Ooof. Cannot catch a break over here. I have been having weird foot and leg pains for a while now, things I never experienced before and attributed to Achilles tendinitis or plantar fasciitis. But then it all evolved into ankle and lower leg pain, and got bad enough that I was having a hard time putting weight on it. When the pain woke me up at night, I decided it was time to see a doctor. Luckily, Tulane recently opened an extended-hours sports medicine clinic geared toward student athletes and busy professionals who are at work or at class or practice from 9-5. I got a 6:30 appointment with the foot and ankle specialist: the same doctor I saw for my last stress reaction (gosh, I'm injury-prone). I really like him - he's the head of orthopedics here, and he is the one who recommended a carbon fiber plate in my shoe, which let me run through a stress reaction all the way to one of the best marathons of my life! (SARCASM, it was terrible in every way). I was happy to get in to see him so fast, and I'm a huge fan of the extended hours offered now!
He's one of those seen-it-all doctors, so as soon as he saw my foot he said, "posterior tibialis, right?" and confirmed the tendon tear by ultrasound. Dang. Diagnosis in ten minutes! Luckily, AS USUAL, I waited so long to see a doctor that I'm past the initial injury and into the healing stage. So the tendon is well on its way to repair. While I only noticed the sudden pain and bulge the last week of October, the damage was probably happening long before, only I was blaming all kinds of other conditions.
The body starts releasing relaxin in pregnancy, a hormone that relaxes pelvic ligaments in preparation for childbirth. Unfortunately, it affects other ligaments and tendons, too, by activating collagenase . This results in tendon laxity and lengthened tendons. In my case, my posterior tibialis tendon is already a mile long thanks to my super high arches, and all of a sudden it was flopping down like loose skin. Without the support of the tendon, my feet pronated inward, pressuring the attachment point and eventually inducing a slight tear of the tendon. This was the bulge and discoloration I noticed. Unfortunately, it's just one of those pregnancy things - and it could have happened even if I was mostly sedentary. The timing sucks, though, because I wish I could run right now: the weather is finally under 70 most mornings (although it's 84F today, bleah), and I have felt MUCH better running in the third trimester than the second trimester, where every step sucked.
By the way, thought I'd mention - women also release relaxin during the second half of the menstrual cycle, meaning that you may be more prone to tendon, ligament, or cartilage injuries at this time (all of which are affected by relaxin).
I'm currently in either a walking boot or ankle brace (my choice, and it depends on my day; if I'm biking to work I pick the ankle brace) plus PT. I don't have a timeline yet because my doctor isn't sure how my relaxing levels play into this. But I hope I can get over it before the baby gets here - get in a couple of runs at least before I have some forced time off!
Thursday, November 7, 2019
Wednesday, November 6, 2019
Some updates
This pregnancy has had its fair share of complications, and I wanted to update readers quickly. August and September were a little stressful!
I had my routine anatomy scan ultrasound in August, and while we didn't get ANY cute pictures, because this kid NEVER stops moving, we did find out that he or she has pyelectasis, a kidney problem fairly common in fetuses. This is a "watch-out", and may require surgery after birth if it doesn't resolve on its own. However, it's also a Down Syndrome marker. I pulled my other anatomy measurements and, plugging my age and all the date into a reliable risk calculator, realized this baby had a 1 in 64 chance of having the condition. I decided it would be prudent to have a non-invasive blood test to screen.
Now, let me be very clear: I do not consider news that a baby has Down Syndrome to be bad news. It's just news. I absolutely value the lives of those living with Down Syndrome, and we would be happy to welcome a baby with this disease. But it is smart to be prepared for the upcoming challenges, were this the case, so we decided to get the test anyway. It came back negative, which was a relief - despite my willingness to parent a child with Down Syndrome, I feel wholly inadequate to do so! But we still had to schedule follow up for the kidneys, and to try to get a better anatomy scan - baby was moving so much that we missed about half the measurements.
We had the next scan a month later, and now that baby is more crowded and can't really swim away, getting images was easier, so we were able to complete all the important measurements. Unfortunately, the kidneys did not improve, so we're still keeping an eye on that.
More concerning is that the uterine mass that started this whole thing, that has been causing me so much pain and grief for over a year now, grew significantly since my last ultrasound. It's not a good situation: it now takes up the entire uterine wall and bulges into the amniotic space, so there is a concern for fetal growth restriction (right now baby's size is fine). The other concern is that its growth rate, appearance, and perfusion are not typical for a fibroid, and are what you would see in a malignancy. This was the original concern that sent me to the OR back in May, where I found out I was pregnant!
Maternal Fetal Medicine is on board - I still have my regular OB, but they are following me for the mass, the other fibroids, and baby's kidneys - and they recommended an MRI for better imaging due to the concern for cancer. I had the MRI, but it was inconclusive. It ruled out a few (benign) diagnoses, but left us with two potential diagnoses: a degenerating (and atypical) fibroid, versus a leiomyosarcoma. The appearance could be either; my symptoms actually match neither. The first is benign and can certainly be addressed post-partum; the second is a very rare but very aggressive cancer with a poor prognosis. Finally, I was referred to another specialist and got him to read my MRI and his report is positive - he doesn't think the appearance is malignant. We're still watching it - I'll have frequent ultrasounds and additional MRIs if the appearance changes or it continues to grow - but for now there are no plans to deliver early for treatment.
I'm glad to finally have a little peace. At every single doctor's appointment or ultrasound I've had, I've gotten potential bad news, so to finally only have a few minor concerns on the radar is a relief. I am pretty confident baby's kidneys will be normal at birth, as they are only very slightly out of normal range, and as long as baby can continue to grow, I think all will be well. Sure, we still have to take this mass out at some point, but that was already the plan originally! We will cross that bridge when we come to it, and just try to ride out these last two months with minimal drama!
I had my routine anatomy scan ultrasound in August, and while we didn't get ANY cute pictures, because this kid NEVER stops moving, we did find out that he or she has pyelectasis, a kidney problem fairly common in fetuses. This is a "watch-out", and may require surgery after birth if it doesn't resolve on its own. However, it's also a Down Syndrome marker. I pulled my other anatomy measurements and, plugging my age and all the date into a reliable risk calculator, realized this baby had a 1 in 64 chance of having the condition. I decided it would be prudent to have a non-invasive blood test to screen.
Now, let me be very clear: I do not consider news that a baby has Down Syndrome to be bad news. It's just news. I absolutely value the lives of those living with Down Syndrome, and we would be happy to welcome a baby with this disease. But it is smart to be prepared for the upcoming challenges, were this the case, so we decided to get the test anyway. It came back negative, which was a relief - despite my willingness to parent a child with Down Syndrome, I feel wholly inadequate to do so! But we still had to schedule follow up for the kidneys, and to try to get a better anatomy scan - baby was moving so much that we missed about half the measurements.
We had the next scan a month later, and now that baby is more crowded and can't really swim away, getting images was easier, so we were able to complete all the important measurements. Unfortunately, the kidneys did not improve, so we're still keeping an eye on that.
More concerning is that the uterine mass that started this whole thing, that has been causing me so much pain and grief for over a year now, grew significantly since my last ultrasound. It's not a good situation: it now takes up the entire uterine wall and bulges into the amniotic space, so there is a concern for fetal growth restriction (right now baby's size is fine). The other concern is that its growth rate, appearance, and perfusion are not typical for a fibroid, and are what you would see in a malignancy. This was the original concern that sent me to the OR back in May, where I found out I was pregnant!
Maternal Fetal Medicine is on board - I still have my regular OB, but they are following me for the mass, the other fibroids, and baby's kidneys - and they recommended an MRI for better imaging due to the concern for cancer. I had the MRI, but it was inconclusive. It ruled out a few (benign) diagnoses, but left us with two potential diagnoses: a degenerating (and atypical) fibroid, versus a leiomyosarcoma. The appearance could be either; my symptoms actually match neither. The first is benign and can certainly be addressed post-partum; the second is a very rare but very aggressive cancer with a poor prognosis. Finally, I was referred to another specialist and got him to read my MRI and his report is positive - he doesn't think the appearance is malignant. We're still watching it - I'll have frequent ultrasounds and additional MRIs if the appearance changes or it continues to grow - but for now there are no plans to deliver early for treatment.
I'm glad to finally have a little peace. At every single doctor's appointment or ultrasound I've had, I've gotten potential bad news, so to finally only have a few minor concerns on the radar is a relief. I am pretty confident baby's kidneys will be normal at birth, as they are only very slightly out of normal range, and as long as baby can continue to grow, I think all will be well. Sure, we still have to take this mass out at some point, but that was already the plan originally! We will cross that bridge when we come to it, and just try to ride out these last two months with minimal drama!
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