Achille’s Heel

I assume any “couch to (name your end goal here) training plan” poses risks of injuries to trainees who aren’t diligent about gradually building their endurance abilities. I was concerned initially with calf cramps and my left swimmer’s shoulder since these have been issues affecting my swims in the past. I never would have imagined though that sudden, whole body joint pain would be my Achille’s Heel.

Progression:

The morning after my last post was the end of the second trimester grading day. Shortly after 8:00am that day, as I began rapidly typing progress notes for my trimester students, the back of my right hand, between my knuckles and my wrist, started to ache and freeze up. I continued to work, and by the end of the day, when I finished handwriting meeting minutes for a referral team meeting, I could barely hold the pen using my normal pincer grasp. As I drove home from work, I couldn’t hold the steering wheel with my right hand because of the pain.

This was a Friday. The Thursday, eight days prior to this, I had had an iron infusion due to low iron levels that popped up in my blood work, which was ordered after I had called in to discuss mouth sores and a scalding tongue sensation. I emailed my physician as soon as I got home from work, wondering if this was a delayed side effect of the iron infusion. She got right back to me and ordered more lab work.

It hadn’t occurred to me until I was trying to fall asleep Friday night, with the painful back-of-hand, fingers, and by then also the wrist, that besides the hand pain, I had been experiencing middle of the night and early morning knee pain. I had woken up the previous three nights, on my right side, with excruciating pain in my knees. I couldn’t straighten either leg or use my legs to roll myself over for several, painful minutes. During the nights, I had chalked these pains up to pushing myself too hard during my Barre3 classes (although I only attended Tuesday night that school week) and then forgot about them by the time I got to work, as the stiffness wore off after moving around a while in the mornings.

By Saturday morning, both wrists hurt (the right hand hurt significantly more and appeared swollen in several spots) the knee pain lasted over half the day, my ankles started to hurt while driving and I had a low-grade fever. I started taking Ibuprofen and by Wednesday the pain had decreased from and eight to a two. I continued to work out as usual, but was gentle and thoughtful with my hand entry placement when swimming. Thursday night, I did a double workout: Barre3 followed by a 6k in the pool. By the time I got home from the pool at 10:00pm, my wrist pain was back to a nine. I went to the doctor the next day. She: 1) reviewed my lab work; 2) noted the swelling; 3) said she was referring me to a rheumatologist; 4) completed my North Channel Medical Application, which asked about my sinuses, ear drums, nervous system, blood pressure, ECG! She said that she had never completed a medical release for a channel swim before and that she couldn’t believe I was going to do it with my joint pain, but that she knew I could do it. Stiff upper lip and all without a wetsuit.

Since that appointment, I’ve continued to swim between 20k and 30k per week, but am sometimes taping my wrist and hand. I’m modifying my Barre3 postures to avoid negative joint pain, but continuing to go 4-5 days per week. The pain varies in location and severity daily. Today it is primarily in the wrists and feet, other days it is in the elbows and knees. Days when I feel it in the feet and knees are better swimming days as I can drag my legs behind me, and don’t have to think about modifying my arm entries. Cold water swimming is the best workout! The water is still so cold in the Pacific Northwest, it is like an ice bath for my entire body, and I just feel relief!

What’s Next?:  

I see the rheumatologist on April 12th. I have already been identified as having Hypothyroidism and Celiac Disease, which I treat with medicine and a gluten free diet respectively. Prior to my Celiac Disease diagnosis in 2010, I was very fatigued, jaundiced and always had significant foot swelling by the end of the day. Rheumatoid Arthritis was a disease that my primary care medical team considered pursuing at the time, pending the celiac results, but when the Celiac Disease testing came back positive and the symptoms disappeared after going gluten free, no referral to a rheumatologist was needed. Lupus is also another condition that has been briefly discussed in past medical appointments when I’ve had facial, neck, and chest rashes.

All I can do is wait for my next appointment and hope that this joint pain subsides or that there is a way to treat it so I can continue with my Couch to North Channel journey. I am seeing my acupuncturist for inflammation and pain management once per week at this point, and it is the next best thing to cold water emersion in terms of pain relief.

Overexertion and exhaustion are common triggers for autoimmune flares, so I am also reflecting on how to incorporate more sleep and rest into my training plan. Obviously I’ve failed tonight as it is 12:38 and I have to get up at 7:00 tomorrow morning. I will continue to reflect and get better at this though!

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