Operation Diagnosis

Alright, I've tallied everything up regarding this hamstring/back/glute/etc issue. Over the last 3 years I have seen 6 doctors, I've had 2 MRI's (read by two different radiologists), multiple x-rays, and a ridiculous number of manual tests. I've seen multiple massage therapists. An A.R.T. practitioner, a chiropractor, and multiple PT's.

Despite all that I am still undiagnosed and a little tired of the ordeal.  I'm wishing Dr. House was real.  And I do find being pushed from doctor to doctor a little irritating.  So, in the interests of getting diagnosed, I thought I'd post my symptoms online so that the 'big giant brain' that is the Internet can assist.  Maybe a prize will go to the winner.

So here are the details.

The issue presents itself with sharp pain in the middle of the glute. Left side only. Very rarely higher, however the pain can and does go down the leg to the back of the knee. Very early on (2-3 years ago) it presented with a burning type sensation that felt like fatigue in the glute and hamstring. When I didn't give it the rest it needed it was debilitating sharp pain when I walked/ran and did other side to side motions.

 

It still does that today, but lately it seems to tighten up the entire hamstring. The actual issue started back up after I'd changed my bike fit back to an optimal fit (according to retul) from what was a fit by my PT that took a lot of pressure off my hamstring. So the seat was a lot more forward and lower with my PT and the retul raised it back up. I noticed some mild pain when I made the change and hoped I'd get used to it. I even lowered my seat a little bit to help. But on New Year’s Eve while doing a 10k run the entire hamstring basically locked up. The next day the same old pain in the glute came back.

The injury, when not symptomatic, can take the pounding of running without any issue, however as I just described, when coupled with cycling (retul fit vs. PT's fit) the symptoms flare up quickly and cause problems with running. When symptomatic running is not possible without further aggravating the issue. I can typically feel it within a minute or two of starting the run.

Sitting seems to aggravate it now; I don’t recall that being the case when this originally started. The injury also appeared to respond to hamstring rehab, however the rest may have been enough. Sometimes ice and heat on the back/glute/hammy helped. Prednisone seemed to help on occasion as well…but not always. I don't take NSAIDs and Pred only when the crohns flares up.

Injections in my lower spine were ineffective.

A.R.T. is very effective for short term relief. She works on the hammy, glute, and hip flexor area. I can feel things loosen up immediately, however that usually only lasts for a few hours.

Okay, those are the symptoms.

I'm thinking about starting up a pool and taking bets. Right now I have one person who has guessed IT Band Syndrome. I am currently guessing there is an issue with my sciatic nerve.

All diagnosis ideas are welcome? 

Hamstring update

So the last couple times I've posted I've alluded to an upcoming hamstring surgery.  Now I'm not so sure that said surgery will actually take place.  It's not that I've changed my mind per se, rather the doctor isn't so sure I'm a candidate.

Apparently hamstring surgery is not typically done for partial tears which is what I originally had.  It isn't that surgery couldn't be done, or even be successful.  However the overall prognosis isn't all that much better than simply doing rehab.  A new MRI is needed to see what we're really dealing with.

With a partial tear, after some rest and rehab the injured area will scar over and that scar tissue will provide a certain degree of strength and stability back to the muscle.  Unfortunately the injured area is generally not as strong as it was prior to the injury and is never as flexible.  Surgery for both partial and full tears comes with its own list of risks and potential complications including a ridiculous amount of time in a brace and on crutches.

What this means for me: 
I don't know yet.  I had another MRI on Thursday last week to see what additional damage I did to the area.  I see the surgeon this Thursday to talk about the results.

Based on how I am feeling, I doubt surgery will be the recomended solution.  I'd like to think that I'd know if I had fully torn my hamstring.  I think the giveaway would be the muscle gathering around my knee...and I am of course assuming a certain amount of pain.  While I've been known to stupidly push through pain in the past, I'm guessing it would be more difficult to push through when there is absolutely no hamstring muscle remaining.

So, we'll see.  In the mean time I've been swimming a fair amount, but that has to stay somewhat limited due to shoulder issues from high school swimming.
I've been biking, but its all been easy stuff.  I will have to modify my bike fit to take the pressure off my glute and hamstring again.  Hopefully we won't go quite as far as we did for last season...I don't need my quads cramping in every race again.  I have not been able to run at all yet, but I've been doing a lot on the eliptical and other rehab type exercizes.  I'm hoping to try a light run in the near future to test things out.  We'll see.

So, this is both good and bad news.
I was hoping that surgery would be the long-term solution that would get me back to normal once and for all.  That doesn't appear to be the case.  So this is something that I will always be dealing with.  Having said that, I will most likely be able to race this season.  I won't need 6 months of rehab.  And I might be able to start slowly running in the next few weeks.

Stay tuned.

Update:
I saw the surgeon today and no longer have a diagnosis of any kind.  The MRI showed no evidence that a tear ever existed. 
So now I am off to a new doctor to see if we can figure out what in the hell is going on.

On the bright side, no surgery as there is nothing to repair.  On the negative, I don't know what's wrong. 

Proximal Hamstring Repair Surgery

So, the time has come.  In my mind anyway.  We'll see if the surgeon agrees or not.

I really took it easy last week.  Lots of swimming and other easy work that didn't involve the hamstring.  Very easy bike riding, no running.  Overall the hamstring has improved, but not nearly enough.  At this point even a light ride aggravates things.  This would lead me to believe that it would take several weeks, if not months of no working out coupled with rehab to get back to a good place.  And at that point there is no guarantee that I'd be back at 100% and it seems more likely that I'd just aggravate things again.  So, it is time to get this repaired once and for all.

For those of you wondering how this surgery happens, here you go:

Warning:  This video is disturbing and nasty.  View at your own risk.

I have no doubt I will be an absolute pleasure to deal with during my recovery.  As far as rehab goes, from what I've heard it sucks.  Here are some of the highlights I've gotten from my PT.

Days 1-7:
I'll be given an ankle pump.  For some reason that sounds dirty to me, but I'm pretty sure it is to make sure my feet and ankles don't swell up.  This is probably a lot like compression socks.  I have friends that enjoy that fashion no-no.

The biggest issue for days 1-7 is that I can't do anything.  I am expected to lie prone or on my side the entire time.  When I asked how I go to the bathroom...the words bedpan and standing toilette were used.  At that point I asked if a medically induced coma was possible.  I don't think that request was taken as seriously as it should have been.  Apparently there are risks to the brain.  My obvious response is that the risk of brain injury is much higher because I'll be bashing my face against something hard after about 2 days.

Days 8-14:
Still pretty restrictive.  Not sure about sitting or anything like that.  But lots of range of motion work.  If its anything like the ROM work I did after tearing my ACL in college...it will royally suck.  I'm not sure if it is still like this...but back in Eau Claire where I did all my rehab it was horribly painful.  I went through the surgery with 2 other kids and they had us on a table cranking on our legs.  For some reason it wasn't bad for me, but the other two had it bad.  They basically needed to be given a wooden stick to bite down on while they basically screamed in agony.  Awesome!  I couldn't find a youtube video of that, instead I have this:

Weeks 3-5:
On crutches.  From what I've heard I can't drive for 4 weeks.  Not really able to sit for about that long as well.
Not sure when I can go back to work.

Weeks 6-9:
Walking with normal ROM.  From this point on things don't sound too bad.  I'm able to do most normal stuff.  I can start very light swim/bike/run.  But no intensity of any kind.  I probably won't be able to push off the walls in swimming.  Biking will have little to no resistance.  Running will be on a zero-gravity treadmill or in very short durations.  Not sure at this point.

Weeks 10-24:
More of the same with increasing durations and intensity.

At that point I will hopefully be cleared for full training.  But I'm pretty sure this is all a best-case scenario.  If I do anything stupid, or in other words, if I am myself, there will be complications delaying things.

I don't know when the surgery will occur.  If it were up to me it would be tomorrow.  Lets get this show on the road.  I am hoping we'll get this moving sometime the week of Feb 18th.  But I am not sure. 

I'm wondering who thought this "healthy lifestyle" thing was actually healthy.  I feel like I should run down the list of surgeries and medical issues that have been caused by athletics again.  I think I blogged about it once before.  I'll have to dig that up.

On Sunday as I was sulking and somewhat depressed, (while eating a 1 pound bag of sour jelly bellies and drinking 20oz of coke) I was thinking about how I might actually be better off being lazy and getting fat.  It may be healthier for me and it seems to work for a huge segment of the population.  Who am I to judge?  In fact, once upon a time I was 265lbs.  I could go back to that pretty easily.  In fact, I bet I could get back up there before my rehab is complete!

I'll have to ponder that.

I should add...I will be taking pictures and logging my progress along the way. 

Decision time

So I did the Run Into the New Year back on December 31.  Overall did okay.  Unfortunately at about mile 2 my hamstring started to get pretty sore.  Being myself I ran through it instead of just stopping.

I have still not recovered.  I then got sick and lost 4 days of training, and the hamstring was still not better.

As I sit here typing this I am awaiting a call back from the surgeon's office for an appointment.  It's looking more and more likely that I'll have to get this corrected...by way of the knife.  The most likely scenario is that once I have the surgery I'd be on crutches for 6 weeks.  Rehabbing in some way shape or form for about 4 months.  At that point I'd be able to start swimming and biking again.  I'd be able to start running around month 5, and full training after 6 months.

I'm hoping I can start swimming with no kicking or kicking off the walls after 6-8 weeks and maybe some really really light biking or something like that so I can burn some calories and stay active.  I'm a much happier person when I'm able to do something.

I'm not sure there is much choice at this point.  If I keep my bike fit where it is, optimal for biking and running, it continually hurts my glute/hamstring.  If I lower it back to where I was last year, I can't generate much more power on the bike and end up with my quads cramping up the moment I get off the bike.  So if I want to train/race something is going to have to be done. 

Obviously 2013 would be a total loss.  I'd be back to full training in September.

I believe the appropriate phrase is...f*ck me!

The Only Easy Day Was Yesterday.

So as the end of the year approaches, it’s time for a little reflection. Of course that reflection comes in many different forms. There are many areas of focus, race results, professional accomplishments, personal accomplishments and so on.

Recently I've seen a lot of talk about the definition of success, so I figured I'd start there. Almost none of this is original thought, rather its bits and pieces of what others have said. I've tweaked, paraphrased and copied until it fit with what I wanted to say. Hopefully this will makes a little sense.


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Success isn't defined by winning a race, it is defined by each of us individually.  It's based on our goals and the things we hope to accomplish in life. Perhaps your goal is weight loss, a promotion at work, or athletic accomplishments.  What your goal is less important than what you do to achieve that goal.

Success is the silence and peace of mind that comes when mind, body, and soul are working together.  Every goal starts with a single step. That step, repeated consistently, becomes a process, a habit.  It continues until the goal is reached. Some people take the necessary steps, others do not. The only one that knows or cares about the step you've taken is you. "The vision of a champion is someone who is bent over, drenched in sweat, at the point of exhaustion...when no one else is watching."

Success is choice; it is the building of a habit. Will you complete the task that will make you stronger, faster, better, smarter? Success comes when you find love in completing those simple tasks every day. Cultivate the love for the process.  Real success is not found in a single day, real success is the cumulative effect of doing the little things right consistently.  People don't get fat by eating one piece of cake, they get fat because they eat that cake consistently.

When your brain tells you that you have every reason to skip a step, and you want nothing more than to listen to your brain so you can spare yourself the pain. That's where success is bred. Do you have the intestinal fortitude to push through? You make the decision right then, in that moment. Will you do what’s necessary to succeed - or won't you? The successful person is often times simply willing to do what the unsuccessful person was not willing or able to do. Will you give into the pain?  Will you give in to the discomfort?  Or...will you adjust to it?

Success is the journey. The challenge isn't someone else’s, it’s yours. The challenge is within us all. It's the aching in your lungs, and the burning in your legs, it's the bile rising in your throat. It’s the voice in all our heads telling us we can't. Failure occurs because we get into our own tiny little brains and defeat ourselves. Success is realizing that the only way out of hell, is through it.

Sometimes in life there is a price to be paid no matter what decision you make. For those that have set goals and succeeded in reaching them, you already know that it pays to be a winner.

The process is simple. Building the habit is simple. It's nothing more than setting priorities and following through.  Most things in life are fairly simple. Simple, unfortunately, is not the same as easy. The only easy day was yesterday.



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Now I have to live by my own words.  I put on 5 pounds of crap in Mexico.  Now that the holidays are basically over its time to get those pounds off and drop down to 185.  I want to hit 350w for a 20min test, and I want to run a 10k under 40min.  Those things won't happen by accident.

Tis the Season!

Well the holidays are upon us.  For many this is a time to reflect, be with friends, family, and those we love most.  For me, its time to go to Mexico!!!  Aimee and I have our 8 year anniversary coming up, so we're both looking forward to the trip.  Hopefully it gets a little colder here in the great white north before we leave, otherwise I'm not sure the trip will feel as worthwhile as it could.

My training is coming along very nicely.  My foot seems to be doing a lot better and I think the problem comes down to shoes.  When I raced that 10k I was in racing shoes without much padding.  I had run in them before, but nothing as hard as a 10k.  So my feet were sore after that race.  Immediately after the race I started running in brand new shoes and I'm pretty sure I had them laced too tight.  I'm not 100% sure that's the problem, but I was able to run hard on Monday with no ill effects.  So for the moment all systems are go.

The crohns appears to be back in remission.  Stress = flare.  That's just how it works.  While some may view the flares as a real negative, I try to take them as a sign that I need to focus on what's really important in life.  Don't get me wrong, the flare ups suck.  But there is always a lesson to be learned.  Sometimes you can't control the external stressors in your life, but other times you can.

I've come to learn that Steelhead 70.3 will not qualify for the 2014 world championships in Vegas.  The race is a couple weeks earlier than than normal so it will qualify for 2013.  As a result I won't be doing that race this year.  I'm not 100% sure what I'll be doing.  But here is a tentative race schedule.

Jhawk Early Bird sprint- April 28
Lake Mills sprint - June 2
Liberty 1/2 Ironman (Minnesota) - June 8
Pleasant Prairie Olympic - June 23 -(try to qual for USAT)
Wisconsin Triterium Olympic - June 29
USAT National Champs - Aug 10
Pigman 1/2 Iron (Iowa) - Aug 18
Austin 70.3 (Texas) - October 27th (Try to qual for vegas 2014)

I'm thinking that this summer of races will really be about having fun and trying to figure out my best pacing strategy.  I don't know that I will really have any specific goals other than going fast and placing as high as I can.  I don't necessarily care about USAT Nationals, it would just be fun.  I will care about Austin 70.3, assuming I end up doing that race.  It would certainly be my A race as it would be nice to spend the end of 2013 and 2014 specifically focusing on the WC's in Vegas. 

With my training going in such a positive direction I'm finding that I already look forward to next season.  But its a long ways out with all of Winter yet to come.  We'll see what happens. 

Thanksgiving Update

So its been a little while again.  Not obnoxiously long, but long enough.

Overall things are going very well.  After my new bike fit with John at W&S I noticed an immediate improvement in bike power, but it came with a price as my hamstring and glute started causing some problems.  I went back in and learned that my pedaling technique is partly to blame as I am pulling up with my hamstring way too much.  that was probably due to when I had my seat way to high and had to pull up.  In any case, I made some adjustments to my technique, followed those up with lowering my saddle by about 2mm and my issues are almost entirely resolved.  So hopefully we can put the quad and hamstring issues to bed.

Biking has been going extremely well since then.  In fact my last power tests showed an almost 5% improvement from September to the middle of November.  So that's pretty good news for just a better bike fit and a little hard work.

My running has been both exceptional, and really bad.  Recently I've felt extremely strong running.  My normal forget about it run pace used to be in the low 8's, and now I'm routinely running in the 7:30-7:50 pace without thinking about it.

My last 5k test had me at a vdot of 50 which is just under a 20min 5k and roughly 41:20 10k.  Both are times I could be happy with.  In an effort to improve my running I signed up for the RACC running series.  The first race was earlier this month where I did much better than I anticipated by running a 40:20 good for 14th overall.  Next step is to break that 40min barrier.

Unfortunately after the race my feet were pretty sore, and my left foot has some kind of problem.  I can run...but not hard.  Even doing something simple like a 3x2 set has my foot hurting.  So for the moment there will be no intervals for a few weeks.  Gotta roll with the punches.

As for swimming, I've discovered I'm a complete slacker.  I have no interest in the water.  I get distracted after about 300 yards with my mind wandering to all kinds of places.  Focus is usually not an issue for me...so it is a little disconcerting.  Fortunately when it comes to running and biking, the focus is still there.  I just need to make sure my foot remains healthy.

My weight is good and slowly going down.  Last time I checked i was down to 195.  Pretty solid for the off season.

The crohns only gets an okay rating.  I've had some issues and more recently (yesterday) had a somewhat serious issue that required some prednisone.  You'd think I'm used to it after all these years, but I don't like taking days off for this kind of crap.  It feels like excuse making and drives me a bit nuts.  If I make excuses it will be for not swimming...not because my poor little tummy hurts.

Anyway, I've been asked to make my posts more funny.  Today is not that day.  But I have been doing some thinking along those lines and I hope to come up with something good in the near future.

I did manage to get myself a new bike.



Isn't she beautiful!

Lastly, USAT age group nationals will be held in Milwaukee this August.  There is a lot of chatter going on and I think its going to be a bunch of locals beating up on each other.  This is the attitude I'll be taking...assuming I decide to race it.

Happy Thanksgiving everyone.