CASE STUDY 1
First Symptoms: Andrea Carrion, 27, had just seen a movie in Los Angeles when she tried to stand upÃ¢â‚¬”and nearly collapsed. "A sharp, burning pain in my knees was so bad that I fell back into my seat," she says. Two days later the ache was gone. But the pain returned in a few months and lasted, on and off, for two years.
First Diagnosis: While visiting family in Peru over Christmas, Andrea went to a rheumatologist, who ran a few blood tests. He said she had fibromyalgia.
First Treatment: The doctor told Andrea to take it easy and continue treating her pain with OTC meds. She returned to L.A., where, six months later, she had a minor car accident. Though she wasn't visibly hurt, within weeks she was on antibiotics for a urinary tract infection, and she'd developed a rash on her chest and across her face. Her hair began to fall out, and her joint pain became so bad that she needed her boyfriend's help getting dressed.
Second Diagnosis: A new rheumatologist noticed the butterfly-shaped rash on her faceÃ¢â‚¬”a red-flag symptom of lupus, a disease that can cause widespread inflammation, pain, and eventually organ damage. An ANA blood test, which looks for specific antibodies present in 97 percent of sufferers, helped confirm the diagnosis.
Of the estimated 1.5 million American lupus patients, 90 percent are women from ages 15 to 40. "Lupus is perhaps the most complex disease out there because it has so many manifestations and can affect any body part," says Jill Buyon, M.D., a professor of medicine at the NYU School of Medicine.
Second Treatment: Andrea was put on daily oral steroids, prescription pain medication, and Plaquenil, an antimalarial drug often used to treat autoimmunity. Though she felt better within a week, the respite didn't last. A few months later, she began getting UTIs and kidney infections, and she developed numbness in her hands and feet. Stomachaches often left her doubled over in pain.
Third Treatment: When she was 31, Andrea rushed to the ER with an awful stomachache. Her bowels were so swollen that doctors feared they might rupture, and her lungs were filled with so much fluid that they had to be drained via a needle in her back. For nine days, Andrea's rheumatologist pumped her full of painkillers and steroids; he added two immunosuppressants to her medications. Soon, her symptoms were under control.
LOWER YOUR RISK
Ban rays. If you are at genetic risk for lupus (or already have the disease), watch out for ultraviolet light, a common flare-up trigger. Slash your exposure by avoiding photocopiers and fluorescent tube lights, both of which emit UVA rays.
Andrea, now 35, is married and works full-time as a reporter. She is closely monitored by her rheumatologist and still takes steroids and Plaquenil daily. Stress triggers minor flare-ups, but she feels normal otherwise.
CASE STUDY 2
First Symptoms: When she was 23, Fatima Cantu fell off a four-wheeler near her Houston home. She recovered, but the scabs on her elbows remained. "It was as if they never healed, but they weren't painful or itchy, so I didn't think much of it," she says. Two years later, though, the flaky red rash began to spread down her arms.
First Diagnosis: Her doctor diagnosed her with plaque psoriasis, a type of genetic disease that occurs when the immune system sends out a faulty signal, causing epidermal cells to grow at warp speed and build up on the skin's surface. Psoriasis usually develops between the ages of 15 and 25, and affects some 3.75 million American women.
First Treatment: Fatima applied prescription vitamin D lotion to the affected areas twice a day. It didn't help. Within three weeks, the plaques covered most of her body. "I was so embarrassed that I'd wear sweaters all summer," she says.
Second Treatment: Over the next six months, a dermatologist prescribed six topical ointments, which Fatima slathered on up to three times a day. The condition grew to cover her scalp and ears.
Third Treatment: A different doctor suggested using a topical steroid cream and Methotrexate, an oral chemotherapy drug used to treat severe autoimmune cases. Fatima's thickest plaques began to soften.
Fourth Treatment: Fatima added six weeks of phototherapy. Twice a week for 15 minutes at a time, her M.D. directed a painless beam of ultra-strong UVB light onto her skin. The intense light can slow the growth of skin cells. "It started working immediately," says Fatima, now 27. "Before long, my skin was completely clear."
LOWER YOUR RISK
Keep it light. If you have a family history of psoriasis, steer clear of hearty brews. Researchers found that women who guzzled full-calorie beer were twice as likely to develop new onset psoriasis as those who drank light beer, wine, or liquor. The gluten in regular suds may be a psoriasis trigger.
Now applying to med school, Fatima doesn't need to take any drugs and has almost zero symptoms.
CASE STUDY 3
First Symptoms: Ryann Fraser, 22, had always been exhausted. "By the time I was in high school, I was downing coffee like it was water just to make it through the day," she says. Her doctor tested her for mono four times before chalking up Ryann's fatigue to a very active lifestyle.
First Diagnosis: When she was 18, a blood test found that Ryann's iron levels were extra low. She had severe anemia.
First Treatment: Ryann took iron supplements three times a day and changed her diet. "I ate steak every day for an entire summer," she says. Her iron levels rose, but not enough.
Second Diagnosis: Bone tired after three years of anemia, she was desperate. Ryann's friend told her that her energy levels soared after she went gluten-free. "I decided to try it for two weeks, but by the second day I felt superhuman," she says. A few weeks later, a blood test and a painless intestinal biopsy confirmed her suspicion: She had celiac disease, a digestive condition in which glutenÃ¢â‚¬”a protein found in wheat, barley, and ryeÃ¢â‚¬”eats away at the small intestine.
"For people with celiac, even a crumb of gluten can set off an army of white blood cells that attack the gut," says Alessio Fasano, M.D., medical director of the University of Maryland Center for Celiac Research. Diarrhea, bloating, and abdominal cramping commonly follow, though not in all patients. If the disease isn't treated, the small intestine becomes so damaged that it can no longer properly digest and absorb key nutrients, which can lead to anemia, osteoporosis, and infertility. But since many instances are so vague, experts believe a whopping 97 percent of people with the disease go undiagnosed. Of the estimated 3 million cases in the United States, the majority occur in women.
Second Treatment: Ryann axed gluten from her diet and is now entirely symptom-free and working as a fitness model in New York City. Her small intestine repaired itself, a process that can take a few weeks to several months.
CASE STUDY 4
First Symptoms: Cheryl Crow's health took a nosedive around the time she turned 20. The Seattle native struggled with dry eyes, a swollen finger that just wouldn't heal, constant bloating, and most troublingly, zero appetite. "I'd take two bites of food and feel full," she says. Within two years, she dropped 30 pounds.
First Diagnosis: After several inconclusive tests, a gastroenterologist wondered if Cheryl had an eating disorder. She didn't. He then suspected high anxiety.
Second Diagnosis: A gastric emptying scan that measures how quickly food leaves the stomach ID'd gastroparesis, in which the gut takes much longer than usual to digest and process food.
First Treatment: Cheryl started a low-fiber, low-acid diet. She cut out citrus fruits, tomatoes, and whole grains. Her doctor also prescribed gastric motility meds to speed up digestion.
Second Treatment: A year later, Cheryl still felt fullÃ¢â‚¬”like, really full, all the time. Totally stressed out, she started having panic attacks. Her M.D. gave her antianxiety drugs to calm her nerves and jump-start her appetite.
Third Diagnosis: Eight weeks passed, and Cheryl caught the fluÃ¢â‚¬”and something else entirely. "I woke up one morning with what felt like hot glue in my hands and feet," she says. Just opening a carton of milk took monumental effort. Her internist performed blood tests, X-rays, and a physical exam that hinted at rheumatoid arthritis (RA), a disease that causes the immune system to attack joint linings, causing pain and stiffness.
Unlike your grandma's arthritis, RA can attack the entire body with swelling that's warm to the touch. It also skews much younger, affecting an estimated 1.3 million Americans from ages 25 to 50Ã¢â‚¬”and 70 percent of them are women. The pain can range from mild to crippling and is often accompanied by dry eyes (a symptom of Sjogren's syndrome) and killer fatigue. Stress and infections (like Cheryl's flu) can trigger the disease in someone with a genetic predisposition as well as cause flare-ups later on.
Third Treatment: Cheryl started taking Enbrel, a prescription drug that quiets an overactive immune system. Within three months, her joint pain, full feeling, and anxiety vanished. "It was like I pushed a reset button on my body," she says. But six years later, her joint pain slowly returned.
Fourth Treatment: "It's not uncommon for a drug to stop working after a while," says rheumatologist Eric Ruderman, M.D., a professor of medicine at Northwestern University Feinberg School of Medicine.
"The body may develop antibodies against the drug, or the disease may change over time." Cheryl switched to another immunosuppressant, Remicade, which she continues to take via IV infusions once every seven weeks.
LOWER YOUR RISK
Kick the butts. Research clearly shows that smokers are nearly twice as likely as nonsmokers to develop RA, whether they are genetically predisposed or not. What's more, when a puffer does get RA, her symptoms are worse and don't respond as well to therapy.
Except for the dull pain she gets in her hands when opening a jar, Cheryl's RA symptoms are under control. Now 30, she's teaching dance classes to pay her way through grad school.
CASE STUDY 5
First Symptoms: Pittsburgh native Amanda Shannon, 21, was surprised when she discovered a fingertip-size bald spot on the back of her head. Soon, it was the size of a quarter.
First Diagnosis: A dermatologist diagnosed alopecia areata, or circular bald patches that occur when the immune system mistakenly attacks hair follicles. More than 4.7 million Americans (about half of them women) have the genetic condition, which can progress to total hair loss, often over the entire body. Though the condition is unpredictableÃ¢â‚¬”hair can regrow and fall out again in cycles, sans pain or itchingÃ¢â‚¬”the more widespread the loss, the harder it is to treat.
First Treatment: Twice a day, Amanda rubbed a topical prescription cream onto her scalp. After a month, she had no regrowth. In fact, she saw a new bald spot.
Second Treatment: Every three weeks for eight months, Amanda was given painful steroid injections in her scalpÃ¢â‚¬”up to 40 pricks in each spotÃ¢â‚¬”to tamp down her malfunctioning immune system. Some hair grew back, but it quickly fell out.
Third Treatment: Sick of needles, Amanda abandoned the steroids and started dabbing a prescription 2 percent squaric acid solution onto her spots with a cotton swab twice a day. "The acid tricks the immune system into attacking the cream instead of the hair follicles," says Jason Reichenberg, M.D., clinical director of dermatology at the University of Texas Southwestern Medical Center. But the solution burned Amanda's scalp, causing blisters and bleeding.
Fourth Treatment: Amanda downgraded to a 0.02 percent squaric acid solution, and her hair grew back within a few months. Her new strands are shorter and thinner, and many mornings she wakes up with lots of hair on her pillow (she treats any new bald spots with the squaric acid solution). But her alopecia goes largely unnoticed and she has finally moved on to bigger concernsÃ¢â‚¬”like planning her upcoming wedding.