Saturday, December 24, 2011

Must. Have. Plan.

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I am lost without a running/workout plan.  I have a really hard time taking things day by day without some sense of the bigger scheme that it all fits into.  I don't have to actually follow the plan.  I just need to have one.  I think that's one of the things that's been so mentally debilitating about this injury: I want to plan my workouts for the next 3 weeks, but I haven't even known whether I would be walking without crutches the next day.

I ran 6 miles this morning.  I had all of my fingers and toes crossed that the acupuncture treatment I had yesterday would help with the pain.  It worked!  My lower leg did not fall off and didn't even hurt.  My hip was still acting up, but that was minor and lessened during the run.

Given how good I felt, I thought it was safe to make myself a plan.  Rule 1 for this plan is: I will not go overboard with running mileage.  Rule 1 refers to goal 1: crossing both start and finish lines in OT race.  I will supplement my running with my Elliptigo this and next week just to keep my muscles strong.  I will also continue to get acupuncture treatment as needed.  I also made an appointment for a sports massage on Thursday with a not so gentle man that my girlies have been raving about.

If nothing else, I will be the most rested runner going into the Trials race in 3 weeks.  That's right, it's only 3 weeks away!

Merry Christmas peeps!    

Friday, December 23, 2011

Charlie Foxtrot

Monday came and went with no call from my HMO to schedule an MRI appointment.  I pretty much sat and stared at my phone most of the day, willing it to ring.  Tuesday morning was more of the same.  Nada.  I finally called them.  I was told that the request must first go through protocol screening by a radiologist and then they could call me to schedule.  She told me there were still appointments available for next week, so I was lucky.  Yes, that made me feel really lucky.

Frustrated, I decided to take matters into my own hands and find out where I could get an MRI on the cheap.  I found a place close to my house that charges $500 for uninsured patients including the radiologist report and could get me in at 1:45 that day, no doctor's referral needed.  Music to my ears.

I asked to listen to Mumford and Sons on the headphones they gave me, though I couldn't really hear the music over the loud clunking and thudding going on inside the machine.  In about 30 minutes, I was done and received a lovely red rose from the technicians for my troubles.  Okay, that was a bit odd, but nice nonetheless.  I got a hard copy of my pictures and a CD with a viewing program on it.

Is this a slice of meat for our Christmas dinner or the inside of my right leg?  
The next two days were a bit of a blur.   I learned to read MRI images thanks to the profusion of information on the internets.  From my readings of the images, I had everything from gout to cancer to edema of the periosteum.  Oh, and of course I saw a stress fracture somewhere on there too.  I thought I had become quite savvy at reading these things and had my diagnosis ready to go waiting for the real doctor to tell me what was wrong.  The result that was supposed to come Wednesday afternoon did not.  I started to get really impatient.  I began worrying more and more, looking at the images in various levels of saturation and contrast to pick out new and unusual features that I hadn't been able to see before.  I'm pretty sure I forgot to shower for a couple of days too.

Couple all of this with the fact that I'm doing absolutely no exercise, my leg still hurts to stand on it, and I have taken the entire week off from work.  I can't concentrate on anything but this pain in my leg and the consequences of that pain.  If it is a stress fracture, should I wear a boot and still line up at the start of the race as some suggest?  Wouldn't I feel like a complete idiot hobbling over the starting line only to quit the race in the first few feet?  What if I just went for it anyway?  I had heard many remarkable stories of people with worse pain than mine showing up at the start line and running completely pain free.  Then I recalled the stories of those who didn't heed the warning signs, ran anyway and ended up with a nice full fracture.  I didn't want that.

Thursday late afternoon, I finally received the report from the radiologist letting me know that there was nothing remarkable on my images.  Nada.  Soft tissue was even "unremarkable".  I got this news after being fit for a walking cast (thanks Mike!).

I am clear to run.  Well, there's the small matter of still having pain in my leg when I walk, but staying off of the leg has reduced that quite a bit.  In celebration of the news, I rode my Elliptigo last night in the dark for an hour, pushing my heart rate up into the high 150s.  I felt awesome and was so much happier.  Exercise is indeed a great mood booster.

I could sit around and bemoan the last week of nothingness and whine about the fitness I've no doubt lost.  That's not my style.  My body was definitely telling me it needed a break.  More than anything, this last week has given my immune system a chance to fight off whatever the hell infection I have going on.  I'm 6 days into the antibiotics and just now starting to feel slightly better.

I learned one other thing that I think is worth noting for those of you who push yourselves as hard as I do.  I had started regularly measuring my resting heart rate a couple of months ago and keeping record of it.  I had never really done this before.  It's just so easy to do now that there are iPhone apps available that can take a fairly accurate reading in a matter of seconds.  And, they record the number for you too!

I was a little surprised when I started doing this that my heart rate when going to bed was about the same as when I woke in the morning.  I was also surprised that my resting heart rate was in the low 50s consistently.  I thought it was in the low 40s, but I thought maybe I was mistaken about that.

A couple of days ago, my resting heart rate plummeted: both the nighttime and morning readings and they've stayed there ever since.  My resting HR is in the low to mid 40s.  It has been elevated for the last 2-3 months.  I had dismissed those who say that resting HR is a good measure of overtraining, but I have now learned the lesson for reals.  The other lesson learned is that a baseline needs to be established during a time when you're rested and healthy!

What's next for me?  Hopefully, I'll be back to running.  I plan to start a very long and drawn out taper from here, listening to my body the whole way.  Goal 1 is to cross both the start and finish lines at the Olympic Trials.  If I can do that in a decent amount of time, then that's icing on the cake.  Given the fact that I'm still in a fair amount of pain from this injury, whatever it is, my next few weeks will be about pain management.  I'm going in for acupuncture today to see if that relieves it at all.  I'm taking Tylenol for the pain and icing as needed.  I will attempt to wrap the leg in various ways to see if that helps.  And I will keep my fingers crossed that nothing else crops up these next few weeks!

Thanks to everyone who has reached out to me throughout this ordeal.  I really appreciate all of the support and well wishes.  You have reminded me that it is truly a privilege to be invited to this race.  You inspire me to get past these setbacks and run my heart out on January 14th!

Oh, and I finally got that call from Kaiser, my HMO, yesterday afternoon to schedule my MRI.  I'll be getting that on January 5th at 10 p.m.  Great timing.

Merry Christmas, indeed!

Monday, December 19, 2011

The thin black line

Thanks to everyone for all of your support these last few days.  I'm sure you can imagine how I'm feeling faced with the thought of having to sit out the biggest race of my life after what happened on Friday.  If this whole ordeal weren't so damned funny, I would probably be crying a lot more.  I thought I'd update you on how my appointment went this morning.  It is a good story.

I was slightly concerned that the orthopedic doc I was seeing this morning might be upset that I had taken the cast off Saturday.  Good thing she didn't know I had made it into that fashionable lamp.  She didn't seem concerned about that, especially since she had looked at my X-rays and didn't see any evidence of a fracture.

It's a major award.
She said she had read through my history, and she knew I was an athlete.  She asked me for the low down on the injury, and I gave her the short version.  She started the physical exam by palpating the bone from my ankle up then from the knee down and asked me if I felt any pain.  I told her I did when she got to the place where I feel the pain when I stand on the leg.  She measured this place with a ruler and told me that she would need an MRI to get more information.  Yay!

She then took another look at the X-ray.  I squinted at the thing, straining to find the thin line I had seen Friday night.  I was perplexed.  Had it disappeared?  She zoomed in on the image, and then, there it was, that thin black line.  I pointed it out (yes, I am an idiot).  She said, something about how the ER doctor was pretty perceptive to have found that when both the radiologist and she had not.  She then told me we didn't need an MRI, because I had a complete fracture.  I was in shock.  Really?  But it didn't make sense. I argued all of my points about walking around on it, running on Thursday.  How could it possibly be a full-on fracture?  She explained that stress fractures are different and that they are very subtle on X-rays at first.  Once the bone starts to heal then they show up.  But, she said this line was a clear fracture.  I was stunned and started to feel like she had punched me in the gut.  She said I could get a follow up X-ray on Wednesday, because by then we might see some change in the bone as it heals.

I then started to cry.  I don't cry much but I started telling her about how I needed to be certain about this because I had reservations to cancel and there were others who were making plans to come see me run.  She handed me a tissue and softened a bit.  She said that the best she could do was to get an X-ray on Wednesday.  Luckily, I kept my wits about me rather than succumb to the sorrow.  They had taken 2 X-rays on Friday night from different angles.  I said, "Well, wouldn't you think that, if this was a full fracture, that it would show up in the other X-ray view they took on Friday?"  She told me this was a good point and zoomed in on that image to the place where the line showed up on the other image.  Nothing.

So I proposed that I should get an X-ray today to see whether or not the line showed up.  She repeated that it didn't matter because the bone wouldn't have started to heal.  She finally got what I was saying when I said, "yes, but assume that it's not a fracture for a minute.  If you don't see that line on the film today, then we know that it was an aberration on the image and that it's not a full fracture, right?"  The light bulb went on and she said, "You're right.  I was stuck on it being a fracture and didn't think of the possibility that it wasn't."  She ordered the X-ray.

I sat in the waiting room wondering if I had been a fool to remove the cast and make it into a lamp.  I thought I must be some kind of tough beast to run on a grade 4 fracture.  The doc sent out an assistant to tell me that the X-ray was negative and that radiology would call me to schedule an MRI.  I don't know if the doc just didn't have time to see me, or if she was fed up with me. Perhaps she was embarrassed to be wrong.  She didn't give any other instructions, so I had to ask the assistant to go back and ask if I should stay off of it or not.  I was told I should not bear weight on the leg.

So, I am being good and staying off of my leg for now, waiting to hear about my MRI appointment.  I'm not even attempting any cross training.  It's no fun.  My dogs are pissed off because they won't get their walk today.  Oh well, we'll have plenty of time for that soon, I'm sure.  I will keep you updated as the saga continues...

Saturday, December 17, 2011

You can't make this stuff up

Where do I begin?

How about where I left off.  After my 9 great days of training, culminating in a fantastic long run, my body told me I had pushed too hard.  The cold I had been fighting started to feel worse and a short shake out run on Saturday left me wondering how I had managed to get run over by a bus in the middle of the night.  I shook it off and tried again Sunday.  The cold was still bad and 10 miles of running felt okay, but not great.

I went to see Dr. Lau on Monday to have him work on my hip since I seemed to still have some residual bad tissue in there that needed to be taken care of.  I ran a double that day and felt okay, but not great.  On Tuesday, the cold was really making me feel awful so I actually took a day off from all exercise.  Wednesday, I went to see Dr. Lau again since I still felt hip and calf soreness on my morning 4 mile run.  He worked on the hip but mostly jammed on a large knot that had formed in my inside shin muscle.  He told me I would probably feel that for a couple of days.  I went to the track that same night to attempt a hard workout of continuous 400s, and it became clear to me after the sixth one that my rundown body was unable to move very fast.  I was surprised that the cold was still making me feel crappy after a week, but I so rarely get colds, I didn't know this was unusual.  I knew I needed to stop there and call it a night.  I did a short cool down run and headed home.

The next morning, when I got up and started walking around, I couldn't put pressure on the right leg without some pretty good soreness in my shin/calf.  I met up with the Bat for an easy 6 anyway.  I felt soreness as I started running, but it subsided the farther I went.  I was limping after I stopped running.  I know enough to know that I shouldn't be running if I can't walk without pain.  However, it made sense that this was from the hard work Dr. Lau had done on the shin the day before.

I went to see Dr. Lau again yesterday to work the hip again, but I also asked if he could show me how to tape my shin since it was still bothering me.  That's when he floated the possibility of it being a stress fracture in my tibia.  This was based on his experience with that injury and the way I was describing the pain.  Here's how I describe it:

I can't feel anything when I press on the bone.  I can pound on the bone and there are no sensitive spots.  He even did the tuning fork test with a completely negative result.  I feel pressure and soreness in what feels like my calf muscle when I squat down on one leg as I'm going down.  If I continue to squat up and down on that same leg, the soreness goes away.  However, I also feel residual soreness in the calf/shin after I release pressure on the foot, so when my foot is no longer in contact with the ground.  That sensation lasts for about two seconds and goes away.  Because these are funky symptoms, he felt like I should at least consider that it might be a stress fracture.

So then my mind started running on its own, formulating a new plan.  Should I just continue to run on it?  I guess I'll know that it's a bone issue when it breaks, right?  No, that's not the best plan.  Maybe I should get a bone scan.  I had one of those 20 years ago when I had a stress fracture in my femur, and it lit up the area like a Christmas tree where the fracture was.  That would tell me for sure.  Dr. Lau said he would feel better if I at least had a test done to rule it out.

My Kaiser Primary Care Doctor, who has been amazingly supportive of me through the years sent a request to nuclear medicine for the bone scan, but no action would come from that until next week.  I sought advice from others who explained that a bone scan isn't the best tool for diagnosing these issues.  I was told an MRI will give me the information to decide what to do about my training.  I found out that there's a gradation of stress reactions and fractures that I could have, and what I do next really depends on where I fall along that gradient.

I sent another message to my doctor requesting an MRI, but he won't see that until Monday.  Even then, I'd need an ortho consult and then, if I was lucky, could get the MRI.  I became impatient. I wanted some information--any information.  I could seek out an MRI from a private facility and pay for it myself.  However, I pay good money for health care and hardly use it.  I wanted to pursue my provider's options first.

I decided that at least I could get an X-ray of the tibia and, if I was lucky, maybe an MRI if they had a 24-hour MRI service at my hospital.  So, I went to the Emergency Room and described my symptoms.  As a side note, they took my temperature during processing, and I had a fever of 100 degrees.  This is actually a big fever for me since my body temp naturally runs low.  It confirmed what I had suspected about my cold having become something more.  It was a good thing I had asked my doc about this, and he had prescribed antibiotics yesterday for what he suspects is a sinus infection.  At least that will resolve soon.

The ER doc looked at my shin and pushed on the bone and told me that it was probably just shin splints. She said I could get an X-ray if I really wanted to.  I was well aware of the diagnostic challenges of X-rays for this problem but decided another piece of information and a small dose of radiation couldn't hurt.  Or maybe it could...

The radiograph came back with a strange thread-like, perfectly straight diagonal black line stretching from one side of my tibia to the other, right at the place where I was feeling the pain.  There was nothing else anomalous about the bone--no white material indicating that my bone was healing from something.  But that line was weird!

The doctor explained that it could be nothing, like all of the other lines that she pointed out on other parts of the image, but that it could be a fracture.  I didn't really understand the implications of what she was saying at that point since my head was spinning with the vision of that line running through my brain, but she said that I would be put in a splint.  Okay, fine.

The Orthopedic Assistant came in to fashion my "splint".  He was very serious about his calling, and this truly was a calling for him.  He explained that he was a perfectionist when it came to splint making and that his aim was to make the most comfortable splint possible for me that night.  He told me I needed to take off my sweats, which I thought odd since we were dealing with my lower leg, but I had running shorts on underneath.  Then, he slipped a long sock onto my right leg that went all the way up to me groin.  I became a little worried.  He started pulling out all of the materials, and I suddenly realized that he was going to create a fiberglass cast for my lower leg!  What the what?  I thought we were dealing with a stress fracture here.  I was picturing a removable boot.

He completed the fiberglass cast on the lower leg and then told me to lay back for the rest.  I was stunned.  A full-leg cast?  Yes, he explained.  He needed to isolate the knee joint since I had such a high risk fracture in my leg.  I asked if he had actually seen the image.  He said he did and that it looked "suspicious".  He decided to put a bi-valve cast on me and, of course, I took advantage of the opportunity to tell clam jokes.  This was very lucky for me.  It basically meant that he split the fiberglass part of the cast completely on both sides, leaving the sock and gauze intact.  He showed me why I should not be afraid of the cast saw because it was specially designed to not cut through skin.  As proof of concept, he turned it on and pressed the spinning blade against his jugular.  That's trust in your tools, right there.

After cutting the cast, he wrapped three large ace bandages around the whole thing so that it could expand and contract as my leg swelled and unswelled.  I was given a follow up orthopedic appointment on Monday morning and was instructed to lay around until then.
The finished product.
This was not a walking cast.  I was not to put any pressure on the foot and was given crutches to get around.  I also could not drive.  The Genius came and picked me up from the hospital, looking a little stunned to see me in a full leg cast crutching out the door.  He dropped me off at home and the oddness of my predicament started to sink in.  How in the world did I end up with a cast on my leg?

I started to realize how little I could actually do with this thing on my leg and crutches under my armpits.  Filling the dog's water bowl and carrying it to the corner of the kitchen was impossible.  I had to scoot the bowl across the floor with my casted foot.  This wasn't going to work.

I tossed and turned all night and then just started cracking up when I looked down at my leg in the morning.  This was actually hilarious.  I had texted a picture of it to Dr. Ball, and he responded with something like "that is fucking awesome."  He remarked how impressive it was that I could develop a grade 4 stress fracture in 2 weeks and walk in the door of the ER: actually run on it the day before for 6 miles.  I finally realized how absurd it was to think that I had a full-on tibial fracture, end to end, as they diagnosed.

So, I blessed the technician for the clamshell cast and ripped it apart first thing this morning as my puppy dogs looked on with confusion.  I was not advised by anyone to do this.  I did it all on my own.  I walked around tentatively at first and then with conviction and very little soreness.  Grade 4 fracture?  Yeah, right.
The remains of the bi-valve or as BW, calls it, the EFF-THAT.
The good news is that I will see an orthopedic on Monday morning, who hopefully won't be pissed off that I cut the cast off of my leg already.  I hope that he understands.  I was mostly worried about leaving my leg in an immobilized state like that.  I started getting uncomfortable soreness and then the pressure I was putting on my other leg, trying to crutch around couldn't be good for me.  I wanted to know whether it was still sore today.  I wanted to cross train on something other than the fucking hand cycle.  Can you blame me?  I hope that I am able to get an MRI soon, or else I will probably pay out of pocket to have one done.  I have too much at stake here to just assume it's a stress fracture and throw in the towel.

This soreness in my calf may well be a stress reaction or a stress fracture or it might just be pissed off soft tissue.  We have diagnostic tools for a reason and I intend to make sure I get what I need out of them.

I don't really have a plan at this point except to use pain as my guide.  I can walk around fine today, with a little soreness when I first start off.  My dogs got a short walk and they are happy.  No running until I know more, but my Elliptigo is out in the garage, winking at me right now.  At least I have options.  For now.  More to come Monday...

Saturday, December 10, 2011


Playing some tunes with LF.  The girl has chops!
Our devoted audience, Kerry and Kevin, and Josh, the Dancing King! 
Since my last post on November 30th, I've run 120 miles including two 20-mile runs and two speed workouts.  That's a lot to pack in to 9 days!  I also got to spend more time with Lauren Fleshman, Kerry Camberg and the rest of the Camberg family.  We spent a fantastic evening playing guitar, singing and dancing around the Camberg house.  Lauren is quite talented!  I look forward to her launching a  musical career once she's done with this little running thing she's so fond of.  

While I'm thrilled to be able to train hard again, the road back to healthy running has not been without its challenges.  Dr. Ball pronounced me cured a week ago Thursday, but I still hadn't run anything harder than a few strides.  I suggested that I run a speed workout the next day (Friday) just to make sure I was cured before heading off into the sunset.  He agreed that this was a good plan.

I did a workout that I had done back in early November: 13 total miles including 2 x 1.5 miles hard + 2 x 1 mile hard with 4 minutes rest between the repeats.  I had no pain during the workout, which was brilliant, but I was disappointed in how slow I was compared to the last time I did the workout, being off by about 10 seconds per mile for each repeat.  It was hard to know whether this was a loss of fitness from 3 weeks of little to no training or whether my legs were just figuring out how to run fast again.  Regardless, it felt good to train hard again.

I left for home that afternoon and got to my half-way point, Edwards Air Force Base, late Friday evening.  I left early on Saturday so I could get home in time to take the Genius to dinner for his carbo loading extravaganza for the California International Marathon the next morning.  I was so excited for him and everyone I knew running this race and was grateful to be healed in time to make it home to watch.

I cried both tears of joy and sorrow watching some of my friends' dreams fulfilled while others' came to an end.  My Genius met his goal of a huge PR and is now a 2:40 marathoner.  Twenty-five women met the B standard and qualified for the Olympic Marathon Trials, including 6 of my Impala teammates!  I was so impressed watching the huge pack of women along the course on their way to this major achievement.  A couple of my friends missed the qualifier, but impressed me nonetheless with their determination and commitment to their goal.  Kerry Camberg posted about her experience here.  I have to say that her commitment to the goal and attitude about the journey make her my new heroine.

I was all fired up after watching the race and took on my own challenge of running my first 20 miler in a month.  I wasn't sure how I would feel.  My legs were sore from my speed work on Friday followed by 14 hours in the car, but I negative split the run and felt particularly strong the last few miles.  I was also surprised that I had accumulated 80 running miles for the week.

My coach told me I needed to get back on schedule with my training since there is not a lot of time left to get in big miles and bigger workouts.  So, I jumped back in with a double run on Tuesday including an evening track session of 12 miles including 10 x 800m with 2 minute jog rest.  I felt like doggie doo and my splits reflected that.  I started out running 2:50-2:51 thinking I would cut down from there and I just didn't have the legs for it.  I had a minor breakdown around the 4th repeat and thought about throwing in the towel.  That's when I thought of Kerry and came up with my mantra for the evening, "Kerry don't Kwit!"  Running hard was what really mattered at this point, and I wanted to have the satisfaction of completing the workout.

I told my coach about this and he said I was absolutely correct in completing the workout at whatever effort I could muster.  He also pointed out that my body was telling me I needed two days of rest between workouts rather than one and that I was likely feeling the effects of my body not being able to absorb the training.  We adjusted my schedule for the week so that my next hard workout would be a long run on Friday.

Thursday, I came down with a cold, of course.  I got in my morning run but wanted to make sure I was feeling well enough to do my hard workout the next day.  I skipped Thursday afternoon's run and went to bed early that night.  Friday would be a vacation day from work (though I still managed to work for 5 hours-FML!) but at least I got to sleep in--12 hours of sleep has amazing restorative powers.

I needed to wait for some work issues to get resolved before I could head out for my long run yesterday.  I finally got out the door at 3 p.m.  I wasn't sure whether I would be able to do the workout or not, but the cold symptoms had subsided some with the help of Dayquil.  The workout was a ball buster: 20 miles including the middle 13 miles hard.  What does hard mean?  Well, I wasn't quite sure, but my coach said that the idea was to start out comfortable and speed up.  I had some rough paces in mind, but I wasn't exactly sure what I would be able to muster.  I broke the middle 13 miles into 5 splits consisting of 2, 2, 4, 4 and 1 mile with no rest in between.

I was pleasantly surprised with how the workout went.  I warmed up for about 4 miles and did some strides, then launched into the workout:

2 miles @ 6:45
2 miles @ 6:37
4 miles @ 6:31
4 miles @ 6:22
1 mile @ 6:21
3 mile cool down for 20 total

I wanted that last mile to be faster, but my legs were not giving me anything more.  Nonetheless, I was thrilled to feel so strong in those last 5 miles.  My average was 6:30 pace.  That's the pace I ran a few weeks ago at the Clarksburg 1/2 Marathon, except the mile splits for that race were reversed!  Better yet, the tightness in my hamstring and IT band that I had been feeling off and on throughout the week completely went away during the workout.  I woke up today feeling better than I have in a month!  I still have my cold, but it is more an annoyance than anything else.  I will run a little over 90 miles this week.

The best feeling in the world during training is when you start to feel the strength in your legs building.  I'm not sure how to describe the feeling, but it is as if you can feel the power in your muscles just while walking around from all of the work you've been doing.  I felt that before I did my long run yesterday and had a feeling it would go well.

My next two weeks are killer.  I will shoot for 100 miles each week and have some hard workouts on my schedule.  I need to do everything right in terms of rest, recovery and fueling in order to make them count.     I found out the hard way earlier this training cycle that I can't do it all.  I nearly missed my chance at running a race I can be proud of at the Trials.  With the rumors flying about new qualifying standards for 2016, who knows whether there will be another OT race for me.  I want to make this one count and thoroughly enjoy the journey.