Tag Archives: symphysis

3M Half Prep

06 Sunday Jan 2013

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austin marathon 2010Ran 56 miles so far this week, some on Town Lake but mostly on the Brushy Creek Regional Trail.  Much of it in the Texas rain.  That’s a really good week of mileage for me considering this is winter.  Haven’t been doing weights or situps; I did try one day but they hurt.  First trick is to establish my routine, then I can enhance it with calisthenics.  One more week of prep before running the Austin 3M Half Marathon on Sunday the 13th.

Not sure how well I’ll do but would like to push myself a bit.  I’ll have been in Texas for 3 weeks at that point so my blood will have lost most of its high altitude benefits.  At least I’ve always been told it takes about 3 weeks for the cardiopulmonary system to acclimate to altitude changes.  That’s to start to adapt, maybe 6 weeks to fully acclimate.  But all I ever really read on the topic is to adjust to higher altitude.  I know it’s critical to hydrate and vitamins are smart.  I’m just assuming it takes a similar amount of time to lose the conditioning.

It’s a funny thing anyway.  At sea level, you can run harder and faster.  Very curious to understand training techniques for adapting to lower altitude.  I suspect speed workouts, fartleks, repetitions on the track are all advisable.  I’m even thinking of running an asynchronous pace in the 3M Half – fartlek style.  There’s really not that much time to train so why not do it in the run itself?  I’ll start out controlled (slow) and rather than smoothly unwinding I might over pace myself, then recover with a slower pace, and repeat.  That will likely annoy other runners pacing with me.  They can suck it, I’m in an experimental mood.  And it won’t be easy to pull off.  I’m gambling that my conditioning is good enough to be able to recover from oxygen debt after each fast pace run.

I am somewhat concerned on how much situps hurt when I tried some the other day.  My core is feeling like it did when I had arthritis.  I’ll be bummed if it returned.  If I have to get another steroid shot, despite what I might have said in previous blog posts on the topic, I think I’ll opt for the anesthesia next time.  Taking a shot from a needle bigger than Dallas in a hip joint isn’t something I care to ever experience again.

A little word on the pic above.  It’s from the 2010  Austin Marathon – which I ran in 2011.  This pic still works for me as it symbolizes running in Austin and it’s free.  I don’t see any good graphics from the 3M Half Marathon which I’ll be running next weekend.  Sort of disappointing considering their outrageous registration fee.  The Boulder Marathon prints up cool posters too.  Cool enough like this one to frame and hang on the wall.  3M better at least have some good swag.

Middle Aged Prime

14 Saturday Jan 2012

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I forget the context but a friend on facebook recently called me middle age.  Ray called me a couple of other things too which I didn’t debate but I did ask him to define middle age.  He responded over 40.  Hmm.  Then I read a story in the WSJ this morning on mid life crises and related nuances of my age.  What’s weird to me is that I just never feel it.  Of course I’m middle age but I don’t spend much time looking at myself and if it weren’t for the reminders like my symphysis pubis arthritis and friends like Ray, I’d be oblivious to it.

But now I’m thinking about it.  I guess that’s what you do with all the free time available to us pending seniors.  But Honey Badger don’t care.  Honey Badger don’t give a shit.  I find it ironic, and not the least bit vain, that Karen and I are in better shape than we were ten years ago.  That’s less true about Karen because she’s been good about maintaining her shape over the years.  She never let herself go as far as I did.  Friends and family constantly inform me that Karen looks so young for her age.  Perhaps because I tend to consider this a backwards compliment, I respond on how the 2′ x 7′ foot slab of double vanity granite in our master bath is a virtual shrine to the mid-life industrial complex.

With my preoccupation over the thought of middle age building, I did what any other average 49 year old with 4 wifi servers in his house would do – I googled middle aged runners.  I came across this cool blog that has a similar theme as mine but the writer probably does a better job at chronicling his races.  And apparently he runs faster than me.  But not by much and reading it motivated me to get in a good workout today.

I’m actually fine with the direction the second half of my life is taking.  I seem to be improving upon my areas of interest.  I’m reading more.  I’m focusing more on trading which for me is more about enjoying a hobby than about planning for retirement.  And Karen and I both are clearly putting much more time into fitness.  Karen doesn’t run, she’s my tiny dancer.  She likes to dance as an aerobics instructor.  This is not something one makes money at – trust me.  You can argue you’re not paying for a gym membership, but the appeal of teaching is that the time spent making a playlist, choreographing the routine and practicing serves as a much more intense and satisfying fitness experience.  Karen taught Jazzercise for over 5 years and has now moved on to teaching Zumba.  She compares them by describing Jazzercise as aerobics with a dance flair to it while Zumba is dance with an aerobics quality.  She favors Zumba.

So after having thought about what I’m doing in my middle years, I’m happy.  That I’m actually becoming more fit each year as I age is a blessing.  I feel fortunate.  The last few years of returning to racing and hiking in the mountains is like reliving the best times of my youth.  It’s a fantasy really.  I’m good with it.

I am Healed

19 Saturday Nov 2011

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Pounded out my first run since getting the cortisone treatment Wednesday, and I am healed.  Absolutely no more pain.  I felt fat and still ran slow, but my abdomen was strong.  I am so happy.  I can’t believe I’ve lived with this for a full year when I didn’t need to.  I still remember wondering why I hurt so much after the 2010 Denver Marathon.  I should have followed up with my doctor much sooner.  Lesson learned.

This has me pretty excited.  The arthritis in my symphysis pubis had been seriously slowing me down.  It was never the kind of pain to keep me from running.  But it took a half mile to recede and would return if I ran too fast.  This was most annoying in the 2011 Bolder Boulder when I felt great at 5 miles and tried to pick up my pace but the pain in my abdomen acted like a governor.

I’m psyched up now to train again for the 2012 trail running season.  I don’t care how ridiculous it might sound for a 49 year old to want to race, but I do.  I want to be competitive in my age division.  I like running fast but was beginning to think I couldn’t anymore.  My new training regimen begins this Thanksgiving break.  I’m climbing back in the saddle.    I’m going to sign up right now for the Moab Half Marathon in March.

Sucker Punch

16 Wednesday Nov 2011

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I wasn’t totally certain what to expect from this steroid shot.  I took off a half day of work since they said it would take 3 hours.  Still somehow I’ve logged in a 10 hour work day.  That’s what they call an IBM vacation.  I could have easily spent 2 hours simply finding a parking spot.  Boulder parking sucks.

True to the expectations set by Nurse Heather, prep took an hour.  A few forms and questions to answer, but mostly waiting.  I read a few chapters from the Steve Jobs biography on my iPhone Kindle app.  Should have brought my Kindle but the sweet thing is how what you are reading on the Kindle synch’s wirelessly to your iPhone.  I was able to get some of my questions answered from Dr. Stilp.  She said it is indeed possible that this treatment will last a lifetime.  She performs this treatment for the same condition every 2 or 3 years.  Typically to runners over 30.  It is possible though I might need a second shot after a few weeks.  I should know based on how the pain recedes and that I should followup with Dr. WW.  It might be that I’ll need some rehab therapy rather than a second shot.  I can run this weekend but should not expect noticeable results for a few more days after that.

The door to the surgery room had a sign reading, “Pain Free Area”.  I asked the nurse if that was some sick humor.  She responded in a serious manner that perhaps so for me since it only applies to patients who receive anesthesia – which I had declined.  Hmm.  She instructed me to lie supine on the surgical bed and she proceeded to prep my lower abdomen with betadine and sterile towels.  Because I expected this as well, I trimmed my belly hair.  I simply trimmed it with clippers.  I didn’t want to shave it with a razor because I think that’s a bit weird.  I don’t want too prepubescent a look lest I suddenly get hit on by football coaches.  Which reminds me, have you heard what high school athletes are saying in the locker room now?  “You can stick it in coach, I’m ready to play.”

Anyway, I’m glad I trimmed because the betadine would have been a hairy mess otherwise.  I suspect they would have shaved me if necessary, but they didn’t so I think my efforts were smart.  The nurse wrapped a blood pressure monitor around my right arm and attached a heart rate monitor to a finger on my left hand.  She then had me fold my arms up over my chest.  A second nurse handed me two squeeze balls, sort of like little stress relievers.  She said I would want them.  Dr. Stilp came in and was quite efficient about things.  She adjusted the towels leaving me embarrassingly exposed.  I now know where the needle’s point of entry will be.  Less than an inch north of my Johnson.

Dr. Stilp applied some topical analgesic to minimize the pain of the needle breaking my skin.  It still hurt a tad bit more than a flu shot, but nothing to cry home about.  That is until she went deep.  After entering the needle, she paused in order to adjust her fluoroscope.  This is an xray image on a monitor directly over my abdomen.  She then looked at the monitor as she pushed the needle further into the joint.  I wasn’t expecting this type of pain.  It honestly felt as if she had punched me in the gut with all her strength.  The nurses on both sides of me then applied moderate pressure to my arms to ensure I didn’t whack anything and exhorted me to take deep breaths.  The scene was not unlike a woman delivering a baby.

Dr. Stilp then told me that she’ll need to do this again and it will hurt the same amount, and that I should try to relax and let her know when I’m ready.  “Are you fucking kidding me?”  I’m not certain I said those exact words.  I might have, I was in a highly emotional and reactive state.  I couldn’t believe she would ask me to relaunch the needle.  It’s like asking someone to commit hari-kari.  I took a couple of deep breaths and told her to go ahead.  I didn’t want time to think about it.  She was right, it hurt just as much the second time.

And before I knew it they were helping me to my feet and escorting me out of the pain free area.  A nurse monitored my vitals for about 5 minutes and then sent me home.  Despite feeling like I was sucker punched twice in the abdomen, I’m glad I declined the anesthesia.  I’ve seen people take that stuff and I’m confident the side effects would not have been worth the pain avoidance in this scenario.  Not feeling any pain now – a few hours later.  We’ll soon see how effective the steroids are when I try out my treated pubic symphysis on a run.

Shot of Steroids

12 Saturday Nov 2011

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Dr. WW called back again to let me know he’d reviewed my MRI with Dr. Stilp – an Orthopedic Surgeon across the street at the Boulder Surgery Center.  She concurs with the radiology diagnosis of arthritis in my symphysis pubis and wants me to call her to schedule myself to receive a fluoroscopic-guided shot of cortisone.  Dr. WW actually let me agree first that I was interested in receiving the shot.  He might have been following some ethics protocol.  He seemed happy with my decision though.  And he related to me that I’m only the second case of symphysis pubis arthritis he’s treated.  The other guy was a few years ago.  That guy was in his 30s which makes me feel better about this not simply being about my age.  Dr. WW ended the call by giving me the phone number to Dr. Stilp’s nurse Heather, to setup the procedure.

Nurse Heather penciled me in for this coming Wednesday afternoon.  I’ll take a half day vacation as this will suck up too much time to simply squeeze it in between conference calls.  Heather briefed me on what to expect.  The shot itself will take just a few minutes, but I’ll need an hour for prep and another hour post-op.  Apparently this isn’t a simple flu shot.  The doctor will use fluoroscopy to guide the needle into the area of my hip bone.  Heather surveyed my medical history over the phone so I won’t have to spend time filling out forms once I arrive.  I declined the anesthesia so I’ll be able to drive myself home afterward.  I’ve never had anesthesia before but have seen others receive it and can say that it doesn’t appeal to me.  Heather answered most of my questions.  I’ll have to wait to talk with Dr. Stilp to answer other questions such as ongoing expectations.  I neglected to ask just exactly where the point of entry will be for the needle.  My buddy Dave suggested I should expect it to be where I least want it, and that stirrups might be involved.  Ouch.

The Call Back

08 Tuesday Nov 2011

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After the trailer MRI by a Radiologist likely located half way around the world, I wasn’t expecting much in terms of a call back.  A voice message from the Orthopedic’s nurse perhaps.  Shoot, assuming there was no big news to relate, I’d be good with a text.  I personally could not read into the picture I took of the MRI scan, but I did have my own guess.  I side with my primary care physician.  She thinks I have a tear in the tendons connecting the abdomen to the symphysis pubis.  It feels that way to me and I could see that taking a long time to heal without proper rehab.  I don’t know enough about sports hernias to say anything intelligent, but a hernia does not sound like the sort of thing I would be running marathons with or hauling up 14,000 foot peaks on the Colorado Trail.  My optimism might be biased by wanting to avoid the potential surgery required for a sports hernia.  So that was my frame of mind as I waited for the call back.

Dr. William Williams called me on my mobile tonight at 7:19 MST.  He used a lot of big words and never definitively committed to anything.  It might as well had been Alan Greenspan who called me.  I’ll be much more direct in my translation.  My symphysis pubis is arthritic.  This is apparently rare in this type of joint.  Dr WW then lectured for several minutes tangentially on the different types of joints and how the symphysis isn’t really a joint anymore than spinal vertebrae.  But it sort of is a joint.  He’d either made his point or realized I was no longer responding and returned to topic.  He exhorted that a hernia is still possible but less likely now given my symptoms.  The advised treatment for the arthritis is a steroid shot and he thinks he might know someone who could administer such a thing if I were interested.  I am.  He’ll talk to Heather. I envisioned my eye doctor’s clinic where the eye glass and frame shop seem to exist as separate entities yet within the same building.  This guy distances himself from the dealers. The upside is that a positive response to the steroids would further suggest I don’t have a hernia.  Or perhaps the upside is that I’ll now have a fairly valid subterfuge for a medicinal marijuana card.

Trailer Medicine

02 Wednesday Nov 2011

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Today was the big event – my first MRI.  I woke up to a half foot of fresh snow.  Much less on the sidewalks and roads.  Not that it mattered, my appointment wasn’t until late afternoon.  The roads were dry and clear by then.  I left a bit early anyway since I’d never been to the Lafayette branch of the Boulder Community Hospital.  Good thing as I mistakenly drove to the Exlempa Good Samaritan Medical Center first.  I figured it out after Registration couldn’t find a record of my appointment.  Still made my appointment on time as the two medical centers are located fairly close to one another.

Registration was quick although Cigna never called in my negotiated rate.  I know I will eventually owe 20%, but don’t know what the 100% is yet.  Fortunately I did not have to pay in advance.  I understand MRIs to cost over $3000.  The Cigna negotiated rate should be about half that, give or take 10%.  I was still ahead of schedule and sat down to read my WSJ that I brought along.  I brought my own newspaper for two reasons.  First, it was delivered late today due to the weather so I wasn’t able to read it in the morning.  Second, I’ve been disappointed lately with the lobby magazine selection in medical offices.  And I say this from experience having been to three others in less than a week.  My Primary Care physician is a woman which might explain the literary tripe in her office.  Then the Orthopedist had a bunch of Yacht Club magazines.  Who the hell even boats in Colorado let alone owns a yacht?  And to his credit, the Podiatrist at least had Time Magazine, but still, my erudite tastes are particular.  I read the Internet.

I just completed a survey of the page one index when the MRI tech stepped in to escort me to the lab.  The MRI room.  The magnetic resonance imaging facility.  We exited the back through sliding doors and walked into the parking lot as she droned on about why her MRI machine was temporarily located in a trailer.  It was one of those modular buildings that often are used as class rooms in fast growing school districts.  She warned me to be cautious navigating the ice as I climbed the pressure-treated wood stairs.

She locked my metallic valuables in a file cabinet and explained the procedure to me.  I was surprised to learn the routine would take 30 to 45 minutes.  My previous experience consisted of 10 minute x-rays.  Good thing I’d dressed comfortably.  Expecting belts and buckles to be an issue with the big magnet, I sported Under Armour fleece lounge wear.  I was both warm and comfy and declined her offer for a blanket.

Recumbent in a supine position, I pierced the alluring grotto feet first.  Soon the machine emitted a noise not unlike a tennis shoe bouncing around inside a clothes dryer, but more synchronous.  A minute or two later I was done.  Apparently I fell asleep to the rhythmic drumming as my iPhone confirmed I’d been in there at least 20 minutes.  So I’m unable to report much more on the details of being MRI’d, but can tell you it’s very cozy.  The pic above is the image of my symphysis pubis after redacting some of the personally identifiable information from the upper right.  Supposedly some Radiologist whom I never met – likely working out of a cubicle in Bangalore – will provide the results to my Orthopedist in about 3 days.  Stay tuned.

Foot and Ankle

31 Monday Oct 2011

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My visit to the Podiatrist wasn’t too bad.  Not sure why I had to undress since it was just my foot, but all in all it was a good prognosis.  Just kidding of course, but I was very happy to have this doctor confirm that yes, I have plantar fasciitus, but totally treatable and not something more serious.

This ultra sound shows abnormal thickness near the heel and inconsistent width throughout the fascia – confirming plantar fasciitus.  The doctor explained a number of stretches I can do and showed me what sort of insoles will help.  Turns out nothing from SofSole is any good.  Even their models intended for pronation won’t provide the necessary support – they are way too soft.  The type of insoles that will work are made of hard plastic – like from Superfeet.

Best of all, this doctor didn’t even blink at my bloodstained toenails.  Didn’t suggest toe treatment.  Didn’t say squat.  He looks pretty fit himself and seems to understand toenails are over-rated.  MRI for my symphysis on Wednesday.

The MRI

29 Saturday Oct 2011

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I don’t imagine MRIs to be very scary, unless of course you are claustrophobic which I’m not.  From what I know, they don’t even use X-Rays like a Cat Scan but instead generate radio waves from a big magnet.  It certainly doesn’t appear to be painful although it could brick my iPhone.  But I’m stupefied how I reached this ripe old age without ever having been referred to a specialist and I now am having four medical visits in less than seven days.  My doctor referred me to a Podiatrist for my plantar fasciitus and to an Orthopedic Specialist for my abdomen.

I immediately started doing the math on potential out-of-pocket costs and discovered both specialists would be in network.  So OK, fine.  I visited Boulder Orthopedics yesterday.  The visit took over an hour which I didn’t expect.  I got an X-Ray which suggests a possible sports hernia – whatever that is, it sounds made up – and the need for an MRI.  Dr. Williams couldn’t be certain of my injury but my Symphysis looks to have some issues.  I’ll spare you the profanity here but know that I’m cussing under my breath as I write this.  I called Cigna as soon as I got home and learned I will be responsible for 20% of the MRI cost.

Seeing how one visit to a specialist has begun to spiral out-of-control, I’m no longer looking forward to visiting the Podiatrist Monday.  I’m picturing thousand dollar custom-built insoles made from rare earth metals.  And I’ll probably have to travel to China to be fitted.  This isn’t going well.