Autoimmune Disease and Me
Alyssa Miyasato and Nathaniel Losing DPM 2023
When starting podiatry school there’s many things to worry about; how to study, where to live, what clubs to join, and if you’ll make new friends. However, for myself (Alyssa) and Nathaniel there were a few other things to worry about “Will my body allow me to do this?” “Will I be able to stand today?” “Will I be able to handle this?”.
Autoimmune disease is defined as “condition in which your immune system mistakenly attacks your body” (1), there’s hundreds of types that affect people of all ages. Today I’d like to talk to you about Ulcerative Colitis, Dermatomyositis, and the journey it’s taken us.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers. As a chronic disease it’s common for there to be flares and phases of remission. The ulcerations always include the rectum and colon but does not extend into the ileum. There are three common types of ulcerative colitis that are defined by how much of the colon is affected. Ulcerative proctitis is limited to the rectum, left-sided colitis starts at the rectum and extends to the splenic flexure, and extensive colitis involved the entire colon and rectum (2). Its most common symptoms are dysentery, diarrhea, Rectal tenesmus, and abdominal pain (3).
I began treatment for UC 8 years ago after long periods of abdominal pain, iron deficiency anemia and dysentery. A common treatment plan for UC is the use of glucocorticoids to bring down inflammation (3). While the steroids were able to place me into remission for months at a time between flares, it eventually caused avascular necrosis of the right talus. Over a period of three months my talus degraded from the inside resulting in a concavity at the lateral articulating surface. Emergency decompression surgery was able to help regenerate some of the bone but made use of glucocorticoids no longer an option for me and left me bound to a wheelchair for many months.
I started at WesternU a few months after beginning biological medications for UC and at the time was hiding my illness from the school’s faculty. Within a few months the medication had started to fail me, but I pushed forward, ignoring the signals my body sent me. This was a mistake, there’s no shame in reaching out for help, there’s no shame in your illness and that’s something it would take me a year at WesternU to realize. By winter break of my first year the UC had advanced to the point I had entered septic shock and needed to be carried into the emergency room by my friend Faustine Vuong, another first year student. She convinced me to finally go to OSA for help to get the resources I needed. However, by this point it was too late, the UC had developed into an extensive colitis and adenocarcinomas had developed along my colon. It was progressing quickly, and a choice needed to be made. One month into second year performed a complete colectomy and ileostomy. A colectomy involved the removal of the colon and an ileostomy is a surgery that makes a temporary or permanent opening called a stoma (4). The stoma is then covered using a colostomy pouch to catch all waste that would normally have become stool. One of the most difficult parts of having to use a colostomy bag is sealing the bag to your body. I had my colostomy bag fall from my body numerous times. Several months later by winter break the ileum was resected and the remaining small intestine was used to create an ileoanal anastomosis, a procedure in which the remaining small intestine is connected to the anus (5).
Ulcerative colitis is a chronic disease that changed my life; however, I’d like to think it changed it for the better. So, if I can survive this journey through podiatry school, I believe anyone can.
Dermatomyositis (DM) is an autoimmune disease that affects the skin and muscles in your body, quite literally, widespread skin and muscle inflammation. The most common effects of this disease on your body are muscle weakness, GI irritability, and skin rashes. (6) Hi, I’m Nathaniel, and this is my story of dealing with an autoimmune disease throughout medical school. I was diagnosed with DM at the age of 17 following a long road of sedentary behavior and turning a blind eye to the problem that I was getting increasingly weak as every day went on. My parents, both medically inclined, refused to believe that their perfect child had something wrong with him, until we all got hit hard with the fact that I will be living with this disease for the rest of my life. 2 years of medication and enough poking and prodding with needles to feel like a pin cushion, I was in a dormant stage of my disease, where it went into hiding for the better part of 4 years. A combination of methotrexate and prednisone were used to control it the first time, with the large wave of side effects from both medications nearly destroying my body from the inside out.
After 3 healthy years with no flare ups, finishing undergrad, and applying for medical schools, I was accepted in at WesternU. My dream podiatry school, one I was so excited to start. At no point during the interview process did I hide the fact that I had a dormant autoimmune disease, because for all intents and purposes, it was in remission and not was not affecting me in any way, shape, or form while interviewing. 3 months passed at the speed of light in the first year in medical school with no issues at all. Then, I started to notice my shoulder strength decreasing on me when I tried to lift my arm above my head, and it wouldn’t quite get there. I figured it was just a recurrent injury of when I tore my rotator cuff playing baseball at 16, whatever, no big deal, I was knees deep in anatomy lessons and biomechanics, I didn’t have time to take care of whatever was going on inside my body, I could wait for Christmas Break to get it fixed. Except, when Christmas rolled around, I was no longer able to get out of bed in the morning without having to physically roll myself over. I couldn’t wash my hair without using the wall to brace myself against, I couldn’t put clothes on without sitting down and physically lifting my legs into the pants. Every day became a battle of “can my body handle this?”, “will I be able to make it to class today?” “if I lean against this wall will people be able to notice that something is wrong with me”. It became as much of a mental battle as a physical one most days, and I can only explain that by saying that going into medical school with a long-term disease is not only a physical process, but quickly becomes a mental one as well.
I fully ignored my symptoms to focus on my studies and I really wish I would have gotten help earlier. But I was too afraid to reach out for help from others as it would make me seem weak and not ready to take on the massive challenge of medical school. I reached out to a local faculty member who recommended a rheumatologist around these parts who I have started to see, and everything has started to turn around. This time on a regimen of azathioprine and prednisone, with little to no side effects, I have been on medication for a year and my body has gotten a lot better. Not perfect, but better than 12 months ago, and getting better every single day. Modern medicine has saved my life and I cannot wait to continue my journey through medical school so one day I can turn around and heal someone the way I have been healed.
Citations:
“Dermatomyositis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 July 2020, www.mayoclinic.org/diseases-conditions/dermatomyositis/symptoms-causes/syc-20353188.
“Ileoanal Anastomosis (J-Pouch) Surgery.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Mar. 2019, www.mayoclinic.org/tests-procedures/j-pouch-surgery/about/pac-20385069.
“Ileostomy.” Cancer.Net, 9 July 2019, www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/types-ostomy/ileostomy. “Types of Ulcerative Colitis.” Crohn's & Colitis Foundation,
www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/types-of-ulcerative-colitis.
Watson, Stephanie. “Autoimmune Diseases: Types, Symptoms, Causes, Diagnosis & More.” Healthline, Healthline Media, 26 Mar. 2019, www.healthline.com/health/autoimmune-disorders.
“Ulcerative Colitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Oct. 2020, www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331.