After six weeks of rest, Matacic, then 33, resumed running. But in June 2015 she left the house for a three-mile run and within five minutes, she felt something strange. It felt like a warm liquid was seeping into her ankle. When she looked underneath her, she suddenly noticed that her left ankle was swollen to twice her size, and she was stunned.
For the next eight years, Matacic, the science editor, tried without success to determine the cause of her increasingly severe ankle pain, which she treated with physical therapy before consulting several doctors. Sometimes her ankles would swell and become deformed like her sausages. At times she became so weak that she had difficulty standing and was unable to climb stairs.
The root cause became clear in January 2023, when Matacic consulted another specialist doctor as a prerequisite for surgery. The experts’ hypothesis proved correct and led to effective treatment.
Matacic has since wondered why it took so long to get an accurate diagnosis. She believes she wasted years relying on physical therapy, which she mistakenly thought would get better if she diligently performed the prescribed exercises, she said. Ta.
“I think my complacency in being tough and being tough was detrimental,” she said.
Until Matacic’s increasingly arduous quest, most of the doctors she saw focused on relatively common causes of ankle pain and may have overlooked clues pointing in another direction. He added that it is sexual.
Matacic, now 42, has long believed in the healing power of physical therapy. Over the years, she has occasionally sprained her ankle or injured her hamstring but has been able to recover quickly.
So when she sprained her ankle in April 2015, she started PT. After eight months, her ankle remained weak and her calf developed stiffness. Matacic tried to run, but her ankle repeatedly swelled and caused persistent pain. At that time, she said, it never occurred to her to consult a doctor. Her former doctor joined the concierge business, but no one could be found to replace her.
I started working as a physical therapist in February 2016. Three months later, no improvement was seen.
In July, Matacic went to see a family doctor at the recommendation of a colleague. Doctors said they don’t know what the problem is, although X-rays and MRI scans didn’t find anything conclusive. She told Matacic that she may have an unspecified neurological or orthopedic problem and offered him two options. gabapentin, widely prescribed (and overprescribed) Medications used to treat nerve pain, or a referral to an orthopedic surgeon. Matacic chose the latter.
In April 2018, she completed the 16-mile Cherry Blossom Race, tried to ignore the tenderness, swelling, and warmth that followed, but then disappeared.
In September, she saw an orthopedic surgeon in Washington, but the brevity of that visit was notable, she said. She said the surgeon rushed her in for about five minutes, said her new X-rays and MRI showed nothing, and she recommended another PT test.
Physiotherapist No. 3 believed that Matacic pulled her hamstring in 2014, which affected her gait, caused her calves to atrophy and weakened her ankles. Matacic spent the next six months doing exercises to improve her strength and balance. In April 2017, she was thrilled to be able to run her Cherry Blossom 5K race pain-free.
The following year, she trained diligently at home, reassured that there were no signs of a serious injury such as a broken bone. When her pain flared up regularly, she “just kind of ran through it,” she said. In April 2018 she full 10 miles With Cherry Blossom Lace, I tried to ignore the tenderness, swelling, and warmth that followed, but then it went away.
But by March 2019, her pain had intensified. She worried that Matacic might have overlooked something. She went back to her orthopedic surgeon and ordered more x-rays and scans.this time he told her Achilles tendonitis – pain and swelling caused by overuse. He told her that surgery was also an option for her. But first he recommended her PT.
In March 2020, Matacic was running up a hill near his home in Maryland when he felt a painless, warm fluid gush into his ankle. She walked home and, determined to finish her workout, hopped on a stationary bike, where she pedaled furiously for 15 minutes “like an idiot,” she said.
“It was painful to get off,” said Matacic, who could barely walk.
This time, it took about three weeks for the pain and swelling to subside.The orthopedic surgeon ordered a new MRI and concluded there was some loosening. ligament Her ankle appears to be caused by a cord of tissue that connects the foot and leg and provides stability. This condition can occur after an injury.he recommended surgery tighten ligaments.
Especially in the early weeks of the pandemic, Matacic was nervous about elective surgery and spent much of the next year in PT, which offered little to no relief.
By July 2021, I had developed persistent dull pain in my lower back and intermittent swelling in my ankles, changing the way I walked and compromising my balance. Worried that she might have a neurological problem, as her family doctor had suggested several years ago, Matacic went to see a neurologist. After an hour-long exam, he flatly denied that possibility.
The following year was plagued by further false starts, including a cortisone injection that Matacic insisted on. Instead of relieving her discomfort, it caused severe pain and impaired her ability to walk for several weeks.
By then her life was shortened. She was reluctant to make plans with her friend, worried whether her unpredictable ankle would rebel. She was craving her exercise, but she was no longer able to run or sometimes walk around the neighborhood. And she found it difficult to stop worrying that she might never get better.
In December 2022, Matacic saw a second foot and ankle orthopedic surgeon practicing in Baltimore.In addition to her ligament loosening, he determined that she had the following ailments: Raynaud phenomenon, a common paroxysmal condition caused by constriction of blood vessels that causes fingers and toes to become numb and turn white. Raynaud’s disease is often caused by cold weather and stress. Primary Raynaud’s disease has no known cause, is usually mild, and does not require treatment. Secondary Raynaud’s disease tends to be more severe and is often accompanied by autoimmune diseases such as rheumatoid arthritis and lupus.
Before considering surgery, the orthopedic surgeon told her she needed to be examined. rheumatologist, A doctor who specializes in autoimmune diseases that affect the joints.
A few weeks before that appointment, Matacic spent Christmas with his parents. After running up and down the stairs many times at his home in Ohio, he woke up one morning to find his ankle “like a sausage,” extremely swollen and in severe pain. She spent the next two weeks on crutches. Matacic’s only advantage, she said, was that she was able to convince her skeptical relatives that “there was really something wrong with her.”
In January 2023, she limped into her rheumatologist’s office in Washington. Adi BerhanuHe clutched an inch-thick binder of medical records he had collected over the eight years since he twisted his ankle at the park.
Berhanu was the first doctor who listened to “all the twists and turns of my tragic story,” Matacic said.
Partly based on her age, previous activity level, and presence on the MRI. EnthesitisA rheumatologist told Matacic he suspected this because the area where the tendon attaches to the bone was swollen. psoriatic arthritis (PsA), a chronic autoimmune disease.
Combination of arthritis and itchy skin disease psoriasis, Psoriatic arthritis affects an estimated 1.5 million Americans, most of whom develop it between the ages of 30 and 50. Symptoms include redness, warmth, fluid accumulation, and joint pain with swelling in the affected area. Inflammatory patches on the skin that indicate psoriasis usually appear first, followed several years later by joint pain from arthritis.
“Sprains heal. Active people who can’t walk or drive are suspicious.”
— Adi Berhanu, Rheumatologist
However, Berhanu noted that a small number of patients, including Matacic, do not initially develop psoriasis, which can make diagnosing the disease difficult.
of Causes of PsA is unknown and probably reflects an interaction between environment and genetics. Mutations in genes that are part of. HLA complex, which helps the immune system distinguish the body’s own genes from invading bacteria and viruses, appears to influence the risk of developing disease. However, genetic markers are indicators rather than evidence of her PsA, and there is no definitive test.
Although it is not uncommon for diagnosis to be delayed, as much as eight years is uncommon. 2021 study Mayo Clinic researchers found that the median delay between symptom onset and diagnosis is about two and a half years. Delays were longer in younger patients and those with enthesitis. Early diagnosis is important because it can be prevented with specialized drug treatment. Permanent joint damage can interfere with your life.
“I’ve never seen anyone so committed to doing the right thing,” Berhanu said of Matacic’s long time at the PT, saying it was a tip-off. “Sprains heal. Active people who can’t walk or drive are suspicious.”
“You should see improvement after four weeks in the boot,” she adds of orthopedic walking boots, which are often prescribed after an injury. “I met a patient who had been in the boot for a year and a half.”
Matacic said he was initially skeptical of the diagnosis because he didn’t want to develop an incurable disease that would require lifelong medication.However, the genetic test results showed a positive reaction. HLA-B27 It was convincing.
Over the past year, medication has dramatically improved her ability to walk without pain. “If she could run again, she would die,” she says, but she doubts that is out of the question given the stress running puts on her joints. She took up swimming instead.
Matacic says she wishes she had taken her pain more seriously and consulted a doctor sooner. She said she feels lucky that she did not suffer any joint damage, despite the long delay in her diagnosis.
“I approached a lot of this as a test,” she said. “I was raised to believe that if you don’t push yourself, you’ll just become a couch potato. But I think the most important thing is to respect the injury.”
Send your solved medical mysteries to Sandra.boodman@washpost.com. No unsolved cases please. To read the mysteries of the past, wapo.st/medicalmysteries.