Earlier this month, the spinal CSF leak neighborhood misplaced a shiny gentle when Connie Rim handed away. Her Fb web page, referred to as My CSF Leak Story, was the place she detailed her lengthy battle making an attempt to get sealed and healed. Just a few days after she handed, her husband posted phrases from Connie about her demise, sharing it with the world.
Connie sustained her leak 5 years in the past throughout spinal surgical procedure, and tirelessly rallied her physique and thoughts in her makes an attempt to get care and discover her means again to a spot of much less ache. Like me, she discovered solace in sharing this journey publicly. In her case, through movies that she posted to Fb and TikTok, detailing her many debilitating signs, explaining the procedures and exams she acquired, and patiently answering questions.
When somebody is chronically sick and takes a break from remedies, there’s inevitably a swell of individuals asking why. “Why aren’t you doing extra?”, as if it’s as much as you to not be higher. As if there’s full management of the lengthy tightrope it’s essential to stroll on if you’re coping with a number of complicated circumstances. Regardless of her openness and uncooked, unflinching movies, individuals nonetheless requested Connie this query.
Maybe in response to this, or for different causes (I don’t know), in Could 2023 Connie posted an extended record of procedures and exams and docs she’s seen proper earlier than she headed out to Mayo for extra leak diagnostics and procedures: “This can’t be my life. This isn’t a life. I’ve been combating to get higher and advocating for myself as a lot as potential however in reality, I’m drained now. Nothing is as simple because it as soon as was,” she wrote then.
By this level, she had been to leak specialists and nonetheless her leak(s) weren’t sealed. She was in fixed ache. She reposted that record, up to date, just a few days earlier than her demise.
She did get therapy after that Could 2023 put up, one which introduced her ache down just a little bit. We may all really feel her pleasure and hope when it did. However that therapy failed, and when it failed it introduced a brand new, horrible set of signs. Since late January 2024, she skilled extreme stabbing ache from three to over twenty occasions day by day, at what she categorised as a stage 10 ache. To be in ache all day, after which layer upon {that a} new and chronic, paralyzing ache… I can’t think about.
By mid-Could, she was gone.
Studying between the strains of the message her husband posted, she hit a wall the place the excruciating ache she skilled second to second couldn’t be managed.
“Some days, I’ve been given 10-Quarter-hour of my treasured baseline ache, and for that. I’m grateful. However in the course of the remaining 23 hours and 45 minutes, I used to be all the time crying, combating, and, at occasions, in a lot ache that I may do something however curl in a fetal place in darkness,” she wrote.
Her household and husband have been loving and type, she had a number of assist, and she or he had a neighborhood who rallied round her. I perceive that these wonderful issues will not be sufficient if you find yourself trapped in a physique that tortures you.
Research present that in a persistent state, ache can disrupt the communications between mind cells, resulting in a discount within the capability to course of feelings — particularly unfavourable feelings. Ache modifications your mind. I skilled a model of this myself not lengthy after my leak started: already in persistent ache for years however not but conscious of mast cell illnesses, I ate a very excessive histamine meal of spaghetti and shared a glass of wine with my household. It was this meal throughout these preliminary leak days, earlier than I went to Duke for therapy, that tipped my physique its new, unruly state. After that meal, I had full-body burning and nerve ache 24/7. And it didn’t go away. It felt like I used to be being dipped in acid, with no respite from the torture.
It was a fellow affected person who urged me to consider MCAS, given my signs. I hadn’t heard of mast cell activation syndrome earlier than. With no docs to assist me, I scrambled to get my mast cells below management and attempt to make it cease. Throughout these weeks of absolute hell, till I discovered over-the-counter drugs that labored for me, I begged an in depth pal to assist me discover a means out ceaselessly. (They declined, have been compassionate all through, and as an alternative tried to search out me a grief therapist regionally. What helped on this case wasn’t remedy, it was discovering respite from the fire-burn throughout my physique because of antihistamines and a low-histamine weight-reduction plan.)
And that was how I felt with only some weeks of torture.
Connie lived with that ache that for a few years. As she stated in her writing, “The ache determines my feelings, NOT the opposite means round (as some individuals consider).”
Her passing hit the leak world very arduous. Even those that didn’t know Connie personally typically watched her movies on TikTok or Fb, or interacted together with her on the teams. In my case, I used to be digital associates together with her for years and we exchanged audio messages about methods, instructed jokes, tried to maintain ourselves sane on this Groundhog Day world we lived in when staying sealed felt like a pipe dream.
And but, regardless of the ache and the exhaustion and the procedures, Connie remained joyful the place she may, she appreciated what love she had in her life, particularly her deep and delightful love for her husband, and noticed humour the place she was ready. She had tons of assist. The ache decided her feelings, as she stated. She was a prisoner of her fixed agony.
I really feel indignant for her and her household, and for all of us. In taking a look at that lengthy procedures record, it looks like she was failed so many occasions alongside the best way. Whilst just lately as this yr, she offered to the ER and later shared a video explaining that the on name physician stated her signs have been psychosomatic. How will you take a look at that blisteringly lengthy record of remedies and assume it’s psychosomatic?! The continuing nerve harm and tissue harm, and scar tissue that may entrap her nerves, all of it is sensible trying on the lengthy record of what her physique had been by means of.
However no, she was instructed it was all in her head.
That’s a part of what leaves me rattled, for anybody with this situation or different invisible circumstances the place metrics for analysis and therapy aren’t lower and dry. I’m engaged on the slides with the US and different spinal CSF leak foundations for the annual consciousness week for this situation, referred to as leakweek (which begins June third). In it, we share the several types of diagnostics and observe that regular imaging doesn’t rule out a spinal CSF leak. Regular opening stress doesn’t rule out a spinal CSF leak. Regular something doesn’t rule it out; we’re trapped on this infinite loop of being unable to ‘show’ quantitatively what we now have aside from signs, but typically we’re instructed we aren’t dependable narrators when sharing our signs.
And so we strive, we strive so arduous.
We current ourselves firmly however with out panic, however not TOO jokingly else we appear ‘not sick sufficient.’ We maintain spreadsheets, we share knowledge, we come armed with supporting research however not TOO many, else it looks as if we expect we all know an excessive amount of. Exterior the few leak consultants on the market, who’re fortunately coaching docs typically, this dance continues. It’s exhausting to stay in ache and to lose your mobility and a lot extra, however add the suspicion and disbelief to the combination and it drags your soul all the way down to the bottom.
As a result of regardless of the advocacy, regardless of the schooling, the myths persist.
Exterior the leak consultants, sufferers report that docs nonetheless assume a lumbar puncture leak is “self-limiting” (i.e., that it goes away by itself — I want!). Many nonetheless doubt the existence of spontaneous intracranial hypotension (SIH), the place a leak can happen instantly; this may be resulting from a bone spur or calcified disc gnawing into the dura til it tears, or a coughing match, or lifting heavy weights, or one thing else being the final straw for a weak spot within the dura mater the affected person wasn’t conscious of. And a extra recently-discovered sort of leak, a CSF-venous fistula, might be elusive on present imaging sorts, although a more recent photon counting CT machine is recognizing them extra ceaselessly. Canada doesn’t have one, and the US solely has just a few.
The brutality of this situation is difficult to precisely put into phrases. Not solely the ache itself however the uncertainty and uphill battle in getting care. It’s generally misdiagnosed and under-diagnosed. The psychological well being burden can also be important: a top quality of life research in spinal CSF leak sufferers from 2023 discovered that over half of the respondents (64.2%) endorsed suicidality, and 22.4% had demonstrated suicidal behaviour. A 2024 research about high quality of life in persistent put up puncture sufferers (like me) discovered substantial psychological well being challenges with melancholy, anxiousness and stress skilled by 83%, 98%, and 88% of the respondents, respectively.
It’s like an enormous cosmic joke, “hey, there’s a situation that always doesn’t present on imaging, the place specialised imaging additionally includes making a brand new gap within the dura mater to search for the unique leak, the place the overwhelming majority of medical college students don’t be taught specifics of SIH or long-term puncture leaks in in present med college curricula, and the place we will’t but determine why persistent sufferers have a very arduous time getting sealed and typically find yourself with new leaks after therapy.”
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August 2024 marks 7 years of leaking for me.
In these very tough intervening years, I’ve realized a number of issues about myself, and about my physique. Concerning the illusions of security I used to have. About how life simply isn’t truthful.
The half that hits hardest has all the time been that stability looks like an phantasm. It’s so tenuous. Moments the place I get respite from the ache are so few and much between, however with frequent anaphylaxis and extreme MCAS within the combine, it looks like the sting of that knife is so skinny. I typically joke that I’m in mattress now, however we’ll all be in mattress ultimately as we age. I simply acquired there first. Beneath the humour is the information that Connie’s story is unfortunately not the exception. That there are different sufferers barely hanging on as they await science to evolve and be capable of deliver them lasting aid.
On daily basis, my inbox is filled with sufferers who can’t get therapy for his or her spinal CSF leaks. Medical doctors who chuckle at them for asking for atraumatic needles for a lumbar puncture, regardless of research displaying it makes a major distinction in reducing the danger of a post-puncture spinal CSF leak. Households who say that their youngsters or siblings or spouses are faking it, that they’re “simply lazy”, that they only “don’t wish to be higher”.
Present me a chronically sick individual, in fixed ache, who doesn’t wish to get higher?! In the event that they’re on the market, they’re a rarity. Each affected person I do know, and I do know many resulting from my public platforms, is like Connie: advocating fiercely, organizing effectively, maintaining hope as finest they’ll, and desperately desirous to get properly.
I haven’t gone again for therapy as a result of repairs don’t maintain for me. I’ve complicating elements like MCAS and adhesive arachnoiditis that make outcomes extra dangerous and fewer healing than the common affected person. However that that doesn’t imply I’ve given up. I’ve stated it earlier than: acceptance doesn’t imply you’ve given up. Like Connie, I’ve a lot to be glad about. However even acceptance, even discovering pleasure once more, isn’t sufficient to eclipse unrelenting ache. Fortunately, I’m not within the form of ache Connie was in, and by sharing all of this I’m not making an attempt to make her demise about me. It’s extra that her passing feels prefer it may have been any of us on this tight knit neighborhood. I respect her alternative, and I’m additionally heartbroken that she was backed right into a nook by her ache and felt like she needed to make it.
This put up isn’t my regular, I do know. I’m indignant. I’m devastated. And it’s lit a fireplace below me to proceed my advocacy work as a lot as my physique permits. Individuals typically ask why I’m so concerned with the Spinal CSF Leak Basis within the US, because it’s unpaid and I’ve my very own enterprise to run. (I’m now the Vice-President of the Board). Advocacy is why. Connie is why. Connie, and different sufferers like her. Different sufferers like me. For these of us who’re persistent, the place repairs don’t maintain, who’re additionally ready and hoping. For the sufferers who can’t get to care as a result of they don’t have docs who know leaks of their areas. For many who want assets to assist their households to grasp.
In supporting the Basis, and dealing with sister nonprofit organizations in Canada and the UK, I can hopefully result in extra change than I can do as one author with a leak.
I’ve been which means to share all of those ideas since I realized of Connie’s passing earlier this month, however it actually messed me up an excessive amount of to place phrases to paper. Right now marks the start of duradash®, although, and I’m fundraising for spinal CSF leak analysis. So I assumed it was day to share, and to try to mud myself off and maintain persisting. What else can I do however try to transmute my rage and my grief about Connie’s demise and the unfairness of all of it into one thing that may transfer the needle on all of this mess?
In August 2017, I knew nothing about spinal CSF, nothing about leaks aside from those in water pipes, and nothing about needle sorts or gauge. I had by no means heard of the dura mater. Years later, there’s quite a bit I want I knew then, however all I can do is maintain writing and sharing, elevating funds for the trigger, and hopefully assist another person get care prior to I may.
I’ll all the time be grateful to Connie for her fierce willpower and need to teach others it doesn’t matter what she was going by means of.
Since I sustained my leak 7 years in the past, there was a number of progress and analysis and advances within the area.
Dropping Connie exhibits us how we now have a lot farther to go. 💔
If you happen to’d prefer to assist me in elevating funds for spinal CSF leak analysis, please see my duradash® marketing campaign web page right here. I set a objective of $1000 however have already eclipsed it because of my Instagram neighborhood; I will likely be upping the objective to $2000 later this week. The two-week fundraiser will finish June eighth, 2024.
