love, woman, depression, sex,

Choose Love

Fibromyalgia has been around for decades. It is a disease that includes a constellation of symptoms, such as severe pain, anxiety, depression, and it can move to different areas of the body. but treatment is not only using medicine, is also how we as partners and family members can contribute to make a person who suffers from it to feel better and get better.

My wife Vanessa and I celebrated our 31st year together this year, and she lives with a chronic illness. Living with a spouse who has a chronic illness is very challenging. You may think that it's easy for me because I’m a doctor, but at times, it can be a long and difficult journey. I certainly have a better understanding of what it is like to live with someone with a chronic illness, but I went a step further. I made a decision to love her.


You see, feelings are flighty. A decision to love is a commitment to love and be loved unconditionally. Feelings come and go, but love requires an active choice. A decision that allows for the possibility of pain but also includes the certainty of hope. Let’s explore how a decision to love can provide the container, safe space, if you will, for those of us living with someone who has a chronic illness. Vanessa contracted Rheumatic Fever at the age of 11, and about six months later, Fibromyalgia-like symptoms started. Unfortunately, it would take another fifteen years while we were dating to be correctly diagnosed.


I was in the midst of a rheumatology rotation, and my preceptor diagnosed a patient we were seeing. Unfortunately, the patient’s symptoms sounded all too familiar. It’s as if I was listening to Vanessa. She managed her symptoms well with Advil. However, it was not until pregnancy and post-partum that her symptoms exacerbated.


These are some of the questions she and patients like her would ask: Do you know what it feels like going through most of your life not knowing why you feel the way you do? Do you know what it feels like to go from doctor to doctor and hear them say ‘what you’re feeling is all in your head,’ ‘not real,’ or ‘I’m sorry, I can’t help you? Yet, much worse, blame it on depression, a midlife crisis, an early change of life? Do you know what it feels like to have family and friends sigh and roll their eyes because your symptoms are frustrating them? They don’t seem to understand why you feel the way you do and may think you are attention-seeking and ruining their plans on purpose? Do you know what it feels like to have your self-esteem decimated, your self-confidence beaten and battered, intrusive thoughts that tell you you're useless, the problem is yours, and you’re responsible for it?


Previously called fibrositis and often confused with many other similar diagnoses, Fibromyalgia has been around for decades. It is a diagnosis that includes a constellation of symptoms, including, but not limited to, severe pain that waxes and wanes and transiently spreads to various areas of the body. In addition, the pain can be incapacitating. Notable associated symptoms include severe and often incapacitating fatigue as well as cognitive dysfunction that Vanessa and I “affectionately” refer to as “Fibro Fog”.


Some form of trauma initiates the ideology of fibromyalgia. In Vanessa’s case, the trauma was an infection. The traumatic event sets up a widespread pain phenomenon much too overwhelming and too difficult for the brain to respond to. This response to these stimuli is called the “wind up phenomenon.” Wind up is a frequency-dependent increase in the excitability of spinal cord neurons evoked by electrical stimulation of afferent C-fibers. The brain “gives up” and sends a response to areas of the body that weren’t directly affected by the initial injury. Patients experience widespread and diffuse bodily pain. Distraction caused by pain often leads to fatigue, cognitive dysfunction, depression, and more.


A key point is the acceptance by all involved as well as the spouse, family, etc. that it is indeed a real diagnosis. It is critical for the patient who is suffering to know they are accepted for who they are. Without support from a spouse or significant other, long-term improvement may be significantly and adversely affected. Another key is acceptance by the patient themselves of their own illness. Vanessa still suffers from feeling like a victim at times and understandably so; however, she has long ago accepted her illness and the limitations that it causes her especially when the weather changes. In combination with a defiant will to persevere and succeed, Vanessa has achieved much in her life including an MBA, but most important to me is the fact she has been an incredible life partner. Were there times that I was frustrated by working a very hard day and coming home to my wife, who was having an unproductive day? I would be lying if I didn’t say the answer was yes. However, I made the decision to love and understand her for the good of Vanessa and our family.


You see, Vanessa did not choose to be afflicted with this illness. I knew full well that the self-flagellation and mental and emotional pain she would put herself through was already too much, and whatever I would say would be an unnecessary dagger to the heart. As colleagues, I urge you to offer love, support, and empathize to chronically ill spouses and family members. It takes a decision to love, persistence, compassion, and lots of love. Vanessa is in a much better place and manages her illness very well. Our marriage not only survives, but thrives, and is better because of my decision to love her no matter what.

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