Having an invisible illness seems to lead to other invisible illnesses.
I have fibromyalgia. I also have IBS / Crohn's Disease. As my fibromyalgia was diagnosed first I assume that the anxiety and stress that placed on me, both at home and in my work, led to the turmoil in my guts. And it's been that way ever since.
Almost thirteen years have passed since I was first diagnosed with fibromyalgia and, in that time, I cannot remember a day when I didn't have symptoms from it. Of course it ranged from mild to moderate, moderate to severe, but always there. After four years of constant pain I eventually began to experience symptoms of IBS which, I assumed, were related to the lower back pain and I instantly thought I had cancer. After many weeks of putting it off I eventually went to see my GP and after a few more tests I was diagnosed as having Crohn's Disease an incurable inflammatory bowel disease. Oddly all tests since initial diagnosis have shown no inflammation so my gastroenterologist has 'downgraded' my condition to Irritable Bowel Syndrome - but it affects me no less because of this downgrading!
So, having lived with chronic pain for almost thirteen years and bowel disturbances for the past eight and a half years, I thought I'd had my quota of 'invisible' illnesses but it appears that I was wrong. For the Gods have decided to test me, yet again, to see how I cope with another layer of invisibility.
This new invisible illness came out of nowhere - as did the other two - but rather than hit me with symptoms all of a sudden - fine one minute, stricken the next - this cloak of invisibility crept up on me over a period of about two weeks. I'm talking about depression.
Obviously, when you live with chronic pain 24/7 for 365 days a year you're going to have times when you feel a little down and fed up with yourself. I've experienced times like that before but I've always snapped out of it fairly quickly and resumed as "normal" a life as I could under the circumstances.
But this depression has gone much deeper than my previous bouts of 'fed-uppedness' (if that's a word?) This depression has really knocked me for six. This depression has been the most invisible of all of my invisible illnesses - with fibro and IBS my family and work colleagues can see me physically wincing with pain or running off to the loo or holding my guts - sometimes they can hear my symptoms too, so as far as invisibility goes they're somewhat apparent to the outside world.
Depression is a whole new ball of wax. Externally there is nothing to see. I laugh at funny TV shows, I act the fool and joke around at home and make pleasantries with my customers and colleagues at work. My face and body show no outward signs of being ill.
In my head I want to explode. I want to shout at people who annoy me - the ignorant customers who don't say please and thank you when I have to fawn over them like they were royalty, the stupid ones who change their mind halfway through a transaction or wander off to get something else leaving me with a growing queue. I want to curl up into a little ball and hide away instead of facing these people. At home I join in because I have an obligation to do so, not always because I want to. I'm short tempered with the ones I love most and I hate myself even more because of it - and so it builds up and up and up until, one day, I know it surely must explode. Yet all the time I fight it so that, externally, my face looks 'real' and 'normal' just as I've tried to hide my chronic pain and gut turbulence for so many years. I try to be a valued member of society but I value myself less and less each day - I feel unworthy of praise, of love, of life itself. Things I love to do are being abandoned - art, drawing, photography, cooking for my family all feel like the most arduous of chores now whereas, six weeks ago, they were my life.
Depression is the most heinous of invisible diseases because there isn't a scrap of evidence of its existence. It's all in my head. I should snap out of it. I should think positively. It could be worse. I could be paraplegic - all the things we're told never to say to someone with depression I've told them to myself over and over again - and it's right they are definitely the wrong things to say to someone with depression because I can't snap out of it, or think positively and it couldn't be worse (surely) and I'm sure most paraplegics feel the joy of life sometimes and I know it's all in my head because it's a mental illness, to do with the brain, which is found, in most people, in the head!
I have not, as yet sought treatment for this depression, prefering to try and fight it myself - but I think I'm losing the battle. My reasons for not seeking treatment are that my GP thinks I'm a malingerer already and I'm worried about the side effects any medication might have on my already feeble guts. I know in my heart what I need to do - I've told many people in my position in the past to get treatment as soon as possible so I'm going to have to bite the bullet........ before I take a bullet.
It seems that every drug prescribed to me by my GP has little or no effect on my pain. So far this year I have had Gabapentin, Pregabalin, Cocodamol, Naproxen and the latest one Nefopam, none of which make any dent in my pain and all of which have given me more grief than benefit.
My fibromyalgia affects my lower to middle back, elbows, hips and knees, and pain from this is exacerbated by my crohn's disease / IBS symptoms. In a last ditch attempt at finding a treatment that works, before referring me to a pain management specialist, my GP decided to try me on Nefopam 30mg x 2 three times a day. I started them last Wednesday, it is now Sunday. On Friday I had to rearrange a work shift which was due to start at 05:45am to 11:30am as I had experienced extreme abdominal spasms and diarrhoea throughout Thursday. The spasms hadn't diminished by the time I started work, so my six hour shift was spent in total anxiety of another attack. When they came, thankfully, they were bearable.
Firday night I slept fitfully and was wide awake at 03:25 I got up to visit the toilet at 05:30 and found that I couldn't urinate. I stood for a few minutes, absolutely bursting to go and when it eventually came it was like the pressure valve had been reduced to a slow. burning, trickle. It's still the same today, plus I have a headache - something I rarely get, but when I do I don't do them by halves! It's a stonker! Last night I got only two hours sleep.
So, they have been the side effects of Nefopam, but what about the benefits I hear you scream. Well, there haven't been any benefits except to say that my abdominal cramps have diminished to a mild burning every so often, but I'm putting that down to Buscopan rather than Nefopam.
My GP said that a referral to a pain management specialist was an admission by him that he could do no more for me and that pain management would provide only 'palliative care' ( I thought that term referred to terminal patients only, but perhaps that's what he meant!? ) I felt like saying he'd done nothing for me anyway, but thought better of it.
And so I find myself back to square one on this snakes and ladders game of Fibromyalgia. I'm taking no more of the Nefopam as they've made me feel awful. I'll make do with cocodamol and my TENS Unit until my pain management appointment comes through .
Of all the many symptoms of fibromyalgia I find the upset bowels and digestion problems the most debilitating.
I have pain constantly and, over the years, I've learned to live with or manage it in my own way, but the crohn's disease I find the most frustrating and soul destroying symptom of my auto-immune system failings.
The fact that it can turn itself on and off in the blink of an eye - so I go from normal, healthy, quiet gut at 9am to full blown diarrhoea and painful flatulence at 9.45am then back again by 6pm, or not, depending on how long it wants me to suffer.
There's no predicting it. There's no eating or avoiding certain foods (in my experience) There's no rhyme or reason to it. It just starts, last a few hours or a few days, then stops and comes back a few days later or a few weeks later or, if I'm exceptionally unlucky, a few hours later! It can take the form of painful bloating and acid reflux, or painful bloating, acid reflux, nausea, diarrhoea, stomach and arse cramping, excessive wind, ultra-urgent diarrhoea or constipation, or a combination of all of these!
It's the unpredictability of crohn's that upsets me the most. I can predict when and how my pain is going to affect me - because it's there all the time and I "just get on with it."
But the crohn's is 'quite literally' a pain in the arse in its unpredictability. Of all my conditions it's the one that makes me the most anxious, the one that gets me wound up to the point of raving maniac and the one that controls how my life is lived because at the slightest hint of a flare I batten down the hatches and all other activities stop and, as a result, it's the one that affects my family the most too.
I mentioned a while back in this blog that I was on Pregabalin (300mg twice daily) - well, I started to get an unwanted side-effect: extreme dizziness, which was making working and even standing up unpleasant and/or uncomfortable so three days ago my doctor switched me onto Gabapentin (100mg three times daily) and as soon as I started taking them I started to get the symptoms of a flare up of my Crohn's Disease. Horrendous stomach cramps, diarrhoea and nausea, and last night I thought I was going to have to go to the hospital because of them.
I'd managed to get through the day in relative discomfort and in the evening had (just about) managed to get through my shift at work - though I was clearly under-par, I got home at 11.30pm and went to bed but couldn't sleep because of the pains inside. At 3am I was on the toilet trying desperately not to pass out. The pain in my gut was unlike anything I'd had before. I was considering calling an ambulance when it dawned on me - could it be the new tablets?
I don't usually read info leaflets in tablets and in any case there hadn't been one with these new ones, but the pains were so bad I had to know if there was a link so I searched "side effects of Gabapentin" This is what I found:
Common: More than 1 in 100 people who take Gabapentin
- abnormal gait
- abnormal laboratory test results
- abrasion
- accidental injury more likely
- acne
- back pain
- blood and bone marrow problems
- breathing difficulties
- bronchitis in children
- changes in appetite
- confusion
- constipation
- convulsions in children
- coordination problems
- cough
- depression
- diarrhoea
- difficulty sleeping
- double vision
- dry mouth or throat
- eye or eyesight problems
- feeling anxious
- feeling nervous
- feelings of hostility
- flatulence
- flu or flu-like symptoms
- fractures
- general feeling of being unwell
- headaches
- hyperactivity or aggressive behaviour in children
- impotence
- indigestion
- infection of the ear in children
- inflammation of the gums
- itching
- joint pain
- memory problems
- mood changes
- muscle twitching
- muscle pain or tenderness
- nausea
- oedema of the extremities
- pain
- pharyngitis
- raised blood pressure
- reflex problems
- respiratory tract infection in children
- rhinitis
- sensation changes such as paraesthesia and hypaesthesia
- skin rash or rashes
- speech problems
- stomach pain
- swelling of the face
- tooth problems
- tremors
- unexplained or unexpected bruising
- unusual thoughts
- vasodilatation
- vertigo
- vomiting
- weakness
- weight gain
(I've highlighted every side effect I experienced during the last 48 hours)
The stomach pains, flatulence and diarrhoea still haven't subsided and I've vowed to myself to never take another Gabapentin. So it looks like another consultation with the quack when I can drag myself away from the toilet! Looks like I'm going to have to manage with just cocodamol for the time being.
