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Sunday, May 22, 2016

Stuck in a moment


The water is warm till you discover how deep
Well, ok.  I guess that I should probably give a little bit of a brief synopsis over where I've been with the hip and pelvis and everything, and where I'm going with it for the three people left out there who actually care, rather than just post vague status updates about injections and frustrations and feigned optimism here and there.  It's time to just get objective up in this joint (joint...get it...like hip joint...).  Anyways, I don't really know where I left up with this whole saga.  I know I had sort of outlined the path that had brought me up to the PRP injections at the end of March-ischial tuberosity (ass) pain that had knocked me out at the end of December, a January spent trying injections and training through it that had only led to continued pain despite unclear MRI findings, and then attempts at decreased training, time off of the bike, deep tissue work, eccentric strengthening, core strengthening, lower extremity stabilization, ART, etc, etc.  If it was somewhat based in science, I threw it at the darn thing.  Yet, nothing stuck.  In late March, in order to address any soft tissue/tendon attachment component, despite negative MRI findings, I underwent PRP injections to my proximal hamstring and adductor tendons.  Those hurt like a mother (probably more than surgery, to be honest).  I spent two weeks not doing much of anything other than mostly upper body swimming after a week, another two weeks of swimming and biking a mere 20min/day (and starting light strengthening), and then was given permission to begin increasing bike duration gradually over the next few weeks.

  The acute PRP pain did decrease, as well as some of the associated soft tissue pain, but still, groin and butt pain remained.  The groin pain began to make me worry about my hip joint and the labral repair, and the butt/ischial tuberosity stayed tender right directly on the bone, enough to make me question that fracture healing.  For some background, the ischial tuberosity was one of the pelvic areas that I had originally fractured in my crash, and it took the longest to heal.  I had originally been told (based on an x-ray) in early April (four months post-crash) that I was healed enough to begin running again, so I did.  In early June, when the labral pain presented itself, I initially started the imaging process with a pelvic MRI, which revealed that although that area wasn't really giving me pain, the fracture line was still present.  In mid-July, after another month of not running, it was described as "healing/healed" on my hip arthrogram report.  Because I was about to undergo hip surgery anyways, no one (including me) was all that concerned about it.  So, when the pain there began to present itself in late December (after running off of the bike for the first time), I immediately began to worry about that site.  My January MRI then reported that I had "contour irregularity of the right inferior pubic ramus (another name for it) compatible with remote fracture".  Basically, the it was apparent where the fracture had been, but it wasn't there anymore.  Dr. Giordano had also told me that I had mild amounts of swelling in the adjacent bursa.  It then made sense to go forward with what I had gone forward with-anti-inflammatory injections to the nearby bursa and tissues, PRP to the attaching hamstring tendon, etc, etc.

  So, better but not better, I ended up at the pain management clinic in early May (El Cinco de Mayo, to be exact...because, Mexico).  Dr. Giordano had gotten me set up with that, thinking that it might benefit me to see someone who could investigate me for possible pudendal nerve issues, which also map pain to the butt and groin areas (and yes, I am cringing talking this much about my groin-but actually "pubic area" is a more accurate description, so groin almost seems like a less dirty euphemism here).  I had set that appointment up in early March when I had set up the PRP injections, figuring that I might as well cover all of my bases to try to figure out what was going on-it just took a couple of months to get in, and I was secretly hoping that I'd be better enough to cancel.  No such luck.  So, after a lengthy consultation, the pain management doctor looked through everything and examined me, and determined that she didn't think that I had a pudendal nerve issue (that hadn't necessarily added up to me, either), but she thought that I was having issues with my former fracture sites, both at the ischial tuberosity and the superior pubic ramus-or, that fracture that was almost but not quite into the hip joint.  She proposed cortisone into those areas, feeling that it would give me better and more lasting relief.  I was on board with this plan, and I felt strangely justified, as I'd been saying all along that the butt pain just felt like bone.  Like, repeatedly.

I wasn't jumping; for me it was a fall

   The following week, I then underwent those injections.  I also learned an important life lesson: don't turn down sedation when needles are getting shoved into the general crotch/ass areas.  Anyways.  A few days later, I did notice some difference in the butt pain, and a couple days after that, maybe slight improvements in the groin.  I continued swimming and biking (which is at 2-3 days of 60-90min rides, followed by a day off), and started to add in some walk/running.  The roller coaster just overall continued, though-one day I'd feel great, the next day I'd want to just saw off the right half of my pelvis and start over.  And don't get me started on 3am.  I've seen too much of it.  After one particularly rough walk/run, I finally decided that maybe I should contact Dr. Giordano, given it had been over three months of mess and I still was limited.  Plus, I still couldn't help but question that ischial tuberosity healing, especially because I'd been able to see the bone during the x-ray guided injections I'd had the previous week.  Even to my untrained eye, I could clearly tell where the fracture had been, and it correlated to the T with where my tenderness was and where the injection was put.  I also have just been continuing to insist, it just feels like something's digging into everything down there.  After making Becky tell me that I needed to email him (this is what socially awkward people do when they have to ask people for stuff or make phone calls-they tell other socially awkward people who care about them about it, so they'll be held accountable to actually do it), I finally blindsided the most qualified person to figure out all of my shit with an overly detailed synopsis of my ass and groin.  I heard back a few days later (turns out he was off in Europe for a month after being specially selected to go learn things), and finally talked over the dreaded phone after some phone tag (which meant extra dreaded phone calls and me being awkward on voicemails...but, given the injury areas, I figured that shouldn't really be the biggest of my concerns).

  The outcome of that was interesting to me, and made me feel somewhat justified.  Dr. Giordano did confirm that there is a small bone spur on my ischial tuberosity.  If that's the cause of my pain, though, isn't totally confirmed.  He reassured me that my hip joint was unlikely to be the cause of my groin pain, despite my concerns, because other than the labral tears, everything in there had been pretty good at the time of my surgery, and my January MRI was clear enough to show a solid repair.  As the pain management specialist had said, he felt that that could be related to the previous fracture there, or there could also be a component of hip flexor irritation, either due to rubbing over any bone callousing or just due to general irritation and overuse.  On my pre-op arthrogram, the iliopsoas bone attachment had lit up with some bone marrow edema, which amounted to an incidental finding at the time, but could indicate that there are some issues there.  My next step will be to get some further bone imaging scheduled (once it's an actual business day, given we were talking on a Saturday) in order to investigate all of those sites, as well as to check on a left-sided sacral stress reaction that had showed up in January (but that had never really been a huge issue clinically).  As far as treatments go, I've basically exhausted a whole bunch of stuff.  What's left for the ass pain is surgical-detach the hamstring, shave off the spur, deal with the bursa, and then reattach the hamstring.  Obviously, this involves a fair amount of recovery time, and comes with its own risks.  As for the groin pain, well, there's not a whole ton to be done there, assuming that fracture healed ok enough (which, no imaging had given any reason to believe otherwise, really).  He explained that I wouldn't be a candidate for any sort of hip flexor fractional lengthening, as this would just strip away too much of the strength that I'd need as an athlete.  Assuming this is all just some pre and post-op sequelae, though, more injections (I was assured this one isn't QUITE as bad, at least...) to the hip flexor would be reasonable.

  Then, we explored the whole mind/body aspect of it.  How much of this is injury, vs me just remembering when life was rainbows and butterflies and nothing hurt pre-crash?  How much of my training limitations are true training limitations, vs fear of pushing through pain because I'm concerned I'm hurting something?  Am I willing to accept my "new normal"?  Interesting conversation to me, because these are all questions I've grappled with in my own head day in and day out.  Back in November and December, before the butt pain started, I did have groin pain every training session to some degree, but I was still enjoying training and while the pain was there, it wasn't limiting me at all.  The butt pain, on the other hand, did stop me from training.  Dr. Giordano assured me that I wasn't necessarily doing myself any damage, and that at some point, I probably just need to try to crank through the pain, and see if I can tolerate it.  Although some might take this whole "you're going to hurt" thing as pessimism and an ultimatum, to me, it was somewhat of a relief.  If there's one thing I trust about myself, it's my ability to put up with stuff while training, and to be told that this is ok was a breath of fresh air.  One thing I've learned over this past 1.5 years is that when it comes down to my basic quality of life, I am infinitely happier being in pain but being able to train and compete, vs having less pain but being sedentary or letting go.  The pain that has less of a resolution (groin) was able to be dealt with before the ass pain began, so I hope that that will continue to be the case.  The pain that limited me (ass) could be addressed if need be.

  So where does this leave me?  Well, first things first, I need to get the bone imaging done and see if anything else pops up, and then follow up with Dr. Giordano in his office (and possibly get the hip flexor injection done at that time).  In the meantime, I'll be trying to gradually increase my bike/run amounts and just see what happens with the groin, and in particular the butt.  Can I accept my new normal and deal with it?  Or, will the butt pain increase again as activity increases again to a level where surgical intervention would be indicated?  Time will tell.  Of course, I definitely don't feel as calm and collected and objective internally about this as I may or may not seem in writing-at times my mind is a jumbled, tortured mess-but there's not a damn thing I can do to change the past; I can only continue to sort of stumble and feel my way into the future.  I have pain, sure, but I still have my health and I still have everyone and everything else that's important to me.  I'm not throwing in the towel.  Surgery or no surgery, I still hope that as time goes on, my body will find ways to rewire itself, and although pain may be with me for some time, I can accept that as long as it figures out function.  I've greatly appreciated every last ounce of support and kindness that has continually lifted me up through this whole weird journey.  At some point last week, it occurred to me that I have some of the greatest minds at what they do invested in little unassuming me and my uncertain future in this random niche sport.  It's still crazy to me, and I don't know what I did to earn or deserve everything that I've received this entire way.  I owe a LOT of people a lot of hard liquor presents and gratitude, and I can't possibly begin to repay them for what they've done for me throughout the ups and downs.  For now, I'll just take things one step at a time-imaging, training increases, etc-and see where it gets me.  Thanks to all who have continued to back me through this!!


3 comments:

  1. hang in there... for what is worth at least you are getting some answers, might not be the answers you want or the outcome you want, but hopefully things will start lining up for you and progress can be made. injuries suck anyways!

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  2. 'Tough times don't last, tough people do'

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  3. I am still here, still caring about you. Don't give up!!

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