Friday, May 13, 2011

Let's Dance.

As in...Dances with Dirt, Gnawbone Edition.  It's tomorrow.  And, yes, I'm running.  Dr. Jones told me to base it on how I was feeling.  So I decided to run a little yesterday, as well as today.

Yesterday Tim and I ran 3 miles together, with Rowan in the stroller.  It. Was. Hot.  Mid-80s, sunny, and pretty much no wind.  How's that for your first run back after a marathon and two days after surgery?  The heat was, honestly, my main complaint on this run.  Now, don't get me wrong, I was sore.  VERY sore on the right.  I have two incisions--one in my belly button (which you can't see), and one on the right side a couple of inches below my ribs.  It's not the incision itself that hurts, but everything underneath it.  But I survived the run (and the heat) feeling like I hadn't run in years.  I was hoping today's run would be better.

It wasn't.  It was a bit cooler out, but still warm, and I was just struggling.  I felt EXHAUSTED on both runs.  I was running 8:30s but it felt like so much effort, almost like I was getting sleepy during the run.  I suppose these are lingering effects from the anesthesia.  I know it's not pain medicine, as I haven't taken any (or needed any) since Wednesday morning.  But, on both runs, I just felt like I could hardly move.  I've felt better at the end of 20s out in Buddha.  Tim was with me on both runs, but I didn't even have the energy to talk to him.

Now, to devote a special section here to the pain I felt on the run.  Yesterday, it was just the incisional soreness.  Today, I had something I've not had for a long time--the left shoulder pain.  When all this first started, and as it worsened, when I would have the abdominal pain, I'd often get a sharp, stabbing pain in the front of my left shoulder.  Definitely referred pain.  Once I took the antibiotics a few weeks ago, though, I stopped having that.  Until today.  Now, it wasn't horrible.  But definitely there.

I know exactly what causes the left shoulder pain.  I have long suspected it had something to do with the diaphragm (though no one would listen to me about that, and they said it was referred from my abdominal muscles...pah-lease!).  But, after my surgery, that evening, I was sitting on the couch watching TV.  And I got the shoulder pain....the pain I've only ever gotten while running.  I got it SEVERELY.  And then I remembered from nursing school--after laparoscopic surgery, people often complain of left shoulder pain because of the gas that is put into the belly during the surgery to allow the surgeon to see everything.  I googled, and determined that the reason this gas causes this pain is because it irritates the phrenic nerve, which controls the diaphragm.  When it's irritated, it doesn't cause pain at the diaphragm, but in the left shoulder.  More specifically, in the front (tip) of the left shoulder.  That's exactly where mine is.

Now, the pain I felt there after surgery likely had nothing to do with my "condition"--everyone who has abdominal surgery has this shoulder pain.  But I recognized it as the EXACT pain I've had there while running, which means that phrenic nerve irritation has to be causing it while I run.

My liver clearly sustained a nasty, chronic infection.  The diaphragm sits just on top of the liver, and so the infection most likely aggravated the phrenic nerve.  But...why now, as it looks like there is no active infection anymore?  I can only hope that the surgery itself somehow irritated the phrenic nerve, and that that will go away.  But if it doesn't, I know Dr. Jones will listen to me.

So over the last few days, I've had some time to digest the results of my surgery.  For the day or so after, all I knew was she found a whole lotta scar tissue on the liver and that I have some (what is likely to be) endometriosis.  I am so analytical, that I wanted to start putting all the pieces together as to how all that has caused not only my pain, but my fatigue, weight loss, night sweats, etc.

I pulled out my timeline.  Letting me just tell you...if you are suffering from some un- or mis-diagnosed health problem, you MUST keep a detailed timeline.  Not only for you, but for the doctors.  They can't possibly remember everything you tell them.  You don't know how many times I've been asked, mid-way through an appointment, something like "So how long after you run does the pain come on?"  "'s WHILE I'm running."  You get 10 minutes with them, tops.  BRING A VISUAL AID.  Anyway--I pulled mine out.  I am clearly dealing with two things here:  an infected (and now healed/scarred) liver and endometriosis (on the left).  In looking at my time line, I see that the right-sided pain began shortly after Rowan was born, but the left-sided pain didn't begin until much later...January.   I remember being surprised the day it showed up.

So what happened in January?  I went off birth control and had an IUD placed.  A-ha!  Ovulation is what stimulates the growth and pain associated with endometriosis.  Obviously, I wasn't ovulating during my pregnancy.  And I was not ovulating six weeks after when I went to my follow-up visit because I was breastfeeding.  At that time, I started the birth control pill (late December), but went off it in January when I had the IUD placed.  So, I was ovulating again (my IUD does not stop ovulation).

But why had I never felt the endometriosis before?  Because, my entire adult life, other than the two times I was trying to get pregnant, I have been on birth control (which keeps a woman from ovulating).  Both of my kids were conceived VERY quickly.  With Rowan, I was monitoring my ovulation and know that I conceived during my first ovulation cycle after going off of birth control.  So I never felt/had the endometriosis before because, other than maybe one week before I was pregnant with Amelia and Rowan....I never ovulated!  Endometriosis relies on ovulation to grow and form.

So, I talked to Michele, the NP, yesterday.  She's putting me back on birth control.  Hopefully, that will help a lot with the endometriosis pain.  She's also treating me with a big, aggressive antibiotic regimen that involves both injections and pills and will last two weeks.  That way, any remaining infection will hopefully be knocked out.

I'm still worried about that left shoulder pain and my diaphragm.  But I have to remember that I have no control over what is happening to my body--I can only keep hope and continue going to doctors who will help me.

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