Archive for the ‘medical’ Category

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Medical: EDS Type 3 vs Hypermobility

November 11, 2009

A new EDS related article was submitted to the American Journal of Medical Genetics.  It argues that the clinical distinctions between Ehlers-Danlos Syndrome Type 3 (Hypermobile) and Benign Joint Hypermobility Syndrome (BJHS) should be put aside in favor of offering more timely and focused treatment to both conditions given the overlapping features/symptoms:

“It is our collective opinion that BJHS/HMS and EDS hypermobility type represent the same phenotypic group of patients that can be differentiated from other HCTDs but not distinguished from each other. Clinically, we serve this population better by uniting the two diagnostic labels. With this approach, we can strive to better define the phenotype and improve measurable outcomes of this patient population. Furthermore, we recognize that it is important that, in those hypermobility patients who develop potentially debilitating symptoms of chronic fatigue or polyarthralgia, whatever the underlying cause, there should be prompt and appropriate intervention [Keer and Grahame, [2003]].”
The article can be read here (with subscription):

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Medical: High prevalence of Food Allergies in Patients with Ehlers-Danlos Syndromes

August 6, 2009

“Collagen abnormalities may cause mucosal lesions, altering tissue integrity and increasing the chance of larger proteins crossing the mucosal barrier and creating an immunogenic response.”

More here

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Medical: HORMONAL ASPECTS OF HYPERMOBILITY

August 5, 2009

Dr. Bird, a leading expert on hypermobility has written about the ‘Hormonal Aspects of Hypermobility.”  As always, we will only be quoting excerpts from this article, even though it is now available online (see link below)

“Although oestrogen tends to stabilise collagen, progestogens loosen it. Many hypermobile patients, though not all, noticed a worsening in symptoms, more pain in the joints, clumsiness or a greater tendency to dislocate in the five days leading up to menstruation and in the few days after menstruation. This is exactly the time when the progesterone compounds far exceed the stabilising oestrogen compounds…. ”

Women who have increased pain during menstruation usually notice this after their period has become irregular which means that the estrogen/progesterone ratio may be off.

His suggestion?

Avoid progesterone only pills or  “progesterone depo contraception preparations or … mechanical devices impregnated with progesterone.”  But he also points out that this is not a one size fits all answer. Some women cannot take estrogen contraceptives, in which case  he suggests trying a different kind of  progesterone. More importantly, you need to discuss the pluses and minuses of your contraceptive choices with your doctor. Handing your doctor a copy of Dr Bird’s article would be a good start.  If you live in the UK,  the article is part of the Hypermobility Leaflet Pack.

And what about post-menopause when estrogen vanishes and the potential for pain increases?  Will hormone therapy help in spite of the risks?  “Since the oestrogen amount [during HRT]  is very small…..[it] is often not enough to provide a protective effect for the joints.”

more here

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Medical: Tiny rifts create fragility in collagen

August 5, 2009

“Researchers at the Massachusetts Institute of Technology (MIT) have for the first time carried out a multi-scale analysis to shed light on how bone’s material flaws lead to brittle bone disease.

The researchers say that the weak tendons and fragile bones characteristic of osteogenesis imperfecta, or brittle bone disease, stem from a genetic mutation that causes the incorrect substitution of a single amino acid in the chain of thousands of amino acids making up a collagen molecule, the basic building block of bone and tendon.

They add that that minuscule encoding error creates a defective collagen molecule that, at the site of the amino acid substitution, repels rather than attracts the collagen molecule alongside it.

According to them, this creates a tiny rift in the tissue, which when repeated in many molecules, leads to brittle tissue, broken bones, deformity and, in the most severe form of the disease, death. For example, if healthy collagen tissue looked like a sheet of paper, diseased collagen tissue would look more like a sheet of paper full of tiny perforations. At each of these perforations, the sheet would be considerably more prone to tearing.

more here

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EDS Alert Newsletter No. 32

June 14, 2009

Please feel free to start promoting the EDS Alert Newsletter where ever you think it might help. Note for readers who use RSS feeds – the link to set up your own feed is here.

This is our quarterly round-up of information about Ehlers-Danlos Syndrome (EDS). For more information about me and this newsletter, please look here for Sources of Medical Info and Support Groups.

We only link to publicly accessible entries and websites. If you would like your post removed from this newsletter please drop a comment below or e-mail us at: edsalert@gmail.com. Please remember when you’re visiting people’s personal blogs or diaries that these often contain information of a personal and sensitive nature and to respect their privacy and concerns. We only quote excerpts from articles that require subscriptions or paid memberships to access.

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Medical: Some Pain Medications May Interact With Anti-Depressants

April 17, 2009

There is one pain medication that carries a possible risk of increasing seizures when combined with anti-depressants.  The medication is known as Ultram or Tramadol (it can also be called Ultracet when it is combined with Tylenol).

This article and this medical alert explains how the interaction can happen – but keep in mind that certain anti-depressants themselves carry an increased seizure risk (ex. Wellbutrin or bupropion) so their combination with Tramadol needs to be discussed with your doctor.

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Medical: Ehlers-Danlos syndrome: associated with prematurity and premature rupture of foetal membranes; possible increase in incidence.

April 5, 2009

An 1966 article in pdf form that discusses the risks/complications of pregnancy and premature birth in patients with Ehlers-Danlos Syndrome. The PDF of the article can be found here

Additional articles can be located using this Google search.

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Medical: So You Think You Have EDS?

April 4, 2009

This is not a medical guide written by medical professionals, but an informal overview published by EDNF members (Ehlers Danlos National Foundation) outlining the range of  medical issues people with EDS may face.  It is a pdf file. Here

Note: you may need to register to view the pdf – registration is free.

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Medical: Pain Medications and Motility? In My Stomach?

March 31, 2009

One of the side effects of pain medications are what we delicately like to call…gastrointestinal issues (GI). They can range from ulcers/inflammation after taking anti-inflammatories (aspirin, ibuprofen) up to and including ‘stoppages’ that result from the use of opioids (codeine, vicodin, tramadol).

It is in the second area that patients can find themselves faced with inaccurate information – even from doctors. The rational solution to treating stoppages is to recommend fiber supplements and more water. But that may not work on patients taking pain medications – their problem is that the pain medications paralyze the stomach ‘muscles’ – throwing more ‘stuff’ at those muscles can lead to more problems (and in some cases bowel obstructions).  Added to this is that when most doctors think of ‘GI’ complications in connection with pain medications, they only think of constipation. The patient may have other problems associated with opiod use such as delayed gastric emptying (the food stays in your stomach while the rest of the plumbing works fine). Again, tossing more fiber and water into a stomach that cannot process existing food leads to….unpleasant results (gastroparesis).  There is still much misinformation when it comes to managing pain medication side effects.

The solution? This article spells out in detail how to manage GI problems related to opioid use. Simply put – patients should make certain that before they start taking pain medications, that they *are* getting enough fiber and water. Then, as soon as they start taking opioids, they should also take stool softeners every day along with a stimulant laxative every 2-3 days (or as needed.)  And in spite of what many GI doctors claim, the article points out that the use of regular stimulant laxatives to manage opiod side effects will not automatically ‘ruin’ your stomach or bowels and will not make you ‘dependent’ on laxatives forever.

Go here for the full article “Managing Opioid Induced Constipation”

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Forum: Benign Hypermobility Syndrome vs EDS?

March 29, 2009

From the Facebook Ehlers-Danlos Syndrome Forum:

“Professors Bird and Grahame disagree about HMS and EDS hypermobility type. Dr. Grahame suggest they are the same and Dr. Bird believes otherwise….” Read the entire thread here

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Asthma and airways collapse in two heritable disorders of connective tissue (abstract)

March 24, 2009

Asthma and airways collapse in two heritable disorders of connective tissue by A W Morgan, S B Pearson, S Davies, H C Gooi and H A Bird

The purpose of this study  was to investigate whether “there was an increased prevalence of respiratory disorders in both the Hypermobility Syndrome (HMS)/Benign Joint Hypermobility Syndrome (BJHS) and Ehlers–Danlos Syndrome (EDS), compared with the normal population.”

The study concluded that there was: “a significant increase in the frequency of a wide range of respiratory symptoms and reduced exercise tolerance. ”   These included “asthmatic symptoms….and atopy….. Pulmonary physiological studies revealed increased lung volumes, impaired gas exchange and an increased tendency of both the lower and upper airways to collapse.”   The study went on to state that  “individuals with HMS/BJHS and EDS have respiratory symptoms in association with various pulmonary physiological abnormalities. The increased … asthma may be due to linkage disequilibrium between the genes causing these conditions or a function of the connective tissue defect itself. In the non-asthmatic population, changes in the mechanical properties of the bronchial airways and lung parenchyma may underlie the observed increased tendency of the airways to collapse.”

(the full abstract is located here)

(and the text of the full article can be ordered here)

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Benign Joint Hypermobility Syndrome: Evaluation, Diagnosis, and Management (abstract)

March 24, 2009

by MAJ Michael R. Simpson, DO, MC, USA From the US Army Health Clinic in Darmstadt, Germany.

This article may of particular interest to both patients and doctors in the Armed Forces.  However the article’s observations are universally applicable.  The study focuses on benign joint hypermobility syndrome (BJHS) which it defines as a “connective tissue disorder with hypermobility in which musculoskeletal symptoms occur in the absence of systemic rheumatologic disease.” The purpose of this study is to point out that while BJHS is well known and has been often discussed “in the rheumatology and orthopedic literature, it has not been discussed in the family medicine literature.”  Why is this important?  Because, as the article explains “most patients with musculoskeletal complaints are first seen by family physicians.”  With primary care physicians as the first line defenders against this disorder, they need to be familiar with recognizing and diagnosing BJHS. And because patients “chief complaint is joint pain”, this means that “BJHS can be easily overlooked and not considered in the differential diagnosis.” The author concludes by recommending the “use of the Brighton criteria to facilitate the diagnosis of BJHS.” As for treatment, the following methods are suggested: “patient education, activity modification, stretching and strengthening exercises for the affected joint, and osteopathic manipulative treatment.”

In short, an helpful first article to take to your primary care physicam.

The complete abstract and a full copy of this article can be downloaded here

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Abnormalities of the lungs and thoracic cage in the Ehlers-Danlos syndrome (abstract)

March 24, 2009
Abnormalities of the lungs and thoracic cage in the Ehlers-Danlos syndrome by J G Ayres, F M Pope, J F Reidy, and T J Clark (1985)

The study took twenty patients with Ehlers-Danlos syndrome with the goal of assessing “the frequency of respiratory abnormalities in this condition.”   Five patients had “one episode of haemoptysis, but none had any defect of coagulation.”  Recurrent sinusitis was noted “notably in those with the type I syndrome.”  In looking deeper into the lung area “two patients had bullous lung disease, one of whom (type IV) had had three pneumothoraces and subsequent pleurodesis; he also had tracheomegaly (the Mounier-Kuhn abnormality).”  The study then went on to focus on  skeletal abnormalities and found minor ones “such as pectus excavatum…..particularly in patients with type IV disease” while “three patients had the straight back syndrome.”  In focusing on lung volumes, the study noted that there “were no consistent spirometric or lung volume abnormalities, but eight patients had a raised gas transfer coefficient (Kco), possibly due to an increased intrapulmonary vascular volume.  The study did qualify this finding by pointing out that there were two other patients  with “very low values of Kco that were unexplained.”

A full copy of this abstract and the article can be found here

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Medical: Dental Issues With EDS

June 29, 2007

Articles about Dental care and EDS are often hard to find. Here are a few that are online.

Orthodontic Care for EDS Type 4
Mandibular Joint, Orthodontic and Dental Findings in EDS
EDS & Oral Symptoms: a questionnaire

Here are excerpts from another article:
Orthodontic Treatment Considerations in Ehlers-Danlos Syndrome By
Louis A. Norton, D.M.D., Professor of Orthodontics

[snip]
Extreme joint hypermobility in many EDS patients often leads to chronic
dislocation of the temporomandibular joint. This makes the placement of
complex orthodontic appliances very troublesome for the patient and the
clinician. In addition, the oral surgeon must be extra cautious to prevent
a dislocation of the mandibular condyle when performing a surgical procedure
in preparation for orthodontics. Because of the tissue repair problem in
EDS, there may be slow healing after dental extractions, followed by soft
tissue scarring. The orthodontic appliance used on an EDS patient should be
very smooth and relatively simple in design. The oral mucosa are very
fragile, liable to injury and particularly vulnerable to sharp objects such
as orthodontic appliances or partial dentures.

[snip] The mobility of teeth during tooth movement may be greater than normal.
This may be caused by stretching, tearing and slow repair of the fibres.
Similarly, the gingiva may be more prone to inflammation and possible
recession. There may have been reports of early onset of some periodontal
defects (gum and tooth support). Classical type EDS in particular is
characterized by extreme periodontitis which can be quite debilitating.
With the added dental mobility of the teeth, slowed repair processes and
poor organization of tooth supporting tissue collagen, the need to wear
retainers long after completion of the case may be greater.

A full copy of this article can be ordered here

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Medical: EDNF Medical Resource Guide (MRG)

June 24, 2007

The US based Ehlers-Danlos National Foundation (EDNF) has a new one page Medical Resource Guide (MRG) to give to your MD. It is one of the best I’ve seen with not only diagnostic criteria but actual treatment suggestions: among them an echocardiogram every *2* years for all EDS patients and a baseline bone density scan as soon as you are diagnosed.

If you’re a member of the EDNF you can get a free copy here (you also gain access to the forums with your membership). If you’re not a member you can order one for 50c plus mailing. Go here.

I also have a few free copies (10) so drop me an e-mail with your snail mail address and I will mail them out to you. I can include a handout to give to coaches and trainers to help them spot people with EDS. School coaches are often the first to notice something is wrong with students who injure themselves repeatedly. Let me know if you want a copy of the School Coaches Handout in your e-mail.

Finally, the EDNF site also offers free medical articles and information

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Medical: EDS

June 21, 2007

The Hinge, a short monthly newsletter, is one of the many benefits of joining the US EDNF organziation. Here is an excerpt:

“Check Up On Your Bones,” an interactive bone health tool for people of all ages, is available on
the NIAMS website. The goal of the checkup is to help users identify the most common red flags
that put their bones at risk and to give strategies specific to individual users to make their
bones stronger and healthier. Since osteoporosis is a major factor for those of us with EDS, this
is a great way to get some helpful information:
http://www.niams.nih.gov/bone/optool/index.asp

You can join EDNF here

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Medical: EDS and Heart Issues

April 28, 2007

People with EDS Type 4 (Vascular) have increased risk of heart problems. What is not as well known is that people with EDS Type 3 (Hypermobility) or in some circles knowns as Benign Hypermobility Syndrome (BJHS) also have an increased risk of heart issues. This is why in the US the NIH (National Institutes of Health) is recommending a baseline echocardiogram plus one every 2-5 yrs more to look for heart issues.

We’ve been discussing this topic here, but I wanted to pull together some of the info into one post.

1. “Cardiac problems are associated with both classical- and hypermobile-type EDS. Individuals with mitral valve prolapse and/or regurgitation require antibiotic prophylaxis to prevent bacterial endocarditis before dental or surgical procedures.[10] An unusually high prevalence of aortic dilation (28%) in individuals affected with both these types of EDS has been reported.[19] An increased risk of aortic dissection is associated with this significant dilatation.[25] Baseline echocardiograms should be initiated at age 5 to measure aortic diameter,[10,35] and follow-up should occur every 3 to 5 years depending on severity.[25]

membership is free
full article here: http://www.medscape.com/viewarticle/520046
or try here

More articles here and here (this last one deals specifically with hypermobility (Benign Hypermobility Syndrome (BJHS) patients.

2. Nazli McDonnell’s abstract: Heart Issues In EDS is here

Echocardiographic findings in classical and hypermobile Ehlers-Danlos syndromes
Keywords: Ehlers-Danlos syndromes • aorta • echocardiography • impaired left ventricular relaxation

Structural cardiovascular alterations in the classical and hypermobile forms of Ehlers-Danlos syndrome(EDS) warrant investigation. We have examined a cohort of 38 patients with hypermobile and classical EDSs using two-dimensional echocardiography. The cohort includes 7 males and 31 females, with an age range from 12-60 years.

*Altered echocardiographic parameters were seen in the initial cross-sectional data analysis in 24/38 patients. (abstract)
*Five of the 38 participants had mildly dilated aortic root (AR) or sinuses of Valsalva (SV), and an additional 7 patients had an abnormal pouching of the SV, although the absolute dimensions did not exceed the normal range.
*Ten patients had mild mitral, tricuspid, or aortic regurgitation, and only one patient had mitral valve prolapse (MVP).
*Three patients had low normal systolic function; three had evidence of mildly elevated pulmonary pressures, and two patients had mild concentric left ventricular hypertrophy (LVH).
*Five patients had evidence of impaired left ventricular relaxation (LVR) based on mitral valve E to A velocity ratio.
*Interestingly, 26/38 subjects demonstrated a prominent right coronary artery (RCA) easily visualized by trans-thoracic echocardiography, and 10/38 had an elongated cardiac silhouette on the 4-chamber apical views. The pouching shape of the SV was more common in hypermobile type than in the classical type of EDS.

The study is ongoing and will accrue longitudinal data on 100 subjects with classical and hypermobile EDSs at 2-year intervals. Published 2005 Wiley-Liss, Inc

3. Notes taken by an EDS patient at a recent speech given by Dr. Nazli McDonnell’s

Excerpts from the Dr. Nazli McDonnell meeting:
“In the meantime, I can say that the info distributed by Dr. Nazli McDonnell is full of hope. She has clearly identified so much ‘crossover’ from type to type. I also don’t know that I’ve ever heard the word crossover & words similar to it, as much as I did this week. & Dr. Marcia Willin’s 2 seminars were absolutely awesome!

Some things that I made notes of:

DR. NAZLI McDONNELL
*We truly have to be our own advocates.
*Keep track of your symptoms, treatments, & outcomes.
*Take notes before you see your doctors (and their nurses) and take notes during & then review them afterwards.
*Make sure you understand everything. If not, ask & ask again until you do. If not satisfied, KEEP LOOKING.
*We are not crazy,. This is NOT all in our heads.
*The study of Connective Tissue Disorders is truly coming into it’s own. We are making great strides. NIH is doing an awesome job with Dr. Nazli McDonnell at the helm.
*There is hope.

Some interesting points that we don’t always hear, in Dr. McDonnell’s discussion:
* There are new variants of EDS being discovered.
* There may be an increase in cardiac disease in EDS patients, even seen in 12-20 y.o.’s
* They are seeing low HDL’s, high LDL’s and ? high TSH (cholesteral and thyroid issues)
* Incidence of EDS in the general population is @ 1:5,000
* Incidence of Chiari Malformation in the general population is 1:10,000
* Incidence of Chiari Malformation in C.T.D. patients is 1:5,000

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EHLERS-DANLOS SYNDROME – LUNGS

April 21, 2007

This article has been removed at the author’s request who only wishes to be contacted via professional channels. If you’re looking for information about lung issues in patients with Ehlers-Danlos Syndrome, we have located  articles by other researchers here and here

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What Is Ehlers-Danlos Syndrome?

April 16, 2007
In response to a few questions, I’d like to help out my friends and family in understanding what Ehlers-Danlos Syndrome (EDS) can do to a person. This may also help friends understand why I have physical limitations and what those limits may be. It will also help me by reducing the time I spend responding to questions that often go over the same ground.1. EDS – What Is That?
Ehlers-Danlos Syndrome (EDS) is a genetic disorder to results in weakened connective tissue. Connective tissue is the glue that holds the body together (think of it as the Force, Luke. It holds the universe together). It is in your ligaments, your skin, blood vessels, your stomach and your bowel, your uterus and your eyes. In short in anything that is not bone.

2. What Does EDS Do To The Body?
When you have EDS it can impact a large portion of the body:

– Your ligaments – and thereby your joints. Without stable ligaments, joints slip and slide in and out of places resulting in micro-trauma, subluxations (it pops back in by itself) or dislocations (you need help resetting). This can include your ankles, your knees, your hips, your wrists, you shoulders, your back, your neck and even your jaw
– Your eyes – retinal detachment and myopia
– Your jaw/teeth – TMJ and loss of teeth (after all, your teeth are rooted in place via ligaments). Periodontal disease is common
– Your heart and your arteries – death by aneurysm is common in one EDS variation where the average life expectancy is 50. In other forms of EDS, low blood pressure and fainting occurs because your blood vessels ‘stretch’
– Your stomach (some patients cannot tolerate aspirin or ibuprofen – the stomach wall lining is too fragile). Bowel ruptures can occur. Constipation and other motility (movement) disorders. Gastroparesis (paralysis of stomach = inability to process food)
– Your uterus (again possible ruptures) , pregnancy complications and urinary incontinence
– Often your ribs flex and dislocate or the lining next to your lungs is inflamed
– Your back
– Your skin – poor wound healing and scarring. Heavy stretch marks (something I had even as pre-teen with no history of weight lost/gains).
– your throat – inability to swallow and acid reflux
(I am sure there are more, but let’s keep moving)

Now luckily, not all of these symptoms happen to every patient – in fact there are 6 types of EDS. There is only one genetic test for one the 6 types (the most severe form called Vascular EDS or Type 4). The other types are matched by doctors as best they can via observation and detailed medical history.

3. What Have I Got?
In my case, when I was diagnosed a few years ago, I was told I had ‘benign hypermobility syndrome”. They called it benign because it was not life threatening. I had suffered for 7 years from dislocations and unexplained joint pain- first in one knee, then the other. It then spread to my hip, my ankles, my shoulder and then my wrists. After being in physical therapy constantly for 7 years, I was finally referred to a rheumatologist, diagnosed and then told there was nothing they could for me. (“You could have the thighs of Arnold Schwarzenegger and it still would not fix your knee problem” Okaaay?, I thought. Then I realized: eeeeew!)

At the Mayo Clinic, I was able to get a more definite diagnosis – because of some skin involvement, I was told I had “EDS Type 3 (hypermobility).” I was once again told that this was not life threatening, but I needed to have an echocardiogram every 5 years (for the possibility of aortic rupture) and I might experience severe osteoarthritis later. In the meantime, practice good ergonomics, do my physical therapy and take anti-inflammatories. I should expect to have a normal life span.

4. Ooops, They Didn’t Tell Me
What I didn’t expect was that I would start to experience some of those other symptoms (beyond the joint pain.)

In the past three years I have experienced:

-Joint pain and dislocations in every large and small joints in my body (except for my right wrist. Go right wrist. Go. Or rather don’t go. Just…stay in place).
– Loss of muscle tone as a result of not being able to walk or exercise without pain
-Gastritis from use of anti-inflammatories.
-Gastropareis (inability to process foods) – first as a result of taking one or two pain pills, now on regular basis
-inability to take any pain meds regularly due to said gastropareis/gastritis
-jaw/teeth problems

5. On The Daily Level
What this means on a practical basis is the following:

-If I sit too long (more than 20) min, my knees begin to slide out of position and start to hurt
-If I sit with straight legs (say in recliner), my lower back is strained
-If I stand or walk for more than 20 min, my muscles strain so hard to keep the joints in place that they become fatigued. Then I experience hip, knee, and ankle pain.
-My typing skills are poor because of wrist and finger problems
-I cannot sleep the night through – because when I roll onto my shoulders they shift out of place (and I wake in pain)
-I have switched to a softer diet to reduce the strain on my jaw. I often eat strained, liquid or soft food to help with digestion
-I have no consistent and effective means of pain control
-Driving is tough because my knees and shoulder and wrists hurt. Sitting as passenger in the car is also painful.
-I often get cranky and tired and confused from the pain – I misspeak and forget things as my body struggles to process the pain signals and the lack of sleep

6. But…But…But … I Saw You Doing X Just This Morning!
Well it boggles me too. I still look normal, I often feel OK and I can move and walk and lift with seemingly little problem. But as the days wear on, the pain increases because my joints and bones are shifting and slipping in ways too small to notice. Sometimes I wake up the next day in excruciating pain with no real link to what I’ve done the day before. This makes it very hard to avoid doing what might cause pain.

7. On Rubber Bands And Grandparents
One EDS patient explained it to me this way: ‘our bodies are like elastic waistbands or rubber bands. After being stretched over and over again they lose their strength and give way.’

If you look at the list above, you may also recognize symptoms that your grandparents or older relatives are experiencing as they enter their 70s and 80s (urinary incontinence, constipation, retinal detachment – those granny ads on TV make sense now). . ‘Sometimes having EDS is like being an 80 year old in a 43 year old woman’s body.’

I am considered one of the lucky ones – having the mild or ‘benign’ form. Something for which I am grateful every day. Really.

What I’ve just written is not the definitive or even medically accurate overview of EDS. I’ve oversimplified many medical issues to help clarify my points. More can be found here.

(c) 2006-2007