So #thankful to have spent the last many days wandering a deserted island, doing what I haven’t been able to do in a good decade.
I am #thankful for my body, which is fragile but resilient. This year, I spent six months mostly bedbound following #COVID19. In the aftermath, I found myself almost as weak as I was after my neurosurgeries. COVID also worsened my #MCAS to a terrifying degree.
In September, I began a (second? third?) long climb of physical therapy and strength training so that I could stand and walk again.
Just two weeks ago, I was in the midst of a herpesvirus flare (triggered by stopping my #MCAS meds), accompanied by intense intracranial and intraspinal pressure. I could barely function.
But by this weekend, I was able to spend four days in the Channel Islands with the love of my life. We hiked 32+ miles over the course of four days. Monday, we did a ten mile round trip along the coast and out to some sand dunes.
We’d spotted them from the top of a hill and I said, “I want to go *there*,” so we did.
Tuesday, we did a 14 mile round trip hike through a canyon that ended at the ocean. That is the most I have ever walked in a single day in my entire life.
So I am sitting with the twin realities that a) I may well be fragile for the rest of my life but b) my days of greatest vitality and stamina may well be in front of me. I wish I could say I felt happy. Someday, I hope to be. Mostly, I feel stunned.
We’re putting together an album of our photos to send to our families. We used to do this every time we traveled together. The last album we made?
Lamu, Kenya. 2010-12-29.
When/where I first got sick...
Ten years ago...
We made the best we could of it, but damn, we missed a lot. In an alternate timeline, we’d have an eight year-old.
I am so #thankful, and amazed, and hopeful. But it’s going to take a long time to believe in this.
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Separately, I’m trying to work on a Medium post re: my concerns about people pursuing neurosurgery. My basic position is diagnosis for all, surgery for a few and only after 6-24 months of intense self-education, seeking multiple opinions, and exhausting nonsurgical options.
(Unless your doctor deems your case medically urgent, which is rare.) I am similarly having a hard time writing this piece as it quickly becomes an overly long, overly technical treatise. This topic is so nuanced and complicated, with many unknowns.
So if you have any questions about surgery...please do ask them. It might help me figure out how to frame and focus the piece!
“Just listen to your patient, he is telling you the diagnosis.“ — William Osler
My problem: I was a novel, when all my doctor really wanted or had time for was a tweet.
That is the reason I have been ill for the better part of a decade. It was all there: diagnosable, treatable, actionable. I simply had too many things wrong with me at once. I was, in a sense, too sick for medicine.
I think I may have stumbled upon my final, outstanding diagnosis, the rare thing that could explain all the dangling symptoms that my other “rare” diagnoses cannot. I’ll never be able to prove it (unless, perhaps, I have another acute episode).
Acetylcholine receptor autoantibodies have been found in subsets of #MECFS and #POTS patients. This can impair autonomic nervous system function and mast cell regulation. What I did not know is that these autoantibodies can also impair collagen synthesis.🤯
Is it possible that a subset of patients have an acquired, autoimmune connective tissue disorder? Could this help explain observations of: herpesvirus reactivation, dysautonomia, MCAS, and elevated hydroxyproline/lysine in a subset of #MECFS patients, w/ w/o hypermobility?
Doctors and researchers recognize that translational medicine (a branch of science that aims to take basic research and translate it into evidence-based medical practice) is important.
We need a similar concept the recognizes the equally important act of translating patient experience and observation into testable hypotheses and, ultimately, clinical care.
If you’re a doctor, you might say “We already do that. We observe patients all the time.” That assumption is flawed.
If I could wave a magic wand:
– we would prove that intracranial hypertension (as measured by ICP bolt) is common in our pt populations, more often than not w/ normal LP opening pressures, w/o papilledema
– we would prove that occult tethered cord is common and runs in families
– we would learn whether we should untethether these kids as kids, if that might help them avoid the hell to come
– we would prove that you can get recurrent leaks that imaging will never catch
– we would understand the relationships between #MECFS#EDS#MCAS#POTS#Fibro, without which we will never be able to get to *prevention*
– every GP/PCP would know each of these diagnoses cold and could refer you to...actual specialists
I also hope the balance of research shifts to include much more investment in #LongCovid relative to acute COVID. Part of why there is so much more research on acute COVID (other than the dire urgency) is that many of these studies are done in hospital settings.
Doctors are learning an astonishing amount in short periods of time by OBSERVING their patients and constantly sharing information. When you gaslight a patient or send them out of your office, you’re saying, in essence, “nothing to see here.”