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A Coin-Sized Dent in Sarah’s Skull Was the First Sign of GSD, or ‘Vanishing Bone Disease’

By 
Cat Cooke

May 21, 2021 • 3 min read

Blog post originally written by the AllStripes community team. AllStripes was acquired by PicnicHealth in 2023.

On an otherwise normal day in 2008, Sarah was driving in her car near her home in Liverpool, England, when she casually touched the top of her head. But this move – one that many of us do without even realizing – quickly turned alarming when she felt a giant dent on top of her head. While she didn’t know it then, finding that dent was the beginning of a long journey ahead.

Sarah got an MRI and CT scan, and a neurologist promptly decided she would also need a biopsy of the area of her skull that seemed to have disappeared.

The results of those scans and biopsy? Nothing.

It was disheartening at first. How could a whole section of her skull just be gone? There had to be something going on, and Sarah refused to take “nothing” for an answer.

Thankfully, her doctors agreed and sent off the specimen to be examined by a research center in Florida with resources to test for more diseases.

When the results came in, Sarah was shocked to learn that she was living with an incredibly rare disorder called Gorham-Stout disease (GSD) that only affects around 200 people (that doctors know of) in the world. Colloquially referred to as “vanishing” or “disappearing bone disease,” GSD is a disease that is characterized by bone loss. “It can appear in any bone,” Sarah describes, “but the main ones are your big bones like your skull, femur, or hips– but it can come anywhere really. It’s a disease that’s eating my skull away.”

Receiving the diagnosis was, at first, overwhelming: “It was quite scary because there wasn’t a lot known about it. Even if you went online, there wasn’t anything,” Sarah remembers.

Feeling incredibly alone and hopeless, Sarah went through a painful depression when she was first diagnosed. “I was very down and upset and cut my self off from everything and everyone.”

But going on antidepressant medication and finding others living with GSD helped pull her out of a dark time. Through the Lymphangiomatosis & Gorham’s Disease Alliance (LGDA), Sarah was excited to have “met so many people at conferences and online who have the same diagnosis. We just help each other so much when you’re feeling down or are in a lot of pain.”

Today, Sarah is mostly cheerful and positive. “I’m fine with it. There’s nothing I can do now. I just have to get on with it,” she shares about why she continues to live a full life despite having a rare disease.

The hole in her head has continued to grow – from starting at around the size of a U.S. quarter coin to now around one-third of her head – and she worries it might spread to other parts of her body.

“Every little ache I have in my bones, I think, ‘has it popped up there?’ You’re forever thinking that it’s gonna come to another part of your body. You’re permanently on edge.” GSD also causes Sarah to be constantly in pain and tired all the time, which has affected her social life.

She’s tried various treatments, such as radiotherapy and chemotherapy injections at home. “It’s all hit or miss,” she says. “Nobody really knows how to treat it or how to cure it.”

That’s why Sarah has joined LGDA’s partner, AllStripes, a platform that enables rare disease patients and caregivers to access all their medical records online and contribute their de-identified medical history to further research for their condition.

“You go to so many different hospitals. My notes are all over the U.K. AllStripes has everything together. With everyone giving their information, it’s going to be very helpful to the Gorham’s community. There’s hardly anyone who knows anything about our disease, so the more publicity it gets, the better.”

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Create a List

List the names of all the doctors, hospitals, and other facilities your loved one visits regularly, along with those they have visited in the past. Try to go back as far as you can, striving for at least the last 5-10 years, but do your best. Even if you can’t remember them all, having a strong baseline can help you quickly identify gaps in records.

Ensure You Have the Appropriate Legal Status

It is important to make sure that you are fully empowered to make decisions on behalf of your loved one with Alzheimer’s. Your relationship status with the patient may not be enough to legally give you access to your loved one's medical information. It is a good idea to talk to an expert about securing special legal status, such as Power of Attorney (POA), a legal document that allows an individual to name someone as their decision maker should they no longer be able to make decisions on their own.

Gather and Organize the Medical Records in One Place

It’s important to have all of your loved one’s medical records together in one spot. This makes it much easier for you and your loved one’s physicians to accurately map the patient’s medical journey and more easily share information between doctors. Fortunately, tools exist to make record management and access simple. A free resource like PicnicHealth helps you collect and organize all of this information. PicnicHealth’s intuitive timeline allows you to pinpoint data across the medical history, eliminating your need for keeping heavy binders filled with paper records or keeping track of multiple software portal logins.

Review the Medical Records to be an Informed Advocate

The better you understand your loved one's medical history, the better you can advocate on their behalf. Access and understanding of this information will help you to ask informed questions with physicians. Through regular communication backed by the data in the medical records, you can help your loved one’s care team develop a more successful care plan.

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Together, we can make a difference.

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1. Build a support network.

When you’re juggling appointment times and insurance claims, putting a robust support system together might not strike you as the most urgent task. Investing the time to cultivate relationships with people can turn to in times of need will pay dividends. The next time you need a last-minute ride or just someone to listen, you won’t be on your own.

There are many condition-specific support groups and support groups for caregivers generally in person or online. In addition to the encouragement and empathy they provide, support groups can be a helpful source of tips, resources, and recommendations for navigating caregiving.

2. Stay organized.

The backbone of effective caregiving is organization. Keep medical information, appointment schedules, and medication lists in order. Use a planner or a digital service like PicnicHealth to stay on top of your responsibilities. This attention to detail can prevent future complications and reduce day-to-day stress.

3. Explore treatments and clinical trials.

We’ve seen incredible breakthroughs in treatment over the past couple of years, powered by patients and their caregivers participating in research. Stay in the loop about the latest in medical advancements and available resources that could benefit your loved one. Whether it’s a new therapy option or a community service that aids independence, being informed can make a world of difference in the quality of care you provide.

4. Make time for self-care.

It may seem self-centered to focus on self-care—but when you feel good, you can be a better caregiver. Whether it’s exercise, a mindfulness practice, a soak in the bath, or just time to rest when you need it, carve out those moments in the day when you can unwind, reset, and stay healthy mentally and physically. Think of it as building up your reserves of kindness, patience, and understanding—which can only benefit your loved one. No one can pour from an empty cup.

Having trouble managing your loved one's medical records?

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LC-FAOD Odyssey: A Preliminary Analysis, presented at INFORM 2021

Data from real-world medical records:

(from 13 patients with LC-FAOD)

16 yrs old

Median age at enrollment

38% Female

15 providers / patient

7.5 years of data / patient

Data from patient-reported outcome (PRO) survey

(from 13 patients with LC-FAOD)

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However, it's important to consult with a healthcare provider or registered dietitian to determine the appropriate amount of protein for your individual needs. In general, a diet with moderate protein intake (about 0.8 grams per kilogram of body weight per day) is recommended for people with kidney diseases.

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A tablet, phone, or laptop with a working camera, microphone, and stable internet connection.
A quiet, distraction-free area with enough space to walk a few steps if applicable.
A chair that you can use during any movements or tasks you’ll be asked to perform.
The tripod mailed to you via Amazon.

What to Expect

Before your video call:

Book Your Assessment
Visit your to-do list on your PicnicHealth Research Dashboard or click the scheduling link sent to your email. Note: Search for “New task for the ORBIT-CIDP Study" to find the video call scheduling link.
Receive Confirmation
Check your email for a confirmation with your scheduled video call time and instructions.

On the day of your video call:

Click on Video Link
Join your personal video call using the link we sent by email, or text message, or find it on your research dashboard.
Meet your nurse
A Registered Nurse (RN) will guide your virtual assessment, which will last about 30 minutes.
Complete the Physical Activity Assessment (INCAT)
The nurse will guide you through questions and, if needed, physical tasks to help researchers gain a deeper understanding of CIDP.
Complete the Movement Assessment (Optional)
If you participate, a nurse will guide you through three short recorded movement activities to complete as best you can:
Chair Task
While seated with your arms crossed over your chest and hands on oppositeshoulders, you’ll be asked to stand up, remain standing for 20 seconds, and then sit back down.
Arm Movement Task
While seated with your arms resting at your sides, you’ll be asked to raise both arms out to the sides until they meet above your head, then lower them back to your lap.
Finger Dexterity Task
While seated, raise your right hand with fingers extended. Touch your thumb to each fingertip in order, then reverse. Repeat with your left hand. This will then be repeated with your left hand.
Earn Compensation

Receive up to $55 for your participation:

  • $25 for completing the Physical Activity Assessment (INCAT).
  • $30 for the Optional Movement Assessment.
Recording: Your research assessment may be recorded to ensure accurate data collection. If you participate in the optional Movement Assessment, it will also be recorded. These recordings may capture your voice and responses, but identifiable information like your face, name, or background will be removed to protect your privacy.
Opt Into the Smart Insole Study Activity
Complete the opt-in survey to confirm your participation.
Receive Your Smart Insoles
Your smart insoles will be shipped to your home via FedEx and should arrive within 1 week.
Create Your Account

You’ll receive an email from Celestra Health with your account details. Follow those steps to set up your account.

  • If you don’t see an email from Celestra Health in your inbox, please check your spam or junk folder.
Download the App
After creating your account, you’ll be directed to a landing page with links to the App Store or Google Play. Use the link to download the correct version of the app for your device.
For illustrative purposes only, your insoles may look different
Log In
Open the app and log in using the email address and password you used when creating your account.
Enable Permissions
  • For iOS users: Enable Motion & Fitness and allow access to Apple Health.
  • For Android users: Enable Activity Recognition permissions.
Connect Your Insoles
Turn on Bluetooth, and follow the app's instructions to connect your smart insoles.
Enable Notifications
Enable push notifications to stay updated on reminders and activity progress.
For illustrative purposes only, your insoles may look different
Start Walking Sessions
When you’re ready to perform a walking session, tap ‘Start’ on the Ad Hoc Walking task card in the app.
Smart insoles are designed to fit comfortably into any pair of closed shoes
Need Help?
Should you need to contact Celestra Health support for any reason, you can submit a ticket through the Help section of the app by tapping the Submit A Ticket card and filling out the form. A Celestra Health representative will typically respond within one business day.
A fully charged device (smartphone, tablet, or laptop) with a working camera, microphone, and stable internet connection.
A quiet, well-lit space that is free from distractions.
Good lighting so your face is clearly visible; having a small flashlight or your phone’s flashlight nearby can help with skin, scalp, or joint checks.
Flexible device positioning so you can easily adjust or prop up your device hands-free if the research staff asks to view specific areas (such as your face, hands, or scalp).
Space to move in case you are briefly asked to stand or walk a few steps.
Your medication information, including your current steroid(s) and BENLYSTA® (belimumab) — either the medication bottles or a list with doses and schedule.
Time to focus without interruptions so the visit can be completed comfortably.
Before Your Video Call:
Schedule your visit
Use the scheduling link on your PicnicHealth Research Dashboard or the link sent to your email.
Tip: Search your inbox for “New task for the BEACON-SLE Study - schedule your remote visit” to find the scheduling email.
Check your confirmation
You’ll receive an email with your appointment time and instructions for joining the video call.
On the Day of Your Video Call:
Join the call
Click the Zoom link sent to you by email or text message, or use the link available on your research dashboard.
Meet with the research staff member
  • They will ask you structured questions about your health and any lupus symptoms you’ve experienced over the past 30 days.
  • If needed, they may guide you through a few simple visual checks (such as looking at your skin, hair, joints, or mouth). You can always tell them if you’re not comfortable with anything.
Receive Compensation
You’ll receive up to $60 for completing your visit.
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