improved my quality of life and health tremendously… but not before I experienced literally every complication you can possibly have with an ostomy. One complication still lingers — prolapse — a common symptom in both CF patients and those with Ehlers Danlos syndrome (EDS), which I was also diagnosed with in 2020. Living with both cystic fibrosis and Ehlers Danlos syndrome is hard for me. The two diseases so often conflict with one another (Imagine a chronic cough with a hole in your abdomen and weak connective tissue!), and I honestly struggle to deal with them both. Most days, I feel terrified of when the other shoe will drop. I know I have more surgeries ahead — some of which will be harder than the ones I’ve already had. It’s another terrifying thought. So how can you trust that everything will be OK when nothing has been OK in a long time? I honestly don’t know. And after a long time of trying to figure it out, I’m not trying anymore. Trust is a brutal battle — just like an organ shutting down or an insurance pre-authorization. Sometimes trying to find the answer to unanswerable questions — like how to trust with a disease — isn’t necessarily the answer we maybe should be trying to find. Sometimes the only way to figure out how to keep going is to step back and realize we have been going — day after day, month after month, year after year. And even when it’s our bodies that so often betray us, we may need to step back and acknowledge that our bodies have enabled us to keep going. Sick or not, CF or not, EDS or not, it keeps surviving. And that body? The one that’s been through what it’s been through and still keeps on? That’s something we can trust.

Ten long years. 10 years of hoping I will improve. 10 years of taking serious medications with serious side effects. 10 years and somehow, I don’t feel I have progressed physically. I haven’t gotten “better,” but I am better at managing my condition and my life. It all started with a toothache and a tiredness that sleep could not cure. The removal of all my wisdom teeth, three rounds of antibiotics, and numerous visits to the dentist later, and I heard the words that I will never forget: “Something is wrong, and you need to urgently see your doctor.” Thanks to my fab dentist (who I’m still with now), that is what I did. But getting a correct diagnosis is not always as simple as seeing your doctor for some tests. And so, several weeks of visiting my GP and having blood tests led to an emergency stay for two weeks in the hospital. Then countless doctors and endless tests later, and I received a diagnosis: microscopic polyangiitis, but I was then later diagnosed with Wegener’s vasculitis. It wasn’t the outcome I had expected, but what was happening to me was still not clear. When one doctor questioned my symptoms and another doctor proved me right, I learned valuable lessons. Ultimately, you must look out for yourself and find experts you can trust. I have learned a lot in 10 years, and maybe I have progressed more than I think. I have a team that I trust, I have some stability with my health, and I have family and friends who understand that sometimes, my illness is too much for me, and I need to hide away. But overall, I have a new life — one that wasn’t planned and one that is restricted in some ways. However, it is a life filled with love and respect. The new version of my life is quite lovely, so I think I will keep it — medications and all. It’s called “chronic illness” for a reason. After my diagnosis, I thought I could battle through. I thought I would win. I thought I was invincible. Unfortunately, I couldn’t win, and I was so far from invincible. 10 years on, I am still battling and visiting hospitals monthly, but I am also still hopeful. I did not understand the words “chronic illness.” When a colleague asked me how I was managing, and I said my illness was still dragging on, his response floored me. He simply said, “Well, it is chronic.” It was such a straightforward comment, but it really hit home. Did I think my illness would just go away? Had I not believed that it would stay with me for the rest of my life? Had I just ignored reality? Am I still ignoring it? I try to forget that I have a severe illness. I try to “prove it wrong,” almost as though if I keep going, somebody will soon tell me it was all a joke and that I am OK. The COVID-19 pandemic changed my life. The last few years have been tough for us all. The COVID-19 pandemic changed many things. For me, it felt like a strange clinical trial — I got to remove all the travel and interactions with people and see what happens to an immunosuppressed person with an autoimmune disease. The lack of infections allowed me to drop my medication dose. It also allowed me to work alongside colleagues as equals and not as the only one who was not physically in the room. The pandemic meant I had the energy to be with my family. The world became as restricted as I have been, and it leveled the playing field. Not anymore, though. As the world becomes “normal” again, I become “abnormal” again, and the pressure to join in returns. I have had a number of common infections, and so my medication dose went back up. The large “clinical trial” that has been my life during COVID-19 has given me resounding answers to some of my problems. But solving these problems is not financially straightforward in the real world. Thank you for all the support. The past 10 years have been tough — full of knockouts and disappointment. But they have also been full of laughter, love, and special people. My family has been amazing. Even if we do lots of shouting some days, when it matters, we are a tight unit, and we deal with everything together. My family members are my strength, and I wish I could repay all the support, love, and kindness they have shown me. To the friends who came to the hospital with me or looked after the girls for me when they were little, thank you. To those who have listened to me cry even if it did not make much sense, thank you. My online friends deserve a “thank you” too. Since writing the book, the support from Instagram, Facebook and Twitter has been critical. Online friends, you may understand me. You are often awake at the same time as I am when I cannot sleep, and you may also know how scary and uncertain this disease can be. Thank you. To my boss and colleagues, thank you for all the encouragement and support, positive words, and understanding when I just couldn’t be in the room. You have been the most fantastic company for the last 10 years. George, the black Labrador and Burt, the cocker spaniel have helped me too. George and Burt, you will never know how much you have kept me moving. The movement has helped me avoid diabetes, brittle bones, weight struggles, and depression. Our walks help me both physically and mentally. This is what the future holds. Unfortunately, the medication that has given me some stability has now caused the doctors to think it has brought on ulcerative colitis, another autoimmune disease. This disease affects my bowel and brings more inflammation, more new investigations, more new medications, and yet another thing to learn to live with every day. But I will manage. The past 10 years of medications have caused osteoporosis in my back and hip, medication dependency, and weight changes. The fatigue is constant, and when I get to the end of a working day, I am lucky if I can speak to my family. I keep going, though. I am proud of how my family and I have all dealt with this life-changing diagnosis. I am proud of our resilience and ability to fight. I am also proud of how my children view this world with kindness, and I know that they will make a real difference as they turn into extraordinary young ladies. Vasculitis forced me to step back, look at my world, and focus my energy on the things that really matter. For now, I celebrate being alive, and I thank everyone who has helped me stay that way. It was not so long ago that a diagnosis of vasculitis was an immediate death sentence. I am grateful for the clinical advances and the care I have been given. Now can someone please invent a cure?

“The only thing predictable about menopause is its unpredictability. Factor in widespread misinformation, a lack of research, and the culture of shame around women’s bodies, and it’s no wonder women are unsure what to expect during the menopause transition and beyond.” – Dr. Jen Gunter Menopause is as unavoidable as puberty, a natural process our bodies undergo as part of the life cycle. Most doctors do not have accurate or thorough information to help guide people through menopause, and there is a communication gap among women where matters of menopause are concerned. Brief references to hot flashes, mood swings, and perhaps a flippant comment about sex being uncomfortable may be shared, but frankly, as a woman of a certain age, the discussions are few and far between. Where does endometriosis fit in with this discussion? One of the pervasive myths about endometriosis is that menopause cures it and that endometriosis can only exist in those who have reproductive capacity. While endometriosis is considered an inflammatory disease that is estrogen-dependent, this assertion is patently false. Not only can those with endometriosis continue to struggle with the condition post-menopause, people who have never had endometriosis can develop it post-menopause. Actual numbers are difficult to assess due to the persistent lack of research surrounding both endometriosis and menopause, but according to this research article by the National Center for Biotechnology Information, the prevalence of postmenopausal endometriosis ranges from 2-5% of postmenopausal women. Considering the difficulty that exists in terms of recognizing symptoms and diagnosing endometriosis to begin with, this presents the post-menopausal individual with a seemingly insurmountable hurdle should they indeed develop endometriosis. So what might be driving post-menopausal endometriosis? The general theory is that peripheral estrogen production, meaning estrogen that isn’t being produced within the ovaries, can stimulate the growth of endometrial lesions. This type of estrogen continues to exist in varying levels among post-menopausal people. Layer on top of that the use of hormone replacement therapy (HRT), which stimulates estrogen production, and this can re-activate or activate for the first time the production of endometriosis. Hormone replacement therapy is the gold standard for addressing the myriad symptoms associated with menopause. It can also help to stem the onset of bone density loss and osteoporosis, a common and potentially debilitating condition that can cause bone fragility and more frequent breakage. While most people tolerate HRT well with few to no side effects, some might be at a higher risk for estrogen-related diseases like endometriosis and certain types of cancers. Additionally, many of the symptoms associated with endometriosis such as gastrointestinal discomfort, bloating, constipation, pelvic floor dysfunction, urinary tract pain, and painful intercourse are common indicators of cancers that tend to affect post-menopausal women at higher rates. These include uterine, ovarian, and bladder cancers. This makes the diagnosis of endometriosis that much more complicated. Doctors are far more likely to order tests to rule out invasive potentially life-threatening cancers than they are to start with the diagnostic laparoscopy needed to identify endometriosis. While this makes sense based on our current medical system, it does mean a delay in or outright failure to diagnose endometriosis among post-menopausal people. So what can post-menopausal people do? First, those who have a history of endometriosis should have an in-depth discussion with their medical practitioners weighing the pros and cons of HRT usage. If they have had a hysterectomy, there is some indication that the recurrence of endometriosis might be less likely, however, that is not a definitive recommendation. And there is extensive literature suggesting the direct correlation of endometriosis to the development of malignant tumors at the site of the endometrial lesions. Therefore, HRT may be contraindicated in those with a history of endometriosis. Localized vaginal progesterone might be the best alternative for these individuals in managing their menopause symptoms. For those without any kind of history of endometriosis, the risk is relatively low, therefore the use of HRT in managing symptoms is not typically contraindicated. The bottom line? Just as with endometriosis that occurs amongst pre-menopausal people, if you have symptoms consistent with endometriosis, don’t let your doctor dismiss them. It may be life-saving to get an early diagnosis so as to curtail the potential development of cancer. Beyond that, however, there’s no reason that you should continue to live with debilitating symptoms consistent with endometriosis beyond menopause. Excision surgery is relatively safe for most post-menopausal people and can effectively address the majority of symptoms associated with post-menopausal onset endometriosis.