I have discussed my shoulder pain on the ol' blog before. It is not getting better, despite many weeks of physical therapy and being very good about my exercises. In fact, I sometimes feel as if it is getting worse. Many nights, the pain wakes and keeps me up. Sleeping while pregnant isn't comfortable and this isn't helping.
My physical therapist was concerned about joint separation and possible nerve damage, so she didn't want to do too much with the shoulder until we could rule out nerve and tendon impingement. So, off I went to the orthpedic surgeon yesterday (it was a busy doctor day: two appointments for me, one for Will).
To say I was left feeling disappointed by the appointment at the orthopod would be an understatement. I went with two expectations: a diagnosis and a plan of action. I went away with neither.
I should have known I was in for a disappointment when the doctor walked in, noted my pregnant belly, and said, "You're pregnant?" (And he said it in the tone that someone might reserve for a leper.) After confirming that I was, indeed, in the family way, he proceeded to tell me that he was not sure why my OB would have sent me to him, since there isn't a lot he can do for a pregnant woman (he is an orthopedic surgeon after all).
I told him that my OB knew a lot of diagnostic tools and treatments would be out of the question right now, but he thought a MRI would be safe and possibly useful means of finding out what was going on. My PT and OB both want a diagnosis so we don't do further harm in the meantime and have a plan of action for after Emma's arrival.
The doctor did a very casual exam that took less than five minutes. He declared that I definitely have tendon impingement and possibly a partially torn tendon, but that he can't tell without both an x-ray and MRI exactly what the source and depth of injury is. The x-ray is out of the question because of Emma and the MRI would show swelling. . . which is a side effect of pregnancy, so he wouldn't know how much was pregnancy-related and how much was injury. He said we'd have to do a repeat MRI after Emma was born anyway, so he didn't see the point in doing it twice. I agree with him, but it was still frustrating.
He told me that I had three "options":
1) Take oral NSAIDs. Not an option while pregnant.
2) Physical therapy. Check. Much as I love my miracle worker, it doesn't seem to be helping. Also, she feels uncomfortable doing too much without pinpointing the exact issue.
3) Steroid injections to the shoulder. He didn't think this was a viable option while pregnant.
He then told me that it takes awhile for the body to "calm down" post-partum, so he advised I wait at least two months after Emma was born to assess my shoulder pain. He told me to follow up with my OB at my afternoon appointment to check on his opinion of the steroid injections and possibly some narcotic pain relievers to help me sleep better at night.
I left almost in tears (darn these pregnancy hormones). I realized that my expectations had been unrealistic. I guess I was just hoping for some magic beans. I also realized something else: I turned into sales rep Katie with this doctor.
When I was working outside of the home, I was an account manager for a pharmaceutical company. Yes, a drug rep, though I worked in hospitals and managed the antibiotic contracts for several large hospitals. I worked in the ICU, OR, ER, and pharmacy departments. My relationship with the medical community was pretty in depth. I was friends with many of my docs. But I also had to "switch on" my sales side with customers. By that, I mean that I was all smiles, sunshine, and rainbows. If something was wrong, I would force it down and just focus on the job at hand. I did this through 2 years of miscarriage and infertility. Most of my customers had no idea what I was going through. I could be in the car, sobbing after a negative beta, then fix my makeup and walk in and sell a contract change like my heart wasn't breaking into a million pieces. A coworker used to say there were two of me: Presentation Katie and Real Katie.
My husband also noticed this when I was pregnant with Will. He said I would be feeling really poopy, but then I would go into the doctor and act like I had not a care in the world. He said it was like watching a play. He knew I wasn't feeling well, knew I had been up all night choking on my stomach acid, but I would "switch on" and you'd think I'd just gotten back from a sunny vacation . . . only to wilt the second we were out the door. I think I did this for so long that it became natural and I didn't even know I was doing it. It has now been two years since I worked in the field, so yesterday with the orthopod, I actually realized I had done it. I downplayed the pain, acted as if I could take it for another four months, shook the good doc's hand and headed out the door. . . where I collapsed in a pile of "I can't do this for four more months" tears.
So, I decided to be more open with Dr. S and ask him if there was anything that could be done to help manage this for the forseeable future. No Presentation Katie. Real Can't Sleep At Night And Can't Lift Will Out Of His Crib Without Seeing Stars Katie.
It worked. Dr. S said that there was no need for me to suffer. He explained that certain steroids do not cross the placenta, and though they can be hard on the mom's body, they do not affect the baby at all. He said that localized injections also tend to be easier to tolerate. His one caveat: he doesn't think they work often or for very long. He said it was a "bandaid approach," but that I could certainly try it without concern for Miss Emma. So, I am calling into the orthopedic surgeon today to see about getting an injection.
He also wrote me a prescription for percocet. I have to be honest, I am not really enthusiastic about taking them. He explained that it will go to the baby (in very small doses), but that it has not been proven to cause any sort of defects. Also, unless I started the max dose every single day, the baby should not have any breathing or withdrawal issues. and that even the max dose would probably not cause that, but we can't be certain. I do trust Dr. S 100% and I fully believe he would not prescribe something that he didn't think was safe. I guess it just comes down to the question: is my comfort level worth sacrificing her health and well being in any way? And the answer is unequivocably no. I know there are many women who have unbearable pain and must be on pain medications during pregnancy. If my neck went out while pregnant, I would have no choice. In order to function, I would have to take a pain pill. . . or more than one. And if, someday, I just can't live with it, I will have those pills there if I need them.
So, there it is for now. I'm keeping fingers crossed that the injections work and I wont even need to fill the prescription and that after I have Emma, the swelling goes down, and is no longer an issue.