Monday, February 26, 2024

Connecting the Dots: My Persistent Ache Defined

It’s been awhile, and although I do share tidbits extra regularly on social media and by way of my publication, I wished to do a full write up of what has been occurring. I haven’t revealed a weblog submit since April, so this can be a lengthy overdue replace. It shares some thrilling skilled information, but in addition the private because it pertains to my well being.

This neighborhood has been an enormous a part of what has stored me afloat throughout the previous few, tough years. With my restricted bandwidth as a result of ongoing spinal cerebrospinal (CSF) leak, I’ve needed to minimize out among the work I need to do. The weblog was placed on hiatus first, as a result of updating on social media (primarily Instagram) is faster and fewer labour intensive.

However whereas I’ve not been placing out new posts right here, I’ve spent many hours updating the backend of the web site, and dealing on various different issues that I wished to share. I’ve additionally seen specialists and discovered extra about my physique, sufficient that that info sheds a really totally different gentle on the a few years of continual ache I endured previous to my CSF leak.

It has taken time to course of the thread that now connects dots I by no means thought to attach, and I wished to maintain my neighborhood up to date.

Private Updates

A number of updates about how I’m feeling, these linked dots, and the place I’m dwelling.

Transferring to Gatineau, Quebec and Dwelling Semi-Independently

Since Might, I’ve been dwelling in Gatineau, throughout the river from Ottawa. My brother lives in Ottawa, and my plan is to ultimately transfer there as nicely. For now, although, Gatineau has been a beautiful center floor. I bought to spend a summer time wandering all the way down to the water, seeing my household, and studying how you can reside largely alone, with a leak.

Gatineau Quebec
Unfiltered / unedited photograph from a sundown over the Ottawa River, taken from the Gatineau facet.

My brother and his associate come over as soon as every week to assist with issues I can’t do, like getting groceries for me, and doing my laundry and my vacuuming. I’m fortunate that I’ve them to choose up the slack that my leak steals away, and I’ll by no means complain about getting extra time with individuals I really like a lot.

At first, adjusting to the condominium felt actually deflating. There have been many issues that I couldn’t attain, or use. The mattress was too low and really painful to get out and in of. The freezer was a drawer underneath the fridge, so I couldn’t open it with out making my CSF leak worse. The dishes and pots had been too heavy for me to scrub myself, or use comfortably. The record went on.

These are fixable issues, after all. I bought a mattress pad, a tiny freezer, and new light-weight dishes and a small pot to make use of, thanks in no small half to the Amazon present playing cards you bought me for my birthday.

However the preliminary weeks right here felt actually deflating. As people we’re so good at adjusting. Generally too good, and we neglect the place we actually are. The angle I misplaced was that I’m really extra disabled than I remembered, one thing that hit me laborious once I moved into this condominium.

Like anything, adjusting to this new life has its ups and downs, and ultimately I bought previous the frustration and began strategizing methods to repair the issues I used to be dealing with. I additionally bought a kitchen rolling cart, a lot of canvas storage bins since every thing has to sit down on counters to be reachable for me, and some different issues that make the place extra snug.

I used to be by no means positive if I’d even have the ability to reside independently once more. So whereas there’s a lot I want I might do, I’m very grateful that I’m able to have extra autonomy after years of being so depending on others for each little factor.

jodi ettenberg gatineau quebec
It’s 3.5 km to the Ottawa River and again, and I’m past grateful that I’m able to stroll there when my physique permits.

Spinal CSF Leak Standing

As I discussed, my spinal CSF leak remains to be lively. However my physique both appears to have produced extra CSF, giving me some further “uptime”, or it has gotten barely higher. I did have a whopper of a setback earlier than my birthday in August, however finally I’ve come again to baseline once more. That baseline now’s higher than it was final yr right now. I get round 5-6 hours of standing time a day, with many breaks to lie down in between.

The web of that uptime is that I’m able to put some additional work in, and I’ve thus divvied up my hours towards among the tasks beneath. I’ve additionally been in a position to deal with longer walks, which at all times helps raise the spirits.

A proportion of that uptime goes towards the requirements of life, since I’m dwelling alone. Doing my very own dishes, making ready my very own meals—all of it takes effort and time, and ache. However it’s been great, and peaceable, and like rediscovering myself once more.

My life does stay very small, and an “thrilling” day for me is once I go for a barely longer stroll than traditional, or make some progress in different methods. Like final month, once I was in a position to go and get take-out meals at a restaurant on my own, for the primary time in a few years. It’s not anyplace close to the depth of the life I used to steer, nevertheless it stays greater than I believed I’d have the ability to claw again.

The little issues are what I now rejoice. And I’m fortunate to have others right here to rejoice with me.

Offended Mast Cells

I lately completed a really lengthy mast cell activation dysfunction web page. Nicely, for now it’s completed! I replace it when new research or analysis comes out.

mast cell activation syndrome symptoms and treatment
Mast cells!

Lots of you know the way powerful the final years have been by way of reactivity to meals, environments, and different unusual new triggers—like daylight. A few of these points began after I bought sick in 2013, however I really had a few years as a baby the place I might cough and itch whereas attempting to sleep. This went away once I hit puberty, and remained largely in repose till 2013. Then, when a lumbar puncture gave me a CSF leak, the sleeplessness, itchiness, tickling in my throat and extra got here again, along with many new points. This culminated in my going into anaphylaxis on the desk throughout my closing spherical of blood patching.

Ever since, I’ve been struggling to stabilize and calm my immune system. I began studying about mast cells as a result of different CSF leakers with complicated instances additionally appeared to have this problem. It was a fellow leaker who steered I look into it initially.

From the web page I wrote:

Mast cells are “sentinels” of the immune system, a kind of white blood cell that helps management the immune processes within the physique. They’re referred to as resident immune cells as a result of they reside in tissues and never in our bloodstream. They usually reside in tissues everywhere in the physique, from the connective tissue, to the endothelial cells, to the epithelial cells, and even within the mind.

Over time, I stored an enormous folder of notes, research, and protocols and whittled down my very own self-experimentation to one thing that has labored. I used to be in a position to self-refer to a specialist exterior of Canada (fortunately my world journey insurance coverage lined the lab work wanted to check for it, however not the specialist appointments themselves), and journey to the US to do the required testing.

Testing confirmed that I do, in reality, have this dysfunction. It’s a doozy, and it impacts each facet of my day-to-day life, along with the leak. I went from consuming tons of road meals and touring the world, to going into anaphylaxis with sure smells, meals, or insect stings.

Given how many individuals have written me through the years with unusual reactions, hives, thick sticky blood, bone ache, rashes, itching, complications, and far more, I wished to share the sources web page as a result of it goes into signs brought on by every of the programs affected by mast cells when they’re dysfunctional.

As well as, the prevalence of long-covid through the pandemic is related. Anecdotally, a lot of you wrote in to say that you just’ve been recognized with a mast cell dysfunction following a COVID-19 an infection. This matches among the literature, however analysis is ongoing on this space. Not less than one mast cell specialist agrees. It’s additionally much like what occurred after I bought sick in 2013.

Given these numbers, I wished to verify I had a useful resource web page for these of you with lengthy covid, too. It has felt so bewildering to handle and deal with this very erratic situation and I understand how exhausting it may be to have a look at the scads of very contradictory info on-line and attempt to make sense of it.

Whereas I’m clearly not a medical physician, nor do I play one on TV, I hope my analysis notes will assist sufferers navigate this difficult illness.

Wonky Connective Tissue

One other thriller solved. It seems that I additionally have a genetic situation that impacts my connective tissue. It’s referred to as Ehlers-Danlos Syndrome (EDS), of which there are totally different subtypes. Based on the geneticist I noticed, I’ve the hypermobile kind (referred to as hEDS), the subtype the place the gene has not but been discovered. Analysis is thus made primarily based on medical findings.

Approach again once I began writing about this spinal faucet and what occurred thereafter, I mentioned that the sufferers that had connective tissue issues had been those who appeared to have the worst outcomes.

Sadly I’m in that boat.

The geneticist confirmed that disparate points I by no means would have thought to attach all lead again to my collagen synthesis. And that the worsening expression of this situation additionally explains the years of continual ache since I bought sick in 2013. (Apparently it’s additionally why I look so younger, although the remainder of my physique feels prefer it’s 90 years previous.)

My appointment with the geneticist was an awesome one. For starters, she was shocked by the pressure of what I put my physique via throughout my a few years of journey. She informed me she was shocked it took so lengthy for every thing to actually collapse. She confirmed that in a few of her sufferers, getting a foul virus can worsen the underlying collagen points, which dovetails with the adjustments in my physique and pores and skin after I bought sick in 2013.

However even earlier than then, there have been so many unusual quirks that ran in components of my household however didn’t appear to have an effect on my pals. These included how my ligaments simply tore, how I had delayed wound therapeutic, how my pores and skin was delicate and velvety and skinny, how versatile I used to be, the truth that native anesthetics don’t work for me—and extra.

This final issue was additionally why my spinal faucet was so excruciatingly painful.

Previous to the lumbar puncture, any issues I raised to medical doctors about my rising ache ranges or easily-obtained accidents had been merely dismissed as “stress.” This minimization or ignoring of signs isn’t new, however is widespread. Says geneticist Dr. Clair Francomano,

“Lots of people hear that it’s all of their head, and that there is no such thing as a physiologic foundation for his or her signs,” Francomano mentioned. “Significantly in the event that they’re healthy-looking younger ladies, sadly there’s a tendency to dismiss their expertise.”

Through STAT Journal, “On a regular basis bumps injured her joints, however discovering the rationale took half a century

For me, the analysis was validating. The stretchy pores and skin and painful joints and a lot extra made sense. As does celiac illness and the mast cell points. A 2021 case management report discovered that celiac illness was one of many most typical gastrointestinal situations related to EDS, and the affiliation was a lot stronger than in controls. And a special 2021 evaluation discovered that in hospitalized sufferers with MCAS, 1 in 3 had a comorbid analysis of hEDS.

However it was additionally deflating. Connective tissue dysfunction sufferers appear to be those the place the leak repairs don’t maintain. In my years within the CSF leak teams, these of us with wonky tissues are those who blow out new leaks and/or have their previous ones re-open regularly, even with surgical procedure. This info is a part of why I’ve been so conservative about pursuing additional procedures.

The analysis additionally hit me laborious for one more motive: all through my life, I joked that I used to be scrappy “regardless that my physique hated me”. I’d say issues like, “oh I used to be constructed from the faulty components of different individuals!” My ex used to say I used to be constructed with no warranties (sure, as attorneys we thought this was humorous). However the fact was the other. Not realizing I used to be a canary in a coal mine, I put my physique via a lot. I pushed myself to the brink many occasions. I stubbornly stored touring even once I bought regularly sick. Even once I handled years of continual ache. 

And all through I used to be mad.

Mad at my physique, mad at my exhaustion, mad that I couldn’t be “regular” like everybody else. 

Why did I at all times get damage? Or sick? Or exhausted?

Now I’ve my reply. All these years once I was mad at my physique, I ought to have been happy with it. Regardless of these underlying issues I didn’t know, it allowed me to see the world intensely for a decade. 

Now I do know. 

Enterprise Updates

Among the tasks I’ve been engaged on within the months since I final revealed.

Sharing Sources about Ache on Patreon

I created the Patreon as a strategy to settle for help from this neighborhood, however it’s slowly morphing into a spot the place I additionally share sources for people who find themselves struggling for continual ache, or those that know somebody who’s in ache.

The unhappy actuality is that the majority of us are in a type of two classes.

Over time, I’ve acquired many questions on how I’ve coped with my very own ache ranges. Now, I’m getting questions on how somebody can help an individual in ache. So the Patreon’s AMAs are a spot the place I reply these questions, and add further sources.

The posts I’ve shared there additionally go into how I made the condominium I’m in accessible, and what adjustments to the setup allowed me to deal with dwelling alone with the disabilities I now have. Most lately, as generally individuals really feel dangerous about asking for assist or accepting assist, somebody requested me to speak about how you can speak to somebody in ache to assist them get help if they’re cussed. (I’ll be answering this within the subsequent AMA).

From suggestions up to now, these have been actually helpful. I sit up for sharing extra.

Additionally, I’m now a Patreon ambassador! I bought an electronic mail from them in the summertime, asking if I’d be concerned with making use of for an ambassadorship programme they had been constructing. I’m one in all a small group of creators (out of their 200,000 customers) who had been accepted.

It’s nonetheless fairly new, and so far it’s been beautiful to fulfill some actually fascinating, tremendous creative individuals. The ambassadorship is unpaid, however options workshop—I’ve attended a number of up to now—and rewarding breakout rooms with others within the programme to share methods and issues/successes. Different perks embody 1:1 product help, social media options, enjoyable swag for my Patreon neighborhood, in addition to paid alternatives to take part in issues like product focus teams or artistic collaborations with their group.

I don’t know the way they discovered me, and it’s intimidating as a result of lots of the different creators have upwards of 2000 Patrons, however I’m trying ahead to taking part! Provided that it was all of you who requested me to start out a Patreon, I’ve this neighborhood to thank!

In case you’re concerned with becoming a member of the Patreon neighborhood, you are able to do so right here.

A One-Time Help Possibility

After I launched my Patreon, I acquired messages from readers who wished to contribute and/or help me in my work by way of a one-time fee. I didn’t have that in place, however do now.

The Curious About Every part Publication

Regardless of all this pleasure of transferring to a brand new place, I’ve managed to maintain my publication working. I’ve been taking part in round with format (and emojis, I can’t assist myself), and primarily spotlighting a number of essential reads every month, together with extra enjoyable photo-essays and quirky items I discover. I generally embody private updates, however the focus of the publication is on gifted and/or essential writing value studying.

Whereas it’s on Substack, and lots of writers have moved to a paid publication mannequin, I don’t plan to take action. The Patreon is the first help system for my revenue, alongside celiac playing cards and the meals maps store. The publication I plan to maintain free.

Even when this website has been extra dormant than I would really like, I really feel comfortable that CAE has gone out each month for the final 11 months.

You may join beneath in case you are concerned with receiving it.

A Massive Piece about Psychological Mindset (Coming Quickly)

I had a submit referred to as Easy methods to Get By way of Horrible Occasions that I had on this website, however I’ve quickly taken it down as I deliberate to publish it individually. However it, and Instagram posts about resilience and reframing, caught the eye of an editor at an enormous outlet, who commissioned a chunk about how I discovered pleasure once more regardless of my restricted life.

I’ve been engaged on this piece over the past whereas and it’s nonetheless in modifying, however I’m excited to share it right here together with the republication of the Horrible Occasions piece.

Redesign of Authorized Nomads:

You could have observed that the location is a bit of totally different!

Arthur the raven, my mascot, may be very outstanding. Ravens are such extremely curious birds, and I selected one as my website’s throughline so as to spotlight that I nonetheless am too, albeit otherwise to earlier than.

arthur the raven legal nomads

And, a brand new slogan: interested in every thing. I’m not telling tales via meals, in order that slogan needed to go. The brand new emblem displays a divergence from my prior lifetime of journey and meals, but in addition the reality of who I at all times was: somebody who wished to study as a lot as potential.

I began to really feel actually dissonant once I regarded on the ‘previous’ Authorized Nomads, so this displays extra of the place I’m in life whereas nonetheless sustaining an analogous construction.

I’ve added well being and continual ache to the primary classes on the house web page, too, since they’re now an even bigger a part of what I write about.

I had actually particular concepts of what I wished, in order with the final redesign to the location I offered the belongings (new logos, Arthur the Raven, and so forth.) to an internet developer as a substitute of hiring somebody who did branding in addition to improvement. The belongings had been inked by my artist-in-Authorized-Nomadsness Ella F. Sanders. The redesign was executed by an internet developer who works for fellow journey blogger Mike’s internet improvement firm. Whereas her work was paid, he donated his personal time professional bono to assist supervise the undertaking.

Submit Overhauls and Web page Updates:

My morning routine is to rise up, make espresso, after which do some work on the web site till I must take a break.

This has allowed me to slowly replace pages and posts over time, and hold Authorized Nomads extra present.

Amongst them:

  • The gluten free guides are up to date for 2021. They’re right here.
  • The gluten free New York Metropolis information has additionally been up to date to replicate restaurant closures and a few newcomers to the scene which might be 100% gluten free.
  • I added a historical past of Belize part, and a “the place is Belize positioned” part, as a result of consider it or not that’s the commonest search time period for this submit. It’s additionally bought COVID-19 guidelines for visiting, when you had been selecting to threat going now.
  • I up to date the Vietnamese Egg Espresso Recipe with locations to get it in North America, and new items and movies concerning the candy deal with.
  • I up to date my piece on sleep points and jet lag with details about how you can sleep higher, and new research about chronomedicine and Covid-19.
  • I up to date my Vipassana Meditation retreat expertise with some new knowledge concerning the risks of these sorts of retreats, and the way in some instances they’ll result in a psychological break.
  • The Various Careers for Legal professionals web page has been up to date to incorporate pandemic info, the rise of consultants within the authorized area, and a extra clear breakdown of how you can go about shifting careers once you really feel overwhelmed fascinated by how to take action.
  • In November 2021, I up to date my historical past of chili peppers submit to incorporate the 2021 Nobel Prize profitable analysis on capsaicin, somatosensory receptors, and ache.

RSS-to-E-mail Adjustments: Feedburner is not any extra. RIP Feedburner.

Google has been threatening to chop RSS-to-email choices for Feedburner for a few years. The service was deprecated years in the past, and this July they lastly mentioned that they had been executed supporting that possibility. So I had to determine what service to make use of so as to get these individuals their emails. (Since I barely write right here, I had a lot of time to do that!)

For these of you who opted to obtain Authorized Nomads updates by way of electronic mail, new posts can be despatched by an organization referred to as ConvertKit. I used to be planning on switching to them proper earlier than my CSF leak occurred, so it solely took me an additional few years. My pal Nathan began the corporate and is a very beautiful human being; I’d a lot fairly give my cash to gifted pals than strangers!

In case you’re not getting Authorized Nomads by way of electronic mail, you’ll be able to join by way of the shape beneath. That is only for LN posts (about each six months, by way of publishing schedule as of late!). My month-to-month publication above is separate.

In case you had been already subscribed to get Authorized Nomads posts by electronic mail, you do not want to do something. I wished to clarify why the emails look totally different, and let everybody know they’ll additionally join that means if they like.

That’s it for now!

Whereas the ache I’m in by no means goes away, these tasks and my newfound autonomy have helped make these previous few months among the finest in years. I might not be cellular or touring the world anymore, however I consider that I’m in a position to assist extra individuals than ever earlier than.

Whether or not it’s serving to navigate powerful occasions, understanding ache and loss, or simply giving extra context to the diseases of family members, this work feels helpful.

And feeling helpful goes a good distance towards life satisfaction for me.

Thanks for permitting me to share this journey with you.

Till subsequent time,

Edited so as to add: I acquired a number of messages saying I’m fortunate to reside in Canada as a result of I might simply see specialists. Sure, I really like Canada, however that’s not what occurred. Canada’s system is nice when you’ve gotten a standard, costly illness. You’ll not go bankrupt attributable to medical care when getting therapy for most cancers, for instance. However entry to specialist care, particularly for uncommon ailments, may be very tough. I’ve additionally been in Quebec for a very long time and nonetheless wouldn’t have a main care doctor, as a result of the waits are so lengthy. I can thus not get a referral to a specialist.

With a view to see these specialists, together with throughout my time at Duke, I needed to struggle laborious to get care. I believe among the expertise you study touring long run apply right here, too; when a path to getting from A to B is not potential, you begin to search for different, artistic connections between them.

For me, this meant self-referring to the mast cell specialist and to the geneticist, nevertheless it took a very long time to make it occur. Concurrently, I stored attempting to go by way of the standard route right here in Canada. I’m privileged that my world medical plan I used on my travels lined a few of these appointments.

The medical programs in each international locations have their issues, and their advantages. I discovered it tough to navigate as I sought out these solutions, nevertheless it took my determining that these situations matched what was occurring, then attending to specialists to see if these theories had been appropriate. I in any other case wouldn’t have gotten care.

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