Monday, February 28, 2011

"I know it hurts. I can feel them."

Yesterday, during my 20-miler, the pain level really started to increase around the 10 mile mark.  I wanted to stop.  I wanted to stop, stomp my feet, pull my hair, and scream.  I suppressed my desire to throw a tantrum and I kept running.  And I kept thinking--"Only 10 more miles, then I get help."  And a mile later, "Only 9 more miles, and I get help" all the way until I got back to my front porch.

Last night, after Rowan went to bed, Tim and I got packing.  We shared a suitcase.  Rowan's stuff, however, took up the entire back seat and the back of our Yukon.  You wouldn't believe how much stuff a 19-pound person requires.  Well, he does.  Two strollers (the normal and the running one), three bags, toys, diapers, etc.  Our car looked like we were going camping in a remote area for at least a week.  I went to bed nervous.  I'm not sure why.  I guess I was nervous they wouldn't find anything.  That I'd get there and they'd say..."Well, sorry, we don't know either."

We got up early, and Tim, Rowan, Rowan's large amount of luggage, and I were off and on our way to Chicago at about 7:30.  Rowan has never been on  a trip this long, and I was a bit concerned about how he'd do.  In addition, he's been coughing.  He's never been sick before, and I wondered if the mix of that with the first long travel might make the trip an utter nightmare.  Thankfully, he did wonderfully.  He slept about an hour and a half and was wide awake and pleasant the rest of the time.  He didn't even poop!  What a good boy.  We only stopped a couple of times, and we arrived in Chicago with plenty of time to spare.

We got slightly lost in downtown Chicago, but Tim realized it quickly so we didn't lose too much time.  We checked into our hotel, which was only a few blocks from the Sears Tower, where the chiropractic office is (thanks for the info, Pete!), changed Rowan's diaper, and headed to see Dr. Kaeser.  We got there early, so we had time for some lunch.  Rowan was doing so well...had not fussed at all.  But I knew that he needed a nap.  He naps three times a day at home, and has usually had two by the time we were finishing lunch.  He was getting tired and fussy just as we headed to the office.

The office was not as I expected.  It is behind some glass doors at the end of a hallway.  I expected something larger, more imposing.  I went in to the desk and told her my name.  She looked at her list and didn't see it.  Surely I didn't dream all this up?  Maybe.  Except, when I told her I was there to see Dr. Kaeser, she knew who I was.   I had to fill out quite a bit of paper work.  Meanwhile, Tim got Rowan to sleep.  After a few moments, Dr. Kaeser came out.  I recognized his voice.

He was utterly hospitable.  He apologized that we had to begin in a massage room, as we were waiting for one of the larger exam rooms.  He commented on how beautiful Rowan is and made sure we were comfortable.  I have never been treated this way by any care provider--no doctor, physical therapist, etc.  There he was, on his day off, crammed in a massage room with me, my baby, and my husband.  And he was on a mission.  We sat down to get started.  I gave him all my records, and also a time line I had drafted, which depicts the whole history of my pain (as the runners will know, we write everything down, so I was aware exactly when it started, when the intensity changed, etc.) as well as all the doctors I'd seen, tests that had been run, etc.  He pulled out my blog posts, which he had printed off.  I knew he had been studying them.  They looked like the articles I have my undergrads read--painted with yellow highlighter, stars, underlines, notes in the margins.  It was at that point I became comfortable.  This guy cared. 

He asked me to go through the time line with him, which I did.  He was able to connect some of the time line to the blog posts.  He made notes on the time line and had me point to where my pain started initially and where it is now.  This took probably 20 minutes.  We then--stroller and all--moved into a larger exam room.  I can't begin to tell you everything he did, but this is the most thorough physical examination I've ever had.  He started by listening to my heart, given the left shoulder pain I have.  Then he had me lie down on my back.  And he found them.

By "them" I mean the spots that rip/tear/pull/stab at me while I run.  The spots on my abdomen that I literally want to rip out and toss on the side of the road.  He went right to them.  And he'd say "That hurts."  He'd say that before I told him.  He pressed on the left side where it hurts so much, and I told him so.  He said, "I know it hurts.  I can feel them."  I knew that he believed me about my pain.  He kept pressing, and he'd say "Ooo...that hurts."  And every single time, he was right.  It DID hurt.  He was digging deep and reproducing the pain I have while I run.  I nearly came off the table in pain, but I was so ecstatic.  He found them!

He went lower, to my pelvis, and found nothing.  Nothing has ever hurt there, so I wasn't surprised.  Then he went up to my right rib cage.  He found another spot.  "That hurts, doesn't it?"  YES!  Yes, you wonderful man, it does hurt.  And I've told every doctor I've seen how much that hurts, and no one would listen to me.  He went up my rib cage, to my breast bone, and pressed in my intercostal spaces.  Ouch! was my response to some of them.  When I say ouch, I mean it was exquisitely tender.  Like electric shock waves going through me.  He followed the paths of those all the way to my shoulder tips, where I often get pain while running.

I flipped onto my abdomen and he worked on my back.  He found one spot--T4--which was incredibly tender.  I could hardly stand him to press on it at all.  He explained to me that the nerves innervated there wrap around the rib cage.  It was interesting to hear him work.  He started predicting things.  "Now, I bet I know where it will hurt up here."  He'd press something, I'd tell him it hurt, and that's what he had guessed.  In my mind, as he poked and prodded, I was thinking, "He's doing it.  He's figuring it out."  It was like putting a puzzle together.  Every pain led him somewhere else, which led him even somewhere else, and so on.  At one point, he pressed down on my shoulders/spine which caused the right-sided pain.  He watched me walk, he watched me run.  He checked everything.  I could tell he was satisfied with what he found.  He knew he was on to something.  He left to go chat with the other chiropractor and physical therapist to get their opinions.

Tim had to leave with Rowan, as Rowan had to take another nap, so he missed this next part.  The other chiropractor, who was also extremely inviting, was interested in my diaphragm.  He examined me, and told me that my diaphragm was high, as it is when it's prone to spasm.  And then it clicked.  He made the pregnancy connection.  When I was pregnant, my diaphragm clearly was smushed.  What's more, I ran with my diaphragm like that.  So, when Rowan was born, my diaphragm should have gone back to normal within two weeks.  It didn't.  It's still in the pregnancy position. And it's irritable.  Want to know how I know?  He palpated it.  OUCH.  And he hypothesizes that the weight bearing associated with running is making it even more irritable, so it spasms badly during that and aches all the time.  He manipulated it, and it felt immediately not as tight.  He did the left side, which wasn't as bad, as well.  He later showed Tim how he could work on my diaphragm at home.  He let us know it should only be done 2-3 times/week.  It's a good thing--I'd have had Tim doing it constantly.  But the premise is we have to get it "calmed down."  It may take time, but it should work.

Then they took a chest x-ray.  My ribs and everything else are fine.  The pain I'm feeling in my right rib is due to intercostal radicular neuralgia--which means a nerve between my ribs is causing pain that radiates.  That has likely happened because of the diaphragm irritating the intercostal muscles.  The diaphragm is the main culprit.  I must give credit to Dr. Wiedenbener, who long ago suspected as much.  Next, Dr. Kaeser worked on the adhesions in my abdomen.  Why do I have them?  We don't know.  I've never had abdominal surgery or any known abdominal trauma.  The only thing I can recall is a car accident when I was 17.  I had some bruised ribs, but that was pretty much it.  He says that's enough to form adhesions, and that these things have probably been "cooking" inside for quite some time.  Pregnancy has a way of bringing things out.  And again, my high level of activity during pregnancy probably really stirred the hornets' nest.

He did deep tissue work on my abdomen.  Man, it hurt.  But I've not been that happy in a long time.  He kept saying "This might hurt."  I don't care!!  I asked him if I'd need surgery for the adhesions.  He wouldn't promise me no...but said that there's a very good chance he can take care of them this way.  The problem with surgery is that it can cause additional adhesions, especially in people prone to them ( fascia has been described as "cardboard-like"). 

Next it was my back--that pinched nerve is painful, and as he manipulated it I could feel the symptoms I usually get while running.  How could I possibly have all these problems?  I have not one problem, but four (actually five--but the additional one has nothing to do with this pain).  I technically have diaphragmatic spasms (caused from Rowan living in there and me running while he did so...and these have set off the whole chain of events), intercostal radicular neuralgia (radiating nerve pain that originates between the ribs, and stemmed from the diaphragm issue), abdominal adhesions (4 large and 2 smaller, not sure where these came from), and a pinched nerve at T4 (pinched nerve in the back which causes radiating nerve pain around the abdomen with compression, which obviously happens during running--this is likely a result of pregnancy).

At this point, I'd been there for three hours receiving constant care.  Next, I saw the PT, who gave me some exercises to strengthen my core.  However, I have to be very careful--no crunches for now, as anything putting pressure on my diaphragm is not good.  I have to sit up straight.  Oh, and I'm supposed to limit sugar, as those make adhesions worse.

It was a whirlwind.  There is no immediate fix, it will take time and additional treatments.  I'm seeing them again tomorrow and will likely be making another few treks up here.  I won't complain about that at all.  They are trying to find someone in Bloomington who can do the same sort of treatments on me closer to home.  I don't say things like this lightly...but Dr. Kaeser and the other chiropractors/PTs at Meridian Chiropractic in Chicago are wonderful physicians and some of the most caring people I've ever met.  I do not know why, and I dare not question, but they want to help me.  And they are.  I'm running 12 miles in the morning--they tell me it may still hurt.  That's okay, as long as I know what it is and that we're treating it.  I told them that the next race I run pain free...their names shall be on my singlet.  They laughed...but I'm seriously not joking.  Pete's name will be there too.


  1. I'm so happy for you it must feel so nice to have answers. While it iwll take time, this is great news.

  2. The title of your blog intrigued me so I had to read it. First, let me say that you write beautifully. The sentences are exactly the right length, the humor just the right amount of dry. Second, your chronicle of pain is probably something that could be published some day. I'm co-leading chronic pain groups at the VA and I don't have to tell you the power of having someone out there who really gets it: The pain is real. The pain is there. Find it and fix it please. I hope your recovery is speedy :) Your blog was a pleasure.
    (Misty Hawkins)

  3. I believe this is wonderful news, Wendy, and I'm keeping those fingers and toes crossed that these wonderful sounding Docs keep things moving in the right direction.