Interim Report: Warning – This is Depressing

I fully expected a clean bill of health when I returned to the doctor last Monday for a follow-up on my quartet of stress fractures. The pain had subsided, I was walking several miles every morning, and I felt ready to return to the racing circuit. I knew I’d be admonished to listen to my body, stop when pain reached a level of 3, and walk slowly to lesson impact on my osteopenic bones. Okay, I could do all that.

Imagine my surprise and consternation when the MRI taken that morning showed an actual break in my big toe plus 3 new stress fractures in different locations than the original ones. It seems I just can’t win! Even with rest, physical therapy, a healthy diet, and additional calcium and vitamin D, broken bones and stress fractures seem to be my destiny. It’s an understatement to say I was depressed.

The doctor was worried about the effect osteopenia would have on my racing and vice versa so he hesitated to give me any advice about drugs to strengthen bone or how to deal with the ramifications of postmenopausal osteoporosis. It was outside his area of expertise (which was sports medicine) so my planned visit next week to an endocrinologist seems timely. He did caution me to avoid high impact activities like running (walking was okay), to wear double rocker shoes like Hokas to minimize pressure on my forefoot, and to seek that ‘sweet spot’ of mileage that would feel ‘just right.’ That might mean walking every day or every other day or even every 3rd day, while I use the off days to lift weights or cross-train. All good advice but not what I wanted to hear. I want to do ultras, not a couple of miles every few days. I want to test my ability to see how many miles I can accomplish in a set time period, and not be satisfied with a measly 2 or 3 miles every day or so.

But reality has interceded. Against medical advice and dire warnings from my husband, I decided to try the 24 hour Southern Discomfort race this past weekend. I told myself I would stop at a pain level of 3. I reassured myself that I would be okay with cheering on runners while I rested and sat on the sidelines – even if I had to stop after 3 or 4 miles. I lied. I cannot watch others take part in a race that I want to do so much. It’s like watching people dance. I also cannot put only 75% into a race when my gut wants to go full throttle at 110%. At Southern Discomfort I should have stopped at 10 laps (about 12 miles) when my pain reached a 3 but I persisted for another 10 laps. Full disclosure – my pain level at that point approached a 6. Had I not spent the last 4 months with my left foot encased in a boot, I would have pushed on for the full 24 hours. Only 9 more laps and I would have achieved a 50k. Fortunately, the thought of ending up in a boot again scared me and I stopped at 20 laps, only 9 hours into the race.

I know that I made the right decision to stop at that point (although I should really have stopped earlier – yes, I know that, really I do). This morning both my feet are slightly painful (in the interest of full disclosure, my right foot often hurt but not as badly as my left, so I don’t know if I have stress fractures in that foot as well). I don’t think I did any irreparable damage, but I have decided to take a break (no pun intended) from ultras for a while. Instead, I am considering doing 5k events that have generous finishing time allowances so I can walk at a slower pace for a shorter distance. It’s also probably time to try medication to build up my bones, an idea I’ve resisted so far, but if it helps, I may be able to do ultras once again.

I’ve learned that it is essential for me to walk at least 30 to 60 minutes every day if I am to retain my sanity. It’s probably healthier too, and when I return to ultrawalking I will limit myself to 3 to 6 races a year instead of the 25 or more I’ve been doing over the past decade. I will certainly include Southern Discomfort on that future calendar. The heat and humidity of Georgia in July didn’t bother me in the least and this year it didn’t rain, at least during the hours I was on the course. Physically I felt fine, with no pain or fatigue at all, except for those nasty stress fractures. John and Kelli, the race directors, are a husband and wife team who do a tremendous job and the organization is superb. The course is a paved 1.1 mile loop, partially shaded and mostly level. Goodies include a soft cotton tee shirt, cap, bag (new this year), and finishers get a hand-painted emu egg with stand and a pint glass (for those who meet certain distance requirements). We stayed at a remodeled Hampton Inn near the Albany Mall and were pleased with the accommodations. There are lots of popular eating establishments nearby (we ate at Applebee’s and Olive Garden). The race, with 6, 12, 24, and 30 hour options, is definitely a keeper!

 

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Relentless Forward Progress – with a Few Backward Steps

Last Wednesday was a busy but fruitful day; I had an MRI in the morning and a ten-week checkup with my physician in the afternoon. Results were mixed. The good news is that two of my stress fractures are completely healed while the remaining two show major improvement. I am now on a plan to wean me off The Boot and allow me a way to begin training again. Until next Monday I can be bootless while in my house but must wear it when I go outside. I can walk on my entire foot instead of having to limp on my heel and doing so without pain feels great.

On Monday I can walk outside (hooray! hooray!) but only for 10 minutes to start. If I do okay and don’t experience any pain, I can lengthen this time to 30 minutes, no more, until my next visit to the doctor in July.

Now for the bad news – the MRI also showed some nerve inflammation with my foot muscles. This can be caused by one of four things: diabetic neuropathy, bone infection, extreme exertion immediately before the MRI, or nerve entrapment. We were able to easily discount the first three. I don’t have diabetes, there was no sign of bone infection, and there was no way I could do anything resembling exertion before the MRI. That left nerve entrapment, and the only way to decisively diagnosis a disconnect between nerve and muscles is an electromyography (EMG) exam. This includes a nerve conduction study along with a needle EMG. This sounds very uncomfortable and painful to me (anything with needles is meets that description) but I was reassured that it is not too bad, and if it helps figure out my problem, I am willing to go for it. Whether a cure is possible depends on where the muscle-nerve disconnect is and what is causing it. I will have to be patient and wait until the middle of June for this test.

I was also referred for a physical therapy evaluation and to set up a treatment program so I can eventually return to racing. I am so excited about the prospect of getting back to my passion! I am focusing on the good news and trying to be positive about the confounding elements. And while I am nervous about having a relapse of these dreaded stress fractures, I am beside myself with joy at the thought of even a ten-minute walk outside!

Stress Fracture Update

I have been completely out of the racing world since the middle of January when I managed 53 miles at the FastTrack 24 hour race despite excruciating pain. I am trying desperately to recover from 4 metatarsal stress fractures in my left foot, but the ‘cure’ for stress fractures is to completely rest the fractured appendage. This means that, during all my waking hours, I must wear a knee-high boot that completely stabilizes my foot and makes any kind of aerobic activity impossible.

My only foray into racing has been to live vicariously through race reports from my friends and – to be frank – reading about their exploits often leaves me envious and depressed. I want to be ‘out there’ moving and, at least for the present, I cannot. I’ve been absent from Facebook because I get so saddened when learning about new races I must miss or reading about ones I’ve signed up for but had to DNS. Walking is my preferred way of dealing with stress, anxiety, and frustration, and that avenue has been frustrated for the last four months.

Yesterday I went to my sports medicine doctor at the University of Florida for a 10-week checkup. To say I was anxious is to minimize the duress I’ve been feeling during this entire recuperative period. I moaned and groaned during the entire trip to Gainesville and for days before the actual journey.

I wish I could say now that I no longer must wear the dreaded boot (dubbed Frankie, after the frenzied wife and mother in the television show The Middle). The news I received at this checkup was decidedly mixed. While it seems that there has been some healing, I still have pain on the anterior part of my foot. I am scheduled for an MRI next week, followed by a meeting with my doctor the same day to discuss the results and plan a strategy for healing and for weaning me off the boot. The very next day I will have a DEXA scan to examine my bone density and make sure my existing osteopenia has not devolved into osteoporosis.

So for the upcoming week it is back to the boot and complete rest for my sore foot. This enforced recovery period is the longest time I have ever been so sedentary and that includes complete bedrest during my complicated pregnancies. I’ve studied the medical literature as well as popular articles, both print and online, on running injuries and stress fractures to see if there are ways I can speed up recovery. As a result, I learned to avoid NSAIDS (they are supposed to retard healing), increase my intake of vitamin D and calcium (to improve bone density), and eat 4 to 6 prunes a day (the potassium has been shown to encourage bone health). Three times a week I lift weights and do abdominal exercises as well as physical therapy stretches to keep my shoulder and piriformis muscles strong (those weaknesses were due to previous injuries). As an adolescent, I used to enjoy hula-hooping so I bought a weighted hula hoop from a company based in Oregon and now spend some time each day with my hoop while watching television. But to be honest, these are all very poor substitutes for racing.

How do I spend all this down time? I knit and crochet various items, especially hats, shawls, and stoles. Some of these I keep, especially the ones made from wool that must be hand-washed and blocked, but most of the others I donate. My recent favorite charity is the Comfort Shawl Project coordinated by the School of Nursing at the University of Florida. So far, I’ve donated 10 shawls to the project, which gives the shawls to patients in the Palliative Care Unit at Shands Hospital. I have several more on my needles (knitting parlance for ‘in the works’). I also make hats for cancer patients undergoing chemotherapy.

In addition to knitting and crocheting, I also read and sew and quilt and I have become quite adept at doing most of these activities (not the reading though) while binge watching Netflix, Hulu, and BritBox. I also eat, partly out of boredom, but also to improve my diet by increasing my protein intake. Since I rarely eat meat and can usually subsist on fruit, nuts, cheese, and bread (and wine and beer in moderation), I often run a protein deficit, so now I make a point of including fish and the occasional steak or chicken in my meals. I normally avoid juice, preferring real fruit, but these days I take my vitamin D pills with a half glass of calcium and vitamin D-fortified orange juice. For my sweet tooth, I choose ice cream with a topping of nuts or granola, so I can get that added boost of calcium. Yes, I can rationalize that ice cream and frozen yogurt is a health food, though I try not to eat the entire container at one sitting. The downside of this relatively healthy (for me) diet – plus all this inactivity – is that I have gained 6 pounds! That is very depressing. But the bottom line is that I would rather weight 112 pounds instead of 106 if that means I am healthier and can get back out on the road walking again.

I can now understand why stress fractures are considered the runner’s worst nightmare. Once a stress fracture occurs, it becomes more likely it will happen again and to the same bone. That means that it will be crucial, once I get the green light to race again, to keep my training in check and stop at the first sign of foot pain. I will never again be able to do 35 marathons and ultras in a year and I am okay with that if I can still do at least one long race a month, taking breaks as needed.

There are so many great races I want to register for, but I am (not so patiently) waiting until my physician gives me the go-ahead. Until then, I am trying to keep busy, eat right, and stay positive.