Tuesday, July 27, 2010

(Almost) 16 Weeks Post-Op


It seems inconceivable, but tomorrow will mark 16 weeks post-op for me.  16 weeks ago, I was eating my last big meal and talking about what life was going to be like without pain and pressure.  I assumed I'd be running by June and back to rebuilding by now.  As we all know, the best laid plans...

Despite the setbacks and frustrations, I will say that my scars are looking great.  Although they still seem huge and grotesque to me, friends assure me that in fact, you almost don't notice them.  While I generally think they are humoring me, the scars have certainly flattened out.

Lateral Incision

Medial Scar (this one has really improved recently)


Monday, July 26, 2010

My Mastercard Commercial

EMG/NCS Round 1 : $1200
Left Leg Fasciotomy: $3000 before insurance
10 hrs of PT x 12 weeks: $720 in co-pays
Repeat EMG/NCS:  TBD

Having surgery and doing full rehab to be worse off than prior to surgery?  Priceless.

Last Week's Goals:  All met except weight lifting (surprise, surprise)
This Week's Goals:  22 miles, 1 session of yoga and 1 session of weights plus assorted cardio.

Monday, July 19, 2010

Wanted: Totally Flat Marathon, perhaps on Treadmill

The search to figure out what is wrong with my leg has led to an interesting discovery: I am asymptomatic on flat surfaces.  Before my EMG on Wednesday, I ran for almost 40 minutes on a treadmill with little trouble.  Today, I ran a flat mile on an indoor track in under 8 minutes, with no pain and no symptoms, followed by another asymptomatic 3 on the treadmill.  What good is this information?  In some ways, not much.  It complicates things because it corroborates Dr. Slauterbeck's thought that something is going on with my gastroc head, a finding ruled out, at least neurologically, by the EMG.

What this discovery does allow me to do, however, is continue to rebuild my fitness. One of the other complications I am currently dealing with is the fact that being out of shape means that I am just not as efficient as usual.  Because of this, it's possible that some of my discomfort while running is a result of compensating for my lack of cardiovascular fitness. Indeed, it's hard to remember cranking out 7 minute miles for 26 miles when a 9 minute mile is a "fast day."

I'm getting more aggressive with my running and general fitness this week, aiming for about 20 miles of running (I did 17 miles last week) plus another 2 hours of cardio, 3 sessions of weight lifting and a nightly core routine.  I'm hopeful that by continuing to improve my fitness, we can suss out what is related to the nerve issue and what is a side effect of my loss of conditioning.

Wednesday, July 14, 2010

Filling in the Blanks

It's been a long week.  I saw Dr. Slauterbeck last week to try and begin piecing together what is going on with my leg.  First, we ruled some things out. Despite some pain around my tibia, I don't likely have a stress fracture.  Dr. Slauterbeck feels confident that the release was successful and that he opened the compartments up so extensively that a recurrence of CS is almost impossible. What we did decide on was that something happens when I'm running that causes an interference with a nerve, likely the peroneal nerve.  To get more information on this, I was scheduled for a dynamic EMG, which I had today with Dr. Zweber.

For those who haven't ever had an EMG, think serious poke from an electric fence, at various places along your leg.  It's not painful, per say, but it's not pleasant either.  We started by establishing a baseline and tested me at rest, both with the electricity and with some strength exercises.  Then I headed to the treadmill to get tested.  The drawback to this, of course, is that I've never had symptoms on a treadmill.  I ran for 40 minutes until my foot felt like it was flopping around and starting to go numb.  Dr. Zweber and I hurried back to the exam room and he repeated the EMG.  So what did we find?

The good news is that there is not a trap at the fibular head, as we had suspected.  I have some tenderness in this area, but the EMG seemed to suggest that the nerve was happy and free here. As we move lower, however, a trap seems to exist just below the lateral incision. This explains the eventual numbness and inability to control my foot while running.  Basically, the sensory feedback that should be coming from my foot as it strikes the ground is getting garbled and my anterior tibialis muscle, ankle stabilizers and toe muscles don't know what to do to coordinate movement.

So what to do?  Dr. Slauterbeck and Dr. Zweber need to put their heads together and figure out what the test results and my symptoms mean, what the solutions might be and what the chances of success are with those solutions.  As Dr. Slauterbeck and I discussed last week, a nerve trapped up by the knee would be a far easier (as easy as nerve surgery is) than a nerve near the ankle.  For me, the location is also complicated by the vast amount of scar tissue found in the area and the incision. 

Wednesday, July 7, 2010

Wish Me Luck!

Saw my PT this morning and he didn't like what he saw from my leg.  There is definitely some abnormal swelling, edema in the ankle and bulging veins behind the knee.  Based on this, he put a call into the surgeon to see me earlier than next Tuesday.  I head over to Dr. Slauterbeck's tomorrow afternoon to have him take a look.

Since my symptomatic run, my leg feels like there is a blood pressure cuff on it, much like it did before surgery.  Those with CECS know how uncomfortable the pressurized feeling is.  However, foam rolling helps relieve some pressure, at least temporarily.  This turn of events makes me hopeful that some soft tissue work may help relieve these symptoms.

I'll update more tomorrow after my appointment.  Send good running vibes my way (not that anyone really wants to be running in this heat right now).

Sunday, July 4, 2010

Why do you run?

Any semi-serious runner encounters this question on a regular basis.  Often, it's an out of shape co-worker or acquaintance who hears you talk about soreness or injury and helpfully informs you that "running isn't really that good for you."  There was even that infamous Glamour article a few years ago that told women that running would make their skin saggy.  I don't know about their research cohort, but my skin is a lot less saggy when I'm running than when I'm not.

As I ruminate over yesterday's run and the seeming return of my symptoms, I find myself asking "why do I run?"  (For those with a time constraint, the answer is that I actually love running. For those interested in a more detailed answer, read on.)

I started running competitively in 7th grade.  At the time, I was not particularly good at or interested in other sports.  My parents had a rule about us being home for dinner and most elementary sports practices happened right at 5:30.  I was always a strong runner, however, often winning the mile run that we occasionally did in gym class.  I did gymnastics a couple of times, rode horses and bikes and was generally an outdoors kid, but not in an organized sense.

I joined the cross country team in 7th grade for the social interaction and because everyone else joined a sport.  I wasn't particularly good, but I wasn't particularly bad either.  By high school, I was a solid runner and often ran in the 5th spot (which scores in XC) during my freshman year.  I didn't improve drastically over my high school career, only getting into the 21:00 minute range in the 5k.  It wasn't for lack of talent; I just ran at a time when my team and Vermont had a series of insanely talented runners.  My teammate Tara would go on to win NCAAs.  Erin Sullivan broke almost every Vermont record.  With limited resources and attention, I was fine at running and very strong at nordic skiing. Even at that time, I suspected that short distance was not my strength.  It took me almost all of a 5K to warm up, but once I was warm, running felt like something I could do forever.

I opted not to run in college.  Burnt out from a rather uninspiring high school career and sick of being told that I was too heavy for running (ridiculous, as I was a good 15 pounds lighter in high school than I am now), I went on to college as a nobody, athletically speaking.  I played field hockey freshman year, and was surprisingly good.  As an inner, my job was to run fast, seemingly forever.  Success.  When I transferred to Albany, however,  playing on a D1 team with only a year of experience wasn't an option.  I occasionally played pickup, but found myself coming back to running by the end of sophomore year.

It would take me almost 4 more years to build up the confidence to race again.  Will watched me run every day in graduate school and as a former runner himself, recognized that my speed was improving.  When we talked about racing, however, I would balk, afraid to put myself out there again. I came home one day to find amazing pink waffles on my pillow with a note that said, "I hope to be watching you race in these by the end of the summer."  It was enough to encourage me to sign up for a 4 mile race.  To my surprise, I did well, finishing 4th among women, and the first woman who wasn't a former Olympian.  I continued to race through that fall, winning a 5K in September, placing 7th in my first marathon in November and winning a race series.  I was back.  Or so I thought.

Running has meant different things to me throughout my life.  In elementary school, it was a source of pride for a kid who otherwise didn't feel particularly athletic.  In junior high and high school, it was a social experience.  I still hold an incredibly special place in my heart for "my" cross country girls. In college, it was a way to keep up with late night beer and pizza.  After Katrina, it was a piece of normalcy in an otherwise insane day.  In grad school, it was sanity and a social event and a major piece of my relationship. 

For those who aren't runners, it would be impossible for me to describe the depth of loss that I'm feeling today.  Of course I can find another sport.  I like biking and hiking, I even occasionally like ultimate frisbee and swimming.  But I love running.  Running is who I am. 

Saturday, July 3, 2010

Just when you think you're in the clear...

Headed out for an easy 5 miler today and at about 3.5 miles in, the old familiar pattern set in.  My leg tingled, felt like there was a blood pressure cuff on it and soon enough, my entire foot was numb.  I stopped and walked for a while and started to jog again when it subsided.  By the end of the 5, however, the numbness was back just like pre-surgery.

I won't write much more today because I'm far too emotional to share it with the world, but I am extremely upset and frustrated at this turn of events.  I spent twice the amount of time in rehab and took it so painfully slow in returning to running to ensure that this day wouldn't come.  Not sure what to do now that I'm right back where I was in March.