On Being A Pregnant Cripple

Check out my smiley belt.  Sexy as.

Back pain is common in pregnancy as we not only put on disproportionate weight, but also produce a hormone called relaxin, which 'relaxes' ligaments, bone structures and arteries in preparation for birth.  This can make some women feel super awesome, but can also cause issues as bits of the body may 'relax' into awkward places.  I have had back pain, and treatment before, but none of it compares to what I am experiencing now due to pregnancy.

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As a relevant, early sidebar, I started doing maternity yoga about three weeks ago.  I decided to do this because I wanted to do some prep for child birth.  I have learnt a lot from this yoga class.  I learnt that I was basically doing everything wrong.  I was sleeping, sitting and standing wrong.  I learnt about relaxin, and about some positions I shouldn't get into, not just because they aren't lady like, but because they might damage me now cos of the stupid relaxin.

I left my first yoga class completely re-educated, traumatised, and worried about how I would possibly be able to sleep in a different-to-usual position.  I cannot stress enough that this education was very useful.  If you are going to give birth for the first time, I recommend going to maternity yoga.  In spite of the fact that it makes me nauseated (due to low blood pressure) and tearful, I am learning things I may never have learnt without it.  And they are practical and logical things - not just hippy la la things.

I'm learning a bunch of exercises, some that will hopefully help my back (I told my yoga instructor I was having issues).  And I bought a Swiss Ball the day after my first yoga class in an attempt to sit on the couch less (the couch is apparently evil).  I haven't been 100% good with my posture, but I'm aware of it and trying, and exercising and I am attempting to sleep differently.

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Concurrently...  About a month ago I found out you can get a physio appointment via your Midwife, so asked my Midwife to organise me one because I was having some lower back pain.  And then waited and waited.  I am a person who doesn't like to 'bug' people, so didn't want to 'bug' my Midwife for a few weeks.  Then she went on holiday, and I would have to 'bug' her birthing partner who I haven't met before.  So I didn't 'bug' her until I had to leave work because I had trouble turning on the computer...

As soon as I 'bugged' her, I got a phone call from the hospital to organise me an appointment for the next day (go Midwife!).  I wish I had been brave enough to bug her earlier.  This is one of the annoying things about being anxious.  I think had I been brave enough to 'bug' her earlier, my back may not have gotten to this point.  It still might have, but case in point, being braver is smarter. 

So on Wednesday I had an appointment with the hospital physio, and she was brilliant.  I like physio - I've done a fair whack of it, so it was also nice to be the 'good' patient wearing appropriate clothing and footwear and knowing stuff and things (once a teacher's pet, always a teacher's pet).   And it was so nice to be told I have the 'typical' symptoms of a hip problem.  It's really nice to be 'typical', because it means people know what to do with you.  My right hip is tilted too far forward, and is not very mobile.  Hence pain with movement, and sometimes extreme pain as other muscles and bits catch in the hip joint.  So the joint needs to learn where it's supposed to go, and needs to be mobilised.  So she did some very mild joint manipulation and fitted me with a Smiley belt and some more exercises to mobilise the hip.  I felt instant relief as soon as she put the belt on.

So I went to work yesterday feeling super confident with my new belt and understanding as to why my back was not my friend.  I wish confidence was a better placebo than I'd assumed.  At about 1.20pm I suddenly got sharp pain in my lower back.  This was a different to normal kind of pain as it was constant (usual pain is with movement).  Then my blood pressure dropped, and I almost collapsed.   I shakily sat down, took some Panadol, drank a bunch of water, and emailed my husband.

I thought it quite likely that my blood pressure dropped because my body was shocked by the pain.  So let him know what was going on, but that we didn't need to do anything unless I couldn't get my blood pressure to come right in the next half hour.  I figured in that time the Panadol would start kicking in, and with less pain, my body would start to calm down (I'm awesomely logical, even when in agony).  Then I started getting cramping across my pelvis.  This is scary when you're pregnant.  Because I have IBS I went to the bathroom to double check if it was gastro cramps (again with the logic), and to check for bleeding, of which there was none.  Phew!

After half an hour things were not right with more cramping and shakiness, so Murray picked me up and took me to the doctors.  Although the Doctor did check my stomach for rigidity to ensure everything was ok with the baby, he did little else - he didn't even check where I was at on a pain scale and I was crying in pain just trying to step up to the bed to get checked (Murray had to help me get down).  He recommended Panadol (despite knowing crying me was me on Panadol), rest and to call my Midwife.  Then they charged me for the appointment because it wasn't deemed to be related to pregnancy.  We were unimpressed.  I have complained.

My back-up Midwife was reassuring.  Although there was nothing she could practically do, she let me know there were options.  You can take more hard core drugs when pregnant than Panadol (yay).  She recommended to go to A&E if the pain levels didn't come down because they could give me these drugs.  And I can go back to the hospital physio which I plan to do next week. 

Over early evening my pain settled to a tolerable level with doing nothing.  Today, I can walk around with my belt on and only look slightly crippled.  But I can't stand for long, I can't bend down to do things like get a cup out of the cupboard, and I certainly can't go to work.  I am hoping that this has something to do with too much or 'new' exercise, and this will dissipate with rest, but who knows.

I am glad there is a plan.  But it is frustrating being in limbo.  How do you handle having a job when you are in a physical limbo?  I feel sorry for my boss.  She has a staff member who 'might' be ok for work but who knows?  I was really hoping to not feel like an invalid until I was much more pregnant than this.   And I shouldn't feel this way because I'm being  good.  I'm doing  the exercises.  I'm going  to yoga.  And I'm resting  (I have little choice).  Surely this means I should get a reprieve?  And yes, I know, patience is a virtue, good things come to those that wait etc.  But those waiting in pain and limbo may go into psychotic rage and kill things...

I am grateful that the baby is ok.  She has been kicking away at my bladder like an evil demon child, which is good.    And my back-up Midwife said pain is commonly 'unpredictable' in pregnancy, so I might wake up tomorrow and feel pretty good.  I really hope so.  In the interim, I am resting.  Our house is a state, but I will just sit (not on the couch) and watch DVD's like a good, albeit impatient, patient.

Getting my knee on the wall

Up until late last year I’d never broken anything really important. I’d broken a finger, a couple of toes and I’d fractured a metatarsal in my foot. They all hurt like bejesus, but never caused any real fuss. When I fractured my talus last year, I don’t think I really knew how big a deal it was going to be. I figured I’d broken some stuff before and I’d been on crutches before, so it’s not worth making a fuss.

When I had the accident, I was pretty sure I’d just really badly sprained my ankle. I badly sprained the same ankle when I was 17 and ended up in a back slab cast and on crutches for a bit. This felt kind of the same. When I was 17 my ankle went floppy, at 29 my ankle went floppy. At 17 my ankle went funny colours and puffed up like a balloon. At 29 my ankle went funny colours and puffed up like a balloon. Immediately on landing from the fall all I thought was ‘shit. This is going to take me out of work for a bit.’ I didn’t really think any further than that.

I really didn’t think I was going to end up in hospital for 4 days. Ascot took an x-ray and were pretty sure it was a talus fracture, so they sent me to Auckland for a cat scan to double check. Auckland took an x-ray and couldn’t see a talus fracture but my ankle had puffed up bigger than a snow boot so the registrar said I’d probably need ligament surgery. I had to wait to be checked by the specialist the next morning and then they’d open me up. I really hadn’t seen that one coming.

I’ll try and paraphrase the rigmarole that was my 4 days in Auckland Hospital: Specialist said talus fracture and ligament damage, but wasn’t sure of course of action. Much waiting for CT scan and plaster (ankle still not fixed in place). Registrar forgot to do paper work for both. Much more waiting. Very angry plaster technician. Gluten free vegetarian hospital food is just pumpkin and/or kumara. Morphine made me ill. Then anti emetics made me ill. Then I got an anti emetic that didn’t make me ill so I could take morphine. Too sleepy to knit from morphine. Course of action: moonboot and crutches. No surgery. Discharged.

Because of the break and the swelling and the extreme pain (which is typical of a talus fracture) I couldn’t start physio until 8 weeks after I had the accident. I was off work for 8 weeks, and then gradually eased back into work whilst still in a moon boot. I had two ACC case managers that weren’t terrible. I had my Civil Union coming up in April. I had a great physio. I managed to walk down the aisle without anyone noticing my slight limp (I think). I managed to go on our honeymoon, and although what I could do was limited, I still did a lot, and had a great time.

Following the whirl wind of our Civil Union I realised that maybe things weren’t going normally. May was 5 months out from the accident and I was still having a lot of issues with movement. I sat on doing anything for a bit. We’d just started doing physio in the gym as well as hands on and I thought that might make some difference. It didn’t. It was extremely frustrating for me because I had made such great improvements in other areas. My balance is extremely good for someone with an ankle injury, and that ankle is very strong.

Dorsiflexion is the movement where you lift your foot up toward your leg, pushing the heel down and the toes up. I never thought about how ankles even worked before my accident. Now I know that without dorsiflexion you can’t do a lot of things. You can’t run. You can’t jump. You can’t skip. You can’t squat down to turn on computers at work, and you can’t dance particularly well. It has many real world ramifications; imagine trying to look after your kids without being able to easily pick them up off the ground? I decided to book a specialist appointment.

Meanwhile, my physio Barb had an accident of her own, unfortunately injuring her thumb quite seriously – not so good if you’re a physio. So Barb had to get some surgery herself, and is still recovering. I got a new physio. The first session with him was absolute torture. I wasn’t sure if I was going to be able to walk without crying afterward. But I could, and after a few torture sessions I started finding that the movement which has been the bane of my existence for the last 8 months was gradually getting better.

I saw a specialist a couple of weeks ago. My accident must have been pretty special because he remembered me despite having never met me. He was consulted on my initial CT because of the break, ligament damage and bone fragment mess that was my ankle almost 8 months ago. It must have been memorable. He said the amount of movement wasn’t great, but that we’d check in again in a couple of months, and if it still hadn’t improved much, we’d have another CT and go from there.

Before I started physio, I was going a little mental. I felt useless – I couldn’t even shower myself if I was home alone in case I had a fall. I felt alienated from my friends – I couldn’t easily go to parties, couldn’t catch a bus to go for coffee. I felt scared – what if my ligaments were screwed and they found out later and I needed surgery and it didn’t work and I couldn’t walk properly ever again? Despite the fantastic support from my partner, friends and whanau, it was a very sad and lonely time. I genuinely think I would have lost the plot without physiotherapy. Physio taught me to focus on the small achievements, and let go of the rest for a while.

When I started working with Barb she showed me the test for dorsiflexion. You stand with your toes on a wall, put your knee on the wall, and creep your foot back whilst keeping your heel on the ground. The average person should get their toe around 14cm away from the wall. When I started physio, I couldn’t actually bend my knee at all with a foot flat on the ground. My knee remained a full foot length from the wall. Today at physio, I got my knee on the wall.

Getting my knee on the wall is still very far away from normal movement (14cm in fact), but it is a massive improvement from where my movement was. This small achievement has solidified for me that my dorsiflexion can improve, and that I can work at it to ensure it does. I am no longer worried that there might be bone fragments restricting my movement. I am no longer concerned about being a disabled parent one day. I’m no longer worried about what the specialist is going to say to me in 6 weeks time. I got my knee on the wall, so I’m going to be fine.