Learning Not to Panic

My ankle was so sore yesterday. Because it was so cold and rainy on Sunday, I spent extra time doing OT listening and balance exercises, the latter which rely on the small intrinsic foot muscles and the chronically tight lower leg muscles around my ankle. Because my talus, the large bone that forms the ankle at the junction between the calcaneus of the heel and the tibia and fibula of the shin, is so arthritic that all of the smooth cartilage that should help coat the bone and facilitate gliding between the shin and foot is gone, my joint is painful and stiff. The articulations between my bones in that area are bone on bone grinding and my mobility is limited because the cartilage that should be there but has eroded away in my case is silky and facilitates a more frictionless movement between bones. In the absence of this healthy coating, the bones lock up and get stuck on one another due to their uneven surfaces with excessive friction. Because the pain is so severe when the bones grind with every movement (like with each step), the muscles are chronically tight in their attempt to guard the joint and prevent me from moving it and experiencing the excruciating pain. I’m already predisposed to excessively tight muscles because of my joint hypermobility and laxity of my ligaments (if the joints are so loose and the ligaments are ineffective at closely holding bones in alignment, the muscles have to overwork and contract to prevent joint dislocations and subluxations).

Anyway, the OT exercises I do actually are not intended to help with ankle mobility and certainly don’t afford any benefit to the arthritic damage (arthritis can’t really be treated or reversed unless a surgical replacement occurs). Nor do they stretch the overly tight lower leg muscles or strengthen my weak foot muscles (those objectives could (and should) be addressed in PT, not sensory OT). Instead, the OT exercises are aimed at improving my balance, proprioception, and kinesthetic awareness (understanding of my body’s position in space). I would need to work on these areas in the absence of my ankle issue. That said, a lot of the OT balance activities involve single-leg work and rely on using my decrepit joint. This means that the pain and stiffness both immediately and in the days following a hard OT session is significantly exacerbated. I certainly wish that this severely increased discomfort was at least resulting from exercises or treatment modalities aimed at actually fixing the arthritis. As I mentioned, there’s nothing to do about that at this point outside of surgical intervention, for which I actually have two consultations lined up next month. The OT isn’t really causing further damage to the ankle at any appreciable rate. My orthopedist said the osteoarthritis damage is already there and the autoimmune psoriatic arthritis disease continues to attack the connective tissue in every joint (as well as others) since it’s not yet controlled. If the OT was truly making the ankle worse, I would stop it. Although it increases the pain in an acute timeframe, I guess the medical professionals feel the OT benefits outweigh the minor (if any) true structural damage, so I’ll continue to abide by their advice to work on my balance and proprioception. They tell me, in fact, that the arthritis and the resultant immobility and jamming up of the joint make improving balance increasingly important to prevent falls that would otherwise ensue from the unexpected joint locking. And so, I’ve been diligently performing my OT work five days a week for several months now.

On Sunday, I put in extra time because the weather was so awful that I didn’t want to go outside. To prevent excessive stir-craziness, I may have overdone the indoor OT activities, and yesterday, I paid for it in even higher levels of pain than I normally have to battle. Fortunately, I kept things in perspective and remained calm about it whereas I usually would freak out and fret that I busted something and I’d been wholly depressed about it. I stayed rational and thought logically about why I was hurting so much and assuaged my fears that I had some sort of injury with the appropriate recognition that I had pushed a bit too hard in the previous day’s OT session (not that doing too much OT was a wise choice, but it’s hard to know the limits of my body when they are constantly changing).

Additionally, my whole body has been especially inflamed and uncomfortable because of my two recent corn contaminations, which are still working their way through my system. I also properly realized yesterday that the sharp back pain I’ve had for a few days is also not an injury but a flare up of the tarlov cyst in my lumbar spine, which is yet another common fallout of a bad contamination. Once the inflammatory process begins in my body, it increases for weeks and travels to several “weak” areas of my body in the same predictable pattern each time. The back pain from swelling of the tarlov cyst is always the last major site and is indicative of a severe reaction. It’s been quite a while since I’ve had such a bad inflammatory process that it reached my back; double corn within such a short timeframe is definitely a major insult to my reactionary body.

I’ll get through it, but if history is any guide (and it usually is in these health cases for me), I’m in for four to six weeks of back pain now. This truly sucks and I’d be the biggest liar if I reported otherwise, but at least this time around I managed to understand relatively quickly (after about three days) that this terrible back pain is attributable to the same contamination process rather than some new injury I caused myself one way or another.

This may seem like the same shade of gray called two different names, but it’s actually an important and helpful distinction. When I used to forget about this typical pattern of pain and flare ups and assumed I had incurred some mysterious injury, I’d catastrophize the potential prognosis of the “injury” and worry relentlessly that I’d broken a bone or something. The anxiety would invariably interfere with sleep, sanity, and my ability to focus on anything else in my life. By recognizing that this sharp back pain is likely not any sort of pathological fracture (pathological because I didn’t fall or do anything that would give reason for a bony injury) but just the unfortunate consequence of my autoimmune issues and contamination, I avoided all of that unnecessary stress (which is also harmful because the stress and worry alone triggers further inflammation). I feel I’m finally making noticeable strides in improving my anxiety control and ability to reason through things instead of panic. For someone with an anxiety disorder, this is a huge achievement. The path to eliminating my worries and anxiety still winds far into the distance, but at least I’m on it and moving forward. Slow progress is still progress.

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