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Her body and her brain were locked in a battle for her health

IU Health North Hospital

Her body and her brain were locked in a battle for her health

A former elite swimmer opens up about the physical and mental toll her gastrointestinal condition took on her well-being – and how psychotherapy saved her.

When Renice Dobbs paces the pool deck, cheering on the west-side swim team she coaches, she’d love to be able to jump in, maybe even race her young crew. Dobbs was once a championship swimmer. She took to the water at the age of 12 and competed with USA Swimming as a member of Indy Dolphins. She even had dreams of making it to the Olympics or at least to the Olympic Trials.

Now the closest she can get to the water is the pool deck. A central line in her chest gives her body nourishment as she struggles with the physical and mental effects of gastroparesis – a disease in which the stomach cannot empty itself of food in a normal fashion.

Still, just being near the water is progress for the 28-year-old Brownsburg resident, who felt her life slipping away as she endured debilitating symptoms, multiple hospitalizations and emergency department visits while doctors tried to find the cause of her nausea, vomiting and weight loss.

It was shortly after her 25th birthday in 2015 when Dobbs started to feel ill. She doesn’t tie it to a specific event, saying it started randomly.

“I thought it was the flu, and it wasn’t the flu,” she said. “Then I thought I was pregnant, and I wasn’t pregnant. It spiraled out of control from there.”

She underwent test after test, she tried medications, and she had her gall bladder removed. Each time, she hoped to find relief. When her symptoms persisted over a year’s time, she and her husband, Michael, opted to go to the Mayo Clinic in Jacksonville, Fla., where the diagnosis of gastroparesis was eventually made after several visits.

By then, she had lost nearly 40 pounds off her 5-foot, 5-inch frame. Her weight dipped to 107 pounds before doctors put in a feeding tube. Doctors in Florida transferred her to IU Health gastroenterologist Andrea Shin.

For the next year, Dobbs was in and out of the hospital, dealing with dehydration, anemia and problems with her feeding tube. She spent Thanksgiving 2017 in the hospital. That was hard enough. Then she was let go from her job as an administrative assistant.

“Things were crumbling around me,” she said.

IN SICKNESS AND IN HEALTH

One bright spot in her ordeal was her husband, who supported her in every way he knew how.

“We’ve been married for six years, and half of it has been me being sick,” she said. “He’s been doing a great job with the ‘in sickness and in health’ part.”

What Dobbs didn’t know during this time was that her symptoms were being aggravated by anxiety and stress. It took several visits with a psychologist for that to sink in with her.

When Dr. Shin suggested she make an appointment with Dr. Anne Mary Montero, a clinical psychologist with the GI division (technically Digestive and Liver Disorders) at IU Health, she was resistant, to put it mildly.

“I’m doing fine,” she told everyone. “Why can’t everybody see that I’m doing fine?”

But in reality, she said, “I was not doing fine at all. I needed Dr. Montero, and I couldn’t see that, and no one could point that out to me without it being offensive to me.”

IT’S NOT ALL IN YOUR HEAD

None of that surprises Dr. Montero, who explains that she is prohibited ethically from discussing any patient’s case but is free to speak in general about treating individuals who suffer a combination of physical and psychological reactions to chronic and/or serious illness.

The physical condition is real, she tells patients, just as the stress is real. But the stigma surrounding mental health can get in the way of proper treatment.

“It’s so unfortunate that the very symptom patients are coming in to get support for can be misinterpreted or internalized as something that patients commonly may feel – that their doctor either doesn’t believe them, thinks they’re ‘crazy’ or thinks it’s all in their head,” she said.

There’s no such thing as “all in your head,” she tells them. Half of all physical symptoms cannot be fully explained by identified medical conditions.

“Physicians who are looking at the constellation of a patient’s symptoms, with all of their experience, intellect and testing resources, may be able to identify a number of significant contributors but remarkably, up to 50 percent can’t be fully medically explained.”

Dr. Montero, who has offices at IU Health North Hospital and IU Health Springmill Medical Clinic, appreciates when the medical care team incorporates mental health providers into a patient’s care when warranted. Psychological factors can constitute at least one layer contributing to a patient’s symptoms. But that doesn’t mitigate other layers that might also contribute, she said.

With 20 years’ experience in the field, she has studied in depth what she calls the brain-gut axis, which describes how the two areas of the body communicate with each other.

Essentially, what’s going on in your gut can affect your brain and vice versa. It can become a vicious cycle.

“It’s how our bodies are wired,” Dr. Montero said. “Digestive organs are like a central processing unit in the body that collectively regulates a lot of our body’s functions. Among those are some emotional responses. It’s a two-way arrow, a reverberating process where one end of the domain affects the other.”

By the time patients meet with her, they often are discouraged after months or years of tests and treatments. They may have had to stop working, their relationships may be in peril, and their quality of life has suffered greatly. It’s no surprise they are skeptical of the focus on their mental health when it’s their physical health that is the problem.

“All kinds of emotions build up before they have the chance to get to my office. Emotional distress feels nebulous and it’s hard to imagine how that can be treated,” she said.

Patients often feel someone is going to blame them for having this distress, she said. “I say the opposite – this is a normal part of the brain-gut interaction; people just aren’t aware of it.”

One of the first things she tells patients is that their symptoms are real, their condition is real. Her job is to help them identify stressors and triggers that aggravate their physical condition, then come up with exercises to manage those stressors.

“I FELT HEARD FOR THE FIRST TIME”

For Dobbs that meant coming up with techniques to deal with nausea and vomiting, the latter often happening three times a day. She practices breathing and visualization exercises to keep the vomiting at bay, though the nausea is always with her, she said. She has gone two months now without a vomiting spell.

After two years of multiple in-patient hospital stays and trips to the emergency department, Dobbs recently celebrated a year without a hospital stay or ED visit. She attributes that to Dr. Montero.

“I felt heard for the first time,” she said.

She admits she didn’t want to talk to a psychologist at first. She knew her symptoms weren’t all in her head, and she was relieved when Dr. Montero assured her she was right.

“I think I even cried,” Dobbs said, after her second visit to the therapist. “I really opened up. I needed somebody to talk to and she was right there.”

In the back of her mind, Dobbs said, she always knew there had to be a connection between her emotional state and her physical health.

“It was something I needed to come to terms with. I’ll always have this baseline condition, but if I’m not handling these other stressors that are triggers, this isn’t going to get better, it’s going to get worse. That was a reality check for me,” she said. “You have this physical condition and when you add stress and anxiety on top of that, it starts to spin out of control. It gets so big no amount of medication or treatment is going to get you back.”

She acknowledges she doesn’t have it all under control, but her monthly appointments with Dr. Montero help guide her through the worst of it.

Two or three years ago, when she was suffering the worst of her symptoms, she said she would wake up every morning feeling physically terrible and mentally exhausted. Hopeless even.

“Even though I still wake up physically exhausted, I feel more ready to take on the world,” she said. “It’s hard to believe that 10 years ago I was a very competitive athlete on the national level.”

Life has changed, but now Dobbs pours her energy into the young swimmers she coaches as part of the USA Swimming club Giant Aquatics.

“It’s my outlet,” she said. It helps her forget about everything else.

The other distraction she and her husband live for is Disney World. They are Disney Vacation Club members, visiting the parks and resorts a few times a year. “It’s a chance to get away from the real world. It’s a magical place.”

They even named their Miniature Australian Shepherd pup Oswald (Ozzie) for Walt Disney’s Oswald the Lucky Rabbit cartoon character, which dates back to the 1920s.

REDUCING THE STIGMA

Dobbs agreed to share her deeply personal story because she hopes to encourage others in similar situations to reach out for help.

“Not every mental health professional is trying to pin you with a ‘crazy’ label. They’re really trying to help you. You can put your faith in them. Dr. Montero deserves to know that’s how I feel about this. She’s been that amazing to me and my journey.”

For her part, Dr. Montero said she is honored when people allow her to come into their lives at such a vulnerable moment. For psychotherapy to be successful, patients have to lean in and engage during treatment, she said.

“As much as I wish I could wave a magic wand and help people feel better, it’s more like dancing. You have to lean in toward one another and teach them steps so they can learn how to do the healing increasingly independently.”

When patients arrive already discouraged, it takes a lot more effort to move forward, she said. “But if they’re open and can lean in with me, I never cease to be amazed at the resilience of the human spirit and the human body.”

– By Maureen Gilmer, IU Health senior journalist
Email: mgilmer1@iuhealth.org

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