Operation Change of Pace

"I come back to you now, at the turn of the tide."
 -- Gandalf the White

"There's always a reason to quote 'Lord of the Rings'."
 -- Brian

For most of my running career, I've been an approximately 10:00 minute-mile runner.  I was usually faster on race day (except the marathon, of course), but this was usually the pace I was usually training at.  I haven't been that fast since my surgery.  I've only gotten two miles under 20 minutes once, and I think I managed one under-30 minute 3 miler.  That's ok.  What's not ok is that I don't seem to be able to consistently replicate my pre-injury attempts at this pace.  Even though I'm not hitting my old speeds, just trying to run at what seems like my natural pace seems to be a recipe for compartment syndrome pain.

Meanwhile, my wife has racked up distance running achievements far exceeding my own: eight half marathons (her ninth is this Sunday) following this past weekend's Shamrock Half Marathon in Virginia Beach.  I've noticed that when I run with her, I feel ok.  She trains at an approximately 12-minute mile pace and also incorporates a one-minute walk breaks every half mile as per an adaptation of one of Jeff Galloway's plans.  In both the Kelly Shamrock 5K in Baltimore two weeks ago and the Shamrock 8K in Virginia Beach, both distances I hadn't been able to hit in the past two month without pain, I ran with Chris, followed her plan, and felt great.  I also ran 4 miles on Monday by myself in Virginia Beach at a 5mph (12-minute mile) pace and felt very good.

The sample sizes are pretty small:  The Sole of the City 10K last year, which I really had no business running; the Kids' Peace Orioles 5K in November 2013, and the aforementioned 5K, 10K, and 4-miler are all post-injury races that I ran with Chris or using her run/walk plan, albeit in varying degrees of fitness and preparation by be me, without any compartment syndrome problems.  Those aren't the only races I felt good in.  I felt good at Rocky Run 10K and Celtic 5-miler last year.  But what about all the training runs where my shins and calves burned or where I couldn't move my foot?  I can't handle every run being a roll of the dice.

Between weather, illness, and my legs feeling like crap, I haven't gone more than 2 miles since February.  On Saturday and Monday, I ran 5 and 4 miles respectively, and felt better than I have since November.  Could it be that my injury is less aggravated at that pace (or that there is something about my stride that is different?).  I recall, when I had my bout of ITBS in 2011, that there was an optimal speed at which to run to reduce symptoms (unfortunately, it was faster than I could go!  I will try to look up that article and update the post, by the way).  Maybe a change of pace can help this injury as well.

I think it's something to try, and my laboratory will be training for and running the Wild Half Marathon in May.  If I can get through the training miles and finish a half marathon without compartment syndrome symptoms, then I'll feel like I'm back in the long-distance game.  If I can't, it's probably time to admit that anything longer than a 10K is out of reach, and focus on shorter races and/or find new hobbies.

The motivation is back. I'm feeling better mentally and have been more focused.  I just have have to be able to get the miles in.

A New Year, But More of the Same

Running Year 2014 neither started nor ended on a really good note for me.  I struggled with my injuries again early in the year  and finally had the surgery. After a rehab that was longer and tougher than I thought (but still probably not bad compared to other surgeries), I started running again, starting from the beginning with the Couch to 5K plan.

It's been a mix of good and bad results.  I think my progress had been a little slower than I thought, and I know that I had let myself get more out-of-shape than I thought, too.  In November, things seemed to take a turn for the better.  I ran a good 5K with no walk breaks t the Kid's Peace Trick or Trot in Baltimore, and then and even better (compared to current expectations, not my PRs back in my "prime") 10K at at the Rocky Run.  I started running four milers in Manchester, and I could feel myself getting stronger.  And then...

On December 8th, I went out for a five-mile run, hoping to get one five-miler in before the Celtic Solstice race that Saturday.  At about 2.5 miles, my calves were tight and sore, and I made the strategic decision to take a shortcut back to my car.  I hit the three mile mark and began to walk, and I realized from the dead feeling in my legs and the lack of full range of motion in my left ankle due to the swelling, I was having the compartment syndrome symptoms again.

I rested all week, and did a lot of stretching, and felt much better for the Celtic Solstice 5-miler.  I'm not sure I got another run in that week, but the next Saturday (Dec 20), I did 5 miles on the rail trail in which my compartment syndrome was ok, but my right knee was very sore.  I think it's my IT band, and I know I've managed that before with stretching and exercises.  I was not terribly concerned.  Knee pain also limited me to two miles on December 23.

Then, the bad one.  The next time I went out to run was the Saturday after Christmas.  My plan was a 2.5-mile out and back on the rail trail north from Hanover Junction.  I was struggling on the "out" part, and should have known to turn back well before 2.5 miles, because by that point my compartment syndrome symptoms were in full swing, and it was a long walk back to my car.

What the hell?  I've lost most of the last three years of running with this problem, had surgery, and it seemed like I'm no closer to having under control than I was at the end of 2011, and I just don't know why I'm ok -- or mostly ok -- sometimes and then other times I'm in pain after just a mile or two.

I need to find the pattern, and isolate what factors will make a difference, because I just can't let every run be a roll of the dice.  If the specter of compartment syndrome pain hangs over every run, there's no way I can dream of half-marathons and marathons again.

Part of me thinks it's just time I accept that.  Even if I ONLY run distances of two or three miles, it's still good exercise.  I like 5Ks.  I could still probably run them, although usually on my bad compartment syndrome pain runs, it sets in before three miles.

I'm not ready for that, though.  I want to unlock the formula for controlling this, and find out what separates the good symptom runs from the bad.

The first variables I'm playing with are hydration and diet.

I enjoy alcohol in moderation, but when a Christmas party left a huge surplus of beer, I started having a single drink on nights of the week on which I normally would not imbibe at all.  The first run in which my compartment syndrome symptoms flared up was two nights after that party, in which I had several drinks and ate lots of salty foods.  I was probably super dehydrated.  The second bad one, on December 27, was the morning after a friend had had dinner with us the night before.  I didn't drink to excess, but I had more than I would normally have the night before a long run.

In response, I'm drastically cutting back on alcohol consumption.  Since most of my long runs are on Saturday, that means no beer during the week or on Friday night.  It also means I have to really make an effort to drink more water.  I have gout, and I know dehydration is a big trigger for that.  Could that be a contributor for this?

I'm also changing my diet to include more things that are thought to be natural anti-inflammatories. In general, I'm trying to eat more fruits and vegetables, including cherries.

Lots of stretching is also essential.

I set out for my run on Saturday morning, with my legs aching and a heavy heart.  I felt like this run was really important.  If I felt ok, I could go on.  If I felt badly, then it was another data point that pointed back to square one.  I got a reprieve, when sleet and freezing rain started just as I was about to run.

Chris and I did a lot of work clearing out one of our storage rooms, and then we went out and met some friends for drinks.  I was careful to mix in a few glasses of water, too.

Sunday morning, with my legs feeling better as I left the house I ran four miles with a sore knee and no hint of compartment syndrome.  My feeling of relief was huge, but I know that I shouldn't get too high over a single good run, just like you were probably thinking I was getting too low over 2 bad runs in December.

I'm going to continue the changes I made to diet and alcohol consumption, and I also want to implement the following:

1. Make sure I don't just sit around all day.  This is tough because I sit around all day at work.  I need to make sure that in the morning or at lunch, I make some time to walk on the treadmill or go for a short run.  I felt like being up and around on Saturday helped my legs feel better than they had that morning.

2. More commitment to core and leg strength training.  I'm good at doing this when I'm in PT, and I'm good at doing some exercises (squats and calf raises) after I run.  I think I was not doing enough, though.  Not only did I in general run less in December, with so much holiday stuff going on, but that also meant I was missing out on strength training.  I'm sure with running less, and doing these exercises less, my legs got weak again. 

3. Make sure I get my mid-week runs in, even if they're only 2 miles.  In December, I basically ran once a week.  That's not a recipe for success.  I need to make sure I get them in the mornings, because running at lunch is a non-starter.  There are many times (today being one) where I planned to run at lunch and then got too busy to take that full hour for stretching, driving to where I run (my house is just not a safe running area), running, doing post-run stretching, and coming back.  I should have just gone up and run at the park closer to home.  It's hilly, and I'm not ready for that now, but closer distance to my house will make this easier to do in the morning or (maybe) at lunch.

Hopefully, I can manage this because I really don't like the idea that I had surgery for nothing or the thoughts of throwing more surgery at this particular injury or losing another year of long runs.

 

In this picture, I'm sitting on a park bench and trying to raise my toes to stretch.  The left foot doesn't have the same raise of motion when the symptoms are active. 

Race Report: 2014 Celtic Solstice 5-Miler

I was feeling very pessimistic about the Celtic Solstice 5-Miler.  I'd had a run on the previous Monday where my old compartment syndrome symptoms were back and I'd cut an attempt at five miles down to a little over three.  It wasn't terrible, but my calves were very crampy (is that even a word?) and my ankles and seemed swollen, and when I turned around back to my car, I sat down on the curb, just to check, and sure enough, I didn't have the full range of motion in my left foot.

Just as running had started to be something I enjoyed again, it was back to this bullshit.

I rested, doing lots of stretching the rest of the week, and the race actually went ok.  I ran four miles of the five-mile race and didn't have any compartment syndrome symptoms during the race, despite my shins still being pretty achy that morning during the long walks back and forth from the car to the packet pickup area.  (These races at Druid Hill Park are fun, but the parking and traffic situation is a little bit of a mess.)

The race is hilly, with a steep, tough incline at the start, and then more moderate hills after that.  It's not as hilly as Dreaded Druid Hills 10K or, I'm told, the Zoo Zoom 8K, which I believe uses some of the same access roads as the DDH.  I enjoy how the course makes tight loops around the park; normally that would annoy me, but it was nice to be able to watch for Chris as I made the zig-zags around the park.   A significant part of the last 2 miles is around Druid Lake.  It's flat but also boring, and my progress seemed very slow at this point.  I took a one-minuteish walk break at four miles as I was heading around the south side of the lake toward the Moorish Tower, and as I passed the tower with a little over a half-mile (I think) to go, I knew it was literally all downhill from there; the slight incline around the rest of the lake and then down the steep hill we started up.

I finished in 56:33, a far cry from my 42:44 at this race in 2011, one of my best-ever finishes and not-coincidentally my last pre-compartment syndrome race, but a perfectly cromulent finish given my current conditioning and circumstances both within and outside of my control.  It's hard not to be disappointed when I see comparisons like that, but it's important for me to keep reminding myself that during the summer of 2011, I was dropping double-digit mileages several times a week and that I had been in what passes for marathon shape around here, and this summer I had six new surgical scars on my leg and didn't even start running again until mid July.  That simplified explanation ignores that 2012 and 2013 were plagued by injury, but also that there was a lot more I should have been doing to keep myself in shape even when running wasn't going well.


 So, in conclusion, I either should or shouldn't beat myself up too badly over this finish.

Race Review
Falls Road Running puts on a good race, and all their events are both fun and challenging (they have race team that's very competitive, but this race gets participants of all levels), but there's a few small ways that I think this race could be improved.   The start was very chaotic and crowded, so I think some more room in the starting area would help, and also pace signs.  I probably would have ignored them this year, anyway, but I think it would be helpful to at least get the idea in peoples' heads.

There is a good post-race party with hot wine from Boordy Vineyards, fruit, and cookies.  All the cookies were gone by the time we got there, which I thought was definitely not cool, but there were bagpipers at the start, food and beverages (beer was available for purchase) and a Celtic band playing Christmas tunes at the post race party, and a fun, fairly scenic course.  It's a race that I would definitely run again, and probably will. 

Another high point is the swag:  a custom Brooks running jacket that makes the $80 registration fee not seem so high.  You can also do $40 with no premium, but I really like this one:

 

Down with Couch-to-5K!

Coolrunning.com's Couch-to-5K Program, I'm sure, has helped many, many people begin running and train for their first 5K.  It's been helping me go back from lazy, post-surgeried couch pototato to elite (ha!) marathoner in just a few short weeks.

Again, just kidding.  I've been doing the Couch-to-5K program since July 19, which is 8 weeks.  There were a few "weeks" of the program that I repeated because I felt like I was still struggling to complete them, and then held myself back again over the last two weeks because been sick with some bad summer cold or upper respiratory infection.  Basically, I've been stuck at "week 4" for about 3 weeks now.

And here's the thing -- I think, if I follow the plan, I always would be.  From weeks 1-3, I think the Couch-to-5K progresses pretty reasonably.  I felt like I needed a repeat of week 3, but then bumped myself up to week 4 and was able to complete several times with mixed success (again, allergies and respiratory illness make for bad training partners).  The jump to week 4, where you are running 5 minutes at a time and your walk breaks are NOTICEABLY shorter, is a big one, but I don't think unreasonable.

But there's the thing:  Week 5 is a bitch.

So let me get this straight, Couch-to-5K.  The longest you've had me run is 5 minutes, and one week later, I'm supposed to run TWO MILES?    The progression to those first two workouts of week 5 seems reasonable, but going from running 8 minutes twice with a 5-minute walk in the middle to running for 20 minutes?  It seems like there needs to be another week or two of transition in there.

 Oddly, it seems like once cross this gulf, the plan proceeds pretty reasonably once again, and it seems like the plan is transitioning the trainee from a program of 3 equal workouts per week to two run/walk workouts and then a "long run", which is how must runners train for longer races.  So, in breaking this down and criticizing it, I do think I see the logic behind it.

At any rate, I feel like I could do week 4 over and over and not really be ready for week 5.  It just doesn't seem like, without doing a lot of other cardio (and maybe that's the point, that I should be!) this this is big leap forward to be expected of new runners. 

So, this is where I get off, Couch-to-5K.  I'm back on the "Run half a mile, walk for a minute, run half a mile" plan that Chris and I have used on the 5Ks I've run w/her the past year and a half.  I used this back in January to try to train myself back up, hoping that I'd successfully physical therapy'd myself through injury. I've done this twice now this week, and there was noticeable improvement the second time, but I suspect it had more to do with the weather being 20 degrees cooler than any actual improvement in fitness on my part from Wednesday evening to Saturday morning.

Basically, what happens is I'll do this as-is for a week or two, then hopefully be able to get through the first mile with no walk breaks, but probably still need them on the second mile.  Then, hopefully, the next week or two I'd need the walk break at the end of the first mile, but then be able to get the second mile without walking.  When I can run 2 miles with no walk breaks, I add some back in and try for 3, and after a few weeks of this, I can hopefully run a 5K again.

So yeah, kind of like the Couch-to-5K.

Bilateral Compartment Syndrome Surgery and Recovery

As I've run less and less over the past few years, these blog posts have become less frequent.  But in those few blog posts there's a lot of space given to complaining about (mostly) and trying to recover from compartment syndrome.  After two years of trying avoid surgery, I finally decided to go under the knife.  I described the lead-up to surgery a few months ago.  Now that I'm (hopefully!) well on the road to recovery, although not nearly as far back on the road to racing again, I figured I'd take the rare opportunity to write a blog post that might actually be informative.

To very briefly recap, I started having symptoms in December 2011. I'd have swelling and discomfort in my ankles and calves, more pronounced in the left one, and a noticeable loss of range of motion.  Shinsplints were the initial diagnosis, with compartment syndrome being the next "option" when my problems didn't really respond to the main treatment of shinsplits (rest).  Any time I took a few months off from running, I'd come back and my symptoms would be better, only to come back every time I got back into some consistency of running.  That's why I won't know if this surgery worked for a few more months.

At any rate, a compartment pressure test confirmed the diagnosis in Spring 2013, and I tried a long program of PT to avoid surgery.  No luck.  I had surgery on May 15, 2014.


As I said in that initial post-surgery blog post, I woke up in a fog of post-anesthesia and painkillers, definitely in pain, but not as bad as I feared.

(a few hours post-surgery)

Despite that, those first few days were bad.  I frequently felt nauseous from the vicodin, and when I moved my legs, I would feel a tearing sensation in my legs in the area of the surgery.  If I touched those areas, they would feel hot to the touch, although I think that burning sensation was in my legs, and not actually heat that I was feeling, since my legs were pretty heavily bandaged at this point.  I limped around the house on crutches.  I expected to sleep like a rock that first night, but got very little sleep, and because of that I probably crutched my way around the house too much.  I had big ice packs that I'd wear over my legs (or wrap around them with velcro as I got a little more able to sleep in different positions) for long stretches of time for the next several weeks.

Still, just two days after my surgery, I was at least out of the house for a quick Dunkin Donuts trip.  It probably wasn't worth the discomfort I was in going up and down the stairs or how long it took me to get from the car to Dunkin, but I'd wanted very badly to get out of the house, and my Dr. had said it would be ok to try things like this as long as I was careful.

I'd love to say I got better every day, but there were good days and bad days over the next few weeks.  I felt "pretty good" a week after surgery when I went for my post-surgery consult.  The doctor said everything looked good and that the procedure had gone well, and that I could start to s l o w l y ween myself from the crutches...which would go more slowly than I'd hoped. I was to start out by trying to get around the house without them, but using them when I went outside. 

(Looking great 7 days post-surgery)

I had my surgery on a Thursday, and went back to work the following Wednesday.  It's important to note that I work from home.  If I didn't, I probably would have wanted the whole next week, and it was probably another two weeks before I could really sit at my desk in my upstairs office comfortably.  My legs were most comfortable stretched out in front of me, and there wasn't really a comfortable way to do that at my desk. I could work downstairs on the couch, but I wanted to be up in my office as much as possible so that I could receive calls on my work phone line.  People at work have my cel number, but if that got established, even for a short time, as my "main" number, I thought that would be very hard to put back  in the bag.  

I also had a massive gout the Thursday after surgery.  My gout flares up, usually in one of my big toes, a few times each year, but it seemed especially bad in the weeks after my surgery.  If I didn't drink a ton of water (and even sometimes if I did), I'd have gout flare-ups the next day.  My orthopedist would later say that for gout suffers, it's not uncommon for them to be more susceptible to flare-ups after surgery. And I was stupid -- I think it was because the day of my surgery through Tuesday, I'd drank massive amounts of water -- oceans of water -- every day.  But once I went back to work, I wasn't drinking as much...since I couldn't carry cups of water up to my office with my crutches.  Sports bottles were the easy remedy for this. 

The second weekend after surgery was Memorial Day weekend, and I pushed myself too hard. Chris and I went to an outdoor music and wine event at a local winery with some friends, and I walked around more than I should have -- and tried to be more independent than I should have been.  My attitude was getting pretty bad at this point.  I didn't want to be dropped off closer to where we were sitting.  I didn't want to not be allowed to carry anything while Chris made multiple trips.  The next day, we went out to eat in downtown York, and walked 2 blocks from the parking garage.  These adventures definitely set me back a little, and I was tired and sore over the next few days, and on crutches more often than not, even around the house.

I'd taken vicodin -- one in the morning and one at night -- on Thursday, Friday, and Saturday, and then generally stopped.  I didn't want to continue it longer than I had to because it's addictive, and because I stopped it so quickly, I'm not sure that I'd say it helped a lot.  I did take them the day of my gout flare-up and then for a few days following the Memorial Day adventures.  I took one vicodin twice a day, half the prescribed dose, at my Dr.'s suggestion, since the anesthesia had knocked me out so easily.  Like I said, it's hard to tell if one vicodin at a time really helped.  I took two the day of my gout flare-up, when I was just in agony, and two vicodin definitely made a difference.  Not entirely good, though, I felt VERY spaced out and nauseous.

(My right leg on May 28.  My right leg had the worse swelling of the two, 

and looked worse here than it did a week after surgery.)

Once the calendar turned to June, I turned the corner.  I was walking mostly with crutches, driving short distances again, and feeling much better.  My ankles were still very swollen, but I was making steady progress forward.  At my second post-op appointment on June 11, my doctor said it would be ok to start light exercise with no resistance (Chris and I started going for walks), but I was still about a month away from running.  I went way for a long weekend with college friends, walked a ton and drove all around Philly and Atlantic City, and needed my ice packs, but was ok. 

At my third and final post-op, on July 16, my Dr. told me I had no restrictions, and that I could start running again.  

So where am I today?  So far, my legs feel mostly fine.  My left leg -- which was the worse-afflicted with compartment syndrome -- is better than the right leg.  On my right leg, I've got some numb spots (which are a known risk of the surgery, they might never heal) and a little bit of swelling around the ankle.  I have 3 incisions on each leg, and the ones on the outside of my ankles are the ones that bother me most, because they continue to be persistently itchy as they continue to heal.

Did I make the right choice?  Here, 2.5 months later, I'm confident that I did.  If I keep running, and my symptoms return, then there was another contributing factor and it's back to the drawing board and probably off the racing circuit, but I'll worry about that in a few months.  

Right now, it's time to run.

Under the Knife

Since the end of 2011, I've been struggling off and on -- more on -- with seems to be exertional compartment syndrome.  I was diagnosed with shinsplints in January, came back after a month rest, faster than ever, and then symptoms -- pain in the ankle and shin, loss of range of motion in the left foot -- became persistent again in the fall.  I rested again, started running again in early 2013, but was seldom pain-free, and the the rather-intrusive compartment pressure test showed that I did indeed have compartment syndrome in both legs. 

I really didn't want to have surgery, even though my orthopedist said that it was the most reliable cure for compartment syndrome, so I tried physical therapy. His opinion was that it was worth trying, but he was pessimistic that it would work. It seemed like it worked when I got serious about running again in January...until it didn't, and symptoms returned.  I made the decision to have the surgery.  I met one more time with my orthopedist, who agreed, naturally, that if I wanted to train for longer races again, that surgery was the best course of action for me.

I met with the surgeon in early April, and he explained that the procedure involves making incisions in the layer of fascia around the muscles in my lower leg compartments, which releases the pressure and should relieve symptoms.  He said that was a relatively simple procedure, and that I could have both legs operated on at the same time, which would make my recovery harder, or I could do one after the other, which would make recovery easier because I would have one "good" leg, but would take twice as long to get both legs "fixed".  I opted to have compartment release surgery on both legs, and I was scheduled to arrive at Wellspan Surgery & Rehabilitation Hospital on Thursday at 7:30am for the outpatient procedure.

I arrived, checked in, and was quickly taken back to remove my clothes (even my underpants) and change into a stylish surgical gown, and then put into a bed in a pre-op room to get ready.

As it turned out, my surgery almost didn't happen, because of this little guy:

This is Domo, aka, "The Fun Panther", our crazy little friend, who left an approximately one-inch long scratch ankle-level on my right shin when he jumped over my lap (I had my right leg crossed over the other).  When I was taken back for pre-op, the nurses quickly said that this little cut might cause my surgery to be delayed.  Cats have a lot of bacteria on their claws, and so they are extra careful with cat scratches because of the risk of infection.  After my surgeon looked at it, and said that it was ok to proceed because it was not near enough any of the incision areas, they shaved my legs and gave me an intraveneous anti-biotic and painkiller.  The anesthesiologist briefly visited and explained his role in the procedure, and then it was go time.

My bed was wheeled back to the operating room, and I slid myself over from the bed to the operating table, unintentionally giving some of the surgical staff a free show.  One of the surgical staff said that they would be giving me the anesthesia, and I would be asleep in about 60 seconds.  I don't think it even took that long...

...and the next thing I recall, I was in my bed with some nurses around me, my legs bandaged and painful, and my head feeling very groggy.  The nurses told me that I told the nurses I was going to make out with my wife and I asked them to bring me my kitty, neither of which happened, of course.

Apparently I made more incoherent conversation with the nurses and then Chris, who had talked with my surgeon while I was still asleep, was brought back so I could talk nonsense with her, too.   I don't really remember much of the conversation, but at some point I was moved from my bed into a recliner, and given my crutches for a brief practice with them, before being wheeled out of the hospital to Chris' car.  When we got home, I groggily made it up the stairs and plopped myself on the couch, where I've spent most of the past three days.

(My legs right after getting home.)

I was definitely in pain, intense at times, but I wouldn't call it excruciating.  I've got a prescription for vicodin, which makes my legs feel better but has made me nauseous at times.  Each of my three days since surgery I've less sharp pains in my legs but more muscle aches and pains.  I didn't sleep much at all on Thursday night, but slept very well last night, and somewhat successfully made my first post-surgery visit outside the house, when Chris took me to Dunkin' Donuts this morning.

I'll learn more about my rehabilitation next Friday, when I go for my post-op visit with my surgeon, and until then at least I'll be on crutches and quite useless.  I was told not to count on driving for four weeks, but that most people are back driving and feeling pretty well in 10 days to two weeks.

And my friend, Domo, who almost prevented my surgery?

He's been a nice little rehab friend.

For further reading about exertional compartment syndrome, here are two other patients' blogs that I've found to be very helpful:

Legs on Fire:  My Experience with Compartment Syndrome
http://legsonfire.wordpress.com/

Life After Compartment Syndrome
http://erana.co.nz/compartment-syndrome/life-after-compartment-syndrome/

Again?

2 miles.  18:18.  So, my fastest run of the new era, but that's not really important.

What's important:

• No compartment syndrome pain through 4 two-mile runs (last Thursday, last Saturday, Tuesday, and today).  Again, not conclusive by any means, but a good sign.
• I felt really out-of-breath.  I was going to do two mile runs this week and next weekend, and then start trying to move up, but I feel like I'll probably be "stuck" on two a little longer than that.  A) I want to be cautious and B) I hate running in warm weather, so this was the worst time for me to begin a comeback.  I'd like to push myself up to 3, even if I have to mix in some walking, in the next two weeks just to get a sense of if my symptoms are really better, or if they only seem better because I am not running far enough.
• Someone upstairs is clearly telling me that running is stupid and I shouldn't do it anymore.:

Trying Again

I ran two miles on Thursday.  That may not sound like much, but it was the first two miles I've ran since April 20...which is also about the last time this blog was updated.

I have not been idle during that time.  I've been fairly diligent with the exercise bike -- since biking was the only cardio my orthopedist said I should do while I was rehabbing -- and also lifting more consistently than I have at any time in the last 3 years.  I've still been trying to earn my donuts.

I've been in physical therapy during May and June, learning new stretches and exercises that I hope will help me avoid the knife.  I've had my muscle fascias for 36 years, after all.  I'd like to keep them.

My run on Thursday was humbling:  2 miles in 19:04.  That's fine, and honestly, I couldn't care less about speed right now.  But afterward, I felt like it had been years, not months since I ran.  Parts of my legs of hurt that hadn't hurt since I decided to take up this stupid sport in 2006.  My quads were still sore from Thursday when I headed out for the second run of this latest comeback (2 miles, 19:34) this morning. I'm sure they'll hurt like hell tonight.  I was completely out of breath.  I can go 60 minutes on the exercise bike, no problem, but running is a whole different beast.

But its what didn't hurt that's important.  Shins=fine.  Ankles=fine.  Calves=sore, but regular soreness, not injured sore.  (I think I can tell the difference!)

It's a small sample size.  Just two runs at a distance where symptoms might not show up. I'll know more at 3 miles, I think.

I'm by no means out of the woods yet.  But right now, I'll take this gladly.

Compartment Pressure Measurement

Earlier in the month, I went to the orthopedist to talk again about the persistent calf and shin pain I've been having, mostly in my left leg.  With x-rays and MRIs coming back clean and rest, stretching, and calf exercises not doing much to help, the doctor determined that it was time to take the next step and do the test for Exertional Compartment Syndrome (which I'm going to call ECP).

Unfortunately for me, the test for ECP involves big needles being jammed into four places on each leg, then me running until my symptoms flare up, and then needles attached to a pressure-monitor being stuck in again.

I'm a wuss.  I've been dreading this.  The doctor and his assistant put iodine on my leg and used a small needle for local anesthetic, and I'll be honest, the procedure itself wasn't as bad as I feared.  It was probably worse for the doctor, who had to put up with my nervous banter between him, his assistant, and Chris (who was kind enough to accompany me for moral support and to drive me home).  I think I did crack one good joke during the procedure:  As the doctor was using a pen to mark where on my leg where he would insert the needle, I deadpanned "that wasn't as bad as I thought."  It was pretty much downhill from there.

When I left the office with the assistant, who accompanied me to show me the likely direction that would be safest for my run, my calves still felt a bit numb.  The run itself seemed ok considering I didn't take any naproxen, I didn't stretch, and I didn't wear compression socks.  All of these anti-precautions were in hopes of making my symptoms flare-up badly and quickly.  Instead, I ran for 20 minutes and while my calves became very sore, I didn't have the level of shin pain that I normally have.  I did feel kind of stupid running around the medical center, but I never run on treadmills and so I thought it was best to go outside.

Despite the lack of shin pain, I sat down to check that my left foot didn't have the full range of motion and given the level of pain in my calves, I figured I was "good" to go back and be re-tested.

The second round of tests hurt a bit more than the first,  but not as much as the results (positive) and the aftermath (calves extremely sore all day).

The measurements showed that even at rest, the compartment pressures in both my legs was higher than normal, and after running the left leg compartment pressure rose even more, while the right leg stayed pretty much the same.  These results do confirm Exertional Compartment Syndrome, and confirm that it's worse in the left leg.

My best option is surgery, but with my doctor's blessing I'm going to try a few weeks of physical therapy first.  It probably won't work, but really don't want to have surgery.  I can't stress that enough.

A second is option is quitting longer distances.  Stop running or stick to the mile, 2-mile, and 5K.  I admit this option is tempting after a frustrating, often unenjoyable last 16 months of running.  But on the other hand...if I'm going to give up running, I really don't want to go out like this either.  I'm probably not going to be a frequent marathoner, ever.  But I'd love to get back to my 2011 form in which I could run 8-10 miles several times a week and train myself up to a half without much trouble.  More specifically, I would really like to be able to run the AC half this year and either the half or hopefully the full next March in VA Beach. 

I've quit a lot of things in my life when they got too tough:  tee-ball, soccer, basketball, cub scouts, jobs.  I don't want to quit running yet.

Still, before I get ahead of myself to the surgery/no-surgery decision, I'm going to cross my shins and hope that PT will do the trick. 

Follow-up Orthopedic Appointment: This is Not Good

Since my shinsplinty-things seem to be getting worse -- or at least more consistently present -- I'd scheduled another follow-up visit with my Orthopedist.

Here's what I hoped would happen:

My orthopedist confirms the diagnosis of shinsplints and sends me to physical therapy.  I learn a bunch of new stretches and exercises and go on to qualify and probably even win the Boston Marathon.


What really happened:

My orthopedist found that I have good strength in my leg and foot muscles and that -- regrettably -- it's time for us to more seriously explore Exertional Compartment Syndrome as a possibility.  This will involve a huge needle being jammed into my leg muscles both "at rest" and after a long-enough run to induce symptoms (so probably 10 minutes, roughly one mile).  If the test confirms ECS, then my best option is surgery.

Good.  Great.  Terrific.

Basically, Compartment Syndrome is when a fibrous tissue membrane, the fascia, around a muscle is too tight to account for the muscle's swelling during exertion.  (Please consult medical websites for a more scientific description.  I'm -- surprise! -- not a doctor).

Here's a website with a good picture that demonstrates this.  (Note:  DO NOT do a "Google Image Search" for "Compartment Syndrome".  Trust me, it's a lot of gross surgery pictures that make me want to retire from this running thing.)

http://www.physioroom.om/injuries/calf_and_shin/compartment_syndrome_full.php

I'd guess that my problem is going to be in the anterior compartment and lateral compartment on my left leg.

So, bad luck for me.  But, excellent for you, since if privacy regulations allow it, I'm going to have my staff photographers (me and my wife) take some pictures of the compartment syndrome test, and maybe Chris can even be in the operating room taking pictures and interviewing surgeons as they cut out parts of my leg.

The test is scheduled for April 16.  I may push it back if the doctor thinks that the test itself is traumatic enough that it will prevent me from limping through Sole of the City, with some help from anti-inflammatory meds, on April 20.

I'll keep everyone posted as I freak the hell out.

April Fool

On Saturday morning, I popped an indomethacin and ran 4 hilly miles in 42 minutes.  I felt like I was back on track.  I felt like I had a chance.  

Today, I didn't take any magic pills.  I ran 1.2 miles in 12 minutes and my shin and the side of my calf hurt and I couldn't move my foot the whole way.  I limped back to my car and I just feel like maybe I can't do this any more and it's not worth trying.  Have I just reached the point where I should just look back on the good times, take all my DNSs, accept that this part of my life is over, and start whatever the next chapter is?

In reality, no.  I clearly haven't gotten there, yet.  

It's been about a year and a half since I first started having these troubles, but I did seem to have a nice comeback last Spring including 5K, 8K, and 10K PRs.  I relapsed rather badly in September and took basically two months off.  Since starting to run again in December, it seemed like there was progress, but it's only been the last month in which every single non-drug-assisted run is bad.  Indomethacin probably isn't a good long-term solution, but  I haven't been back to the orthopedist since November (I've got my appointment tomorrow).  I haven't been through PT yet, although I've got a feeling that's where I'm headed.  I haven't had surgery. I've still got 25 pounds I need to lose.

There's still a lot left to try. I know that.  And I both know of and know personally runners who have come back from more severe injuries. I'm not ready to quit, but now that runs like this are the norm, it's just too easy to wonder whether it's worth trying anymore or if I'd be happier if I just gave up.

 This slug, seen on my run this morning, 

would beat me in a 5K right now if I don't take indomethacin.

Shinsplints are Stupid. I Don't Recommend Them.

I know I'm a wimp.  I was a wimp in elementary school, when even the younger kids beat me up, and I'm a wimp now.

One of my friends is running a marathon in a couple weeks with four big metal screws in her hip.  Granted, she loves running WAY more than I do.   (By which I mean, she actually likes the running part, whereas I like the finishing the race part and the celebrating afterward part)

Still, it sucks when after one mile it feels like your calves are going to burst, as they did on Tuesday, when I did the walk of shame back to my car, or when after my 3 prescription-strength anti-inflammatory assisted miles on Saturday I didn't have full range of motion in my left foot.

I'm trying to pull my left foot back like my right one.  
It won't go any farther than this. D'oh.


I'm trying, though.  

I realized after the fact that prescription-strength anti-inflammatories, indomethacin, to be specific, were probably the secret to my "success" in both the Kelly St. Patrick's Day Shamrock 5K and the Shamrock 8K.  I have the occasional flare-up of gout, and I take indomethacin to reduce the painful swelling in my big toe, but it also fights inflammation in general, even if gout's not the cause. (I also take colchicine, which treats the gout itself.)  I was having a minor gout flare-up on and off in the week between the two races, and so I realize that I took my gout meds before both of these races.  I'm still confused, though.  I was having good runs (well, except for the fact that I'm still not in good shape!) at the end of February without the aid of any drugs. I'm going to the orthopedist on April 2, but in the meantime I'll probably try to get a few runs in with the help of my meds.

I also put some new insoles in the Brooks Adrenaline.  Between the insoles and the indomethacin, I got 3 miles yesterday, considerable improvement over the 1 on Tuesday.  I'm also doing a ton of calf raises and trying to use weights to strengthen the muscles around my shin, too.   I've now lost 3 big races to shin & calf problems.  This needs to end.

 
                           If nothing else, the purple insoles make the Brooks Adrenaline much more stylish.

Down and Out (Again) in Manchester, PA

It seems like just a few weeks ago that things were looking up.  I had to overcome my own lack of motivation (and I did get out and run again the next day from the "Inertia" entry), but my shins were feeling a lot better.  In my previous blog entry, I described running, slower than usual, but still running, the Shamrock 5K in Baltimore.

Unfortunately, things are really not so good.  Two weekends ago, I went out for a run and had the full-on shinsplint/ankle-swelling/lack-of-motion problem that caused me to shut myself down in October.  I gave myself a few days of rest, and limped through two miles on Thursday before giving up due to calf soreness.  I was suprised, honestly, how well I held up in the 5K.



I tried again tonight, and got through only about a mile and a half.  The ankle and shin seem ok, but my calves were really in a lot of pain.  I felt like I would only do more damage if I pressed on, so I dejectedly walked back to my car as I passed by.  My goal had been four miles.  Part of me thinks that I quit too early -- but I don't think there was any way I was getting 4 miles or even three this evening.

Problem:  I'm signed up for an 8K on Saturday.  

I'm hoping that because it's flat as a board and because it's a reminder of my glory days, going past the same Neptune statue that I ran by to finish my first marathon (and one of just two that I've run), that I can drag my carcass through the 8K.  I know it's walker friendly if it comes to that and I know Chris won't let me DNF, too...it's just hard to accept that what seems like relatively minor, lingering injuries are setting me back for so long and that I'm going to bomb at a race that I kicked butt at last year.

So, here's the plan, as such:

1. Continue to try to strengthen the ankle and shin muscles, and work on core.  I'd been doing well at this, but we have not had our weekly personal training sessions the past few weeks due to schedule.  That could be a factor, but I have to do more on my own.

2. Lose some goddamn weight.  I was 20 pounds, at least, lighter when I ran my last marathon.  I have to:
 a. get to the gym more and not rely on running as my sole source of cardio.
 b. EAT LESS  -- No dessert for me until I can run 5 miles.  (I will allow myself dessert on Saturday night if I finish the 8K)

3. Cut back on the race schedule.  When I outlined my race schedule for the year, regular commenter Danny opined that I'd signed up for too many races.  So, revised:

March

• 10 - Kelly St. Patrick's Day 5K, Baltimore, MD. (Done)
• 17- Townebank 8K, Virginia Beach, VA (Too late to do anything about this.)

April

• 13 - Yuengling Light Lager Jogger 5k. Pottsville, PA
•  20 - Sole of the City 10K, Baltimore MD

May -- None.  

June

• 1- Manheim Downtown Development Group: Rock-N-Glow 5K Race, Manheim, PA (Chris is running a half that morning.  I think I can hang at this one.  Plus, it's a crazy one that I can more easily write off as "just for fun".
• 22 - Dreaded Druid Hills 10K, Baltimore, MD. This is 3 whole months away.  While a lot can happen in three months, this is a tough race and I'm glad I didn't sign up for this one yet.

By doing this, it gives me over two months to try get back in shape and decide if I want to tackle Dreaded Druid Hills or not. I'm not signed up for it, so at least I haven't wasted money if I end up skipping it. 

I should, in theory, be able to do some of the Movie Madness 5K in Manchester on April 6, and two now-missing 5Ks, HACC Dash and Armed Forces Day 5K in Harrisburg in May if things are going well -- they are all small races that won't fill up.  I had put a half marathon in June in Philadelphia as a possibility, but I don't think that's even worth considering.  

 

I probably would have been better off, and more motivated/less frustrated, if I'd just started completely over from "Couch-to-5K" back in January.  That still might be my best option, but it would probably rule out Sole of the City. 

In summary, I know there are a lot worse running injuries and a lot of people who are tougher and more dedicate than me out there.  But still, **** you, shins.

What I Learned from the Cat

With only a few exceptions, every time I've run for the past two years, I've used my foam roller to stretch out beforehand.  And almost every time I've used the foam roller, a big, friendly black cat comes waddling slowly over, flops on the floor, stretches out, and purrs his head off.

It probably makes my pre-run preparation less efficient since I have to break in between reps for tummy rubs, but it's really cute.  

Unfortunately, for the last two weeks I've had to foam roll without any assistance.  Pooka the Cat lost the use of back legs two weeks ago, due to what seemed to be a pinched nerve (at least this is the level of detail at which I can explain what the vet told me).    Since then, he's begun a slow and steady recovery and he can now limp around, though he usually falls every few steps. 

Since he's been injured, he's had to be confined, partly for his own good, and partly for ours, since I didn't think he can make it to the litterbox under his own power.  As soon as I brought him home from the vet, I set up a comfy nest for him in a big plastic bin.  He had, food, water, blankets, and a litterbox.  He hated it, but when I gave into his crying and put him on the spare bed in my office, he dragged himself off of it the second my back was turned.  Though he's getting around much better now, I still don't want to leave him out and wandering when we're not around, since he's not navigating stairs very well and since getting down from furniture is still a challenge for him (he can get up on some things, but doesn't land well when he gets down.  He's feeling well enough now that he can climb out of his bin, so I have to leave him in the bathroom closet when we're not around.

What's impressed me, though, is the cheerful good humor with which Pooka has endured this and all his other medical mishaps (he's had surgery for bladder stones, was diabetic, and has hyperthyroidism).  Despite being completely unable to walk, he still was usual happy, purry self.  I, on the other hand, have let some shin problems turn me into a bitter, lazy grump.

It's ok to be frustrated by injuries.  But, as my expensive, fluffy pal taught me, I don't have to be such a dick about it.

Shins...ok?

I'm having a good week of running.  I haven't said that since at least September, and probably earlier than that.

It's only good in my current limited perspective.  The 3.1 miles I ran on Sunday and the 3.1 miles I ran tonight would be 2 of my 3 slowest-ever 5Ks (along with the York Jingle Bell 5K last December).  It's not hard to think back exactly two-years ago, when I ran 10miles effortlessly on Fat Tuesday as my last double-digit run before my first marathon taper.  It's a long away from that in terms of both distance and pace.

But that's not important right now.  What is important is that my left shin felt great.  What's important is that on Sunday I ran through Mt. Wolf, which, as the name implies, is super hilly, and finished my 3.1 without any walk breaks.  I was sore tonight, mostly in the quads, from that run and from last night's session with our personal trainer at the Y, but the shin was fine.  

I still think I'm going to have to defer from the Shamrock Half Marathon in a little over a month.  Adding 10 miles of distance in a month is more than i can do, I think.  But for the first time in a really long time, I can actually envision myself coming all the way back and finishing half marathons, marathons, and Spartan Races (just kidding!) again.

What's made the difference?  I think it's that for the first time ever in my running career, I'm really worrying about core strength and working on strengthening my legs.  I have to give most of the credit to Chris for dragging me to her personal training sessions at the Y, and to our trainer, Mike F. at the Harrisburg YMCA, for making us do 6 different kinds of squats in a row, followed by 4 or 5 different kinds of planks.   Though I'm usually cursing him at the time and threatening to kill and/or divorce Chris for dragging me along, it's the only thing I can think of to explain this recovery.  No pain-free runs in a row hasn't happened in a long time, and I should probably downgrade myself to "cautiously optimistic" instead of "dreaming of long distances."

I'm guessing I'll come crashing back to earth soon, but I'm going to enjoy the rare runner's high while it lasts.
**************************************************************************************************
Meanwhile, as sketchy a runner as I've been lately, I've been an even worse blogger.  A couple of entries though that I'd like to get posted "soon":

• The sad yet inspiring story of an injured kitty and his adorable kitty PT. (With cute pictures!)
• 2013 Race Schedule
• Running....From the Police? (Not as exciting or useful as it sounds)

2012: The Running Year in Review

Better late than never, right?  

My motto for 2012 was "Revenge!"  By the goals I'd outlined for myself, it was a total failure.  I deferred from both of the long races I'd signed up for (Shamrock Marathon in March and Atlantic City Half in October) and refrained from running for most of January, October, and November.  Injuries were really the name of the game in 2012.  

Because of that, I don't want to go month-by-month like I have in both of the other two year-in-review type posts I've done.  Instead, I'm going to borrow a format that my lovely wife, Chris at nevertrade.blogspot.com, used for a post.   

Best Race Experience
TowneBank Shamrock 8K -- J&A Racing does a great job with the Shamrock series of races in Virginia Beach.  I ran the marathon in 2011, and deferred and ran the 8K in 2012.  I think a lot of time it's (Whatever) MARATHON and oh, there's another race, too.  At Shamrock, 8K runners get really nice long-sleeve shirts, medals, and their own post-race beer party.  They really do a great job of giving all the runners the same fun experience (fun during the race itself may vary).  Not only does J&A put on a good event, the 8K course is scenic, flat, and fast and I ran the hell of it: 41:40, a PR by over a minute.  I was disappointed that I wasn't running the marathon, but still had a great time at this race and in Virginia Beach.  

Best Run of the Year
Hershey 10K -- this was a humid, miserable kind of day and definitely wasn't one of the more enjoyable races I've run (because of the weather and because I went way too fast out of the gate, it wasn't a bad event).  What it was was a 10K PR by over 5 minutes.  52:33.  I have no idea where this came from. If this time is to be believed, it's probably the best run I've ever had. I started too fast, up with the people that actually are REALLY fast, died,  and recovered to have a negative split that put me at the 8K mark below my PR time from Shamrock. This is a pretty huge outlier for me from any other 10K or 6 miles I've ever run, or the course was mismeasured.  Either way, I wouldn't be surprised if I never touch this PR.