Hot August Nightmares

My inbox has been overflowing with emails from people wondering what has been happening with me and why I haven't been blogging. Here's the down & dirty version.

In late July/early August, Stephanie and I took a trip to the Bay Area for a week. This was a planned trip. Stephanie wanted to finish up the last of like 20 week-long classes to receive her full Montessori credential. The plan was for me to take care of Elliott while Stephanie was in class. It was an added bonus that we got to spend time with Auntie Nicole and her family. This was first time Elliott met cousin Eric and the second time he met cousin Sarah (she was 4 months old and present at his birth).

A few days before the trip, I started experiencing a funny pain in my right ankle. I thought I had banged it on the footboard of our bed as this has happened numerous times. It felt a little bruised, but no big deal. Each day before the trip, the discomfort got a little worse, but I was able to walk it off during the course of the day, plus I worked the 2 days before we left and there wasn't anything I could do about it if I wanted to.

We drove down on Saturday in the new Prius [We love this car, by the way. The whole trip cost us about $100 in gas-- not bad for putting over 2000 miles on it] By the time we arrived in Foster City on Saturday afternoon, my right ankle was swollen and tender and painful to walk on. Over the course of the next few days it kept getting worse. By Tuesday when I woke up crying in pain [and asked Stephanie to drive me to the Kaiser E.R. in Redwood City [Coincidentally the same hospital Stephanie was born in. The point being, you know it was bad if I was willing to go to a Kaiser E.R.] it was so painful I couldn't walk on it, and it also started to swell and discolor. Making matters worse, the same thing started happening in my left foot as well.

I was seen by a Dr. Bhopale. Nice guy. Did the usuals. Blood work, X-ray. The X-ray was negative for a fracture. He also tapped my ankle joint but was not able to aspirate very much fluid. Good thing, I guess, because this meant there was no infection. At first he thought I might have gout. They drew some blood for lab work. My uric acid level was normal. My sed rate was elevated at 45. After 4 hours of testing, he basically told me he didn't really know what was going on and that a "wait and see" approach was the best he could offer me. I thought, "Wait and see? Until what? My feet fall off?" Anyway, he sent me on my way with a pair of crutches, a brace, and a prescription for Indocin (anti-inflammatory) and Vicodin for pain. I took both religiously for the next 6 days until we arrived back in Portland. The Indocin did nothing for the inflammation, but the Vicodin helped with the pain to a large degree. At the end, I had taken it every 4 hours for nearly a week.

We got back to Portland on the 5th of August. On the 6th I had scheduled an appointment with a rheumatologist. I ended up seeing a doctor named Anita Goel. Fantastic doctor. After examining me, within 5 minutes, she said, "I think you may have sarcoidosis." She pointed out a red, puffy nodule just below my right knee that she explained was erythema nodosum, a defining characteristic in people with sarcoidosis. She confirmed her suspicions with a chest X-ray.

Sarcoidosis is basically an auto-immune disorder that starts in the lungs, but can affect any organ in the body. It involves the lymph nodes [which, in my X-ray, look like a nice sparkly constellation around my heart] and can cause inflammatory responses in other parts of the body, in my case, the feet. Something triggers the condition and sets off a chain of events whereby the immune system recognizes the body's own cells as foreign and attacks them. The cause of sarcoidosis is unknown. It can be severe enough to cause death, but can also be self-limiting and go away in as few as three years. [All this information is, of course, paraphrasing all the internet research I have been conducting, and probably a little less than completely accurate]. Dr. Goel prescribed steroids for me, which worked extremely well within 24-48 hours. By the time I had my follow up appointment a week later, my feet were pretty much back to normal and I was able to return to work. And, aside from a few nights of sleeplessness from the steroids and feeling generally run down, I am feeling much better.

I was obsessed with figuring out how this happened to me. I can live with the fact that the cause is unknown. I may have had sarcoidosis for some time and just not known it. What I couldn't understand was what triggered it. Finally, all I could come up with was the Hepatitis B vaccine I had received for my job just 24 hours before the pain in my ankle started. I got a copy of the insert from the employee health nurse. Interestingly enough, common side effects include arthritis and erythema nodosum (which is what helped Dr. Goel diagnose me). I asked Dr. Goel about this on my follow up visit. She said she didn't think the Hep B vaccine is what triggered it, but she also couldn't say definitely that it wasn't, either. Considering that I had never experienced any prior symptoms, and the pain started 24 hours after receiving the vaccine, I can't think of anything else it could be.

Anyway, the long and the short of it is, that is why I have not been blogging, emailing or returning phone calls. In the midst of all this happening, Stephanie and Elliott have been sick as well. We had our first fever scare with Elliott. He had a fever of 105.6 a couple of weeks ago. He's doing fine now, but had us nervous for a while to say the least. I think we're all finally on the mend.

Also, I have been spending my blogging time simply gathering all the stuff I needed to apply to the Writing Program at Portland State. I just sent off the packet yesterday. I'll let you all know when I find out. Thanks again to Valerie, Paul and Cari for the recommendation letters. The meant a lot to me. It's nice to know I'm surrounded by such amazing and kind people who are willing to say they like me on paper.

In case this is the only entry for August, I am looking forward to getting back on track in September. I have a couple items burning a hole in my brain I would like to share with all of you.

-C