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Thursday, June 13, 2024

Dropping Connie


Earlier this month, the spinal CSF leak neighborhood misplaced a vibrant gentle when Connie Rim handed away. Her Fb web page, referred to as My CSF Leak Story, was the place she detailed her lengthy battle making an attempt to get sealed and healed. Just a few days after she handed, her husband posted phrases from Connie about her loss of life, sharing it with the world.

Connie sustained her leak 5 years in the past throughout spinal surgical procedure, and tirelessly rallied her physique and thoughts in her makes an attempt to get care and discover her means again to a spot of much less ache. Like me, she discovered solace in sharing this journey publicly. In her case, through movies that she posted to Fb and TikTok, detailing her many debilitating signs, explaining the procedures and checks she obtained, and patiently answering questions.

When somebody is chronically unwell and takes a break from remedies, there’s inevitably a swell of individuals asking why. “Why aren’t you doing extra?”, as if it’s as much as you to not be higher. As if there’s full management of the lengthy tightrope it is advisable stroll on if you’re coping with a number of advanced situations. Regardless of her openness and uncooked, unflinching movies, folks nonetheless requested Connie this query.

Maybe in response to this, or for different causes (I don’t know), in Might 2023 Connie posted a protracted listing of procedures and checks and medical doctors she’s seen proper earlier than she headed out to Mayo for extra leak diagnostics and procedures: “This can’t be my life. This isn’t a life. I’ve been preventing to get higher and advocating for myself as a lot as doable however in fact, I’m drained now. Nothing is as simple because it as soon as was,” she wrote then.

By this level, she had been to leak specialists and nonetheless her leak(s) weren’t sealed. She was in fixed ache. She reposted that listing, up to date, a number of days earlier than her loss of life.

She did get therapy after that Might 2023 put up, one which introduced her ache down just a little bit. We might all really feel her pleasure and hope when it did. However that therapy failed, and when it failed it introduced a brand new, horrible set of signs. Since late January 2024, she skilled extreme stabbing ache from three to over twenty occasions each day, at what she categorized as a stage 10 ache. To be in ache all day, after which layer upon {that a} new and protracted, paralyzing ache… I can’t think about.

By mid-Might, she was gone.

Studying between the traces of the message her husband posted, she hit a wall the place the excruciating ache she skilled second to second couldn’t be managed.

Some days, I’ve been given 10-Quarter-hour of my treasured baseline ache, and for that. I’m grateful. However throughout the remaining 23 hours and 45 minutes, I used to be at all times crying, preventing, and, at occasions, in a lot ache that I might do something however curl in a fetal place in darkness,” she wrote.

Her household and husband have been loving and type, she had numerous assist, and she or he had a neighborhood who rallied round her. I perceive that these wonderful issues might not be sufficient if you end up trapped in a physique that tortures you.

Research present that in a power state, ache can disrupt the communications between mind cells, resulting in a discount within the potential to course of feelings — particularly damaging feelings. Ache modifications your mind. I skilled a model of this myself not lengthy after my leak started: already in power ache for years  however not but conscious of mast cell ailments, I ate a very excessive histamine meal of spaghetti and shared a glass of wine with my household. It was this meal throughout these preliminary leak days, earlier than I went to Duke for therapy, that tipped my physique its new, unruly state. After that meal, I had full-body burning and nerve ache 24/7. And it didn’t go away. It felt like I used to be being dipped in acid, with no respite from the torture.

It was a fellow affected person who urged me to consider MCAS, given my signs. I hadn’t heard of mast cell activation syndrome earlier than. With no medical doctors to assist me, I scrambled to get my mast cells underneath management and attempt to make it cease. Throughout these weeks of absolute hell, till I discovered over-the-counter drugs that labored for me, I begged an in depth good friend to assist me discover a means out perpetually. (They declined, have been compassionate all through, and as an alternative tried to seek out me a grief therapist regionally. What helped on this case wasn’t remedy, it was discovering respite from the fire-burn throughout my physique because of antihistamines and a low-histamine food regimen.)

And that was how I felt with just a few weeks of torture.

Connie lived with that ache that for a few years. As she stated in her writing, “The ache determines my feelings, NOT the opposite means round (as some folks consider).”

Her passing hit the leak world very onerous. Even those that didn’t know Connie personally typically watched her movies on TikTok or Fb, or interacted along with her on the teams. In my case, I used to be digital associates along with her for years and we exchanged audio messages about methods, advised jokes, tried to maintain ourselves sane on this Groundhog Day world we lived in when staying sealed felt like a pipe dream.

And but, regardless of the ache and the exhaustion and the procedures, Connie remained joyful the place she might, she appreciated what love she had in her life, particularly her deep and exquisite love for her husband, and noticed humour the place she was ready. She had tons of assist. The ache decided her feelings, as she stated. She was a prisoner of her fixed agony.

I really feel indignant for her and her household, and for all of us. In taking a look at that lengthy procedures listing, it looks like she was failed so many occasions alongside the way in which. Whilst not too long ago as this yr, she introduced to the ER and later shared a video explaining that the on name physician stated her signs have been psychosomatic. How are you going to have a look at that blisteringly lengthy listing of remedies and assume it’s psychosomatic?! The continued nerve injury and tissue injury, and scar tissue that may entrap her nerves, all of it is smart wanting on the lengthy listing of what her physique had been by.

However no, she was advised it was all in her head.

That’s a part of what leaves me rattled, for anybody with this situation or different invisible situations the place metrics for analysis and therapy will not be minimize and dry. I’m engaged on the slides with the US and different spinal CSF leak foundations for the annual consciousness week for this situation, referred to as leakweek (which begins June third). In it, we share the various kinds of diagnostics and be aware that regular imaging doesn’t rule out a spinal CSF leak. Regular opening strain doesn’t rule out a spinal CSF leak. Regular something doesn’t rule it out; we’re trapped on this countless loop of being unable to ‘show’ quantitatively what we’ve got apart from signs, but typically we’re advised we aren’t dependable narrators when sharing our signs.

And so we strive, we strive so onerous.

We current ourselves firmly however with out panic, however not TOO jokingly else we appear ‘not sick sufficient.’ We preserve spreadsheets, we share knowledge, we come armed with supporting research however not TOO many, else it looks like we predict we all know an excessive amount of. Exterior the few leak consultants on the market, who’re fortunately coaching medical doctors typically, this dance continues. It’s exhausting to dwell in ache and to lose your mobility and a lot extra, however add the suspicion and disbelief to the combination and it drags your soul all the way down to the bottom.

As a result of regardless of the advocacy, regardless of the schooling, the myths persist.

Exterior the leak consultants, sufferers report that medical doctors nonetheless assume a lumbar puncture leak is “self-limiting” (i.e., that it goes away by itself — I want!). Many nonetheless doubt the existence of spontaneous intracranial hypotension (SIH), the place a leak can happen abruptly; this may be because of a bone spur or calcified disc gnawing into the dura til it tears, or a coughing match, or lifting heavy weights, or one thing else being the final straw for a weak point within the dura mater the affected person wasn’t conscious of. And a extra recently-discovered sort of leak, a CSF-venous fistula, will be elusive on present imaging varieties, although a more recent photon counting CT machine is recognizing them extra often. Canada doesn’t have one, and the US solely has a number of.

The brutality of this situation is tough to precisely put into phrases. Not solely the ache itself however the uncertainty and uphill battle in getting care. It’s generally misdiagnosed and under-diagnosed. The psychological well being burden can also be important: a top quality of life examine in spinal CSF leak sufferers from 2023 discovered that over half of the respondents (64.2%) endorsed suicidality, and 22.4% had demonstrated suicidal behaviour. A 2024 examine about high quality of life in power put up puncture sufferers (like me) discovered substantial psychological well being challenges with melancholy, anxiousness and stress skilled by 83%, 98%, and 88% of the respondents, respectively.

It’s like a giant cosmic joke, “hey, there’s a situation that always doesn’t present on imaging, the place specialised imaging additionally entails making a brand new gap within the dura mater to search for the unique leak, the place the overwhelming majority of medical college students don’t study specifics of SIH or long-term puncture leaks in in present med college curricula, and the place we will’t but work out why power sufferers have a extremely onerous time getting sealed and typically find yourself with new leaks after therapy.”

***

August 2024 marks 7 years of leaking for me.

In these very troublesome intervening years, I’ve discovered numerous issues about myself, and about my physique. Concerning the illusions of security I used to have. About how life simply isn’t truthful.

The half that hits hardest has at all times been that stability looks like an phantasm. It’s so tenuous. Moments the place I get respite from the ache are so few and much between, however with frequent anaphylaxis and extreme MCAS within the combine, it looks like the sting of that knife is so skinny. I typically joke that I’m in mattress now, however we are going to all be in mattress finally as we age. I simply obtained there first. Beneath the humour is the data that Connie’s story is unfortunately not the exception. That there are different sufferers barely hanging on as they watch for science to evolve and be capable to deliver them lasting reduction.

Daily, my inbox is filled with sufferers who can’t get therapy for his or her spinal CSF leaks. Docs who snort at them for asking for atraumatic needles for a lumbar puncture, regardless of research exhibiting it makes a big distinction in reducing the chance of a post-puncture spinal CSF leak. Households who say that their youngsters or siblings or spouses are faking it, that they’re “simply lazy”, that they simply “don’t wish to be higher”.

Present me a chronically unwell individual, in fixed ache, who doesn’t wish to get higher?! In the event that they’re on the market, they’re a rarity. Each affected person I do know, and I do know many because of my public platforms, is like Connie: advocating fiercely, organizing effectively, maintaining hope as greatest they’ll, and desperately eager to get nicely.

I haven’t gone again for therapy as a result of repairs don’t maintain for me. I’ve complicating elements like MCAS and adhesive arachnoiditis that make outcomes extra dangerous and fewer healing than the typical affected person. However that that doesn’t imply I’ve given up. I’ve stated it earlier than: acceptance doesn’t imply you’ve given up. Like Connie, I’ve a lot to be thankful for. However even acceptance, even discovering pleasure once more, isn’t sufficient to eclipse unrelenting ache. Fortunately, I’m not within the type of ache Connie was in, and by sharing all of this I’m not making an attempt to make her loss of life about me. It’s extra that her passing feels prefer it might have been any of us on this tight knit neighborhood. I respect her selection, and I’m additionally heartbroken that she was backed right into a nook by her ache and felt like she needed to make it.

This put up isn’t my typical, I do know. I’m indignant. I’m devastated. And it’s lit a hearth underneath me to proceed my advocacy work as a lot as my physique permits. Folks typically ask why I’m so concerned with the Spinal CSF Leak Basis within the US, because it’s unpaid and I’ve my very own enterprise to run. (I’m now the Vice-President of the Board). Advocacy is why. Connie is why. Connie, and different sufferers like her. Different sufferers like me. For these of us who’re power, the place repairs don’t maintain, who’re additionally ready and hoping. For the sufferers who can’t get to care as a result of they don’t have medical doctors who know leaks of their areas. For many who want sources to assist their households to know.

In supporting the Basis, and dealing with sister nonprofit organizations in Canada and the UK, I can hopefully result in extra change than I can do as one author with a leak.

I’ve been which means to share all of those ideas since I discovered of Connie’s passing earlier this month, but it surely truthfully messed me up an excessive amount of to place phrases to paper. At present marks the start of duradash®, although, and I’m fundraising for spinal CSF leak analysis. So I believed it was an excellent day to share, and to try to mud myself off and preserve persisting. What else can I do however try to transmute my rage and my grief about Connie’s loss of life and the unfairness of all of it into one thing that may transfer the needle on all of this mess?

In August 2017, I knew nothing about spinal CSF, nothing about leaks apart from those in water pipes, and nothing about needle varieties or gauge. I had by no means heard of the dura mater. Years later, there’s rather a lot I want I knew then, however all I can do is preserve writing and sharing, elevating funds for the trigger, and hopefully assist another person get care prior to I might.

I’ll at all times be grateful to Connie for her fierce dedication and need to coach others it doesn’t matter what she was going by.

Since I sustained my leak 7 years in the past, there was numerous progress and analysis and advances within the area.

Dropping Connie exhibits us how we’ve got a lot farther to go. 💔

Jodi ettenbergJodi ettenberg

In case you’d wish to assist me in elevating funds for spinal CSF leak analysis, please see my duradash® marketing campaign web page right here. I set a purpose of $1000 however have already eclipsed it because of my Instagram neighborhood; I shall be upping the purpose to $2000 later this week. The two-week fundraiser will finish June eighth, 2024.

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