Saturday, May 30, 2015

Torn

     Walking out of work the other night, one of the tendons in my husband's ankle tore halfway through. He didn't step wrong, he didn't roll his ankle, he wasn't coming down a flight of stairs - he was just walking across the flat surface of the parking lot at the end of the night. By the time he got home, it was already starting to swell. Dammit.

     He's been getting steroid injections in his ankles for a few months in order to alleviate the burning pain that was making mobility difficult for him, and he'd had no problems up until this point. That's not to say that the injections have anything to do with the tearing of his tendon, because they likely don't. Marfan's is a connective-tissue disorder, and that's exactly what tendons are made of. The dengenerative nature of the disorder meant that it was really just a matter of time before something like this happened, and frankly, we got off kind of lucky this time.

     It wasn't any better the next morning, so I suggested he go to the urgent care, even though that's one of those proceed-with-caution things due to past experiences there. At the very least, I wanted him to call the orthopedist to see what they could suggest. He did, and there had apparently been a  cancellation for that morning, so he was told to come in to be examined.

     His ortho did the exam and figure out that he'd torn one of the big tendons in his ankle, I think the one that runs from just above the ankle bone down to the arch of his foot, about halfway through. We have to take our breaks where we can get them, so I was just grateful that he hadn't torn it all the way through, which likely would have required surgery. Not only would that mean time away from work coupled with extra medical bills, but my husband's a lousy surgery candidate, mostly due to the blood thinners he's on. His susceptibility to spontaneous pnuemothorax doesn't help the situation, either, as that can and has happened during a previous surgery.

     The doctor wanted to put him on prednisone, which a steroid that everyone ever has probably been on at some point or another, and was going to be most helpful in reducing the swelling and helping the tendon to heal. This, in addition to a heavy-duty ankle brace/walking boot hybrid. Problem? The lovely, stroke-preventing blood thinners that my husband has been taking daily since getting his after-market heart valve installed a little over a decade ago.

     Steroids typically don't play nicely with blood thinners, a fact we learned the hard way about three years ago, when he was issued a prescription to clear up an infection in his elbow. Unfortunately, not only did they not clear up the infection, they reacted with the warfarin and shot my husband's INR up so high that he was hospitalized for several days because they were afraid he was going to start springing bloody leaks at any moment. What doesn't kill you, eh?

     Now that he's aware of the potential danger posed by the steroids, my husband made sure to ask the ortho whether or not it was a good idea to take them alongside his blood thinners. If it wasn't, the plan was just to wear the brace and suck it up, because not taking his warfarin is not an option. Teamwork to the rescue, though, because the ortho said that he'd talk to my husband's primary care physcian about it before sending the order to the pharmacy. If she said no, then the only option was to suck it up, buttercup.

     A compromise was reached, though, one which everyone felt comfortable with. My husband could start the steroids, but he would have to go get his INR tested twenty-four hours later so that they could be sure he wasn't about to bleed into his eyes, or suffer the alternative, which was a possible mini-stroke (again) due to his blood being too thick. I say that because that's the other possible interation between blood thinners and steroids - they make the blood thinners much less effective, thus thickening a person's blood to potentially dangerous levels. This has happened once before, and the result was my husband suffering a mini-stroke one day while I was at work. It's not an experience I'm eager to repeat.

     We got lucky again, and when he went in the next day, his INR was at 2.4, just a tiny bit outside the lines of acceptability, but certainly no reason to get alarmed. His pcp gave him the thumbs-up to continue the course of meds, and his ankle is doing much better, though he's still wearing the brace.

     What seems like a minor incident, though, is actually more likely a portent of things to come. Like I've said before, Marfan's is a connective-tissue disorder, and it's not selective in which tissues it affects. His aortic valve has been replaced, and that's the biggest danger zone, but what about the rest of him? It's becoming more and more of an issue, the overall deterioration, and no one seems to know how to stop it, or at least slow it down to normal levels.

      

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