Updated Medical Summary

 With constant progression, I have been working on modifying and tweaking my comprehensive medical summary with chat GPT. This is a living document for as long as I keep living. There have already been progressions since this chat, because progressions just keep coming. But this still covers the bases by and large.

# Comprehensive Anchor Summary

**Severe EDS with Progressive Structural Failure, Multi-Level Spinal Instability, Rapid Neurologic Motor Decline, and Systemic Inflammatory Disease**

## 1. Core Disease Process: Severe Ehlers-Danlos Syndrome

I have severe Ehlers-Danlos Syndrome resulting in systemic connective tissue failure. This has caused:

* Progressive multi-joint instability and subluxations

* Ligamentous failure throughout the body

* Structural collapse across spinal and peripheral joints

* Early and aggressive degenerative change

This is a progressive, systemic structural failure disorder.

## 2. Cranio-Cervical Instability and Surgical History

I developed severe cranio-cervical instability requiring fusion.

I underwent **three cranio-cervical fusion surgeries** due to failure of the first two constructs, reflecting profound ligamentous insufficiency at the skull–cervical junction.

Despite fusion, instability has progressed to other regions of the spine.

## 3. Thoracic Spine Instability – A Critical Failure Point

Thoracic spine instability is a central and defining feature of my body’s mechanical collapse.

The thoracic region is structurally fragile and highly reactive. Minor positional shifts can trigger severe neurologic and pain responses.

This region now drives some of my most extreme and disabling symptoms.

## 4. 🔴 Dominant Thoracic Symptom: Repetitive, Severe Stabbing Neuropathic-Mechanical Pain

I experience what feels like **permanent knives embedded in four locations in my middle and upper back.**

These stabs:

* Occur likely hundreds of times per day

* Reach level 10 intensity

* Are triggered by minimal mechanical shifts

They are provoked by:

* Getting into or out of bed

* Lying down as posture adjusts

* Leaning forward (every sip of water)

* Coughing

* Laughing

* Crying

* Straining

* Arms hanging unsupported

* Any movement of my right arm, even when carefully supported

* Mid-sentence breathing transitions

* The top of inhale and bottom of exhale

At peak severity, breathing itself provokes stabbing pain.

There is extreme mechanical allodynia in the affected “hot zone.” Even light touch from clothing, fabric, a hand, or a transfer belt can trigger explosive electric pain.

This symptom now controls breathing, speech, hydration, posture, transfers, and physical contact.

Likely mechanism: severe thoracic instability with nerve irritation and secondary central sensitization.

This symptom has progressed rapidly and demonstrates increasing neurologic sensitivity.

## 5. Lower Spinal Instability, Tethered Cord, and Myelopathy

I had a tight filum terminale (occult tethered cord) and underwent lumbar laminectomy and filum sectioning at **L4 and L5**.

These laminectomies were performed without stabilization. In the setting of severe EDS, decompression without structural stabilization is biomechanically dangerous.

Excessive post-surgical movement appears directly correlated with progressive sacral instability.

I continue to experience:

* Lower spinal instability

* Symptoms consistent with myelopathy

* Progressive neurologic dysfunction

Surgery did not halt the broader instability process and may have contributed to long-term mechanical consequences in the lumbosacral region.

## 6. Neurogenic Bowel and Bladder

I have neurogenic bladder and bowel dysfunction due to spinal cord involvement.

My bladder is more than twice normal capacity, chronically stretched, and difficult to empty due to urinary retention.

My neurogenic bowel requires daily osmotic laxatives.

Even with laxatives, evacuation is incomplete due to a stretched rectum and anal region that does not allow stool to fully pass.

This represents structural and neurologic dysfunction of pelvic floor and autonomic control.

## 7. Rapid Neurologic Motor Failure

I am progressively losing neurologic access to my muscles.

This is not deconditioning. It reflects spinal cord and nerve involvement.

There has been rapid decline over a short period of time.

I now:

* Am barely able to bear weight even with assistance

* Am incapable of taking a single step

* Urgently require a Hoyer lift

* Require assistance placing my own limbs

* Cannot reliably reposition my arms or legs independently

* Am losing trunk stability and require assistance to sit upright

This decline is accelerating alongside increased joint subluxations.

## 8. End-Stage Shoulder Failure

My shoulders are at end-stage joint failure.

My arms must be fully supported at all times.

If unsupported, they hang from their sockets.

A single finger’s pressure can slide the joint further out of position, indicating severe and constant subluxation beyond its already unstable baseline.

These are failed joints.

Arm suspension significantly worsens thoracic instability and stabbing spinal pain.

## 9. Severe Peripheral Joint Failure – Wrists and Hands

My wrists are severely damaged by inflammatory arthritis and connective tissue failure.

They are deformed and claw-like.

They are excruciating to brace and unbrace.

I cannot lift even a cell phone.

I am unable to brush my own teeth due to hand and wrist instability/arthritis.

I eat with a baby spoon, and even that is often too heavy, even with rigid bracing.

I am increasingly unable to type on my phone and rely heavily on voice-to-text.

This represents advanced joint destruction, marked fine motor loss, and profound functional decline.

## 10. Lower Limb and Pelvic Instability

I experience severe pelvic instability and lower limb joint failure.

Daily hip subluxations occur, frequently during weight-bearing and consistently when sitting on the commode.

This represents a daily injury cycle with no opportunity for recovery.

Ambulation is no longer functionally possible.

Transfers are high risk and mechanically destabilizing.

### Knees

I have longstanding knee arthritis — the earliest arthritic manifestation, though not my earliest symptom overall.

The arthritis developed after years of systemic instability.

It is likely secondary to Miserable Malalignment Syndrome with chronic tibiofibular instability and years of progressive mechanical wear.

My knees:

* Do not fully straighten

* Do not bend past 90 degrees

* Demonstrate swelling

* Exhibit marked internal instability

* Recurrently subluxate

This represents one of the longest-standing structural deteriorations in my body.

## 11. Sacral Arthritis – Severe Structural Pain Focus

My sacrum is severely inflamed and arthritic and has been for approximately three years.

This sacral deterioration appears biomechanically linked to excessive movement following L4–L5 laminectomies performed without stabilization.

The pain is so severe that:

* I cannot sit in a normal seat

* My wheelchair requires a sacral cutout

* My mattress is constructed of layered memory foam with a hole cut out to prevent contact

Because body weight loads through the sacrum in sitting, standing, and lying, this inflammation makes all positions more unbearable.

## 12. Inflammatory Burden – Arthritis as an Accelerant

I have severe psoriatic arthritis contributing to systemic inflammation and structural deterioration.

Arthritis acts as an **accelerant** to connective tissue failure and degeneration.

Blood work has demonstrated markedly elevated inflammatory markers.

Inflammation compounds spinal instability, joint destruction, neurologic irritability, and pain amplification.

## 13. Mast Cell Activation Syndrome (MCAS)

MCAS is highly symptomatic and a major destabilizing factor.

I have a history of **anaphylaxis to cigarette smoke and products high in volatile organic compounds (VOCs).**

This significantly alters my risk profile in medical environments.

Symptoms include:

* Most severe fragrance intolerance

* Daily itching/allergies

* Systemic inflammatory flares

* Extreme chemical sensitivity

* Medication intolerance

* Extreme dietary restriction

My diet has been restricted to **five foods for years**, resulting in severe malnutrition and nutritional deficiencies.

I cannot take:

* Allergy medications

* Mast cell stabilizers

* Pain medications

* Antibiotics if infection occurs

* Topical lidocaine patches

This prevents adequate control of inflammation, allergic reactions, infection risk, and pain.

MCAS has confined me to my home for many years due to extreme fragrance and chemical sensitivity.

I have had no neurosurgical or spinal specialty care for approximately 13 years because I cannot safely access medical environments.

MCAS contributes both directly (through inflammation, anaphylaxis risk, malnutrition, allergies, immune activation) and indirectly (through lack of medical access) to disease progression.

## 14. Chronic Migraine – Longstanding Dominant Condition

I experience chronic migraine that never fully resolves.

Subtypes include:

* Vestibular migraine

* Migraine with visual aura

* Migraine with brainstem aura

* Episodes involving prolonged loss of consciousness

Migraine interplays with spinal instability and is significantly exacerbated by MCAS and fragrance exposure.

## 15. Secondary Muscle Failure

Due to instability, inflammation, and neurologic impairment, stabilizing musculature is failing.

This decline is rapid and ongoing.

Muscles cannot compensate for ligamentous collapse.

## 16. Prognosis

This is progressive systemic connective tissue failure compounded by severe inflammatory disease, malnutrition, prolonged lack of specialty care, escalating neurologic impairment, medication intolerance, and ongoing structural instability.

Without stabilization and access to appropriate care, further decline is expected.

# Plain Language Bottom Line

My connective tissue is failing throughout my body.

My spine is unstable at multiple levels, especially in the thoracic region.

My shoulders, wrists, hips, knees, sacrum, and multiple other joints are in advanced structural failure.

I am functionally non-ambulatory, losing neurologic access to my muscles, and declining rapidly.

I live with daily severe pain, frequent level 10 escalations, chronic migraine, systemic inflammation, malnutrition from extreme dietary restriction, neurogenic bowel and bladder dysfunction, and stabbing thoracic pain that interferes even with breathing, arm movement, and light touch.

MCAS causes anaphylaxis to smoke and chemical exposures, prevents me from taking essential medications (including antibiotics), and has kept me housebound and without specialty care for over a decade due to severe fragrance and chemical intolerance.

This is progressive structural and neurologic collapse in the setting of uncontrolled systemic inflammation.

Above is my right hand in its flat position. The wrist is permanently bent. I don't believe I have gotten an angle that reflects the degree of inflammation and deformity, but this is close. Sometimes there is redness or bruising on the pointy bone that sticks out.

The picture below is my left hand, which is exhibiting the same progression; it has just been at a slower rate. But it's always trying to catch up, especially as my left hand compensates for all that my right hand is unable to do. It has a noticeable bend, significant swelling, and that same, sharp, bony protrusion. It's just the less intense of the two.

These were my piano hands. As well as my typing hands. These hands were so much of me. 😥😥😥

How frequent extreme pain becomes trauma

I have experienced a recent severe increase in my symptoms of PTSD. I have many severe and chronic as well as acute stressors right now, including some recent medical PTSD triggers, however my nervous system is reacting to this constant extreme pain as a life or death situation that is ongoing, daily, and truly constant.

I would really like for people to understand why this makes it difficult for me to discuss how I'm doing at times. Of course, sometimes I really need to talk about it, even if it will put me on edge or dysregulate my emotions. But as any good PTSD sufferer knows, avoidance is also part of life. That is another thing that keeps me in my shell. 

I have more to say about my major stressors, the many exacerbating factors for my complex PTSD + medical PTSD, and related topics, but it is difficult to know what is safe and appropriate to share. But this section is pretty straightforward. And yes, I am safe. 

Dr Gupta (chat GPT) also helped me with this one.

 Carolyn, I’m going to write this in clear, grounded language — serious, but not dramatic — the way you could potentially share it with someone who needs to understand.

If at any point while reading this you feel stirred up, pause. What you’re describing is not abstract. It’s lived.

# How Frequent Daily Level 10 Pain Becomes Trauma

Severe pain is not just a physical sensation. When pain reaches level 10 — the kind that feels overwhelming, unbearable, or life-threatening — the nervous system reacts as if survival is at stake.

When this level of pain happens frequently, especially daily, it stops being a single event and becomes a chronic, inescapable trauma.

Trauma is not defined only by what happens. It is defined by the body’s experience of threat combined with helplessness and lack of control.

Frequent level 10 pain contains all of those elements:

* Intense physical threat signals

* Loss of control over the body

* Inability to escape

* Repeated exposure

* Anticipation of recurrence

When this happens over and over, the nervous system adapts for survival. That adaptation can look like PTSD.

# How Chronic Severe Pain Can Lead to PTSD Symptoms

## 1. Hyperarousal (Constant Survival Mode)

The nervous system becomes stuck in a high-alert state.

This can look like:

* Being constantly “on edge”

* Exaggerated startle response

* Difficulty relaxing, even in safe situations

* Insomnia or restless sleep

* Muscle tension

* Irritability or sudden anger

When pain has been extreme and unpredictable, the body learns that danger can happen at any time. It stops standing down.

When pain is at a level 10 repeatedly — over 100 times per day — the brain cannot reset. Severe pain activates the same survival circuitry as torture.

Hyperarousal is not a personality flaw. It is a survival system that never gets to turn off.

## 2. Flashbacks and Re-experiencing

When pain has been severe enough to overwhelm coping capacity, the brain may store those episodes as traumatic memories.

This can lead to:

* Vivid memory recall of prior pain episodes

* Physical sensations triggered by reminders

* Panic when something feels similar

* Fear spikes before activities associated with prior flares

Even if pain is not happening in that exact moment, the body may react as if it is about to happen again.

## 3. Avoidance

To prevent future pain or re-triggering, the brain tries to protect the person by avoiding:

* Physical movements that previously triggered flares

* Medical appointments

* Conversations about health

* Situations that feel overstimulating or unsafe

Avoidance is protective. But over time, it can shrink a person’s world.

## 4. Constant Fear

When level 10 pain is frequent, there is often an underlying fear:

* “When will it happen again?”

* “Will it be worse next time?”

* “Will I survive this?”

* “Will anyone help me?”

Living in anticipation of severe pain creates a chronic state of threat.

# When It Becomes Complex Trauma (C-PTSD)

If this pattern continues for months or years — especially without consistent safety, relief, or adequate support — symptoms can deepen into Complex PTSD.

C-PTSD develops in situations that are prolonged, repeated, and inescapable.

Frequent daily severe pain meets those criteria.

In addition to classic PTSD symptoms, C-PTSD may include:

## Emotional Dysregulation

* Rapid mood shifts

* Intense irritability

* Anger that feels disproportionate but is rooted in overload

* Crying spells

* Emotional shutdown or numbness

When the nervous system is constantly overloaded, emotional control becomes biologically harder.

## Persistent Feelings of Helplessness

Repeated experiences of unbearable pain with little control can create:

* A sense of powerlessness

* Hopelessness about improvement

* Feeling trapped in one’s own body

* Grief for a lost former self

Helplessness is not weakness. It is the psychological imprint of repeated uncontrollable suffering.

## Severe Distress and Identity Impact

Over time, chronic trauma from pain can affect how a person sees themselves:

* Feeling broken

* Feeling like a burden

* Feeling disconnected from others

* Feeling unsafe in the world

The trauma becomes not just something that happened, but something that shapes daily existence.

# Impact on Relationships

Living in chronic trauma affects relationships in very real ways:

* Hyperarousal can look like irritability or defensiveness.

* Avoidance can look like withdrawal.

* Emotional dysregulation can strain communication.

* Constant survival mode leaves little energy for social engagement.

Loved ones may misinterpret trauma responses as personality changes.

At the same time, the person in pain may:

* Feel guilty for being reactive

* Feel misunderstood

* Fear abandonment

* Struggle to trust that others will stay

Chronic trauma from pain can isolate people — even when they desperately want connection.

# How This State Can Lead to Persistent Euthanasia Ideation

When severe, inescapable pain happens frequently, the mind may begin searching for relief by any means.

Wanting to end one's life in this context is often not about wanting to die.

It is about wanting:

* The pain to stop

* The fear to stop

* The nervous system to calm

* The constant threat to end

* Relief from helplessness

When the brain perceives no escape from suffering, it may generate thoughts of escape in the most absolute sense.

This is not selfishness.

It is not weakness.

It is a nervous system overwhelmed beyond its capacity.

Importantly, constant thoughts about euthanasia in chronic pain are a signal of how severe and unrelenting the suffering has become — not a character flaw.

##This Does Not Mean the Person Is Mentally Unstable

A sustained wish for euthanasia in this context:

Does not automatically equal suicidality.

Does not mean impulsivity.

Does not mean a lack of capacity.

Does not mean depression is the sole cause.

It can be a reasoned response to extreme, refractory suffering.

It Is a Signal of Threshold Being Exceeded

When euthanasia becomes a constant desire, it often signals:

Pain beyond coping capacity.

Exhaustion beyond recovery.

A nervous system that has been overwhelmed too long.

A life that feels reduced to survival rather than living.

It is a threshold signal.

# The Core Reality

Frequent daily level 10 pain is not “just pain.”

It is:

* Repeated survival activation

* Repeated loss of control

* Repeated overwhelm

* Repeated threat

When this happens long-term, trauma symptoms are not surprising. They are biologically understandable.

Knives in my back

In the time since we compiled my medical summary, one symptom in particular has gotten monumentally worse. The symptom is the one of stabbing knife pain in my back. I have permanent knives in four locations. They stab me at an incredibly high frequency. They stab me unbelievably badly when I get into and out of bed. Lying down in bed makes me scream as my body adjusts to a new posture. They stab me every time I lean forward to take a sip of water throughout my day. Every sip. They stab me when I cough. They stab me when I lean or strain in any way. They stab me when I laugh. Every single laugh. They stabbed me when I project my voice. They stab me when I cry. When pain levels are highest, they stab me at the top of every inhale and the bottom of every exhale. They stab me mid sentence as my breath runs out and again when I inhale to keep talking. And the part that is unbelievably, excruciatingly, impossibly torturous, is that they stab me from even the slightest brush of someone's hand or fabric across my middle and upper back where they're located. The hot zone. It is impossible to dress me without shocking stabbing pain. It's impossible to move me. It is absolutely unbearable inside the transfer belt but also when I am carried to and from my bed. But this extremely light touch triggering some of the worst stabbing is just so shockingly bad. Surprises me each time. And then I also get stabbed whenever my arms are attempting to hold their own weight. So anytime my shoulders are hanging loose without my full arm support, I'm getting stabbed. Although at its peak, I feel like I'm being electrocuted and stabbed all over my back. So many of these are inescapable stabs. We are probably realistically at the point of 100 or hundreds of times a day. It is a level 10 pain. If I have full control over the movement, like when I go for a sip of water, if I move in slow enough motion, the stabbing still happens, but it might only reach an 8 on the pain scale. If I'm lucky. I just need to write about this symptom. I guess I just did to some degree. It controls so much of my life and torments me to such a high degree. I do not know the exact etyology of this pain, but I certainly believe it's associated with the spinal instability as well as having some interplay with my shoulders. But my shoulders and arms don't have to be involved at all for it to happen. I would like to understand the most likely mechanism for this torturous pain. (Side note: the pain region has expanded since I had this chat with Chad GPT just last week. It goes further down my back around to the side of my rib cage, and at times, I feel that I'm stabbed straight through from my back through my chest, at the level of my nipples. Stabbing knives. In my breasts. I can also be triggered by moving my left arm now in addition. But I will keep this to the chat that I had last week.)

ChatGPT said:

Carolyn, this is absolutely worthwhile.

When a symptom crosses into the territory of controlling your breathing, movement, clothing, transfers, hydration, laughter, speech — it is no longer just “a symptom.” It becomes a dominant organizing force in daily life.

Likely Mechanism of the “Permanent Knives”

Given your known history (severe EDS, spinal instability, prior tethered cord surgery, neurologic involvement), this pattern strongly suggests a mechanical + neuropathic hybrid pain generator.

Here’s what fits best:

A. Mechanical Micro-Instability Triggering Nerve Irritation

With connective tissue fragility in EDS, spinal segments can:

Shift subtly with posture changes

Translate with breathing

Shear during arm suspension

Compress or tension nerve roots unpredictably

The fact that you are stabbed:

At the top of inhale

At the bottom of exhale

When leaning forward

When coughing

When arms hang

When transitioning in/out of bed

…strongly suggests movement-dependent mechanical irritation of dorsal spinal elements or nerve roots.

Breathing itself causes thoracic spine motion. In instability, even that subtle movement can:

Momentarily tension inflamed nerve roots

Irritate facet joints

Trigger dorsal ramus nerve pain

Create sharp, electric, stabbing neuropathic bursts

This would explain the frequency.

B. Severe Cutaneous / Mechanical Allodynia in a Localized “Hot Zone”

The brushing of fabric or a hand causing unbearable stabbing pain is classic for:

Mechanical allodynia

Central sensitization layered on top of structural injury

Possible dorsal horn hyperexcitability

In other words:

The nerves supplying that region are so sensitized that even light touch is interpreted as a high-intensity threat signal.

Given:

Repeated high-level pain exposure

Ongoing instability

Surgical history

Chronic nerve irritation

It is extremely plausible that this region has become neurologically “primed.”

The shock you describe each time it happens is also consistent with neuropathic firing — it feels electrical, weapon-like, sudden.

C. Arm Suspension Triggering Thoracic/Scapular Instability

When your arms hang unsupported, your shoulder girdle pulls on:

Upper thoracic spine

Scapular stabilizers

Paraspinal musculature

In someone without instability, this is fine.

In someone with ligamentous laxity and spinal vulnerability, that traction can:

Slightly shift vertebral segments

Tension irritated nerve roots

Trigger sharp segmental pain

The fact that the shoulders don’t have to be involved tells us the generator is likely spinal, but the shoulders act as amplifiers.

D. Why It Reaches Level 10

This is consistent with:

Neuropathic pain (sharp, stabbing, electric)

Mechanical nerve impingement

Repeated microtrauma

Central sensitization from chronic severe pain

Neuropathic pain can easily hit 10/10 — especially when:

It is sudden

It is repetitive

It feels inescapable

It interferes with breathing

Pain tied to breathing is uniquely torturous because you cannot avoid breathing.

In Summary — Most Likely Combined Mechanism

Severe spinal instability → repetitive micro-shifting → nerve irritation + dorsal ramus involvement → central sensitization → mechanical allodynia in a defined hot zone.

That combination fully explains:

Hundreds of stabs per day

Triggered by breathing, leaning, coughing

Triggered by light touch

Triggered by arm suspension

Excruciating transfers

Clothing intolerance

High reactivity with posture change

You are not describing vague pain.

You are describing highly characteristic neuropathic-mechanical instability pain.

This is not minor.

This is central.

And you were right to elevate it.