That time I didn’t have anorexia

June 19, 2015

I was horrified when I looked in the full-length mirror and saw how thin I was. I forget why I was looking in the mirror while I was naked in the first place. I usually only looked it in to check my outfit, but that day, I was naked, and I was shocked. I immediately went to my mother and showed her. She took me to the doctor. I was diagnosed with anorexia. I insisted I wasn’t trying to lose weight. They assured me they believed me, that this was a different type of anorexia, that they knew it wasn’t intentional. If I’d only understood then what I understand now, I’d have recognized the bullshit.

I hadn’t thought about that in a long time, but I’ve been reading this book on Celiac Disease and it’s really opened my eyes to a lot of misdiagnoses in my past. As I read about eating disorders, this memory came flooding back to me. I remember being weighed; I was 89 pounds (and about 5’0″ tall.) I was told to drink high protein shakes. The nutritionist wanted me to gain 11 pounds in the next two weeks. I gained a lot, but not that much. I had to continue with the high protein shakes and eat more at every meal. She wanted me to eat more high calorie foods, too. That was my treatment.

Now I wonder how different my life might have been if they’d asked me questions about my health. Instead of assuming this underweight teenage girl was anorexic because she was underweight and a teenage girl, what if they’d probed more? What if they’d recognized my own fear – after all, I was the one who told my mother I needed to see a doctor to find out why I was so thin – and considered other options? What if, when I told them I sometimes skipped meals, they had let me explain why? (I tried to explain but they wouldn’t listen.) Maybe they would have learned about my digestive problems, about how often I was doubled over in pain, about how frequently I had diarrhea. Maybe it would have occurred to them that I wasn’t absorbing nutrients properly.

The doctor and nutritionist terrified me. I’d never had an eating disorder, and suddenly I became anxious about food for the first time in my life. They insisted I had to eat three meals every day. This meant that if I slept in and ate brunch at 11am, I needed to squeeze in another meal before dinner. In college, I would get out of bed early on Saturday to eat breakfast before heading to brunch with my friends an hour later. It didn’t stop the diarrhea, and it certainly made me worry about food constantly, but it did keep me from being quite so thin. I maintained a weight of around 100-105 for a long time. It was better, but still too low.

I don’t remember when my perspective changed, but it did. At 22 I insisted on seeing a gastroenterologist and was diagnosed with IBS for the first time. The appointment was 10 minutes long, with no physical examination, just a recital of my symptoms and then a diagnosis. I wasn’t told there was a diet to follow. I learned that on my own a year later when I accidentally found a pamphlet in a doctor’s waiting room. My first colonoscopy and endoscopy were years later. They ruled out Crohn’s disease and cancer. Then I was on my own again with the IBS diagnosis. I was still constantly sick. My next endoscopy with a different doctor didn’t give me any more information, but it changed the diagnosis to IBS, reflux, and some mystery ailment. The doctor said she wasn’t sure what it was, but that IBS and reflux alone didn’t explain my symptoms. Then she said she couldn’t do anything else for me. I have no idea if either endoscopy checked for Celiac. Maybe they did and the damage to my intestine wasn’t visible yet. Maybe they didn’t look.

It wasn’t until age 32 that I tried going gluten free. My primary care doctor didn’t want to test me for Celiac or send me to a nutritionist. I pushed on seeing a nutritionist and she gave me a referral to someone who was very nice but who, as it turned out, had absolutely no experience with gluten free diets. No wonder it took me another TWO AND A HALF YEARS to eliminate all of the gluten contamination in my diet!!!

I assume that I don’t have hidden gluten in my diet anymore because, for the first time in 20 years, I don’t have nausea, diarrhea, constipation, and abdominal pain on a regular basis! The feeling is miraculous and I am constantly thankful to be free of it all.

Still, I have to wonder, how might my life have been different if, instead of assuming that every underweight teenage girl was anorexic, that doctor had actually examined me and maybe figured out that I had Celiac Disease or gluten intolerance? (Note: I don’t know which I have because I was never tested and the only way to test for Celiac disease is to eat gluten again, which I can’t do. My doctor should have tested me before I started the diet.) Ok, gluten intolerance wasn’t known 20 years ago, but Celiac Disease was, and they never even considered it. For that, I may never forgive them. I’m just so grateful that I finally took things into my own hands, did my own research, and got better. And next month, for the first time ever, I’m seeing a Celiac specialist! I can hardly wait!


No! I’m not using my health as an excuse!

June 8, 2015

Somehow I had a strange insight when I was a kid. Well, the insight wasn’t strange, but having it at such a young age is probably unusual. I realized that if I ever used my pain as an excuse to get out of doing something when it really wasn’t a problem, no one would ever trust me again.

Maybe that’s why I felt so defensive today when someone accused me of that.

Ok, I’ll be fair. She thought I was doing it in an honest way. We were talking about her upcoming move out of state, and I said that I’d love to try moving someplace for just 6 months. I’d store my things in my parents’ basement and rent a furnished apartment near the ocean in Maine for 6 months, just to see how I liked it. She loved the idea, and pushed me to consider it. I pointed out that I couldn’t even think about it until my health was better. She asked if I was using my health as an excuse because I was really just scared to try it.

So I went on the defensive. I don’t talk bluntly about my health problems, but I’d had a recent setback that she hadn’t known anything about, and I was in no mood to have anyone suggest that being away from my doctors for 6 months was a problem only in my own mind. I told her something that she probably hadn’t realized: that while none of my health problems are fatal, that’s because they’re not fatal with proper treatment. But without proper treatment, yes, they could kill me. Ok, I didn’t happen to mention that death would take years, maybe decades, but that’s beside the point, right? And in the meantime, things could get awfully bad.

I’ll admit, I’m more fearful than I used to be. I used to jump at chances. Now, I’m weary. But who can blame me? So yes, I don’t take as many chances as maybe I could, or should. But then again, I take a lot of small risks on a regular basis, so who’s to say what’s right?

As for moving away for 6 months, I know that’s a risk I shouldn’t take. I don’t have a single doubt in my mind. What if I’d been away a few weeks ago when things went bad? I wouldn’t have gotten my blood work done, which means I wouldn’t have known to adjust my thyroid meds. I was having horrible symptoms of adrenal insufficiency, but I didn’t realize it until my naturopath pointed it out. My pulse was low, but I hadn’t checked it. My blood pressure was so low that she couldn’t even hear it. She tried three times. A machine wouldn’t have been able to read it either, so I wouldn’t have known about that. And if I was in Maine, I wouldn’t have visited my naturopath and started on folate (which I should have done a while ago, to be honest.) I would have gotten worse and worse until I couldn’t properly care for myself. Eventually, my parents would have had to come get me and take me to their house. I would have been bedridden. Now, I’m already seeing a bit of recovery. If I hadn’t caught it early, recovery could have taken months or years. So I have no doubt.

Even so, it sucks to have my judgment questioned. I know it’s hard for health people to understand this. As I pointed out to my friend, we’re taught that when you get sick, you take medicine and then you’re better. But for some of us it doesn’t work that way. We take the medicine and we stay sick. Sometimes we get even sicker. If we’re lucky, we stabilize. That’s what happened to me, I stabilized. Then that went to hell. I’ll probably never be stable. I may never be able to move away from my doctors for 6 months. I’m ok with that. I just need my support network to be ok with it, too.


Healthcare fail: the diagnosis that wasn’t

May 24, 2015

The details may change, but the gist is the same. The symptoms are there, the request made, the answers not given, the diagnosis left unmade. It’s happened to many of us. It’s happened to me several times, actually. I’m still wondering how it happened with my Celiac Disease. Of course, technically I haven’t been diagnosed with Celiac to this day….

The first doctor ignored me for a while. When I was insistent that I wanted to be tested for lactose intolerance he said there was no test for it. Instead, he had me keep a food and symptom journal. He sent it to a nutritionist, then reported back that I didn’t have lactose intolerance. He didn’t care to investigate further. Last year I found the nutritionist’s letter in my records. She’d said it didn’t seem to be lactose intolerance but there was clearly something going on and she wanted to see me. I never got that message.

Then there was the gastroenterologist who diagnosed me with IBS after 2 minutes of a 10 minute appointment. He gave me a prescription to take before meals. Funny, but those pills never seemed to help. A couple years later I found a guide to an IBS diet on my own and followed it the best I could.

Another doctor took me seriously, at least, but was woefully inadequate. He ordered a colonoscopy to rule out Crohn’s, since an aunt had that. It was ruled out and my symptoms continued to be attributed to IBS. Well, my gastrointestinal symptoms did, anyway. It was assumed my other symptoms were completely unrelated. How convenient for them. How horrible for me.

Then there was another gastroenterologist. She did an endoscopy. I wonder if she checked for Celiac? I would hope so, but she never mentioned it. She said she was checking for reflux. She doesn’t practice any more and I haven’t had a chance to find her notes in my hundreds of pages of records. But I do remember her diagnosis: IBS and reflux, plus something else that she wasn’t sure of, but I shouldn’t be too worried. I’m not kidding! That’s what she said! She said that my symptoms could not be entirely explained by IBS and reflux so there had to be something else. I was sure I didn’t have reflux. My aunt and grandmother had it, and my symptoms weren’t anything like theirs. Still, I took the pills she prescribed. And I got worse. Sigh.

At last my rheumatologist suggested I should get tested for Celiac. In hindsight, I can’t believe no one suggested it sooner! I have classic symptoms. It even took my rheumatologist a while – I’d been seeing her for several years when she brought it up. I resisted, of course. I didn’t want to give up my favorite foods. And I was scared. Anything with food was scary, since I was so sick so much of time. Still, I might have let her run the test. If only she could. Her department didn’t let her run any tests that weren’t part of her specialty. The computer system didn’t even offer it as an option! She could run my blood count and ANA every day of the week, but no Celiac tests.

On the bright side, she put the idea in my head. That meant I was more open to it several years later when I was doing hypothyroid research and came across the link between Hashimoto’s Disease (autoimmune hypothyroid) and Celiac Disease. Many Hashi’s patients have Celiac or gluten intolerance, so some professionals recommend a gluten free diet. Hmm. It made sense. After reading that same advice from several different sources and thinking about my symptoms, I knew I had to give it a try.

I talked to my new PCP (primary care physician), who didn’t think I needed to worry about it. She hadn’t heard of the link and seemed doubtful about the research I had come across. She dismissed my symptoms as being IBS. Going gluten free was the new fad diet. I told her I wasn’t doing it as a trend or to lose weight. I pushed her, and she gave me the necessary referral to see a nutritionist. She didn’t run any tests.

The nutritionist took me seriously. She gave me useful information. I was on my way.

I knew that if it worked, I’d have to eat gluten again in order to be diagnosed. I was looking forward to it; I’d get to eat my favorite foods again for weeks! How great! You see, after being gluten free for a while the antibodies die down and the intestine heals, so there’s no way to run an accurate test. The only way is to eat gluten again. The better way is to be tested before going off gluten in the first place.

Eating gluten sounded great at first, but something changed. I stopped feeling nauseated every day. My diarrhea almost completely disappeared. The cramps were gone. The gas and bloating went away. The pain that put me in agony, pondering if death would be better, was no longer a weekly or bi-weekly occurrence. I was free! I could live! I could go to the park for the day without worrying about not being near a bathroom! I could join friends for meals without worrying about being sick for hours afterwards!

Yes, I occasionally get glutened and it’s all kinds of horrible. That pain and nausea and diarrhea all return with a vengeance, but at least I know that it’s temporary. The worst of it lasts a few hours, and the lesser symptoms linger for a few days. I know from experience that it could be so much worse. And most days, I don’t have any of that! I’m grateful every single day that those symptoms are gone.

It hasn’t been easy. Eating out is all kinds of challenging now. But it’s completely worth it. It’s so worth it, that I have no desire to eat gluten for even one day, never mind for the weeks that would be required for testing. I’m incredibly careful to avoid even a tiny amount of accidental exposure. I’m not about to do it intentionally. So I remain untested. Maybe I have gluten intolerance. Maybe I have Celiac Disease. Does it matter? Either way, I’ll be avoiding gluten. (And yes, the difference matters because of secondary issues, but I’m still not going to get tested.)

Unfortunately, though, damage has been done. After what I suspect was 18 years of undiagnosed Celiac Disease, I got pretty damn sick. I’ve been reading about how some researchers believe untreated Celiac can lead to Hashimoto’s Disease, which I developed. Hmm. And we know that my poorly treated Hashimoto’s led to adrenal insufficiency. And that led to me having to leave work. I don’t think untreated Celiac caused all of my health problems, but it sure led to a lot of them.

I try hard not to dwell on the “what ifs” in life, because it doesn’t help. Still, from time to time, I wonder what would have happened if that first doctor had taken me seriously 20 years ago. Could I have avoided most of this?

Or course, there’s also the flip side: what if I had listened to my doctors and believed that my problems had nothing to do with gluten? How much sicker would I be right now?


I make no apologies

May 19, 2015

Yesterday I wrote about how my entire personality changed because of my need to stand up for myself in medical situations. I want to be clear about one thing: I make no apologies for how I act.

Sometimes I’m wrong. Sometimes I screw up. I’m human, so of course I do things wrong. I try to take ownership and apologize when I’m at fault. Sometimes I screw that up, too, but I do my best. I’m not talking here about any of those things. I’m talking about medical situations where I’m pushy.

Like many of you, I was taught to be apologetic when I push too hard, but I only apologize when I truly cross a line. The rest of the time, I do what I need to do without apology, because if I apologize, then it encourages their low standards.

A couple years ago I had an appointment with a specialist. I waited almost 6 months for the appointment, but it was worth it so that I could see this particular doctor. When I finally showed up, I was taken in 30 minutes late to meet with someone else. My doctor was out and instead of calling and asking if I’d like to reschedule, they had me meet with this one. He was terrible. He said they couldn’t help me and suggested a psychologist. Before I left, I got the name of the person in charge. I called her and expressed my displeasure at the long wait and not being able to see the doctor I had been desperate to see. I was very strong in my expression of displeasure. I was not mean or nasty, I did not swear, but I was strong. Within a week she got me an appointment to see that doctor. Instead of the usual 15 minutes, he spent a full hour with me. Unlike the other, he discussed options, asked my opinion, took my view serious, and ran tests. He found that I had a serious but treatable problem. I called back the woman in charge, told her how well things went, and thanked her profusely. I certainly never apologized.

I asked my doctor to test me for lactose intolerance. He said there was no test for it, but that I should keep a food and symptom journal and he’d send it to a nutritionist. We did that, and he told me that nutritionist said I’m not lactose intolerant and I should just avoid foods that bother me. It didn’t feel right, but I went along with him. After 20 years of frequent diarrhea, nausea, cramping, and pain so bad that I literally wanted to die, I found out that I had Celiac Disease. Last year I was going through old medical records and found the letter the nutritionist had sent back to him. She said that I didn’t appear to be lactose intolerant but that something was definitely wrong and I should see her. I’ve been very sorry about that – sorry that I didn’t push for better treatment.

I have dozens, probably hundreds, of stories like these. I bet you do, too. I regret the times I didn’t stand up for myself but I haven’t once regretted the times that I did. So I’ll make no apologies. And if anyone has a problem with that, too bad for them.

P.S. If I sound defensive and bitter, you can imagine why.

Now it’s your turn. Have you had to be pushy in order to stand up for yourself? Did you regret doing it? Did you regret not doing it? Share one or two of your favorite stories in the comments!