Thursday, June 29, 2017

For Now, I'm a Goal-Oriented Walker

Two weeks ago, I had back surgery.  Today, I had my first follow-up appointment, and a nurse removed my sutures.  The incision is healing nicely.  There were no signs of bleeding or infection.  The area around the incision was slightly inflamed for the next few hours, but I don’t expect it to cause me any significant discomfort.

Last week I had a great deal of pain on my right side.  I think some muscles and/or nerves were inflamed after the surgery.  Sitting was often uncomfortable.  Lying down was downright painful.  This week, the pain began to decrease.  I’m cautiously optimistic that it will gradually go away.  I’m transitioning from prescription painkillers to small doses of ibuprofen.

I can finally take a shower without wearing a waterproof bandage, but most of my other restrictions are still in place.  I can’t do any high-impact activities for the first 12 weeks after surgery.  That includes running!

I have several other restrictions that are only in place for the first six weeks.  They include most forms of exercise.  The one notable exception is walking.  I’ve been encouraged to walk several times a day.

Before I left the hospital, I asked one of the nurses how far I should walk.  She said to start by walking around the block.  After that, I could lengthen my walks by about five minutes each day.

When we left the hospital, I walked to the parking ramp.  The next day, I started joining Deb for her daily one mile walks around our neighborhood.  Since then, I’ve also been walking on a treadmill.

I go for walks three or four times a day.  I always walk at least a mile.  On at least one of my walks, I go farther than I did the day before.  I’ve been consistently adding a quarter mile each day to my longest walk.  Today, my longest walk was four miles.

At first, I stuck to a pace of three miles per hour.  That’s a “casual” walking pace.  If you use a site like Google maps to get walking directions, the estimated time will be based on that pace.

After a few days, I picked up the pace to 3.1 miles per hour.  That pace still felt pretty easy.  Since then, I’ve been bumping up my pace every two or three days.  I’m currently walking at 3.5 miles per hour.

I’m not supposed to bend or twist my back, so I’m paying close attention to my arms and shoulders. I’m sure I could walk much faster, but I might start to have a vigorous arm swing.  That, in turn, might translate into movement of my back, which could slow my recovery from the surgery.  Runners and race-walkers usually bend their elbows at a 90 degree angle.  I’m keeping my elbows straight, so my arms hang loose by my sides.  They move back and forth a little, but not nearly as much as they would if I bent my elbows.  With this minimal arm motion, my shoulders remain square.  As long as I can do that, I’m reasonably confident I can walk without twisting my back.

Because I can’t run for 12 weeks, I have to cancel a lot of races I had planned to run.  I’ve already cancelled my travel plans for five races.  I expect to cancel plans for a few more, but I might not have to cancel all of my summer races.

Later this month, I’m scheduled to do the first two races of the Prairie Series.  These races don’t have any time limits, so I’m tempted to walk at least one of them.  Even if I walked at a casual pace, I probably wouldn’t be the last person to finish.  I can drive to those races, so there aren’t any flights to cancel.  If I don’t do them, I’m only out the entry fees.  I can wait until the day before the first race to make a decision.

Technically, walking a marathon wouldn’t violate any of my restrictions, but I’ve been told to build my mileage slowly.  At the rate I’m going, I wouldn’t get all the way up to a marathon in just a few weeks.  That would be a big step up.

The only other races I’m reluctant to cancel are two international races that I was going to run in August.  It was a rare opportunity to make one trip to Europe and do marathons in two different countries.  I’ve already paid for the flights.  Unfortunately, these races do have time limits.  One has a six hour time limit.  With six more weeks to work on my walking proficiency, I might be able to do that.  The time limit for the other race is 5:30.  I have serious doubts about being able to walk that fast.  I would need to average 12:35 per mile.  I once did a half marathon at an average pace of 11:49, but I had a pretty vigorous arm swing.  If I was confident I could finish at least one of the races, I would make the trip.

I discussed these marathons with the nurse at the neurosurgery center.  He had reservations about the Prairie Series, even though I’d be able to walk slowly.  The problem is that those races are only a few weeks away, and I would need to make a big step up in distance.  He didn’t veto it.  Ultimately, I need to pay attention to how I feel and be willing to stop if walking is giving me discomfort.  He was afraid once I started the race, I would be unwilling to stop.

Surprisingly, he had no problem with my attempting to do the European marathons, even though I would need to go much faster.  I think the key there is that those races are two months after my surgery.  When I discussed this with Deb, she asked me what I would do if I was 25 miles into the race and realized I couldn’t make it within the time limit.  Would I be tempted to run?

I haven’t made my final decisions about any of these races.  For now, I’m going to keep up my daily walking.  It’s the only exercise I’m getting, so I’m embracing it.  Last week, I walked 32 miles.  This week, I’m on pace to walk 48 miles.  Walking is much more comfortable than sitting, so I don’t mind if it takes up most of my free time.

The main advice the nurse gave me was to let pain be my guide.  If I’m walking so much (or so fast) that it causes me discomfort, I should stop.  Likewise, if I have to continue taking painkillers in order to walk so much, I should stop.  For that reason, I plan to ween myself off painkillers as soon as I can.  After that, if I can walk without discomfort (either during my walks or later in the day), I’m doing OK.  If not, I need to back off.  I have a couple more weeks to see how it goes more making decisions about races.  Then, if I’m going to start a race, I have to be willing to stop if I’m having discomfort.

Friday, June 16, 2017

Today I Had My Back Surgery

Today, I had my back surgery.  I arrived at 8:00 to check in and get prepped.  The surgery was scheduled to start at 9:40, but the surgeon was running ahead of schedule, so they were able to wheel me into the OR a few minutes early.  They gave me a sedative before we left the pre-op room.  I remember them wheeling my bed through the hallway, but I don’t remember arriving at the OR.  By then, I was already asleep.

The surgeon called this procedure a posterior microdiscectomy.  The release form had a much longer description, which I can’t remember.  This is a stock image (from a different hospital) that shows roughly what they did.

The surgery took less than an hour.  Then they moved me to a recovery room, while they waited for the anesthetic to wear off.  Then they moved me to an observation room, where family can visit.  It’s possible I regained consciousness in the recovery room, but the first thing I remember is being in the observation room.

It was immediately apparent that the surgery was successful.  I no longer had the chest discomfort that I’ve had for the last 19 days.  I also had no discomfort in my legs.  That can be a side-effect.  I wiggled my toes in both feet.  No loss of feeling or motor control.  So far, so good.

I eventually learned that they only had to make a small incision, they didn’t have to remove much of the bone, and they were able to remove the disk material that was impacting my spinal cord.  There were no complications.  The surgeon characterized the procedure as “boring.”  You don’t want surgery to be exciting, so that was good news.

This was my first major surgery, so I didn’t know how my body would react to the anesthetic.  I seem to have had a best-case scenario.  By the time I got to the observation room, it was wearing off quickly.  I didn’t have any nausea, and I felt like eating.  I started with some water and crackers.  Then the nurse asked me if I wanted any other food.  I asked if they had pizza.  They did.  Hospital food isn’t as bad as I was led to believe.  Either that, or it has improved.  Now it’s like ordering room service.  My first post-op meal was pizza and cranberry juice.

I have some post-surgical pain at the site of the incision, but so far it’s minor.  They gave me a prescription for a narcotic pain reliever, but so far I haven’t needed it.  I’m hoping to manage the pain with Tylenol.  I’m also taking a muscle relaxant.

For the next two weeks, I have to follow a few rules to minimize the risks of infection or bleeding.  I can’t shower for two days.  After that, I can shower with a water-proof bandage, but I can’t bathe.  I can’t take aspirin or other NSAIDs.

I also have rules to prevent reinjuring by back or tearing open the incision.  For at least two weeks, I have to avoid bending or twisting my back.  I have a brace to help with that.  For six weeks, I have a 10 pound lifting restriction.  That probably rules out any air travel, since even a carry-on bag ways well over 10 pounds.  I’m not to do any yard work or housework.  YAY!  (I don’t mind helping with the housework, but I hate yardwork.)

I have to avoid high-impact activities for 12 weeks.  That includes running.  I’ve already cancelled travel plans for my next five races.  I expect to cancel my plans for several others. 

I'm allowed to walk.  In fact, they strong encourage walking.  There are a few races on my schedule that may be walkable, but I don’t know if the doctors will want me walking that far.  I’ll ask about that at one of my follow-up appointments.  For now, it looks like it’s going to be a boring summer.

I know I said boring is better than exciting, but these restrictions will test my patience.  I hate cancelling races, but I want to put this behind me.  I don’t want to make it worse, like I did with the injuries I had two years ago.

Wednesday, June 14, 2017

I Need to Have Surgery to Relieve the Pressure on my Spinal Cord.

When it comes to healthcare, it’s important to be your own advocate.  Doctors can give you answers, but sometimes you have to know which questions to ask.

When I went to the clinic two weeks ago, their focus was my heart.  I had chest pain on the left side, which is a red flag.  It took nine days before they could completely rule out heart problems.  Then they gave me a clean bill of health and said, “Good luck on your trail run.”  At that point, they were assuming I had a muscle strain that would heal with rest.  So was I, but I wanted to know for sure.  I scheduled a consultation with an orthopedist.  Had I not done that, I wouldn’t have known I had a spinal injury.

After an exam, the orthopedist knew it was a nerve, rather than a muscle injury.  She was on the fence about ordering an MRI.  MRIs are expensive.  I have insurance, but I would still have a significant out-of-pocket cost.  I wanted to know for sure, so I encouraged doing the MRI.  Had I not done that, I wouldn’t have learned how serious my condition was.

Had I not aggressively pursued more information, I probably would have started the Bighorn Trail 100, not knowing that I had nerve damage that would make me more apt to trip and fall, and also not knowing that a fall could easily result in permanent disability.

After seeing the MRI and doing a more thorough exam, the orthopedist referred me to a neurosurgeon for a consultation.  I had that appointment on Tuesday.  It was only then that I understood.  The doctor told me I needed surgery.  Not, “I recommend surgery” or “Surgery is your best option.”  It was more like, “You need surgery as soon as possible.  We can get you in on Friday.”  Surgical procedures aren’t normally scheduled that quickly.

I was a little shell-shocked.  I thought there was a good chance that the disk extrusion would heal eventually with non-intrusive treatments.  It probably would, but there's a more immediate concern.  The disk is exerting so much pressure on my spinal cord that it's already causing nerve damage.  It's imperative that they relieve the pressure as soon as possible.

So far, I had been lucky.  I was having intermittent discomfort in my chest.  I wasn’t having pain anywhere else.  I wasn’t having weakness or numbness in my legs.  I wasn’t losing motor control.  I wasn’t losing control of my bowel or bladder.  All of those things were possible.  If I move in a way that causes further compression of the disk between my T8 and T9 vertebrae, it could put more pressure on my spinal cord, resulting in nerve damage that would likely be permanent.

To impress upon me how certain he was that I needed this surgery, the doctor used the phrase “slam dunk.”  Then he started talking about Superman.  Actually, he asked me if I knew who Christopher Reeve was.  If you don’t know, he was the star of four Superman movies.  Then he injured his spinal cord in a horse riding accident.  After that, he was paralyzed from the neck down.  He eventually died at the age of 52.  That’s four years younger than I am.

His point was that unlike most tissue, nerves don’t heal.  If you injure your spinal cord, the damage is permanent.  I was already showing symptoms of nerve damage in my right leg.

I’ve never had surgery before, and I never thought I would have spinal surgery without getting a second opinion first.  As he showed me my MRI images for the second time, he explained why my T8/T9 extrusion was so serious.  I quickly came to understand that the risk of not having surgery was significantly greater than the risks of the surgery itself.  I was nervous about the surgery, but I was much more nervous about what could happen at any time before the surgery.  Suddenly three days seemed like a long time to wait.

The procedure is basically to make an incision in my back, cut a hole through the bone, and then remove enough disk material to relieve the pressure on my spinal cord.

This morning, I went back to the hospital with Deb, so she could see the MRI images herself and ask questions.  Then I had a preparatory procedure that involved having a CT scan so they could insert a marker into my back.  That will show the surgeon precisely where my vertebrae are.  The surgery requires pinpoint precision.  In the afternoon, I had another doctor appointment to go over pre-op procedures.

Tomorrow, I don’t have any doctor appointments, so I’ll have a full day to freak out.  I’ll read through all my instructions for the surgery, and I’ll do one last workout on the stationary bike.  I’m not allowed to run, because the impact could cause further damage to my spine.  After the surgery, I’ll still have strict restrictions on my activity while I recover.  For the first two weeks, I won’t even be able to ride the bike.  I probably won’t be able to run for the next three months.  I’ve already cancelled the Bighorn 100, but I need to start cancelling reservations for my other summer races.

My surgery is scheduled for Friday.  Believe it or not, neuro-surgery is now an outpatient procedure.  The procedure itself should only take one to two hours, but it will be done under a general anesthetic, so I’ll have to stay in the hospital until that wears off.  I should be able to go home the same day.

Wish me luck.

Monday, June 12, 2017

I Finally Know What's Causing My Chest Pain.

I finally found out for sure what’s causing my chest pain, and it wasn’t good news.

When I saw an orthopedist at Tria last Thursday, it was hard to localize the pain.  That led her to believe it was a pinched nerve, rather than a strained muscle.  No one muscle could explain all the places where I was feeling pain, but a nerve could.  On my chest X-ray, she noticed some smaller than normal gaps between some of the vertebrae in my upper back.  That could mean a bulging disk, but the only way to be sure was to do an MRI.  I went in on Friday to get MRIs on my neck and my upper back.  I had to wait until today, to see the doctor for the results.

She knew I still needed to decide whether I was going to run the Bighorn Trail 100, so she suggested that I do another short run to see how I feel.  If I was in pain after a four mile run, I probably shouldn’t try to run 100 with this injury.

On Friday, I did an easy 3.5 mile run, while doing my best to minimize the movement of my left arm.  On level ground, that wasn’t too difficult, and it enabled me run without any discomfort.  When I got to a small hill, it was harder to keep my left arm from moving.  I had a small amount of discomfort, but it wasn’t too bad.

Previously, the pain seemed to come from all over the left side of my chest.  Now it was more consistent.  Certain movements of my left arm caused pain in one of the pectoral muscles.  Over the weekend, I learned to avoid most of the movements that caused pain.  If I kept my left elbow pinned to my side, I could move my left hand and forearm without any discomfort.

That made me wonder if I could run without discomfort if my left arm was in a sling.  I gave that a try on Sunday.  I ran on the treadmill, which made it easy to experiment with different grades.  Running slowly on level ground, I felt OK.  It was similar to the run I did on Friday, but I didn’t need to make a conscious effort to control my arm motion.

After about a mile, I started to run uphill.  As I put more effort into the run, I would occasionally notice momentary discomfort in my left pec, but it wasn’t a big deal.  Eventually, I set the grade steep enough that I had to walk.  I was still working hard, but I was much more comfortable.  Walking is far less jarring than running, which makes it easier for me to keep my arm relaxed.  That part of my workout was promising.

As I turned the grade back down and resumed running, I once again noticed some temporary discomfort.  Overall, doing a mostly uphill workout wearing a sling felt about the same as doing an easy level ground workout without the sling.  I still had big concerns about running with a sling.  I didn’t know if it would cause muscles in my upper back to get sore.  I also didn’t know how much the strap would make me chafe after running with it for several hours.  I wasn’t convinced that I could do the race this way, but I also wasn’t convinced that I couldn’t.

I still had to make a decision about Bighorn.  I booked my flight with miles, so I had until this morning to cancel the flight without penalty.  As recently as Saturday, I desperately wanted to do the race, but it seemed like a bad idea.  I felt surprisingly good yesterday and better this morning.  I felt like I was turning the corner.  It may help that I’ve been getting better at avoiding motions that cause discomfort.

This morning, I had my follow-up with the orthopedist.  Going in, I was optimistic.  I felt much better this morning than I did last Thursday.  With four more days to recover, I was leaning toward doing the race.

I told the doctor how I felt over the weekend and how my runs went.  She was encouraged by my progress, but didn’t want me to do any more running with a sling.  She shared my concerns, but was also worried that it would alter my stride in ways that could cause other problems.

Then she gave me the results of my MRIs.  I have a couple issues in my cervical spine, but the big issue was in the thoracic spine.  I have a large disk extrusion between my T8 and T9 vertebrae.  The disk is filling most of the space where my spinal cord should be.  That’s pushing my spinal cord way to the left.

She was expecting to see a disk impinging on one of the thoracic nerves.  That would explain my chest pain.  This disk was impinging on the spinal cord itself, which could potentially cause a multitude of problems in my lower body as well.  She was a little surprised that I wasn’t having more symptoms.

She couldn’t tell me it was OK to run Bighorn, but she also wasn’t willing to tell me I couldn’t do it.  Then she decided to do some tests of nerve function in my legs and feet.  One of the tests revealed a neurological symptom in my right foot.  After doing that test, she told me she didn’t want me to do the race.

Her concern was that all the jarring of a long trail race could cause me to develop worse symptoms in my legs.  That in turn, could cause me to fall.  She was worried I would not only be setting myself up for failure, but I could develop symptoms that are much worse than what I have now.

She referred me to a neurosurgeon at another clinic for a consultation.  That doesn’t mean I need surgery.  It just means I need the opinion of a specialist.  I’m still cautiously optimistic that this injury can resolve itself over time.

I see the neurosurgeon tomorrow morning.  In the meantime, I’m not supposed to run or do any activity that’s jarring to my spine.  I’m also supposed to avoid activities that twist my back or create pressure in my chest.  I can resume some strength training exercises, but something like a bench press is still out of the question.  To maintain some of my aerobic fitness, I can ride a stationary bike.

After today’s appointment, I cancelled my flight.  I won’t be running Bighorn this year.  That was disappointing.  I’ve worked so hard to get in shape for it.  Until two weeks ago, I like my chances of finishing it this year.

My other summer races are also in question, but I’m taking it one race at a time.  For now, I’m waiting to see what the neurosurgeon says.