News

By Tammy Kosbab, Edited by Jude Houston

The other morning when I woke up ALL of my muscles ached, my head was throbbing, my eyes felt a little puffy, and I really, REALLY did not want to get out of bed. Similar to the past, I couldn’t understand what I did to cause this and knew it was best to forget even trying to figure this out because of the awful brainfog! It seemed my entire body had turned into muck overnight.

Thankfully, because of Dr Lawrence Afrin, Dr Anne Maitland, Dr Mathur, Dr Steinman, and others in the EDS community like EDS Wellness, EDS Awareness, and the EDS Society, I now know that these symptoms were a result of my being swollen, inside and out. I also now know that this swelling is called angioedema and that it is caused by “allergies.” The swelling certainly wasn’t the kind where a stranger could look at me and immediately notice. However, it was similar to the kind of swelling I had experienced my entire life that I always thought meant that I had a chubby face. I used to think that it was normal to have red marks and indents on my skin from my clothing for hours after changing, or similar red marks and indents on my skin from my bedsheets for hours after waking up.


These are some photos of me swollen and not swollen. It is NOT always this noticeable.

Despite my inability to think clearly, it was apparent that there was only one thing I knew I had to do. I reached for the medication that is ALWAYS within my reach because I know it helps significantly. I took the Gastrocrom. Unhappily, I crept out of bed, went to the bathroom and caught a glimpse of the mirror. Once again, I saw my “old” swollen face, which is the face that I previously thought was ‘normal.’ There was a red rash on my face, a large indentation and two blisters where my skin must have tried to swell under my CPAP mask when I was asleep. To test my Mast Cell Activation Disorder (McAD) diagnosis, I stepped on the scale to see if indeed the diagnosis was correct and…literally overnight, I gained about 6 pounds from my previous weight. Wow! Even in the past and prior to this diagnosis, I gained 9 pounds in 12 hours or less and I thought that was normal.

I’m still amazed that ALL of the seemingly unrelated symptoms came back. Even now, days later, when I stand up too fast, I got dizzy and when I am upright for too long, I become very tired. I now had burning tongue/mouth sores, bleeding gums, heart palpitations, nerve pain, muscle pain, fascia pain, eyeball pain, ear pain, joint pain, and in case I forgot to mention it – I had debilitating pain! Sadly, like many others a Ehlers-Danlos Syndrome (EDS), this is how I previously felt on a daily basis. It had became my normal throughout my entire life until I was properly diagnosed.

Since my diagnosis fo MCAD, my health issues have changed for the better these past 4 months because now I know why my issues escalate and what I can do about it to perhaps reduce the symptoms.

Here is a quick and hopefully simple explanation of how I understand MCAD for those who don’t quite understand it. Mast cells throughout the body contain histamine, heparin, cytokines and other “mediators.” Mast cells are commonly known for releasing these mediators in response to SPECIFICS allergens for retain people, such as strawberries, peanuts, mold, pollen, grass, and others. These are called IgE mediated AKA specific allergies and this is what the allergist would look for when performing a skin prick test. THis IS NOT Mast Cell Activation Disorder.

Instead, MCAD is when a person has a normal number of unstable mast cells which are easily triggered to release the mediators once a certainly threshold is reached. It’s like mast cells with ADHD – they overreact and can release mediators to just about any non-specific thing in the environment.

In other words, the resulting histamine and other mediatora that are constantly being released in the body wreaks havoc! If you want to know what MCAD can do to a person research the word “histamine” and you will find histamine allows blood vessels to be permeable and thus, this is why fluid leaks out of the vessels resulting in tissue swelling.

Think about this: Where are blood vessels located? All over, mostly INSIDE the body, right?
Can we see them? Not usually.
So if a blood vessel in the ____________ (insert internal body part name here such as stomach, colon, brain, spinal column, muscle, etc.) is leaky, can a person see that this internal body part is swollen? Probably not.
Can a person feel it? Well I certainly can, but thats only because I now know that these things aren’t normally normal and since then hey typically happen at the same time that I have all of the other symptoms, it makes complete sense.

The day before this happened it was a beautiful spring day with wonderful fresh-air – pollen and all. I tried to stay inside but have you ever tried to stay away from the air?!? Probably my biggest mistake that day was forgetting to take one of four doses of the Gastrocrom. Live and learn!

Gastrocrom is a medication that “calms” down or stabilizes the mast cells. It’s like taking a bag of oranges and making the holes in the net smaller so the oranges don’t fall out so easily. Imagine the net is the mast cell and it is holding the oranges, which represent the histamines and other mediators.

When the histamines, for example, are released they circulate in the blood until they find a place where they can plug in and be utilized. These are called histamine receptors. There are 4 receptors in the body, but only two of them have known medications that block the action of the Histamines. THESE are called H1 and H2 receptor blockers. I take the H1 blocker called Allegra in a high dose and the H2 blocker Pepcid in a higher than normal dose under the guidance of my doctor.

Tomorrow will be my recovery day which includes relaxation, a chance to retighten the netting and decrease the swelling while also getting work done. The fridge and toilet are also close by so I think I should be good. Ah yes, this is life with the ups and downs of MCAD.

If this sounds like you or if you wish to understand more, please do research and find someone to help you. It is very important when finding someone to help you to remember this: MASTOCYTOSIS IS A CONDITION OF TOO MANY CELLS and it is not MCAD. Also there is not a lot of research that has been done on MCAD and many medical professionals may have never even heard of it.

My favorite resource is the book: Never Bet Against Occam by Lawrence Afrin. Recently I had the pleasure of meeting him at an EDS Wellness’s retreat “Wellapalooza”. Fortunately, I had the amazing opportunity to have relatively long conversations with both Dr. Afrin and Dr Maitland about MCAD in 2017, and was also able to hear their presentations on MCAD several times in person. This information presented greater understanding and direction and provided an opportunity to take back control of my health even when a spring day fills my life with fresh air. Find their presentations on EDS Awareness and EDS Wellness websites.

This is probably the blog I’ve been most interested in writing since I agreed to write here, in this medium, for all of you. I’ve needed to write this here for two reasons:

  1. For those of you who understand and need someone who feels it, too
  2. For those of you who DO NOT understand and needs someone to break it down for you

If I had to list the most frustrating things about having Ehlers-Danlos Syndrome, the first one would be that there is no cure/easy fix. The VERY CLOSE second thing would be that you cannot see at all that I am dealing with this very harsh reality. Unless I have literally dislocated a joint in front of you, you have no idea that I deal with this condition or what I am handling on a daily basis.

A Typical 20-Something Selfie

So, here is me. If you know me personally, you’ve probably seen a few photos like this. I enjoy doing my hair and makeup. I love picking out clothes and finding jewelry to match. I even paint fingernail art, because it calms my anxiety and it’s actually something I taught myself how to do during my many major leg surgeries in high school.

The problem is, that people who don’t know me, also see this person daily. The problem is, when I park in a handicap parking space because I wear braces on both of my legs under my clothes and regularly dislocate the joints that connect my legs to my back, people see a blonde, well-dressed, make-up 20-something–and let me tell, they are NOT quiet about their thoughts on it. I regularly hear from people that I don’t look ill. I regularly hear that I don’t look like “anything is wrong with me.” I read a meme once that said “When you say I don’t look sick, I’m not sure if you’re insulting me or asking what concealer I use.” It made me smile, because for a second it took away the hurt of realizing people are judging me every day without understanding what is happening with my body, without understanding the sort of pain that can come with my multiple chronic conditions.

People with EDS also struggle because we don’t always have consistency in our reliance on mobility aids or our need for assistance. If I had a dime for every time someone made a crack about me “faking it” because I was no longer using a cane or crutches after working my butt off in physical therapy and having a “good day,” I would be a retired 27-year old. Some days, I have visible braces on multiple parts of my body. Some days, I need my crutches. Some days, I use a cane. Some days, I can’t really walk at all and I need to stay home. If you think the inconsistency is become I’m faking it and not because my body is inconsistent, I will happily trade you!

I think the problem is two-fold because sometimes, when I explain the condition, I’m told that if I’m dealing with that, I couldn’t really look nice or put the effort into my appearance. I’m told I couldn’t be working or doing what I’m doing with my life. It becomes a situation where it is impossible to win, because I’m seeking attention if I don’t make the effort to conceal how poor I feel and I don’t feel poorly if I do conceal it.

I enjoy putting together outfits and wearing makeup. For me, when I look better, I feel better–if only psychologically. When my body feels like it is absolutely falling apart and nothing is in my control, I see no harm in still feeling good about how I look.

There is no uniform for the chronically ill. You are NOT required to conform to someone’s expectations of what a “sick” person should look like. You do not need to justify to yourself or anyone that you do not “look sick” enough so therefore, your struggles are not as real or not as valid as those more visible. There is nothing fair about this situation–it is particularly unfair that it regularly includes providing context for who you are and how your body is simply because its outward appearance doesn’t match its internal composition.

You owe neither an apology nor an explanation for that.

“But You Don’t Look Sick” Oh Well.

CHANGE THEIR WORLD. CHANGE YOURS. THIS CHANGES EVERYTHING.