Back in the Distance Saddle Again

Evenin' sports fans,

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:
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.

She continues:

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...

The Waiting is the Hardest Part...

Good evening sports fans

The song lyric of the week: Tom Petty & the Heartbreakers' "The Waiting is the hardest part..."

Last week, I had my visit to the endocrine specialist at the University of Maryland School of Medicine. We went through a complete history of my running, health, various tests, etc. The doctor's initial reaction was not exactly what I wanted to hear: In a nutshell, she said that some people are genetically predisposed to stress fractures due to low bone density and I may be one of them. Indeed, her words were "this probably not what you were hoping to hear." She said it was no coincidence that my first stress fracture was in my 40's. She also thought that running 60 miles a week may not necessarily be in my future. Again, not what I want to hear.

But, she did want to rule out other things and did agree that my bone density was dropping and I have low vitamin D levels. So I took another battery of blood tests. Ready for the list? Iron, Transferrin, Ferritin, T Transglutaminase (TTG), TSH, T4 free, comprehensive metabolic panel w EGFR, CBC with differential and platelet, C Telopeptide, Alkaline Phosphatase, PTH intact, Protein Electrophoresis, and Immunofixation Electrophoresis.

So now I'm waiting for the results of those tests.

Meanwhile, the orthopedist wrote a prescription for a follow up MRI, which is scheduled for next Wednesday. I see the ortho next Thursday. Hopefully the MRI will show good news.

Meanwhile, not all is gloom and doom. I ran Monday and Tuesday and barely felt anything at all in the pelvic region. So that is great news. Indeed, I felt so good on Monday that I was about two miles into my run before I even bothered to look at my watch; and would you believe I was running 7:15s? It felt REALLY good. Of course, I was a bit sore the next day. But this was the good kind of sore -- in the quads, from running harder than I've done in months. I was back to a slower pace on Tuesday.

Meanwhile, my long run will go up to 8 miles this weekend. I figure I'll do a slow progression of long runs 6, 8, 10, 12, 14, 16, 18, and 20. This puts the 20 miler during the last weekend of March -- just in time to taper for Boston. Oh well, at least I'll have one 20 miler in the bank which should get me through Boston -- it won't be my fastest marathon but I should avoid both the DNS and the DNF.

Even if the MRI shows me 100% healed, I think I'll stick to this conversative schedule. I've already written off racing Boston. And truth be told, I'm actually kinda excited about taking it a bit slow. I think I'll bring my camera and take pictures and videos along the way. And then, with any luck, I'll resume full training in the summer with XMP for the 2013 Marine Corps marathon.

So here I am sports fans, waiting. Waiting for the endocrinologist to call about my blood tests. Waiting for the MRI. Waiting for the orthopedist.

But also waiting for my 8 miler this weekend (which will be my longest run since August). Heck, just waiting for my next run.

I guess, maybe, it isn't so hard...

January Update

Howdy sports fans.  Just thought I'd drop a quick note updating how the recovery is going.

I think my last note was just before New Years.  Anyhow, the ortho "quasi" cleared me for running -- nothing too long and definitely nothing too fast.  "What doesn't hurt?" he asked at once visit.  "Easy miles" was my reply.  "Then stick to that."  So, my recovery training plan has focussed on slowly building back mileage at a slower pace -- leaving building back pace for another time.

So, I turned to my old distance progression chart -- 2 weeks of 12 miles (4 x 3 miles), 2 weeks of 16 miles (4 x 4 miles), 2 weeks of 20 miles (4 x 5 miles), and 2 weeks of 24 miles (4 x 6 miles).  I finished that last week and am doing one more week of 4 x 6 miles.

Next week, I see the bone specialist at the University of Maryland, so I figured I'd do one more week of 24 miles.  See what the specialist has to say.  Then, the ortho is going to prescribe another MRI to make sure everything is healing properly.  After that, I'll add a 5th day of 6 miles which will become my long run (hopefully).

Not much more to say right now.  I guess I'm in a wait and see sort of mood.

Tendonitis of the...elbow?

Howdy sports fans!  Just so you know, I give equal coverage to other parts of the body as well.  In addition to dealing with another pelvic stress fracture, since mid-summer I have been dealing with a very painful tendonitis of the right elbow.  Technically called "tennis elbow," although I have no clue where the tennis comes from because I don't play (it hurt so bad, the doctor told me to cut back, so now I only play five-is - -get it?)

Anyhow, back in August, the ortho gave me a cortisone shot for the elbow.  That worked, for a couple of months, then the pain came back.  Hard to grip with the right hand, pain in the elbow when working or typing or using a mouse, etc.  So the ortho recommended a procedure called platelet rich infusion therapy or PRP.  They remove blood from the left arm, spin out the platelets, and inject the platelets directly into the tendon (apparently the elbow is not a very vascular area so it can be hard to heal from certain types of tendonitis).

Today was the first of two platelet injections.  Let me tell you friends, it hurt like hell!! The ortho has to inject the platelets directly into the heart of the tendon near where it connects to the bone.  Youch!  I can barely move my arm and, several hours later, can only just now start using my hand (it went a bit numb).  I go back in two weeks for the final set of injections.  Yippee!!

Anyhoo, for your viewing pleasure, some pictures:

Taking the blood from my left arm

spinning out the platelets in the centrifuge

X or rather "dots" mark the spots for injection

preparing the injection site

Platelets!!

Owwwww!

All done, for now

2012 Year in Review

Holy cow, sports fans, two posts in one day.  But I can't let the year end without my obligatory end of the year running recap.

The year started off well enough - on track for some decent mileage.  Then I got my second stress fractures in two years (femoral and pelvic).  Anyhow, I ended the year with a total mileage of 1784.7 miles (second highest since I started keeping a log in 2003).  My average run was 8.9 miles.  My average weekly mileage was 40.5.

Meanwhile, I swam a total of 49.52 miles (2.13 miles of which were in triathlons) and I biked a total of 234.63 miles (82 miles of which were in triathlons).

On the racing front, it was very disappointing.  My planned race schedule was scrubbed for the most part.  I ran one marathon (not my best), and two triathlons.  Meanwhile, I had DNS's (Did Not Start) in one half marathon, one half ironman, two marathons, and one ultramarathon.  Bummer.

What's in store for 2013?  Number 1: figure out what the hell is wrong with me so I can get back to running without having more pelvic stress fractures.  I meet with the metabolic bone disorder specialist later in January.  Number 2:  avoid DNS and DNF (i.e., figure out some way to start and finish Boston, which I've already signed up for, purchased airline tickets and hotel room).  Number 3: as always, run more with Jordana (i.e., maybe run Boston literally with her, and maybe do an ultra with her).

But above all, just have fun running and keep running my own race.

Signing off for 2012.

Hard Ashe vs Dumb Ashe

Hello sports fans,

As you know, there is a fine line, a very fine line, between being a hard ass (or at least doing hard ass things) and being a dumb ass (or, rather, doing dumb ass things).  This past Wednesday, I have the strong feeling that I crossed that line.

The temp is about 35 degrees and it is raining.  Do I run or not run?  I'm thinking -- it would be pretty hard ass/bad ass to go running today.  So why not?  I head downstairs to the lockerroom.  Put on my short sleeve running shirt, long sleeve running shirt, and running shorts.  I look for my long running pants -- didn't I pack them?  Crap, I forgot them.  Oh well, I say to myself, they would only get waterlogged.  Lace up my shoes, put on my gloves and hat and off I go.  When I first stepped outside, it did not seem that bad.  It was cold, but not terribly.  It was raining, but not particularly hard.  The wind did not seem bad either.  So off I went.

As I was leaving my office, I overheard one person say to another --- "that guy (i.e., me) is pretty hardcore."  Or stupid.

Anyhow, the first half of the run was not that bad.  I was holding about an 8:30 - 8:40 pace, which isn't bad considering this would be my second time running at the 5 mile distance (as you may recall from my last injury, I'm doing the slow progression to increased mileage - a couple of weeks at 3 miles, then 4, then 5, etc.).  I was not feeling that cold and the rain was no more than a distraction.  I think I saw maybe a dozen other runners out there as well.  Good, I thought, I'm not the only idiot out here.

As I said, it was a good first half of a run.  I reached the Lincoln Memorial and turned around for the 2 1/2 miles back.  Then the distinction between hard ass and dumb ass hit my in the face.  Literally.  The reason the wind and rain and cold had not been so bad was simply because I had been running with a tailwind.  Crap!! So now I'm soaking wet, in 35 degree rain, running INTO a 20 mile per hour headwind.  Crap!!

I quickly got really cold.  I reached down to smooth out my running shorts and realized "I CAN"T FEEL MY THIGHS!"  They were numb from the cold!  And (mothers cover your children's ears) my privates were frozen.  This was not fun.  At all.  My gloves were soaked, my shoes and socks were soaked.  I was cold and miserable.  My pace dropped to about a 9:30 which only prolonged my continued exposure to the elements.  I seriously considered ducking into the metro or running into one of the museums.  But the realization that I would still need to re-enter the cold to get back to my office kept me going.  The sooner I finish, I thought, the sooner I finish.

So of course what happens?  With about 1/2 mile to go, an obviously lost tourist stopped me -- that's right, I'm running and she stops me.  "Where is the Supreme Court Building?"  And nice guy that I am, I stop, and proceed to explain to her how to get to the Supreme Court (we were near the Capitol reflecting pool).  After thanking me profusely, I continued my miserable run.

When I finally entered my building, I was freezing cold -- my legs and privates were numb, my fingers were aching.  As I retrieved my ID from the guards' desk, I remarked "Some people simply have zero common sense.  I am one of them!"

At first the shower was unbearable (the FTC showers, it would seem, have only two temperatures -- freezing and scalding -- I have yet to figure out how to modulate them).  Eventually, I thawed enough to enjoy the shower.  But I was freezingn and shivering for the rest of the day.  I thought about heading across the street for a Starbucks, but the thought of going back outside was too much.

So, there you are sports fans.  Was I a hard ass/bad ass runner?  or just a dumb ass without enough sense to stay out of the rain?  I'll let you decide.

But I did get in my 5 miles....

Volunteering My Ashe Off

Hello again sports fans. This past weekend was supposed to be my reintroduction to ultras after my 2009/2010 stress fractures. As many of you may know, I grew up in Virginia Beach. Summer cross-country practice usually had us doing long runs in Seashore State Park. Nowadays, whenever we are visiting the folks, Jordana and I sometimes run in Seashore State Park (now called First Landing Park). I had often commented that the park would be an ideal setting for a trail race. As luck would have it, 4 years ago the Tidewater Striders inaugurated the Seashore Nature Trails 50K in December. The first three years did not work for us (first year I had the stress fractures, the next two years we were running Rehoboth Marathon the weekend before). But this year, the stars all seemed to align -- we weren't doing Rehoboth and we would be in Virginia Beach that weekend. So this summer, I signed Jordana and me up for the race. Me - a reintroduction to ultras. Jordana - her first ultra.

Then I had my latest injury. Race weekend arrived. We loaded up the kids and drove down to Virginia Beach. Jordana was ready for the race. And me? Well, if you can't run the race, volunteer. I had emailed the race directly earlier and he said to just find him and he'd put me to work.

So, as Jordana was taking care of pre-race necessities (and all you marathoners and ultramarathoners out there know what I mean), I found the race director, was given a "RACE CREW" long-sleeve shirt, and was put on bag drop duty. The course was a double loop through Seashore State Park with 2 aid stations (that runners passed 4 times each). Runners could send a drop bag to the 64th Street aid station (which they pass at around miles 8, 12, 20, and 24). So for the better part of an hour, I was helping runners fill out and attach the bag drop label.

After the gun went off, we would drive the bags to the aid station. I had told the race director that I wanted to volunteer at 64th street to cheer my wife as she ran by and offered to take a few bags. I backed up the Honda Odyssey and we ended up loading all the bags into my car. Actually, it was quite fortuitous. When I got to the 64th street entrance, they were not letting any cars park at the trail head. But since I had all the drop bags, in I went.

After we unloaded the bags, I helped in the set up of the aid station. Filling cups with water, gatorade, and soda (pepsi, gingerale and mountain dew); cutting PB&J sandwiches; filling tins of M&Ms, Skittles, pretzels, potato chips, etc. Then we just hung around waiting for the runners to come.

As I mentioned, the runners first hit us around mile 5 on their way to the Narrows and the first turnaround. The front runners whizzed passed with few, if any, stopping. Eventually the main body of runners started coming through and we became busy with "what can I get you?" and calling out "water here, gatorade there" etc. I cheered Jordana as she ran through. Then about 30 - 60 minutes later we repeated the drill as the runners passed at around mile 9 heading back towards the Nature Center.

After most of the runners had passed to finish the first of the two loops, we began preparing for round 2 (when they returned twice for the second loop). This time they would be hitting us around miles 20 and 24 and we knew they would be much hungrier, thirstier, and more tired than the first time.

Meanwhile, I chatted with several of the other volunteers. The person in charge of the 64th Street aid station, as it turned out, ran cross-country for Indian River HS the same time I ran for Princess Anne. We reminisced about Regionals, the William & Mary invitational, and Norfolk Collegiate invitational (our shared races). We talked about the fast runners of our day -- the twins Lloyd and Floyd West from Menchville, Carlos George from Kempsville, and David Coulter from Green Run. It was a fun trip down memory lane.

All too soon the front runner ran past us -- "I'd like a bottle of pepsi on my return please" he called out. Was he serious? So I emptied a 16 oz water bottle and refilled it with Pepsi. We kept the top off so it could de-fizz a bit.  When he ran past us again, he grabbed the bottle, thanked us, poured into his own water bottle and kept on running down the trail.  Ok....

Then more runners started filing past. Most were a bit more frazzled than before. Whereas the first time, they often ran past grabbing a cup of gatorade or water, this time they stopped. Handing us their water bottles so we could offer a refill, all the while munching on the sandwiches and salty goodies. A common response to our question "what can we get you" became "you take my number and do the out and back while I wait here." When they returned from the out and back to the Narrows, the reply became "you take my number and finish the race!"

Eventually Jordana came holding her hand. She said she had taken a serious fall, landing on her hand. It was black and blue and bloody. One of the medical workers cleaned her up and put on a bandage. And off she went. When she returned at mile 24, a doctor who was working at the aid station examined her hand a bit more closely and suggested she visit the ER after the race as it could be broken. Yikes. Meanwhile, off she went to finish the race.

As Jordana left the aid station for the last time (around mile 24 at this point), I made my good-byes, as I had all along planned to work until she passed by the last time so I could drive back to the start/finish area and run the last 5 miles with her. Got in the car and drove to the finish then shuffled my way to our meeting point -- where the King Fisher trail entered the Cape Henry Trail.

I got there just as she was approaching. And off we went. I was so impressed with her pace as she entered Ultra-territory. As we neared the final aid station, I sped up so I could fill up her water bottle so she wouldn't have to stop. And off we went onto the Bald Cypress-Osmanthus Trail loop (the kids ran this with her on her first loop). We took this one slow as it was quite technical -- many cypress tree roots sticking up to trip the runner. Indeed, Jordana fell two more times -- landing both times on her injured hand. A weaker runner would have given up, but Jordana picked herself up, shook it off, and kept on running. Eventually, we left the loop for the easier Cape Henry Trail with only less than a mile to go -- mostly on the road to the finish. She passed 3 or 4 runners on this final stretch. As we neared the finish, I dropped off so she could cross alone, savoring completing her first 50K.

All in all, it was a great day. The weather was perfect running weather -- cloudy in the upper 40s. I was so jealous that I could not run. I really hope that I heal so that I can run this next year or the year after.

Meanwhile, I had a blast volunteering. If you have not done so, I highly recommend it. I've always appreciated the volunteers and try to always thank them. But having worked as a volunteer, I appreciate them all the more.

So there you are sports fans. Meanwhile, I'm still slowly trying to come back -- I'm up to 16 mile
weeks (4 miles 4 times a week). The pubic area is still sore. I see the specialist in a month. Boston is fast approaching...

Stay tuned....