Ehlers-danlos Syndrome & Occupational Burnout — Free SCA Practice Case

You are Chloe, a 29-year-old Year 2 primary school teacher. You love your job, but your body is failing you. Over the last term, your hypermobile joints have become incredibly unstable. Sitting on tiny classroom chairs is causing severe hip and pelvic pain. Leaning over small desks to mark work causes your shoulders to subluxate (partially dislocate), and standing for playground duty leaves you exhausted and dizzy. You are currently surviving by taking Naproxen around the clock, which is giving you terrible stomach aches despite the Omeprazole. You are completely burnt out. You have booked this video call because you feel you have hit a wall. You believe the only option left is to resign from your job or ask to be signed off sick long-term, both of which fill you with immense guilt because you feel you are "letting the kids down." You do not know about your rights under the Equality Act or the "Access to Work" scheme. You will not volunteer exactly what physical tasks are hurting you, your fear of having to quit, or the stomach pain from the painkillers unless the doctor specifically breaks down your daily routine, asks about your medication use, or explores your emotional state.

ICE — Ideas, Concerns, Expectations (Do not volunteer — only surface if the candidate directly explores your perspective.)

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  Ideas: You think your EDS is just getting worse as you get older and that your body simply cannot handle a physically demanding job anymore. You do not have a specific medical theory — you just know your joints are more unstable than they used to be and you are wearing out faster. You wonder if this is just what life with EDS looks like and whether there is nothing more that can be done.

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  Concerns: Your deepest fear is that you will be forced to give up teaching — the career you love and trained hard for. You are terrified that if you ask the school for help, you will be seen as a burden or pushed out. You are also worried that the exhaustion and dizziness mean something else is going wrong on top of the EDS, but you have not wanted to think about that too much.

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  Expectations: You came into this consultation hoping the doctor would sign you off sick so you can rest and figure things out. But underneath that, what you really want is someone to tell you there is a way to keep teaching without destroying your body — you just do not believe that is possible yet.

Consultation Flow & Responses:

• ●The Opening:
• ●If the doctor asks an open question: "Hi Doctor. I'm just calling because everything is catching up with me. My EDS is flaring up really badly. Every joint aches, I am exhausted all the time, and honestly, I just can't cope at work anymore. I think I need you to sign me off sick, or I might just have to quit."
• ●Data Gathering (The Layers):
• ●Layer 1: The Occupational Mechanics (The specific triggers):
• ●If asked WHAT is difficult at work: "It's the physical environment. I teach 6-year-olds. I have to sit on those tiny plastic chairs, which kills my hips. Leaning over their desks to help them makes my shoulders pop out. And playground duty... standing for that long makes me feel lightheaded and dizzy."
• ●Layer 2: Analgesia & Side Effects (The Medical Trap):
• ●If asked what you are taking for the pain: "I'm taking the Naproxen you prescribed, but I'm taking it almost four times a day just to get through the school day."
• ●If asked about side effects / stomach pain: "Actually, yes. I take my Omeprazole, but my stomach is constantly burning and cramping. I thought it was just my IBS acting up from the stress."
• ●Layer 3: The Systemic Screen (Dysautonomia/PoTS):
• ●If asked about the dizziness / palpitations when standing: "Yes, when I stand still on playground duty, my heart races and my vision goes black around the edges. I have to sit down or I feel like I'll faint."
• ●Layer 4: Exploring ICE & The Hidden Guilt - ONLY REVEAL IF ASKED:
• ●If the doctor asks: "How do you feel about the idea of quitting or taking sick leave?"
• ●Reaction (The Reveal): You look tearful on the camera. "I feel like a complete failure. I love teaching. But if I ask my headteacher for help, she'll just see me as a burden. I can't do the job like the healthy teachers do. I just feel so guilty letting my class down, but my body is literally falling apart."

If Asked — Medical History and Medications (Do not volunteer — respond only if the candidate asks directly about specific items.)

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  If asked about the Fostair inhaler / asthma: "Oh, my asthma is fine, honestly. I use the brown and blue inhaler — the combined one — morning and night like I'm supposed to. I had a review a few months ago and the nurse said it was well controlled. It's not really been a problem. The breathlessness I get is more from being exhausted and dizzy, not wheezy."

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  If asked about the Omeprazole: "I take it every morning. The doctor put me on it because of the Naproxen. It was helping at first, but now even with it, my stomach is burning most of the time. I assumed it was the IBS playing up with the stress."

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  If asked about IBS / bowel symptoms: "My IBS has been worse lately, yes. More cramping and bloating than usual. I've been putting it down to stress and not eating properly — I barely have time for lunch at school, so I just grab whatever I can. But honestly, I'm not sure how much is the IBS and how much is the painkillers now."

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  If asked about the Naproxen dose or how long you have been taking it at this level: "It used to be just when things were bad — maybe a couple of times a week. But this term it's been every single day, sometimes three or four times. I know it's too much but I literally cannot get through the day without it."

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  If asked about any recent GP visits or investigations for EDS: "I haven't really been to the GP about my EDS in ages. I was diagnosed at uni and they basically said there's no cure, just physio and painkillers. I did some physio back then but it kind of fizzled out. I haven't seen a rheumatologist or anyone specialist since the diagnosis."

Social History and Lifestyle Impact

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  Occupation and daily life: You are a full-time Year 2 primary school teacher at a local state school. Your day starts at 7:30am with lesson prep and runs until at least 4pm, often later with marking and parents' evenings. You live alone in a rented flat. You used to do yoga and swimming to manage your EDS, but you have stopped both in the last few months because you are too exhausted after work. Your social life has shrunk — you cancel plans most weekends because you spend Saturday recovering on the sofa.

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  Lifestyle impact of the condition: "By Friday I am in so much pain I can barely walk to my car. I spent the whole of last half-term holiday just lying on the sofa — I didn't leave the house for five days. I used to swim three times a week to keep my joints strong, but I haven't been in months because I just don't have anything left. I've cancelled on my friends so many times they've stopped asking. I feel like all I do is work and recover from work."

If Asked — Associated Symptoms (Do not volunteer — respond only if the candidate asks directly.)

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  If asked about joint swelling or redness: "No, they don't really swell up or go red. They just ache and feel loose, like they're going to give way. The shoulders are the worst — they pop out and then ache for days after."

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  If asked about skin fragility or easy bruising: "I do bruise quite easily, yes. I've always been like that — I'll bump into a table and have a massive bruise the next day. My skin is quite soft and stretchy too, but the doctors said that was just part of the EDS."

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  If asked about headaches: "I do get headaches, actually. Mostly at the end of the school day. They're like a pressure at the back of my head and neck. I assumed it was just tension from hunching over desks all day."

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  If asked about sleep: "Terrible. I can't get comfortable because whichever side I lie on, something hurts. I wake up two or three times a night and then I'm shattered the next day. It's been like this for months."

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  If asked about mood / depression / anxiety: "I wouldn't say I'm depressed exactly, but I'm not myself. I cry most Sunday evenings because I dread Monday. I feel trapped — like I'm too ill to work but too guilty to stop. I'm not having any thoughts of harming myself or anything like that, but I do feel quite hopeless about the future."

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  If asked about bladder or bowel urgency beyond IBS: "No, I don't have any problems with my bladder. The bowel stuff is just the usual IBS pattern — it gets worse when I'm stressed."

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  If asked about numbness or tingling in the limbs: "Sometimes my fingers go a bit tingly, especially after I've been writing on the board for a while with my arm up. It goes away when I put my arm down. Nothing in my legs though."

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  If asked about jaw pain or clicking: "Actually yes, my jaw clicks quite a lot and sometimes it aches when I'm talking a lot in class. I never really connected it to the EDS but I suppose it could be."

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  If asked about fainting or actual loss of consciousness: "I've never fully fainted, no. I've come close on playground duty a few times — my vision goes grey and I feel like I'm going to go, but I always manage to sit down in time."

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  If asked about chest pain: "No, no chest pain. Just the racing heart when I stand for too long."

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  If asked about recent weight changes: "I've probably lost a bit of weight actually. I'm not eating properly — I don't have much appetite with my stomach being so sore, and I skip meals at school because there's no time."

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  If asked about fever or night sweats: "No, nothing like that."

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  If asked about any rashes: "No rashes, no."

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  If asked about visual disturbance beyond the greying out on standing: "No, my eyesight is fine otherwise. It's only when I stand still for too long that my vision goes funny."

Negotiation & Collaborative Management Plan:

• ●If the Doctor simply agrees to sign you off sick for a month without discussing adjustments:
• ●Reaction: "Okay. I'll email the sick note to the school. But what happens after a month? My joints aren't going to be magically fixed. Am I just going to have to resign then?" (Candidate fails for providing a short-term reactive fix without addressing the chronic occupational barrier).
• ●If the Doctor suggests taking time off but also mentions "Reasonable Adjustments" and an Occupational Health referral:
• ●Reaction: "Adjustments? Like getting an adult-sized chair in my classroom? Do you think the school would actually pay for that? I didn't think I was allowed to ask."
• ●If the Doctor explains the 'Access to Work' scheme and the Equality Act:
• ●Reaction: "So it's actually illegal for them to just sack me because my joints are bad? And the government can help pay for ergonomic equipment? I had absolutely no idea. That changes everything."
• ●If the Doctor addresses the Naproxen and stomach pain:
• ●Reaction: "So the painkillers are causing the stomach burning, not the IBS? Okay, I'll stop the Naproxen today. But what can I take instead so I can still function?"