And maybe that’s why you’re tired too! Join me on a journey of discovery about one of the most poorly recognized and unbelievably tangled health webs you can find involving not just one, but several intertwinedsystemic conditions I personally unofficially call the “Chronic Constellation” for lack of a better name.
Each syndrome alone is enough to take a person down at the knees, but combined as we so often find these, they can be downright show stopping, if not even lethal sometimes, sadly. Oh, That’s Why I’m so Tired!
I confess, I’ve given short shrift to dysautonomia on my blog mainly because I’m just one disabled destitute person, and I can’t do justice to all of our comorbidities. Or not as much as I’d like. For what it’s worth, I consider all forms of dysautonomia (there are several) to be secondary to other conditions, whether autoimmune diseases, connective tissue disorders like HSD and EDS, or any form of MCD (Masto or MCAS), or a combo of all of the above as I’ve see all too often.
As my late friend Judy used to say: the body can only express itself in so many ways. So when things are wrong, several causes may lead to common outcomes like dysautonomia. I think in the hypermobile community it’s from a combination of stretchy vessels, weak valves, hypovolemia from multiple drivers, and vasodilation from highly co-occurring MCAS in most of us.
Some folks will actually lack proper innervation of their bodies, however, so it’s not just being stretchy, but possibly lacking proper myelination and or even fully formed nerves which lends to some forms like Familial Dysautonomia aka Riley-Day Syndrome. (This is not just “POTS that runs in the family”, to be clear. It’s a rare, familial form of pure autonomic failure.) So they often can’t detect when their oxygen is low, or their blood pressure is too high or too low and need close monitoring.
Toss in ADHD and we’re sort of doomed, as we have trouble keeping track of anything, much less our body’s needs that we either don’t feel fully, or find too easy to ignore especially if we’re hyperfocused. (Phone alarms and smart watches can all help here.)
There aren’t any studies correlating ADHD and hypermobility yet, but… there should be soon, since it’s also starting to be seen as co-occurring with autism, which has been studied in EDS patients (or vice-versa).
I sometimes feel like I’m just collecting diagnoses. But I truly couldn’t make this stuff up if I wasn’t witness to it in massive online groups (60,000 in one, almost 100K in another) and in real life every day. That’s why I called the whole kielbasa (collection) The Chronic Constellation here back in 2016, for lack of a better name.
I use the space above on my home page to highlight some of our more common comorbidities – aka co-occurring conditions every month. We have many, so you will see many through the year!
Happy News! As of late January 2022 followers will be pleased to learn that the EDS Toolkit for Doctors formerly hosted by the Royal College of General Practitioners in London since 2018 has indeed been saved and is now hosted by Ehlers-Danlos UK here:
“Development of this toolkit in 2018 was led by Dr Emma Reinhold, with contributions from pharmacist Lisa Jamieson MSc, Prof. Lesley Kavi, Dr Hanadi Kazkaz, Dr Alan Hakim, Nikki Paiba, Dr Gemma Pearce, Dr Philip Bull and Jan Groh. The toolkit was hosted by the RCGP between May 2018 and November 2021.”
COVID-19 emerged on the world stage in early 2020, and is continuing well into 2022 now as you all know. We’re deep in the Omicron variants in the US as I type this in February 2022. I’m personally suspecting it may take at least another two years to fully play out and slowly become “endemic“.
People residing in the US: As of January 2022, every home in the US is eligible to order 4 FREE at-home rapid antigen tests (RATs) via covidtest.gov
Here is what The Ehlers-Danlos Society advised in 2020 for what it’s worth. (Mostly WHO guidelines without specificity to EDS.)
A couple of other articles of interest to our community in particular:
Please take care not to “whale watch”, that is, go leaping from one highly touted solution to another. “Oh look, a solution over here!” “Oh hey, there’s another one over there! Ooh!” leading to “wildly careening about the boat” so to speak.
We are all desperate for answers and “cures” but this is how snake-oil salesman make their livings. Pause, and gather data. And consult YOUR doctors and practitioners first. And listen to your own bodies. Always. There are no panaceas, sorry.
And, as of 8/11/20, per this article, it appears your home made cotton masks DO work folks – so keep wearing them if you can. It’s helping.
ETA 1/2/22: I now highly recommend a KN95 mask if possible though for better security against Omicron et al.
Good news,Project EDS ECHO for doctors was rolled out in May 2019, and is officially underway. This should really help to “infect” more doctors with the latest information and insight into the forms of Ehlers-Danlos syndrome and Hypermobility Spectrum Disorders, so patients don’t have to do all the heavy lifting anymore! It’s found here: http://ehlers-danlos.com/echo .
So far (as of 2019) 150 doctors have signed on and earned CME’s for participating, thank you! The Ehlers-Danlos Society hopes to reach 1000 practitioners by 2020. (New “sessions” roll out periodically.) Help us reach that goal by sharing it with all your doctors! (Along with the EDS Toolkit for doctors freely available here too.)
EDS in Celebrities
Yes, I know that Sia, Jameela Jamil and Lena Dunham all have EDS, among others. Apparently including the late Elvis Presley per this post in 2021. I’ve long suspected he and the late Prince, David Bowie and Michael Jackson myself. (I think MJ was confirmed somewhere?)
Hypermobility lends to great vocal ranges and agility, dancing ability, and… chronic pain after all. I wouldn’t be surprised if we continue to slowly uncover more. (Or they uncover themselves, smile. I’m also suspecting Lady Gaga now too.) And I mean outside of all the acrobats who appear annually on all of the talent shows, smile.
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Update March 2018 – The non-specialist LAY versions of those 18 crunchy papers above are HERE now too for the win! Big thanks to The Ehlers-Danlos Society for writing these up for the rest of us who don’t speak medicalese, or whose brains are just too tired to parse it. I think even some doctors will appreciate them too! And…
Update May 2018 –The Royal College of General Practitioners in London, England successfully rolled out a brand new, brilliant “EDS Toolkit“ online for their GPs (and other allied healthcare professionals) to learn and study from! And I got to help draft it at the invitation of the primary author, Dr. Emma Reinhold, a GP with hEDS and MCAS herself I met on Twitter along with some other much esteemed company.
ETA May 2022: It was just migrated FROM the RCGP (rcgp.org.uk/eds) TO The Ehlers-Danlos UK (gptoolkit.ehlers-danlos.org) organization this year, where it will live on indefinitely now. NB This is NOT The Ehlers-Danlos Society, an entirely different, international organization that ends in dot com.
I’m very pleased to have played even a small part in “midwifing” this project along. Please share it far and wide with any and all doctors you can! It is freely available to anyone and everyone on the web, not just the NHS.
The International 2017 EDS Classification via The Ehlers-Danlos Society
You might wish to refer to this FAQ document previously shared by The Ehlers-Danlos Society for clarification on the new criteria and terminology update as well. We will now be referring to EDS in the plural as the “Ehlers-Danlos syndromes” with an “s” on the end. (Or trying.)
As well as diagnosing an entirely new category of severalHypermobility Spectrum Disordersfor those who look a lot like they have EDS, suffer much the same, but don’t meet the criteria for any more specific diagnoses involving hypermobility of varying degrees yet.
I.e, they are subclinical for hEDS as I was for my first 44 years, and may now be technically again since I stiffened so much with age and arthritis. Kind of like how Pluto was re-classified to a dwarf planet 10 years ago right? It never changed a spot. We just changed our minds about it.
These forms of HSD also all supplant and replace the former diagnoses of Hypermobility Syndrome, Joint Hypermobility Syndrome, and Benign Joint Hypermobility Syndrome to my understanding. I like to think of the HSDs as the less visible bulk of patients “below the water line” as shown here:
The criteria for what has been called hypermobile EDS or hEDS were just tightened in 2017, so I will no longer refer to this form as common anymore accordingly. I actually no longer meet the new criteria since it requires a much higher Beighton 9 pt score than before. I now fit one of the forms of the new catch-all bin of the Hypermobility Spectrum Disorders better even though I was extremely bendy as a child, but…
NB you do NOT need to “lose” your diagnosis of hEDS until/unless someone requires you to, such as to meet the criteria for a research study. Further, you will still have a diagnosis that represents a hypermobile disorder, but just with a different name. It is hoped this will lead to speedier presumptive care and management rather than just leaving patients suffering because they did not meet the new higher bar of hEDS diagnosis.
I, Jan, unscientifically personally now feel very strongly that the newly recognizedHypermobility Spectrum Disorders as such are NOT rare at all, but also just rarely diagnosed – and not just because they are newly introduced. But because they’ve always been dismissed as “normal” or early aging, or “just depression”, fibromyalgia, chronic fatigue or hypochondria under any name/classification scheme when they should not be!
It is my deepest wish that one day, this disease cluster will be as well known as multiple sclerosis, and much more quickly recognized. Everyone knows someone with a hypermobility spectrum disorder, if not even EDS. I will continue to post and tweet to that end, while I finish writing my book. Join me.
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