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The Autoimmune Empire: Depression

Depression is the mind attacking itself. It’s been called a “psychic autoimmune disease.”

This morning, part of me woke up asking, what can I fix? What problem can I attack?
I know — ME!

My motives are good: what can I purify and improve? But the target is wrong.

My impulses — to fix, to cure, to control — may be overactive and delusional, just as my immune system is overactive and confused. My Crohn’s disease is treated with immunosuppressants, designed to calm down the immune system.

My mind, over time, has learned to calm down itself. I have come to accept that I can control very little, so I have learned to give up more, to surrender. This has required me to endure some grief.

I have also simply run out of steam as I’ve aged. No wonder depression was such a problem of my youth: all that energy! All those good intentions run amok! Age itself acts like an immunosuppressant of the mind. As an older friend once told me of the remission of his own depression: “my angst circuits just burned out.”

I have recovered a lot since my severely depressed youth. But a big stress can trigger depression again, just as a big virus can trigger a body’s immune system to attack itself. In fact, having an autoimmune disease seems to be triggering some depression in me now. I can’t fix my Crohn’s disease. But my mind still responds to the stress by saying, FIX IT! Failing to fix it, my mind turns on itself, because what else does it have at hand?

Only surrender, and grief. I wish my immune system could grieve whatever it needs to grieve and leave my tissues alone. Meanwhile, I hope my mind learns to accept it, because however unpleasant Crohn’s disease is, depression is worse.

My Auxiliary Digestive System

I have a machine that chews and poops for me!

Shortly after my Crohn’s diagnosis, I bought a masticating juicer:

A masticating juicer, sometimes referred to as a slow or cold press juicer is simply a style of juicer that crushes juice out of ingredients at a slow speed. In typical masticating models, juice is extracted from foods through a strong augur/screw, which pushes ingredients at high pressure against a fine screen/sieve. This not only forces juice out of ingredients, but it is a very efficient method to ensure that all juice produced is kept separate to the remaining pulp. Link

After chewing my food, it poops out the insoluble fiber, something my own digestive tract is not capable of doing properly right now. The pulp comes out one chute; everything else (juice) comes out the other, falls into a pitcher, and gets poured down my own meat-based digestive system, where nutrients are absorbed and turned into more me without aggravating the lesions (trigger warning!) in my colon.

After it has chewed, juiced, and pooped my food, I take the juicer apart and clean it. If I could do that to my own digestive tract, Crohn’s would be a lot easier to deal with.

If only I could do this with my own large and small intestines.

At the bottom of the juicing chamber is a tiny port through which the fiber gets pushed as it’s separated from the liquid. Occasionally this gets clogged and the machine “backs up.” To get things moving again I merely open the pulp chute and poke at the clog with a special cleaning tool. So much easier to fix these things outside the body.

A meat-based system would require dangerous, specialized, and expensive surgery to remove an obstruction like this. My juicer requires only a plastic pick.

Hopefully my juicer will remain the only external digestive system I need. Because I really don’t want a colostomy bag.

Covid Reactive Autoimmune Pathology

In general:

Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

High risk of autoimmune diseases after COVID-19

Patients with COVID-19 have 43% increased risk for new-onset autoimmune diseases

Autoimmunity is a hallmark of post-COVID syndrome

Inflammatory Bowel Disease (of which Crohn’s is one):

SARS-CoV-2 infection as a potential trigger factor for de novo occurrence of inflammatory bowel disease

Crohn’s Disease (my personal form of CRAP):

COVID-19 as a Trigger for De Novo Crohn’s Disease

Psoriasis (my other personal form of CRAP):

New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Systematic Review

New-onset and flares of psoriasis after COVID-19 infection or vaccination successfully treated with biologics: a case series

And Eczema, which is not exactly an autoimmune condition but is allegedly related, and which in my case also got worse after the vaccines and further worse after Covid, but hell maybe it’s because I’m just getting old:

Large cohort study shows increased risk of developing atopic dermatitis after COVID-19 disease

My point is, CRAP is a great acronym for this, and as far as search engines are concerned I coined it. You’re welcome!

My Disciplinarian

“I admire your discipline,” said a friend, referring to my extremely strict, narrow Crohn’s diet. But there’s nothing to admire, because it’s not SELF discipline. It’s being subject to a brutal, sadistic “disciplinarian” that punishes the hell out of me if I make one false move. If you had this taskmaster you’d be “disciplined” too.

(Not a $150 Drawing, but looks like one.)

Little Miss Food

Sometimes I miss food.

By food I mean Indian food, Thai food, Mexican food, salsa fresca, salads, pizza, pasta, and my homemade bread and soups: tomato, lentil-kale, vegetarian chili. Tortilla chips, potatoes with skins on, sesame seeds, nuts, herbs, and Numb Oil Tofu from Golden Harbour.

I miss eating with others. This genuinely lovely article by Brandon Showalter felt like a knife in my heart:

“Why have I been doing this, you ask? And how do I do it in light of such deep and profound differences among us? It’s actually not that complicated. As my past and present housemates can attest, I’m an unabashed foodie, I have a knack for hospitality, and extending it is an expression of normal life. I may as well give away what I love. And who doesn’t love to eat?”

I love to eat, I just can’t.

A month and a half ago I drastically restricted my diet. Fiber was out; fish was in. That was harder than it sounds, because as a vegetarian (and occasional vegan) since age 17, I prided myself on nutritious, whole-foods, hippie-style cooking. I would eat seafood a few times a year, but only away from home; I did not store or prepare it in my own kitchen. Same with eggs: an occasional restaurant treat, not on my shopping list or in my fridge. With my Crohn’s diagnosis I surrendered my dietary ideals, overcame my squeamishness, rose above my principles, and started making seared Ahi tuna steaks and scrambled eggs. I now consume about 3 times more lactose-free milk than I used to, and zero beans and lentils. The exquisite batch of vegetarian chili I made in November languishes in my freezer. I should give it away already but that would be yet another admission of defeat.

Friends pity me now, which I enjoy. But the fact is, many years before I developed Crohn’s, I would sometimes I lose my appetite for weeks at a time. Occasionally I have eschewed eating due to utter boredom and frustration. Even without any dietary restrictions (except my refusal to eat birds and mammals, which would have put me at a disadvantage at Brandon’s house anyway) food has, over the years, lost its brilliance. I have longed to recapture the thrill of my early 20’s, when the world was full of new flavors and cuisines, and every California burrito was a revelation. Age has dulled my tastebuds, but more than that, experience: I have tasted damn near everything already, many times. A memory of food usually exceeds the real thing, so eating is often tinged with disappointment: that tom kha phak is good, but not as good as that place in San Francisco in the 90’s…

A capacity for enjoying food is a blessing and shouldn’t be taken for granted.

On the brighter side, Crohn’s forced me to discover juicing. After several weeks without a salad I despaired of ever eating anything fresh again. Then I learned that a quality juicer would remove the insoluble fiber from just about any produce item. Some other Crohn’s patients wrote about doing well with fresh juices, so I ordered an entry-level masticating juicer off Amazon (since upgraded), bought a fridge’s worth of fruits and vegetables, and set off on my first culinary adventure in decades. Not only was I getting quality nutrients that didn’t make me crap my pants, I was also discovering new flavors and reawakening an interest in food — or more accurately, drink.

I can’t go out to eat these days, so I try to lure friends to my house for juice. We can’t break bread, but we can sip pineapple-ginger.

Woman does not live by juice alone (unless she’s on a “juice fast” but I’ve lost enough weight already thank you) so I continue to ingest white rice and peeled potatoes and fish and cheddar cheese (not at the same time! that would be gross) which isn’t really that bad. A person can get used to anything, and after a month-and-a-half this is just how I eat now. It’s pretty boring, but then so was almost everything, before.

I am missing much….

But really, I’m not missing much.

Medical Impostor Syndrome

Maybe I should start concealing my hair loss with a jaunty hat!

When I was a child I wanted to be sick, because when I was sick I got to stay home from school. Sometimes I was effortlessly sick and got to stay in the oddly quiet house with its peculiar mid-day creaks and sounds and winter light through the windows and extremely lame daytime TV. But at least once I sat near the heat register before school, then asked my Mom to feel my forehead, and with grave worry she said I should stay home. SCORE! But I suffered a vague sense of being ill at ease – my “dis-ease” not physical, but guilt. I hadn’t earned my reprieve from school by being really sick.

One time I got stung by a bee at recess. I don’t think my grade school had a real nurse back then, so when students got owies we went to “the office” where a grumpy secretary would give us a band-aid. I was in a lot of pain, it hurt like hell, and I cried and cried, not just from the pain but from the terror of the pain. “It doesn’t hurt that much!” said the secretary. But it did.

A few years later, in Junior High, I was beset by horrendous menstrual cramps. I also developed painful abdominal cramps and diarrhea even when I wasn’t menstruating. I drank barium and underwent medical scans but no specific cause was found, so I was diagnosed with the vague “irritable bowel syndrome,” with no treatment and no sympathy (in contrast to my brother, who had already been through several surgeries for what was later diagnosed as Crohn’s). Doubled over in pain at school, I would go to the office where the grumpy nurse would roll her eyes. “You just have to live with it!” she would snap, as I begged to go home. “Period pain” plagued the rest of my life; I would spend 3 days a month in bed, in agony, until at age 50 I got a hysterectomy and sweet, permanent relief. I was finally permitted a hysterectomy because doctors finally discovered an orange-sized fibroid in my cervix; decades of mere pain weren’t enough to merit any treatment.

Now I have late-onset Crohn’s disease, presumably triggered by my extended bout with COVID this Spring. (Many autoimmune disorders are linked with COVID; I call it COVID-Reactive Autoimmune Pathology, or CRAP.) I got myself referred to the GI department not because of pain, but because months of bad poops had me concerned. One colonoscopy later and bam, I have an incurable progressive RECOGNIZED autoimmune disease that even qualifies as a disability. I’m prescribed a $150,000-a-year designer treatment which my insurance actually covers, and everyone feels sorry for me. I soak up pity like a thirsty sponge.

Just as I’ve seen no correlation between quality of artwork and recognition/money, there seems to be no correlation between pain and external compassion. Some of the worst pain in my life, no one gave a shit about. But Crohn’s? Everyone validates it, and assumes I’m in more physical pain than I am. Yes I am in pain sometimes, if I stray from my ridiculously narrow diet of fresh juice and “safe foods” (Rice Chex, rice cakes, white rice, peeled potatoes, lactose-free dairy, eggs, and fish). But mostly I’m fine. Friends express sympathy and support, but do I deserve it? Sometimes sharing my diagnosis feels like putting my head near the heat register of my childhood home.

On the other hand, I can’t eat real food any more, and when things go wrong they go very, very, crap-in-my-pants wrong. I’m losing my hair and have some dreadful co-morbid skin conditions. And I have these really cool pictures of the inside of my colon (TRIGGER WARNING!):

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