Sky Runs

Taking the long way round

Tag: stress fracture

The Homestretch

Oh it’s been a while after all, but it feels much longer.

Recovery will take as long as it takes and I’ve mostly made peace with that. I don’t feel that I’ve had any setbacks and I’m grateful for that. Once I wrapped my head around the fact that I could be on crutches up for up to three months then it became an ultra of recovery. I did hit a low point as I neared the halfway mark towards the second half of May–my leg was hurting more, perhaps I was trying to do too much–I felt miserable for a few days but like all low points it passed. A kind ultrarunner loaned me the ultrasound bone stimulator that she no longer needs, and within a few days of starting treatments with it I was able to take my first few wobbly steps without crutches. I could have cried with joy.

A week or so later I had my second MRI and follow-up doctor’s visit. The MRI report downgraded my injury to a “stress reaction” and noted that the bone was not fractured (seems it’s just weak) with accompanying bone marrow edema. My ortho gave me a prescription for physical therapy and the green light to get in the pool- pool walking, aqua aerobics, and swimming are fine. My fantastic PT adds new exercises to my routine every week and also said I could bike- recumbent stationary, no resistance. I’m fine with all that.

I’m coming up on week 10 of crutches but for the past few weeks I’ve been able to use forearm support crutches, which are easier to get around with than the underarm type. At home I can get around with one crutch but I take both when I go outside and have walked up to half an hour or so with them, though I’ve been advised to limit my walking around to only what is necessary.

My next ortho appointment and MRI will be in three weeks, and I’m hoping for a good result and permission to get off the crutches at that time. Running is still a ways off, but I’d really like to walk freely and start yoga by mid-late summer. That is as far as my recovery horizon can realistically stretch. While my PT said he sees no reason why I wouldn’t be able to get back to my previous level of activity and ultras, I have to say that I have no idea what lies on the other side of this injury–whether I’ll still be willing to put up with the pain and risk of hurting so much and for so long again. There are, after all, many other adventures in this world to be had, and I have a ready imagination for them.

The Injuries

After I had processed the report findings while sitting in radiology at Mt Sinai, I got in a taxi to pick up my x-ray records from the urgent care center on the west side. While I waited I texted a couple of friends with the news and felt a little on the verge of tears, I think I choked up a bit when one friend called me right away to see how I was doing. Even though I had tried to prepare myself for this diagnosis over the last few days, it still came as a blow. Crutches, no running, no walking even. I love to walk, so that last one really hurts.

After this first of the brief pity parties, I got home and digested the rest of the report: Oh, torn labrum too. Maybe that was what added to the terrible initial pain? This was the full list of goodies in my right hip:

  1. Femoral neck stress fracture: compression side
  2. Labral tear
  3. Low-grade muscle strain in the gluteus maximus
  4. Moderate hamstring tendonitis
  5. Inflammation in the area where the pubic bones join

But only the first two are worrisome. The upside: No mention of arthritis, which another friend points out is really good news. And there was nothing to indicate the need for a hip replacement either, which was one of the worst-case scenarios mentioned by others. And if a lot of the pain I experienced was coming from the tear, that might have actually saved me- with a fracture alone I may well have insisted on running until the bone broke in two. It’s not that I listened to my body and decided to drop, my body stopped listening to me, and I had no choice.

On Wednesday I was pretty excited to finally see a specialist. I think I lucked out with Dr. Bharam. He is one of the top hip doctors in town, and it also turns out he’s the one who operated on my friend Sara’s torn labrum a few years ago. What a small world. However, I was a little worried that, with him being the man to see for labral surgery, he would want to get me under the knife stat.

Again, no need for concern yet. He said it would be best to put off even thinking about labral surgery while my stress fracture heals. The femoral neck stress fracture is very serious, as there’s limited blood flow to the area, and additional stress to the can result in a full break, requiring pin surgery, or a hip replacement, and maybe no more running ever. As a result, the initial course treatment for very conservative (aka a whole lot of nothing)- I stay on crutches for another five weeks, with no cross-training at all, and then I’ll come back for a check-up and another MRI at the end of May. In the meantime I’ll have a bone density scan and see an endocrinologist for further blood work to look into potential underlying issues.

I try to maintain a positive (or at least neutral) attitude to this injury but it’s rough at times. I know, it could be much worse. Even over the last 10 days I’ve seen many positive changes: the scary pain is gone and the crutches are better than the wheelchair, just as the wheelchair was a huge improvement over no chair. I’m at home, I’m comfortable, I don’t have to go to an office or be on my feet for work, and I have a lot of love and support coming my way every day.

Still, I had no idea it was possible to develop a stress fracture in a matter of hours, and a torn labrum too. My previous understanding of fractures and labral tears was that they build up over time. Something starts bothering you, but just a little, so you run through it, and it gets progressively worse over the course of weeks or months until the body says enough and you go to the doctor and your worst fears are confirmed. So these assumptions were entirely wrong, as my doctor (and the internet) told me: people get stress fractures running 20-30 miles a week, people get stress fractures walking around and taking a wrong step. I’ll have to get over this eventually, but right now it scares the crap out of me to think that any time, on any run (especially during an ultra, when I’m geared to push through the pain) there could be another stress fracture lurking and waiting to get me: “Surprise! And FU too!”

I know I’ve been lucky to avoid major injuries so far, especially as I started becoming competitive over the last two years. In my first few years of running, I struggled with IT band issues that derailed a couple of marathons where I’d go out too fast and end up walk/running to the finish. After switching from heel striking to a mid-forefoot strike those problems seemed to go away and have never bothered me again. Everything else I’ve dealt with (hip bursitis, tight hamstrings and calf muscles, achey knees and buttocks) I’ve filed under “niggles” that have responded to treatment and adjustments in training, and my race-day performances have never been hampered by these issues.

Would it be any easier if I’d gone through a long injury process before and knew what to expect of the layoff and coming back? I don’t know, though over recent months I’ve felt a little uneasy about how important or central running was becoming to my life, because I know that I’m not young, and no matter how hard I might work at training for an planning the perfect race, what ultimately happens on race day has a lot of luck in the mix.

The next step is hard but necessary- withdrawing from all the major races on my calendar this year: Rock the Ridge, TGNY, Badwater, and Spartathlon. NYC Marathon? Still a possibility as it’s more than six months away, but I’m leaning hard towards rolling over my entry to 2016. Realistically (ie based on my research of online discussion forums), I shouldn’t expect to be running 60+ miles weeks before the end of the year. I’m setting my sights on Boston 2016 as my comeback race, and then gearing up to get back into ultras in late spring and summer. In the meantime, non-running adventures await.

Ten Days to a Diagnosis

I wish this could be another simple 10 days of recovery post like the one I wrote after One Day, but it’s a little more complicated and uncertain. This recovery is bound to take a bit longer, though I know I will come back stronger one day.

Day One: Sunday

After spending several hours hanging around the USA tent, with me lying around or sitting on a chair, and TSP trying to be helpful to other crews and runners, we all decided to head back to the hotel, clean up and rest for a bit, and return to the stadium before the finish. TSP carried me to the car, back to the hotel room, and everywhere else, hurting his back a bit in the process as well.

I cleaned up gingerly and lay in bed for a while, but was probably still too wired and filled with adrenaline to sleep. TSP talked to the hotel concierge and found out that there was a 24-hour pharmacy nearby that sold crutches- except they only had a small window that was open all the time– the front doors (and crutches) would not be available until 9am.

We had breakfast and piled back in to the car to the pharmacy. At this point it was excruciatingly painful to put any weight on the right leg, move it in certain ways, or get jostled while being picked up and put down. I don’t want to be dramatic and say it was beyond a 10 on the pain scale, so let’s just leave it at 10.

We arrived back at the stadium just in time for the final minutes of the race- everyone was picking up the pace and Katalin was running with the American flag! Unfortunately, I found out the hard way that the crutches would be useless to me- they were support crutches meant for people who can still use both their legs to some extent. So TSP carried me into the stadium and while Tiger summoned some of the event medical personnel who were able to carry me in a chair back to the USA tent, where most runners of my teammates were laying exhausted after their huge 24 hour efforts- women took the gold with the 1,2 and 4 individual rankings, while men moved up to 4th team with 2 guys in the top ten.

I was so proud to just be sitting around the gang, but then we learned that the 12:30 lunch had been canceled and the awards ceremony pushed back from 2pm to 4pm. I didn’t want to go back to the hotel in the meantime since that would mean more pain from being picked up and carried, and the Italian medical staff had mentioned that I could go to the hospital- where maybe I could borrow a wheelchair or crutches in time for the ceremony? Thus began my foray into the Italian health system.

Hey, at least it was free, and I was in the company of TSP, Tiger and Atsede. I was taken by ambulance to the Orthopedic Trauma Hospital, where they regularly see all sorts of gnarly alpine casualties, got an x-ray, an injection of anti-inflammatory in my butt, and, after the nurses saw how much I cried using the restroom afterwards, an IV full of paracetamol plus prescriptions for more. Alas, the drugs did nothing for me, there were no wheelchairs available (and all orthopedic stores were closed as it was Sunday) and it all took so long that I wound up missing the awards ceremony. The good news was that the x-ray came back clear- no fracture. What a relief.

This was by far the roughest day. The injury was fresh and painful, I was sleep-deprived, and the emotions were heavy- I cried in fear of the pain, heartbroken over the loss of a dream, and was moved to more tears by all the messages of concern and good wishes I received.

Day Two: Monday

By Monday morning TSP’s back was really hurting, but I came up with the idea of having two other guys carry me down to breakfast in one of the chairs from the hotel room. At least this way I was able to see some of my teammates downstairs before they left.

Afterwards TSP drove out to one of the orthopedic shops that the doctor at the hospital had referred us to and came back with both a wheelchair and big underarm crutches. Score! He said he had to negotiate the purchases using only the translation app on his phone, as the store people spoke no English. The wheelchair was just able to fit around the room and in and out of the bathroom of the very small hotel room, and I felt a huge sense of relief at not having to be picked up and put down any more. We celebrated with a fine dinner at a place called Opificio in Rivoli (the neighborhood closest to the hotel)- excellent pizza, steak and beer.

Day Three: Tuesday

Tuesday was our last full day in Italy, so we all wanted to do a little bit of sightseeing, something I really felt up for now that I was somewhat mobile. The bunch of us went to the original Eataly in Lignotto for lunch and souvenir shopping, and afterwards TSP wheeled me to through the nearby automotive museum while the others wound up walking all the way back to the hotel- about 8 miles! They still weren’t back when we were ready for dinner, which at the hotel’s suggestion this evening involved a twisty drive up into the real hill village of Rivoli where we had our most formal meal of the trip, complete with some wine. After this I was really too tired to pack much, or ask TSP to help me pack.

Day Four: Wednesday

Wednesday was our flight day. I was pretty nervous about how I was going to get on to the plane and survive an eight-hour flight without using the toilet, or what kinds of swelling and pain the trip would entail. Immediately after the race my right ankle had swollen up, and it remained while the rest of my right leg puffed up as well from a lack of circulation, especially the foot. My left leg was got puffy too- I felt like I had gone from being in the best shape of my life to a shapeless blob in a matter of days!

At least the acute and horrendous pain had eased off a little, so that I felt like I might be able to use the crutches. When I had first tried them on Monday, I still felt too much jostling in the right hip when I took a step with my left leg, but by Wednesday I could manage a bit if I was careful.

I needn’t have worried- the Alitalia and airport staff were extremely accommodating. An escort wheeled me to the plane, where I was boarded using a much smaller, aisle-accessible wheelchair. My seat was changed to one directly in front of the larger, accessible bathroom on the plane, which I was able to grasp and slide my way into, no problem.

Disembarking at JFK was the same deal- a smaller wheelchair was brought on to the plane and I was able to switch back into my own chair outside the airplane doors. I was whisked through immigration and customs and really appreciated the help in getting me home in a hurry.

I was also worried about how accessible my apartment would be- while I have plenty of space there are some tight hall areas and my bathroom is definitely too narrow for a wheelchair, plus I have a regular old bathtub. As it turned out it was fine- I could wheel close enough to the bathroom to use the doors and walls for support once I got in, and with the tub I just had to sit on the edge and lift my right leg in before continuing and standing on the left leg to shower.

Day Five: Thursday

By day five I felt comfortable enough on the crutches to largely ditch the wheelchair while at home. I felt much better being vertical than constantly seated.

Since I still couldn’t walk at all I decided to see a doctor in a hurry, so I went to an urgent care facility nearby. It was a nice day out so I thought I’d wheel myself half a mile to get some air, but I got exactly two blocks before my arms were exhausted, the way there was an uphill grade and the sidewalks were too cambered and uneven. I paused at the next bus stop and had my first ride strapped into the wheelchair section.

After I had fully explained my injury and shared the report and CD of the xray from Italy, the doctor ordered another x-ray because he was concerned about my inability to bear weight on the right leg, and he said sometimes a fracture doesn’t show up right away. Oh.

The new x-ray came back and the doctor indeed saw something there. It looked like a white band running laterally along the inner neck of the femur, but nothing like the femoral neck stress fracture images I later looked up on Google. Hmm. An MRI was ordered, which my insurance company luckily approved on the spot, and I got an appointment for it the following Monday.

Day Six: Friday

Friday I had scheduled an appointment with my primary care doctor. Since I am fairly new to my insurance plan I figured I should see him before I start asking for referrals all the time.

The office was not far from my apartment but too far for me to wheel myself. Tiger and Dwight came to the rescue and took me over there and waited while I had my consultation, followed by a physical., with urine and blood samples and an EKG. The rest of me is in pretty good shape, resting heart rate of 40, blood pressure under 100/70. When my bloodwork comes back I find that everything is good overall- thyroid, cholesterol, Vitamin D, etc. all normal, and though my iron is still low, my ferritin is good and I’m not anemic.

While on the exam table, the doctor asked me to raise each leg as far up as possible. Left leg: no problem. Right leg: I hesitate, and then, it rises. It doesn’t hurt but there’s a little bit of residual achiness. Still, it feels like huge progress.

Day Seven: Saturday

I slept a lot this day. The leg felt better but I had come down with a cold over the previous days so I rested to get over it. My stomach started to bother me later in the day and continued to be a problem over the weekend. Bleh.

Since this injury I’ve had many dreams about about walking. The first night, I dreamed about hiking in Hong Kong with Maggie- I think we were doing a race of 2 25km loops, like PHUNT, except it was in the mountains of Hong Kong so we were hiking it. Subsequent dreams have been a lot less adventurous. Usually they simply involve me suddenly standing up and walking around the house without the crutches, or doing something mundane that is currently off-limits, like using my stepladder to get the paper towels out of the high cabinets in the kitchen.

Day Eight: Sunday

After staying inside all day on Saturday I’m feeling a little stir-crazy. It’s nice out. Everyone is running races. Boston is tomorrow and instead of running or cheering I’ll be getting an MRI. I’m better every day and there’s no pain, I feel almost as if I could just get up and start walking like in the dreams.

I’m very grateful for all of the messages of care and inquiries about my well-being. However, can’t say much before I get the MRI and see a specialist. I don’t want to speculate or worry needlessly, but I also have to mentally prepare myself for the chance that it could be a stress fracture in the neck of the femur, which is a pretty bad one to have. According to Google, it heals slowly and requires crutches for some time, and running could be off-limits for months. I think I could live without the running part (just barely) but not being able to walk around or do other activities would be a blow.

In today’s adventure, my friend Lori came over and took me to the Duane Reade across the street. Originally I planned to ask her wheel me over, but then I decided to try going the distance on the crutches while she helped with the basket and bags. Well, that was about the extent of my endurance for now. It was a bit of a workout.

 Day Nine: Monday

I feel as if though I could almost walk, and I use the crutches more for support than to completely keep the weight off the right leg. After not taking any anti-inflammatories or painkillers on Sunday, I feel a bit achey and twingy, so I decide to go back on to them until I see a specialist. I know that if it’s a stress fracture, anti-inflammatories can stall the healing process, but I’m feeling like it’s a muscle tear which could continue to respond to the drugs. Anyways it is only a few more days until I see a doctor who can tell me what’s what.

At least, I hope it will just be a few days. While watching Boston online I started my search for a specialist. I call the Hospital for Special Surgery and am told the earliest appointment available is the end of June! Mt. Sinai tells me to call back on Friday for scheduling. I research a bunch of orthopedic surgeons in my insurance network but most seem to specialize in other areas: spinal injuries, shoulders and elbows, pediatrics… Finally I find a hip doctor and submit an online request for an appointment, but I’m worried that this could take a while.

Today is MRI day. My first. I’m expecting a lot of banging and clanging but I forget to bring earplugs., doh! The dream team of Dwight and Tiger pick me up by car to take me to my appointment, and they waited for me the whole time. Thank you so much.

I spent about an hour in the general waiting area before I was called back to the MRI section. There was a robe and a gown in the dressing room so I put the smaller robe on and then the larger gown on top- the lady who assisted me thought this was funny- I guess most people just wear the gown? After a short wait, the radiologist came and took me back into my MRI room, which was very spacious with a huge skylight above. For some reason I always pictured MRIs as taking place in much smaller subterranean rooms. We chatted about the source of my injury, running and ultras, as I got adjusted into the machine. I had to leave my metal crutches outside the room so this all required some careful maneuvering and near-walking on my part.

I lay still, had earplugs inserted and my feet taped together. Then I went in. Almost but not quite all the way in so it was never claustrophobic. I could always see the light of the room if I opened my eyes. I focused on staying perfectly still, breathing calm but shallow, and resisting the urge to pass any gas as I worried that might move my hips in some way. There was a lot of noise but not banging and clanging- it was far more space-age sounding whirls and beeps and honks. After 20 minutes or half an hour the radiologist returned and shifted my position so that my body was in a sort of side bend, like a parenthesis, and I went through another 15 minutes or so of the noise. There was an intercom system so I was told in advance how long each segment would last, anywhere from a few moments to a minute or three or five or six.

 Day Ten: Tuesday

I woke up to the excellent news that Dr. Bharam, the hip specialist I’d requested an appointment with, would be able to see me the following day. That was a huge relief. It also meant I needed to have something to show him. I’d requested to have a copy of the MRI report mailed to me and was told it would take 3-4 business days, so I called the radiology department to see if it was possible to pick up results any sooner and was told I could come in and get a CD that very day. While I was out, I figured I would also stop by the urgent care center to get a copy of my xray images as well.

I took a taxi over to the east side but traffic was so bad that I requested to get off two blocks from the hospital and hopped over on my crutches, rather than circling around by car for another 15 minutes. It was a beautiful day out, and I could make out runners in the park. Someday I’ll be back. To walk this longer distance, I alternated taking 5-10 larger and faster (and more tiring) steps hopping on my left leg, with my right leg off the ground, with sets of shorter steps using the right leg for light support and balance.

Down at radiology, I got the CD and saw that there was also a printed report inside. I sat down and to look it over. I had to read it several times: stress fracture, stress fracture, stress fracture.

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