On The Tyranny of Co-morbidity

While I wait for the endocrinologist to call so I can be questioned by med students, some thoughts on one of my least favourite words: co-morbidity.

Co-morbidity, which is such a terrible word that it no longer looks like a word after only three uses, is the occurrence of several conditions in the one person, usually linked. People usually associate things like heart disease and diabetes as co-morbid, because everyone knows being fat means you get diabetes and heart disease, right? But it’s Complicated, because of course it is. Health is complicated.

In my previous post, I ran down a little list of conditions. None of them are, in and of themselves, disabling. You can live with diabetes just fine. Ditto Factor V Leiden, PCOS, pernicious anaemia. Even adrenal insufficiency is manageable, although tricky, on its own. What becomes a problem is when you have multiple things wrong – and the thing about chronic illness is that once something goes wrong, it’s so much more likely that another thing is going to go wrong. Especially when one of those things is endocrine or autoimmune. Once those systems start to break down, it’s like the big rolling stone in an Indiana Jones temple. Hard to stop.

But, of course, we don’t like to talk about these things, because we’re terrified of being seen as fakers or hypochondriacs. Because there’s just too many things wrong with us for one person! It’s unrealistic!

(Spoiler: it’s not that unrealistic. You just don’t understand what chronic illness is like.)

So. Co-morbidity. This makes all the things that would, on their own, be inconvenient but not disabling turn into Big Hecking Deals. For example, this is a list of Little Things Wrong With Me that aren’t conditions in and of themselves, or are quite manageable when they’re taken in isolation:

Sleep apnoea. Borderline hypertension. Borderline high cholesterol. Arthritis of the hip and lower back. Propensity for shoulder bursitis. Shoulder and neck tension. Borderline personality disorder with general anxiety disorder. Migraine. Obesity.

Now, take those Little Things and add them to the list of conditions. They all exacerbate each other. The medications that I have to take mess with each other. I’m on thirteen medications at the moment, and at least three of them have “trouble losing weight” or “weight gain” as a side effect. It’s a balancing act and I am not good with balance.

The thing about co-morbidities is that a lot of the time, it’s hard to point to one condition as the culprit when you’re talking about your symptoms. This is a problem when it comes to things like trying to get disability support, because the government likes to make things as difficult as possible for disabled people. I could sit down right now and say, “I’m feeling dizzy and have a bad headache. When I came back from going to the toilet and put my dressing gown on, the effort of being upright and wrestling with a heavy piece of fabric made my heart race enough that I could feel it in my temples. Sometimes I find myself panting slightly because breathing is just that difficult. I’m always tired. I feel like my brain is wrapped in cotton wool and translating words from my brain to my mouth takes so much energy that a lot of the time I end up just saying ‘you know, the thing, with the thing’. I can’t walk down a flight of stairs without feeling weak and standing up at the kitchen counter long enough to make a sandwich makes my back hurt badly enough to make me cry.”

And then the Process goes “okay, but what condition causes that?” and you know what, I don’t know. A combination of them. All of them. Because my body is trying to keep going and does not have much to work with. I have to be selective about what I’m trying to deal with at the moment, because I just can’t deal with all of it. I’m keeping up with my medications and my blood tests, and I’m trying to find the right dosage to manage my adrenal insufficiency (spoiler: I don’t think we’re there yet). In theory, I’m trying to lose weight, but that involves meal replacement bars and exercise and I’m not physically capable of either at the moment. More on that in a later blog.

Co-morbidities are the worst, and whoever thought of them should be fired. My doctors, thankfully, are pretty understanding. Hopefully the med students will get something out of mine, because god knows I only get frustration. But if you have a chronically ill person in your life and they seem inconsistent about why they’re unwell, maybe this is why. Maybe it’s not. Chronically ill people can be flakes too. But this is a thing. You get a lot of “well, clearly she’s faking [it’s always a she. Why are dudes never faking, I wonder?] because she said she had this last time, but now she says she has this”. Well, maybe she has both.

I mean, look at the title of this blog. I’m a medical snowflake. I wouldn’t believe me if I met me. I’m not realistic. But I’m real.