Medical school is a huge challenge on its own, but being diagnosed with a life-changing illness as a second-year resident is even harder. Dr. Erika Erlandson’s battle with residency was also fraught with cyclical autoimmune symptoms which would lead to a six-year struggle to receive a diagnosis for her invisible illness.
Erika knew she was a horse girl by the time she was five years old. Growing up, her brother took part in a therapeutic riding program for his disability, and she would beg to ride around on the ponies after he finished with his sessions. Erika’s parents ended up buying a pony for the program that could also teach her how to ride, and thus began her early education in dressage.
In high school, Erika started adventuring out to try other disciplines, including natural horsemanship practices and trail riding, before finally discovering her passion while in college. “In medical school, I was gifted an OTTB,” Erika says. “She loved to jump, so I started eventing. From the very beginning, it was a good fit.” While pursuing her undergraduate degree, Erika had remained local in order to keep her horses, but was able to move them with her to the University of Kentucky for medical school.
Unfortunately, that was the year that Erika would begin experiencing several health complications. “Like many people, I had a long, frustrating journey with the medical system before receiving a diagnosis,” she explains. “Mine was about six years. My symptoms were cyclical – I would have good days and bad days, good weeks and bad weeks. I got diagnosed with many things before the true diagnosis was discovered, including ‘medical student syndrome’, where you think you have what you are learning about; depressive disorder; anxiety; and chronic fatigue from sleep deprivation.”
After years of normal lab results, negative MRIs, and debilitating symptoms, it wasn’t until residency that she finally received a diagnosis of Sjogren’s syndrome and seronegative Rheumatoid Arthritis. “Once the diagnosis was identified and I began treatment, my quality of life improved significantly,” she recalls. “I was spending five to six days in bed per flare, which were occurring about once per month. With the right treatment, this decreased to three to four days every three to four months. After that, I was stable for about ten years.”
Recently, Erika’s battle has shifted a bit as her health issues progressed, and as it is with many people living with an autoimmune disease, we never know which way the tables may turn. “In the last two years, the disease has changed course and resulted in a couple of hospitalizations,” she explains, “and I recently had an ED visit due to a delay in authorization of my immunosuppressant medication.” The progression is especially difficult for Erika, since having a seronegative disease means that the normal antibodies (markers for the disease) for rheumatoid arthritis don’t show up on blood tests, so it’s difficult to quantify or track the disorder’s progression.
Now working as a physician in Pediatric Physical Medicine & Rehabilitation, Erika has worked to become well-equipped with tools and tactics to balance her intense job, health, and life with horses. She says the way her diagnosis affects her life balance can be complex. “On a daily basis, it affects the amount of activity and number of things I can do in a day,” she explains. “I have to practice ‘activity modification’ for energy conservation – that is, less activities today to conserve energy so I can still function tomorrow.”
Many of those living with invisible illnesses refer to this practice of activity modification as the “spoon theory”. The theory invites you to imagine that you are given a number of spoons at the beginning of each day, and certain activities require you to give up a set number of these spoons to complete the task. For example, doing laundry may cost someone two spoons (although it’s a good five or six spoons for me!), but going grocery shopping might cost much more, so if you need to go to the store later, you may have to put off the laundry until the next day. Those with autoimmune diseases have a considerably lower daily supply of spoons than an able-bodied person, and therefore must manage our supply much more closely.
Most adjustments she has to make are weather-related – a struggle that every autoimmune patient can relate to. “I don’t tolerate heat,” Erika explains, “and I don’t sweat as much as necessary, so I’m easily overheated. As a result, I can only compete in the spring and fall – if there is a clinic or something I want to do in the summer, I have to be done riding by 11am at the latest. My current instructors are very in-tune to this for me, and they bend over backwards to help me succeed. I feel very lucky.”
Erika’s life as a busy medical professional has also had to see many adjustments since her diagnosis, including seeing patients while working from home via telehealth visits. Having horses as something to work for was a huge factor in finding ways to manage her career, and once she began to prioritize her work-life balance, she was able to more easily focus on maintaining her riding. Her most prevalent struggles involve managing the stiffness in her spine and joints, which affect her position in the saddle and her ability to absorb the impact and movement of the horse.
“In general, horseback riding is very helpful to my autoimmune disease because it helps me maintain good core strength, and a lot of my pain and stiffness is in my back and SI joints,” she says. “My trainers have been amazing and have bent over backwards to understand how I can move and change my aids to maximize the parts of my body that are strong.” Even though she may have trouble sitting the trot when in “dressage land”, she has adapted to use a kind of half-seat to prevent having to take all the motion in her joints, and has even taught her horse to respond to a different style of half-halt aids in a way that is easier on her body.
Being open and vulnerable with her trainers has been vital to Erika finding adaptations for her riding. Her jumping trainer helped her find new ways to hold her reins when her horse is excited on cross country, such as tying them in knots, bridging her reins, or even wrapping them with vet wrap. They also helped adjust her jump position to prevent needing to absorb the horse’s impact in her back. “They helped me figure out on days when I don’t feel good what the most important things to do in warmup are, so that I don’t wear myself out before I go on course,” she explains.
In addition to the physical benefits, Erika also attributes her mental health to her choice to find adaptive ways to continue riding. “Riding helps me maintain motion in these joints and keeps my core strong, which is imperative to controlling the pain – and maybe most importantly, the horses help me stay emotionally and psychologically balanced. The best thing about being around the horses is the ability to be fully authentic and true to oneself, without judgment or expectations. They meet us right where we are.”
Erika currently competes at Training level with her horse “Smartie” (SBT Rynca), a 13-year-old Irish Sport Horse who she says accommodates her limitations. “The most incredible thing about Smartie is the relationship we have developed over the last eight years,” she says of her compassionate gelding. “It sounds totally crazy, but he knows how I’m feeling and how much my body can handle on any given day, and he acts accordingly.”
The first time Erika experienced a symptom flare-up while competing at an event, she became rather worried about riding in such a condition. Even though she could barely get out of bed, Smartie took care of her. “[He] did not put a foot wrong, didn’t overjump, and made all the turns very smooth,” she remembers. Erika likes to say that Smartie has an “overdrive button” to take care of her when she’s not feeling her best. “He knows my energy levels and how I’m doing… They’re in tune to more than we maybe think they are.”
When considering how her riding life might be different if she was afforded the same opportunities able-bodied riders have, Erika says her goals would likely have been much more competition-oriented. While it might look different than other people’s, she says this doesn’t make her current goals any less valid. “Everyone has their stuff,” she says. “Mine just happens to be physical… My goals are based on what I’m able to do.”
Currently, there are very few adaptations allowed in competitive sport that can level the playing field for people like Erika, and the criteria for para equestrian riding is very specific – allowing only those meeting ten specific diagnoses or impairments, none of which are systemic-related. She hopes to advocate for changes in the sport, including offering adaptations to able-bodied events for people with impairments that don’t qualify for para riding, particularly in reference to adaptive equipment dispensation.
Adaptive tack and equipment has been incredibly helpful to Erika, who currently uses several tools in her daily riding that aren’t all allowed in competition. “Correct Connect has changed my life,” she explains in reference to the brand that offers lines of training equipment and tack geared towards assisting those with physical impairments. She currently rides in soft reins with their special silicone gloves that allow for better grip, geared towards those with arthritis as they also act as compression technology. Correct Connect also produces reins with stopper attachments for those with impaired grip strength, and while Erika says they would likely be a big help and wishes she could use them, they are not legal in USEA competition.
Erika also agreed with the concept of requesting adjustable ride times at events, as stated by previous riders featured in this column. As someone who currently can only handle competing in the spring and fall, she says, “I might actually show in the summertime if I knew I could ride before noon.” She hopes that USEA will work towards a goal of inclusion for those with disabilities, helping to make certain allowances “so people feel like they could participate more easily”. Currently, Erika prefers to frequent the derby-format competitions that are prevalent in her Michigan area – a one or two-day event that helps her maintain her energy levels. Erika is, however, competing in the American Eventing Championships in Kentucky this week and is grateful that the USEA has been extremely cooperative in accommodating her needs – including allowing for her to compete in the morning before the heat in all phases.
Rather than trying to maintain highly competitive goals, Erika chooses to focus instead on progressing her relationship with her horses and with riding. “My goals are mostly around doing Training level the best I can and feeling strong doing it,” she explains. “My goals are not competition related, but more that I want to be able to gallop for five minutes.” She advises others with similar limitations to “adjust your perspective glasses, so you can be successful in whatever state of health you are in.”
Erika hopes to be an example of positive success to others fighting a similar battle. She also continues her dressage training diligently amid her area community that she says has been relentlessly supportive. “If you ask, people will be very supportive and go out of their way to help you be successful,” she says. “It was easier once I told people.” The small things can certainly go a long way, and she is grateful for the allowances that her community has made to help her accommodate her health. “Where you sit determines what you see. We’re all in it for the same reasons, and the more inclusive we can be might change people’s lives in ways that we don’t realize.”
Eventing is one of the toughest horse sports out there, and I believe anyone facing additional challenges deserves to be recognized. If you are also a person facing challenging or unique circumstances, combating differences and diversity, or living with a “special” body, I would love to hear from you, share your story, and advocate for your differences. Send me an email at [email protected] for the chance to be featured in a future article!