Thursday, June 8, 2017

I Still Don't Know What's Causing That Chest Pain

This is a long overdue follow-up to my race report for the Coeur d’Alene Marathon.  During that race, I started experiencing some discomfort on the left side of my chest.  Chest pain, particularly on the left side, can be a symptom of heart problems.  I didn’t have any other symptoms, so I continued running.  I went on to have a pretty good race.  Immediately after the race, I felt fine, but the pain came back later in the day.  It only hurt when I moved my left arm or the left side of my torso, so I assumed it was most likely a muscular problem.

It didn’t seem life threatening, so I waited until I got home to see a doctor.  I used to see a doctor who specialized in sports medicine, but he recently moved.  Since I don’t currently have a regular clinician, I made an appointment with whoever could see me soonest.  That turned out to be a doctor at a different clinic who could see me the next morning.  Her specialty is internal medicine.

While I wanted to assume it was a muscular problem, I needed to know for sure that it wasn’t a heart condition.  When the nurse took my pulse and blood pressure, they were both within the normal ranges.  My oxygen saturation was 99%.  The doctor listened to my heart and lungs, and they sounded good.  The pain on my left side was intermittent, and corresponded to movements of my left arm or the left side of my torso.  That seemed to indicate muscle injury, rather than a heart condition.  To be on the safe side, she ordered a blood test, an EKG and a chest X-ray.

The EKG looked normal, and the X-ray didn’t show any abnormalities.  The blood test was for an enzyme that would be elevated if there was heart damage.  Later in the day, I learned that test result was negative.

The doctor’s best guess was that my arm motion during the race caused an injury to some of the small muscles between my ribs.  She said that type of injury is more likely if you’re dehydrated.  I didn’t feel like I was dehydrated during the race, but I did feel dehydrated the previous night.  My hotel room was really dry.

The doctor prescribed Naproxen and rest.  When I asked if there was anything else I could do, she suggested I could ice it.  That was last Tuesday.

I have a family history of heart disease, so she also recommended having a stress echocardiogram.  I’ve never had one before.  The earliest I could get one scheduled was today.  In the meantime, I mostly rested, and I tried to avoid using my left arm.

Last Wednesday, I went for a short run.  It was my first run since the Coeur d’Alene Marathon.  It wasn’t really a serious training run.  I just wanted to know if I could run without pain if I minimized my arm motion.  I held onto my T-shirt with my left hand to ensure my left arm wouldn’t swing.  Running that way, I had no discomfort, but it’s an awkward way to run.  As I said, it wasn’t serious training.  It was more of an experiment.  I ran for a little over a mile, and didn’t have any discomfort.

On Thursday and Friday, I did workouts on the stationary bike instead of running.  I seemed to be able to get quality workouts on the bike without causing discomfort.  Then I spent the weekend at the FANS 24-hour race, volunteering, and crewing for some friends who were running and walking.  Just walking back and forth between our campsite and the start/finish area was enough to make my side hurt.  That wasn’t encouraging.

I felt much better on Monday, so I went for a short run.  This time I ran 3.5 miles.  I ran at a slow enough pace that I wouldn’t have much arm motion.  That felt OK, so I tentatively decided to try a similar run on Wednesday.

There was rain in the forecast for Wednesday, but Tuesday was a beautiful day for running.  Against my better judgement, I decided to run for a second straight day.  I only ran 3.5 miles, but I ran a little bit faster.  I think I got overconfident.  I felt OK at the time, but later in the day, my side started to hurt.

On Wednesday, I hurt more than at any time previously.  Sometimes, I hurt just sitting in a chair without moving.  That was a first.  I didn’t even ride the stationary bike that day.  I just rested.  I also made an appointment with an orthopedist.  I had to get a better understanding of the extent of my injury.

This morning, I had my echocardiogram.  That involved pedaling on a recumbent bike with gradually increasing resistance while they took images of my heart.  Within an hour of getting home, I got the results.  With respect to my heart, I had a clean bill of health.

In the afternoon, I had my initial consultation with an orthopedist at Tria.  The doctor found it odd that I couldn’t localize the pain.  Sometimes it hurts in my left side, just under my armpit.  Sometimes the pain seems to extend into my left pectoral muscle.  Sometimes it radiates into my back.  If this was a muscle injury, the location of the pain should be more specific.  It seemed more likely to her that this is a pinched nerve.  There were spots on my X-ray that looked suspicious, but she couldn’t see anything conclusive.  I’m having an MRI tomorrow to look at the disks in my neck and upper back to see if I have a bulging disk.  I probably won’t learn anything until Monday.

I’m scheduled to run the Bighorn Trail 100 in just over a week.  I’ve done a lot of good training, especially in May.  I haven’t done much since Coeur d’Alene, but I would have been tapering anyway.  If it was just a matter of fitness, I would be ready to race.  If I had to endure some discomfort, I’d still race, as long as I had a realistic chance of finishing.  My concern is that attempting to run 100 miles would make this injury much worse.  I don’t want to start another downward spiral like the one I had two years ago.

If it is a disk that’s impinging on a nerve, the motion of running shouldn’t make it worse, but the jarring might.  A trail run will involve more jarring than a road race would.  The doctor’s advice was to do another short run before making my decision.  If a four mile run causes problems, running 100 miles is probably a bad idea.

I’ll probably make a decision about Bighorn in the next few days.

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