My current rotation on GI has led me to observe patients with a range of diagnoses, namely inflammatory bowel conditions like ulcerative colitis and crohn's disease, irritable bowel syndrome, and neuroendocrine tumors. Although these diseases/syndromes are all incredibly different from one another, all who they afflict are subject to extreme GI-related anxiety. This is an anxiety I've known all too well during my entire life. During my first few days at the clinic I was shocked to hear some of the things I dealt with myself growing up and all through pharmacy school repeated from the mouths of the patients we saw. Feelings and thoughts I believed to be exclusive to myself were suddenly the same sentiments shared by other people. After seeing some of these patients and silently reflecting on our shared struggle, I decided to write a little bit about my experience with chronic illness and anxiety while in pharmacy school.

Pharmacy school is an emotional and physical challenge that can take a toll on both your mental and physical health. Therefore it never surprised me to hear about fellow classmates who had to deal with worsening or new onset chronic illness in the midst of their pharmacy school years. I used to feel immense sympathy for those who juggled doctors appointments around exams and struggled with just feeling well enough to show up to class. I felt immense sympathy until I became one of those people who couldn't fit in doctors appointments, who never felt well in class and who was too sick to focus on my education. When that happened, my sympathy turned into empathy.

In my P2 year, I dropped to 86 lbs. I had stopped eating full meals and relied solely on baggies of cheerios and the pre-packaged cheese/cracker boxes at Wawa. I avoided eating in public or with friends as often as I could. I was so nauseous every day that I had to plug my nose while walking by food trucks or be subject to dry heaving in public. I was constantly nervous about where the closest bathroom was, if I'd be able to leave class/rotation, and if i'd make it through the day without throwing up or passing out. This was me at my worst and it was years and years of denial in the making.

It started when I was 6 years old. An unfortunate accident landed me in CHOP's GI department with a colon so dilated it was a miracle I was able to function at all. As a little kid, I didn't have much of an understanding of what was happening but I knew the pain was intolerable and the medications just as bad. For a short period of my life I was able to ignore my illness and avoid preventing the subsequent pain and discomfort with medication. I'd go through pockets of being absolutely fine and it was like I was never sick. I never thought as myself as a person with a medical problem. But then the pain and sickness would come roaring back and I'd wish I was anyone but myself.

Eventually the episodes would present so intensely that I'd fear the next one. I'd stop myself from leaving the house if I felt the slightest belly twinge. I'd map out all the bathrooms, plan extensive escape plans, and make any excuse to drive myself so I wouldn't be stuck. If I knew I was going to be out for a night, I'd make sure I didn't eat just in case my stomach decided to descend into chaos post meal while I was still out. Eating meals out in public were almost always taboo unless it was one of my very few "safe foods" (soup, caprese sandwich, more soup).

It used to be that the anxiety would only linger for a short period of time after an episode finished, maybe a week or two. As I went through my college years, the periods of anxiety became longer and longer until I knew my anxious state better than my calm state. It became suffocating. When pharmacy school came around I was managing my GI-related anxiety and my GI symptoms as if they were this part of me that I had to accept as is. I didn't seek out additional treatments or professional help until my P2 year when after a bad break up, and a bad semester I was left an anxious set of bones. I was inattentive, distracted and in a lot of distress. I didn't even realize what was happening with my weight until I came home for the semester and one of my college friends said, "what is going on with you? You don't look well". A few days after that I got on a scale for the first time in years at a doctors appointment and was stunned to see myself about 15 lbs below my normal weight.

I wish I hadn't waited so long to seek out help. Had I known that making the time to go see a doctor would be the first step in taking control of my condition I would have felt better a lot sooner. I'm extremely lucky that despite my medical troubles I never fell behind in school, and my grades did not suffer. I know there are others who are not so lucky. So my advice is this:

1. Do not wait to seek help. If you're struggling, tell a teacher you trust, a doctor, or a friend. There is no reason to suffer in silence when there are people around you who have access to resources that can help you.
2. Advocate for yourself. That includes in school, in our crazy healthcare system, and in life. 
3. Remember that you don't have to prove anything to anyone. I constantly felt like if I didn't over-explain my situation to people that they would never believe me later when I needed to bail on something due to sickness. It took a while for me to realize that only I knew my condition inside and out and other people really don't have to for it to be real and valid.
4. Seek out accommodations. If your school has a process, use it! Even if you don't enact your accommodation in the entirety of your schooling, at least you have it just in case. It'll do wonders for your anxiety. 
5. People will understand more than you think they will. I've learned so much from sharing my story with classmates. You'll be surprised to learn how many people have experienced similar hardships.