OpenHealth Q&A

Navigating the Challenges of Chronic Illness

I'm a 23-year-old female, standing 5’4” and weighing around 130 lbs, although I've recently lost 15 lbs due to my health issues. I don’t smoke, although I used to frequently use THC products. However, I decided to stop using them two months ago, recognizing that they could contribute to my ongoing problems. My medical history includes extensive eczema, TMJ discomfort, and persistent musculoskeletal pain, particularly affecting my back, right hip, knees, and ankles. I collaborate closely with my healthcare team but feel quite overwhelmed and uncertain. I’m reaching out for suggestions on topics to discuss with my physicians, strategies for managing my symptoms, or any insights that might help me address challenges I haven’t yet considered. Approximately a year and a half ago, I experienced unexpected seizures, which led to two EEG tests. These tests revealed mild irregularities but did not indicate a seizure disorder, and after making some lifestyle changes, the seizures ceased. However, I continued to feel extremely fatigued and unwell, developing symptoms like itching, swelling, joint pain, and redness in my hands. A rheumatologist performed testing, which yielded a positive ANA and slightly elevated rheumatoid factor (RF). As my discomfort escalated, we initiated treatment with plaquenil. In December 2024, I faced a severe flare-up and began a regimen of methotrexate (MTX) and prednisone, though I have since discontinued all steroids and immunosuppressants. I have endured episodes of severe diarrhea lasting one to two months, followed by a complete halt in bowel movements—I went an entire month without any at all in February. Imaging studies revealed significant fecal accumulation but nothing alarming. The medication Linzess initially helped, but its effectiveness waned. Amitiza worked temporarily as well but ultimately lost its impact. Currently, I am taking Amitiza and a small dose of IBSrela as needed, yet I still struggle with either constipation or excessively watery stools. Abdominal discomfort is significant, often manifesting on the lower right side, but I sometimes experience pain in other quadrants as well. I recently underwent a hemorrhoid banding procedure due to issues with prolapsing hemorrhoids. A colonoscopy and upper endoscopy didn't show serious issues besides a minor polyp and other benign findings. Both my celiac panel and biopsy returned negative results. Three weeks ago, my RF levels increased, currently at a titer of 1:4, accompanied by a speckled ANA pattern. I have spent the last eight months battling severe pain and tested negative for Sjögren's antibodies. At school, I was informed that if I cannot bring my symptoms under control, I may be unable to continue my clinical experiences. Unfortunately, my consultation with a functional GI is not scheduled until February, leaving me anxious about what to do in the meantime. As an occupational therapist, I possess various tools to manage chronic conditions, yet I find myself at a loss. I have revamped my diet to emphasize whole foods such as chia seeds, soybeans, fresh fruits, lentils, potatoes, and flax seeds, and I’m diligent about my water intake. While I limit gluten and dairy, I haven’t completely eliminated them yet. Additionally, I am using probiotics (Align brand), psyllium fiber supplements, Beano digestive enzymes, and pepper oil. I engage in light cardio and stretching most days, and now that the weather is warmer, I’ve been hiking frequently. I've also been attending therapy to address psychosocial factors that may be affecting my health. My current medications include: - Mirtazapine (7.5 mg, prescribed to enhance appetite) - Effexor (37.5 mg, originally prescribed at a higher dosage for pain and mood stabilization, but we’re tapering down to explore alternatives) - Adderall XR (15 mg; I recognize it can worsen some of my symptoms, but I stopped taking it for two months to assess any changes, and saw no difference in symptoms. Functioning without it is also challenging.) - Over-the-counter stool softeners (two with breakfast and two before sleep) - Naproxen (440 mg in the morning and 220 mg at night) - Lubiprostone (24 mcg) - Tenapanor (12.5 mg as needed) - Hyoscyamine (as needed) Medications I've trialed include: - Linzess (290 mcg, effective for a while but later became ineffective) - Amitriptyline (20 mg, given a solid effort for around three and a half months; it caused excessive sleepiness and sadness without alleviating pain) - Dicyclomine (indifferent results; I didn’t notice any differences after use). Any feedback or advice would be greatly appreciated!

Answers (1)

6/30/2025, 4:21:04 AM

OpenHealth AI

It sounds like you're navigating a complex set of health challenges, which can feel quite overwhelming. Your active engagement with your healthcare team and efforts to self-manage through lifestyle strategies are commendable. I’ll summarize key points and provide actionable steps tailored to your situation.

Main Points

1. Chronic Illness Management: You're dealing with symptoms that impact your daily functioning, requiring ongoing adjustments and symptom management.
2. Symptom Tracking & Communication: Keeping an open line of communication with your healthcare providers is vital.
3. Holistic Approach: Exploring various strategies, including dietary changes, physical activity, and mental health support, can help optimize your well-being.

Explanation

You have a history of complex health issues that include joint pain, gastrointestinal problems, and a positive ANA, which can indicate autoimmune conditions. The array of medications you're taking, along with trial medications that haven't worked as expected, highlights the necessity for careful monitoring and adjustment in your treatment plan.

Your lifestyle changes, including a diet focused on whole foods and self-care strategies, are great steps. In addition, your engagement in therapy is an important part of overall health management, especially when coping with chronic conditions. The anxiety about your clinical experiences suggests that maintaining your health should be prioritized to ensure you can continue in your role as an occupational therapist.

Actionable Steps

1. Symptom Journal: Begin a detailed symptom journal to document daily experiences of pain, bowel symptoms, fatigue levels, and emotional well-being. This can help identify triggers and patterns, which you can discuss with your healthcare team.

2. Dietary Adjustments: Since you’re monitoring your diet:

   • Continue to refine it based on your symptom patterns—note any foods that consistently lead to discomfort.
   • Consider working with a dietitian specializing in gastrointestinal disorders for personalized dietary recommendations.

3. Medication Monitoring: Given your complex regimen, discuss with your healthcare providers about:

   • Regularly reviewing the effectiveness of your medications, especially those related to pain management and gastrointestinal symptoms.
   • The possibility of pharmaceuticals impacting each other and overall well-being.

4. Scheduled follow-up with specialists: As you prepare for your February appointment with the functional GI specialist:

   • Make a list of symptoms and prior treatments to discuss.
   • If symptoms worsen significantly before then, it may be worth reaching out to your primary care doctor or rheumatologist for interim advice.

5. Physical Activity: Continue your light cardio and stretching routines. Gradually increase activity levels as tolerated, and explore activities that may also improve your mental health, such as yoga or meditation.

6. Support Network: Engaging in support groups for individuals with chronic illnesses, either online or in-person, might provide additional emotional support and coping strategies.

7. Mental Health Care: Keep attending therapy to address any psychosocial aspects of your condition, ensuring you have a good support system to handle anxieties related to your health and clinical responsibilities.

Remember, managing chronic illness is a gradual process, and finding the right combination of treatments and lifestyle changes requires patience and persistence. You’re doing well by actively seeking solutions, and I encourage you to keep advocating for your health.