As the keen-eyed among you may have noticed, there was a distinct radio-silence from this end of the Blogosphere for a good three-month period at the end of last year, and I kind of want to explain why… It’s a little personal, perhaps a bit much for those of you who either don’t know me, or who aren’t particularly close to me, to read. So if you think you’d feel uncomfortable, I suggest you stop reading at this point. Those I consider closest to me already know this story, and many of them helped get me through an exceedingly rough patch, and I cannot thank them enough for that.
“Houston, we have a problem…”
Basically, I got first-person experience with several aspects of the Chilean healthcare system at the Clinica Alemana (apparently the second best private clinic in South America. And by private, I mean a place where the first place they deposit you is the cash register so that you can pay them… Not even kidding). To cut a VERY long story short, I had been having increasing problems during the year with eating, in that I started to feel difficulties with swallowing food. It was happening so subtly over such a long timescale, that it wasn’t until perhaps July that I eventually confessed to my Mum when I went back to the UK after the CoolStars conference in Barcelona, that there may perhaps be something not quite right. It wasn’t all food I had issues with, though, although the types of food I added to the list of ‘no-goes’ kept increasing as time went on. This naturally concerned me greatly, but still I couldn’t quite bring myself to think of it as a ‘problem’ that I should seek medical help for – after all, I wasn’t in any pain, it was just weird. It felt as though the food was catching in my throat every time I swallowed, and subsequently felt like I was going to choke on whatever I was eating at the time… Which to me just seemed completely ridiculous, and resulted in lots of “pull yourself together, Amy!” moments of frustration. But I started eating less and less, and getting more and more upset about that fact.
The worst bit was that I was still feeling hungry, I still *wanted* to eat… I just couldn’t! I started to become so stressed about the entire thing that I stopped eating in public entirely – I wouldn’t have lunch around anyone else in the office, I would turn down offers of meals out with my friends, and if I did summon up the courage to go out, I would try and force myself to eat something beforehand so that I had the excuse of “sorry, I’ve already eaten” should they comment on why I was turning down food (which they did, and which I was). My social life started to take a bit of a nose-dive, as I hid myself away in my apartment.
Then one evening, during my now-somewhat-limited dinner, I started to have a full-on panic attack as I was eating. Now, if you have ever had a proper panic attack, you’ll know about it. You literally feel like you are going to stop breathing and die, and that is not an exaggeration. I hadn’t had one before, and it was terrifying – my heart started racing, I started to hyperventilate, I got light-headed, dizzy, was trembling uncontrollably… I was in the apartment on my own and so terrified, that I ended up video-calling one of my closest friends on Skype so that he could just watch me to make sure I didn’t drop dead on the floor (at least, that’s what felt like was going to happen). It took a good 3 hours of him talking me down, and me pacing around the flat and on my balcony, for us to get my breathing back down to its regular level and for the shaking to stop, by which time I was completely physically and mentally exhausted. I think I slept for about an hour that night, convinced that if I stopped concentrating, I would stop breathing.
Food, glorious food…
“Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person’s life and may take days to initially recover from.”
Sadly, I can vouch for all of that! I had one other bad panic attack a few days later, and in between / after those two events, I just had an ever-present high level of anxiety. I felt so rotten, that I even stopped going into the office. And scarier still, the panic attacks put me off eating solid food completely, as it felt as though my entire throat would just close up and I couldn’t physically swallow any more. So, my work life and my social life really started to take a hit, and I couldn’t bring myself to eat anything that wasn’t in liquid form. I got very good very quickly at making soups and smoothies! But even eating that, my stress level would be through the roof when faced with whatever bowl of mush I had made myself that day. Just getting through something as simple as that was exhausting, and could take me up to an hour to finish one bowl of soup when I was at my worst.
A friend of mine suggested I keep a food diary, so that I could keep track of what I had during a given day and see any progress being made. Looking back at it now feels a little bizarre. You never expect to take a human function as basic as eating for granted! For example, on November 16th, I ate:
— 1 x pot greek yoghurt
— 1 litre homemade smoothie (with banana, mango, milk, and a nutrition powder I ended up taking 3 times a day to keep my calorie intake up)
— 1 x pot creme caramel
… And that was it. I followed similar menus most days between 29th October (when I started the diary) and 25th November (when things started to improve). It’s quite amazing that I had enough energy to even get out of bed in the morning, let alone do anything else. But, we are designed to adapt, and adapt I did. I eventually created some sort of food preparation/eating routine in my day, and just carried on with the mindset that “yes, I’m completely terrified at the moment, but this is the situation, there’s nothing that can be done about it right now, I just have to deal with it and get on with things.” Every time I managed to eat something more ‘textured’, it felt like a massive victory, and would give me a minor boost that perhaps there was an end to it… But the majority of the time, it felt like I was going to be stuck that way forever, and that scared the hell out of me.
But at any rate, after a few days of struggling on my own with feeling like utter crap and not eating anything (plus needing one of my friends to rush to my aid at 1am one morning during one panic attack), I admitted defeat and went to the A&E of the Clinica Alemana, the only way I could see a doctor.
I explained everything to the doctor on duty and she sent a psychiatrist to come and talk to me, as anxiety and panic is obviously a mental issue, rather than physical. So, after a bit of chat, he prescribed me both anti-anxiety meds to give immediate relief, and a very low dosage of an antidepressant just to try and balance me out again, and booked an appointment for me to go see another psychiatrist at the clinic a couple of weeks later. They also booked for me to have a consultation with a gastroenterologist to rule out any physical issues. Basically, they were telling me it was psychosomatic, it was all in my head.
So I took my plethora of drugs back home with me, and started on them straight away. Taking the anti-anxiety meds was perhaps just as horrible as not taking them, as it would basically just knock me out and make me completely useless… So again, I still couldn’t really deal with going into work. I was supposed to take half in the morning, half in the evening, but after a couple of weeks I just took it when I felt I needed it, as it was stopping me from functioning properly. I had the follow-up consultation booked with the clinical psychiatrist to see how the tablets were taking effect. There was zero difference in me in the (by now) three weeks since I went to the A&E, and he told me he had expected there to have been at least a little progress – again, not forgetting that he thought this was all psychosomatic. So, he started asking very probing questions about my past, my present, my relationships, my friendships… I found this all very uncomfortable, because I didn’t book in to do this, this was something I had been told to do (and I’ve had a couple of counselling sessions back home, so I know the difference in mindset between going voluntarily and just sitting there like a plonker). It also didn’t help that we were botching it by switching between English and Spanish all the time. So after a while, he crosses his arms, looks at me over his glasses, smiles softly at me, and says: “I think you’re depressed.” My reaction? “Umm… I am?!” Because I’d been feeling better in the past couple of months than I had done the rest of the year (aside from the not-eating thing, obviously!), so this didn’t add up in my head. His diagnosis was a condition called “dysphagia caused by globus pharyngis” (in English: difficulties in swallowing due to a psychosomatic ‘lump in the throat’). and basically told me that I “needed a good cry” to make it feel better. Umm… Right. He tells me to keep taking the anti-anxiety meds, ups the antidepressant to a whole tablet a day from a half, and asks me to email him in two weeks time to state any progress and how I feel. So I go home from that appointment feeling, a) a bit unfulfilled, and, b) generally a bit baffled by what I had just been told. If he had asked me 6 months earlier if I thought I was depressed, in all honesty, I would have said “yes” and quite happily have thrown some drugs down my throat to make it go away. But now? I wasn’t happy about this outcome at all. (I remember talking to Andrew about me thinking that it probably wasn’t necessary for me to be taking the antidepressants, to which he replied: “I think they should be issued to all PhD students as standard!!” – but that’s another topic of conversation!)
The Week of Hell (WoH)…
At the time, I dubbed the following week, the “Week of Hell (WoH)”. Starting on a Monday, about a week after the visit to the psychiatrist, I had to go for an endoscopy (as recommended by the A&E doctor). I had put off booking to have this done for almost a month, because the thought alone terrified me. “How shall we help the girl who can’t even swallow soup properly? I know, let’s shove a camera right down her windpipe and into her stomach!” Sounded like an awesome plan to me. So, with Dave coming with me to hold my hand (literally, at some points!), we went back to the clinic. Signing hospital disclaimers is always fun, especially when in a foreign language. But reading about the potential side effects did not help my nerves whatsoever! Eventually, I was whisked away by a nurse, who couldn’t speak any English, into a little room. I then had to sign another form to say that I agreed to be sedated (yes, please knock me out!!), and she assured me I wouldn’t really notice anything – I’d have some sort of consciousness so that (I guess) I could respond to instructions, but I wouldn’t remember anything. I was then told to lie on the bed while she jabbed a cannula into one arm to administer the sedative, stuck a blood-pressure cuff around the other, placed heart monitor pads on my chest, and hooked an oxygen tube around my face. I was so tangled up in wires that I couldn’t move even if I’d wanted to! She then sprayed a local anesthetic into the back of my throat then told me to swallow it, which made everything totally numb – that was quite a horrible sensation, as I couldn’t even feel myself breathe! I had to start laughing a bit at how rapidly the heart monitor was bleeping at this moment (to the point where one nurse said to the other in Spanish: “Is she alright..?” “Yeah, she’s just nervous!”). I was turned over onto my side, told to bite down on a mouth guard that they would feed the camera through, then injected with the sedative. It took about three injections to knock me out, as I was determined to make sure they wouldn’t start while there was a chance I was awake! But they were true to their word, and I was totally unaware (except for one extremely brief moment that must have been the point where the camera hit the back of my throat), until they wheeled me into the recovery room to sleep it off. After 30 mins, I was able to stagger out and be taken back home.
Two days later, I had a follow-up appointment with the gastroenterologist. He poked and prodded me for a while to see if he could feel any physical obstructions (he couldn’t), and took my weight… I had lost a full stone since moving to Chile 9 months earlier, without even trying. And there wasn’t much on me to begin with, so I felt like it was starting to show – indeed, looking back on some photos from that time now, I can see it. At any rate, after talking about my family’s medical history and such (my grandfather died of oesophageal cancer 4 years ago), and checking my endoscopy results (which all came back fine, thankfully), his diagnosis was the same as the psychiatrist. He booked me in for one last physical test: an x-ray with a Barium swallow, to trace how my body reacts when ingesting something. Seeing as though I’m currently studying Barium stars, I found this highly topical! Although I failed on my first attempt to go, because I got there and immediately felt really ill, like I was really light-headed and thought I was going to be sick – Dave told me that I just went as white as a sheet! No doubt it was just a culmination of all the pills I was popping, lack of sleep, lack of food, and general stress catching up with me. So we bailed, and booked a new appointment before we left. A few days later, I was back at the clinic for a second go (by this time, the receptionist at International Patients knows my face and my name by heart) of swallowing various disgusting things while funky pictures were taken. Even better, I was being imaged ‘live’, and could watch my skeleton swallow the bright white liquid and see it travel through my gooey insides on telly! I must admit, that was pretty cool, and I even got to keep the x-ray images afterwards.
Another appointment with the gastroenterologist was booked to go through the x-ray results, with the added bonus of this now all coinciding with my Dad visiting at the end of November. I had been in and out of this clinic for a month now, and I just wanted some sort of conclusion to it all to be able to do what I have to do, and get on with dealing with it. Even the duty nurse at the International Patients clinic was wishing for some resolution for me by this point! So I went along to my appointment, he looked at my films and the corresponding report from the radiographer. The difference this time being that they had actually found something…
At the point where your oesophagus meets your stomach, just behind the diaphragm, there is a muscle that helps prevent the back-flow of food and liquid once you have swallowed it. From all the things they made me ingest during the test, they discovered that this muscle has been weakened in me, and so it was causing stomach acid to go back up from my stomach into my oesophagus and cause inflammation. One of the symptoms of this is – you guessed it – difficulty in swallowing food. Words cannot describe the relief that flooded through me at that moment. I had never been so happy to be ‘sick’ in my entire life! I always knew in my head that all this trouble wasn’t psychosomatic, and now I had the proof in front of me. Of course, the stress and anxiety can exacerbate the condition, and the condition itself is not always symptomatic… So I could have had this problem for years, and just not known about it! It turns out that both my parents suffer from this, in fact, so it could well be genetic. I was prescribed a drug called omeprazol that stems the production of stomach acid, and told to take it every day for a month to allow my body to heal, then only take it when I feel the symptoms welling up in the future. Honest to god, this thing turned out to be like a miracle drug. Within a few days of taking it, I started to eat my first morsels of solid food again for the first time in almost 6 weeks, and by November 28th, I was tentatively trying my first full meal. It would still take me an unnaturally long time to get through it, but by god, I felt invincible! That first night after I got the new diagnosis, I sat down on my couch and just cried my heart out for about an hour. The sheer relief of there being light at the end of the tunnel was indescribable at that moment. All that bloody hard work to keep myself going on a daily basis had finally been worth it.
– – –
There are a couple of reasons I wanted to write such an open post. I was talking to Roger about writing this particular entry the other day, as I have been in two-minds as to whether I want to make it so public or not. He described it perfectly in a simple word: cathartic. Writing has always been a good release for me, even from a young age, and having been through a fairly traumatic time, I am treating the blog as my way of coming to terms with all of the emotional and physical craziness that I went through. I did learn a bit more about myself and my character during that time, which may not have happened otherwise. On top of that, it’s always such a relief to find out that you’re not the only person on the planet struggling with x,y or z, and is one of the many great advantages of e.g., internet forums – people coming together with similar problems, and helping people like me find comfort in the fact that things CAN get better. I can only hope that someone in a similar position stumbles upon this article, and takes something positive away from it.
The second reason I decided to go ahead with publishing it is simply this: depression and anxiety are absolutely nothing to be ashamed about. A shocking number of people suffer from one or the other (or both), as I found out on this journey, with so many saying to me “actually yeah, something similar happened to me”. Depression in particular is such a taboo subject and is a word that gets thrown around very casually (at least in the UK), that people can feel that they won’t be taken seriously should they bring it up. For many people who haven’t experienced it first hand in some way, either by being a sufferer themselves or by having a loved one go through it, it can be hard to understand (or at least relate to) what that person is going through, and can very easily generate thoughts towards that person along the lines of: “oh, just get over it, stop overreacting”. But to be on the inside of that, it can feel like you’re drowning in air with no hopes of rescue. It’s terrifying, and it feels never-ending… But that’s not an inevitability. Either you ‘heal’, or you learn mechanisms to cope with it on a daily basis… But it does get better. It’s just a matter of time.
I finish this (rather long) post by leaving you with this quote:
“Victory at all costs, victory in spite of all terror, victory however long and hard the road may be; for without victory there is no survival.”
– Winston Churchill.
Ne’er a truer word spoken.
Hasta la proxima,
(From a now-healthy) Amy