When we last spoke, I was waiting for tests, waiting for my follow up MRI. Well, all the tests are in and the Maryland specialist was right in her initial assessment -- nothing wrong with me. Let's quote the good doctor:
The secondary causes of fracture that have been ruled out by my evaluation, and your prior evaluation includes:She continues:
thyroid and parathyroid disorders, hemochromatosis, multiple myeloma, hypogonadism (low testosterone), hypercalciuria (high urine calcium excretion), liver/kidney disease, celiac disease and idiopathic (cause unknown) high bone turnover.
There has been a fair amount of research done on why people get stress fractures and we simply can't find a specific reason in most people. In your case, vitamin D deficiency and mild low bone mass are certainly contributors. The cause of vitamin D deficiency is generally lack of intake. The primary source of vitamin D is the sun but we can only make vitamin D in our skin at our latitude in the summer months
So there it is: vitamin D deficiency and mild low bone mass (which appears to be, in my case, genetic). The good news on the former, is that with my increased dosage of supplements, my latest vitamin D levels are at a good level (I'm taking 2500 IUs of vitamin D daily).
Interesting, she also found that I'm iron deficient -- although that has nothing to do with my bone issues (more to my no-red-meat diet). My regular doctor wanted to make sure there was no gastric issues (can you say fecal occult blood test?) and there weren't. So at night I'm taking vitron-C to supplement my iron.
Meanwhile, I had my follow up MRI (load torpedo bay 5!). The femoral neck appears to be fully healed -- no edema, no swelling. Still edema in the pubic symphysis -- but that is not a weight bearing part of the pelvis. The ortho basically said to let pain be my guide on that front. However, the MRI did show what looked like a cyst in the femur which the ortho and the radiologist thought might be an osteiod osteoma (a type of benign tumor). Yikes! So they ordered a CT scan to confirm. Luckily I was off that day and was able to schedule a CT scan that day. Scheduled a follow up with the ortho the following monday (Presidents Day). Turns out that the spot is a synovial herniation pit -- in other words, an indentation on the outer edge of the ball of the femur (which when viewed head on in the MRI gave the appearance of an osteoma). Whew!!
So the end result of all this is that I can resume a conservative return to medium mileage -- sufficient to get me through Boston. The ortho wants me to let pain be my guide in terms of whether I'm running too much. Nothing major -- I should stay in the 40s in terms of weekly mileage at least until I feel no more pain.
Meanwhile, the ortho prescribed a bone stimulator to help the pubic symphysis heal. I got that last week. The Exogen Ultrasound Bone Healing System. Basically, it's a device that uses ultrasound to stimulate bone growth. I use it 20 minutes a day (at night). I do a follow up with the ortho in 6 weeks to see how things are going.
Of course, the proof is in the pudding. I've been running my daily 6 miler at about a 7:45 pace (for a while I wondered if I'd ever get below 8 minutes) with almost no pain! And last weekend I did a 15 mile long run -- only minimal soreness towards the end. And the best part of my long run was that I was able to run the first 7.5 miles with some of my XMP buds!! It was so good to get back out with my running friends.
So there you have it, sports fans. I'm back in the distance saddle again. Slowly building back my mileage -- not quite to the 60+ miles per week pre-injury but hopefully enough to let me start and finish Boston (which I plan to run at a moderate pace). After Boston, I'll re-evaluate to see whether I can resume the higher mileage and/or start working on speed again.
This weekend -- 18 miles.
Stay tuned...
