Saturday, April 30, 2011

It's here! Almost...

Yesterday, Tim and I got up at 2 am to head to Indy for our flight to Portland.  Rewind, though, to the night before.  We had to pack.  I've never had to pack for a marathon before.  Let's just say it was, at times, a tense experience.  "I don't need those?  Why?  Can't I take them just in case?"  This was in reference to hats, gloves, and tights--none of which the weather predicted us needing.  But you NEVER KNOW.   I also brought three different race outfits and three different pairs of Frees.  "Why?" Tim asked.  Well...what if my race shoes just fall apart (as they have done in a taper dream)?

We went to bed at a decent hour, but neither of us was ready for the 2 am alarm.   We said goodbye to mom (who is staying behind with Rowan and Amelia) and headed out.  I took one last look at Rowan in his crib.  His little (well, not so little) legs were wedged between the slats of the crib.  I fixed him up, kissed him, and we left.

The drive up was uneventful...until we got to the airport.  Just as we were veering to the lane that says "Economy parking," I saw police lights behind us.  I said "I think we're getting pulled over."  "For what?" Tim asked.  Because we were barely moving.  We pulled over, and the police man approached our car with a flash light.  He had pulled us over because Tim was speeding (really?) and he has a tail light out.  We didn't get a ticket, but that was not the start to the day I had anticipated (or wanted).

We were in the terminal with plenty of time.  I've had in my mind that, no matter how not hungry I am, I have to carb load.  I ate three cookies at 2 am, and now it was time for "breakfast" at 5 am.  I had a bagel/bacon/egg sandwich.  We made our flight just fine--it was to Denver.  I took Dramamine before we got on, and I passed out asleep before we even took off.  I woke up about 5 minutes before we landed.

When we landed in Denver, it was 10:30.  But we had been up a LONG time.  That's 12:30 Indiana time.  We ate at a pizza place--calzones.  We hopped aboard another plane to Portland.  As an aside, Southwest Airlines uses something called "open seating" that we really didn't like.  You just get on and pick your seat.  It was hard to find two seats together.

I was awake slightly longer on the Portland flight (maybe 15 minutes), but with another Dramamine in me fell asleep again until almost the end of the flight.  Once in Portland, we had to get our rental car.  As expected, the rental car people tried to sell us everything:  extra insurance, pre-paid fuel, etc.  We bought none of it and took off in our silver Ford Focus.

But we weren't headed straight to Eugene.  We had a very important stop to make first.  We are lucky enough to be friends with the Bowders, Mark and Alita, who live in Washington state (with their son Alec, who is 10 and runs miles to earn time on his DS...I love that system).  Anyway, Mark was kind enough to send us a pass to the Nike Employee Store that is located in Beaverton, Oregon...very close to Portland.  What is the Nike Employee Store?  I'll save my major hyperbolic descriptors until a few paragraphs below, but it's basically a Nike store where everything--all the new stuff, not like discontinued stuff--is 50% off.  Mark is a wear tester for Nike and I think they give him these passes as a token of appreciation.  And we got one!  Thank you, Mark!

When we pulled up to Nike, we couldn't believe how crowded it was.  There were parking spots.  This was at 10:30 am (1:30 pm in Indiana...we're all messed up).  We found a spot in the very back and went in.  But you don't just "go in."  You have to be checked in.  It's akin to going through security at the airport, except you don't have to take your shoes off.  I was astounded, though, that a guy in front of us was wearing Asics.  Anyway, we got up to the counter and they asked for our pass, which we gave them.  Then they needed photo ID.  Now, there was a little concern on Mark's part that we might not get in.  Our addresses on our licenses don't match--Tim's is still his old one from before we were married.  So I brought a bank statement with both our names and address on it.  That was our ticket in (so thank you to Mark for calling to find out we needed it!).

I can hardly describe, in words, my reaction when we walked in to the actual store.  Music was playing.  To the left, there were all things women's running.  Sports bras, singlets, jackets, shorts.  To the right, it was men's.  To the back, it was kids.  I texted Mark with:  "OMG!!!!"  "Yes, you're definitely in there now.  Have fun!" was his reply.

You have to understand, we are Nike people.  I don't even like my daughter to wear non-Nike shoes.  Come to think of it, I don't like Rowan to wear non-Nike shoes, and he's not even walking yet.  I will run in nothing other than Frees (except I do have the New Balance minimus trail shoes, which are like Frees for the trail), and all of our running gear is Nike.  We found ourselves surrounded by all the Nike merchandise we could possibly take in visually....and all of it for 50% off!  The store was as big as a football field.

We didn't know where to start.  Tim said "Let's take a look around, walk around, then we'll devise a game plan."  That worked out fine until we made it to the kids shoes.  We stopped and obsessively looked at all infant shoes.  Tim found a pair of black, high-top Chuck Taylors in Rowan's size.  He had to have them, obviously.  After that, my memory is a little hazy.  That's because we got to the women's shoe section.   I lost Tim, who had gone on to the men's shoe section.  I was surrounded by all the Frees I could imagine--and all 50% off.  Tim and I reconnected from time to time, both with armfuls of orange boxes.  It soon became apparent that we'd need a cart, which Tim fetched.

After my shoe experience, it was on to running apparel.  Then, it was onto running/soccer apparel for Amelia.  We now have matching running shorts.  I also found her some shoes and sandals.

I don't know how long we were in there, but it was a long time.  All told, we came out with 8 pairs of shoes and more clothes than I care to admit.  Wow.

After that, we were hungry again.  Getting up at 2 am will do that to you.  We went to Olive Garden for our fifth meal of the day.  Breadsticks and pasta.  I ate until I could eat no more.  Then it was time to head to Eugene for the expo.

I've been to many marathon expos, but never for a marathon I was actually going to run. So this was a first for me.  The expo was not huge (like Chicago or Boston), but it was good-sized.  Our favorite booth was that of the Oregon Track Club, who were selling singlets and t-shirts to benefit Pre's trail.  Both Tim and I now have Oregon Track Club singlets.

We got our packets and our shirts.  I'm not very happy with the shirt, as the size small I got comes almost to my knees.  I asked about an extra small, but they didn't have any.  Oh, well.  We made it to our hotel and promptly got in bed and started eating again.  This time, pretzels and Nutella.  We watched "Spirit of the Marathon" and went to bed at 8 pm.

I woke up, wide awake, at 6:45 am (9:45 Indiana time) and haven't been able to get back to sleep.  We are meeting the Bowders in about 40 minutes.  After that, we're going to run a couple of miles on Pre's trail.  Then it's back to the room to obsess over getting everything ready for tomorrow.  At 5:30, a v-team dinner.  Then an early bed time.  And then....go time!

Thursday, April 28, 2011

Carbs, carbs, carbs

Three days til race day.  The name of the game is carb loading.  The goal is to get the glycogen stores tapped up so that there is plenty to burn on race day.  Carb loading is one of the benefits of running.

Unless you have no appetite.  And I don't.  I don't mean that it's low.  I mean that it is nonexistent.  This is a consequence of my antibiotics and the whole infection thing going on.  So I'm not able to truly enjoy the carb loading, though I'm doing my best to do it.  Never in my life have I had to force myself to eat (I usually have to force myself to stop), but that's what I'm doing now.  And it's not very enjoyable.

But when I ran 4 miles today, it became clear to me that food is what I need.  My legs felt very good, but I felt weak.  Obviously, some of that may be from the medicine or the infection (I have felt generally weak this whole training cycle, and now we know why), but I have to believe a lot of it is just lack of glycogen.  So I've been drinking Gatorade, and Tim is making me carb-rich meals.

This run was better than the last couple, but I still just feel like I have no energy.  I will keep eating lots of carbs, hydrating, and simply hoping for the best.

The abdominal pain was there, and it was much worse in my back today than usual.  That's just part of this training cycle for me, and it will be part of the race to some degree.  I've accepted that and am honestly no longer stressed out about it.

Meanwhile, the weather looks PERFECT for a marathon.  Low of 46, high of 68.  The hourly forecast shows that it will just be in the low 50s by the end of the race (it takes a while to warm up there).  Partly cloudy and a slight wind of 5 mph.  I'll take it!

We fly out at 6 a.m. tomorrow.  Eugene, here we come!

Wednesday, April 27, 2011

Almost There

As I'm typing this...3.5 days(ish) to race day.  WOW.  I've never been so close to a marathon start line.  I think I may have mentioned it, but I don't like this taper business.  It's not that I miss running as much (I mean I do, but I was kind of ready for a break), but the runs I DO have just feel awful. I was fine pretty much all last week, but this week my legs feel horrible, as does my breathing.

They tell me it's normal.  Taper, they say.  But it still scares me.

I don't have a whole lot to report today, so I'm going to talk about some other stuff that might interest you.  Yeah, Tim.  What's he been doing?  Well, in the past two days, he's been admiring his brand new Cervelo bike.  It arrived on Monday, and seeing him open it was like watching a kid at Christmas.  If you know Tim, he's pretty it was kind of like watching a really sleepy kid on Christmas morning, I guess.  I know nothing about bikes, but it's very pretty and weigh less than my 8-month-old.  It must be good.

He wanted to ride it when he first got it, but it was raining.  Apparently you're not supposed to take them out in the rain.  With as much as it cost...let me tell you, it should be okay to take out in the rain.  I've run with Bill enough to know that triathletes baby their bikes.  It's something I do not understand, and I daresay I won't ever.  Being that in love with a bike.  But Tim is with this one.  He's been on it around the block, but that's it.  Wouldn't want to risk anything happening to it.

I kid about his bike and his adoration for it, but Tim really deserves it and I'm happy that he's happy.  It does look wildly uncomfortable, though.  You should see how thin the frame is.  I don't see how those guys stay on those for hours.

In other news, my dissertation is in full swing.  With all the (NON-MUSCULAR) abdominal drama going on, I haven't blogged much about my PhD progress.  But, don't despair, I've made some.  My study was FINALLY approved on April 8 (it's insane that it took them from Jan. 27 to that date to approve it).  I began recruitment the end of last week, and it's going amazingly well.  Now, I've gotten quite a few no's, but also a lot of people saying yes.  I've done three interviews today alone.  I have one tomorrow, and then several the week after Eugene.  And I've only called a fraction of the pool from which I have to draw.  I am so thankful, as recruitment in behavioral research can sometimes be a REAL problem.  So much so that dissertations can go on for YEARS.  I am fully confident that I'll be finished collecting data by early June.  Then it's time to go into hiding and write for months.  Then defend the sucker by October and get the heck out of school.  For good!

Still riding the happy wave of knowing that I'm having surgery on May 9 and that this pain is coming to an end.

Tuesday, April 26, 2011

Red Letter Day

"Mark it down."  That's what my friend JoAnna told me to do about today.  And so that's what I'm doing...with this blog post.

I don't know if I even mentioned it in my blog (for my own sanity, I had to stop talking so much about what avenues I was pursuing about this pain.  Plus, I was beginning to look a little insane), but a couple of weeks ago, after the first failed surgeon appointment during which I was told I had pulled muscles, I had a bit of a meltdown.  My mom and brother had to come over.  They, along with Tim, had to convince me that we WOULD get this figured out.  My mom told me that we would make an appointment with a surgeon, a woman, who has operated on her.  Her specialty is bariatric surgery, but she's also a general surgeon.  And, did you notice that...she's a SHE.  I really felt like a female would listen more to me.

She did.  My appointment was today, and mom went with me.  Like I have said previously, after I went to Florida, I gave up on the idea of getting this fixed for Eugene.  So I went into the office very calmly, as I no longer have that "race against the clock" feel.  We didn't have to wait long.  I remembered Dr. Rosemarie Jones from my mom's surgeries, and I remembered that I really liked her.  She remembered my mom as soon as she walked in.  They hugged and reminisced, and then she asked me to explain what was going on.

So I did what I have done forty thousand times thus far...I explained my pain.  I told her when it started, what it felt like, what made it better, and what made it worse.  I was cautious about telling her about my running, because my experience so far has been that when they hear runner, and particularly a long distance runner, they automatically assume it's muscular.  I think I started by saying that it was made worse with "weight bearing exercise" and "anything involving gravity."  I then told her everything I've been through, that most of my tests are normal, and how they keep telling me it's muscular.  She raised her eyebrow and shook her head.  I trusted her.

So I mentioned that it's terribly worse when I run, and that it's majorly affecting my quality of life.  I told her how I saw the NP last week, and how I found out that I did have pelvic inflammatory disease, but that it's asymptomatic (as far as pelvic pain) and that the antibiotics she put me on have helped a LOT.  She said "Sounds like Fitz-Hugh-Curtis Syndrome."  In my mind, I was saying "Yes!  YES IT DOES!"  I found FHC Syndrome online the day before I went to see the NP.  The NP had never heard of it, but she read about it and agreed that it seemed to fit.  Dr. Jones said that they used to see a lot more cases of FHC given that physicians didn't used to prescribe antibiotics so readily.  However, as medicine modernized, women were treated much more promptly and the syndrome was now rare.

She examined me, and I told her how lifting and doing sit ups does NOT make it worse.  "Then it can't be muscular," she said.  Exactly.  EXACTLY, MY FRIENDS!  She had me lie down and do a bit of a crunch.  She said "Does the pain get better or worse with that?"  It gets better--always has.  Any time I tense my abdominals or bear down, the pain lessens.  When I run, and the pain comes on intensely, my body just naturally has me bear down...just like pushing when having a baby...and the pain lessens.  I told her this.  "Well, that's a hallmark sign of adhesions.  When you bear down, it causes the adhesions to shorten due to the pressure change, and the pain subsides.  That's why breathing makes them worse, because it lengthens them."  I explained that I have told EVERY single doctor I have seen about that, as I've always found it bizarre and significant.  I also told her how holding it helps, and she agreed that makes sense with adhesions.

So, she said "At the minimum, I think we need to do a scope.  A laproscopy, where we take a look in there.  And I'll get rid of those adhesions."  I wanted to jump up and down.  Finally, someone who believes me.  I just kept talking about all I'd been through.  I told her what the other surgeon said.  I told her they told me I'd never be fixed.  She just smiled and shook her head. She found the way that I've been treated absolutely inexcusable.  She explained that so many doctors rely way too much on imaging studies and never listen to the patient.  This is what has happened to me--my imaging studies are normal, so it must be muscular.  I told her that I had my muscles LENGTHENED by a robot and that that actually made the pain worse.  I've told everyone else that, too, and they still say it's muscular.

Except for Michele, the NP, the others have also ignored the fact that I've had persistent night sweats and unintentional weight loss.  I weigh just under 114 pounds--the lightest of my adult life. Lighter than when I ran 80 miles a week.  And I'm eating.  It just falls off, and has been over the past few months.  Obviously, that's not normal, nor are the night sweats.  When I mentioned to Dr. L about the weight loss, he said "That's from running too much."  But what they don't ask is, "Do you usually lose that much weight when you're running only 60 miles a week as your peak?" Because the answer is no, not at all.  Night sweats and unintentional weight loss are signs of an underlying infection.

So Dr. Jones said "When can we do this surgery?  I can do it tomorrow morning.  I'll work you in."  I told her about my race on Sunday.  She looked at the calendar and said "You can run on a marathon on Sunday even if I do the surgery tomorrow.  That way the adhesion pain will be gone for your race, and you'll just have incision soreness."  You do not know how tempted I was to say "Yes."  I almost did.  But...I just can't do that.  What if something went wrong?  What if I got an infection?  I can't put my race at risk like that--not one that I've worked so hard to even get to.  I just wished that I had seen her earlier.

She asked when I return from Oregon, and I told her Monday.  "What time do you land?  I could fit you in that day."  I don't get in til 5:30.  Unfortunately, she only operates on Mondays and Wednesdays, and so I'm having to wait until May 9 (unless there's a cancellation on the Wednesday before).  But that's fine.  Perfect, actually.  I'll run the race, recover a bit, and go in for surgery.  The only thing is, Dances with Dirt is the Saturday after.  She said "Oh, you can run it.  You'll just be a little sore."  I love this woman.

Of course, if I can't run DWD, that's okay.  It's not a goal race, it's just fun.  But I think I'll be able to do it.  So, mom and I left....elated.  So you might wonder, if it's an infection, and the antibiotics are making me feel SO much better (they are...I sit here and am not even thinking about the pain), why do I need surgery.  Well, when the infection spreads up to the liver, it causes a localized peritonitis there, which can lead to adhesions.  While the antibiotics get rid of the inflammation, they don't get rid of the adhesions.  I think I'm feeling better because the tissue that's being pulled on is not nearly as inflamed.  If she goes in and there are no adhesions (meaning all my pain was from the inflammation), that's fine with me.  But somebody's GOT to look in there.  And she agrees.  If there are no residual adhesions, fine.  But I'm kinda guessing there will be, as I'm still in pain (just much less) with the antibiotics.

Oh, and she couldn't believe I run in a TENS unit.  She was even more shocked when she heard I've run in two at once.

Anyway, I've been praying that I would be led to a person--that one person--who can help me.  I was today.  She can't wait to help me, and she asked for the names of all the doctors who have misdiagnosed and mistreated (as in prescribing the wrong therapies) me.  She's going to fax them pictures of the adhesions she finds, as well as the dictated report.  It was funny to watch how satisfied she was already feeling about that prospect.

Now, let me just say this:  I don't think that any of the physicians I have actually SEEN have purposefully mistreated me.  Dr. Spier comes to mind. He was the GI doctor who listened to everything I said.  He just couldn't figure it out, but he desperately wanted to help me.  Drs. Kaeser and Russell also really listened to me and tried to help me.  But why didn't Dr. Stowell, the very competent OBGYN, at least suspect this?  He told me that it couldn't be a GYN problem.  It totally is.  Everything I read about FHC says "a syndrome to suspect in women with right upper quadrant pain for whom imaging tests are normal."  HELLO!  And Dr. L, who has been treating this pain for months.  When none of the usual treatments worked, why didn't he question the diagnosis?  As a nurse, if I try an intervention for a patient, and it doesn't work--I don't just keep using it over and over.  And I try to figure out the real etiology of the problem.  The first surgeon I saw, Dr. Haddad (who is a very, very competent surgeon, and the rest of the doctors are competent as well), completely blew me off when I mentioned adhesions.  "From what?" he said.  Dr. Jones listened to ME.  She was not focused on my test results or my history, but my symptoms.  What a concept.

I dropped mom off at her house and drove home.  And it was, at that point, that I began to weep.  Honestly--not crying, not tearing up, but weeping.  In a way that I have done very few times in my life.  This time, it was out of relief.  Finally, this hell is coming to an end.  I had all but resigned myself to living in pain, to running--one of my favorite things in the world--in pain and always with my TENS unit.  I thought my days of racing all out were completely over.  Now, there is hope.  There has been hope before--I thought the robot would probably work.  But this time, I'm actually feeling a lot better.  The symptoms fit, there is evidence of infection--I know we've figured it out.  This saga, which I never intended to become the focus of this blog, is ending.

The blog will continue, of course.  I only hope I can convince you to stick around.

Now.  Onto running.  I ran 4...yes, only 4...miles this afternoon.  And I'm still feeling off.  Running does NOT feel easy.  I just feel uncomfortable.  Like I'm working.  Like I want it to be over.  I'm telling you, during my last long run of my peak the HEAT...I felt far better than this.  Tim says it is normal.  Well, if it's normal, it's cruel.  Because I'm freaking out.  I officially hate taper, but boy I'm happy today.  Red letter day, indeed.

Monday, April 25, 2011

Taper Illness.

I woke up this morning at 5:30 (not on purpose) with a VERY sore throat.  The kind that makes you wince every time you swallow.  "Great," I thought.  As the day has gone on, I have developed a stuffy nose.  A bad cold, basically.  Tim always gets sick during taper.  I just didn't expect it to happen to ME.  But it has, and I'm lucky that I still have 6 days to get better.  I started a round of Zicam and am hoping it shortens the symptoms.  It won't affect my running this week, as I'm only running a total of 10 miles leading up to Sunday.  4 tomorrow, 4 Thursday, and 2 Saturday.  Then it's go time.

I had an appointment with my pain doctor today, Dr. L.  I spoke with him about what the surgeon had said (that I need to take six weeks off and let it heal, blah blah blah) and Dr. L said that will never work.  What I have...or should I say what he is CONVINCED I not amenable to rest.  He told me that if I take time off, it will just come back as soon as I start running again.

Of course, I'm not convinced it's totally muscular.  It may be muscular to the point that something is pulling on the muscle.  But it's not just an irritated muscle--I refuse to believe that at this point.  We again went round and around in our usual fashion.  "If it's muscular, why doesn't it hurt to do a sit up?"  "Well, it should, but you must have a high pain tolerance."  Whatever.  Just inject it.

So he did.  In the two spots he injected last time, because I actually thought I got some benefit from that (by having him inject just two spots those two spots got a WHOLE lot of cortisone).  On the right side, the one up high by my rib, as he injected it I noticed it didn't hurt as much as it normally does.  The left one wasn't as bad earlier.

Okay, here comes the part.  You know, the part where I worry about something that very few of you would even DREAM of worrying about.  So, the numbing medication from the injections usually wears off in a couple of hours and gives way to some muscle soreness at the injection sites.  Well, this time, that happened on the left, but not on the right.  In fact, I can touch, even push, on the right side where he injected...and I can in no way tell it was injected.  I know it was, because I witnessed it, but now I have half convinced myself that I was not given cortisone on the right.  That he accidentally injected me with normal saline instead.  Now, to my credit, I've seen stuff like that happen when I worked at the hospital.  So--in my mind, I will get no benefit from the right-sided injection 6 days before my marathon.  GREAT.  I'm calling them tomorrow, but you know they'll just tell me it was cortisone.  In addition to thinking I'm NUTS for calling a pain clinic concerned with my lack of pain.  But I just don't understand why I have no (absolutely ZERO) soreness where the right-sided injection was placed.  The only explanation, in my mind, is that there was no actual medication in it.  That's what causes the soreness.

Feel free to talk me off the cliff.

Sunday, April 24, 2011

Not Good.

My last "long" run of taper, that is. Tim said to me "Your first long run of taper will be awful."  That was last week's 15, and it wasn't.  Then 10 miles I ran today was the hardest run of the training cycle (running wise, not pain wise).  It required MUCH more effort than any of the 20s or 20+s I've run.

My legs didn't hurt.  They just felt like lead.  The best way to describe the run, from start to finish, is that I was working.  At a pace that generally feels very, very easy.  I felt like I couldn't get into any sort of rhythm.  Everything, from my breathing to my stride, felt awkward.  I felt like I was bonking just a few miles in.  I took two gels throughout (which I usually would never do on a 10 miler), and got minimal benefit.  I began to lose all confidence.  How can I possibly hold any kind of decent pace for 26 miles when I feel like this?  Where did my fitness go?  My legs felt better at the END of my peak week.

Now, I'm on two different kinds of antibiotics (which will be finished three days before the race), and I've noticed that those are making me feel pretty awful, and my appetite is very much decreased.  So I've not been eating much at all, and I think that probably caught up with me.  And, as Tim tells me, it's taper.  It makes you feel weird.  It makes you doubt yourself to degrees you didn't realize were possible.

Anyway, other than feeling like a non-runner had taken over my body, this was a really interesting run.  We've had a lot of rain.  We were concerned that the bottom of Slaughterhouse Hill might be flooded.  Tim mentioned that we could run our course backwards (meaning we'd hit SH hill early), and if it was flooded we could reroute.  This is my last longish run of taper.  I am a very routinized individual.  I was going to, if at all possible, run the same 10 mile course out there that I run every time I run 10 miles.  So Tim went to check before the run. It was clear. When we headed out, there was a pretty steady rain.  When we approached the 2 mile mark, near the base of the I Street Hill--we got  a surprise.  It was TOTALLY flooded.  There were high water signs.  We just didn't think to check there.  I said "Let's go down to the water, then turn around."  When we got down there, Tim said "It's only about 6 inches.  Let's just take our shoes and socks off and walk."  It was probably a little over a tenth of a mile long.  I thought about it for a second, and I thought he was crazy.  And then I thought about how doing that would allow me to run my usual route.  So, I took off my socks and shoes.

When we started to cross, it was 6 inches.  Except, it kept getting deeper.  We kept going anyway.  I'm sure it was a sight to see and I have never so much wished I had my camera.  It was raining hard, windy, dark, and, apart from me and Tim, completely void of any animal (that we could see) or human activity.  It was like an armageddon scene:  two runners trying to escape a flood.  Nike Frees high over their heads (must save the important things).  At its highest, the water was up to my waist.  And it was cold.  Mid-run ice bath, anyone?  And I had my TENS on.  I'm pretty sure the manufacturers of it would not recommend crossing a RIVER while wearing it.  But I didn't notice any ill effects.  We emerged on the other side, slipped our shoes on, and trudged on.  I've done a lot of things on runs, but that's the first time I've done that.  And it was a lot of fun.

Now, the other good part of this run, in addition to the water wading, is that my abdominal pain was the best it's been in a LONG time.  I had both TENS units on, and turned the new one off just a mile in, as it felt too much.  I even had to turn the other TENS off eventually.  I noticed that the TENS was hurting me.  Usually, the other pain is so bad that the TENS feels like a really rough massage.  It felt painful today because I didn't have nearly as much underlying abdominal pain.  I had it off from about 2 to 7, then turned it back on, but only at half strength.  I couldn't handle it at full strength, and I'm usually wishing it would go higher.

So...I'm thinking that I would really like to only wear the small TENS during the race.  It's a pound less of weight (and I really can tell a difference).  But that will depend on how my runs go this week.  I get cortisone injections tomorrow (more for peace of mind than anything...I'm not sure they help at all), so it's possible I might be able to run the whole thing TENS free.  But, of course, I would never chance that.  I'll at least have the small one with me and hooked up, but I might be able to turn it off and on.  And, I might freak out and wear both of them.  We'll see.

My pain has been less, too, just sitting around.  Why?  Well, it's been improving ever since the NP started me on the antibiotics.  She gave these to me because I had some signs of pelvic inflammatory disease (again, NOT from STDs), and in a condition known as Fitz-Hugh-Curtis syndrome, this infection can spread upward, where it usually lands on the liver and diaphragm, causing adhesions to form between these two organs if the condition goes on for a while.  So, I'm wondering if that's what we're dealing with.  In any case, I'll take the good fortune.

Saturday, April 23, 2011

Two is (sort of) better than one.

Two TENS units, that is.  I received my 4 channel TENS unit in the mail yesterday.  This is a machine that has EIGHT electrodes.  My old one only has four (it has two channels).  Imagine the possibilities with double the electrodes!  Something like that could really beat the crap out of me while I run.  Perfect.

I couldn't wait to try it out.  So I did.  In case you're not well-versed in TENS units (I hope, for your sake, that you're not), there are different kinds of modes.  There is a constant mode, where the electricity is given, well, constantly.  Then there is something called a burst mode.  This one delivers bursts of electricity, and it's akin to getting punched.  I have tried the constant mode, and it's not strong enough.  I rely on burst mode at the highest intensity.  Well, the new TENS has a burst mode. this will only go up to 5 Hz.  The booklet reads that this limit is set because going above that in this mode would be far too intense.  On my old TENS, it goes up to 150 Hz in this mode.  Well, the 5 Hz burst mode just wasn't going to cut it.  I have to turn my TENS up all the way....every single run.  I was sort of bummed.  Then Tim said "Why don't you just wear both TENS units?"

Hey!  That's a great idea!  It means I'll be carrying an extra pound or so, but it's probably worth it.  I quickly tested to see if they'd fit in my dorky fanny pack.  They do.  So...I can have 12 electrodes hooked to me.  4 of them will be bursting, and the other 8 I can set on continuous mode at the 150 Hz.

So I tried it today.  First of all, that's a LOT of electrodes to wear.  I felt like a suicide bomber when I headed out for 6 miles.  It was a glorious sight--I had the electrodes everywhere.  In every spot where I ever get pain.  I've never had that luxury before.  I turned both units all the way up.  Within a mile, I realized that was just too much.  I felt like I couldn't breathe.  I ended up turning the new TENS down to about half strength, and that was much better.  The other thing is--I really noticed the extra weight in the fanny pack.

I'm not totally sure if I'm going to wear both or just the one on race day.  I'm confident that if I wear both, it can cover up the pain, but the extra weight will annoy me.  And slow me down...but, what?  Maybe 3 seconds a mile?  I'm willing to give it up.

This was not an easy or particularly enjoyable run.  First, I'd had NO sleep.  Rowan is very sick and was up all night.  Second, the antibiotics I'm on are making me feel pretty awful (though my pain is somewhat better).  I just feel fatigued and have no appetite.  And, thus, third, I hadn't eaten anything when I went out to run.  Nothing hurt (in terms of legs) just felt...labored.  That scared me.  I'm almost tapered--isn't this supposed to feel easy now?  I found myself completely doubting my fitness.  Did I run enough 20s?  (I ran 7).  I haven't run 20 for two weeks!  I don't even remember what it feels like to run a 20.  I'll never be able to do it. Tim tells me it's completely normal to feel this way.  Taper madness.  But I was shocked to find myself so doubtful of my fitness and abilities.  Hoping it all comes together on race day.

Thursday, April 21, 2011

What took me so long?

As I mentioned in a recent blog post, I have seen 10 doctors about my abdominal pain.  Some have been much more helpful than others, but I've found that none of them can seem to look outside their specialties.  The pain doctor thinks it must be muscular, because that's what he deals with, etc.  Another thing that I've re-learned (and I say re-learned because I've been a nurse for 8 years and have had my fair share of physician interactions) is that one doctor will not question another doctor provided they work in the same community.  At every doctor's appointment, I have been open and honest about which doctors I've seen, what they've said, etc.  I've found that, once a doctor hears what another one says, he (because I have not seen any female doctors) always agrees with the other doctors right there.  I have heard things like, "Well, if Dr. X thinks it's muscular, it must be."

Physicians play a vital role in this society.  We need them, and they provide great services.  However, there are some aspects of illness (which is different than disease) that physicians, in general, are horrendous at treating.  I was thinking about this yesterday, and something which was said to me by a very prominent and successful nurse researcher kept popping into my head.  This researcher was asked once, as she sat on a committee at the National Institutes of Health, "Nurses do research?"  "Yes," she replied.  "All that stuff that happens between diagnosis and death?  We're kind of all over that."  And "all that stuff" is messy.  It's not clear and delineated.  It's rough.  And it's what patients care most about--quality of life.  I've been part of research studies with patients with a variety of chronic diseases.  They don't care about their lab values.  They care about being able to do their daily activities, whether that be playing with their grandchildren or going to church.  For me, it's running.  The goal of my profession is to get people to a place where they are as well as possible, with well meaning that they function at or near their perceived capability level (Brenda Lyon, 1990).

With all that in mind, I went to see a nurse.  An advanced practice nurse, a nurse practitioner, named Michele.  She is a gyn NP.  I've seen her before, but not for this issue.  Every time I've seen her, I've been impressed with her thoroughness.  She not only talks to me, but she listens.  She welcomes ideas from ME.  So I saw her this morning.  I told her the whole story, and she took notes.  I showed her articles that I've found online that I think could potentially explain my pain.  She read them and made copies of them. When I told her "They say it's muscular but it doesn't hurt me to do crunches or to pick up my son, it only hurts worse when I'm walking a lot or running."  She said "Well, that can't be just muscular.  Something has to be pulling."  She asked me the simple question of "What makes the pain worse, and what makes it better?"  We are taught to assess pain in this manner in the very early semesters of nursing school.  This is the first time, throughout this entire process, that I have been asked those questions.

She came to the conclusion (the same one I've had) that the key aggravating factor is gravity.  Not use of my abdominal muscles.  Gravity.  She asked me if I had seen a surgeon, and I told her my experience.  She told me she didn't know what it was, but that she 1) believed me that the pain could get severe; 2) understood how this is affecting my overall quality of life; 3) thoroughly believes IT'S NOT MUSCULAR; and 4) is going to try to figure it out.  Now, doctors have told me number 4 as well.  But they're not like nurses.  When we say we're going to investigate something?  Look out.  Well, I'm a case in point.  I've done hours of research about this.  A physician will generally only look in his/her area of expertise.  And this is not a fault on their part--it is how they are trained.  Nurses, however, think holistically.  And they consider everything.  So I'm feeling better with a nurse on my side.

She did a pelvic exam, which revealed some uterine tenderness.  She also drew some labs (no one else has done that).  I have some symptoms/evidence of pelvic inflammatory disease, which is usually caused by STDs. Well, I'm happy to report I have none of those--nor have I ever.  She explained, though, that PID can be caused by other bacteria that normally exists.  Sometimes, the infection of PID can spread upward, and usually lands on the liver and diaphragm.  So, she is treating me with antibiotics.  I will also have a pelvic ultrasound scheduled.

It was a worthwhile visit.  It's given me some mental piece.  Finally, someone with some authority agrees with me that it's not muscular.  I'm sure she'll be discussing the issue with the physician with whom she works as well.  All I need is for a doctor (or APN) to acknowledge that I've been misdiagnosed.  I think I'm going to get that.

On my way home, reveling in how wonderful nurses are, I got a phone call.  Three weeks ago, I made an appointment with Dr. Steiner at Orthopedics of Southern Indiana.  He's a very good sports medicine doctor and very hard to get into.  I actually had considered canceling the appointment or rescheduling for after Eugene.  Turns out I didn't need to. 

When I answered the phone, it was the secretary from Dr. Steiner's office.  She was calling to let me know that Dr. Steiner wouldn't be seeing me because he doesn't deal with the abdomen.  Ummm...okay.  So I said "Do you realize the pain is much exacerbated when I'm running."  "Yeah, but he just doesn't deal with the abdomen.  And his nurse said he wouldn't want to see you, okay?  I'm sorry, have a good--"  I cut her off.  "Okay, so to whom is he referring me, then?"  I couldn't believe what was happening.  She was calling me, two days before my scheduled appointment, which was made 3 WEEKS AGO, to tell me that the doctor has decided not to see me.  On top of that, he had no suggestions as far as what I should do.

She told me to hold on a minute.  As I listened to the stupid hold music, I became infuriated.  I am so sick of being treated like this, and I am so angry that it happens to other people far more vulnerable than I am.  She came back on the phone and said, "No, his nurse said there are no referrals to make.  It sounds like you've seen every doctor in town anyway."  At that point, I said "Okay.  I just want to repeat what is happening here to verify that you agree.  You are calling me two days before my scheduled appointment to tell me that the doctor will not see me.  You are telling me that, though he is board certified in sports medicine, and my condition is extremely aggravated by running, he will not see me.  You are telling me he has no suggestions as far as what kind of doctor I should see.  You are telling me that, basically, my situation is hopeless."  She was silent, and then said "Yes."

I proceeded to thank her, and went on to tell her that, as a very serious runner, I know all the runners in town.  In addition, I've been injured a lot and runners come to me often asking for doctor recommendations.  I ended by saying "Guess who's on my black list now?" and I hung up.  I was incredibly angry.  This is not the way people should be treated.  I guarantee you--were I a male elite or sub-elite athlete--I would have been seen, no questions asked.  But they've labeled me--a woman with vague pain who is doctor shopping.  Well, that's a can of worms they shouldn't open.

Next, I called back and left a voicemail for his nurse.  I will continue calling her every day until she answers or calls me back.  I cannot believe how the staff at Orthopedics of Southern Indiana treated me.  I can totally understand him saying, during my appointment, "I just don't know if I can help you."  But I don't understand contacting me two days before my appointment.  An appointment made almost a month ago and which precluded me from making an appointment with any other sports medicine physicians....who actually treat sports-related pain.  I will be writing a letter to the medical director of the clinic (whom I sort of know).  And I will be using their actions as an exemplar to my nursing students of how NOT to treat patients.

Oh, and I ran 7 miles today.  Pretty good run.

Tuesday, April 19, 2011

Not a fan of taper.

Are you shocked?  Until today, I was doing okay.

I looked at my running schedule and it said "7."  Are you kidding?  Seven?  And I don't run again til Thursday.  And I only get to run 7 more.  That is insane.  Saturday is 6 and Sunday is just 10.  I don't even want to talk about what the next week (race week) holds.

I headed out for my 7 today in the rain.  There was no avoiding it, as it was going to rain all day.  My legs, finally, felt FANTASTIC.  I ran my first mile in 7:15 and it felt like a jog., taper works, but I still don't like it.  I averaged faster than 3:20 marathon pace for the whole run without even trying.  So I'm encouraged by that.

What was NOT encouraging was that my pain kept breaking through.  I say breaking through because I had the TENS unit on.  It was turned all the way up (as usual), but I was in a lot more discomfort than I usually am when I wear it.  I also had, for the first time in two weeks...the left-sided pain.  This was discouraging and confusing.  I rely on the TENS to make my runs (relatively) okay.  And this was the first time it didn't do that.  Now, I've had this happen before, but it's usually fleeting.  And this could have been, too (it was only seven miles, of course).  Anyway, it freaked me out, naturally.

I was disappointed.  When I ran my 22 miles with the TENS unit on and had manageable discomfort, I thought "Okay, I can do this.  I can do that for 4.2 more."  But today was so much worse...despite the TENS being there.  It's been two weeks since my last cortisone injection, and it may be that it's beginning to wear off (it does help a little).  I decided not to get one til next Monday--6 days before race day--to make sure that the cortisone is peaking at the right time.  Otherwise, if I got it tomorrow, it would peak at the end of my taper.

Today was just a reminder that I have no control over what's going to happen to me on marathon day.  The pain could be there.  Well, it WILL be there...but it could be what I call unmanageable.  As much as I want to, I can't predict if that will happen.  If it doesn't...great.  If it does...well, I'll do the best I can.  I know I will finish.  And I'm pretty sure it will be with a semi-respectable time.  But after today I'm not holding myself to any time goal.  It's too much pressure.  If all I had to worry about was running hard, I could think about time and splits and pacing.  The running hard isn't my worry--it's dealing with that stabbing pain.  And, no matter your pain tolerance, your body just says "Whoa....slow it down....this is bad for us."  I'll just do what I can.  So I don't want you all to expect me to put up any sort of time (can you tell I'm used to striving for external validation?).  If you track me, or if you are waiting on the edge of your seat to see what I ran...just know that, in this race, and I can say this with a straight face, the time does not matter to me.  My victory is in even starting the race.  To finish, well, I have to be happy no matter the numbers.  I know that seems cliche and maybe even like a cop out....but only I am truly aware of the deep, dark moments I have experienced throughout this training cycle.  It has been an internal struggle like no other I've ever experienced.  I've covered many miles having to dig down to a place I've very rarely been.  The fact that I'm not terrified to run is a miracle.  So...while I will certainly be wearing my Garmin...I'm showing up on May 1 to start and finish a marathon.  No other promises.

Monday, April 18, 2011


Okay, before I blog about my life and my running...did you watch the Boston marathon today?  I was pretty much only interested in the women's race.  And, specifically, I was interested in the performances of Desiree Davila and Kara Goucher (and Joan Samuelson, too).  Though Kara did not win, she ran a big PR.  Given that I have a baby around the age of her son, I can tell you that that is a HUGE accomplishment.  I hope she is not disappointed with her performance.

And Desiree, just wow.  Second place in 2:22:xx.  That's insane.  I am so happy for her and for women's marathon running in the United States.  And we have to give a shout out to Ryan Hall, who ran 2:04.  The winning time for the men was the fastest marathon EVER run!  Now, it won't beat the current WR given that Boston is a net downhill course...but still...just, wow.

Okay, back to me.  I saw Dr. Stowell, the doctor who delivered Rowan, this morning.  There has been some consideration on my part about whether my pain could be due to endometriosis.  In a word:  no.  The reason is that I don't have any pelvic pain.  Now, endometriosis can spread/grow anywhere in the body, including the diaphragm.  But it always starts in the pelvis and grows from there.  I just don't have any pelvic pain. 

Though he couldn't help me, Dr. Stowell acknowledged that this pain is a result of my pregnancy.  I didn't have it before or during the pregnancy.  I had Rowan, and boom there it was.  He mentioned that he's seen several women sustain abdominal strains as a result of pregnancy, but that those usually don't last over a few weeks.  In addition, he said they usually complain of pain lifting/twisting (as you would expect with damage to the ab muscles).  I don't have that...and, anyway, I have an MRI that says my abdominal muscles look totally normal.  He said that it is feasible to believe that something is either pulling/pushing on a nerve, or that something got stuck together.  EXACTLY.  That's what I think is going on.  I told him of my plans to see a surgeon in Indy next week, and he thought that was a good idea.

So...while I didn't get any answers, I finally had someone listen to me and acknowledge that this pain originated with my pregnancy (AND NOT RUNNING).  I am hopeful that it can be totally resolved.  Until then...I'm getting a new TENS unit tomorrow.  A 6-lead one, which will allow me to stimulate more areas while I run.  I have to go to the outpatient therapy clinic to be "trained" on it.  They don't realize that I know a LOT about TENS units at this point, and the only way to deal with my pain is to turn the intensity all the way up.  I get to wear it during my 7 (yes, just 7) miler tomorrow.  And taper continues...

Sunday, April 17, 2011

Still Tapering.

Because, in case you didn't know, this madness lasts THREE WEEKS.  The first week of taper is in the books with 45 miles total.  I had some good running this weekend.  Yesterday was trail run day, and probably my last trail run before Eugene.  It was me, Wes, dad, Scott, Emily, and Russ.  We did the Three Lakes Loop.  I'm glad we did it, as it also serves as the course for the half marathon Run with the Foxes, which I intend to run the end of May.  It's also just one of my favorite trails.  The pretty parts are beautiful, and the tough parts are really challenging.  It's a good mix of enjoyment and suffering.

I was supposed to run 9 miles, and the last time I ran this loop it came out to around 9.3.  However, before we started, Wes, Scott, and Russ informed us that the trail is actually more like 10.4 miles.  Dad and I delayed the start waiting for our Garmins to lock in.  Russ said "Oh, you don't need those GPSs, I know exactly how long this trail is."  He clearly doesn't know who he's dealing with.  Dad and I, even knowing that our GPSs will be wrong on this course due to all the switchbacks, would never dream of running without them.

It was a good run.  I wore my TENS, and got a few jolts of extra power during the creek crossings, but other than that I felt pretty good.  The pain broke through on the right one time, but quickly settled.  And I'm still only counting it as 9 miles.

Today was "long run" day.  I use quotation marks because there really are no long runs left before Eugene.  Just 15 miles today.  Interesting how that seems SO short.  It was me, Tim, and dad today.  Dad is gearing up for the Indy Mini and I really think running a 15 on this course three weeks out is a really good move.  He's going to benefit from the hills.  We didn't have nearly as many hills as we do on a 20, but we still managed to work in the twin towers.  And Slaughterhouse, of course.  My effort was very low the whole run, but my legs didn't feel that great. Kind of dead.  Truthfully, I had more spunk on the 22 than on this run.  Tim says this is normal for the first "long" run during taper.

I wore my TENS again, and it covered up about 80% of the pain.  I'm making myself wear it every run just so that I get used to it.  Another thing--I only took one gel with me. I thought, "Oh, 15?  That's nothing."  Well, by four miles my stomach was growling.  I took the gel and that helped for about three miles, when I became really hungry again.  I ended up taking an extra gel of Tim's and that saved me.  I also didn't get to eat breakfast because I got up too late.  Bad move.

This next week I am only running 30 miles.  Now that is tapering. 

I see Dr. Stowell tomorrow.  He is the doctor who delivered Rowan.  I'm going to tell him about my pain and see what he has to say, specifically related to the possibility of endometriosis. 

Thursday, April 14, 2011

Full Steam Ahead

For the past six or so months, my goal has been to get my abdominal pain figured out so that I could be pain free during my marathon in Eugene on May 1.  I forced myself to run through stabbing abdominal pain for hundreds of miles, always thinking "I want to keep my fitness for when they figure this out."  When I got home from Florida, I made the decision to let go of the expectation of being pain free, or anywhere close to it, by May 1.  I'm too exhausted to try and frantically search for an answer between now and then, and it's just stress I don't need.  I temporarily derailed from that plan when I saw the surgeon earlier this week.  After it was clear that he wouldn't consider anything other than a "running injury" (which we know this is not), I fell into a little mini-depression.  It has been, as you've witnessed, disappointment after disappointment.  I cannot bear to sit around and think anymore, at least for now, "What is this?  How can I get help?"  I'm just accepting this as my situation right now--I am in pain all the time, and it's much exacerbated when I run.  End of story.  I've decided to wear my TENS unit during the race (and on every run between now and then) and hope that it's a good day pain-wise.  I am also getting cortisone injections a week before, as this last round did help some (though they just don't last long).

So, in the spirit of moving forward, let's talk about the plan.  What plan?  Race day plan!  Whenever someone would ask me what I was planning to do in Eugene, I'd always say "Well, it depends on if I get my abdominal pain figured out."  I haven't yet.  But I've found a way to make it tolerable via the TENS.  I cannot run at my hardest/fastest with the TENS on, but I can do a pretty good job of it.  So, after consulting with Tim, here is the plan:

First, there is no specific time goal.  There is only strategy.  We will start the race at a 3:20 pace (7:38 minutes/mile).  Actually, we may start the first few miles a bit slower, but make that up quickly after.  The plan is to run the first half at that pace.  Given it's a flat course, that's a very conservative pace for me.  That almost feels like jogging.  But this is my first marathon and I'm dependent on a MACHINE for crying out loud.  Conservatism is in order.  At the half, assuming things are going well (meaning that the pain is being kept under control by Mr. TENS), we will speed up.  Now, I'm not dropping the hammer with 13.1 still to go.  But we'll slowly inch it down.  I'd like to try 7:30 for the next few miles.  Then a few 7:25s.  After that, I'll give everything I have left.  Who knows what that will be.  I may be dying by then.  And if I get to the half and I'm struggling with the pain (or anything else), I'll be happy to stay on 3:20 pace.  So, like I said, no specific goal time, just a plan.  The time will be what it will be.  This will by no means be my fastest marathon, nor one where I'm pushing myself to the limit.  But, I daresay, it will be my most memorable and most satisfying.  I've been through a hell of a road to get here, and I will treasure each step I take to complete this race.  I honestly do not care about the time.  My main concern is that I actually enjoy the experience.  For a very competitive person, that's saying a lot.

Eugene is 17 days away.  Only 9 runs and a total of 63 miles stand between me and that start line.  I've never been in this position before.  Though I wish aspects of it were different (I'll let you guess on those), I am SO STINKING EXCITED!  I ran 10 miles today and 6 of them around a 7:08 pace.  It felt easy and my legs felt great.  That's taper for you.  I was imagining myself in the race and, despite being electrically stimulated and forced to wear a fanny pack while running, I couldn't help but smile.  I'm almost there.  Finally.

Speaking of electrical stimulation....I've been trying to perfect the TENS unit set up.  I've put the patches different places, messed with the intensity, tried different patches, etc.  I bought longer patches thinking that I would benefit from having a larger area covered.  However, the longer patches do not generate as high an intensity as the smaller ones (more surface area=less concentrated intensity).  So I figure I need one with more channels (one that can hold more electrodes).  Mine only has four...and I've been putting three on the right side and just one on the left.  I remember Dr. L telling me that they make them with six channels.  I got online and began looking for them.  All around $200.  Really nice ones around $450.  I was going to buy one, and then I thought:  Hey, I'm a chronic pain patient.  If I allegedly have some incurable, chronic pain "syndrome," then my insurance should cover this.  I picked up the phone and called the pain clinic.  I talked to the nurse and told her I needed a TENS unit.  I further explained that I had one with four channels, but that Dr. L told me about the six-channel ones.  "I want one of those," I said.  She asked me if there were any other specifications I wanted.  I told her I wanted a lightweight but very intense one.  She said she'll have him write a prescription for one and I will get it from the physical therapy department at the hospital.  And my insurance will pay 90%.  Small victories.

No run tomorrow.  Trails on Saturday.

Monday, April 11, 2011

Doctor Number 10

Throughout this process, I have seen 9 doctors/practitioners:

-a GP
-a Sports Medicine Specialist
-a GI Specialist
-4 Chiropractors
-1 PT
-an anesthesiologist/pain specialist

I have had an ultrasound, MRI, CT scan, HIDA scan, and a colonoscopy.  All of which have been unremarkable.  But my pain continues to be there.  So today I saw doctor number 10, a surgeon.  A good one.  And he doesn't think I need him.  He, too, thinks my problem is musculoskeletal.  That running (and anything involving impact) causes spasms in my abdominal muscles.  He is going to contact my pain management doctor and discuss me taking some systemic steroids, as well as some Neurontin.  He also thinks I need to take those and not run for 4-6 weeks.  I'm supposed to let my injury heal.  Even though that probably won't work (it may help, but won't fix it), as they all tell me that myofascial pain syndrome is not reversible.

But what is my injury?  It's not a torn or even a strained muscle (MRI ruled those out).  And which muscle is it?  It's deep in my abdomen, and high up under my rib cage.  It's somehow connected to my diaphragm.  I've injured my diaphragm?  What?  Basically, he is not willing to do an exploratory surgery.  I have nothing that would put me at risk for adhesions (no previous surgery), and no symptoms other than pain that increases with activity.  He did throw around the word fibromyalgia (though my pain doctor never has, and I think he would have by now).  He said I need a long period of rest, coupled with systemic anti-inflammatories, to let myself heal (as opposed to just treating symptoms).  It might help, but it's something I'm going to have to keep managing.

As I sat there, I wasn't really upset.  I do not want to have surgery just to have it.  I was (and still kind of am) just so convinced that something is VERY wrong inside of me.  I want whatever it is to come out.  But if there's nothing to come out...well, he's right, I don't need him.  The conversation involved talk of TENS units, how effective they are, etc.  And I began to realize "I am a chronic pain patient."  I am.  My pain can be treated, but it can't be fixed.  I actually feel relieved being able to admit that.  Every time I've had cortisone injections, I've been waiting for that pain free moment to come.  It hasn't.  And Dr. L told me it wouldn't, but I didn't believe him.  Now I do--and I realize I need to use the injections as a tool, not as a cure-all.

I am still going to meet with my OBGYN to talk about the possibility of endometriosis.  And I can't really tell you what I'm going to do beyond May 1.  I'm so emotionally drained that I may need the 6 weeks off anyway.  I also think "Well, fine, I'll just buy the best TENS on the market and keep on running."  The TENS makes it tolerable, but it doesn't make it good.  I miss good runs, and I don't know how to get them back.  At some point, I'm sure I'll finally break down and rest.  But I can't think about it right now.  I'm too geared up for my first marathon.

I had an appt. for cortisone injections on April 20th.  I changed it to April 25th.  I do seem to get some relief from the injections, but it's quite fleeting.  That is about as close as I can be injected to actual marathon day.  I hope it proves a good decision.  At this point, I'm just praying for a decent day pain-wise on May 1.  I'll be relatively rested from taper, so maybe that will help.

They tell me it's fine to keep on running in the TENS unit, and I guess there are worse things in life.  Also, on every TENS unit I've seen, it says "Do not use while exercising."  Oops.

Sunday, April 10, 2011

Hello, Taper Town.

It is, officially, taper time.  I've never been here before.  But, I'm getting ahead of myself.  I wasn't yet in taper when I woke up today.  I had one last long run:  a 22 mile county run.  You know, the course with all the massive hills.  Adding to the difficulty is that today was going to be a hot one.  70 at the start and 86 at the finish.  Lots of sunshine.  Gulp.

I didn't sleep well.  I was nervous about this run.  I kept telling Tim I was just afraid I wouldn't make it through it.  I couldn't articulate why, but I was afraid of something catastrophic happening.  At 7:00, he delivered me my pre-long run meal of cream of wheat.  I ate it in bed, then turned over and went promptly back to sleep.  He stayed up and took care of Rowan so I slept until a little after 8:00.  I have an amazing husband, and I'm spoiled.  After I got up, Tim went to stash us some drinks.  He had frozen them, Kathy-style, so they were sure to be refreshing out on the run.  While he was out, I treated both my calves with the robot.  They were tight from yesterday's run.  Before I knew it, it was time to get ready to go.

I decided to make today's run a dress rehearsal.  I wore everything that I think I'm going to wear on race day, right down to my socks.  This also meant I should wear my TENS, as I'm planning to wear it during the race.  I wear it in a little fanny pack (I look like a complete dork).  The nice thing about having a fanny pack is you can stuff gels and all kinds of other stuff (tape, extra batteries) in it.  I put the TENS on, and just as I was testing it, I saw Bill running up to the house.  He did his long run yesterday, but he was going to join us for part of our run today.  As I stepped out to greet him, it hit me how friggin' hot it was.  And the sun was in full force.  I tend to handle heat pretty well, but I hadn't run in anything quite this hot for a long time.  So, now I was able to worry about that.

And we were off.  We started off easy, and I immediately became aware that my legs were a lot more fatigued than they were yesterday.  No pain, just fatigue.  I kept telling myself to just take it easy.  As we started up the first major climb, the I Street Hill, three, actually four, words kept repeating in my mind:  "It is effing hot."  And boy, was it.  We had no wind.  I could feel the heat radiating off of me.  My legs felt good, but I didn't know how long that would last.  After that climb, I started to feel better.  I was consciously holding back.  I was running with two people who can and would go quite a bit faster than we were, but I didn't want to blow this run.

Bill peeled off around 5 miles and headed home.  Then it was just me and Tim.  He let me set the pace.  I request that he not run the hills with me.  He runs hills much faster than I do, and I'd prefer he just wait on me at the top of them.  Otherwise, he's unnecessarily making some very hellish hills last even longer for himself.  Before we got to the next major climb, in Buddha, I began to notice that I was having some moderately severe breakthrough abdominal pain on the right.  Which is rare, because the TENS usually covers it up pretty well.  About a half mile into feeling this pain, I stopped to change the batteries.  I had trouble doing that (sweaty hands!) and we spent several minutes messing with it.  But it was worth it, as the fresh batteries gave the TENS some more oomph. 

Then it was time to start climbing.  There is a big, long hill in Buddha.  And, as we ascended, there was no wind.  It was utterly still.  And HOT.  It felt like my face was on fire.  I also began to feel what felt like heart burn.  I had taken a gel at 4 and 8 miles, and it almost felt like they would come up.  I didn't feel nauseated, just had heart burn.  I made it up that god forsaken hill, and as soon as my heart rate recovered, I felt strong.  I told Tim "I'm getting stronger as this run goes."  And that is my usual pattern.  I'm a late starter.  But, alas, I was drenched in sweat.  It could still get ugly from here.

Within just a few minutes of cresting that hill, we saw a red Tracker coming toward us.  It was Bill!  He was our angel of mercy.  With him he had ice cold Gatorade, bags of ice, and salt tabs.  What a guy.  Honestly, it was wonderful.  I downed the Gatorade very quickly, and stuffed the ice in my sports bra and shorts.  That was kind of a turning point in the run as far as the heat--with the ice on board, I felt so, so, so much better.  Bill left us and told us he was going to stash the other two Gatorades atop of the second twin tower hill (the two biggest climbs in the run come back to back, and are thus named the twin towers).  He left us, and we set off for a major downhill portion of the run.

About a minute into that portion, all the Gatorade I had just consumed began to come up.  I didn't even break stride, but I kept puking.  Still no nausea.  It was just uncontrollable--anything I drank came right back up.  But still, I was feeling strong.  We stopped at the bottom of the descent where Tim had stashed more fluids.  We were roasting, and we both filled up our various garments with ice.  I took another gel, despite the puking.  And I finished my Gatorade.  We started running and, within five minutes, my gel and my Gatorade came back up again.  And again.  I puked on this run probably 10 to 15 times.  I did not feel sick, but the stuff was just not staying down.  I began to worry about dehydration.  I was sweating horribly, very thirsty, and clearly absorbing nothing.  But I still felt great.

Before long, around the 12.5 mile mark, we saw Bill AGAIN!  This time he gave me a high five (bringing my point total up to 16...let's just say I won by a lot).  I think he recorded us on his phone.   As he was pulling off, Tim asked if he was riding.  His response was yes, but at 1:00.  So Tim might not make it in time to ride.  They both told me not to worry about getting him home in time for the ride, but it was all the motivation I needed to speed it up a bit.  I knew Tim really wanted to ride.  I also knew that I felt very, very strong and that negative splitting the run would give me a confidence boost.  So, without telling Tim, I picked it up.

Not very much, I just made the pace a little more steady.  And I continued to do so throughout the run.  I also continued to throw up anything I put in my mouth.  Watching me, I'm sure someone would have thought I was really struggling.  But I wasn't.  The abdominal pain was coming and going (breaking through a bit because the TENS electrodes were coming off...I've never worn them when that sweaty), and sometimes it was pretty sharp.  But I'm so used to it I could kind of block it out.  And my legs were just....strong.  I was very hot, but it didn't seem to affect me too much.

We got to the base of Slaughter House Hill, and climbing that monster is honestly the only time I felt kind of bad during this run.  There was no wind, we were 20 miles in, and it's just a steep mo fo.  But I survived it.  Just two miles left.  I told Tim, "I think I'm going to make it.  I'm going to make it to taper."  I picked it up even more.  My legs felt actually kind of fresh, like maybe I had only done 10 miles, not 20.  The last two miles were the fastest of the run, and well below marathon pace.  That shows me that, as I said yesterday, I am strong.  I'm not that fast right now, but I could run and run forever.  And I could do it on some bad ass hills.

We waved at Bill as we passed his house, and soon we were home.  Tim immediately got in the kiddie pool in the back yard (our ice bath).  As soon as I checked on my mom and Rowan, I got the TENS off and joined him.  HEAVEN. We were so hot.  I usually dread getting in that pool.  Not today.  We rolled around in it like pigs.  And, just like that, I entered taper.

It may seem strange that it's such a big deal to me to enter taper.  But it just is.  I've never done it.  I've trained for two other marathons.  I've made it not quite to peak week, then I've been hurt.  Not this time...I MADE it.  My training has been conservative, I'm handicapped by the mystery abdominal pain, but I'm where I've never been before.  I survived the hard part.

Tim made it home in time for the ride, and I set to trying to rehydrate.  I was not at all hungry, but I managed fluids just fine.  I have no idea why I couldn't keep anything down while running.  That's never happened to me on a run before, not even on hot ones.  I really didn't mind it too much.  I'd just turn my head to the side, puke, and keep on going.  But I know that, in the marathon, that dehydration could catch up with me.  Hopefully it doesn't happen May 1.

So, as I've entered taper, I'm already obsessing about some things.  But I'll save that for the next blog post.  I'll need something to keep me occupied.

Saturday, April 9, 2011


As in, drenched.  Today was trail run day.  The plan was for me, Tim, dad, Wes, and Scott to run 13 miles on a pretty tame trail--the Deam Trail at Hoosier National Forest.  As Tim and I were on our way to meet the others, Wes called and said "Are you sure you want to run in this?"  I was like...what?  It was barely raining at that point.  He told me that a storm was coming in.  But my iPhone said not til noon, and it was just 9:45.  So I said "Yes, I want to run in this."

We met at Paynetown, or Pate Hollow, another, much less tame trail at Hoosier National Forest.  By this point it was raining hard.  There was some thunder and a bit of lightning.  Wes made it known that he didn't want to run in this.  Dad and I were busy looking at our iPhones to see if there was going to be a break soon in the weather.  We figured out that we had two choices:  run now in the rain, or run later in the heat and humidity.  Tim, dad, and I went for the former.  I needed to run as early as possible given my 22 tomorrow.  I couldn't wait til the afternoon.  We opted to run at Paynetown, which is a 6-mile loop trail.  That way we'd never be more than 3 miles from the car.  It meant a much harder run, but it was a trade off we had to make.  Wes and Scott refused to run in the storm, and tried to lay guilt trips on us.  They remarked how we had kids.  And we were going to go run in that?  What would our poor children do when they found out we'd all been killed by lightning, wind gusts, or hail?  Lightweights!

Wes and Scott left, announcing that they were going home, back to bed, and would run later.  And the three soldiers marched on.  I led on the way out.  It's been a long time since I've run Paynetown.  It's not an easy trail.  I used to have to psyche myself up just to run on it.  So I was gearing up for a tough run.  As we set out, it was raining hard.  There was thunder and a little lightning.  No wind to speak of (or hail, Wes).  The rain made the temperature perfect.  It was a little muddy, but not bad yet.  We climbed the first major hill and, as we crested, I thought to myself "That wasn't nearly as bad as I remember."  And hill after hill...I kept thinking that.  Last time I ran this trail I was running 75-80 miles/week consistently, but it always kicked my butt.  Now, it was manageable.  Nay, enjoyable.  Why?  Because I run TONS OF HILLS now.  I am strong.  I may not be at my fastest, but I'm by far at my strongest.

The rain turned to a downpour for about 5-10 minutes, but within 3 miles, it really wasn't bad at all.  It rained to some degree the whole time, but it made it nice and cool.  We finished the first loop and I felt great.  We stopped at the car to gel and Gatorade up, and Tm asked me "How is the abdominal pain?"  I had decided to leave the TENS in the car, as I didn't want it getting wet.  I hadn't mentioned the pain to that point because I hadn't had ANY.  At ALL.  So I told him this, and we headed out for loop two.  Well, as soon as we did, the abdominal pain began to surface on the right.  I notice that eating or drinking brings it on, so it was probably the gel and Gatorade.  Anyway--I got away with 6 pain free miles.  The most in months.

As the second loop went on, the pain did worsen.  It never got stabbing, but it was there and radiating around my back and into my sides.  For whatever reason, the cortisone just doesn't affect it like it should.  I think that reason is because something is literally pulling on my insides.  Dr. L mentioned that my floating rib is catching me there, and I think that may be part of the issue.  My pain is right where that rib is (also where he injected).  And if I hold it in place, the pain is much better.  If it is my rib, I want it OUT.  But I'm digressing.  I promised myself I wouldn't obsess about the abdominal pain until after my race.  There's simply not enough time to get rid of it at this point.  But I'm convinced that some sort of surgery will be involved.

I felt amazing during the second loop, despite the abdominal pain.  My legs were strong.  I could have pushed up the hills, but I didn't.  And, for the first time, I did not fall at Paynetown.  I've never not wiped out there.  And today, with all the rain, I stayed vertical.  Dad had one little slip, but that was all.  When we got back to the car, we had to turn around to add on to get an even 13, which meant climbing monster hill again.  My legs still felt great.  We finished, trash talked about Scott and Wes, how they were going to roast during their run, and how they OBVIOUSLY should have run with us, and we were done.

As we got in the car, I could feel my left hamstring.  It's just sort of nagging, but didn't bother me on the run.  I'll use Therbo on it.  Last long run tomorrow.  22 miles.  I think it may just be me and Tim.  Bill and Kathy aren't coming, Wes is a weak maybe, and dad hasn't decided.  The Millers will be out there, though, running what my dad has now named the "Hell Course" in Bedford.  We'll traverse some major climbs.  We'll endure some heat.  But where will we end up when we finish?  Taper Town!  Strong as ever.  I can't wait.

Friday, April 8, 2011

Things are looking up.

Relatively, yes, they are.  I did my double runs of 7 and 6 yesterday.  I was concerned about that left hamstring.  It was quite sore at the end of my 13 on Tuesday.  I wrapped it before my run.  Thankfully, except for maybe the first tenth of a mile, I never even felt it (on either run).  And it was just stiff then.  Of course, being this close to taper, I did notice to other things:  my right knee and my right quad.  About half way through each run, I could feel my right knee and my right quad.  Normally, I wouldn't give either of these niggles a second thought.  But I am extremely hypersensitive right now.  Everyone warned me this would happen (though I didn't think it was supposed to happen leading UP TO taper).  I just keep asking myself:  Am I injured?  I'm not.  I just have some soreness and fatigue, which is very appropriate for the peak week of training.  But I'm freaking out anyway.

As for the abdominal pain--it was much better.  I was definitely sore from the cortisone injections, but it felt different.  This morning, it feels even better.  Maybe we did the right thing by injecting an entire 10 ml into one spot.  I'm not counting it a success yet, though.  I need to see how Saturday and Sunday go.

More good news:  I FINALLY got IRB approval for my dissertation.  The IRB at Indiana University is, well, having some problems.  Some challenges.  Which happens...but it was starting to affect my (and others') life way too much.  My advisor finally emailed the higher-ups.  Within 14 hours, we had approval.  I wish we'd done this earlier.  So now the real work begins.  I will begin recruitment immediately and begin collecting data for my study.  Which means I'm getting closer and closer to GRADUATING.

Trail run tomorrow (with Wes, Scott, Emily, maybe dad?, and possibly Tim...depending on how his foot feels).  Then it's the LAST LONG RUN OF THE CYCLE!  Crap!  The last one!  22 miles.  It's going to be hot, so we're starting earlier and I'm hoping to take it pretty easy.  Keep my head down and make it to taper.

Wednesday, April 6, 2011

Hello, hammy.

What I thought was my groin talking to me yesterday was actually my left hamstring.  It might sound strange, but I'm terribly relieved at that.  Groin strains are HORRENDOUS and take forever to heal.  Hamstrings can be much easier to deal with.  I had Tim beat the crap out of it (as in massage/Graston) last night, so it was quite sore today.  It's the inner hammy and up close to my butt.  I still have to watch it...but I jogged about a half mile earlier (sorry, couldn't help it), and it felt fine...just a little sore but no sharp pain and nothing changing my stride.  But I'm listening to it, don't worry.  At this point, I will not push through anything.  I have a double run tomorrow of 7 and 6.  If I'm at all concerned, I'll scrap the 6.

I saw Dr. L again today.  Two more cortisone injections.  I found out you cannot have your diaphragm muscle injected (that whole thing about being too close to the lungs...).  And that is right where my problem is.  Now, I still think I need to have surgery.  However, I was thinking that if he injected the area I might get temporary relief.  He got as close to the diaphragm as he could (up under my ribs, even) and injected an entire 10 ml of cortisone/lidocaine.  He did the same on the spot on the left where I have the most pain.  I'm not at all expecting it to work.  I had the appointment so I decided to try it one more time.  We'll see.  I will say that, in my half mile test run, I didn't even notice it...but the lidocaine is still working.  I have an appointment with a general surgeon (Dr. Hadad) on Monday--simply to discuss my case.  He knows about my situation, and has offered to talk about surgical options as far as at least exploring what's going on in there.

Tim is having a scary issue with his foot.  He's had a pain on the left outer edge for about a month, but it came and went and he usually didn't feel it while running, just after.  However, after his tempo last night, as he was cooling down he got a very sharp pain in that area.  So sharp he couldn't keep running.  He had to get a ride home.  It's one specific spot on the lateral side of his foot.  Doesn't hurt to move his foot around as far as fanning the toes, etc., but hurts with weight bearing activities.  Of course, you can imagine what we're fearing:  a stress fracture.  The good news is that the metatarsal, the 5th one, is not commonly fractured via repetitive stress.  I've massaged it, and it does feel a little crunchy (as in tendonitis), but I'm not taking the butter knife to it just in case it's a fracture.  What's concerning to me is that it's one very small area (dime-sized) that is painful.  He'll call tomorrow for an appointment. Fingers crossed.

Tuesday, April 5, 2011

Taking that Step.

As in, I'm seeing a surgeon.  We've pretty much exhausted all other options.  My MRI was normal.  However, some things don't show up on MRI.  What are those things?  Adhesions....and endometriosis.  My friend (and cousin via marriage) Tatiana pointed out that my pain seems a lot like hers was when she had pelvic endometriosis.  Her pain was worst when jarring around.  Until she mentioned this, I had never even considered endometriosis, though I had been considering that it had to be some kind of adhesion.  Something is just stuck together in there.

For those of you who aren't familiar endometriosis, it occurs when uterine tissue grows outside of the uterus, generally on pelvic structures.  It causes adhesions and pain, particularly with movement (as the adhesions pull).  Endometriosis can, however, occur in other parts of the body.  There is even an animal called Diaphragmatic Endometriosis (DE).  Basically, the endo grows in and around the diaphragm, causing adhesions.  The main symptoms are upper abdominal pain radiating to the back and shoulder (hello!), and endo is triggered by pregnancy (hello again!).  I read an article about DE written by a Dr. Redwine from Bend, Oregon.  He described the presentation of DE in five women.  One woman described her pain as a side stitch.  That's how I'd describe my pain--severe, severe side stitch-type pain.

So how is endometriosis diagnosed?  Laparoscopic surgery.  It can be treated then, too.  However, DE cannot be treated laparoscopically.  A laparotomy (in which the abdomen is cut wide open) is required.  This is because the adhesions are behind the liver, which must be displaced in order to remove them.  That would require considerable recovery time.  In addition, endometriosis can come back.  It's fueled by estrogen.  So a hysterectomy may be needed.  That's fine with me, as Rowan is my last baby.

Now, I'm not saying I have DE.  I've never had pelvic endometriosis, and I don't know if that's a prerequisite for DE.  But it's possible.  And I am confident of one thing:  I NEED surgery.  Someone needs to at least take a look around in there.  My abdomen hurts all the time, and the pain becomes unbearable while running.  Something is pulling on something else.  As I've long said, this is going to require a cut.

I've made an appointment with my OBGYN (who delivered Rowan), but I can't see him for two weeks.  In the meantime, I'm waiting on a call back from a general surgeon.  I'm not sure exactly who I need to see.  It may be that the general surgeon needs to do an exploratory surgery, and the OBGYN may have to go in later.  Anyway--no one will cut on me until after Eugene.  I've come too far to let that race go now.  But as soon as it's over, I'm ready.  Let's do this.  Whatever it takes--get rid of this beast.

Now, onto running.  I ran 13 miles today.  I wore the TENS and used it the whole time.  I just needed a semi-comfortable run.  And that's what it gave me:  not great, but not the horrific pain.  The wind was VERY strong, just as it was on Sunday's run.   I ran out in the county, and the hills really got to my legs.  I probably should have run on something more flat.  At around 11 miles, my left groin began to hurt a little, as did my left hamstring and both my quads.  I worry, in that array of pain, only about the left groin.  My left groin, in August of 2009, sidelined me for 4 months.  Now, it didn't feel like that (no way could I have run through that groin pull once it happened), but it's talking to me a little.  I have to listen.  I have tomorrow off, and 13 more on Thursday.  If the groin is still sore, I'll cut that back.  And definitely running on flat stuff.  This groin has actually been talking to me for a few weeks, but usually after my long runs.  This is the first time it happened during a run.  I suspect it is just soreness and will go away, but I'm not risking anything.  My TENS won't help that.

Monday, April 4, 2011

Home Again.

And with consistent Internet access!  Brace yourself for a long blog post.  I arrived home from Florida yesterday afternoon.  I had planned to blog on the plane on the way home.  However, I sometimes suffer from severe motion sickness, as does Amelia.  In the last half hour of my flight on the way to Florida, I was hit with some of the worst motion sickness I've ever had.  I have the type that causes me to vomit, but the vomiting doesn't make me feel any better.  I didn't want to chance it on the way back, so I took a Dramamine (which I carry with me at all times).  And it makes me very sleepy.  So I slept the entire flight.

I have so much to report on, but let me first say a few things I learned about traveling. I've done a lot of traveling to conferences, but usually all the transportation is arranged and I'm with other people.  This was my first time traveling by myself, and organizing everything by myself.  Some things I learned:

-It is very, very, very beneficial to have a rental car.  It is also very, very, very beneficial to ask on Facebook about what you should/shouldn't buy when renting a car.  I posed this question and was told that I didn't need the extra insurance coverage they provided, and that I should not pre-pay fuel.  Sure enough, they tried to push this stuff on me.  I didn't do it, and I saved a lot of money.  Thank you, Facebook pals.

-The GPS I rented to go in the rental car saved my life while I was there.  Totally worth the $11/day.  I have GPS on my iPhone, but it's too dangerous to look at it while driving.  I actually now really want a Garmin GPS for my own car.

-Bring your own Splenda.  I had, for the first time, a Starbucks barista refuse to put 11 splenda in my cappuccino.  Yes, she refused.  Luckily, I had some emergency ones in my purse.

-Cheap hotels can be just as good/better than the expensive ones.  You'll find out more about this if you keep reading.

-Always take your Dramamine.  See above.

I landed in Tamp around 7:30 on Wednesday night.  I picked up my car (a Nissan Versa hatchback, with which I fell in love).   I had to make the 30 minute drive to St. Pete Beach.  The drive went well, except it was storming and I didn't have the foresight to learn how to use the Versa's wipers prior to getting on the interstate.  I couldn't figure them out, and suddenly I couldn't see anything.  I had to pull over on the interstate to find them.  Other than that, I loved the car.

I arrived at where I would be staying--Dirse Motel and Apartments.  It is right next to the biggest (and pinkest) hotel on the beach, the LeCesar Beach Resort.  The owner of the Dirse Motel, Jeanie, is a friend of Al's (the robot guy), and he had arranged for me to stay in an apartment that is part of her private residence.  I had spoken with her on the phone, and knew that she was Lithuanian.  I pulled up to her house, and I saw the shadow of a very round lady sitting on the porch.  She hurried over to my car and looked genuinely excited to see me.  "Velcome, velcome!"  I got out of the car.  "Oh, you is so small.  So small, like little girl.  Come in, come in!"  I told her I would drop my stuff and then needed to get some dinner.  She would have none of that.  She was like a character right out of a novel.  At 76, Jeanie is no spring chicken.  But she is one of those women who just never stops.  I went into her house and found a HUGE, and I mean HUGE, dinner waiting for me.  An entire loaf of bread.  Steak, salad, rice, papaya, and tea.

I can eat a lot.  I run a lot, and I love to eat.  I could not keep up with Jeanie.  Each time my plate got near empty, she instantly refilled it.  When I told her I was full, she pushed the plate toward me and said "You eat, no?"  She is one of the nicest people I've ever met.  And so I ate.  And ate.  Until finally she had mercy on me.  While I ate, she told me about how she runs this motel (which is actually 4 cottages) all by herself.  She does all the cleaning, all the bookkeeping.  Jeanie has never physically seen a computer.  I showed her a video of Rowan on my iPhone, and she was genuinely freaked out.  "How da baby get in de phone?!  Make happen again, make happen again!"  After I ate and amazed her with my iPhone, she told me that one of the other guests had left, so I could stay in one of the cottages.

I went to bed exhausted, bloated, and full of anticipation.  I couldn't wait to see Al.  He is an expert in muscles.  If you want to read about his story, and how he came to invent the robot, you can read about it here. I would have 3 days with him.  First, though, Jeanie cornered me and made me eat breakfast.  She had prepared, for me alone, two breakfast burritos, oatmeal, two bananas, toast, papaya, coffee, milk, and orange juice.  I did the best I could to eat, but only managed to eat a little less than half of it.

Day 1:
It was storming.  Badly.  And it was supposed to get a lot worse.  I arrived at the clinic at 8:00 am.  I met Al, and his assistant George, as soon as I got there.  Al was larger in stature than I'd anticipated, but other than that he was pretty much as I had imagined him.  He immediately began his assessment.  He had me stand, sit, lie down, bend over.  He kept mentioning things for George, his assistant, to note.  I heard the names of muscles, but other than that I was kind of unsure what was happening. 

Next, while I was lying on the robot table (basically like a massage table with a robot over it), he measured where my heels hit.  My left leg was longer.  I've always kind of known that, since as a teenager I remember having to cuff the left leg of my jeans under because it always appeared longer than the right.  Al explained to me that my left leg, as far as the bones in it, is not actually longer.  No--the muscles on the right side of my body are so contracted that they are, in effect, shortening that leg.  He found major tightness in the right iliacus, psoas, diaphragm, rib cage (between two of my ribs the intercostal space has completely disappeared), right popliteal muscle (behind the knee), and pectoralis major and minor.  Basically, the right side is a train wreck.  On the left, all he could find was a slight issue with the top of my quad.

But wait a second here.  Hold the phone.  My overuse injuries have been, 100% of the time, on my left side.  My left leg/ankle/foot are always causing me grief.  Why is it the normal side?  Because, Al said, that side has
 been forced to take a lot of extra load since my right side has been in a constant state of contraction.  "We'll fix that," he said.  Okay, now what about my abdominal pain?  He said that the abdominal pain must be as a result of the heightened state of contraction on the right side, and it was causing the psoas to spasm.  Okay, I'll buy that.

Then we started in with the robot.  It's not the R2D2 kind of thing you might be imagining.  Basically, you lie on a hydraulic massage table, and a robotic arm is positioned over you.  On the clinic model, there is a computer attached to the top of it.  Al programs it so it can travel along a muscle.  We started with my right psoas, and he set it to travel on it from my right iliacus up to where the psoas meets the diaphragm.  I lay there, and the probe began to come down into my psoas.  I cannot describe what it felt like other than to say that it was extremely painful.  It holds that constant pressure there a few seconds, recalculates something or other, and then goes in a bit deeper.  It does this over and over.  I was very uncomfortable the first minute or two, but it changed over time from pain to discomfort, then to pressure....despite the probe pressing harder and more deeply each time.

We did this routine on the above-mentioned muscles on my right side.  This took pretty much all morning.  Then we measured my legs again.  EQUAL.  You can't deny an objective measurement.  By lengthening the muscles on my right side, we got my left and right legs to match.  I was so impressed.  I left for lunch, and couldn't wait to get back.  However, during lunch, I got a little worried.  I still had my usual pain. He had turned that right psoas into puddy, and as I was walking from the car to the restaurant and back...I felt my normal ache.  Shouldn't it be gone?  Or at least better?

When I returned to the clinic, it was time for more treatment of the right-sided muscles.  I immediately told Al that the pain was still there.  He had me lie down and he felt my psoas--he could feel the stringy knot over it (which I've been feeling for months).  As much as he tried, he couldn't identify what that string was.  He thought maybe it was the psoas minor adhering to the psoas major.  Whatever it was, it wouldn't budge.  Not from his hands, nor the robot.  In order to keep me from being anxious, Al said to me "Give us more than one day.  We can fix this."  Everyone I've seen, apart from Dr. Kaeser, has told me they can fix me.  No one has.  And so, when someone tells me that, I certainly don't believe it.  But I was willing to keep trying.

We worked on my iliacus, and actually managed to get the right leg longer than the left (we fixed that by balancing the left).  But every time I'd just get up to use the bathroom, etc. the pain was still there.  Al said I must be stressed, and that was my stress point.  It was at that point that I began to get discouraged.  What is wrong with me is not caused by stress.  Now, I'm not saying Al is not good at what he does, or that he's some kind of quack.  He's not at all.  But he couldn't figure it out, but he wouldn't just come out and say it.  I tried to keep faith--maybe it wouldn't hurt when I ran.  The day came to an end, and I left.  I had planned to run 10 miles on the miles and miles of paved trails there.  However, the storm was now horrendous.  There was lightning, 50 mph winds, and hail.  I couldn't run in that.

I began to get angry.  I HAD to run.  Jeanie's place didn't have a treadmill, and it was potentially lethal to run outside.  I talked to Tim, and he told me to look for a YMCA.  I searched via my GPS, and I found one--21 miles away.  So I drove, through what the locals called the worst storm in 30 years, to this Y.  I was hoping they had an indoor track, but they didn't.  So I paid $10 to run on a treadmill.  I began my run with so much anticipation.  Would this be it?  The first time I could finally say--I'm pain free!  Well, it wasn't.  It was bad, actually, by the 2 mile mark.  I wanted to stop out of sheer frustration.  There I was, in a strange place, in the middle of a storm, surrounded by strangers who were enjoying their exercise, and I was about to explode.  Somehow, I kept running.  But I was, emotionally, at my lowest point since all this started.  I could see my face in the reflection from the TV screen attached to the treadmill.  I thought about how the people around me had no idea of the horror through which I was currently going.  I stared at myself.  And I became angry.  I hated looking at myself.  At that moment, I did not want to be aware of my own reality.  I wanted to escape and not experience this moment of utter disappointment, loss, and hopelessness.  But I kept running.

The pain spread to the left.  Then into my left shoulder.  I was so unbelievably angry.  Livid.  I began asking all the "Why me?" questions.  I indulged myself in catastrophic thinking for a few moments.  I'll never be able to run like other people.  I'll never be able to compete again.  I'll never maximize my potential or realize my running talent.  I might as well just quit.  Just stop right now.  It's over.  Hopeless.  No one will ever figure this out.  You are doomed.  But I kept going anyway.  I made it to 8 miles, and decided that was good enough.  I got off the treadmill in a daze.  I got into my car, completely unaware and unconcerned with the heinous storm around me.  And I bawled my eyes out.

I drove back to Jeanie's.  She met me with a smile.  It was all I could do not to break down.  She offered me food, which I declined.  I retreated to my cottage and immediately called Tim.  I so much needed him with me.  I have discovered, through this process, how emotionally dependent I am on him (which I guess is okay, since he's my husband).  He suggested I call Al.  I did, but had to leave a message.  I spoke again with Tim, with Wes, and my mom.  I was in utter despair, but they managed to calm me down.  I went straight to bed and the storm, symbolically, raged on.

Day 2:
Another huge breakfast with Jeanie, and off again.  Al was all smiles when I arrived at the clinic.  I know he expected that I had had a great run, and I also knew he hadn't yet heard my message.  "Well?" he asked, with great anticipation.  I kept my composure.  I began by telling him that my legs felt amazing (and they had...for the first time in over a year, my left ankle was not sore at all while I ran, and my toes didn't bang up against my shoes, as I was heel striking versus my usual toe striking).  Then I told him that I still had the pain.  He briefly showed a look of confusion, then had me hop up on the table.  "Your psoas, ilacus, and everything is tight again.  When you run, it must tighten up."  He worked quickly, and released them all again with the robot.  He was incredibly pleased with the results.  "So, you have to make sure you release these before you run, and after.  Who cares if you tighten up while you run, as long as you can loosen it back up after the run?"  I explained to him that, as it's so-called tightening during the run, that it hurts very, very badly.  And that is keeping me from being able to run the way I want to.  "Just stop during your run and treat it."  But what about races?  "You can stop and treat it during a race, just have a robot on the course."  I wanted to kick and scream.  Al knows muscles, but he wasn't getting this.  I explained again that what I needed was for that pain that occurred while running to go away.

At that point, though he didn't acknowledge it, I think Al understood what I was saying, as I could see the wheels turn in his head.  His robot did what it was supposed to do.  It did lengthen my muscles.  But it didn't stop the pain.

The second day was my training day.  I had decided to buy a robot (a much less expensive one) to take home with me so I could treat myself, and they had to train me to treat all of my problem areas.  We did it for about three hours, and it was very frustrating at first.  I had difficulty getting right on the muscles.  Al made it look so easy, but it wasn't.  Eventually, though, I felt comfortable.  After lunch, Al worked again on my right side, and a little on my left to make sure I was all evened out.

Then he wanted to watch me run.  I went outside and ran while he watched.  "Oh, look at that!" he said.  He explained that he saw two major flaws.  The first was that I wasn't using a cross arm motion--my left arm was going forward as my left leg did, when it should have been the opposite.  Second, my right elbow was crossing the center line.  At that moment, he was convinced that my running form, and particularly the right elbow crossing center, was the cause of my pain.  "That's putting torque on your psoas and diaphragm," he said.

We went inside and I was confused--if it's my running form, then why did it only happen right after my pregnancy?  Al says that's coincidence.  I've been running like that long enough that my psoas and diaphragm finally went into spasm.  It had nothing to do with the pregnancy.  But that's a problem--because I know it was caused by my pregnancy.  But Al was not convinced of that.  He is an expert (and he truly is) in muscles--he found glaring muscle abnormalities, he found problems with my running form that irritated those muscles, the pain happens while running--that must be the cause.

But it's not.  It's just not.  I've been running this way for a long time.  It may not be perfect, but most runners don't have perfect form.  And they don't feel as though they're being stabbed while they run.  I think he was thinking that my pain was of an overuse nature.  I have run through many, many, many overuse injuries.  I know what they feel like.  Now, they can hurt, but not like this.  I also had tried to explain to him that, when I press on the pain, and hold it, it diminishes greatly.  He said that's because I'm stretching the muscle.  But I think it's because I'm taking away the effects of gravity.  It aches all the time, but the impact of running brings out the beast.  And trails make it better--less impact.  But he could not see past his diagnosis.

And that's probably okay, because I don't think it was within the realm of possibility for him to take away my pain.  He knows his stuff.  My stuff just isn't his stuff.  Well, in part it is--I have a lot of muscle imbalances.  And there's a reason this is my first marathon--I keep getting horrible injuries.  I think what he found answers a lot of the question as far as why that kept happening to me.

I went back to Jeanie's and decided to run a few miles to see how I felt.  Maybe he was right.  I ran 4 miles, and they were some of the most painful I've had since this started.  The pain was worse.  Even though I half-expected it, I was devastated.  All of this was compounded by a deep missing of my husband and kids.  I called Tim and was hardly able to talk.  I wanted him there...I NEEDED him there.  I called my mom and asked her to please come to St. Pete Beach.  I needed someone with me when I went back to the clinic.  I was hysterical.  It was a new low.  In the end, I calmed down, and no one bought a plane ticket.  

The next day, I would only see Al briefly, as I was just picking up my robot.  Tim told me that, when I saw him again, I should try once more to explain how I was feeling.

Day 3
I wasn't supposed to see Al until 3 pm, so I slept in.   By 9 am I was headed to Fort de Soto park for a run.  It was hot and sunny.  10 miles were scheduled, but I had done 4 miles the day before.  That made up for the two miles I skipped Thursday and meant I only had to do 8 today.  I wasn't sure if I'd do 10 or 8.  As I was just about to start running, my phone rang and it was Al.  He wanted to come watch me run.  Obviously, he was still trying to figure all this out.  He was calling me on a Saturday morning to come watch me run again.

And so he arrived, after I'd run 3.5 miles, and I pointed right to where the pain was.  He immediately had me lie down on the ground and he palpated the spot (several people stopped to offer assistance--funny, neither he nor I considered how this might look).  "That," he said "is where the psoas fuses with the diaphragm."  The psoas and diaphragm are connected by a web of fascia, and actually become one muscle.  That's the worst spot of my pain.  We had a robot, so I treated my iliacus (which was tight again) and he watched me run.  Again, he could see that my right arm was crossing center.  And, again, he was convinced that it was causing the intense pain.  He gave me an assignment:  force myself to not allow the right arm to cross center while I run.  And he'd see me at 3.

So I did that.  I ran very slowly so that I could concentrate on my arm.  I didn't let it cross.  I even kept it at my side for a mile.  And still, I had pain.  If that arm is the cause, and I didn't even move it, then the pain should have been at least better.  I only went 8 miles.  It was really hot and I was just over it.  Then I bought a huge ice cream, sat on the beach, and waited to see Al again.

I went to pick up my robot (which I ended up shipping home because I didn't want to mess with the boxes...and it was cheaper to ship than to check the boxes as luggage).  Al watched me run once more.  He gave me another treatment.  He watched me run again.  He really, really, really wanted to be able to take the pain away.  He spent considerable time--much of it unpaid--trying to help me.  And he did, as I mentioned earlier.  But he couldn't get rid of the pain.  He says he's convinced if I fix my form the pain will go away.  Obviously, I don't think that's going to happen.  But I will use my robot faithfully.  It will allow me to run many more miles than I have been able to--it "undoes" all that running lots of miles does.

And that was the end of my visit.  The next morning, I bid farewell to the lovely Jeanie, and her lovely cottage on the beach for which she only charges $60/night.  Turned in the Versa, and headed home.  I returned home not under the circumstances I had envisioned.  I had imagined a celebration, and telling stories about how good I felt on my last run.  Instead, Tim and I had to come up with a plan as to what to try next.  

First, it is important for me to give up the notion that I could possibly be pain free by May 1.  That's just not feasible, and it stresses me out to have a deadline.  I will run Eugene.  I will wear my TENS and enjoy it as much as possible.  Beyond that, I can't plan anything for that race.  Second, I have an appointment with Dr. L (cortisone injection doctor) on Weds.  We obviously need to explore other options--a nerve block, possibly an injection into the diaphragm?  I don't know, but something.  Third, I need to see Dr. Steiner, another sports medicine doctor in Bloomington.  I've made an appointment for April 25th (he's good, so he's busy).  Finally, I think I'm at the point at which I want to see a surgeon.  Now, I'm not getting cut on before Eugene.  But, as my husband and brother can attest, I have always said "This will end with a cut."  And I'm more convinced of that now than ever.  Something has to be stuck to something else.  When I bounce, it hurts.  When I brace it, taking away the effects of gravity, it doesn't.  I hypothesize that my transverse colon, diaphragm, and psoas are somehow melded in a way they shouldn't be.  But this has gone on long enough.  Time to poke around in there and see what's up.  Because, I can assure you, something is very, very wrong.

For now I'm just going to finish up marathon training.  I will have my TENS on all my runs, just in case I need it, and it will certainly be with me on May 1.  Now begins the search for a VERY good surgeon.

Oh, and I did run yesterday when I got home.  17 miles in the heat and wind with Tim, Kathy, and Bill.  It wasn't too easy, but the pain was tolerable.  Bill had a very bad run (he sweats more than any human I've ever seen), but the rest of us finished strong, if tired.  22 miler next weekend and then--gasp--taper.  Onward.