Back in Physical Therapy

I dislocated my ankle in July on a stupid little hike and went into physical therapy with a pt familiar with my pelvic woes. After a few months, she said that she had done all she could for my ankle in isolation, but that I needed to start pelvic therapy because the ankle problem was influenced by my unstable hips.

Bummer. On the other hand, hurting my ankle gave me the opportunity to work with the physical therapist on changing how and where I place my feet when I walk and learning about my pelvis in relation to my feet. It feels very odd. The "old me" walked with what I thought of as assertiveness - shoulders back, confident, long strides landing on my heals. Now I walk with my shoulders rolled into their natural position forward, my chin tilts down while I pull my head back and up (the book "Eight Steps to Pain Free Living" by Esther Gokhale describes the head placement well); I take smaller steps with the primary impact of my foot being right behind the ball of my foot. I feel sometimes like I am going to fall on my face because it is so different. But apparently this is the path to better mechanics and stability.

And, now I am with an awesome physical therapist Heather Rose at Palo Alto Medical Foundation. Realistically, I don't think I will be cured. The pain syndrome itself (vulva aside) has been going on for too long. But there are many ways we are focussing on improving my quality of life. Who new? More to follow...

Good Outcome: Stanford Vulvar Dermatologist Visit

I had been dreading seeing a dismissive dermatological gynecologist I thought I had already seen a few years ago, but NO! Dr. Joanna Badger (now referred to in my household as "Mary Poppins") is a vulvar dermatologist. And most kind.

My current treatment plan with her is to up the amount of Pristique (a SNRI I was already on) from 250mg to 300mg (my dosage I was on originally was pretty high). I then had to abandon all my creams, ointments, boric acid suppositories, and even my fluconazole (!) for the duration of this trial so as not to have too many confounding factors in play. She mentioned that she could have gone the tricyclic route instead of the SNRI, but I have been on a tricyclic before (awful) and am on Pristique already (convenient). She worked the dosage out with my psychiatrist.

I noticed an immediate and consistent drop in pain. This has made the biggest difference to me thus far in my 16 years of treatment. 

I returned to her a few weeks ago with the results that the pain had dropped significantly, but was not gone. She again worked with my psychiatrist and right now I am at 350mg with the expectation of going to 400mg. All of this depends on how I "tolerate" that high level of medication. FDA approval is to 400mg.

To summarize: 250mg took care of my psychiatric stuff; 300mg took maybe even better care of my psychiatric stuff and lowered my pain, but my eyes and throat are dry; and I haven't noticed any improvement at 350mg in my head or vulva, but still have dry eyes and throat. I will go up to 400mg this week although I doubt there will be improvement (prove me wrong gods, prove me wrong!). I will likely return to 300mg.

Something interesting here is that I was super-freaked that I had yeast infections as soon as she said I should get off Diflucan. She asked me my symptoms and said that just smelling the smell of bread with some white discharge did not constitute a yeast infection and I need to mellow out.