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AFTER EVERY DUSK, THERE IS A DAWN

Updated: Apr 14, 2019

In the 90s, before the varicella vaccine became a mandatory component of immunization schedules, chicken pox were an inevitable pain and joy for most children. Their itch was beyond aggravating, but it would only last a week and then we’d be immune forever! Like most things in my life, however, I was an exception to the rule. One of my lesions decided to remain unhealed on my body, developing into a tiny 1cm wide scar on my right shoulder. Having been raised to be a warrior in all things, I said nothing of the mark until months later when it had grown into a 1 inch wide keloid - in other words, an overproduced scar; flesh coloured, but thicker and more raised than the surrounding skin. I guess that warrior mentality kept me from thinking of this scar as an abnormality, up until the 9th grade where a few of my private school colleagues refused to enter the pool with me during a swim meet, for fear of contracting my “disease”. I still think back on this day that marked my first understanding of what it meant to be self-conscious, to feel lesser than, to feel anything but absolutely beautiful. I wish so badly that I could go back and comfort my 14 year old self. To not let judgment make me eventually give up on my love of swimming, or prevent me from wearing anything revealing at the shoulders even until now, 13 years later. My keloid never stopped growing, and by the end of senior year it had become 2 inches wide. It was then, that the pain started. Keloids are associated with intense itch and neuropathic pain. Something I can only describe as several hot blades being dug into 1 localized area all at the same time, over and over again…and I promise that is an understatement. My parents took me to a renowned plastic surgeon in Mississauga, Ontario after my high school graduation, to pursue treatment for the first time. To my luck (not), surgery was deemed impossible. Not only was there no guarantee that the keloid would not reform, it being a scar afterall, but the location put me at risk of surgery causing damage to the nerves crossing my shoulder. Instead, my scar was injected with steroids that were meant to soften and shrink the keloid, thereby reducing my pain. In an effort to maximize the short treatment period I had before moving to Ireland for Medical School, this doctor became aggressive with the delivery of steroid injections. He assumed his treatment plan would do me no harm, and so failed to warn me of possible side effects. Remember when I said I was often the exception to the rule? Within a few weeks these steroids had triggered something called Cushing’s syndrome, a condition referring to excess cortisol (steroid) in the body. The presentation? A face so puffy you wouldn’t recognize yourself, increased susceptibility to infection, abnormal fat deposition on the abdomen and neck, male pattern hair growth on a woman’s body, alopecia on the head, loss of regular menstrual cycles, osteoporosis, acne, easy and persistent bruising, wide and deep purple stretch marks (striae) on all parts of your body (even your hands), insomnia, emotional lability, the list goes on. What an incredible gift for a 17-year old girl moving across the world by herself, just wanting to put her best foot forward as a University freshman.


When my own Google symptom search revealed this potential diagnosis, my mother and I marched to my plastic surgeon with fury and confusion. And without so much as an ounce of concern, we were shrugged off with “Cushing’s IS a possible side effect, it happens to 1 in a million, guess you’re that 1!” (Great.) Needless to say the injections were halted, but the damage had already been done, and my symptoms continued to escalate. I moved to Ireland, and so began battling all the unrecognizable ways my young, athletic, once scarless body was changing before my eyes. I stopped looking in mirrors to avoid the stranger looking back, clumps of my hair started falling out with each brush stroke, dark striae took over my body like a tiger had clawed across every curve, one menstrual period lasted for 6 months straight, I contracted several illness usually reserved for immense immunocompromise, and I never slept - mostly from the resultant depression but also from the snickers of this new group of colleagues, mocking me either for falsified older pictures on social media (as I looked completely different to them now), or claiming my story was a smokescreen for dramatic weight gain. There is no treatment for a steroid overdose, one must simply wait for it’s natural clearance from the body, and mine took 3 long years, but the scars and pain are with me for a lifetime.


Today it is 9 years after the 12th grade summer when this all escalated. I am a Doctor from the Royal College of Surgeons in Ireland, and a Post-Graduate student at Harvard University. I plan to love, travel, raise children, pursue Family Medicine and devote my life to chronic disease prevention and advocacy for 3rd world health. I am healthy, immeasurably happy, and grateful for the abundance of blessings in life that I do not deserve. I will have to write a book one day on the wild trials of this (almost) decade. You will find it in the Non-Fiction Horror section of your local Indigo and Chapters. I won’t scare you with the gorey details but I will say – surgical removal followed by radiotherapy is now a treatment option for keloids that have not responded to drug therapies. However, my initial keloid is now 6 times its original size, causes me at least 6 times the pain, and is even more inoperable than before. Luckily however, within 2 of my striae formed 2 new keloids with their own set of pain (Yay ME!). These were each 2 inches in diameter before they were finally surgically excised 5 days ago, and I have just completed my first cycle of radiotherapy on the scars to prevent recurrence. I sit here in recovery reflecting on the amount of challenges I have overcome, and while I’ve only shared the mildest fraction of my journey with you, I need to admit that there were days when I saw no tomorrow. Even in my warrior strength, I felt isolated, mentally and physically hurt, helpless, unnecessarily tested, and lost. My chronic pain and my hidden illnesses consumed me. They limited every aspect of my life and eventually the unrelenting battles broke me. I shared my story with so many people who did not feel my anguish like I would have felt theirs, and I stiffened my upper lip in front of family so as to never show “weakness”. So at the end of the day my only survival option was to show myself the love I needed to heal; to have faith in myself and silence the naysayers. To soothe myself from within so as to overcome every flavor of pain that came my way. In rebuilding my health, to become so immune to people’s thoughts and opinions that I could laugh at the misunderstanding and finally sleep in peace. At some point, my health, my family, my love, my sanity, my career, and my dreams were all threatened. But even when I could not see where I was going, I did not stop. And I hope one day, I can reassure another man or woman, that as after every dusk there is dawn, through every darkness there is light. And if we just fight a little longer, we will finally be bathed in it. And that's a promise, from one warrior, to another.


Author: Mashal Khan


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