Getting back into shape...

Let me start this posting by commenting on how much it sucks to get out of shape.  The problem is that I remember where I was, and in starting to workout again, I think its an easy thing to just start with those workouts.  You'd think that my muscles screaming at me would be an indicator to back off, but that would make sense. 

In any case, from an injury standpoint, things are going well.  My foot is on the mend and I am able to run again.  In fact, I started some very light running about 2 weeks ago, about 7 weeks post surgery.  Since then I've been able to build up to 3-4 mile runs with some walking mixed in because I'm fat and out of shape.  Having said that, despite some disappointment at the fitness I'm in (as compared to the fitness I want to be in or was in) I'm doing pretty well.

Swim:
I am out of shape.  No way around that.  I took a few months off and am paying the price.  Fortunately for me, swim fitness will come back quick.  I've been in the water a grand total of 5 times and can already feel things coming back.  My wind isn't there yet, but my stroke feels reasonable.  I just need to keep on keepin' on and I'll be back to myself.
Unfortunately my swim partner Scott has recently been told that he is an under-achiever in the water.  In fact, he has been for the last several years.  This of course means that I have been an under-achiever as well.  His sets are considerably faster than when I left the pool, this makes me sad.

Bike:
Overall I am in better shape on the bike than anywhere else.  I was able to start riding about 2-3 weeks post surgery.  Just easy stuff, but everything helps.
The hip/glute/piriformis/sciatic injury is starting to get under control.  Over the last few months it has become clear that this is entirely a bike fit issue. 
Years ago my first professional bike fit put my seat height at 79.5cm.  That was when I first started to see some of these issues.  I made some modifications myself, and ultimately started having real major issues that appeared to be my hamstring.

After some major time away and rehab, I came back to the sport with a new bike fit.  My PT had me at roughly 74cm on the bike seat.  That is a MAJOR difference.  And it worked, the injury was fine and did not resurface.  It did lead to other issues such as a lack of power and cramping quads.  So I went for a retul fit and they promptly raised my seat back up.

Now, keep in mind, 'back in the day', I did not really track all my coordinates.  Fortunately my PT did track some of this so I know what range I need to be in.  I'd also add that I thought I had a torn hamstring which I rehabbed, so moving my seat back up made sense at the time.

In any case, today I am slowly working my way back down to a point where the seat height is not causing me issues.  I am currently sitting at 78cm and will probably move down another 5mm.  I may adjust the seats placement over the bottom bracket as well, i'm not 100% sure. 

The good news is that the changes appear to be working.  I did some really hard riding in the last week and a half and have not suffered any real consequences.  I've also added running, and no issues so far. 

Run:
The good news is I'm way ahead of schedule.  I had not planned to run until next week when I originally had the surgery.  As I was not in pain, I started running 2 weeks ago.  I'm running every other day at the moment 3-4miles per run. 

The bad news is that I am really out of shape.  I'm taking walk breaks and feel like death.  That's all I have to say about that.

Weight:
My weight is up.  That's what happens when you're used to burning 4,000-5,000 calories per day, eat accorndingly, and then stop working out.  I accept responsibility for my poor eating habits.  I put on 15lbs total.  I'm already down about 3 from the last few weeks.  Once I can really start hitting it, the weight should drop off pretty quickly.  I don't have to show much restraint when I'm burning high numbers.

Crohns:
I've actually been having some pretty significant issues.  As I look back over time, I've been ina little bit of denial about it too.  It seems like the last year and a half or so I've been having bouts as a regular occurance.  On the bright side I can control them with prednisone.  On the bad side, they keep returning. 

I spoke with doc, and I'm on a lengthy dose of prednison now that is ramping down in the next week.  It sucks, I hate it, and it kills my sleep.  But I need to get the cycle of inflammation down.  Hopefully a longer cycle of pred will knock this down and put it in remission for a while.

In any case, assuming things continue to progress well, I might do some real races this year.  I'm still keeping my eye on Pigman, so we'll see if that happens. 

A Little Ray of Sunshine

For a change of pace I have some good things to write about.

My foot appears to be healing just fine.  I get the pin out of my toe next week Wednesday.  Overall I am walking with no pain and in a normal shoe.  Although I don't know that I'm supposed to be in a normal shoe, I am doing so without any pain.  In fact, I'm walking better now, 3 weeks after surgery than I was before the surgery.  That can't be a bad thing.

I've been able to start biking again.  On the not so good front, my pirfiormis started acting up almost immediately.  However I saw the PT again and we may have uncovered the issue within my SI joint.  After a little manipulation and some specific rehab, its already feeling considerably better.  For a change, I'm actually pretty hopeful we've finally uncovered the root cause of my issue and can resolve it by the time my foot is good enough to run on.  So even that is good news.

My weight is not nearly as bad as I thought it would be.  I only put on about 10lbs with 2 weeks of no working out.  Changing my diet for those two weeks was never really an option...so it is what it is.  Once this week is out I'll be biking every day and watching what I eat a bit more so those pounds should fall off pretty quick.  Not helping matters was my Crohns.  It acted up a few times forcing me to a diet of cheese burgers and chocolate shakes.  They may be yummy, but healthy and nutritious they are not.  The grease lets everything slide right through, so that's helpful.

As things are starting to get a little better for me, I've begun to look towards the summer a little bit.  We might actually get some good whether in the near future...so biking outside would be great.  I won't while the pin is in my toe as I do enough stupid crap on accident...no need to do it on purpose. 

I'm hoping to start light running in June.  The earlier the better.  I'll start to think about potential races after that.  I'm really doubting it, but maybe Pigman in IA is an option before I go to Canada with a trip to the Austin 70.3 after that.  It will all depend on the foot as I'm not going to push it.

Allow me to leave everyone on this note:

Moving on

Before I begin with what will be a relatively normal posting, I'd like to spend a brief moment on what occured in Boston.

To start with, I'd like to offer my condolences to those who are either directly or indirectly impacted by this event.  I've thought about training for a stand alone marathon with the hopes of qualifying for Boston at some point, but I love triathlons too much to break from them for that long. 

All told I probably knew 10-20 people that were at the race.  My childhood neighbors were posting pictures prior to the explosions.  Aside from the people I knew directly, endurance athletes share a common bond.  We see each other training on the popular trails and roads.  We talk to each other at the races.  We spectate together at races our friends are in, and we have a sense of community.  We've suffered through countless miles trying to achieve our goals. 

The Boston Marathon was, is, and will again be an awesome event.  It will carry on. 

In any case, tomorrow I get to see my foot for the first time.  It's been completely bandaged and wrapped for two whole weeks.  I've also been unable to wash my foot and its starting to get a little bit ripe.  So I do look forward to that. 

Overall my foot feels pretty good.  There is a giant pin in the toe, and that will hurt if I move my foot the wrong way.  Other than that it is mostly pain free.  We'll see how it feels with the bandages off and a little more mobility.  I am sure I'll have to be careful. 

What's funny is that even though I am walking in surgical boot...I think about walking far less than I used to.  Now that the pain is gone, I simply walk naturally....and that is a very good thing.  We'll see if I can do that without the bandages.

To the best of my knowlege, the pin stays in my foot for another 2 weeks.  Here is what they'll be doing:

It's pretty sweet.  I'm even tempted to do it myself, but I'm not sure I could get it at the proper angle.  I'm thinking about recording the event so everyone can see if I turn into a little baby and cry.  I've had several friends offer to come over with a pair of pliers and remove the pin for me.  As nice of an offer as that is, and I'm sure it would save my insurance provider a little money, I will pass.

Other than that, I am a little concerned about my piriformis syndrom.  Despite zero working out for the last two weeks, it still bothers me on occassion.  I had to cancel my follow-up appointment on this last week due to my foot.  I'm going to try to get in this week if there is an opening.

Other than that everything seems to be doing well.  Part of me is hoping I can start some light riding tomorrow.  Bike shoes have flat bottoms, so if I keep a nice steady pace and no cranking on the pedals I don't see what damage I can do.  We'll see what the doctor says.  The other problem will be the sciatic nerve/piriformis issue.  Biking seems to cause that issues as well.  So starting up may not be the best idea.

I have discovered that foam rolling and digging into that area with a ball seems to help in the short term, but make it a little worse in the long term.  I wonder if I accidentally dig into the nerve and need to move the ball onto the muscle more.

I have no doubt my weight is up.  That's the main reason for wanting to start biking now.  I need to burn calories as eating less appears to be totally out of the question.

Post Surgery Update

So as many of you know, and some do not, I had surgery on my right foot on Monday.

It came on very fast as things just seemed to line up properly.  First off the injury to my piriformis muscle was creating a number of issues.  My shoulder was hurting from all the swimming, and I was basically thinking of taking some time off.  Add that to the fact that my 2nd toe on my right foot had been bothering me for a number of years, and it was time to get that corrected.

Long story short, 10 years back (roughly) I had a bunion removed off of my right foot.  As a result the big toe was shortened and the 2nd toe was very long in comparison.  Over time that toe hammered and the tendon underneath became very tight.  Walking/running gave me this tearing sensation that would range in pain depending on the day.  But it was always there and always irritating.

I rarely mentioned it because I generally pushed through.  I knew what it was and there was no real reason to complain about it as I could choose to fix it any time.  Well, the time was right.

Surgery went really well and the doc thinks he fixed everything up for me.  I was hoping I could have him get a few pictures with my phone as he was taking the saw to my toe, but Aimee didn't think that would be a good idea.  Truly a shame, I know!

Right now recovery is roughly 2-3 months.  That is for running specifically.  I'm guessing that I'll be able to bike in 1 month.  Swimming will probably come shortly after that with running being added last.

The foot is weight bearing (to a point) right now.  So I am able to get around.  I took a couple days off of work and am able to work from home as well.  Tomorrow I'll be back in the office with some ice and a pillow.

In any case, my race schedule for the season is "kaput".  But that's okay as I had no real race goals anyway.  I'm hoping I can come back from the surgery fully rehabbed and ready to go. 

On a side note, I need to watch the calorie intake or else I'm gonna look like this in 4 weeks:

Anyway, I'll keep up with the updates as I progress.

Slacker-itis

So rehab is starting to make some progress.  Overall I think Piriformis was the issue.  I am now able to bike and run, although I am not able to do so with any intensity at this point.  That's the good news.  The not so good news is that all the extra swimming I did flared up some older shoulder issues from high school and college...so I have taken a little break from swimming.  And now I have a full blown case of swimmer slackeritis.  The idea of getting up in the morning to swim is so revolting I simply turn the alarm off in the mornings and roll over.  I'm not proud of that. 

Having said that I can fully justify my behavior by simply saying...who cares.  It's swimming.  I'll be one of the top swimmers no matter what.  That may sound arrogant as hell, but seriously, a few weeks off won't impact anything in the grand scheme.

On another note, the bad news is that I am considering another surgery.

Before I continue, allow me to difinitively say that I do not have Munchausen syndrome.  http://en.wikipedia.org/wiki/M%C3%BCnchausen_syndrome

I'm sure denial is an indicator for this disorder...and so maybe I do have it.  But I was once told that if you're able to question your own sanity...then you can't be insane.  I'm all good.

In any case, here is the deal.  Many years ago, probably close to 10, I have a rather large bunion removed from my right foot.  The surgical procedure ended up shortening my big toe, and not by an insignificant amount.  At the time I thought nothing of it as I wasn't terribly athletic yet...I had just started into triathlons.  I'd had the bunyon all my life, wearing dress shoes all the time for work and then starting to run caused a lot of problems.

Long story short, one of the potential problems that was not addressed with the bunion surgery is that my 2nd and 3rd toes are now too long.  And as I wear socks, my toes get bunched up.  Typically the big toe is strong enough to prevent that, but not in my case as the toe is too short.  That, over the years has led to hammer toes. 

Overall I'd say I've been dealing with this for at least 5-7 years.  I can't remember when it first started to surface.  At one point I had the tendon lengthened in my 2nd toe, and that seemed to help a lot.  But over time the problem has returned.  As things currently stand walking actually hurts worse than running.  Dress shoes tend to suck.  It's a giant pain...in my foot.

I haven't posted anything about this for a vareity of reasons, but the primary one was that I could ignore it.  As my regular readers, my natural tendency is to ignore the pain until it becomes a full-blown issue preventing me from doing what I want or even requiring a trip to the ER. 

I've tried orthotics and they helped a bit.  I tried a metatarsal pad, which I still use.  But that's been ineffective.  Lately I've been using a tape-job that essentially limits the toes range of motion.  For the most part, this is the most effective treatment I have.  And it is only 30-40% effective.  It only makes things a bit less painful.

As I was doing some rehab and thinking about the season I came to realize a few things:

First off, I know for a fact that I am favoring that foot.  And that could lead to a host of other problems...including an imbalance in my hips causing the piriformis syndrome.  Even if that isn't the cause, now that my glute pain is gone, I've noticed that my foot actually hurts.  That's not good considering how little I've been running.  It's generally sore with some sharp pain thrown in with every step.  I've also noticed that my right leg is generally sore in the foot/ankle/shin region.  That can't be a good thing.

But more than that, I have no real plans for this season.  I have no race to qualify for, and I don't even really care.  I've always known that my foot would require some work, and I've taken every half-measure possible at this point.  Perhaps the time for half-measures is at an end.  Especially since I'd like to train and race for the long-term, this may be the best overall option.

Last time I saw a foot doctor for this they did say that shortening my 2nd and 3rd toe should resolve this issue.  Recovery is around 3 months, so if I were to have this done in about a month from now, I'd be able to get back into some training after 2 months, running after 3 or so.  That puts me into July.  Not so bad. 

We'll see what the doctor says in early April.

In the mean time, rehab and working out will continue as if there are no issues.  Should be fun.

Piriformis Syndrome

Welcome back to the wonderful world of medicine.  It's awesome to be back with all of you so soon.

Allow me to recap where we are for today's episode.
Two years ago I was Dx'd with a minor hamstring tear. 
New MRI last week shows no such tear.  Looking at the old MRI's, we're not sure there ever was a tear.  It's pretty doubtful.

That basically means all the pain I've been dealing with is undiagnosed.  It took me 6 MD's to get to that point.  Awesome.

So I saw a new doctor last week, after having that MRI taken.  We talked about things for a bit and based on my symptoms she thinks it is Piriformis syndrome.  For those of you that did play guess my Diagnosis...Mark was the winner.  Although its hardly fair as he is also my PT.  His big prize is getting me as a client...again.  Congratulations!

http://en.wikipedia.org/wiki/Piriformis_syndrome

So first let me say, anytime you see the word "syndrome" in a diagnosis...it means they don't know what the hell the real problem is.  Just sayin...

Having said that, this at least gives me a plan of attack. 

Today I went in for a corticosteroid injection right into the piriformis muscle.  (Not to be confused with the performance muscle.  Those are two completely different things!!)  It was actually more unpleasant than I expected.  Having crohns disease I lost any semblance of pride long ago.  But as I was lying on the table with my left cheek hanging out, one of the fellow's comes in and starts talking about getting pictures.  Being an immature idiot I get a little laugh going.  The doctor doesn't get it because clearly this fine medical professional is talking about ultrasound pictures as that is what they are using to guide the needle that is in my rear.

Of course this laugh causes movement.  Do you think it is a good idea to move when there is someone holding a needle in your body?  No, of course not.  I don't think I need to explain why I chose this movie clip.....

Anyway...as I sit here writing this, the pain killer they also injected has worn off.  I am quickly discovering that jabbing a specific muscl (repeatedly) with a needle actually hurts.  On the bright side, if the location of the pain is any indication, this is the problem I have been having.  I am currently sore in exactly the location I've been hurting in all this time, and the pain is shooting down my leg in the same way it did while working out. 

I have to take the next 5 days off.  And I mean completely off.  The doctor was very explicit and left me with no wiggle room.  Apparently the injection makes me more susceptible to tears.  Wouldn't that just be ironic as hell?  After the last couple years of thinking I had a hamstring tear that I was rehabbing, I finally find out it is piriformis syndrom.  I get it treated and that treatment actually causes a tear of some kind.  The more I think about it, that sounds exactly like me.  I should probably get some crutches just to be safe.

Anyway, nothing for 5 days and then I start rehab.  At this point I do not know what the rehab will consist of, what kind of biking and running I can do, or anything else for that matter.  Hopefully I'll know more in a few days.

The good news is that I'll likely be racing this season.  And I don't think my bike fit has to change dramatically.  So hopefully I can get back a lot of the gains I made and stay strong for the season.  And no quad cramping would be fantastic as well.  I'm not sure what will happen to my race schedule at this point.

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?