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...


  1. i am still confused of what you have ? i just got a hairline fracture of the cuboid while running and rolled my ankle

  2. trifitmom, That's probably because I don't know what I have. I need an MRI to rule some things in or out at this point. What I am 99% sure I don't have is a fracture across my entire tibia that warrants a full-leg cast! Sorry about your ankle. Boo.

  3. probably not the "pep" talk you wanted to hear but had a friend have similar issues years ago, and after going back and forth, and continuing to run, she eventually broke her entire FEMUR. Yes, stress fracture when to a full blown fracture of everyone tried to tell her "thats about impossible to do!" but she was down and out for a long long time. Continue to find all the right answers, be honest with your body, I know its a pain, but you'll find the right answers and be back stronger than ever sometime soon. Happy Holidays! Get well soon!

  4. Thanks, Brett. That's why I stopped running with the first mention of stress fracture. I don't need a broken bone. I've already had the tester cast to convince me of that! The huge challenge is getting the information I need to make decisions. The easy answer for doctors is to tell me to stop running, of course. I think that's why they're unwilling to offer the diagnostic tests, because the answer is simple to them. If this were any other race, I would assume the worst, take some down time and try for another race. This is the Olympic Trials Marathon and I feel like it requires a little more due diligence than simply assuming the worst. Rest assured, I won't go out and run until my leg breaks!

  5. I sure hope it's not the 'worst case' scenario Jaymee. Get the MRI and the bone scan then you can move on from there (after a second and third diagnosis). A full cast would be bloody annoying to say the least - even one that you can take off. Hope you don't require that, and that it's some other issue that doesn't stop you from making the trials. Good luck!

  6. Thanks Ewen. I hope to be back blogging about fast training again soon. This injury and sickness stuff is for the birds!