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Dry Bones

Posted Feb 14 2012 6:39pm

My ankle is a disaster. I learned from my orthopedist last week that I ruptured at least two of the four primary ankle ligaments when I slipped on ice three weeks ago. I can’t drive. I’m still stuck in a giant boot, reliant on crutches and generally barely functional.

It’s all too easy for me to focus on my latest injury. It hurts like hell, and it’s making it even harder to me to scratch out the semblance of a normal life. It was challenging enough to strike a balance with sarcoidosis every day. Throw in a painful and debilitating orthopedic injury and my house of cards is in danger of collapsing.

“Poor me to have yet another setback,” I think. “If I had been wearing better shoes (or had charted a different course through the ice, had better luck, chosen not to walk onto the ice at all, not gotten out of bed that day, etc., etc, etc., ad infinitum) this wouldn’t have happened.”

But my ankle injury isn’t really about the vagaries of fate. It’s not really about my ankle either, as odd as that sounds. The dissolution of my ankle is yet another piece in the complex puzzle of sarcoidosis eroding my body. In other words, my ankle blew up that day not because I took a hinky step on the ice but because of a chain of consequences caused by sarcoidosis—the chronic auto-immune disease I’ve been battling since 2004.

Remember “Dry Bones”—that kids’ song about skeleton bones? “With the toe bone connected to the foot bone, and the foot bone connected to the ankle bone, and the ankle bone connected to the leg bone.” And so on, ending in the refrain, “Oh those bones, those skeleton bones, oh those skeleton bones, how they scare me!”

My ankle injury is connected to its own long list of problems, its own song of dry bones

With the ligaments thinned by the prednisone,
And the prednisone caused a huge weight gain,
And the prednisone emptied the foot bones,
And the foot bones were eaten by the sarcoid.
Oh that sarcoid, that sarcoid,
How it scares me!

Clearly, I don’t have a hidden calling as a lyricist. So, let me make some sense. Since 2004, I’ve been taking prednisone—a corticosteroid with some nasty side effects—to help control sarcoidosis. Because of a recent disease flare-up, I had to go way up on my daily dose of prednisone, as well as get huge IV infusions of the stuff. Although prednisone has seemed to check the sarcoidosis from devouring my heart tissue, it has caused serious problems of its own. It stretches and thins ligaments and other connective tissues, making them less stable. It decreases bone density, and weakens the points where ligaments and bone connect. Prednisone also causes weight gain. I’ve put on nearly 100 pounds since I started taking the drug. The result of all this is that my weakened ligaments are carrying extra weight. Sometimes they snap. To add insult to injury (or maybe just injury to injury), I’ve got sarcoidosis in my bones. Together with the prednisone, the disease is hollowing out my bones, fraying the skeleton which is supposed to support me. Dry bones, indeed.

In the end, dwelling on what feels like the inevitability of injury is just as depressing as feeling wronged for having an isolated injury heaped onto an already sick person. But sometimes it’s important for me to understand the whys of things, to be able to grasp the internal processes that bring me to where I am now. It’s sobering, though, to contemplate the extent of damage this disease has wrought on my body.

With understanding of the underlying causes of the injury, I can make some practical changes. Given that this is the third time I’ve ruptured ankle ligaments while doing nothing more dangerous than walking, I think it’s time to impose a new rule on myself. I will not leave the house without ankle braces tightly laced on both feet. I’ll also stick with the bone-density treatments I take to shore up my bones from the effects of disease and prednisone. I’m going to try and chip away at my excess weight. This is pretty much all I can do.

Have you ever understood that there’s a complicated (and not always pleasant) cause to something in your life? How do you manage this?


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