Old age ain’t for sissies

I have been in near-constant pain for almost two months…on bed rest for nearly half of that now, and it is really, really getting old!

It all started on 12 March...Hubby and I went out for dinner and while awaiting dessert, I decided to make a trip to the loo. It being a balmy night (March is the end of summer in South Africa), we were sitting outside on the patio; the loo, however, was inside and, from the server’s directions, apparently at the back of the dimly lit dining room.

The floors were tile; there was a raised dining area to the left, accessed by two or three steps, also tile. They were also the same colour of tile as the main floor, they had no edging to indicate that there were steps there, and in the dim light, they blended right into the floor. I hit the steps with my left foot…which had only the flimsiest of sandal on it…and fell up the steps…leave it to me to find a way to not only fail to see some steps, but to manage to fall up them!

I really didn’t think I was badly hurt. OK, I had two small scrapes where my ankle and the top of my foot impacted the leading edge of the steps, but I neither reported it to the restaurant nor told my husband. I felt foolish, after all, tripping over steps because I was more focussed on finding that elusive ladies room than looking for virtually invisible obstacles in my path.

When I first started feeling pain, it wasn’t in my foot or ankle. Two days after I managed to embarrass myself in the restaurant, I awakened with what I thought was a sciatica attack. I’d only had sciatica a couple of times before and it had always resolved within 24 hours, following a good sleep, so I was puzzled when I awakened the following morning and not only was the pain still there, it was moving down my leg. Sciatica is the inflammation of the sciatic nerve which goes from the lower spine through the buttocks and down the back of the thigh. Not only was the pain still burning from my back, through my bum and down my thigh, it was moving further down my leg than any sciatica attack had ever gone before, and the pain was more diffuse than I remembered it. But, true to form, I just assumed it would get better in a day or two, as my aches and pains generally do, and ignored it. That, as it turns out, was the wrong thing to do.

Pretty soon the pain had gone down my leg to my foot, and from there, into my big toe. I knew it wasn’t gout…I’d been tested for gout and DVT (deep vein thrombosis) only a few months back. The foot started to swell up…and before long I was having pain so acute I couldn’t stand even the weight of a sheet on the skin. It burned, my skin was tender to the touch and just when I thought it couldn’t get any worse and I had to see a doctor about it, I caught the flu and my entire body ached so badly I couldn’t isolate the leg pain from the flu pain. I was a mess!

Slowly, the flu symptoms subsided, leaving me with the pain from my lower spine down to my big toe, but with a new twist: it began to spasm at night. Now, even with OTC codeine-and-paracetamol, I couldn’t sleep more than two to three hours at a stretch. Then one night Hubby woke up and found me sitting in the big chair in the bedroom, quietly massaging my foot and ankle, where the pain was the most acute, and silently crying. The following morning, after learning that the doctor wasn’t able to see me, we walked…well, he walked, I hobbled…into the ER at our nearest hospital, ready to put my misery out of me.

It was the 9th of April, nearly a month since I lost the skirmish with the stairs…but we still had not made a connection between a pain that seemed to start in my spine, radiating down my leg, to my klutzy moment at the restaurant. During this month we had driven down to Durban and back, viewed a dozen or more houses, tramped through several malls, and generally lived our normal life, sore leg and all. Every night I had gone to bed, expecting the “sciatica” to have taken its leave while I slept, and each morning I would awaken to the burning pain running down my leg, now with the addition of hot splinters of pain throughout my foot, ankle and great toe. It was time to get a proper diagnosis.

I’ve always felt quite comfortable in South African hospitals. I have never received anything less than first rate care, and usually more promptly than in American hospitals, too. The ER doctor was a pretty young blonde who listened well and asked the right kinds of questions. When I pulled up my jeans so she could see my foot, I saw the healing wounds caused by the stairs and, on the spur of the moment, told her about my clumsy meeting with the stairs. She duly noted it but, like me, was focussed on the pain radiating from my lower spine. She ordered a series of hip and back x-rays and, as an afterthought, ordered a couple of x-rays of the foot, “just in case,” she said.

At this juncture, I have to warn you about those automated blood pressure cuffs…they kept trying to get a blood pressure on me and the readings were stroke level! Now, I’m 63 and I’m fat…nobody expects my BP to be 120/60 any more…but they were getting readings in the 240/190 range and I knew that had to be wrong…over the past five years of so, I have consistently had readings in the 135/80 to 145/85, depending on how stressed I was at the time of my doctor’s visit. I almost titled this entry “Near Death by Sphygmomanometer” because I swear to you, that machine was out to kill me!

The nurse wrapped that cuff around my arm, switched on the machine and I knew almost immediately that something was wrong because it didn’t stop inflating until I was holding my breath and squirming against the pain. It started deflating, automatically searching for the arterial pulse that would give it its first reading but apparently is couldn’t find it, and the thing began inflating again! My fingers began to turn purple, my hand started to swell up and I could feel my eyeballs start popping out of my head. I cried out a couple of times and when nobody seemed to think anything of a patient writhing in pain and turning blue and purple over a blood pressure reading, I began to yell “Take it off! Take it off me!” Tears spouted out of my eyes and just as I was about to frantically claw it off my arm, one of the nurses announced a reading of 240/190 and the doctor nearly stroked out! Once the feeling came back into my hand I suggested that the reading was that high because the machine had nearly amputated my arm and the doctor suggested that maybe we should let the pain shot she had given me take effect and we’d try again after the x-rays.

Well, the x-rays were a revelation…they indicated I had some damage to some spinal joints…fairly common at my age…and there was narrowing in a couple of nerve channels in my lower spine, which surely explained my occasional bouts of sciatica. But the surprise came when they looked at the x-rays of my foot…not only did I have a seriously arthritic big toe, I had broken a bone in my foot, and that was likely the primary source of all my pain!

Well, as it turns out later, that was only part of the problem…the ER put a “backslab” half cast on my foot, told me to keep it elevated, and gave me a referral to an orthopaedist. Before they would let me go, however, they had to assure themselves that my blood pressure wasn’t going to make me keel over from a stroke in their hospital, so one of the nursing sisters began to wheel that monster machine over me and I felt myself go all balky. Shaking my head, I told the doctor I wasn’t going to submit to its not-so-tender-ministrations again. “I’m kind of afraid of it, after what it did to me earlier!” I told her. “Don’t you have an old fashioned hand pump one somewhere?” That send the staff scurrying around but sure enough, a manual sphygmomanometer was scrounged up and everyone heaved a sigh of relief when the doc gave my reading as being only slightly elevated, most likely because of the continuing pain, the shot they had given me having had no appreciable effect.

By the time I was able to get in to see the ortho, another two weeks had passed, weeks in which the pain in my leg and hip had pretty much subsided, but during which the pain in my foot and ankle had intensified. I was now unable to sleep more than a couple of hours at a stretch, despite the pain meds the ER doc had prescribed, and was in some degree of pain 24/7. The ortho said the bone was healing well…it was now about six weeks after I had had my losing altercation with those steps…and he took the back slab off, ordering me to buy a pair of athletic shoes with a sturdy arch support and to wear them when I was out and about. He further told me that I should be walking around…not too much…but to start exercising my foot and ankle with mild walking so that I didn’t develop thinning bones. And he gave me what he said was a stronger pain prescription and told me to come back in two weeks if I was still having pain.

OK, this guy is a specialist…a very expensive, Royal College of Surgeons in Edinburgh kind of specialist, who charges significantly more than our medical covers. When the two weeks was almost up and 1) the pain meds were essentially useless and 2) my foot hurt even worse and 3) I figured out for myself what was wrong with me and now knew what my course of treatment needed to be, we made an appointment with our new GP and took my aching foot and ankle for her to take a look at.

On 3 May I hobbled into her office, gave a brief rundown of my condition to date, then told her I thought I had a bad tendinitis, something I had suffered before…but not in my foot. My symptoms…including the “worse at night” phenomenon…were consistent with tendinitis and, when she saw and probed my foot, she agreed. But, before I could ask for the magic bullet that cures tendinitis in a matter of days…a cortisone shot into the affected area…she announced that, because my foot was still tender over the broken bone, cortisone was out of the question at this point in time. Cortisone, apparently, retards bone growth, as does aging, and so the bone needed a little more time to heal. But she seemed to have an idea of what had caused my various…and seemingly unconnected…pain experiences. She felt I really did have a form of sciatica, but one caused from the trauma of slamming my foot into those steps…the wounds, after all, were still visible six weeks later! The shock of connecting, full force, with those immovable steps (and tile over concrete is very unforgiving) probably sent a shock up my leg, causing some kind of trauma to the nerve, which explains why the sciatica didn’t go away overnight as usual. The way my foot connected with the steps caused it to violently snap back into an exaggerated ballerina’s “en pointe” position, aggravating the tendons in the ankle and top of the foot. One of those tendons anchors near the base of the big toe, which is already inflamed from arthritis, causing even more pain. Don’t ya just love hindsight? Three more weeks, she told me. Three weeks of anti-inflammatories, pain meds, and “keep that foot elevated!”

That was two weeks ago. My next appointment is 25 May, and I’m keeping that foot elevated. Unfortunately, however, either I’m resistant to the pain meds that have been prescribed for me or I’m just a wuss because the best I get is a dull throb and the other night it was so bad that it the pain woke me from a sound sleep and I sat up for over an hour, massaging the sore tendons, waiting for the next dose of the pain meds to throttle it back down to that dull throb, and trying to cry quietly so that I didn’t wake Hubby…it’s not his foot, it’s not his pain, and he has to go to work in the morning!

So, that’s what I have been up to for the last few weeks…hope you have been doing better!